Renal Flashcards
What does a large pear shaped bladder indicate?
Chronic problem - remodelling (should be round)
Where in the bladder is a TCC most common?
The bladder neck
How might you diagnose a bladder TCC?
Look at urine sediments, rectal palpation, rake with a catheter while applying negative pressure to break off some of the tumour, ultrasound guided FNA.
How can you treat bladder TCC?
By the time you find it, usually too late to treat surgically. Treat medically with peroxicam (NSAID).
Which kidney is most likely to be missing in renal agenesis?
The right kidney
What is the most common prostatic disease to occur in intact male dogs?
Benign prostatic hyperplasia
How much of the canine semen volume is made up by the prostate secretions?
97%
What are the clinical signs of prostatic disease?
Penile discharge at times other than urination
haematuria / dysuria, tenesmus / obstipation / ribbon faeces
stiff gait (if painful)
+/- urethral obstruction / fever
What should you never forget in a physical exam of a sexually intact middle aged male animal?
Rectal exam
Patchy areas of mineralisation in the prostate on radiographs is strongly correlated with what?
Carcinoma
How can you further investigate suspected prostatic disease?
Routine bloodwork/urinalysis
Urine bacterial culture
Semen collection
Prostatic massage and wash
Ultrasound guided FNA (worry about seeding)
What is the most common treatment for benign prostatic hyperplasia and how effective is it?
Castration - leads to a 50% decrease in prostate size in 3 weeks
What is pollakiuria?
Dramatically increased frequency of urination
What are the differentials for red/brown urine?
Haemoglobinuria, myoglobinuria or haematuria
How can you differentiate haematuria from haemo/myoglobinuria?
Spin a urine sample - if the red colour is caused by red blood cells they will sediment out
What is haemoglobinuria indicative of and what are your differentials?
Indicative of intravascular haemolysis:
Immune mediated haemolytic anaemia
Zinc, onion, copper toxicities
Vena caval syndrome (clot or heartworm)
DIC
Microangiopathy
Inherited RBC defects
What is myoglobinuria indicative of and what are your differentials?
Indicative of severe muscle damage:
Rhabdomyolysis
Snake envenomation
What are your differentials for haematuria?
Bleeding from a genital structure
Bleeding from the urinary tract
Haemostatic disorder
What are some questions that can help you determine the source of haematuria?
Is the bleeding only at the beginning or end of the urine stream?
Does bleeding from prepuce or vulva occur at times other than urination?
Is bleeding associated with straining and increased frequency of urination?
Are RBC casts present in the urine?
Is blood found in voided but not cystocentesis derived samples?
What do RBC casts in the urine indicate?
Bleeding in the kidneys
What would bleeding at times other than urination make you consider?
That bleeding could be coming from the reproductive tract
What two categories of pathology can cause straining?
Obstruction and/or inflammation
What is reflex dyssynergia?
A functional obstruction causing males to urinate in spurts. They may not be able to completely empty their bladder.
What is increased urination / accidents at night called?
Nocturia
Define the limits for isosthenuria:
1.008 - 1.012
What are the differential diagnoses for primary polydipsia?
Psychogenic
Hepatic insufficiency / disease
Hypothalamic disorder
Drugs (chlorapromazine, anticholinergics)
Hyperthyroidism
What are the differentials for primary polyuria?
Neurohypophyseal (central) diabetes insipidus (inability to produce ADH)
Nephrogenic diabetes insipidus (inability to respond to ADH)
Renal failure
Pyelonephritis
Pyometra
Hypercalcaemia
Hypokalaemia
Hyper/hypoadrenocorticism
Hyperthyroidism
Hepatic insufficiency
Diabetes mellitus
Drugs (nephrotoxins, diuretics)
What should you include in your initial approach to a case of PU/PD?
Signalment
History
Physical exam (incl. RECTAL)
CBC
Serum chemistry profile
Urinalysis
What is ‘overt’ proteinuria?
Dipstick-detectable excessive protein in the urine (>0.3g/L)
What is microalbuminuria?
Mildly excessive albumin in the urine - concentration is abnormally high but below the limit of detection of (conventional) dipsticks.
What can cause false positives on a dipstick?
Antiseptic contamination
Damp reagent strips
Very alkaline urine
Very concentrated urine
What can cause false negatives on a urine dipstick?
