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ALL the renal/urinalysis Flashcards

1
Q

Renal disease

A

morphologic or functional lesions of any size, distribution, or etiology involving one or both kiendys

  • +/- accompanied by renal failure
  • tells nothing about function
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2
Q

Renal failure

A

accumulation of nitrogenous wastes & alteration in water/electrolyte/acid-base status due to reduced functional renal mass

  • may eventually lead to uremia
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3
Q

Azotemia

A

an increase in NPN compounds in blood

  • does NOT imply presence of clinical signs
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4
Q

Uremia

A

azotemic renal failure with the presence of clinical signs

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5
Q

Renal insufficiency

A

when loss of functional nephron mass is more than 66.6% but less than 75%

  • animal is polyuric b/c can no longer concentrate urine, but not yet azotemic
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6
Q

What is the first course of action when presented with an azotemic patient?

A

determine source of azotemia (pre-renal, renal, post-renal)

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7
Q

When does pre-renal azotemia occur?

A
  1. reduced renal perfusion
    • decreased delivery of blood to kidneys
      • congestive heart failure
    • decr. effective arterial blood volume
      • IV voume loss or shift to ECF (hemorrhage, severe burns, pancreatitis, hypoadrenocorticism, shock)
      • Extravascular fluid loss (vomiting, diarrhea)
      • increased vascular capacity (sepsis)
  2. increased urea production/protein catabolism
    • high protein diet
    • GI bleed
    • starvation
    • infection
    • azathioprine
    • tetracyclines
    • exogenous corticosteroids
    • fever
    • burns
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8
Q

USG of dog/cats with pre-renal azotemia

A

CONCENTRATED

dog >1.030

cat>1.35

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9
Q

What type of urine sediment is associated with pre-renal azotemia?

A

inactive

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10
Q

Renal excretion of urea

A
  • glomerular filtration
  • tubular reabsorption
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11
Q

How does tubular flow rate affect reabsorption?

A

slower tubular flow rates = greater reabsorption

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12
Q

Differentials for decreased BUN

A
  • liver failure, low protein diets (i.e. decreased production)
  • diuresis (i.e. increased excretion…due to decreased tubular reabsorption)
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13
Q

Give an example of a normal case of lower serum creatinine

A

puppies (don’t yet have a large muscle mass)

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14
Q

How is creatinine excreted?

A
  • glomerlular filtration (almost exclusively)
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15
Q

What is a good indicator of GFR?

A

creatinine clearance

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16
Q

What species might have minimal tubular secretion of creatinine?

A

dog

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17
Q

When might you have false elevations of creatinine and why?

A

Diabetic ketoacidosis

  • acetoacetate is a non-creatinine chromagen which contributes to serum creatinine
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18
Q

When do creatinine/BUN levels change most: early in renal disease with a large decrease in GFR or late in renal disease with small decrease in GFR?

A

Later in renal disease with small decrease in GFR

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19
Q

renal azotemia occurs with ____% of nephron loss

A

75% & greater

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20
Q

When does post-renal azotemia occur?

A
  1. obstruction to urine outflow
  • calculi
  • stricture
  • foreign body
  • tumor
  1. urinary tract rupture
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21
Q

What type of urine sediment is associated with post-renal azotemia?

A

active

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22
Q

What form of azotemia is hyperkalemia possibly associated with?

A

post-renal

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23
Q

USG associated with post-renal azotemia

A

USG can be variable-because the kideys are still functioning at first

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24
Q

What are two diagnostic methods that might be used when post-renal azotemia is suspected?

A
  • abdominal ultrasound-preferred over rads
  • abdominal fluid creatinine - with ruptured bladder, fluid creatinine will be > serum creatinine
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25
Q

Once pre and post-renal causes of azotemia are eliminated, how is renal azotemia confirmed? What are two exceptions?

A

Azotemia + isosthenuria or minimally concentrated urine

Exceptions:

  • cats (can concentrate late into renal disease)
  • glomerular disease
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26
Q

clinical findings that support renal azotemia

A
  • glucosuria w/o hyperglycemia
  • mod./severe proteinuria
  • mod./severe cylindruria
  • alkalinuria with concurrent systemic acidosis
  • non-regenerative anemia
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27
Q

How do kidneys in ARI vs. CKD differ on ultrasound?

A

ARI-normal to large kidneys

CKD-small, irregular kidneys

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28
Q

Which form of renal disease is likely to be associated with anemia?

A

CKD

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29
Q

List common causes of ARI

A
  • ethylene glycol toxicity
  • drugs (aminoglycosides)
  • hypercalcemia
  • hypokalemia (cats)
  • volume depletion
    • sepsis
    • pancreatitis
  • infectious causes
    • bacterial pylelonephtritis
    • leptospirosis
  • multiple disorders (18%)
  • unknown cause (22%)
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30
Q

Risk factors for ARI

A
  • advanced age
  • preexisting renal disease
  • dehydration/reduced renal perfusion
  • hypokalemia, hypercalcemia
  • diuretics, nephrotoxic drugs
  • liver disease-possibly
  • any factor known to cause renal failure
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31
Q

What is a common cause of CKD in older cats?

A

pyelonephritis

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32
Q

Clinical signs of urine outflow obstruction

A
  • dysuria
  • hematuria
  • paradoxical incontinence
  • fluctuations in urine volume
  • markedly distended bladder
  • inability to pass urinary catheter
  • renomegaly if hydronephrosis present
  • uremic signs
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33
Q

Things to consider if azotemia is persistent after obstruction is relieved

A
  1. not enough fluids are being given to make up for fluid losses due to post-obstructive diuresis
  2. preexisting renal disease has led to renal failure
  3. the obstruction was long-standing and caused renal failure
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34
Q

How can you evaluate for post-obstructive diuresis? Within what timeframe should this resolve?

A
  • measuring urine volume every four hours
  • should resolve in 48-72 hours
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35
Q

What species is more prone to post-obstruction diuresis?

A

cat

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36
Q

Clearance

A

the volume of a substance removed from the plasma per unit time

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37
Q

The clearance of substances such as Na, Cl, and Ca is _________ (greater or less) than GFR

A

less

(these are reabsorbed only-no tubular secretion)

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38
Q

Clearance of PAH is ________(greater/less) than GFR

A

greater

substance is secreted, but not reabsorbed

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39
Q

How is uric acid handled by the kidneys?

A

it is both secreted and reabsorbed

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40
Q

How is creatinine handled by the kidney?

A

filtered by glomerulus and not substantially reabsorbed or secreted

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41
Q

Most appropriate test for determinng reneal excretory function when non-azotemic renal failure (renal insufficiency) is suspected

A

exogenous creatinine clearance

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42
Q

What are the advantages of radioisotope studies?

