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Renal > lower urinary tract disease > Flashcards

lower urinary tract disease Flashcards

1
Q

acute renal failure define

A

charachterised by sudden onset of haemodynamic, filtration and excretory failure of the kidneys

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2
Q

define acute kidney injury

A

abrupt decline in kidney function

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3
Q

acute renal failure prognnsis

A

maybe reversible if caught early

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4
Q

high GFR and changes to creatinine

A

big changes to GFR will not affect a low creatinine much

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5
Q

low GFR and creatinine changes

A

small changes in a low GFR will cause big changes to creatinine

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6
Q

define oliguria

A

anything less than 1ml/kg/hr

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7
Q

when will oliguria be normal

A

hypovolaemia

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8
Q

prerenal azotemia urine specific gravity

A
  • cat - over 1.035

- dog - over 1.030

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9
Q

renal azotemia urine specific gravity

A
  • cat - under 1.035

- dog - under 1.030

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10
Q

prerenal azotemia urine sodium conc

A

under 10mmol/L

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11
Q

renal azotemia urine sodium conc

A

over 20mmol/L

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12
Q

prerenal azotemia response to fluid therapy

A

dramatic

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13
Q

renal azotemia response to fluid therapy

A

minimal

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14
Q

chronic kidney failure history (3)

A
  • chronic weight loss
  • reduced appetite
  • PU/PD
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15
Q

kidney palpation/visualisation acute renal failure

A

swollen painful kidneys

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16
Q

kidney palpation/visualisation chronic kidney failure

A

small fibrotic kidneys

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17
Q

tx pyelonephritis

A
  • antibiotics based on culture for 4-6 weeks

- cultures a week after starting and ending treatment

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18
Q

diagnose leptospirosis

A
  • demonstrate high antibody titre in serovar

- demonstrate a rising titre over a few weeks

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19
Q

stage 1 chronic kidney disease (4)

A
  • plasma creatinine - dogs below 125mmol/L - cats below 140mmol/L
  • non-azotemic
  • normal or near normal GFR
  • some other renal abnormality
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20
Q

stage 2 chronic kidney disease (3)

A
  • plasma creatinine - dogs 125-180mmol/L - cats 140-250mmol/L
  • non-azotemic to mild azotemic
  • clinical signs absent or limited to PU/PD
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21
Q

stage 3 chronic kidney disease (4)

A
  • plasma creatinine - dogs 181-440mmol/L - cats 250-440mmol/L
  • mild-moderate azotemia
  • PU/PD
  • external clinical signs like vomiting may be present
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22
Q

stage 4 chronic kidney disease (3)

A
  • plasma creatinine - dogs and cats over 440mmol/L
  • PU/PD
  • external clinical signs like vomiting
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23
Q

6 intrinsic renal disease causes

A
  • infectious
  • metabolic
  • neoplastic
  • congenital
  • other
  • unidentified
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24
Q

congenital cause of cat intrinsic renal disease

A

polycystic kidney disease

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25
Q

define obstructive uropathy

A
  • big kidney little kidney syndrome

- little kidney blocked first. clinical signs show when big kidney is blocked

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26
Q

management of renal secondary hyperparathyroidism

A
  • dietary phosphate restriction

- intestinal phosphate binding drugs

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27
Q

ACE inhibitors and glomerular hypertension and hyperfiltration

A
  • preferentially dilate efferent arterioles
  • reduce glomerular capillary pressure
  • reduce glomerular capillary permeability to protein
  • reduced proteinuria and development of glomerulosclerosis
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28
Q

risk with erythropoietin treatment

A

antibodies may develop against foreign protein and this could be cross reactive to the endogenous protein

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29
Q

blindness and chronic kidney disease

A

chronic kidney disease causes hypertension which causes retinal detachment, retinal haemorrhage and hyphema

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30
Q

what parts of the urinary tract are sterila

A
  • kidneys
  • ureter
  • bladder
  • proximal urethra
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31
Q

most common bacteria in urinary infection

A

E.coli

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32
Q

bacteria need to stick to urothelium

A

P or S fimbriae

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33
Q

how to culture urine

A
  • 2ul of urine on blood agar and MacConkeys

- incubate aerobically for 18 hours at 37*C

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34
Q

urinary tract infections seen most in (2)

A
  • older cats

- bitches

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35
Q

define microburia

A

microbes in urine

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36
Q

define bacturia

A

bacteria in urine

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37
Q

define funguria

A

fungi in urine

38
Q

define pyuria

A

white blood cells in the urine

39
Q

what kind of culture need to diagnose urinary tract infection

A
  • quantitative

- collection by cystocentesis

40
Q

3 drugs commonly used in urinary tract infections

A
  • ampicillin
  • potentiated moxicillin
  • cefalexin
41
Q

how do crystals form in urine

A

urine is supersaturated causing nucleation to start and crystal growth

42
Q

where cystoliths found

A

bladder

43
Q

4 clinical signs cyctoliths

A
  • dysuria
  • polakiuria
  • haematuria
  • inappropriate urination
44
Q

urethroliths cause (6)

A
  • abdominal discomfort
  • poor or absent urine stream
  • licking genital area
  • obstruction
  • post renal azotemia
  • enlarged painful bladder
45
Q

to find composition of bladder do (2)

A
  • quantitative analysis

- x-ray diffraction

46
Q

medical management of uroliths (4)

A
  • increase water intake to dilute crystal concentration
  • diet therapy
  • drug therapy
  • change urine pH
47
Q

how to uropulsion (7)

A
  • anaesthetise
  • fill bladder with saline
  • position urethra vertical
  • agitate bladder
  • leave stones to settle
  • initiate voiding with brisk urine flow
  • antibiotics
48
Q

struvate stones are made of (2)

