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VMS3011 Veterinary Medicine 2 > Renal Treatment > Flashcards

Renal Treatment Flashcards

1
Q

Chronic renal failure (companion animal)

A
  • 1). DIET - dec phosphate + protein intake (dec uraemia)
  • 2). PHOSPHATE BINDERS e.g. Pronefra - >1.6 mmol/L
  • 3). HYPERTENSION - Amlodipine (Amodip): Ca^2+ channel blocker, SID, 0.625 mg - 1.25 mg); Telmisartan (Semintra) (Angrotensin receptor blocker (ARB) (1.5 mg/kg BID then 2 mg/kg SID)
  • 4). PROTEINURIA - Telmisartan (ARB); Benazepril (Fortekor) (angiotensin-converting enzyme inhibitor (ACEI))
  • 5). POTASSIUM SUPPLEMENTATION - Kaminox
  • GI SIGNS: antiemetics: Maropitant, Metoclopramide; appetite stimulants: Miratazapine; H2 blockers: Famotidine; proton pump inhibitor: Omeprazole
  • ANAEMIA - blood transfusions, EPO injection
  • HYDRATION support - stage III/IV
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2
Q

Chronic renal failure stage 1 (companion animal)

A
  • Use nephrotoxic drugs w/ caution
  • Correct pre-renal + post-renal abnormalities
  • Fresh water available at all times
  • Monitor trends in creatinine + SDMA to document stability or progression
  • Investigate for + treat underlying disease/complications
  • Treat hypertension if systolic blood pressure > 160 mmHg/evidence of end-organ damage
  • Treat persistent proteinuria w/ renal therapeutic diet + medication (UPC >0.5 dogs; UPC > 0.4 cats)
  • Keep phosphorus < 4.6 mg/dL (<1.5 mml/L)
  • Renal therapeutic diet + phosphate binder if required
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3
Q

Chronic renal failure stage 2 (companion animals)

A
  • Stage 1 Tx
  • Renal therapeutic diet
  • Treat hypokalaemia in cats
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4
Q

Chronic renal failure stage 3 (companion animal)

A
  • Stage 2 Tx
  • Keep phosphorus <5.0 mg/dL (<1.6 mmol/L)
  • Treat metabolic acidosis
  • Consider anaemia Tx
  • Treat V+, inappetence, nausea
  • Inc enteral or subcut fluids to maintain hydration
  • Consider calcitriol therapy in dogs
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5
Q

Chronic renal failure stage 4 (companion animals)

A
  • Stage 3 Tx
  • Keep phosphorus <6.0 mg/dL (<1.9 mmol/L)
  • Consider feeding tube for nutritional + hydration support + ease of medicating
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6
Q

Acute kidney injury (AKI) (companion animal)

A
  • 1). Prevent absorption toxins - induce emesis (apometic); activated charcoal (prevents systemic absorption)
  • 2). Cessation nephrotoxic substances
  • 3). Treat underlying cause
  • 4). IV fluids - electrolyte imbalances, high rate if hypovolaemic (work out deficit); monitor w/ urine output/BW/PCV + TS
  • 5). Assessment urine output - indwelling urinary catheter
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7
Q

Acute kidney injury - management of oliguric/anuric renal failure (companion animal)

A
  • IVFT - tailored to hydration status, caution of fluid overload
  • Furosemide (alleviate vol overload) - 0.5 - 1 mg/kg IV/CRI
  • Hyperkalaemia - calcium gluconate (heart protection); insulin (co-transporter of K^+); glucose; sodium bicarbonate
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8
Q

Acute kidney injury - management in recovery phase (companion animal)

A
  • Matching ‘in’ + ‘out’ - weight to see if urinating
  • Hydration status assessment
  • Taper fluids once eating, drinking + azotaemia resolved
  • Hypertension Tx
  • GI complications
  • Nutritional support
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9
Q

Acute kidney injury (horse)

A
  • Manage underlying cause
  • Discontinue nephrotoxic drugs
  • Fluid therapy
  • Supportive Tx - nutrition, managing concurrent disease
  • Diuretics if horse not producing urine after 12 - 24 h: furosemide (1 - 3 mg/kg q2h IV); dobutamine infusion

If ineffective: dialysis
- Haemodialysis
- Peritoneal dialysis - intermittent

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10
Q

Acute kidney injury - acute tubular necrosis (cow)

A
  • Removal/binding of ingeted toxin if within first 24 h: rumenotomy; admin activated charcoal
  • IVFT - renal perfusion + urine production restoration
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11
Q

Chronic kidney disease (horse)

A
  • Maintain hydration
  • Address any existing underlying causes
  • Palatable diet - adequate protein intake <10%; supplement diet w/ CHO + fat
  • Reduce calcium intake, avoid alfalfa
  • May require NaCO3 supplementation
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12
Q

Chronic kidney disease - renal amyloidosis (cow)

A
  • No Tx, poor Px = euthanasia
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13
Q

