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RUSVM Small Animal Medicine II 2017 > Nephrology and Urology > Flashcards

Nephrology and Urology Flashcards

1
Q

Azotemia

A

Abnormal increase in the concentration of non-protein nitrogenous wastes in blood

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2
Q

Causes of Pre-Renal Azotemia

A 
Dehydration
Hypoadrenocorticism
Cardiac disease
Shock 
Hypovolemia
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3
Q

Causes of Renal Azotemia

A 
Parenchymal disease
infections 
cysts
inflammation 
neoplasia
toxins
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4
Q

Causes of Post-Renal Azotemia

A

Blockage

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5
Q

Renal Failure

A

When the kidneys are no longer able to maintain regulatory function, excretory Function, and endocrine Function

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6
Q

When does Renal failure occur?

A

When greater than 75% of the nephron population is non-functional

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7
Q

Characteristics clinical findings associated with Uremia

A

Hypoalbuminemia
Azotemia
Hypercholesterolemia
Peripheral edema

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8
Q

What the indirect methods for measuring Glomerular function?

A

Serum urea levels
Serum creatinine levels
Cystatin C
SDMA

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9
Q

What are the accurate techniques for measuring Glomerular function?

A

Clearance of radioisotopes with renal scintigraphy

Iohexal/inulin/creatinine clearance tests

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10
Q

What percentage of nephrons have to be destroyed before GRF is decreased?

A

66%

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11
Q

What is the gold standard for measuring Glomerular function?

A

Renal scintigraphy

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12
Q

What can cause an increase in urea?

A

GIT bleeding
Intravascular hemolysis
high protein diets

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13
Q

What causes the production of Creatinine?

A

breakdown of creatine in muscle

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14
Q

When do you get a decrease in creatinine?

A

Reduced muscle mass

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15
Q

What are the limitations of Creatinine?

A

Does not discriminate between causes of azotemia, Acute vs. chronic renal failure, or Reversible or irreversible renal failure

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16
Q

Cystatin C

A

small polypeptide protease inhibitor produced by all cells with a nucleus that is freely filtered by the glomeruli and does not undergo tubular secretion

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17
Q

SDMA

A

methylated form of the amino acid arginine which is produced in every cell and released into the body’s circulation during protein degradation and excreted exclusively by the kidneys

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18
Q

What is the best method for Urine collection?

A

Cystocentesis

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19
Q

What are the useful tests on the Urine dipstick?

A 
Protein 
pH
blood
glucose
ketones
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20
Q

What is the gold standard of urine concentration?

A

Osmolality

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21
Q

What test measures concentration of urine relative to plasma?

A

Urine Specific gravity

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22
Q

What is the range of urine specific gravity for hyposthenuria?

A

1.000-1.007

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23
Q

What is the range of urine specific gravity for Isosthenuria?

A

1.008-1.012

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24
Q

What is the range of urine specific gravity for Hypersthenuria?

A

Greater than 1.012

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25
Q

What is the range of urine specific gravity for minimally concentrated?

A

1.013-1.030

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26
Q

What is the range of urine specific gravity for Inadequately concentrated?

A

1.013-1.022

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27
Q

What is the range of urine specific gravity for adequately concentrated urine in dogs?

A

greater than 1.030

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28
Q

What is the range of urine specific gravity for adequately concentrated urine in cats?

A

greater than 1.035

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29
Q

What are the DDx for a urine specific gravity of 1.005?

A

Diabetes Insipidus

Psychogenic Polydipsia

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30
Q

What is a test you can perform for an animal with low concentrating urine?

A

Partial Water Deprivation Test

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31
Q

Fractional excretion of electrolytes

A

The fraction of electrolyte clearance relative to creatinine clearance

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32
Q

What crystals are found in Lhaasa Apsos?

A

Calcium dihydroxylate

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33
Q

What crystals are found in bull dogs?

A

Cysteine crystals

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34
Q

What crystals are created due to Ethylene Glycol?

A

Calcium monohydrate

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35
Q

What crystals are seen in dalmations or with hepatic shunts?

A

Ammonium biurate

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36
Q

What are common crystals seen in cats?

A

Struvites

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37
Q

What causes a false positive on Urine protein creatinine ratio?

A

Lower Urinary Tract Disease

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38
Q

Urine protein creatinine ratio

A

comparison of protein to creatinine

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39
Q

What is the most common bacterial cause of UTI?

A

E. coli

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40
Q

Gross macroscopic hematuria

A

Sufficient blood to be apparent to the naked eye

Urine is brownish to red

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41
Q

Occult microscopic hematuria

A

Hematuria not present to the naked eye

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42
Q

Pseudohematuria

A

Red to brownish urine without intact red blood cells

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43
Q

What are the causes of pseudohematuria?

A

Hemoglobinuria

myoglobinuria or chemicals

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44
Q

What causes systemic hematuria?

