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MODULE 17 - Urinary, Endocrine and Oncological Disease > PATHOLOGY - Polyuria Polydipsia (PUPD) > Flashcards

PATHOLOGY - Polyuria Polydipsia (PUPD) Flashcards

1
Q

What is polyuria?

A

Polyuria is an increase in both the frequency and volume of urine

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2
Q

What is a key factor when supporting PUPD patients?

A

It is essential to provide PUPD patients with continuous access to water as most PUPD cases begin with polyuria and the polydipsia is secondary to compensate

Really important to get this across to owners as often they will restrict water because they think it will prevent accidents in the house

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3
Q

What are the differential diagnoses for PUPD in dogs?

A

Diabetes mellitus
Renal failure
Hyperadrenocorticism (Cushing’s disease)
Hypercalcaemia
Neoplasia
Hepatic failure
Pyogenic foci
Hypoadrenocorticism (Addison’s disease)
Diabetes insipidus
Psychogenic polydipsia

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4
Q

What are the differential diagnoses for PUPD in cats?

A

Renal failure
Hyperthyroidism
Diabetes mellitus
Pyogenic foci
Hepatic failure
Neoplasia
Hypercalcaemia
Diabetes insipidus

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5
Q

Which history questions are important when investigating PUPD?

A

Have there been any behavioural changes? (i.e. is the dog lethargic, normal, had any episodes of collapse etc)
How is the patient’s appetite?
Have there been any dermatological changes?
Has there been any vomiting or diarrhoea?
Has there been any discharge?
Is the patient on any medications?
Recent medical history?

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6
Q

What should you particularly focus on when doing a clinical examination on a PUPD patient?

A

Full clinical examination
Lymph nodes
Dermatological changes
Discharge
Abdominal palpation
Rectal examination
Thyroid palpation

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7
Q

Why is a rectal examination particularly important when investigating PUPD?

A

A rectal examination is particularly important when investigating PUPD as anal sac adenocarcinomas can cause hypercalcaemia and consequently PUPD

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8
Q

Which initial diagnostic tests can you do when investigating PUPD?

A

Urinalysis
Biochemistry
Haematology

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9
Q

Which differential diagnoses can be ruled out based on a urine specific gravity (USG)?

A
  • PUPD can be ruled out if the USG is above 1.035 as the body is incapable of producing large volumes of concentrated urine
  • Isosthenuria and hypersthenuria rules out diabetes insipidus as this would result in hypostheuria (however be aware that hyposthenuria does not confirm a diagnosis of diabetes of insipidus)
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10
Q

Which differential diagnoses can be ruled out based on a urine dipstick?

A
  • No glucose in the urine can rule out diabetes mellitus
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11
Q

Which parameters should you assess on biochemistry when investigating PUPD?

A

Glucose
Calcium
Urea
Creatinine
Electrolytes (sodium, potassium, chloride)
Phosphate
Thyroid hormones

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12
Q

Which parameters are the most important to assess on biochemistry when investigating PUPD?

A

Glucose
Calcium

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13
Q

What can be indicated by a mild hyperglycaemia on biochemistry?

A

Mild hyperglycaemia can indicate stress, however this is not a cause of PUPD

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14
Q

What can be indicated by a severe hyperglycaemia on biochemistry?

A

Severe hyperglycaemia suggests the patient has diabetes mellitus

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15
Q

What should you be aware of if a cat presents with a severe hyperglycaemia?

A

Sometimes stress can cause a severe hyperglycaemia in cats

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16
Q

What is the post common cause of PUPD secondary to hypercalcaemia?

A

Neoplasia can cause hypercalcaemia and secondary PUPD

17
Q

Which neoplasms can cause hypercalcaemia?

A

Lymphoma
Anal sac adenocarcinoma
Plasma cell myeloma
Carcinoma

18
Q

Which other diseases can cause PUPD secondary to hypercalcaemia?

A

Hyperparathyroidism
Hyperadrenocorticism (Cushing’s disease)
Toxicity

19
Q

Which electrolyte imbalances are indicative of hypoadrenocorticism (Addison’s disease)?

A

Hyponatraemia
Hyperkalaemia

20
Q

What can be indicated by an inflammatory leukogram on haematology?

A

An inflammatory leukogram could indicate pyogenic foci

21
Q

What can be indicated by a stress leukogram on haematology?

A

Stress
Hyperadrenocorticism (Cushing’s disease)

22
Q

If you cannot diagnose the PUPD based on intial clinical pathological tests, what should be your next step?

A

Rule out hyperadrenocorticiam (Cushing’s disease) with a low dose dexamethason suppression test

23
Q

If you are able to rule out hyperadrenocorticism (Cushing’s disease), what should you next step be when investigating PUPD?

A

Diagnostic imaging

24
Q

What can radiography be used for when investigating PUPD?

A

Radiography can be used to rule out neoplasia

25
Q

What can ultrasound be used for when investigating PUPD?

A

Ultrasound has very limited use as a survey scan unless you are very experienced, ultrasound is better for further assessment of a suspected disease

26
Q

What is central diabetes insipidus?

A

Central diabetes insipidus is due to posterior pituitary gland hypofunction which results in decreased antidiuretic hormone (ADH) release. ADH is usually responsible for increasing the permeability of the collecting ducts of the nephrons to increase reabsorption of water into the bloodstream to concentrate the urine. If there is decreased ADH secretion this will result in large volumes of hyposthenuric urine being produced

27
Q

What are the potential causes of central diabetes insipidus?

A

Neoplasia
Congenital
Trauma
Inflammation

28
Q

What is nephrogenic diabetes insipidus?

A

Nephrogenic diabetes insipidus is where the kidneys are unable to respond to antidiuretic hormone (ADH)

29
Q

What causes nephrogenic diabetes insipidus?

A

Decreased antidiuretic hormone (ADH) receptors

30
Q

How do you differentiate between diabetes insipidus and psychogenic polydipsia?

A

Water deprivation test

31
Q

Why are water deprivation tests so rarely done?

A

Water deprivation tests are so rarely done as they can risk the life of the patient as you are depriving them of water

32
Q

What are the indications for a water deprivation test?

A

Severe PUPD with normal renal function, no hypercalcaemia, no hyperglycaemia and no hypercortisolaemia

33
Q

How do you carry out a water deprivation test?

A

Phase 1: Water restriction
Phase 2: Water deprivation. Empty the bladder every 2 hours, do a USG and check the urea and creatinine every 2 hours
Phase 3: Administer 2-4mg DDAVP (synthetic ADH) and monitor the USG for 2 to 4 hours. Slowly begin to reintroduce water

34
Q

When should you stop a water deprivation test?

A

USG rises above 1.025
5% body weight loss
Dogs becomes azotaemic or appears lethargic

35
Q

How do you interpret a water deprivation test?

A

If the USG begins to increase before the administration of DDAVP, this is indicative of psychogenic polydipsia as the ADH and the ADH receptors must be working. If the USG increases following administration of DDAVP, this indicates central diabetes insipidus as there must be ADH receptors available there is just no production of ADH. If the USG does not change following DDAVP administration, this indicates there are ADH receotors to bind to and thus this is a nephrogenic diabetes insipidus

36
Q

Which further diagnostic tests should you do if you suspect a central diabetes insipidus based on a water deprivation test?

A

MRI

37
Q

What is the most common cause of psychogenic polydipsia?

A

Psychogenic polydipsia is most commonly seen in young dogs in multidog households where one dog is dominant of the water bowl, causing the other dogs to carry out excessive fluid intake in the absence of physiological stimuli to drink

MODULE 17 - Urinary, Endocrine and Oncological Disease (12 decks)

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