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Sem 6: SAM 2 > Renal Tubular Diseases, UTIs, Uroliths and Crystals > Flashcards

Renal Tubular Diseases, UTIs, Uroliths and Crystals Flashcards

1
Q

Which dog breeds are predisposed to renal glucosuria?

A
  • Basenji
  • Norwegian Elkhound
  • Scottish Terrier
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2
Q

What clinical signs do dogs with renal glucosuria typically present with?

A
  • PU/PD but otherwise BAR/healthy
  • Diagnostics revealing normoglycemic glucosuria
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3
Q

What is the pathophysiology behind renal glucosuria in basenjis, norwegian elkhounds, and scottish terriers?

A
  • Genetic, inability to reabsorb glucose in the PCT or DCT
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4
Q

What area of the kidney is most affected by Fanconi syndrome?

A
  • Proximal tubular disorder
  • Failure to absorb many electrolytes: glucose, K+, Phos, Bicarb, Ca+, AAs
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5
Q

What bloodwork findings are consistent with Fanconi syndrome?

A
  • Electrolyte imbalances: failure to reabsorb glucose, K+, Phos, Bicarb, Ca+, AAs
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6
Q

What is an acquired cause of Fanconi syndrome?

A
  • Jerky treats
  • Gentamicin
  • Chlorambucil in cats
  • HypoPTH
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7
Q

What breed is predisposed to Fanconi syndrome?

A
  • Basenjis
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8
Q

What clinical signs can be seen in a patient with Fanconi syndrome?

A
  • PU/PD
  • Bone density loss / osteomalacia
  • Weight loss
  • Aciduria pH < 6

(clinically unwell… unlike renal glucosuria)

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9
Q

How can you differentiate Fanconi syndrome vs renal glucosuria in a Basenji presenting with PU/PD?

A
  • Check CBC!!
  • Normal BG with glucosuria in renal glucosuria, also present clinically well
  • Low BG and glucosuria with Fanconi syndrome
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10
Q

What happens with Type I Renal tubular acidosis?

A
  • Distal tubular disorder
  • Failure to excrete H+ = metabolic acidosis
  • Increased excretion of Bicarb = Alkalinuria)
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11
Q

What happens with Type II Renal tubular acidosis?

A
  • Proximal tubular disorder
  • Defective bicarb reabsorption = metabolic acidosis
  • H+ secreted in urine to compensate = Aciduria

Seen with Fanconi syndrome

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12
Q

Does cystinuria have a sex predilection?

A

Yes, males > females

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13
Q

A 5 year old male English Bulldog presents with PU/PD. Upon further urinary testing, hexagonal shaped crystals are seen. What is your diagnosis and what is the treatment plan?

A
  • Cysteine crystals
  • Alkalinize the urine with potassium citrate
  • 2-MPG / Tiopronin binds cysteine
  • Feed non-acidifying, low protein, low Na+ diet
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14
Q

Hyperuricosuria is common in what dog breeds?

A
  • Dalmations
  • English bulldogs
  • Black Russian Terriers
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15
Q

What is the pathogenesis behind hyperuricosuria?

A
  • Genetic or due to PSS (hepatic dz)
  • Defect in conversion of urate to allantoin
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16
Q

Treatment plan for hyperuricosuria?

A
  • Protein restricted diet
  • Allopurinol (converts urate to allantoin)
  • Alkalinize the urine with potassium citrate
  • Increased hydration
  • Management of hepatic dz if needed
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17
Q

What is the most common heriditary renal disorder in cats?

A

Polycystic kidney disease

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18
Q

What breed is predisposed to polycystic kidney disease?

A

Persians

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19
Q

How can polycystic kidney disease be prevented?

A

Complete elimination of all affected Persians from breeding programs!

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20
Q

Infection with which urease producing bacteria can result in struvite urolithiasis?

A
  • Staphylococcus
  • Proteus
  • Enterococcus
  • Mycoplasma
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21
Q

Which stones are radio-opaque and can be seen on survey radiographs?