A

Hemostatic defects

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45
Q

What causes Renal Hematuria?

A 
Neoplasia
Calculi
Trauma
Infarction 
Cysts
Glomerulonephritis
infection
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46
Q

What causes Bladder, Ureter, and Urehral Hematuria?

A 
Bacterial infection 
calculi
trauma
neoplasia
polyps
cyclophosphamide
Feline idiopathic cystitis
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47
Q

What causes Genital tract Hematuria?

A 
Prostatic disease
estrus
infection 
neoplasia
trauma
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48
Q

What are the clinical manifestations of kidney disease?

A 
PU/PD
Anorexia
GI signs
weight loss
pale MM
Lethargy
Blindness
Distended Abdomen
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49
Q

Name some Renal Toxins

A 
Lilies
Ethylene Glycol 
Aminoglycosides
Grapes
Raisins
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50
Q

Pollakiuria

A

Frequent Urination

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51
Q

Stranguria

A

Straining to urinate

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52
Q

Dysuria

A

Inappropriate urination

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53
Q

How much urine is produced per hour?

A

1-2ml/kg/hr

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54
Q

What are primary causes of enlarged kidneys due to neoplasia?

A

Renal adenocarcinoma
Renal lymphoma
Renal sarcoma
Nephroblastoma

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55
Q

Why does Renal Carcinoma cause Polycythemia?

A

overproduction of erythropoietin by the tumor or due to renal hypoxia

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56
Q

What is the treatment for Renal carcinoma?

A

Nephrectomy

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57
Q

What is the prognosis for an animal with Renal Carcinoma?

A

16 months with treatment

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58
Q

What renal neoplasia is common in cats?

A

Renal Lymphoma

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59
Q

How do you treat Renal lymphoma?

A

Multi-agent chemotherapy (COP or CHOP)

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60
Q

What is the prognosis for Renal lymphoma?

A

60% have remission

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61
Q

What are non-neoplastic causes of renomegaly?

A 
Acute nephrosis
Acute pyelonephritis
FIP
Leptospirosis
Amyloidosis
Hydronephrosis
Polycystic kidney disease
Portosystemic shunts
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62
Q

Acute Kidney injury

A

Encompasses mild damage that does not cause azotemia to severe damage associated with complete anuria

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63
Q

Acute renal failure

A

Decreased GFR leading to retention of nitrogenous wastes

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64
Q

What is the criteria for Acute Kidney Injury?

A 
R - Risk 
I - Injury 
F - Failure 
L - Loss
E - End-stage kidney disease
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65
Q

IRIS

A

Intenational renal interest society

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66
Q

Grade 1 AKI

A

Blood creatinine less than 1.6 mg/dl

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67
Q

Grade 2 AKI

A

Blood Creatinine 1.7-2.5mg/dl

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68
Q

Grade 3 AKI

A

Blood Creatinine 2.6-5.0mg/dl

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69
Q

Grade 4 AKI

A

Blood creatinine 5.1-10mg/dl

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70
Q

Grade 5 AKI

A

Blood creatinine greater than 10mg/dl

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71
Q

What are the pre-renal causes of AKI?

A 
Hypoxia
Ischemia
Dehydration 
hypovolemia
hypotension 
decreased effective circulatory volume 
anesthesia
hypoadrenocorticism 
Trauma
surgery 
shock 
heatstroke 
Hypoalbuminemia 
hypoperfusion
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72
Q

What are the renal causes of AKI?

A 
Prolonged renal hypoperfusion 
Prolonged obstruction 
Excessive vasoconstriction 
Thrombosis 
Transfusion rxns 
Infectious causes
Neoplasia 
Immune mediated causes
Secondary to systemic disease
NSAIDs 
Ethylene glycol
Aminoglycosides
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73
Q

Post renal causes of AKI

A

Urine leakage or obstruction

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74
Q

What are the four phases of acute renal failure?

A

Initial
Extension
Maintenance
Recovery

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75
Q

Initial phase of Acute renal failure

A

decrease in urine output or increase in creatinine without clinical signs

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76
Q

Extension phase of Acute Renal Failure

A

Continued hypoxia and inflammation
Proximal tubule and loop of henle susceptible to toxic and ischemic damage
Compromised Sodium:Potassium pump
Increased cytosolic calcium
Loss of brush border or apical and basal cell surfaces

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77
Q

Maintenance phase of Acute Renal Failure

A

1-3 weeks duration
Urine output is increased or decreased
Urine = ultrafiltrate

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78
Q

Recovery phase of Acute Renal Failure

A

Heralded by polyuria

Extreme Sodium loss

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79
Q

What are the risk factors for Renal tubular necrosis/injury?

A 
Dehydration 
Hypovolemia
Anesthesia
Hypoxia
Systemic inflammatory syndrome
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80
Q

How do you manage the risk factors for Renal tubular necrosis/injury?