A
  • not time consuming
  • don’t require urine collection
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43
Q

Disadvantage of radioisotope studies

A
  • must be performed at referral institution
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44
Q

Tests of glomerular function:

A
  • endogenous creatinine clearance
  • exogenous creatinine clearance
  • radioisotope studies
  • plasma clearance of iohexol
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45
Q

Easiest & most reliable method available for calculating GFR

A

plasma clearance of iohexol

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46
Q

Contraindications for water deprivation test

A

animal with renal failure or insufficiency

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47
Q

Tests of tubular function

A
  • USG, urine osmolality
  • fractional clearances of electrolytes
  • ammonia challenge tests
  • (water deprivation tests)-technically a test of renal tubular concentrating ability but don’t us in animal with renal failure/insufficiency
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48
Q

Ammonia challenge tests are used for what?

A
  • assessing urinary acidifying ability when evaluating renal tubular disorders, specifically renal tubular acidosis
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49
Q

What are two potential values of doing a renal biopsy in an animal with AKI?

A
  1. establish etiologic dx
  2. facilitate prognostication via evaluation of overall appearance of renal tissue and integrity of tubular basement membrane
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50
Q

What is the primary purpose of a renal biopsy when the animal has PLN?

A

determine whether or not to use immunosuppressive drugs

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51
Q

Contraindications to renal biopsy

A
  • uncontrolled coagulopathy
  • severe hydroephrosis
  • large renal cysts
  • perirenal abscess
  • extensive peylonephritis
  • solitary or extremely small kidney
  • end-stage renal disease
  • inexperienced operator
  • incomplete patient immobilization
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52
Q

What region of the kidney is biopsied?

A

cortex

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53
Q

Why should the corticomedullary junction and medulla be avoided when performing a renal biopsy?

A

large renal vessels are present

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54
Q

Three methods for renal biopsy are:

A
  1. percutaneous
  2. laparoscopic
  3. laparotomy
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55
Q

What are some advantages to using laparotomy to perform a renal biopsy?

A
  • both kidneys can be visualized with the midline approach
  • hemorrhage can be controlled
  • can ensure adequate biopsy
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56
Q

Complications occur in ___% of dogs & cats undergoing renal biopsy

A

17

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57
Q

What is the most common complication that occurs from renal biopsy?

A

hemorrhage

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58
Q

How is severe hemorrhage defined?

A

PCV<20%

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59
Q

What is the likely cause of hydronephrosis after a biopsy?

A

obstruction of the ureter with blood clots

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60
Q

Polydipsia definition

A

water consumption >100 ml/kg/day

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61
Q

Polyuria definition

A

urine production greater than 50 ml/kg/day

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62
Q

Oliguria definition

A

production of less than 1.0 ml/kg/hour of urine

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63
Q

Hx/PE abnormalities suggestive of renal failure

A
  • changes in urine volume
  • GI abnormalities
  • abnormal kidney size/contour/texture or pain on palpation of kidneys
  • hematopoietic abnormalities
  • skeletal abnormalities-“rubber jaw”
  • cardiopulmonary & vascular abnormalities
  • neurologic abnormalities
  • non-specific signs
    • anorexia
    • chronic progressive weight loss
    • lethargy
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64
Q

What size should the kidneys be?

A
  • 2.5-3.5x the length of the second lumbar vertebral body in dogs
  • 1.5x the length of the second lumbar vertebral body in the cat
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65
Q

Abnormal fluid retention might be related to _____

A

PLN

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66
Q

Common causes of CKD

A
  • most often undetermined
  • glomerulonephritis
  • prior ARI episode
  • pyelonephritis (often older cats)
  • familial
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67
Q

Four therapeutic goals for renal failure

A
  1. avoid stress
    • if animal stops drinking->pre-renal azotemia
  2. provide unlimited fresh water
  3. avoid nephrotoxic agents
  4. allow for adequate exercise
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68
Q

Risk factors for ARI

A
  • advanced age
  • pre-existing renal disease
  • dehydration or other causes of decreased renal perfusion
  • hypokalemia
  • hypercalcemia
  • concurrent use of diuretics or nephrotoxic drugs
  • liver disease (MAYBE)
  • presence of other factors known to cause renal injury
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69
Q

Causes of infectious ARI (“nephritis)

A
  • bacterial pyelonephritis
  • leptospirosis
  • rickettsial diseases
    • RMSF
    • ehrlichiosis
  • “lyme nephritis”
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70
Q

Phases of ARI

A
  • induction (initiation)
  • maintenance
  • recovery
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71
Q

What is often given in cases of ethylene glycol ingestion?

A

4-MP (fomepizole)

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72
Q

What are some reasons the kidneys may be large instead of small, as is expected with CKD?

A
  • renal neoplasia
  • hydronephrosis
  • compensatory hypertrophy of solitary surviving kidney
  • renal cysts
  • renal abscesses
  • FIP
  • renal amyloidosis
  • membranous glomerulonephropathy–cats
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73
Q

ARI therapeutic goals

A
  • prevent further damage
    • remove inciting cause
    • remove pre & post-renal factors
  • production of diuresis
  • sustain patient’s life during recovery
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74
Q

Why is production of diuresis in ARI relevant?

A

polyuric patients have better prognosis

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75
Q

CKD therapeutic goals

A
  • alleviate clinical signs
  • reduce rate of progression
    • eliminate obvious factors causing acute deterioration
    • implement factors known to slow progression
    • keep current knowledge base!
  • work w/in owner comfort zone
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76
Q

FACTORS KNOWN TO SLOW PROGRESSION OF CKD IN DOGS & CATS

A

HAD2P

  • manage Hypertension
  • mange Anemia
  • feed renal Diet
  • manage renal 2ndary hyperparathyroidism
  • reduce magnitude of Proteinuria
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77
Q

Factors impacting morbidity of CKD

A
  • UTI
  • hypertension
  • hypokalemia (primarily cats)
  • ureteroliths(primarily cats)
  • gastroenteritis
  • dehydration
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78
Q

Staging CKD is based on _____

Substaging CKD is based on _______

A

Staging-CREATININE

Substage-PROTEINURIA, HYPERTENSION

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79
Q

When does uremia occur?

A
  • severe AKI
  • stage IV CKD
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80
Q

Restoration of euvolemia should occur within what timeframe?

A

6 hours

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81
Q

Signs of severe overhydration

A
  • weight gain
  • edema
  • distended jugular veins
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82
Q

What is the first method you should try in a patient to try to remedy oliguria?

A

Fluid diuresis (not effective if already overhydrated)

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83
Q

What drug is synergistic with furosemide?

A

dopamine

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84
Q

When is chronic fluid therapy appropriate to initiate?

A
  • Stage 4 CKD
  • sometimes used in recovering ARI
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85
Q

How should alkalinization be approached in an ARI patient vs. CKD?