A

- Calcium phosphate
- Calcium oxalate
- Struvite
- Silicate

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22
Q

Which stones are radiolucent and need contrast studies for visualization?

A

- Cysteine
- Urates
- Xanthine

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23
Q

When is extracorporeal shock wave lithotripsy recommended for nephrolithiasis?

A
  • Dogs only!
  • For struvite and calcium oxalate stones only
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24
Q

How can struvite stones be medically managed?

A
  • D-methione acidifier!
  • Restrict Mg, NH3, and PO4
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25
Q

What crystals can be seen with ethylene glycol toxicity?

A

Calcium oxalate monohydrate

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26
Q

How can you medically manage a patient with calcium oxalate stones?

A
  • Alkalinize the urine with Potassium citrate
  • Thiazide diuretics (not indicated if hyperCa)
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27
Q

What test can be performed to diagnose Type I Renal tubular acidosis?

A

Ammonium Chloride challenge, measure pH over time

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28
Q

What test can be performed to diagnose Type II Renal tubular acidosis?

A

Sodium bicarbonate challenge, measure pH over time

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29
Q

What dog breed is overrepresented for cysteinuria?

A
  • English bulldogs
  • Males > females
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30
Q

What is the prognosis of renal glucosuria?

A

Good prognosis!

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31
Q

What is the most common kidney neoplasia in dogs vs cats?

A

Dogs - Renal Carcinoma
Cats - Renal Lymphoma

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32
Q

List differentials for bilaterally enlarged kidneys

A
  1. Lymphoma / Carcinoma / Neoplasia
  2. FIP
  3. Acute Glomerulonephritis
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33
Q

What is the treatment of choice for a dog with renal neoplasia?

A
  • Nephrectomy if unilateral disease
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34
Q

What is the treatment of choice for a cat with renal neoplasia?

A
  • Usually lymphoma in cats so tx of choice is chemotherapy

(CHOP protocol)

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35
Q

What clinical findings are consistent with sporadic cystitis?

A
  • Sporadic bacterial infection with lower urinary tract signs
  • ** < 3 episodes in 12 months**
  • Stranguria, hematuria, dysuria, pollakiuria
36
Q

What clinical findings are consistent with recurrent cystitis?

A
  • ** > 3 episodes within 12 months or > 2 episodes within 6 months**
  • Recurrent bacterial infection with lower urinary tract signs
37
Q

What is the definition of pyelopnephritis?

A

Imflammation of the renal pelvis and surrounding parenchyma

38
Q

What bacterial pathogen is most commonly associated with UTIs?

A
  • E coli
  • Usually ascending infection from GI or perineal regions
39
Q

What underlying diseases can alter the antimicrobial properties of urine, predisposing to bacterial overgrowth and UTIs?

A
  • Diabetes mellitus
  • HAC / Cushings
  • Hyperthyroidism
  • CKD
40
Q

What underlying diseases can alter the mucosal defense barriers, predisposing to bacterial overgrowth and UTIs?

A
  • TCC
  • Chronic UTI / Chronic kidney disease
  • Uroliths
  • Cyclophosphamide
41
Q

List risk factors for developing UTIs

A
  1. CKD
  2. Endocrine disorders (DM, HAC, HyperT)
  3. Female gender
  4. Pyoderma
  5. Ectopic ureters
  6. Indwelling catheters
42
Q

A patient presenting with lower urinary tract signs like stranguria and hematuria, and evidence of a fever and abdominal back pain should raise concern for?

A
  • Prostatitis
  • Pyelonephritis
43
Q

When should a urine sample be analyzed?

A

Within 30 mins of collection

44
Q

What values can not be accurately interpreted on urine dipstick?

A
  • not useful for WBCs, USG, Nitrite, or Urobilinogen
45
Q

How are hyaline casts in urine interpreted?

