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Equine Medicine > Equine Urinary > Flashcards

Equine Urinary Flashcards

1
Q

How is acute renal failure diagnosed?

A

Sudden onset azotaemia and a low USG

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2
Q

What are the most common origins of acute failure in adult horses?

A

Pre-renal and renal

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3
Q

What are some common causes of haemodynamic renal failure?

A

Hypovolaemia
Volume redistribution in effusions
Decreased cardiac output
Altered vascular resistance - sepsis and endotoxaemia

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4
Q

What is the most common cause of acute renal failure in the horse?

A

Ischaemia = acute tubular necrosis

Due to: prolonged haemodynamic changes, renal infarction, NSAID toxicity (prostaglandin inhibition)

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5
Q

List nephrotoxins that lead to renal failure.

A 
Antibiotics - aminoglycosides, polymyxin B, tetracyclines
Haemoglobin
Myoglobin
NSAIDs
Heavy metals
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6
Q

What should you monitor when using nephrotoxic drugs?

A

Serum creatinine

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7
Q

List some aminoglycosides

A

Neomycin
Gentamycin
Amikacin

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8
Q

What is the most nephrotoxic aminoglycoside?

A

Neomycin

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9
Q

How can you reduce the risk of nephrotoxicity?

A

Single dose once daily

Pre-treat with calcium

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10
Q

How can you diagnose acute renal failure?

A 
History and clinical signs
Urinalysis - proteinuria, presence of casts 
Azotaemia - high creatinine, high BUN 
* differentiate from dehydration using USG - isothenuria or dilute
Electrolyte changes 
- hypocalcaemia and hyperphosphataemia
- metabolic acidosis
- occ hyperkalaemia 
- hyponatraemia
- hypochloraemia
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11
Q

How should you treat acute renal failure?

A

IVFT - improve renal perfusion and cause diuresis
0.9% NaCl or hartmanns at twice maintenance - 2x5L

Correct metabolic disturbances - eg spike fluids with potassium or bicarbonate

Induce diuresis - IV furosemide, dopamine CRI (potent renal vasodilator), DMSO

Discontinue nephrotoxic drugs and consider non nephrotoxic analgesia

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12
Q

What are some non-nephrotoxic analgesics?

A

Morphine, butorphanol
Ketamine
Carprofen
Paracetamol

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13
Q

How should you monitor the response to treatment in acute kidney failure?

A

Body weight
PCV / TP
Serum biochemistry
Provide nutritional support

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14
Q

What are signs of over hydration / oliguria?

A

Ventral oedema, stocked up, anasarca

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15
Q

What are the causes of chronic renal failure in horses?

A

Glomerulonephritis
Chronic interstitial nephritis (progression from ATN)
Renal neoplasia eg adenocarcinoma, lymphoma
Renal amyloidosis

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16
Q

What are the clinical signs of chronic renal failure in horses?

A 
Chronic weight loss
Lethargy
Poor hair coat 
PU/PD
Poor performance due to mild anaemia
Oral ulceration
Gastroenteritis 
Inconsistent ventral oedema
17
Q

How can you diagnose chronic kidney disease in horses?

A 
Persistent isothenuria - 1.008-1.014 
Mild anaemia 
Mild hypoalbuminaemia 
Electrolyte abnormalities
- hyponatraemia
- hypochloraemia
- hypophosphataemia 
- hypercalcaemia 
- low bicarbonate 
Ultrasonography 
Endoscopy
18
Q

What is the normal sizes of the equine kidney on ultrasonography?

A

14-15cm

19
Q

How should you treat chronic kidney disease in the horse?

A

Palliative
Ensure water and salt is always available
Low calcium and low fat diet (risk of hyperlipidaemia)

20
Q

What are some prognostic indicators for chronic kidney disease in the horse?

A

Long survival creatinine <200U/L
Poor long term prognosis if above this
Grave >800

21
Q

How does urethritis usually present and what underlying conditions lead to it?

A

Older geldings, secondary to a preputial or distal urethral condition

  • trauma
  • neoplasia
  • foreign body
  • urethral concretion
22
Q

How does urethritis present?

A

Malodorous, swollen sheath
Red discharge on legs
Pollakiuria

23
Q

How can you diagnose urethritis?

A

Examine the penis and prepuce

Check for urethral concretions

24
Q

How can you treat urethritis?

A

Clean with very mild topical antibacterial agents

25
Q

What commonly causes cystitis in horses? And how can this be diagnosed?

A 
Secondary to urolithiasis, neoplasia and paralysis 
(Bacterial cystitis is rare)
Dx: urine sediment 
>10 leukocyte per hpf
>20 organisms per hpf
26
Q

What 3 uroliths are uncommonly found in horses? (Geldings)

A
  1. Yellow, green, spiculated - easily fragmented
  2. Grey-White smooth stones - harder as they contain phosphate
  3. Sabulous cystitis - sludge, usually due bladder paralysis
27
Q

What conditions lead to nephrolith formation?

A

Pyelonephritis
Tubular necrosis
Papillary necrosis

28
Q

What is the clinical presentation of cystic and urethral calculi?

A 
Dysuria
Haematuria
Stranguria 
Pollakuria
Pyuria
29
Q

How can you diagnose cystic and urethral calculi?

A

Palpation per rectum or endoscopy

30
Q

How can you treat cystic and urethral calculi?

A

Surgical removal
Laparotomy
Perineal urethrotomy in males
Forceps retrival

31
Q

What post operative care can you provide?

A

Antibiotics post-removal
Urinary acidifiers
Salt to increase water consumption
Decrease calcium intake

32
Q

What is the normal daily intake of water?

A

20L

33
Q

List some differential diagnoses for PU/PD in the horse?

A

Renal failure
PPID
Psychogenic water consumption

34
Q

What is the pathogenesis of PPID causing PU/PD?

A

Become diabetic - glucosuria and osmotic diuresis
Antagonism of ADH by cortisol
Impingement of the posterior pituitary leading to reduced ADH secretion

35
Q

How can you work up PU/PD in a horse?

A
  1. Determine whether the horse is azotaemia and compare to USG - renal disease
  2. Water deprivation test
  3. Rule out Cushings - ACTH stimulation test
  4. Perform a modified water deprivation test
  5. Response to exogenous ADH - none = central DI
36
Q

List some differentials for haematuria in the horse.

A 
Cystitis 
Pyelonephritis 
Urolithiasis 
Urinary tract neoplasia 
Drug toxicity - NSAIDs
Urethral defects
37
Q

List some differentials for pigmenturia.

A

Myoglobinuria - atypical myopathy, other myopathies

38
Q

List differentials for haemoglobinuria.

A 
IMHA
Neonatal isoerythrolysis
Oxidative injury to RBCs 
Equine infectious anaemia 
DIC
End stage liver failure

Equine Medicine (2 decks)

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