A

ARI

  • sodium bicarb IV

CKD-stage 4

  • sodium bicarb PO
  • potassium citrate PO-often in cats for added potassium benefit
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86
Q

What parameters indicate alkalinization is appropriate?

A

pH<7.20 or TCO2<12

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87
Q

Is hyperkalemia more common in ARI or CKD?

A

ARI

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88
Q

When is hyperkalemia seen in CKD patients?

A

CKD patients on ACE inhibitors or those with oliguria/anuria

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89
Q

Appropriate treatment for hyperkalemia >8mEq/L or if arrythmias are present

A
  • sodium bicarbonate
  • insulin & dextrose
  • calcium gluconate
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90
Q

How can you prevent hypokalemia from occurring during forced diuresis?

A

add KCl to fluids

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91
Q

What are some consequences of hypokalemia to be aware of?

A
  • renal vasoconstriction
  • K+ depleted cells are more susceptible to necrosis
  • downregulation of aquaporin-2 (inhibits ADH)
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92
Q

Renal diets improved MST by how much in dogs? cats?

A

dogs: 3x
cats: 2.4x

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93
Q

What is one drawback to renal diets?

A

caloric density contributes to obesity

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94
Q

What is the phosphate binder that is usually used when renal diets alone are not enough to control hyperphosphatemia?

A

aluminum hydroxide

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95
Q

How is anemia generally treated in ARI vs. CKD?

A
  • ARI–>Whole Blood Transfusion
  • CKD–>epoetin, darbepoetin
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96
Q

What are some ways GI distress can be managed?

A
  • dietary protein restriction
  • H2 blockers
    • Cimetidine, Ranitidine, famotidine
  • Proton pump inhibitors
    • omeprazole, esomeprazole
  • antimetics as needed in ARI or acute exacerbation of CKD
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97
Q

Uncotrolled hypertension ocular effects

A
  • retinal, vitreal, or anterior chamber hemorrhage
  • retinal detachment & atrophy
  • retinal edema
  • perivasculitis
  • retinal vessel tortuosity
  • glaucoma
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98
Q

How much can an ACE inhibitor be expected to lower blood pressure when used by itself?

A

15%

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99
Q

Enalapril and Benzapril are used for what?

A

ACE inhibitors used for treating hypertension

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100
Q

ACE inhibitors are used for managing hypertension but have what added benefit?

A

reduce proteinuria

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101
Q

In early stages of AKI, what parameters should be measured daily/several times a day?

A
  • BUN/Creatinine daily
  • PCV/TS several times a day
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102
Q

Paramenters to be monitored and how often with CKD

A
  • PE, hx: 2-4x per year
  • panel, PCV/TS, UA: 2-4x per year
  • urine culture: 2x per year
  • blood pressure: every visit
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103
Q

Uncontrolled hypertension effects on the heart

A
  • left ventricular hypertrophy with secondary valvular insufficiency
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104
Q

Uncontrolled hypertension effects on kidney

A
  • progressive renal decline of renal disease
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105
Q

Uncontrolled hypertension effects on brain

A
  • cerebrovascular hemorrhage
    • may manifest as head tilt
  • depression
  • seizures
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106
Q

Clinical signs of renal disease can vary depending on:

A
  1. etiology of disease
  2. severity of disease
  3. duration of disease
  4. rate of progression of primary dz process
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107
Q

Why are clinical signs often more severe in an animal with ARI than an animal with CKD that has the same level of renal dysfunction?

A

Animals with ARI have not had time to adapt to the physiologic changes asssociated with renal failure

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108
Q

What laboratory finding would suggest ethylene glycol toxicosis?

A

hippurate or CaOx crystals

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109
Q

What are some clinical signs that occur in CKD that may allow differentiation from ARI?

A
  • long hx of weight loss & PU/PD
  • poor BCS
  • non-regenerative anemia
  • small, irregular kidneys
  • fibrous osteodystrophy
  • gastric or other tissue mineralization
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110
Q

Renal diet characteristics

A
  • mod. protein restriction
  • phosphorous restriction
  • sodium restriction
  • Omega 3:omega 6 ratio enhanced
  • high in water soluble vitamins
  • increased caloric density
  • increased fiber content
  • added K+ in feline diets
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111
Q

What might happen if a diet is too restricted in protein?

A
  • aggravate anemia, acidosis
  • protein depletion & muscle wasting
  • worsen renal hemodynamics
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112
Q

When is amlodipine indicated?

A

In hypertension cases that aren’t responding enough to an ACE inhibitor alone

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113
Q

What UPC value is associated with more rapid progression of CKD in dogs? cats?

A

dogs: UPC>1
cats: UPC>0.4

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114
Q

Clinical signs of hypokalemia often develop when serum potassium is less than what value?

A

2.5 mEq/L

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115
Q

How does increased GFR affect protein passage through glomerulus?

A

increase

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116
Q

How does decreased renal plasma flow affect protein passage through the glomerulus?

A

increase

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117
Q

How does decreased GFR affect protein passage through the glomerulus?

A

decrease

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118
Q

How does increased renal plasma flow affect protein passage through the glomerulus?

A

decrease

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119
Q

What are the components of normal urine?

A
  • albumin (40-60% of total urine protein)
  • low molecular weight proteins-small amounts
    • Peptide hormones (insulin, PTH, GH), enzymes (lysozyme), Ig fragments
  • Tamm-Horsfall Protein
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120
Q

How much protein is found in normal dog urine?

A

5-10ug/dl

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121
Q

Post-renal proteinuria is associated with hemorrhage or inflammation of:

A
  • ureter
  • bladder
  • urethra
  • prostate
  • prepuce
  • vagina
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122
Q

3 subtypes of renal proteinuria

A
  1. functional/physiologic
  2. tubular
  3. glomerular
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123
Q

What does a persistently elevated urine protein content indicate?

A

proteinuria associated with glomerular disease

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124
Q

Causes of glomerular proteinuria

A
  • glomerulonephritis (membranoproliferative or proliferative)
  • membranous glomerulonephropathy
  • amyloidosis
  • glomerulosclerosis-including focal segmental glomerulosclerosis
  • minimal change disease
  • hereditary nephritis
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125
Q

Causes of tubular proteinuria

A
  • acute tubular necrosis
  • Fanconi
  • drug/toxin-induced proximal tubular damage
  • aminoglycosides
  • NSAIDs
  • heavy metals
  • ethylene glycol
  • hypercalcemia
  • hypokalemic nephropathy
  • tubulointerstitial disease
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126
Q

50-90% of dogs with chronic renal failure have ______

A

glomerular disease

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127
Q

What is the most common cause of proteinuria?

A

post-renal

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128
Q

With tubular proteinuria, what is the expected USG?

A

isosthenuric-minimally concentrated range

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129
Q

What is the expected USG with glomerular proteinuria?