A
  • Pre renal or Renal proteinuria
46
Q

How can granular or cellular casts be interpreted in a urine sample?

A

Indicative of tubular degeneration

47
Q

List indications to perform a urine culture

A
  • Patients with LUTD but inactive sediment
  • Suspect pyelonephritis (fever, abd pain)
  • Septic patient
  • Suspect struvite urolithiasis
  • Patients needing surgery of urinary tract
48
Q

What diagnostic can be performed to ID suspect radiolucent calculi?

A

Retrograde double contrast cystography

49
Q

What diagnostic can be performed to ID suspect ectopic ureters?

A

Excretory Urogram or IV pyelogram

50
Q

What is the first line treatment for sporadic or recurrent cystitis?

A
  • Withhold Abx tx pending C&S results
  • Then give Amoxicillin or TMS 3-5 days
51
Q

What is the first line treatment for bacterial prostatitis?

A
  • Fluoroquinolones (Enrofloxacin) or TMS for 4-6 weeks
  • Also castration!
  • Start treatment pending culture results
51
Q

What is the first line treatment for a patient with suspect pyelonephritis?

A
  • Fluoroquinolones (Enrofloxacin) for 10-14 days
  • Start treatment pending culture results
52
Q

What antibiotic should not be used to treat a UTI if a patient has concurrent kidney disease?

A

Dont use Gentamicin!

53
Q

The urinary tract is the most common extraintestinal source of MDR ________ and _________ spp. in dogs

A

E. coli and Enterobacter spp.

54
Q

What physical exam and bloodwork findings can be present in a cat with a urethral obstruction?

A
  • Bradycardia!! Low HR!! due to hyperkalemia from obstruction
  • Post renal azotemia
55
Q

Where are uroliths most commonly found?

A. Renal pelvis
B. Ureters
C. Urethra
D. Bladder

A

D. Bladder

56
Q

What is the most common urolith seen in cats vs dogs?

A

Cats - Calcium oxalates
Dogs - Struvites

57
Q

List factors that influence the growth of uroliths in dogs and cats

A
  • Urine pH and concentration
  • Less frequent voiding
  • Presence of UTI (struvites in dogs)
  • Diet and hydration
58
Q

What is the signalment that is most consistent with urolithiasis?

A
  • More common in males
  • Except struvites more common in females
  • Purine, cysteine, and struvites seen in young animals
  • CaOxalates seen in older animals (cats)
59
Q

What stones form in the presence of alkaline urine?

A

- Struvites
- Calcium phosphate

(Tx is to acidify the urine)

60
Q

What stones form in the presence of acidic urine?

A

- Calcium oxalates
- Cysteine
- Urates

(Tx is to alkalinize the urine with Potassium citrate)

61
Q

Which uroliths can not be dissolved with medical management and therefore requires surgical intervention?

A
  • Calcium oxalate stones
  • Silicate stones
62
Q

What methods can be used to treat urolithiasis?

A
  • Catheter to pass small stones
  • Urohydropropulsion under GA
  • Cystoscope guided removal
  • Lithotripsy (dogs only)
63
Q

What is the treatment plan for a patient with silicate urolithiasis?

A
  • Can’t be dissolved with medical management
  • Surgical removal required
  • Cefazolin 3-5 days prior to procedure
64
Q

What is the treatment plan for struvite urolithiasis in dogs?

A
  • Treat underlying UTI
  • Medical management via dissolution diet
  • Wet food and acidifying diet
  • Hydration is key!
65
Q

When is diet change to medically manage struvite urolithiasis contraindicated?

A
  • If CHF, hypertension, or nephrotic syndrome
  • If patient is at risk of pancreatitis
  • Not for pregnant, lactating or growing animals (restricted proteins delay healing)
66
Q

What can cause juvenile onset Calcium Oxalate urolithiasis in dogs?

A

Hereditary CaOx uroliths in YOUNG BULLDOGS due to mutation in Uromodulin (cystallization inhibitor)

67
Q

What is the treatment plan for a cat with Calcium oxalate uroliths?

