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Small animal > URO > Flashcards

URO Flashcards

1
Q

what diseases cause a reduced renal repose to ADH

A

Addisons, Cushing, diuretics, high salt diet, post-obstruction, HyperT

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2
Q

how does osmotic dieresis cause PU and common electrolytes

A

Solute in urinary tubules pulls fluid out into urine
Glucose: DM, renal glucosuria, Fanconis syndrome (allow with lots of that electrolytes in small dog breeds)
Sodium: Addisons, diuretics, high salt diet, post-obstruction

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3
Q

What causes a loss of concentration gradient

A

low salt diet
medullary washout (e.g. prolonged PUPD, prolonged aggressive fluid therapy)

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4
Q

how does Phaeochromocytoma cause PU

A

(Catecholamine producing tumour of the adrenal gland i.e. adrenaline)
Adrenaline = Primary sign is hypertension = high GFR = polyuria

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5
Q

What electrolytes are high with renal disease

A

Phosphorus is GFR dependent so slow GFR = high phosphorus
Potassium should also be cleared by GFR so is high

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6
Q

what molecules are high in blood with renal failure

A

urea and creatinine
SDMA

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7
Q

what is lost with a PLN

A

albumin

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8
Q

safer alternative to water deprivation test

A

trying to differinate between central and nephrogenic DI, and psychogenic

just do vasopressin trial xxx don’t dehydrate dogs on purpose

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9
Q

threee categories of AKI

A
  1. Haemodynamic = redcued renal perfusion
  2. Intrinsic Renal i.e. actual damage to the kidneys (ischeamia, infectious, immune-mediated, sepsis, nephrotoxic drugs)
  3. Postrenal i.e. urethral obstruction, uretral obstruction or urine leakage
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10
Q

signs of lepto

A

AKI and liver damage and dyspnoea
SNAP test in all AKI patients!!! zoonotic!
Treat with doxycycline

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11
Q

two treatment options for an AKI

A
  1. IVFT: match losses and maintain fluid status using very high fluid rates (up to 10x maintenance but avoid volume overload)
  2. Dialysis if no response to IVFT> Peritoneal catheter => infusion of dialyse solution (glucose) => left for 20mins-hours => drained and repeated
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12
Q

signs of CRF

A

○ PU/PD
○ Anorexia
○ Weight loss
○ Dehydration
○ Pallor
○ Vomiting and diarrhoea (due to uraemia)
○ Mucosal ulcers
Uraemic breath

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13
Q

How does nephron loss cause further renal damage

A

Nephron loss > other nephrons GFRs increased to compensate> glomerular capillary wall damage and more plasma protein filtration > further glomerular and tubulointerstitial damage.

Nephron loss > reduced total GFR> build up of products normally excreted (e.g. urea)> uraemic crisis.

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14
Q

How can anaemia develop from CRF

A

Reduced renal function > reduced Erythropoietin (EPO) production > nonregenerative anaemia

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15
Q

What is iris staging

A

Guidelines for treatment
Stage 1-4 based on
- Creatinine OR SDMA

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16
Q

which is more specific: SDMA or creatnine

A

creatine can come from muscle mass too
excreted by kidney so high in renal failure with 75% nephron loss

SDMA is most expensive but high with 40% nephron lost and kidney specific

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17
Q

key principles in CKD management

A

Diet very important stage II onwards

Later stages - more emphasis on
- Treating 2ndary anaemia/acidosis/nausea
- Maintaining hydration
- Ensuring adequate nutrition

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18
Q

stage 1 treatment

A
  • care with nephrotoxic drugs
  • fresh water always
  • Monitor SDMA and creatinine
  • Treat hypertension and proteinuria
  • Renal diet and phosphate binder
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19
Q

What is uraemic crisis

A

Build up of urea and other toxins usually excreted in kidneys to intolerable levels. Due to-
○ End stage Chronic Kidney Disease
○ Acute Kidney Injury
○ Acute on Chronic –AKI (e.g. ischemic or toxic insult) exacerbating existing CKD

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20
Q

uraemia crisis treatment

A

Work out if AKI, CKD or acute on chronic and treat as needed but in addition…

  • IVFT- Hartmann’s to Replace dehydration + ongoing losses
  • blood gases- assess for acidosis. Bicarb if pH <7.2
  • Treat nausea, Antiemetics e.g. maropitant
  • Treat GI ulceration: Omeprazole +/- H2 Blockers +/- sucralfate
  • Nutritional support- Important! Appetite stimulants( Mirtazapine) and Feeding tubes (Nasogastric so don’t have to GA)
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21
Q