A

normally concentrated unless late in disease

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130
Q

Three most common causes of glomerular proteinuria

A
  • amyloidosis
  • glomerulonephritis
  • focal segmental glomerulonephritis
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131
Q

The urine dipstick is what type of test?

A

qualitative

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132
Q

What protein is the urine dipstick most sensitive to?

A

albumin

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133
Q

What circumstances can yield false positives with a urine dipstick?

A
  • highly alkaline urine (pH>8-9)
  • dipstick immersed for long periods of time
  • urine is contaminated with quaternary ammonium compounds(e.g. cleaning agents)
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134
Q

Under what circumstances do false negatives occur with a urine dipstick?

A
  • dilute urine
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135
Q

False positives may occur with what circumstances when using the bumintest?

A
  • organic iodides(radiographic contrast dyes)
  • large amounts of penicillins, sulfisoxazole, or thymol(urine preservative)
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136
Q

Highly alkaline or dilute urine may produce false _______ with the bumintest

A

negatives

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137
Q

When is a quantitative test indicated?

A
  • when animal is hypoalbuminemic
  • repeat positive screening tests and a normal urine sediment examination
  • absence of pre & post-renal causes of proteinuria
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138
Q

What is the gold standard for measuring urine protein losses?

A

24 hour urine protein content

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139
Q

What test correlates well with the 24 hour urine protein content in both cats and dogs?

A

UPC

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140
Q

Normal UPC values in cat & dog

A

dog: <0.5
cat: <0.4

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141
Q

What are two diseases that are considered with especially high UPC ratios?

A
  • glomerulonephritis
  • amyloidosis
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142
Q

What should you do if you detect proteinuria in a dog or cat with mild to moderate pyuria?

A

reevaluate a urine sample after the cause of pyuria is eliminated

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143
Q

What test characterizes protein fractions in urine samples, thereby allowing for the determination of relative contribution of albumin and globulin to total urine protein content?

A

urine protein electrophoresis

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144
Q

The usefulness of urine protein electrophoresis is limited to what two situations?

A
  1. detection of low molecular weight proteinuria associated with overload proteinuria
  2. identification of albuminuria as the cause of hypoalbuminemia in animals with LUT hemorrhage or inflammation that is not responsive to therapy
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145
Q

What is the point-of-care RIA that is used to detect microalbuminemia?

A

E.R.D.-HealthScreen

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146
Q

Factors that lead you to suspect glomerular proteinuria

A
  • hypoalbuminemia
  • concurrent systemic infectious or inflammatory disease
  • patient has renal azotemia but NOT isostheunuric (pre or post renal causes of azotemia have been excluded)
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147
Q

Factors that would lead you to suspect tubular disease

A
  • normal serum albumin
  • other abnormalities suggestive of tubular disease
    • glucosuria w/o hyperglycemia
    • isosthenuria
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148
Q

What is pathognomonic for glomerular disease?

A

Nephrotic syndrome

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149
Q

Nephrotic syndrome

A
  • hypoproteinemia(hypoalbuminemia)
  • proteinuria
  • hypercholesterolemia
  • edema
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150
Q

Three reasons why animals with glomerular disease are predisposed to thromboembolic disease

A
  1. Loss of ATIII
  2. hyperfibrinogenemia
  3. enhanced platelet function
151
Q

What types of casts are associated with degeneration and necrosis of tubular epithelial cell?

A

granular, waxy, fatty

152
Q

What is the explanation given for the development of ascites and edema?

A

decreased oncotic pressure->decreased plasma volume->decreased CO->decreased renal blood flow->activation of renin-angiotensin system->increased aldosterone->renal salt and water conservation

153
Q

What factors are serine prteases?

A

Factor II, IX, X, and XII

154
Q

What form of glomerulonephritis do cats most often have?

A

membranous

155
Q

What form of amyloidosis is reported in dogs and cats?

A

reactive(secondary)

156
Q

Where is amyloid deposited in most dogs?

157
Q

Where is amyloid primarily deposited in cats?

158
Q

How does amyloidosis look on light microscopy?

A

homogenous eosinophilic material characterized by green birefringence when stained with Congo Red

159
Q

What test might be beneficial annually in a breed predisposed to amyloidosis?

A

microalbuminemia screening

160
Q

What are some causes of glomerulosclerosis?

A
  • hypertension-induced
  • diabetes mellitus (primarily people)
  • secondary to another glomerular injury
  • focal segmental glomerulosclerosis - primary glomerular disease recently demostrated in dogs
161
Q

What is a specific goal of therapy for amyloidosis?

A

decrease deposition and increase mobilization of amyloid fibrils

162
Q

What is a specific goal of therapy for glomerulonephritis?

A

decrease the deposition of circulating immune complexes & decrease resultant inflammation

163
Q

Describe supportive care for proteinuric patients

A
  1. ACE-inhibitors-indicated in all dogs and cats with renal proteinuria, even if they do not have systemic hypertension (Enalapril, benzapril)
  2. renal diets
  3. diuretics if edema & ascites are present
    • spironolactone may be pref. to furosemide because it inhibits aldosterone(aldosterone may contribute to progressive renal damage)
  4. dietary salt restriction for edema/ascites
  5. B vitamin supplemenation to replace losses in polyuric patients
  6. free access to water, limit stress, ample exercise
  7. Aspirin or clopidogrel (plavix) in patients at-risk for thromboembolic dz
  8. control hypertension if present
  9. edematous & azotemic/uremic patients very difficult to manage; may need plasma transfusions or plasma expanders to increase plasma volume, thereby removing pre-renal factors and allowing effective diuresis
  10. treat uremic signs
164
Q

What is a contraindicated medication to give to animals with amyloidosis?

A

corticosteroids

165
Q

What is the usefulness of colchicine?

A

should be instituted before onset of proteinuria or renal failure in Shar peis to be most effective

166
Q

What are some early signs of Shar peis at risk for amyloidosis?

A
  • recurrent fevers
  • swollen, painful hocks
167
Q

What parameters should be monitored to assess for progression of disease or response to therapy in proteinuric animals?

A
  • serum creatinine & albumin
  • UPC
168
Q

What are two reasons for a decrease in proteinuria?

A
  1. improving glomerular function
  2. decreasing GFR with overall worsening of the disease state (detected by increasing serum creatinine)
169
Q

What should be performed if proteinuria is detected and pre and post-glomerular causes can be excluded?

170
Q

What are the ‘NINs’?

A
  • non-infectious inflammatory diseases
  • infectious diseases
  • neoplastic diseases
171
Q

Under what circumstances should you consider a renal biopsy?

A
  • animal has persistent proteinuria and
    • no identifiable underlying disease
    • proteinuria has persisted after treatment of underlying disease
  • treatment must be an option
172
Q

How should a renal biopsy be evaluated?

A
  • light microscopy
  • electron microscopy
  • IFA
173
Q

“advanced azotemia” refers to serum creatinine above what?