A
  • Can’t be dissolved, surgical removal is the tx of choice
  • Prevent recurrance with alkalinizing diet
  • Alkalinize the urine with potassium citrate if diet therapy fails
  • High risk of recurrance
68
Q

What dog breeds are over represented for getting cystein uroliths?

A
  • YOUNG Newfoundlands
  • Bulldogs
69
Q

What is the pathophysiology behind cysteine uroliths seen in young Newfoundlands?

A
  • Hereditary defect in metabolism of COLA amino acids
70
Q

What is the treatment protocol for management of cysteine uroliths in dogs?

A
  • Medically manage since these stones can dissolve
  • Switch to alkalinizing diet low in protein and salt
  • Potassium citrate or 2-MPG (Tiopronin… binds cysteine) for adjunctive therapy
71
Q

What signalment is most commonly seen with patients presenting with Silicate uroliths?

A
  • Young males
  • History of a vegetable diet
  • Unique Jackstone appearance
  • Forms in acidic urine
72
Q

What is the most common cause of FLUTD in cats?

A

Feline interstitial cystitis (FIC)

73
Q

List risk factors for FLUTD in cats

A
  • Young males
  • Multi cat households
  • Obesity / BCS
  • indoor/outdoor lifestyle
  • Diet
  • Alkaline urine
  • Decreased voiding frequency
74
Q

What clinical findings are present in a blocked cat?

A
  • Large, firm, painful bladder
  • Bradycardia with hyperkalemia
  • Azotemia
75
Q

What clinical findings are present in a cat with non obstructive FLUTD?

A
  • Small bladder
  • Otherwise doing well but with lower urinary tract signs like stranguria/dysuria/hematuria etc
76
Q

What is the treatment protocol for addressing feline patients with FLUTD?

A
  1. IV fluids
  2. ECG to assess hyperkalemia
  3. Blood for PCV, TP, BUN, BG and electrolytes
  4. If K+ > 6 mEq/L give Insulin and Dextrose
  5. If K+ > 8 mEq/L give Calcium gluconate (cardioprotective, doesn’t treat the hyperkalemia)
77
Q

What is the most common treatment protocol following initial stabilization of obstructive FLUTD?

A
  • Retrograde flushing with Polypropylene/TomCat catheter and sterile 0.9% NaCl
  • Urethral massage if due to urethral plugs
78
Q

When is an indwelling catheter indicated in a cat with FLUTD?

A

- Severely ill patient
- Grossly abnormal urine or calculi
- Severe bladder distention

79
Q

Potassium citrate is an indicated agent to prevent which type of urolith stones?

A
  • Calcium oxalates
  • Urates
  • Cysteine

(Not good for Struvites or Calcium phosphate stones)

80
Q

2-MPG / Tiopronin is a treatment option to medically manage which type of urolith stone?

A

Cysteine

81
Q

What clinical findings can be seen in a cat with polycystic kidney disease?

A
  • Hematuria
  • Increased risk of UTIs
  • Large irregular kidneys on palpation
  • Being a Persian cat
82
Q

You have a new client who comes in with their 7 month old Persian cat. The owner has been googling PKD and wants to know if her cat has this mutation. What do you advise?

A
  • Screening can be done at 10 months of age
  • Lesions will be missed if trying to diagnose sooner
83
Q

Ddx for presence of ammonium biurate crystals on urine sediment?

A
  • Genetic Hyperuricosuria in Dalmations, English bulldogs, Black Russian Terriers
  • Portosystemic shunt (hepatic dz)
  • Urease producing bacterial UTI
84
Q

List causes of obstructive FLUTD in cats

A
  • Urolithiasis
  • Urethral plugs (composed of struvite)
  • Urethral swelling, spasm, reflex dyssynergia
85
Q
A

Sem 6: SAM 2 (26 decks)

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