What renal and extra renal conditions predispose to CKD

A
  • Renal diseases
    ○ Glomerular disease
    ○ Fanconi’s syndrome
    ○ Polycystic Kidney Disease
    ○ Pyelonephritis
    ○ Nephrotoxin exposure
    ○ Neoplasia

Extrarenal issues
○ Hypertension
○ Cardiac disease
○ Hyperthyroidism
○ Diabetes
○ Urolithiasis/ obstruction
○ Cystitis
○ Neoplasia
○ Hypercalcaemia

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22
Q

how to renal disease and hypertension drive eachother

A
  • Renal injury stimulates sympathetic pathways
    • Renin release and angiotensin conversion
    • Vasoconstriction and aldosterone release so more sodium reabsorption
    • This drives hypertension
      This drives renal injury
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23
Q

treatment of renal hypertension

A

○ ACE inhibitors (ACEi) e.g. Benazepril, Enalapril
○ Angiotensin receptor blockers (ARB) e.g. Telmisartan, Spironolactone
○ Calcium Channel Blocker (CCB) stop vasonstriction e.g. Amlodipine

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24
Q

What is Pyelonephritis

A

bacterial infection of the renal pelvis and parenchyma

CS: Fever, abdo pain, PUPD
US: renal pelvis dilatation with hyperechoic mucosa, altered cortex/ medulla echogenicity.

25
Q

Antibiotic choice fir UTI or pyelonephritis with CKD

A
  • Amoxicillin +/- Claw: Really excreted so high cons in urine
  • Can use TMPS but beware adverse effects
  • Nephrotoxic antibiotics: Aminoglycocides (anything -mycin) and enrofloxacine
26
Q

Common neoplastic mets to the kidney

A

Carcinoma
Lymphoma

27
Q

What is polycystic kidney disease

A

hereditary
fluid filled cysts present from birth in some cats
start effecting kidney function at ~7 years

DX: ultrasound shows cavities, genetic screening

28
Q

What is falcon sydrome

A

Disease of proximal tubule > reduced resorption of solute
Can be idiopathic, hereditary or from chicken jerky or Gentimycin

Loss of Na, K, P, albumin, bicarbonate, glucose, amino acids

DX: increased ^^ in urine despite normal blood levels

Tx: Remove cause, Supplements

29
Q

Signs of glomerular disease and dx

A

Secondary to CKD or can worsen CKD
Damage = albumin and anti-thrombin lost into urine (PLN)

Dx: hypoproteinaemia and proteinuria (HAS to be present)
Definitve = renal biopsy (only sample cortex)

30
Q

Causes of glomerular disease n cats and dogs

A

cats = neoplasia and systemic infection (FeLV, FIP, FIV)

dogs = often from renal disease
- Immune-mediated glomerulonephritis when immune complexes form in glomerular walls
- Amyloidosis when chronic inflammation results in protein deposition in the glomerulus

31
Q

treatment of glomerular disease

A

Treat underlying cause
- Manage Nephrotic syndrome if present
- Limit proteinuria with ACEi (or ARBs)
- If glomerular inflammation at biopsy consider Immunosuppressives e.g. mycophenolate, azathioprine, cyclophosphamide, cyclosporine

Monitor and manage CKD as per IRIS staging

32
Q

what is nephrotic syndrome

A

Result of a PLN, pathogenic of glomerular disease

Signs: Pitting odema, low albumin, high lipids (excessive protein loss leads to TAG mobilisation for energy)
(excessive protein loss decreases oncotic pressure = fluid leakage)

33
Q

treatment of nephrotic syndrome

A

anti-proteinurics: Ace inhibitor like Benazapril

Anticoagulant like Aspirin or clopridical (risk of clots as antithrombin lost alongside albumin)

fluid removal if severe side effects

34
Q

How can spinning samples tell apart haemaglobin and myoglobin in urine

A

○ Blood sample and centrifuge
○ Plasma likely to be red with haemoglobinaemia
○ Plasma likely clear with myoglobinaemia

35
Q

common causes of H and M in urine

A

Haemoglobinaemia
- Haemolysis - See pre-hepatic jaundice

Myoglobinaemia
- Usually secondary severe muscle damage
- With high AST/CK, History, exam.

36
Q

where can disease be localised to with stranguria and pollakiuria

A

lower urinary tract

37
Q

How to narrow differentials of stranguria

A

Ultrasound bladder to see size

Big Bladder - Obstructive disease
- Failure of bladder to empty (neuromuscular)
- Detrusor atony – overstretch and damage – flaccid, easy to express
- UMN bladder (Thoraco-lumbar disease) – urethral sphincter tone remains high preventing urination, difficult to express
- Inflammatory, infectious, iatrogenic can all have a big bladder.

