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CAM > IP9 renal 2 > Flashcards

IP9 renal 2 Flashcards

1
Q

CS of FLUTD

A 
Multi trips to litter box
Vocalizing/😭
Straining w/ nothing coming out
Hematuria
Pollakiuria
Agitation
Pain
Collapse, bradycardia, coma
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2
Q

FLUTD Incidence/ Signalment

A

Disease onset: 🚹 = 🚺
Males obstruct much more easily
1st onset: 1-5 yo
Any breed

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3
Q

Causes of FLUTD (Syndrome)

A

~ 50% - no cause ID
Other 50% - CAB 🚕
calculi, urethral plug (debris+crystals from bladder), bladder anomaly (diverticulum)

Stress contributes

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4
Q

FLUTD Predisposing diets

A

High Mg diets

Alk Urine pH > 7

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5
Q

FLUTD Dx: 🚫blocked

A

UA – ✅USG is conc
+/- serum biochem profile
Symptomatic tx

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6
Q

FLUTD Dx: Blocked

A

Unblock (Emergency)

UA – ✅ USG
Chem – Wait 18-24h to resolve post-renal azotemia
Rads or u/s? Definitely if >1st presentation

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7
Q

FLUTD Treatment

A

Manage hyperkalemia (IV insulin + dextrose, NaHCO3, Ca-gluconate),
IV catheter and fl,
unblock.

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8
Q

What is “Post-obstructive diuresis”?

A

Following mod-sev urinary obst, 2-5d period ⏩ massive PU can occur ➡️dehydration + electrolyte wasting.

Back-P➡️renal tubular damage
impt to monitor urine output and make sure replacement fluids are adequate.

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9
Q

Other in-hospital management:

A

Analgesics
[K+] supplementation
Fl. therapy
alpha blocker (prazosin) to relax int urethral sphincter (not sure if it helps)

🚫Abx – while urinary catheter is in place.
Urinary catheters can block!!!

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10
Q

Complications?

A

Bladder rupture
Urethral rupture
Repeat obstruction

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11
Q

FLUTD Prevention strategies?

A

Diet: Acidifying, low Mg
❇️water intake

Anti-inflamm?
?? Amitryptilline (human antidepressant – increases substance P in mucosa)
?? Glycosaminoglycans (restore GAG layer in mucosa)
Surgery: Perineal urethrostomy?

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12
Q

Canine prostatic disease predisposers

A

Intact 🚹🐶: Testosterone ➡️benign prostatic hypertrophy (BPH) in all male dogs – ⬆️w/age.
BPH ⏩ prostatitis (infx), abscess.
Paraprostatic cyst: Dev anomaly
Prostatic neoplasia: 🚫hormone-assoc (unlike in Hu)

Castrated 🚹🐶: Prostatic neoplasia

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13
Q

Prostatic disease CS

A 
Similar to LUTI
Bloody preputial discharge indep of voiding
Pain, tenesmus, 
Gait change
Infertility
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14
Q

Prostate Dx

A

Rectal exam: Size, shape, pain, mobility. (Know normals for intact and castrated male dogs)

Rads- Prostatomegaly, calcification, sublumbar masses, localized peritonitis.
U/S– Internal structure, abscess, cyst
Cytology – look for malignancy (Fine-needle aspirate can “seed” cancer cells - avoid here!)

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15
Q

Treatment: Benign prostatic hyperplasia

A

Castration ⬇️CS = Prostatic involution takes ~4wk

If still enlarged, 🔎 another cause
Rx involute prostate: Finasteride ⛔️5-hydrotestosterone (only use if breeding value)

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16
Q

Tx: Bacterial Prostatitis

A

Acute: sepsis and life-threatening – tx as a case of systemic illness

Chronic: Abx & castration
Abx must x-BPB – lipid soluble, weak base, poorly protein-bound (Fluoroquinolones, TMS, chloramphenicol)
FTC

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17
Q

Tx: Prostatic abscess

A

In addition to bacterial prostatitis tx, may need Sx drainage

Acute: tx sepsis
Chronic: Abx (FTC) & castration

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18
Q

Tx: Prostatic neoplasia

A

2 MC:
Prostatic adenocarcinoma
TCC

Tx options: Poor
Can’t remove Sx – complications
Bad location for radiation
🚫chemotherapy-responsive
Palliate with castration 
Piroxicam (NSAID with anti-tumor properties)
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19
Q

Tx: Paraprostatic cyst

A

Sx repair

20
Q

Hallmark Signs of Lower Urinary Tract Dis

A

Stranguria (straining)
Pollakiuria (Multiple, small volume voids)
Hematuria (Blood in urine – typically macroscopic but maybe🔬)

21
Q

Other LUTD dx clues

A

PE: Painful palpation➡️ voids/urinates, or has an exceedingly large or small bladder. +/- feel Cystic calculi.

UA: WBC, RBC, or bacteria in urine sediment
Imaging: See calculi

22
Q

Lower urinary tract infectious agents

A

Bacteria: 1° G(-) ➡️ MC E. coli

Yeast/🍄 infx possible

23
Q

Signalment for LUTI?

