Ur-ine Trouble Flashcards by Cimmeron Madrid

What is a difference between colic and dysuria in foals?

The foal will extend the back legs out and seem to have difficulty urinating. This is likely due to colic impaction and not the bladder, even though the owner will think it is the bladder

How well did you know this?

Not at all

Perfectly

What about renal uroliths?

Can appear in the kidney or ureter and are difficult to do

Colic is rare

Can be dx with ultrasound

Can cause microscopic hematuria

Remove the affected kidney if no azotemia

How well did you know this?

Not at all

Perfectly

What are signs of urethral stones?

Dysuria and colic

How well did you know this?

Not at all

Perfectly

How can you remove/treat urethral stones?

Endoscopy or a perineal urethrostomy if male

How well did you know this?

Not at all

Perfectly

What are clinical signs of bladder stones?

Hematuria (post exercise - pounding on the bladder)
Dysuria
Colic
Pyuria
Incontinence

How well did you know this?

Not at all

Perfectly

How do you diagnose bladder stones?

Transrectal palpation

Cystoscopy: Sedate and empty the bladder

How well did you know this?

Not at all

Perfectly

How do you remove bladder stones?

A. Manual extraction is females
B. Perineal urethrostomy in males
C. Mechanical lithotripsy (put stone in bag and hammer to get it smaller?)

How well did you know this?

Not at all

Perfectly

What urinary structures can you palpate on a transrectal palpation?

Palpate empty

The bladder: Size, wall thickness, masses, calculi, and tone

Caudal pole of the left kidney, the right is too far up

Ureters are not palpable unless there is a stone

How well did you know this?

Not at all

Perfectly

What urinary structures can be seen on ultrasound?

Bladder: Urine, mass, ruptured bladder, and stone

Kidney: Size, echogenicity, masses, and cyst

Can be done transrectal or transabdominal

How well did you know this?

Not at all

Perfectly

What is a diet to help prevent/treat calculi?

No alfalfa (Ca carbonate)

Grass hay

How well did you know this?

Not at all

Perfectly

How to get and what to look for in a UA?

Collect sample in the stall and then observe urination (look for blood and when? Throughout or end?

What is the color?

Will always be turbid (Ca carbonate)

USG be hypo (<1.008), iso (1.008 - 1.015), or hyper- sthenuric (>1.015)

How well did you know this?

Not at all

Perfectly

What can a dipstick tell you in horses?

Don’t work well since the pH is 8-9, but can estimate it 7-9
1. Glucose - (tubular dysfunction vs hyperglycemia)
2. Blood: usually false negative
- Myoglobin, Hb, RBC
- False + because of pH
- Microscope:
3. Bilirubin: hemolysis
4. Protein (estimate)
- Protein/Cr
- Colostrum
- Pre, renal, post- renal
5. Ketones are not used

How well did you know this?

Not at all

Perfectly

What can you find on a sediment (within the hour)?

WBC (should not be there), RBC (can be there with catheterization)

Bacteria

Casts

Crystals

Enzymes: GGT (tubules)/Creatinine
- GGT also shows kidney tubular damage
Fractional CL electrolytes: Urine and serum

How well did you know this?

Not at all

Perfectly

What is are some big indicators of renal dysfunction on urinalysis?

Azotemia + Isosthenuria

How well did you know this?

Not at all

Perfectly

What toxins can affect the kidney and what part of the kidney does it act?

Gentamicin and pigments

Cortex

How well did you know this?

Not at all

Perfectly

What can cause hypoxia and what part of the kidney does it act?

Flunixin

Dehydration

Affects the medulla

What does NSAID toxicity cause?

Papillary necrosis

What are clinical signs of acute renal failure?

There is no way to know from clinical exam/signs
NO CLINICAL SIGNS
A. Of the primary problem, NOT of ARF
B. Not suspected unless renal function evaluated (bloodwork + USG)
C. Identify patients at risk
D. Associated with oliguria - anuria (rare)
E. +/- Lethargy

How do you diagnose acute renal failure?

Blood work
- Azotemia
- +/- Hyponatremia
- Hypocholeremia
- Hyperkalemia
UA
- USG: Isosthenuria
- RBC
- Proteinuria
- Granular casts
- GGT

How do you treat acute renal failure?

Treat the primary cause
Fluids at 2x maintenance
Dopamine (increased blood pressure)
Monitor the azotemia: on/off fluids
- Should respond very fast. If the (Cr) doesn’t change, then you should be worried about permanent damage
Prognosis: varies with damage

Tell me about calculi

Most occur in adults with 60% being in the bladder

75% cases are geldings

Can cause complete or partial obstructions

Made out of calcium carbonate

Alfalfa diets predispose

What mechanisms should you consider with edema?

Decreased oncotic pressure
Increased hydrostatic pressure
Decreased lymphatic drainage
Increased capillary permeability

What is polyuria and what are its specs?

Producing >50mL/kg/day (25L/day approx.) of urine

Requires 24 hour urine collection

Can lead to polydipsia

What is polydipsia and what are its specs?

Drinking >100mL/kg/day (50L/day approx.) of water

Consider diet, the environmental temp, and workload

What is primary polydipsia?

Psychogenic is the most common form Likely have a low USG (<1.005) with a normal physical Can be due to medullary washout, no Na in the medulla so they can’t concentrate even if they wanted to Sure reason not known, hard to manage

What is secondary polydipsia?

Can be secondary to: A. Azotemia B. PPID: age and other signs C. Systemic disease (sepsis) D. Diabetes insipidus is less common - Could be central or nephrogenic

How do you diagnose polydipsia?

Perform a water deprivation test - Do not do if azotemic or dehydrated - Baseline UA, BUN/CR, and body weight - Give no water with a slow feeder hay net - Asses BW and USG every 6 hours A normal horse or primary PD with have USG >1.025 in 24 hr Stop test if BW loss or > 5% or if dehydration occurs If medullary washout or chronic perform a modified test where you give water every 6 hours to see if they can regain the medullary wash to correct it. If they can = no problems

What are some chemistry and CBC values that could be seen with end stage renal disease or chronic renal failure?

1. Anemia 2. Hypoproteinemia (hypoalbuminemia) 3. Hypercalcemia 4. Hyponatremia 5. Hypochloremia 6. Hyperkalemia

What are some urinalysis values that could be seen with end stage renal disease or chronic renal failure?

USG: Isosthenuria (1.008-1.015) No sediment abnormalities Strip - positive for protein and glucose No sediment abnormalities?

How do you diagnose chronic renal failure?

1. Renal biopsy (may not change anything if end stage) - US guided - Diagnostic vs prognostic

What can cause chronic renal failure?

1. Congenital (rare) - Less than 5 years old - No acute renal failure - Examples: Renal agenesis, hypoplasia, dysplasia, etc. 2. Acquired (most common) - Previous injury - Cause may be unknown

What are some clinical signs of chronic renal failure?

A. Lethargy B. Weight loss C. Oral ulcers or uremic odor from nitrogenous wastes accumulation D. PU/PD E. Anemia

How do you treat chronic renal failure?

No cure, the goal is to keep up the quality of life 1. Fresh water available at all times (from increased drinking and lack of concentrating ability 2. If HCO3 is low, give 3. Diet: Maintain a good BCS with - Good quality grass - No alfalfa (since it has tons of Ca) - Fat - Omega 3 fatty acids Do not breed

What is a good summary of signs indicating chronic renal failure?

1. Persistent isosthenuria (1.008-1.015) 2. Proteinuria 3. Azotemia 4. Clinical signs