A

Aggressively treat shock
Treat dehydration
Avoid nephrotoxic drugs

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81
Q

What are the Renoprotective drugs?

A

Calcium channel bloackers
Selective DA-2 receptor drugs
Selective DA-1 receptor agonists
Erythropoeitin analogues

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82
Q

What is normal urine production per hour?

A

1-2ml/kg/hr

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83
Q

What is abnormal urine production per hour?

A

less than 0.5ml/kg/hr

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84
Q

Diagnosis of AKI/ARF

A 
Identify a predisposing cause
Reduced urine output 
Casts - RTE cell casts
Azotemia
Renal tubular biomarkers: 
GGT: Creat
NAG:Creat
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85
Q

Treatment of ARF

A

Maintaining fluid balance

Correct hypotension

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86
Q

What drugs are use in the treatment for ARF?

A

Mannitol
Furosemide
Dopamine
Fenoldopam

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87
Q

What is the correct shock dose for dogs?

A

60-90ml/kg/hr

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88
Q

What is the correct shock dose for cats?

A

45ml/kg/hr

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89
Q

What is the amount of insensible fluid loss?

A

22ml/kg/day

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90
Q

What is the amount of Maintenance fluids for a dog?

A

60ml/kg/day

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91
Q

What fluids would you use with for treatment of ARF?

A

Crystalloids

  1. 9% NaCl
  2. 45% NaCl + dextrose
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92
Q

What are the fluid requirements for ARF?

A

Dehydration
Insensible losses
Ongoing losses
Sensible losses

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93
Q

Oliguria

A

less than 0.5ml/kg/hr urine producton

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94
Q

How do you treat Oliguria?

A

Mannitol
Furosemide
Dopamine
Calcium Channel blockers

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95
Q

Mannitol

A

Osmotic diuretic that increases circulatory volume and decreases cell swelling

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96
Q

Furosemide

A

Loop diuretic the increases urine production without increasing GFR

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97
Q

What does Fenoldopam do?

A

increased urine output

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98
Q

What is the benefit of Dopamine?

A

a pressor when ARF is secondary to cardiac output failure or severe hypotensive

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99
Q

What drug is used in the standard of care for Leptospirosis?

A

Calcium Channel blockers

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100
Q

What do Calcium channel blockers do?

A

Prevent calcium moving intracellularly

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101
Q

What is the definitive treatment of ARF?

A

Extracorporeal renal replacement therapy/ dialysis

Peritoneal dialysis

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102
Q

What are the indications for Dialysis?

A

FLuid overload with pulmonary edema
Hyperkalemia
Progressive azotemia
Acute toxicity

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103
Q

What is the complication of Peritoneal dialysis?

A

Dialysis disequilibrium syndrome

Blockage of the peritoneal drain by the omentum

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104
Q

What is the treatment for Ethylene glycol?

A

4-methylpyrazole

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105
Q

What is the treatment for NSAIDs?

A

Misoprostal

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106
Q

What is the treatment for Leptospirosis?

A

Penicillin and doxycycline

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107
Q

What is the treatment for Pyelonephritis?

A

Culture

Fluoroquinolones or TMS

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108
Q

What is the treatment for Aminoglycoside toxicity?

A

Ticarcilin IV

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109
Q

What is the treatment for TMS toxicity?

A

Urinary alkalinization

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110
Q

What is the treatment for Hyperkalemia?

A

Insulin
Dextrose infusion
Calcium gluconate
Correct metabolic acidosis

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111
Q

What is the treatment for Acidosis?

A

Sodium Bicarbonate IV

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112
Q

What is the treatment for Hypocalcemia?

A

Calcium gluconate

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113
Q

What is the treatment for Hypercalcemia?

A

Furosemide/glucocorticoids
Calcitonin
Biphosphonates

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114
Q

What is the treatment for Hyperphosphatemia?

A

Aluminum hydroxide/carbonate

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115
Q

What is the treatment for Hypertension?

A

Amlodipine and hydralazine

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116
Q

What is the treatment for Gastrointestinal problems associated with ARF?

A

Prokinetics: Ondansetron, Metoclopramide
Antiemetics: Metoclopramide, maropitant
Omeprazole, pantoprazole, famotidine, ranitidine

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117
Q

What is chronic kidney disease?

A

Loss of functional renal tissue due to prolonged process

Usually progressive and irreversible

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118
Q

What are the degenerative causes of CKD?

A

Chronic interstitial nephritis

Renal infarcts

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119
Q

What are the developmental causes of CKD?

A

Familial renal dysplasia

PKD

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120
Q

What is a metabolic cause of CKD?

A

Hypercalcemia

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121
Q

What is the neoplastic cause of CKD?

A

Renal carcinoma

Renal lymphoma

122
Q

What is an infectious cause of CKD?

A

Pyelonephritis
Lyme nephropathy
Leptospirosis

123
Q

What is an iatrogenic cause of CKD?