Small Bladder – non-obstructive disease
- Anatomical – e.g. ectopic ureters
- Neuromuscular – e.g. USMI
- Inflammatory, infectious, iatrogenic or idiopathic
- FIC

38
Q

Stranguria + big bladder approach

A

OFTEN EMERGENCY
biochem: azotemiae and hyperkalaemia
pocus: check for uroabdomen and stones
catheterise: release obstruction and drainage bladder. If not do cystocentesis

39
Q

Stranguria + small bladder approach

A

Non-obstructive disease history. History key

○ Environmental changes – FIC in cats
- Description of the urination – is it incontinence being misinterpreted? Is there nocturia, bed wetting, etc.
- Age – young (congenital/anatomical) vs middle aged (idiopathic) vs old (neoplasia, neuromuscular e.g. USMI)
- Acute – infectious/inflammatory vs chronic – neoplasia, neuromuscular, anatomical

40
Q

difference between cat and dogs struvite uroliths

A

dogs = associated with UTI and urease producing bacteria
cats = often sterile

41
Q

second most common stone and risk factors

A

calcium oxalate
acidic diets and oral calcium supplements given outside of meal times

42
Q

Signalment and risks for urate crystals

A

Dalmations and Black Russian terriers
often associated with PSS

43
Q

Tx for the 3 main crystals

A

Really important to find out type first
All need pain relief

Struvite: often have UTI so give antibiotics. Acidifying diet
Urate: often treated with allopurinol. Manage shunt if present. Alkalinising diet

Calcium oxalate: Diet cannot dissolve but can prevent in future. High moisture Alkalinising diet

44
Q

Most common bladder cancer

A

transitional cell carcinoma
highly invasive with common mets

45
Q

Dx of bladder neoplasia

A

A cystourethrogram or ultrasonography to determine the location and extent of the tumour

Biopsy of the tumour is required for definitive diagnosis

46
Q

What is FLUTD

A

Feline Lower Urinary Tract Disease – group of conditions
Causes of FLUTD –
○ FIC – Feline Idiopathic Cystitis = most common. Very commonly stress related, and often very frustrating for both owners, and you as the vet, to manage
○ UTI – normally in older cats with co-morbidities causing dilute urine eg CKD, diabetes
○ Urolithiasis
○ Urethral plugs – occur if there is severe inflammation/infection, can cause obstruction
○ Neoplasia – uncommon

47
Q

Management for feline idiopathic cystitis

A

manage pain
manage stress (L-tryptophan and a-casozepine can reduce anxiety)
increase water intake

urinary diet (acidic for struvite, alkaline for CO and urate, restrict phosphorus, magnesium and calcium)

48
Q

Urination process

A
  • Detrusor has stretch receptors which sends sympathetic message to spinal cord (via hypogastric nerve)
  • Urethral sphincter relaxes and detrusor contracts
49
Q

what is USMI

A

urethral sphincter mechanism incontinence
Non-neurogenic incontinence in dogs
- leak urine when relaxed or excited
- commonly females, spayed, older, overweight

50
Q

Tx of USMI

A

Aim to improve urethral sphincter tone

Phenylpropanolamine - Propalin, urolin
- Mimics the sympathetic nervous system to allow bladder filling
- Detrusor relaxation and sphincter contraction (SNS)

Oestrogens (Incurrin)
- mimic hormonal influence in urethra (for tone)
- only in spayed bitchesss

Can be used together

51
Q

UMN bladder vs LMN bladder

A

UMN = large and hard
LMN = flaccid and soft. can be manually emptied

52
Q

Tx for high urethral tone

A

Sympatholytics lie prazosin and phenoxybenzamine
skeletal muscle relaxants like bentos, ACP

53
Q

renal diet

A

low protein
low phosphate and phosphate binders
Potassium and Vitamin. supplements
High calories and water (wet best)

cats need high protein and low carbohydrates. feed higher value protein

54
Q

suture pattern to use with cystotomy

A

absorbable monofilament
long lasting (10-14 days)
No knots on inside - continuous inverting or simple continuous

55
Q

signs of ectopic ureters

A

young Doug
constant leaking of urine

56
Q

what is detrusor instability

A

causes urge incontinence
Bladder irritation (often UTI or stones) makes animal feel like they need to urinate and overstimulates detrusor reflex

57
Q

4 causes of neurogenic incontince

A

UMN injury
LMN injury
Detrusal-urethral dyssynergia (bladder doesn’t empty fully which can lead to UTI or detrusor atony)
Detrusor atony - Bladder has overstretched and stretch receptors give up sending signals to the brain

58
Q

what drug can help with detrusor dysfunction

A

Bethanecol (parasympathomimetic)

Small animal (11 decks)

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