Not sensitive detection for protein other than albumin (may have hyperproteinuria, just not hyperalbuminuria - won’t be picked up)
What different methods are there for measuring proteinuria?
Dipstick, 3% sulphosalicyclic acid precipitation test (SSA), urine protein : urine creatinine ratio
What are differential diagnoses for pre-glomerular proteinuria?
Multiple myeloma, various leukaemias, B-cell lymphoma, haemolytic crsis or rhabdomyolysis.
What are differential dianoses for glomerular proteinuria?
Glomeruloephritis, hereditary nephropathies, amyloidosis,
What are differential diagnoses for tubular proteinuria?
Drug toxicities, pyelonephritis, heavy metal poisoning, acute tubular necrosis, fanconi syndrome, vesicoureteral reflex
What are differential diagnoses for post renal proteinuria?
Lower urinary tract disease (infection, inflammation, calculi, neoplasia), genital inflammation / infection
What is seen in nephrotic syndrome?
Heavy proteinuria, hypoalbuminaemia, hypercholesterolaemia
What can you do to treat glomerular nephritis?
*Attempt to identify and treat the underlying cause
ACE inhibitor (be careful of dose)
High quality, protein restricted food
Which breeds are prone to renal amyloidosis?
Abyssinian cats and Shar Pei dogs
What are some complications of glomerular proteinuria?
Renal failure, hypercoagulable sate, thromboembolism, systemic arterial hypetension
What percentage of cardiac output goes to the kidneys?
~20%
At what percentage loss of kidney function do we start to see azotaemia?
75%
What can have an effect on BUN?
Diet, GI bleeding, catabolic rate, dehydration
What are the defense mechanisms of the bladder?
Musocsal defence: antibody production, glycosaminoglycan layer, intrinsic antimicrobial properties, uroepithelial exfoliation
Urine composition: high/low pH, hyperosmolality, high concentration of urea
In what situation are you more likely to see an e.coli UTI in cats opposed to a staph UTI?
E.coli: in cats that are not properly concentrating their urine
Staph: can withstand dehydration - see in cats catheterised in a dirty manner
What is the most common bacteria causing UTI?
E. coli
What factors can predispose to urolith formation?
Highly concentrated urine, urine retention, favourable urine pH, nidus for nucleation/crystallisation, decreased concentration of crystallisation inhibitors
Which are the two most common type of uroliths?
Struvite and Ca oxalate
You see big, radio-opaque stones on radiography, what type of urinary calculi are they most likely to be?
Struvite
What is the most important mineral component of feline urethral plugs?
Struvite
Which bacteria species produce urease?
Proteus spp and Staphylococci spp
What are the treatment principles for struvite uroliths?
Treat UTI if present!
Can remove stones surgically
OR
Try to dissolve them using a struvite dissolution diet (can take months) +/- urease inhibitor
What are the treatment principles for calcium oxalate crystals?
Surgical removal and analysis
Avoid excessively salty foods
Do struvite crystals form more readily in acidic or alkaline urine?
Alkaline
What type of uroliths can you get?
Struvite
Ca oxalate
Urate
Cystine
Silicate
What type of urolith are Dalmations prone to?
Urate
Dogs with liver failure are prone to what type of urolith and why?
Urate - increased excretion of ammonium urate
Which uroliths are often ‘jack’ shaped?
Silicate
What predisposes to feline lower urinary tract disease (FLUTD)?
Highly concentrated urine and infrequent voiding
Give examples of pseudo-incontinence:
Puppy excitement, submissive behaviour, poor housebreaking,nleft inside too long, disorders leading to urgency
What drug can be given to detract the detrusor?
bethanechol (cholinergic)
What drugs can be used to relax the bladder sphincter?
Phenoxybenzamine (alpha blocker), diazepam
What drugs are used for urethral sphincter mechanism incompetance?
Alpha-adrenergic agonists (ephedrine) and hormones (oestradiol, testosterone)
What drugs would you give for detrusor hyper-excitability?
Anticholinergics (imipramine)
Which antibiotic has good prostatic infiltration?
Enrofloxacin
What type of urolith are these likely to be?
Struvite
What is there evidence of in this radiograph?
Vesico-ureteral reflux