A

Vitamin D supplementation

Nephrotoxic durgs

124
Q

What is an immune mediated cause of CKD?

A

Immune-complex mediated glomerulonephritis

125
Q

What are the effects of Hyperphosphatemia?

A

Drives renal secondary hyperparathyroidism

Causes progression of disease

126
Q

What causes Hypokalemia in CKD?

A

Reduced intake

Increased renal potassium loss

127
Q

What causes anemia in association with CKD?

A

Erythropoietin deficiency
Decreased life span of RBC
Effect of PTH on bone marrow and RBCs

128
Q

What causes renal injury in CKD?

A

Proteinuria

129
Q

What is the treatment for Proteinuria associated with CKD?

A

ACE inhibitors

ARB (telmisartan)

130
Q

What are the aims of Treatment and Management of CKD?

A

Treat underlying cause
Improve clinical signs/quality of life
Slow the progression

131
Q

What causes Vomiting and nausea associated with CKD?

A

Uremic gastritis
Hypergastinemia
Stimulation of the CTZ by uremic toxin

132
Q

What are the appetite stimulants used for the treatment of CKD?

A

Cyproheptadine in cats

Mirtazapine in dogs and cats

133
Q

How do you treat Hyperphosphatemia associated with CKD?

A

Dietary phosphate restriction

Intestinal phosphate binders

134
Q

When would you begin a cat on a Renal Diet?

A

IRIS stage 2

135
Q

When would you begin a dog on a Renal Diet?

A

IRIS stage 3

136
Q

How would you treat Hypokalemia associated with CKD?

A

Supplement IV

Oral potassium supplements

137
Q

How would you treat non-regenerative anemia associated with CKD?

A

Erythropoietin therapy

rHuEPO or Darbopoietin

138
Q

What is the Hypertension therapy for cats?

A

Amlodipine

139
Q

What is the Hypertension therapy for dogs?

A

ACE inhibitors

140
Q

How do ACE inhibitors work?

A

inhibit conversion of angiotensin I to angiotensin II

Reduce glomerular capillary pressure and glomerular size

141
Q

Telmisartan

A

Angiotensin receptor blocker

142
Q

Management of acute on chronic disease

A

identify and treat underlying cause

IV fluids

143
Q

What is considered a non-proteinuric UP/C value in dogs?

A

less than 0.2

144
Q

What is considered a non-proteinuric UP/C value in cats?

A

less than 0.2

145
Q

What is considered a borderline proteinuric UP/C value in dogs?

A

0.2 to 0.5

146
Q

What is considered a borderline proteinuric UP/C value in cats?

A

0.2 to 0.4

147
Q

What is considered a proteinuric UP/C value in dogs?

A

greater than 0.5

148
Q

What is considered a proteinuric UP/C value in cats?

A

greater than 0.4

149
Q

What is a physiologic cause of proteinuria?

A

Strenuous exercise
seizures
fever
stress

150
Q

What is the pre-renal cause of proteinuria?

A

Abnormal concentrations of protein been presented to the kidneys

151
Q

What is the renal cause of proteinuria?

A

Defective renal function or inflammation of renal tissue

152
Q

What is the post-renal cause of proteinuria?

A

Inflammation in the ureter, bladder, urethra or prostate

153
Q

What causes a false positive of Proteinuria on the urine dipstick?

A

Alkaline urine

Contamination

154
Q

What causes a false negative of proteinuria on the urine dipstick?

A

Acid urine

Bence-jones proteinuria

155
Q

What causes proteinuria in association with glomerular disease?

A

Defective renal function: Glomerular pathology or tubular pathology
Inflammation of renal parenchyma: Pyelonephritis or acute tubular necrosis

156
Q

What is a renal cause of Proteinuria?

A

Increased Glomerular permeability

decreased tubular protein reabsorption

157
Q

Protein losing nephropathy

A

condition causing severe proteinuria due to primary glomerular disease

158
Q

Glomerulonephritis

A

condition where immune-complexes are deposited in the glomeruli

159
Q

What is the cause of glomerulonephritis?

A

Familial nephropathy basement membrane: X-linked hereditary PLN of Samoyeds or Alport syndrome of English Cocker Spaniels
Immune-complex glomerulonephritis
Non immune complex GN
Amyloid deposits in glomeruli

160
Q

What are the infectious causes of Glomerulonephritis?

A

Borreliosis
Dirofilariosis
Ehrlichiosis
Leishmaniosis

161
Q

What is the cause of Hypercoagulability of Glomerulonephritis?

A 
Mild thrombocytosis 
Increased platelet adhesion and aggregation 
Loss of antithrombin
Altered fibrinolysis
Increase in large clotting factors
162
Q

How do you measure hypercoagulability?

A

Thromboelastography

163
Q

How do you indirectly measure hypercoagulability?