A
  • magnesium ammonium phosphate

- triple phosphate

49
Q

why dogs get struvate stones

A

urinary tract infections

50
Q

steps in formation strvate stones

A

urease producing bacteria cleave urea into ammonium and bicarbonate so making urine alkaline

51
Q

appearance of struvate stones

A

bog and faceted

52
Q

complications dissolving struvate stones

A

bacteria in them will be released with every layer dissolved therefore need antibiotics

53
Q

what species calcium oxalate stones common in

A

male older cats

54
Q

where calcium oxalate stones are found

A

upper urinary tract

55
Q

medical dissolution calcium oxalate stones

A

not possible

56
Q

ammonium urate stones are seen in

A
  • dalmatians

- animals with hepatic dysfunction

57
Q

why dalmations predisposed to ammonium urate stone formation

A

dont have uricase which converts uric acid to ammonium

58
Q

prevention ammonium urate stone formation (2)

A
  • low protein diet

- allopurinol which blocks x-oxidase which turns xanthine into uric acid

59
Q

cystine stones why form

A

renal tubular defect resulting in excess urine cystine which isn’t very soluble

60
Q

calcium phosphate stones are associated with

A

primary hyperparathyroidism

61
Q

most common urolith in rabbits and horses and why

A

calcium carbonate

as they have a high calcium concentration in urine

62
Q

define cystotomy

A

opening bladder to remove stones

63
Q

cystotomy how to (7)

A
  • place urinary catheter attached to extension set
  • open caudal midline ventral celiotomy and empty bladder
  • pack of abdomen
  • ventral midline cystotomy
  • remove calculi
  • flush up urethra until all are removed
  • close using monocryl avoiding entering bladder lumen
64
Q

define feline lower urinary tract disease (FLUTD)

A

clinical presentation that can be due to lots of causes

65
Q

6 clinical signs FLUTD

A
  • haematuria
  • strganguria
  • pollakiuria
  • dysuria
  • licking penis or prepuce
  • vocalisation or hiding
66
Q

young cats common cause FLUTD

A

idiopathic

67
Q

5 things predispose cats to urinary tract infections

A
  • diabetes mellitus
  • chronic kindey disease
  • hyperthyroidism
  • urolithiasis
  • bladder tumours
68
Q

feline lower urinary tract disease young cats present

A

65% idiopathic

- episodic and resolves in 3-7 days unless there is a urethral obstruction

69
Q

4 theories as to cause of idiopathic FLUTD

A
  • infectious
  • crystralluria
  • vesicourachal diverticulum
  • interstitial cystitis
70
Q

infectious agent theory idiopathic FLUTD

A
  • never successfully found bacteria etc

- viruses have been isolated in urethral plugs

71
Q

crystalluria theory iFLUTD

A
  • disproved
  • struvite crystals have been seen in presenting cats as well as healthy cats, and have been found to help in plug formation but need inflammation +/- urethral spasm
72
Q

vesicourachal diverticula theory iFLUTD

A
  • disproved
  • vesicourachal diverticula are microscopic outpoachings of the bladder observed in iFLUTD but they leave a few days later after resolution
73
Q

3 proposed mechanisms interstitial cystitis

A
  • neurogenic inflammation
  • deficient GAG layer
  • sympathetic overactivity
74
Q

5 tx iFLUTD

A
  • feed canned food
  • increase water intake
  • reduce stress
  • synthetic GAGs
  • amitrptyline
75
Q

5 diagnose procedures young cat with first FLUTD

A
  • rule out obstruction
  • rule out behavioural change/identify stress triggers
  • urinalysis
  • educate owner
  • tx
76
Q

3 steps young cat with recurent FLUTD

A
  • go through as if it was first case
  • imaging to rule out urolithiasis
  • try GAGs
77
Q

if getting desperate and can’t find cause recurrent FLUTD young cat (5)

A
  • go through as if first and recurrent case
  • consult behaviourist
  • oral analgesics
  • maybe retry imaging
  • be honest and open
78
Q

functional urethral obstruction also known as

A

reflex dysynergia

79
Q

define reflex dysynergia

A
  • rare condition seen mainly in dogs

- dysfunction with urethral relaxation not occurring as not receiving sense to urinate

80
Q

3 clinical signs reflex dysynergia

A
  • dysuria
  • pass small spurts urine
  • large residual volume
81
Q

managment reflex dysynergia

A

medical

82
Q

how obstructive uropathy causes azotemia (4)

A
  • increase pressure in bowman’s space
  • GFR falls
  • decreased renal blood flow
  • protein enters filtrate
83
Q

bladder enlargment due to overdistension can cause (4)

A
  • ischaemia
  • oedema
  • haemorrhage
  • mucosal sloughing
84
Q

obstruction and progression times

A
  • 48 hours - CNS depression, vomiting and decreased food and water intake
  • 72 hours - death
85
Q

treatment obstruction (3)

A
  • IV fluids to dilute potassium
  • calcium gluconate
  • relieve obstruction
86
Q

cystocentesis dog with obstruction urinary

A
  • avoid as can cause septic peritonitis

- if have to do then empty bladder completly

87
Q

post unblocking urinary obstruction care

A
  • keep up with ins and outs using IV fluids

- may get hypokalaemia so supplement

88
Q

define retrograde hydropulsion

A

pushing calculi from urethra back into bladder

89
Q

how to retrograde hydropulsion (3)

A
  • get a person to block urethra with a finger through the anus
  • fill urethra with saline while blocking distal urethra
  • get person to let go and pressure of fluid should push stones into bladder
90
Q

define cystotomy tube

A

tube placed across the body wall and into bladder to drain into a bag

91
Q

define urethrostomy

A

permanent surgical opening into the urethra to divert urine flow

Renal (3 decks)

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