A

serum creatinine > 4.0

174
Q

What breeds are associated with primary renal glucosuria?

A
  • norwegian elkhouds
  • beagles
175
Q

What breeds are associated with congenital renal tubular dysfunction?

A
  • Basenji
  • Norwegian elkhound
  • Schnauzer
  • Shetland sheepdog
176
Q

Glucose threshold in dog? cat?

A

dog: 180-220 mg/dl
cat: 200-300 mg/dl

177
Q

What three categories are glucosuria classified into?

A
  1. glucosuria assoc. w/ hyperglycemia
  2. primary renal glucosuria
  3. renal tubular dysfunction
178
Q

What are the criteria for a diagnosis of primary renal glucosuria?

A
  • glucose present in all urine samples
  • fasting blood glucose
  • normal glucose tolerance curve
  • no progression to DM
  • familial hx of renal glucosuria (norwegian elkhounds, beagles)
179
Q

List four differentials for glucosuria associated with hyperglycemia

A
  1. diabetes mellitus
  2. acute pancreatic necrosis
  3. parenteral dextrose therapy
  4. exogenous or endogenous epinephrine(primarily cats)
180
Q

What are possible clinical signs with primary renal glucosuria?

A
  • polyuric/polydipsic
  • may have bacterial cystitis
  • usually have normal renal function
  • often ASYMPTOMATIC
181
Q

How should dogs with primary renal glucosuria be treated?

A

no specific treatment needed, except treatment of recurrent UTIs

182
Q

Prognosis for primary renal glucosuria

183
Q

This disease is associated with multiple transport abnormalities

A

congenital renal tubular dysfunction (Fanconi syndrome)

184
Q

How does congenital renal tubular dysfunction progress?

A
  • initially, only abnormal urinalysis
  • slowly progresses to CRF
185
Q

Long term prognosis for congenital renal tubular dysfunction

A
  • poor; expect chronic debilitation
186
Q

How is congenital renal tubular dysfunction treated?

A

manage the signs of CRF as they arise

187
Q

Aminoglycosides harm what part of the nephron?

A

proximal tubule

188
Q

Some causes of acquired tubular dysfunction?

A
  • aminoglycosides
  • pyelonephritis
  • chronic hypocalcemia
  • copper storage disease
  • lead toxicity
  • jerky dog treats(chicken, chicken/sweet potato)
  • other tubular toxins
189
Q

When glucosuria is associated with euglycemia, what is the most likely origin?

A

renal tubular

190
Q

When glucosuria is of renal origin, what are the differentials?

A
  • primary renal glucosuria
  • renal tubular dysfunction
191
Q

Where in the kidney is the problem if isosthenuric?

A

global or problem with loop of henle

192
Q

Hyposthenuria indicates a problem with what?

A

ADH mechanism

193
Q

What is the serum osmolality with primary polydipsia?

A

possibly low

194
Q

What are the rule-outs for primary polydipsia?

A
  • hepatic failure
    • congenital PSS
  • hypothalamic lesion
  • psychogenic
195
Q

What is a normal serum osmolality?

A

290-310 mOsm/kg

196
Q

What are some causes of CDI?

A

anything that damages neurohypophyseal system

  • idiopathic
  • trauma
  • neoplasia
  • pituitary malformation
  • inflammation
197
Q

What is the mechanism of nephrogenic diabetes insipidus?

A

lack of response of distal tubule & collecting duct to ADH

198
Q

What is the expected USH for nephrogenic diabetes insipidus?

A

hyposthenuric

199
Q

What is the expected USG with osmotic diuresis?

A

isosthenuria-minimally concentrated

200
Q

How does hyperadrenocorticism interfere with concentrating ability?

A

glucocorticoids:

  • inhibit ADH release
  • promote renal resistance to ADH
201
Q

How does hypoadrenocorticism interfere with concentrating ability?

A

sodium loss-medullary washout

202
Q

How does pyelonephritis interfere with concentrating ability?

A
  1. endotoxins compete with ADH binding sites
  2. inflammation & infection in renal pelvis destroys countercurrent mechanism
203
Q

How does hepatic failure contribute to reduced concentrating ability?

A
  • decreased urea production-medullary washout
  • psychogenic polydipsia
204
Q

How does hypercalcemia reduce concentrating ability?

A

may interfere with or damage ADH receptors and interfere with renal tubular handling of sodium

205
Q

How doe hypokalemia reduce concentrating ability?

A

decreased responsiveness of the terminal nephron to ADH

206
Q

How does acromegaly reduce concentrating ability?

A

development of DM, osmotic diuresis (per clin path notes)

207
Q

What species is most prone to post-obstructive diuresis?

208
Q

List some causes of osmotic diuresis

A
  • DM
  • primary renal glucosuria
  • renal insufficiency/failure
  • post-obstructive diuresis
209
Q

Iatrogenic polyuria can be caused by ________

A
  1. diuretics
  2. glucocorticoids
    • dogs mostly
    • if cats develop PU from glucocorticoids, they are probably diabetic
  3. phenobarbital, other anticonvulsants
210
Q

What is the use for plasma osmolality when evaluating a PU/PD case?

A

rule out primary polydipsia-may have low serum osmolality

rule out primary polyuria-may have increased serum osmolality

211
Q

Contraindications for a water deprivation test

A

known renal failure or dehydration

212
Q

Normal dog response to water dehydration test

A
  • dehydrate slowly
  • achieve max USG of 1.050-1.075 in 40 hours(some require 78 hours)
  • no further increase after vasopressin adminstration
213
Q

How do dogs with CDI respond to water deprivation test?

A
  • rapidly dehydrate (within 3-6 hours)
  • do not produce concentrated urine even in face of severe dehyration
  • vasopressin will cause a 50-800% increase in urine concentration
214
Q

How do dogs with NDI respond to water deprivation test?

A
  • cannot concentrate urine with severe dehydration
  • do not respond to vasopressin​
215
Q

What is the diagnostic approach to PU/PD?

A
  1. complete Hx/PE
  2. repeat USGs
  3. quantify water intake or urine output
  4. CBC, biochemical panel, UA
  5. specific tests (e.g. adrenal, renal function tests)
  6. Plasma olsmolality test
  7. gradual water deprivation test if indicated
  8. DDAVP-as alternative to water deprivation test or when water deprivation test has not aided in establishing diagnosis.
216
Q

What response to the DDAVP test is suggestive of CDI or partial NDI?

A

decrease in water consumption >50%

217
Q

How is psychogenic polydipsia treated?

A

reduce water intake gradually, over several weeks, to normal daily volume

218
Q

How do dogs with hyperadrenocorticism or psychogenic polydipsia respond to water deprivation test?

A
  • concentrate into range of minimal concentration or sometimes over 1.030
  • 10-50% increase in urine concentration in response to vasopressin
219
Q

How can CDI be managed?

