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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
What crystals can be seen with ethylene glycol toxicity?
Calcium oxalate monohydrate
26
How can you medically manage a patient with calcium oxalate stones?
- Alkalinize the urine with **Potassium citrate** - Thiazide diuretics (not indicated if hyperCa)
27
What test can be performed to diagnose Type I Renal tubular acidosis?
**Ammonium Chloride challenge**, measure pH over time
28
What test can be performed to diagnose Type II Renal tubular acidosis?
**Sodium bicarbonate challenge**, measure pH over time
29
What dog breed is overrepresented for cysteinuria?
- **English bulldogs** - Males > females
30
What is the prognosis of renal glucosuria?
Good prognosis!
31
What is the most common kidney neoplasia in dogs vs cats?
Dogs - Renal Carcinoma Cats - Renal Lymphoma
32
List differentials for bilaterally enlarged kidneys
1. Lymphoma / Carcinoma / Neoplasia 2. FIP 3. Acute Glomerulonephritis
33
What is the treatment of choice for a dog with renal neoplasia?
- Nephrectomy if unilateral disease
34
What is the treatment of choice for a cat with renal neoplasia?
- Usually lymphoma in cats so tx of choice is **chemotherapy** (CHOP protocol)
35
What clinical findings are consistent with sporadic cystitis?
- Sporadic bacterial infection with lower urinary tract signs - **< 3 episodes in 12 months** - Stranguria, hematuria, dysuria, pollakiuria
36
What clinical findings are consistent with recurrent cystitis?
- **> 3 episodes within 12 months or > 2 episodes within 6 months** - Recurrent bacterial infection with lower urinary tract signs
37
What is the definition of pyelopnephritis?
Imflammation of the renal pelvis and surrounding parenchyma
38
What bacterial pathogen is most commonly associated with UTIs?
- **E coli** - Usually **ascending infection from GI or perineal regions**
39
What underlying diseases can alter the antimicrobial properties of urine, predisposing to bacterial overgrowth and UTIs?
- Diabetes mellitus - HAC / Cushings - Hyperthyroidism - CKD
40
What underlying diseases can alter the mucosal defense barriers, predisposing to bacterial overgrowth and UTIs?
- TCC - Chronic UTI / Chronic kidney disease - Uroliths - Cyclophosphamide
41
List risk factors for developing UTIs
1. CKD 2. Endocrine disorders (DM, HAC, HyperT) 3. Female gender 4. Pyoderma 5. Ectopic ureters 6. Indwelling catheters
42
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?
- Prostatitis - Pyelonephritis
43
When should a urine sample be analyzed?
Within **30 mins of collection**
44
What values can not be accurately interpreted on urine dipstick?
- not useful for **WBCs, USG, Nitrite, or Urobilinogen**
45
How are hyaline casts in urine interpreted?
- Pre renal or Renal proteinuria
46
How can granular or cellular casts be interpreted in a urine sample?
Indicative of tubular degeneration
47
List indications to perform a urine culture
- Patients with LUTD but inactive sediment - Suspect pyelonephritis (fever, abd pain) - Septic patient - Suspect struvite urolithiasis - Patients needing surgery of urinary tract
48
What diagnostic can be performed to ID suspect radiolucent calculi?
Retrograde double contrast cystography
49
What diagnostic can be performed to ID suspect ectopic ureters?
Excretory Urogram or IV pyelogram
50
What is the first line treatment for sporadic or recurrent cystitis?
- **Withhold Abx tx pending C&S results** - Then give **Amoxicillin or TMS 3-5 days**
51
What is the first line treatment for bacterial prostatitis?
- **Fluoroquinolones (Enrofloxacin) or TMS for 4-6 weeks** - Also castration! - Start treatment pending culture results
51
What is the first line treatment for a patient with suspect pyelonephritis?
- **Fluoroquinolones (Enrofloxacin) for 10-14 days** - Start treatment pending culture results
52
What antibiotic should not be used to treat a UTI if a patient has concurrent kidney disease?
Dont use Gentamicin!
53
The urinary tract is the most common extraintestinal source of MDR ________ and _________ spp. in dogs
E. coli and Enterobacter spp.
54
What physical exam and bloodwork findings can be present in a cat with a urethral obstruction?