A

Increased/decreased number of platelets
Decreased antithrombin
Increased fibrin
Increased d-dimers

164
Q

Nephrotic syndrome

A

Kidney disease characterized by edema and loss of protein from the plasma into the urine due to increased glomerular permeability

165
Q

How do you diagnose Glomerulonephritis?

A

Kidney biopsy
Light microscopy
Transmission electron microscopy
Immunofluorescent antibody assessment

166
Q

What are the findings associated with Nephrotic Syndrome?

A

Proteinuria
Hypoalbuminemia
Ascites/Edema
Hypercholesterolemia

167
Q

What is the treatment for Glomerulonephritis?

A

Immunosuppressive therapy

168
Q

What drug should not be used alone for the treatment of Glomerulonephritis?

A

Glucocorticoids

169
Q

What is the first choice of treatment for Glomerulonephritis?

A

Mycophenolate

170
Q

If Mycophenolate does not work for Glomerulonephritis then what do you add?

A

Cyclosporine
Chlorambucil
Azathioprine
Cyclophosphamide

171
Q

How do you treat Protein Losing Nephropathy?

A

treat proteinuria with ACE inhibitors, ARB, and Renal diets

treat hypercoagulability with aspirin or clopidogrel

172
Q

What is the most significant cause of renal disease and acute uremia?

A

Ureteral obstruction from calcium oxalate

173
Q

What is the clinical sign that cats with Acute unilateral ureteral obstruction present with?

A

Acute Abdominal pain

hematuria

174
Q

What is the clinical signs for Acute bilateral ureteral obstruction in cats?

A

bilaterally enlarged and painful kidneys
Azotemia
oliguria/anuria

175
Q

“Big Kidney Little Kidney” Syndrome

A

cats with past unilateral ureteral obstruction that causes the kidney to progress to fibrotic end stage. the contralateral hypertrophied kidney becomes acutely obstructed by a ureterolith causing further enlargement

176
Q

Bilateral Chronic Kidney Disease with Concomitant Ureteral Obstruction

A

Chronic kidney disease secondary to fibrotic changes from previous obstruction predisposes to intrinsic kidney disease and a sudden obstruction causes decompensation of the tenuous residual kidney function

177
Q

What do you see on ultrasound with ureteral obstruction?

A

hydronephrosis and dilation of the proximal ureter

178
Q

What is the advanced imaging used for diagnosis of ureteral obstruction?

A

Antegrade pyelography

Computed tomography

179
Q

Antegrade pyelography

A

guided pyelocentesis and antegrade injection of positive contract media into the renal pelvis and ureter to delineate the size and patency of the ureter

180
Q

What is the medical management for ureteral obstruction?

A

Stabilize uremia
mannitol
Ureteral relaxants - Prazosin and amitryptilline
Pain management

181
Q

What is an excellent choice of management for ureteral obstruction in dogs?

A

Lithotripsy

182
Q

What is the standard of car for ureteral obstruction?

A

Ureteral stents through cystoscopy or Surgically

183
Q

Subcutaneous ureteral bypass system

A

indwelling bypass using a combination locking loop nephrotomy/cystotomy tube

184
Q

How do you stabilize a cat with ureteral obstruction?

A 
Heat
Fluids
ECG
Emergency panel
Cystocenetesis
185
Q

What is treatment for hyperkalemia in an obstructed cat?

A

Calcium gluconate
IV insulin
Bicarbonate
Shock fluids

186
Q

How do you relieve the obstruction of a cat?

A 
Retrograde 
Penile massage/rectal massage of urethra
Anesthesia and positioning
Cystocentesis
Penis extrusion 
Catheterization
187
Q

What is the ongoing management for a blocked cat?

A

Indwelling U-cath placement
Monitor urine production/urine sediment
Analgesia
Anti-spasmotics

188
Q

What is the treatment for a blocked cat with an owner that cannot afford treatment?

A

Euthanasia
or
Repeated cystocentesis and anti spasmotics

189
Q

Anti-spasmotics

A

Prazosin/Phenoxybenzamine

Pheromones for stress

190
Q

What is a clinical finding associated with Urethral rupture?

A

Hyperkalemia
Hyponatremia
Acidosis

191
Q

What is a consequence of Uretheral rupture?

A

Stricture

Urethrocutaneous fistula

192
Q

What is the cause of Uroabdomen?

A

Trauma

193
Q

How do you treat Uroabdomen?

A

Medical management and urinary catheterisation

Surgery once stable

194
Q

What are non-obstructed lower urinary tract diseases?

A 
Urinary tract infections 
Urolithiasis
Feline lower urinary tract disease
Prostatic disease
Neoplasia
195
Q

What are the clinical signs of urinary tract disease?

A 
Dysuria
Pollakiuria/periuria
Stranguria
Pigmenturia
Incomplete voiding
Urinary incontinence
196
Q

What causes Dysuria/Stranguria/Pollakiuria?