UTI (companion animal)

A
  • AB therapy: Ampicillin/TMPS
  • NSAIDs
  • Glycosaminoglycans (GAGs) (esp feline idiopathic cystitis)
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14
Q

‘Sludgy Bladder’ (rabbit)

A
  • IVFT
  • Analgesia - meloxicam (cascade, 6 x dose)
  • AB - enrofloxacin/TMPS
  • Sx - remove calculi; flush bladder
  • Hygiene - chlorhexidine; fusidic acid; zinc oxide; rearguard (cyromazine)
  • Diet - avoid calcium rich diet; change to Timothy hay
  • If suspected encephalitozooanosis - albendazole/fenbendazole for 30 d
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15
Q

Lower urinary tract trauma (companion animal)

A

Stabilisation:
- IV - manage azotaemia, correct electrolyte imbalance (prevent bradycardia due to hyperkalaemia)
- Urine drainage - catheter placement; intermittent cystocentesis; peritoneal catheter (can also be used for lavage to treat hypothermia)

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16
Q

LUT trauma - bladder rupture (companion animal)

A
  • Conservative - indwelling urinary catheter
  • Surgical debridement + repair
17
Q

LUT trauma - urethral rupture (companion animal)

A
  • Urinary diversion to favour wound healing
  • Conservative management - indwelling urinary catheter
  • Surgical - surgical repair of wound; perineal urethrostomy
18
Q

Bladder tumour - transitional cell carcinoma (dog)

A
  • Chemotherapy
  • Piroxicam (NSAID)
19
Q

Feline idiopathic cystitis (FIC) (cat)

A

(No cure)
- Litter tray management
- Stress management - Feliway; tricyclic antidepressants e.g. amitriptyline
- Enhance water intake, wet diet, reduction in urine SG
- Analgesia - metacam, butorphanol, buprenorphine, NSAIDs
- Environmental enrichment
- Glycosaminoglycans (GAGs)

20
Q

Urolithiasis (companion animal)

A
  • 1). Medical - treat UTI; dietary modification
  • 2). Surgical removal - invasive
  • 3). Catheter retrieval
  • 4). Voiding urohydropulsion - GA; agitation + gravity
  • 5). Retrograde urohydropulsion (pushing uroliths back into bladder) - catheter + lubricant/saline mixture, finger to occlude pelvic urethra + create high pressure around urolith, flush back into bladder
  • 6). Lithotripsy - breaking up uroliths into smaller fragments by laser to pass through urethra
21
Q

Ureteric obstruction (companion animal)

A
  • Subcutaneous ureteric bypass (SUB)
22
Q

Urethral obstruction (companion animal)

A

Emergency stabilisation:
- IV catheter
- IVFT - Hartmann’s 5 - 10 mL/kg bolus over 10 - 15 min
- Protect heart from hyperkalaemia - calcium gluconate/dextrose + insulin
- Analgesia - opioids, burprenorphine; NSAIDs (once eating, urinating + adequate renal perfusion)
- Urinary catheter - GA/sedate - Vygon Kat Kath (can flush + left in situ, softens w/ body temp in urethral lumen) - assess closed collection system, calculate urine vol produced (1 - 2 ml/kg/hr)
- Antispasmodics - prazosin (0.25 - 1 mg, BID/TID), smooth muscle relaxant; dantrolene (0.5 - 2 mg/kg BID)
- Monitor azotaemia + electrolytes
- Discharge when normal consistent voiding behaviour + correction of biochemical parameters

23
Q

Urinary incontinence, improving storage (companion animal)

A
  • IUS (intra urethral sphincter) stimulant - sympathomimetics: phenylpropanolamine (or ephedrine, pseudoephedrine; sensitisation of adrenergic receptors: oestriol (oestrogen)
  • Bladder relaxant (detrusor muscle relaxant) - antimuscarinic: propantheline; tricyclic antidepressants/anxiolytics: imipramine, amitriptyline
24
Q

Improving bladder voidance (companion animal)

A
  • Bladder contraction (detrusor muscle stimulant) - paraysympathomimetic: bethanechol (+ cispride, gastric prokinetic, inderict PS stimulation)
  • IUS (intra urethral sphincter) relaxant - phenoxybenzamine, non-selective alpha-adrenergic receptor antagonist; prazosin, selective alpha-adrenergic antagonist
  • EUS (external) relaxant - smooth muscle relaxants: diazepam, dantrolene
25
Q

Urethral sphincter mechanism incompetence (USMI) (companion animal)

A
  • Weight loss
  • Alpha-sympathomimetics: phenylpropanolamine (PPA) (propalin), 1.5 mg/kg q8 - 12 hrs PO
  • Ephedrine - converts to PPA in liver, enurace + caniphedrin
  • Oestriol (incurin) - 0.5 - 1.0 mg/dog q24 hrs PO for 5 -7 d then q2 - 3 d as needed