- **Bradycardia!! Low HR!!** due to **hyperkalemia** from obstruction - Post renal azotemia
55
Where are uroliths most commonly found? A. Renal pelvis B. Ureters C. Urethra D. Bladder
D. Bladder
56
What is the most common urolith seen in cats vs dogs?
Cats - Calcium oxalates Dogs - Struvites
57
List factors that influence the growth of uroliths in dogs and cats
- Urine pH and concentration - Less frequent voiding - Presence of UTI (struvites in dogs) - Diet and hydration
58
What is the signalment that is most consistent with urolithiasis?
- 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
What stones form in the presence of alkaline urine?
**- Struvites - Calcium phosphate** (Tx is to acidify the urine)
60
What stones form in the presence of acidic urine?
**- Calcium oxalates - Cysteine - Urates** (Tx is to alkalinize the urine with Potassium citrate)
61
Which uroliths can not be dissolved with medical management and therefore requires surgical intervention?
- Calcium oxalate stones - Silicate stones
62
What methods can be used to treat urolithiasis?
- Catheter to pass small stones - Urohydropropulsion under GA - Cystoscope guided removal - Lithotripsy (dogs only)
63
What is the treatment plan for a patient with silicate urolithiasis?
- Can't be dissolved with medical management - Surgical removal required - **Cefazolin 3-5 days prior to procedure**
64
What is the treatment plan for struvite urolithiasis in dogs?
- Treat underlying UTI - Medical management via dissolution diet - Wet food and acidifying diet - Hydration is key!
65
When is diet change to medically manage struvite urolithiasis contraindicated?
- **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
What can cause juvenile onset Calcium Oxalate urolithiasis in dogs?
**Hereditary CaOx uroliths in YOUNG BULLDOGS** due to **mutation in Uromodulin (cystallization inhibitor)**
67
What is the treatment plan for a cat with Calcium oxalate uroliths?
- **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
What dog breeds are over represented for getting cystein uroliths?
- **YOUNG Newfoundlands** - **Bulldogs**
69
What is the pathophysiology behind cysteine uroliths seen in young Newfoundlands?
- Hereditary defect in metabolism of COLA amino acids
70
What is the treatment protocol for management of cysteine uroliths in dogs?
- 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
What signalment is most commonly seen with patients presenting with Silicate uroliths?
- Young males - **History of a vegetable diet** - Unique **Jackstone appearance** - Forms in acidic urine
72
What is the most common cause of FLUTD in cats?
**Feline interstitial cystitis (FIC)**
73
List risk factors for FLUTD in cats
- Young males - **Multi cat households** - **Obesity / BCS** - indoor/outdoor lifestyle - Diet - Alkaline urine - Decreased voiding frequency
74
What clinical findings are present in a blocked cat?
- Large, firm, painful bladder - Bradycardia with hyperkalemia - Azotemia
75
What clinical findings are present in a cat with non obstructive FLUTD?
- Small bladder - Otherwise doing well but with lower urinary tract signs like stranguria/dysuria/hematuria etc
76
What is the treatment protocol for addressing feline patients with FLUTD?
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
What is the most common treatment protocol following initial stabilization of obstructive FLUTD?
- **Retrograde flushing with Polypropylene/TomCat catheter and sterile 0.9% NaCl** - **Urethral massage if due to urethral plugs**
78
When is an indwelling catheter indicated in a cat with FLUTD?
**- Severely ill patient - Grossly abnormal urine or calculi - Severe bladder distention**
79
Potassium citrate is an indicated agent to prevent which type of urolith stones?
- Calcium oxalates - Urates - Cysteine (Not good for Struvites or Calcium phosphate stones)
80
2-MPG / Tiopronin is a treatment option to medically manage which type of urolith stone?
Cysteine
81
What clinical findings can be seen in a cat with polycystic kidney disease?
- Hematuria - Increased risk of UTIs - Large irregular kidneys on palpation - Being a Persian cat
82
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?
- Screening can be done at **10 months of age** - Lesions will be missed if trying to diagnose sooner
83
Ddx for presence of ammonium biurate crystals on urine sediment?
- Genetic Hyperuricosuria in **Dalmations, English bulldogs, Black Russian Terriers** - Portosystemic shunt (hepatic dz) - Urease producing bacterial UTI
84
List causes of obstructive FLUTD in cats
- Urolithiasis - Urethral plugs (composed of struvite) - Urethral swelling, spasm, reflex dyssynergia
85

Sem 6: SAM 2 (34 decks)

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