A

Irritation of the bladder: bacterial, uroliths, or interstitial cystitis
Neurological disease
Secondary lower urinary tract disease
Neoplasia

197
Q

How do you diagnose Lower Urinary Tract disease?

A 
Collect urine on free flow and cystocentesis 
Urinalysis 
urine culture
urethral cytology
Radiography 
Ultrasonography 
Cystoscopy 
Bladder biopsy 
Excretory contrast studies 
Urethral profilometry
198
Q

Is Bilirubinemia normal in a dog?

A

Yes

199
Q

Is Bilirubinemia normal in a cat?

A

No

200
Q

What are the causes of Hematuria?

A

Renal
Lower Urinary Tract
Reproductive
Systemic disease: Bleeding disorder, Hypertension, or Hyperviscosity

201
Q

What is the number one cause for UTIs?

A

E. coli

202
Q

What is the most common route of UTI?

A

Ascending

203
Q

What are the drugs of choice for an uncomplicated UTI?

A

Amoxicillin
Cephalosporins
TMS

204
Q

Uncomplicated UTI

A

the first time it presents with bacteria in the urine without stones in the bladder

205
Q

What is classified as a Complicated UTI?

A

Relapse
Reinfection
Superbugs

206
Q

Reinfection UTI

A

New/different organism

C and S positive greater than 7 days after last treatment course

207
Q

Superinfection UTI

A

C and S positive at day 7 after starting antibiotics

208
Q

Relapse

A

Same organism/strain, 7 days after last treatment course

209
Q

What causes a Relapse?

A

Inappropriate drug choice
Dose
frequency
duration

210
Q

What causes Lower Urinary Tract Disease?

A 
Anatomic urinary tract abnormalities
Voiding abnormalities
Upper urinary infection 
Endocrine diseases
Prostate
Uterine/Vaginal disease
Immune compromise 
Iatrogenic diuresis
211
Q

Urachal Diverticulum

A

cord from the bladder to the mother does ot disappear

212
Q

Patent Urachas

A

cord from the bladder to the mother has an opening to the skin

213
Q

What is the treatment for Recurrent UTI?

A

One daily bedtime administration 30-50% of original dose of Nitrofurantoin that is an urinary disinfectant

214
Q

What are the alternative techniques for Recurrent UTI therapy?

A

Probiotics
Polysulfated glycosaminoglycans
Fosfomycin
Cranberry extract

215
Q

Therapy for Urolithiasis?

A 
Diet
Urohydropulsion 
Cystotomy with baskets
Cystrotomy 
Lithotripsy
216
Q

Retrograde Urohydropulsion

A

Hydropulsion of uroliths into the bladder

217
Q

Struvite

A

Big Smooth Radiodense Magnesium Ammonium phosphate due to Urease producing bacteria when the urine pH is high
In cats it is diet related

218
Q

What breeds of dog get Struvites?

A 
Mini Schnauzers
Lhasa Apso
Cocker Spaniel 
Shih tzu
Bichon Frise
219
Q

What is the treatment for Struvites?

A

Hills S/D diet that dilutes the acidic urine

Walthams S/O

220
Q

Calcium Oxalate

A

Spiny radio-opaque small stones that are common in male dogs due to acidifying diets, obesity or Hypercalcemia

221
Q

What kind of stone is associated with Ethylene glycol toxicity?

A

Calcium monohydrate

222
Q

What is the treatment for calcium oxalate crystals?

A

Therapy for hypercalcemia

Surgical/lithotripsy/cystoscopy

223
Q

How do you prevent Calcium Oxalate formation?

A 
Hills U/D
Walthams S/O
Thiazide diuretics
Potassium citrate 
Avoid Vitamins C and D
224
Q

What is the crystal that looks like a “hairy apple”?

A

Ammonium biurate

225
Q

What causes Ammonium Urate and Xatnthine formation?

A

Hepatic disease (PSS, cirrhosis)
Genetic tubular defect
Breeds: Dalmations, Black Russian Terrier)
Decreased uptake of uric acid from hepatocytes to form allantoin

226
Q

Ammonium Urate

A

Radiolucent crystal associated with lower urinary pH

227
Q

What is the treatment for Ammonium Urate formation?

A

Diet - low protein and increased pH
Xanthine oxidase inhibitors: Allopurinol
Supportive care for hepatic dysfunction

228
Q

What breeds are associated with Cystine Calculi?

A

Australian cattle dogs
Newfoundlands
Dachshunds
Bulldogs

229
Q

Cystine Calculi

A

Tubular carrier proteins fail to reabsorb cystine

Radio-opaque crystal

230
Q

How do you treat Cystine crystals?

A

Alkalinize Urine

Low protein diet

231
Q

Calcium phosphate uroliths

A

usually secondary to primary hyperparathyroidism

232
Q

Silica Uroliths

A

Associated with plant sources, poor diets rich in rice and soybean husks, cheap diets devoid of proper protein

233
Q

What are the potential causes of Feline Lower Urinary Tract Disease?