A
  • DDAVP = intranasal preparation into conjunctival sac q12 or 24 hours or oral formulation(may not be effective in some dogs)
220
Q

How can nephrogenic diabetes insipidus be managed?

A
  • eliminate underlying cause whenever possible
  • thiazide diuretics (Chlorothiazide)
    • used with caution
221
Q

What is a consideration when using serum osmolality to differentiate primary polyuria from primary polydipsia?

A

this is only effective if the animal has had free access to water leading up to the test

222
Q

What terms are related to problems in the lower urinary tract?

A
  • dysuria
  • stranguria
  • pollakiuria
223
Q

Reasons for inappropriate urination

A
  • behavioral
  • secondary to LUTD
224
Q

What terms are associated with disease anywhere in the urinary tract?

A
  • hematuria
  • pyuria
225
Q

Hematuria/pyuria differentials

A
  • infection
  • calculi
  • neoplasia
  • idiopathic (cats; RBC>WBC)
  • coagulopathy (hematuria only)
  • trauma
  • ischemia
226
Q

Most comon differential for feline LUTD w/o obstruction in a young cat

A

Idiopathic cystitis

227
Q

Most common differential for feline LUTD w/o obstruction in an older cat

A

bacterial UTI

228
Q

Differentials for Feline LUTD w/o obstruction

A
  • bacterial UTI
  • cystolithiasis
  • idiopathic cystitis
  • bladder neoplasia (rare in cats)
229
Q

Differentials for FLUTD with obstruction

A
  • Urethral plug
  • Uroliths
  • Unidentified
  • neoplasia-rare
  • stricture
230
Q

What is the most likely cause of FLUTD w/ obstruction if NOT an older cat?

A

urethral plugs

231
Q

Two types of functional obstruction

A
  • spasm
  • reflex dyssynergia
232
Q

Most comon mineral found in urethral plugs

233
Q

What is an example of an extraluminal obstruction?

A

neoplasia in pelvic canal pressing on urethra

234
Q

What are the two most common differentials for canine LUTD without obstruction?

What are other differentials?

A
  • bacterial cystitis
  • cystoliths

other:

  • prostatic disease
  • bladder neoplasia
  • bladder trauma
235
Q

What are the two most common differentials for canine LUTD with obstruction?

others?

A
  • uroliths
  • neoplasia

others include foreign body(catheter?), stricture, neoplasia, trauma, reflex dyssynergia, muscle spasm

236
Q

What are the normal host defenses to the urinary tract? give an example of how they are often broken

A
  • normal micturition
    • ​incontinence
  • anatomic structures
    • ​hooded vulva
  • mucosal defense barriers
    • E. coli, urolith damage to mucosal surface
  • antimicrobial properties of urine
    • ​USG altered
  • systemic immunocompetence
    • ​Cushing’s or exogenous steroid admin.
237
Q

What infectious agent is most associated with chonic or recurrent UTI?

A

Pseudomonas

238
Q

What is the most common cause of bacterial UTI?

239
Q

What is a cause of fungal UTIs?

A

Candida spp.

240
Q

What other finding is common in animals found to have a UTI caused by Candida?

A

Immunosupppression; e.g. hyperadrenocorticism

241
Q

What is a typical history of animals with lower urinary tract infection?

A
  • pollakiuria
  • urge incontinence
  • stranguria
  • dysuria
  • hematuria
242
Q

Expected UA findings in an animal with LUTD

A
  • bacteriuria
  • hematuria
  • pyuria
  • increased epithelial cells
  • alkalinuria
  • proteinuria
243
Q

When might urinalysis findings be inconsistent with what you might expect for a LUTD?

A
  • immunosuppressed animals (DM, hyperadrenocorticism)
  • dilute urine can mask findings
  • bacteria not always detectable
244
Q

How should a urine sample for culture be collected?

A

cystocentesis

245
Q

How many CFU/ml are consistent with UTI if cysto sample was used?

A

>1000 CFU/ml

246
Q

How many CFU/ml are consistent with a UTI if a catheterized sample was used?

A

>10,000 CFU/ml

247
Q

What kind of signs are NOT found in association with lower UTI?

A

systemic signs of infection

248
Q

What are some components of a history consistent with pyelonephritis/prostatitis?

A
  • lethargy
  • depression
  • anorexia
  • PU/PD
249
Q

Biochemical changes of sepsis

A
  • hypoglycemia
  • increased alk phos
  • increased bilirubin
250
Q

If you are lucky enough to find WBC casts in urine, you can make a diagnosis of _________

A

pyelonephritis

251
Q

What may be needed to detect chronic pyelonephritis or prostatitis?

A

Ultrasound; there are almost always ultrasonographic abnormalities but not always other expected abnormalities (fever, pain, CBC, UA-although usually UA is abnormal too)

252
Q

What findings are associated with pyelonephritis on excretory urogram?

A
  • renal pelvic dilatation or asymmetric filling of diverticula
253
Q

How to handle initial episode of UTI

A
  • history
  • PE
  • UA
  • urine culture, ideally
  • antibiotic treatment; ideally based on culture results, or empirical
    • often clavamox
    • 10-14 days
254
Q

How to handle persistent or recurrent UTI

A
  • History
  • PE
  • UA
  • need urine C/S
  • +/- CBC, biochem
  • evaluate prostate in males
  • +/- radiography/ultrasound/contrast studies
  • antibiotic theraby based on C/S
    • 30-45 days
  • repeat culture 5-10 days after stopping therapy
    • negative–>repeat 2x at 2-4 wk intervals
    • positive–>treat another 30-45d based on C/S
255
Q

How should you address a suspect pyelonephritis/prostatitis?

A
  • History
  • PE
  • Urine C/S
  • (prostatitis-ejaculate or prostatic wash for C/S)
  • CBC, biochem
  • ID & correct predisposing factors
  • Antibiotic treatment similar to recurrent UTI
    • 30-45 days
    • repeat urine cultures-continue until 3 negative urine cultutes obtained over 3 month period
  • (prostatitis-castration)
256
Q

How is “recurrent” defined when talking about UTIs?

A

>2 UTIs in 6 months

or

>3 UTIs in a year

257
Q

What are the urinary tract’s normal host defenses?

A
  • micturition
  • anatomic structure
  • mucosal defense barriers
  • antimicrobial properties of urine
  • immunocompetence
258
Q

Ancillary therapeutic aids for treating UTIs

A
  • permit complete & frequent voiding
  • avoid periods of prolonged urine retention (>4-5 hours)
  • urinary antiseptics
  • urinary bladder irrigation-little value
  • analgesics, antispasmodics
  • cranbery extract-useful if infection known to be E. coli if high enough dose
259
Q

What is a very good indicator of prostatic disease?

A

Blood dripping from urethra independent of urination

260
Q

What clinical signs characterize prostatic disease?