A

🚺>🚹
Young or geriatric (lower natural defense)
Uncommon in healthy, middle-aged animals
Intact males (Source? Prostate)

🐱: Isosthenuria predisposes (therefore, older cats)

24
Q

Common risk factors for LUTI:

A

PU/PD (bacteria like isosthenuric urine)
Endocrine: DM, Hyperadrenocorticism, 1° hyperPTH)
Urinary catheterization
Urine retention (2° to micturition disorders, bladder atony)

25
Q

Dx LUTI

A

UA: Hallmark test for LUD
(pH typically >7, sediment blood cells or bacteria, but sedi + culture findings not always 100% correlated)

Urine culture: Always desirable, but sometimes there are $$ limitations or the bladder is empty)

26
Q

What is normal bladder residual volume?

A

Less than 1/4 mL/kg

Failure to completely void attracts asc bact to attach & grow

27
Q

What Dx should I do in different situations?

A

Healthy first-time offender:
UA, urine culture (desired)

Repeat offender:
UA and urine culture even more important! Also bloodwork, imaging studies

Sick: UA + u.culture and 🔎 underlying disease

28
Q

Empirical treatment options?

A

First-time offender?
FTC Abx with G- spectrum and wide safety margin for an appropriate dose and duration. (Augmented penicillins, higher-generation cephalosporins, fluoroquinolones, TMS)

Signs should improve in 2-3 days.

29
Q

Recurrent UTI or UTI with concurrent illness?

A

Culture is imperative, and Abx based on C+S.
🔎 underlying predis cause – if you can correct that, you will have a better chance to cure the UTI

Avoid the trap of “The first antibiotic must not have worked so I will try another one…”

30
Q

Long term follow up for recurrent UTI?

A

Negative C+S after tx, and then 2 more negatives over next 2 months.
If urine pH still Alk >7 after resolving infx, consider urine acidification.

31
Q

Why do bladder stones form?

A
  1. Nidus of infx
    a. Bacteria
    b. Debris
    c. Crystalline nidus
  2. Bladder mucosal damage
    a. Loss of GAG
  3. Unusual accumulation of crystals
32
Q

Clinical signs of cystic calculi?

A

Similar to LUTI
Urinary obst
LUTI that does not respond to conservative tx
Predisposed breed or signalment?

33
Q

4 MC calculi types

A

Mg ammonium phosphate (a.k.a. “struvite”)
Calcium oxalate
Urate
Cystine

34
Q

Which calculi are
radiodense?
Radiolucent?
Echodense?

A

Radiodense: Mg ammonium phosphate, Ca oxalate

Radiolucent: Urate, Cystine

Echodense: All of them!

35
Q

Which urine crystals are always abnormal?

A

Ammonium biurate

Cystine

36
Q

Why is urinary obstruction a medical emergency?

A

Bladder rupture
Bladder (detrusor) atony
Hyperkalemia
ARF

37
Q

Facts about Mg Ammonium Phosphate (“Struvite”)

A 
*** Bact infx predisposes!***
🚺>>> M
Urine pH >7.0 (alk)
High protein diet (a.k.a. table food) predisposes
Intact 🚹 bact prostatitis ➡️ 2° struvite
38
Q

Mg ammonium phosphate: therapy

A 
Sx removal = immediate fix
Medical dissolution possible
•	Hill’s S/D diet = low protein, low phosphorous, high salt (for diuresis causing hyposthenuria)
•	95% response rate in 1-2 months
•	DO NOT USE > 4 months!
•	Concurrent Abx
39
Q

Mg ammonium phosphate: prevention

A

Monitor for, and educate client about ⛔️infx
Dx + tx infx early and completely
Good quality diet if on table food

Consider prevention diet (e.g. Hill’s C.D., Royal canin Stone diet…)

40
Q

Facts about Calcium Oxalate

A

M = F
Radiodense
Urine pH

41
Q

Calcium Oxalate management

A

Dissolution impossible – must resolve with surgery
Prevention: ~50% will recur within 3 years
Diet: Moderate calcium restriction? High salt diet to increase diuresis?
Manage hyperadrenocorticism
Alk urine (Potassium citrate)

42
Q

Facts about Urate

A

2 subsets:

Dalmatian dogs: Inborn error of metabolism. 🚹 more clinical, but all affected. Urine pH

43
Q

Urate Tx

A

Dalmatians: Low-protein, non-purine diet (Hill’s U/D) lifelong
Surgery or dietary dissolution
Manage obstruction
Alk urine
Tx infx if present
Xanthine oxidase inhibitor (Allopurinol) to ⬇️full urate metabolism

Non-Dalmatians: Dx and tx liver disease.

44
Q

Facts about Cystine

A

PT defect –
AA Cystiene not reabs in PT, form Cystine which is insoluble

Inborn defect – English breeds and Dachshunds
Urine pH

45
Q

Cystine management

A

Sx removal
Management similar to urate – low protein U/D diet, urine alkalinization

💊 complex with cystiene ➡️more solu compound:
D-penicillamine or 4-MPG

CAM (6 decks)

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