A 
Bacterial 
Uroliths
Neoplasia 
trauma 
anatomical 
behavioral
Feline interstitial cystitis
234
Q

What is the gold standard of diagnosis for Feline Interstitial cystitis?

A

Cystoscopy

235
Q

What are the clinical signs of Feline Idiopathic Cystitis?

A 
Hematuria 
Stranguria 
Pollakiuria 
Inappropriate urination 
Palpate a large firm bladder 
Inability to urinate
236
Q

How do you diagnose Feline Idiopathic Cystitis?

A

Exclusion

Cystoscopy

237
Q

Pudendal Nerve

A

somatic nerves to the external urethral sphincter causing the sphincter to be tight

238
Q

Pelvic Nerve

A

parasympathetic nerve to the detrusor muscle that allows the animal to pee through contraction and received pain stimulations from the bladder

239
Q

Hypogastric Nerve

A

Sympathetic nerve allows the detrusor muscle relax and the urethral sphincter to contract and store urine

240
Q

What is the treatment for Feline Lower Urinary Tract Disease?

A

Reduce stress
Multiple Litter boxes
Plenty of Water sources
Activity/playing

241
Q

What is the preferred method of dislodging an obstruction in Feline Lower Urinary Tract Disease?

A

Catheterisation

IV fluids

242
Q

What is the treatment of Feline Lower Urinary Tract Disease?

A

Wet food not dry
Pheromones for stress
Analgesics - opioids

243
Q

What are some Vaginal Diseases?

A 
Hemorrhage 
Vaginitis
Hyperplasia 
Prolaspe
Neoplasia
Persistent Hymen
244
Q

What is the main cause of Feline Lower Urinary Tract Disease?

A

Stress

Concurrent disease with stress

245
Q

Persistent Hymen

A

Persistent sheet of tissue in the vagina

246
Q

Juvenile vaginitis

A

seen in young females that will resolve in 6 weeks

247
Q

What is the predisposing factor for vaginitis?

A

sunken vulva

248
Q

Vaginal Hyperplasia/Prolapse

A

Hyperplasia of the vaginal wall that prolapses when the female comes into heat and will resolve after the dog goes out of heat

249
Q

What are the neoplasias of the Female Genital tract?

A

Leiomyoma/Leiomyosarcoma

Transmissible Venereal Tumors

250
Q

What are the prostatic diseases?

A

Benign Prostatic Hyperplasia
Prostatic cysts
Prostatitis
Prostatic Neoplasia

251
Q

What are the clinical signs of Prostatic Disease?

A

Difficult defecation

Tenesmus

252
Q

What are the clinical signs of Acute Prostatitis?

A

the dog is very sick

253
Q

What are the clinical signs of Chronic Prostatitis?

A

recurrent UTIs
preputial discharge
Non-painful prostate
symmetrically enlarged prostate

254
Q

Hoe do you diagnose Chronic Prostatitis?

A

UA for UTI

Ultrasound

255
Q

What is the therapy for Benign Prostatic Hyperplasia?

A

Orchidectomy

Medical chemical castration

256
Q

What is the therapy for Prostatic Cysts?

A

US drainage

Marsupialize

257
Q

What is the therapy for Prostatitis?

A

Antimicrobials

Surgery - Orchidectomy

258
Q

What is Finasteride used for?

A

converts testosteron to dihydrotestosterone to avoid castration

259
Q

What antibiotics penetrate the Prostate well?

A 
Fluoroquinolones
Doxycycline
Trimethoprim
Rifampin 
Erythromycin
260
Q

What antibiotics do not penetrate the prostate?

A 
Nitrofurantoin 
sulfonamides
vancomycin
penicillins
cephalosporins
261
Q

What are the clinical signs of Prostatic Neoplasia?

A

Lameness
Painful gait with pain in sacrum
prostate palpable
Palpable sublumbar LNs

262
Q

Where would metastasis be located with Prostatic Neoplasia?

A

LN
Vertebrae
Lungs

263
Q

What is the treatment for Prostatic Neoplasia?

A

Chemo - Mitoxantrone
radiation
stents

264
Q

Mitoxantrone

A

Topoisomerase inhibitors disrupt DNS synthesis and repair

265
Q

What are the Neoplasias in the Bladder or urethra?

A 
Transitional Cell Carcinoma 
Muscle Neoplasms 
Squamous cell carcinoma
adenocarcinoma 
fibrosarcoma 
hemangiosarcoma
266
Q

How do you diagnose Bladder or Urethra Neoplasia?

A 
Urine sediment 
Imaging 
Catheter suction samples for cytology 
Endoscopy 
Cytology 
Biopsy
267
Q

What is the treatment for TCC of the bladder?