A
  • hematuria
  • blood dripping from urethra independent of urination
  • tenesmus
  • signs compatible with UTI
261
Q

If treating prostatic disease with castration, how soon should bleeding resolve and prostate size decrease if it was BPH?

A
  • bleeding stops in 4 weeks
  • prostate decrease by 70% in 3-4 months
262
Q

Most common prostatic tumor types

A
  • adenocarcinoma
  • TCC
263
Q

What is the most likely diagnosis if the prostate is enlarged in a castrated male dog?

A

prostatic neoplasia

264
Q

What is the mean age of dogs affected with prostatic neoplasia?

265
Q

What does cytology look like if BPH?

A

mild inflammation, hemorrhage

266
Q

How does the prostate feel with prostatic neoplasia?

A

firm, irregular

267
Q

____% of bladder & urethral tumors in dogs are malignant

268
Q

Most bladder/urethral tumors of dogs are what type?

269
Q

What less common tumor types can occur in lower urinary tract of dogs?

A
  • SCC
  • adenocarcinoma
  • undifferentiated carcinoma
  • mesenchymal
  • benign fibroma, leiomyoma
270
Q

What % of dogs diagnosed with LUT TCC have metastasis at diagnosis?

271
Q

Risk factors for lower urinary tract neoplasia

A
  • obesity
  • female
  • exposure to herbicide-treated lawns
  • Breed
    • scottish terriers-18x risk > mixed breed
    • shetland sheepdog-4x increase
    • beagle-4x increase
    • west highland white terrier-3x increase
    • wire-haired fox terrier-3x increase
    • airedale terrier
272
Q

What NSAID is usually used for lower UT neoplasia?

273
Q

What chemo drug is usually used for lower urinary tract neoplasia?

A

mitoxantrone

274
Q

What sex of cats has higher incidence of bladder tumors?

275
Q

What types of bladder tumors are most common in cats?

A
  • carcinomas (~56%)
  • benign mesenchymal tumors (19%)
  • malignant mesenchymal tumors (19%)
  • lymphoma (7%)
276
Q

What type of tumor are most urethral tumors in cats?

277
Q

Radiographic findings of FIC

A
  • focal or diffuse bladder wall thickening
  • irregular mucosa
  • vesicoureteral reflux
  • contrast cystography normmal in 80% of cats
278
Q

What is the role of diet in the management of FIC?

A
  • target mildly acidic urine, dilute urine with few crystals
    • added water
279
Q

What are the effects of added water in dietary management of FIC?

A
  • decreases concentration of noxious substances
  • decreases bladder contact time with urine
  • increases removal of excess crystals
  • decreases palatability for some cats
280
Q

Components of MEMO

A
  • limit stress
  • limit resource competition
  • free access to water
  • places to hide
  • placees to sun
  • opportunities to express natural behavior (climbing, etc.)
281
Q

What is a stepwise approach to treating feline interstitial cystitis?

A
  1. treat immediate signs
    • ​​pain control, fluids, diet changes
  2. MEMO
  3. Feliway & other stress reducers
  4. psychotropic drugs
    • ​​amitriptyline, others
282
Q

Clinical signs of urethral obstructions

A
  • stranguria
  • urine in unusual places
  • hematuria
  • no urine if severe
  • licking penis
  • uremic signs
  • PE: distended, tense bladder
283
Q

What is phenoxybenzamine and what is it used for?

A
  • alpha-adrenergic antagonist-decreases smooth muscle urethral tone
284
Q

Consequence of urethral obstruction

A

bladder atony - over-distention and loss of tight junctions of the detrusor muscle cells

285
Q

Important biochemical changes associated with urethral obstruction

A
  • acidemia
  • hyperkalemia
  • uremia
286
Q

Appropriate treatment for an obstructed, azotemic & uremic patient

A

relief of obstruction, fluids needed for survival

287
Q
A

Struvite (triple phosphate)

288
Q
A

Calcium Oxalate Monohydrate

289
Q
A

Calcium Oxalate Dihydrate

290
Q
A

Ammonium biurate

291
Q
292
Q
A

Calcium carbonate

293
Q
294
Q
A

Cholesterol

295
Q

Most common urolith types in dogs and cats

A

struvite & calcium oxalate

296
Q

What urolith type tends to form in alkaline urine?

297
Q

What urolith type is associated with hepatic disease?

298
Q

What urolith type has a high incidence in dalmations?

299
Q

What urolith type has a high incidence in Dachshunds?

300
Q

What urolith type has a high incidence in German Shepherds?

301
Q

What urolith type tends to form in acidic urine?

302
Q

What urolith type has the highest radiographic density?

303
Q

Decreased tubular absorption can promote the formation of what stone types?

A
  • cystine
  • urate
  • calcium
304
Q

most ____liths are not associated with any clinical signs

A

nephroliths, ureteroliths

305
Q

What is by far the most common location of uroliths in dogs?

306
Q

Most common site of urethroliths in a dog

A

just caudal to os penis

307
Q

Uroliths that conform to the shape of the surrounding tissues are probably ______

308
Q

Name two urease-producing bacteria

A
  1. Staphylococcus
  2. Proteus
309
Q

What is the difference in struvite stone formation in cats vs. dogs?

A

Dogs: form in infected urine

Cats: form in sterile urine

310
Q

How do you treat struvite uroliths in dogs?

A
  • treat UTI based on C/S
  • dissolution
    • diet-acidify urine, restricted in phos.
  • removal
    • sx
    • voiding urohydropropulsion if stones small
311
Q

Prevention of struvite uroliths in dog

A
  • evaluate for cause of chronic UTI
  • monitor for UTI recurrence
    • urine dipsticks at home; culture if any episode of hematuria or 3 days or more of urine pH > 8
312
Q

Treatment of struvite uroliths in cats

A
  • diet that produces acidic urine, restricted in phos. & mg, diuresis
  • removal
    • sx
    • voiding urohydropropulsion if small stones
313
Q

Prevention of struvite uroliths in a cat

A
  • encourage water consumption; feed canned diet
  • maintenance diet restricted in Mg & Phos. that promotes acidic urine
314
Q

Nephroliths are commonly what stone type?

A

calcium oxalate

315
Q

Risk factors for developing calcium oxalate stones

A
  • increased calcium absorption from gut (dogs)
  • decreased tubular reabsorption of calcium
  • secondary to hypercalcemia
  • decreased concentrations of CaOx inhibitors
    (Glycosaminoglycans, Tamm-Horsfall protein, Osteopontine, Citrate)
  • increased oxalate ingestion(veg. grass)
  • dry diets
  • vitamin C, D supplements
  • water restriction, urination restriction
  • furosemide
  • glucocorticoids
316
Q

What breeds of cats may have a lower risk of CaOx stone formation?

A
  • Birman
  • mixed breed
  • abyssinian
  • siamese
317
Q

Can CaOx stones be dissolved?

