Investigating Urological Dx

Question 1

Clinical Presentations

Answer 1

• PU/PD
• Dysuria
• Stranguria
• Pollakiuria
• Periuria
• Urinary Incontinence
• Non-specific signs

Question 2

Signalment and Hx

Answer 2

Age - CKD = older, congenital = young
Breed - dalmatians & stones, persian cats & PKD
Env & diet - high mineral diets = urolithiasis
Previous hx
Med hx

Question 3

Full Clinical Exam

Answer 3

• Palpation
• Urogenital area - licking/ inflam/ urine/blood staining
• Neuro assessment
• BP measurement

Question 4

Ddx:

Answer 4

Vascular
Inflam
Traumatic
Anomalous
Metabolic
Infectious
Neoplasia
Degen/Dev

Question 5

Urine Sample

Answer 5

• free catch
• Catheter
• Cystocentesis

Question 6

Urinalysis

Answer 6

Visual exam
Specific gravity
- Hyposthenuric = more dilute
- Isosthenuric = equivalent
- Hypersthenuric = more conc
Dipstick
pH
- Cattle/horse = 7.5-8.5
- Cat/dog = 5.5-7.5
- Increased w UTIs
- Decreased w resp acidosis, starved, pyrexia
Glucose
- DM = dogs, cats
- PPID = horses
Ketones
- DKA = dogs, cats
Bilirubin
- Increased = liver dx, bile obstruction

Question 7

Urinalysis - Blood

Answer 7

RBCs = haematuria
Free haemoglobin = haemoglobinuria
Initial = LUT, genital
Terminal = Intermittent from kidneys, ureters, bladder
Total = throughout
- Persistent from UUT
- General bladder dx

Question 8

Urinalysis - Protein

Answer 8

Pre-renal
- Excessive protein via blood
- Immunoglobulins
- Pigment
Renal
- Defective renal function - filtration barrier
loss, protein losing nephropathy
- Renal parenchyma inflam = tubular dx,
interstitial dx
Post-Renal
- Protein entering distal to kidney
- Inflam, infection
Protein: creatinine ratio
- >0.4 = abnormal

Question 9

Urinalysis - Sediment Exam

Answer 9

• Centrifuge
• Microscope

Question 10

Urinalysis - Urine Culture and Sensitivity

Answer 10

Errors:
- Non viable bacteria
- Pseudobacteria
- Dilute urine
GOLD STANDARD if UTI

Question 11

Blood Biochem and Haem

Answer 11

BUNmmol/L
Creatinine umol/L
SDMA - Kidney dx - cats, dogs, horses
Dehydration
Anaemia/ haemolysis
Inflam

Question 12

Azotaemia - Pre renal

Answer 12

Pre-renal = reduces renal blood flow
* Dehydration/hypovolaemia
* Hypotension/shock
* Decreased urine vol
* Increase USG (>1.030)
Should resolve w fluid therapy

Question 13

Azotaemia - Renal

Answer 13

Renal = 1° renal dx -> reduced GFR
* Glomerular dx
* Tubular dx
* Interstitial dx
* Increased urine vol ?
* USG 1.008-1.015

Question 14

Azotaemia - Post-Renal

Answer 14

Post-Renal - defective excretion distal to nephron
* Obstruction (increase intratubular pressure)
* Ruptured urinary tract.
* Decreased urine vol
* Variable urine SG
Dysuria
Reversible

Question 15

Radiography

Answer 15

Plain and Contrast
Cystography = bladder
Urography = renal

Dog - 7cm x 5cm x 4.8cm
Cats - 3.5cm x 2.5cm x 2.2cm

Question 16

Ultrasound - Renal

Answer 16

Transabdo = small animals
Trans-rectal of left kidney = horse/cattle.
Assess:
* Size
* Position
* Architecture
* Capsule – thickening/loss of integrity.
* Cortex – evidence of interstitial dx/fibrosis.
* Medulla – loss if corticomedullary definition.
* Pelvis – dilation.
* Renal blood Flow (doppler)
ID:
* Masses.
* Renal calculi.

Question 17

Ultrasound - Bladder

Answer 17

Transabdo = smalls
Trans rectal = large
Asses:
* Bladder wall thickness.
* Soft tissue masses.
* Intraluminal calculi

Question 18

Urethroscopy/ Cytoscopy

Answer 18

Rigid/ flexible scope urethra -> bladder / laparoscopic
Indications:
* Chronic cystitis.
* Dysuria/Stranguria/Pollakiuria.
* Haematuria.
* Incontinence.
* Neoplastic cells in sediment.
* Vaginal discharge.
* Breeding problems.

Question 19

Renal Biopsy

Answer 19

Indications:
- Tx based on renal histo
- Reversible damage
- Acute renal failure
- Protein losing nephropathy
- Unilateral renal mass
Contraindicated = chronic renal dx