A 
Piroxicam
Surgery
Chemotherapy - Mitoxantrone
Photodynamic therapy 
Urine diversion - catheter
268
Q

What causes Detrusor Atony?

A

caused by trauma or over distension causing disruption of the nerves

269
Q

Where do you find the parasympathetic innervation to the bladder?

A

S1-3

270
Q

Where do you find the sympathetic innervation to the bladder?

A

L1-4 in dogs

L2-5 in cats

271
Q

Where do you find the somatic innervation to the bladder?

A

S1-3

272
Q

What overrides the Pudendal nerve to increase urethral sphincter tone?

A

Cerebrum

273
Q

What are the UMN bladder signs?

A

Detrusor areflexia with sphincter hyperreflexia
Small bladder to large distended bladder
Small volumes of urine
Difficult to express

274
Q

Where is the lesion located when there are UMN bladder signs?

A

Aboove sacral segment

275
Q

What is the treatment for UMN bladder signs?

A

Baclofen

276
Q

Baclofen

A

Antispasmodic causing muscle relaxant

277
Q

What are the LMN bladder signs?

A

Detruspr areflexia and sphincter areflexia
Large bladder
Easily expressed
Constantly leaks

278
Q

Where is the location of the lesion when LMN bladder signs are seen?

A

Sacral spinal segment or pelvic segment

279
Q

What is the treatment for LMN bladder signs?

A

Express bladder 3-4x/day

Bethanecol

280
Q

Bethanecol

A

parasympathomimetic causing contraction of the bladder

281
Q

Detrusor-sphincter reflex dyssynergia

A

with initiation of detrusor contraction the urethral sphincter spasms

282
Q

What is the treatment for Detrusor-sphincter reflex dyssynergia?

A

Alpha-adrenergic blockers (Phenoxybenzamine)

283
Q

In what species do you see Dysautoanomia?

A

Cats

284
Q

What causes Detrusor Atony?

A

Overfill due to obstruction

285
Q

How do you treat Detrusor Atony?

A

Manually express the bladder and keep the bladder small and hope the nerves grow back

286
Q

Detrusor instability/detrusor hyperreflexia (Urge Incontinence)

A

Detrusor contraction during storage of urine or low compliance of the detrusor muscle which may be confirmed by cystometrography

287
Q

What is the treatment for Detrusor instability/detrusor hyperreflexia (Urge Incontinence) ?

A

Anticholinergic - Oxybutynin imipramine or dicyclomine

288
Q

Urinary incontinence

A

the involuntary escape of urine during the storage phase of the urinary cycle
Intermittent or continuous dribbling of urine with a normal voiding episode
Loss of voluntary control of urination and consequent leakage of urine

289
Q

What is the cause of Urinary Incontinence?

A

Urinary Sphincter Mechanism Incompetence

290
Q

What are the clinical signs of Urinary Sphincter Mechanism Incompetence?

A

Soiled perineal coat

Urine scald

291
Q

How do you diagnose Urinary Sphincter Mechanism Incompetence

A

Urethral pressure profile

292
Q

What is the pathophysiology of Urinary Sphincter Mechanism Incompetence?

A

Lack of estrogen decreases sensitivity of the smooth muscle receptors to sympathetic stimulation
Spaying reduced urinary sphincter pressure

293
Q

What is the Pressure transmission theory for Urinary Sphincter Mechanism Incompetence?

A

when urethral neck is not in the abdominal cavity it is not subjected to the same pressures as the intra-abdominal bladder, the bladder pressure exceed urethral pressure and the urine leaks

294
Q

What is the Hammock theory for Urinary Sphincter Mechanism Incompetence?

A

the anatomic structures maintaining the position of the bladder and urethra are abnormal

295
Q

What are the indications to perform a Urethral pressure profile?

A

Urinary Sphincter Mechanism Incompetence
Detrusor instability
Reflex dyssynergia
Neurogenic abnormalities

296
Q

What is the medical management for Urinary Sphincter Mechanism Incompetence

A

Estriol therapy + PPA

297
Q

What are the side effects of Estriol?

A

increased mammary tumors

298
Q

What are the surgical treatment for Urinary Sphincter Mechanism Incompetence?

A 
Bovine Cross-Linked Collagen Implantation
Colposuspension 
Urethropexy 
Transobturator Vaginal Tape inside out
Static Hydraulic Urethral sphincter
299
Q

What are the clinical signs of Ectopic Ureter?

A

Wet coat
Inflamed perineum
Excoriations

300
Q

What is the treatment of choice for Ectopic Ureter?

A

Cystoscopic laser ablation

301
Q

What are the most accurate diagnosis of Ectopic Ureter?

A

Excretory urogram CT

Cystoscopy

302
Q

How long should you continue antibiotics for UTI associated with Ectopic Ureters?

A

6-8 weeks

RUSVM Small Animal Medicine II 2017 (4 decks)

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