Surgery:
- Artificial urethral sphincter (AUS)/collagen implant
- Move bladder neck into abdo - colposuspension; urethral sling; cystourethropexy

26
Q

Restricted bladder filling - detrusor overactivity e.g. bladder hypoplasia, bladder neoplasia, transitional cell carcinoma (companion animal)

A
  • Inc bladder capacity/dec spasticity (voidance)
  • Antimuscarinic (anticholinergic) agents - propantheline
  • Relaxants - imipramine
27
Q

Ectopic ureter (companion animal)

A

Surgery:
- Intramural - transurethral cystoscopic ablation of intramural ectopic ureters - ureteral orifice relocated to urinary bladder
- Extramural - surgical re-implantation of ureteral orifices to urinary bladder
- Nephrectomy/ureterectomy if unilateral
- Supportive Tx - PPA/oestrogen

28
Q

Bladder distension - detrusor atony (companion animal)

A
  • Address underlying cause
  • Relieve any obstruction, catheterise if necessary
  • Parasympathomimetics e.g bethanechol (only effective on smooth muscle cells)
29
Q

Reflex dyssynergia - failure of coordination of sphincter relaxation + detrusor contraction (companion animal)

A
  • Prevent bladder distension + restore normal detrusor contraction
  • Catheterisation - prevents inc bladder filling
  • Parasympathomimetic (bethanechol) - restores detrusor contraction
  • Sypatholytic agent (prazosin) - allows sphincter relaxation (dec outflow resistance)
  • Monitor for UTIs
30
Q

Urinary tract infections (UTIs) (equine)

A
  • AB that concentrate within urine - trimethoprim sulphonamide (TMPS) = first line, broad spectrum (or penicillin, cephalopsorins), 7 - 10 d
31
Q

Urolithiasis (equine)

A
  • AB for concurrent bacterial infection

Surgical resection where possible:
- Cystotomy - laparoscopy + techniques to manipulate +/- break down calculus
- Urethrostomy (perineal)
- Nephrectomy (nephrolithiasis) - viable option for unilateral disease if ruptured

  • Manual crushing/fragmentation (mallet + osteotome) - lithotripsy: extracorporeal shock wave therapy; trans-endoscopic lithotripsy: electrohydraulic shockwave/laser; Holmium YAG
32
Q

Sabulous urolithiasis/sabulous cystitis (large animal)

A
  • Promote bladder emptying e.g. bethanechol
  • AB to control cystitis
  • Anti-inflammatories
33
Q

Patent urachus (foal)

A
  • May resolve w/ supportive care - urachus may close spontaneously
  • Care with umbilical disinfection - may prematurely remove stump -> acquired patent urachus
  • Systemic AB therapy
  • Surgical resection of umbilical remnants if obviously septic structures and/not responding to medical Tx
34
Q

Uroperitoneum (foal)

A

Initial medical support to address metabolic disturbances:
- Peritoneal drainage
- IVFT - address azotaemia
- Address hyperkalaemia - IV glucose/dextrose solution; sodium bicarbonate solution?
- Broad spectrum AB

Once stabilised:
- (K^+ < 5.5 mEq/L)
- Surgical repair of bladder - two layers, second layer inverting, monofilament suture, pos laparoscopy assisted
- Resection of umbilical remnants if indicated

35
Q

UTIs - corynebacterium renale (ruminant)

A
  • Prolonged + aggressive antimicriobial therapy - penicillin (first line due to C. renale): propenicillin (22 - 44 mg/kg IM BID), ampicillin (11 mg/kg IM BID)
  • Urine acidifiers e.g. ammonium salts to reduce adherence of C. renale (not palatable on food)
  • Unilateral nephrectomy may be indicated in chronic/refractory cases
36
Q

Urolithiasis (ruminant)

A

Surgical intervention - clear/bypass obstruction + regain urine output
- Amputation of urethral process
- Urethrostomy - perineal/pre-pubic
- Cystomy
- Tube cystomy
- Bladder marsupilsation (draining)

37
Q

Acute renal tubular necrosis/AKI from lily toxicity (cat)

A
  • Decontamination if ingestion of lilies in last 6 h: activated charcoal, emetic, gastric lavage, wiped down/wash coat
  • Anti-emetics - maropitant if continued V+ to relieve nausea (visceral pain relief); metoclopramide; pot oesophagostomy tube for additional nutrition
  • Gastric protectants - omeprazole – proton pump inhibitor (PPI) to reduce gastro-oesophageal reflux; famotidine – histamine (H2) receptor antagonist
  • Others: mirtazapine – appetite stimulant. Only if nausea and vomiting controlled (watch); IV antimicrobials – have to justify
  • Treatment of hyperkalaemia – indicated if significant ECG changes/arrhythmias - loss of p waves, peaked t waves + eventual bradycardia; IVFT, calcium gluconate, insulin + glucose

VMS3011 Veterinary Medicine 2 (20 decks)

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