318
Q

What stone type has a high incidence in English Bulldogs?

319
Q

Allopurinol can potentially lead to the formation of what type of stones?

320
Q

Treatment of urate stones

A
  • dissolution: diet promotes alkaluria, diuresis, & restricted in protein
    • allopurinol therapy
  • removal
    • sx
    • voiding urohydropropulsion if stones are small
321
Q

What stones are shaped like jacks?

322
Q

What are some dietary sources of silicates?

A

corn gluten, soybean hulls, other plant protein

323
Q

Therapy for silicate uroliths

A

surgical removal

324
Q

What is the primary cause of cystine uroliths?

A

Cystinuria-inborn error of metabolism where there is defective renal tubualr absorption of cystine

325
Q

Treatment of cystine uroliths

A
  • dissolution: diet that promotes alkaline urine, diuresis, and restricted in protein
    • 2-MPG (Thiola)
  • removal
    • sx
    • voiding urohydropropulsin if small stones
326
Q

Parasympathetic innervation to bladder

A
  • pelvic nerve
327
Q

Somatic innervation to bladder

A

pudendal nerve

328
Q

Sympathetic innervation to bladder

A

hypogastric nerve

329
Q

What type of receptors are predominately responsible for internal urethral sphincter function?

A

alpha-adrenergic

330
Q

During voiding, what nerve inputs are inhibited?

A
  • sympathetic input to internal sphincter
  • somatic input to external sphincter
331
Q

During the voiding phase, what is the role of parasympthetic activity?

A

stimulate detrusor contraction

332
Q

Three reasons for problems with urine storage

A
  1. USMI
  2. detrusor hyperreflexia/instability
  3. ectopic ureters
333
Q

Causes for problems with bladder emptying

A
  1. decreased detrusor muscle contractility
    * LMN, UMN
  2. increased urethral resistance
  • outflow obstruction w/ paradoxical incontinence
  • reflex dyssynergia
334
Q

Where the lesion if you have UMN bladder?

335
Q

What are the clinical findings associated with UMN bladder?

A
  • unable to void-greatly distended bladder
  • difficult/impossible to express
336
Q

How should you treat UMN bladder? give specific drugs used

A
  • relax internal urethral sphincter
    • phenoxybenzamine
    • prazocin
  • relax external urethral sphincter
    • diazepam
  • may need to catheterize initially
  • prevent urine scalding with petroleum jelly
337
Q

Where is the lesion located with LMN bladder?

A

sacral cord or pelvic nerve

338
Q

Clinical findings associated with lower motor neuron bladder

A
  • urinary incontinence
  • urinary bladder easily epressed
  • absent or diminished perineal reflexes
339
Q

What happens to urinary bladder/sphincter with LMN bladder?

340
Q

Treatment of LMN bladder

A
  • intermittent bladder expression, catheterization
  • bethanecol to cause detrusor contraction if urethra is patent
  • prevent urine scalding with petroleum jelly
341
Q

What is reflex dyssynergia?

A

incoordination between detrusor contraction and urethral relaxation

342
Q

Reflex dyssynergia is associated with what three things?

A
  • prostatic dz
  • UMN lesions
  • increased sympathetic activity
343
Q

What causes detrusor areflexia?

A

damage to tight junctions from prolonged overdistension of bladder

344
Q

What is the most comon cause of detrusor areflexia?

A

urethral obstruction

345
Q

What drug is useful for detrusor contraction?

A

bethanecol

346
Q

Breeds with higher incidences of ectopic ureters

A
  • Siberian Huskies
  • Miniature & Toy Poodles
  • Labrador Retrievers
  • Fox Terriers
  • West Highland White Terriers
  • Collies
  • Welsh Corgis
347
Q

What other abnormalities are often associated with ectopic ureters?

A
  • renal dysplasia
  • hypoplastic bladder
  • vestibular vault abnormalities
  • severe hydronephrosis
  • pyelonephritis
348
Q

Gold standard for dianosis of ectopic ureters

A

cystourethroscopy, vaginoscopy

349
Q

If using contrast for diagnosing ectopic ureters, what method is best?

A

retrograde urethrogram

350
Q

What are factors that can complicate USMI?

A
  • obesity
  • pelvic bladder
351
Q

What disorder is primarily characterized by incontinence when the animal is in a lateral position?

352
Q

USMI stand for ________________________

A

Urethral Sphincter Mechanism Incompetence

353
Q

What is the most common cause of urge incontinence in dogs?

A

bacterial UTI

354
Q

What is the most common cause of urge incontinence in cats?

A

sterile inflammation of LUT

355
Q

Ectopic ureters are more commonly diagnosed in what sex?

A

female (20x)

356
Q

Reflex dyssynergia is more common in what sex?

357
Q

What disorder is most likely if incontinence occurs when animal is lateral?

358
Q

How is estrogen synergistic with phenylpropanolamine?

A

Estrogen may increase the # of alpha receptors

359
Q

Differentials for continuous incontinence

A
  • ectopic ureters
  • severe USMI (male)
360
Q

Differentials if incontinence is intermittent at rest

A
  • USMI
  • occassionally ectopic ureter
361
Q

Differentials if incontinence is intermittent while walking

A
  • detrusor instability
  • vestibular, vulvar, or vaginal anatomic abnormality
362
Q

Differentials if normal stream but interrupted

A
  • reflex dyssynergia
363
Q

What is indicated in all animals with abnormal micturition?

A

Urine Cultue

364
Q

What imaging studies are used in the case of neurogenic incontinence?

A
  • MRI
  • CT scan
  • Myelography
  • Epidurogram
365
Q

Endoscopy is the best way to:

A
  1. dx ectopic ureters
  2. provide initial treatment of ectopic ureters
  3. assess vagina & urethra
366
Q

Drugs for detrusor relaxation

A
  • Propantheline
  • Oxybutynin
367
Q

Indications for Bethanecol

A
  • detrusor areflexia
  • LMN bladder
368
Q

Most common cause of incontinence in female dogs

369
Q

age of cats at risk for CaOx stone formation

A

7-10 years

370
Q

Breeds of dogs at risk for CaOx stones

A
  • Miniature or Standard Schnauzer
  • Bichon Frise
  • Lhasa Apso
  • ShihTzu
  • Miniature Poodle
  • Yorkshire Terrier
371
Q

Why do urate stones form in cats?

372
Q

Why are Dalmations predisposed to urate stone formation?

A
  • decreased hepatic uric acid transport
  • decreased proximal tubular uric acid reabsorption
373
Q

How do you select an appropriate phosphate binder?

A

Use aluminum containing products or Renalgel® if serum phosphate is > 7 mg/dl. Once

374
Q

What is the most effective calcium-based phosphate binder?

A

calcium acetate

Companion Animal Med & Surgery (12 decks)

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