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Year 4 small animal > Urinary > Flashcards

Urinary Flashcards

1
Q

Indications for nephrectomy

A

Normal function of contralateral
Renal/ureteral neoplasia
Trauma
Persistent renal haematuria
Polynephritis - polycystic disease
End stage hydronephrosis
Chronic end stage pyelonephritis
Ectopic ureter

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2
Q

Contraindications for nephrectomy

A

Azotaemia
Persistent isosthenuria

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3
Q

Indications for renal biopsy

A

Renomegaly
Acute renal failure
Familial - renal amyloidosis, renal dysplasia, polycystic kidneys, basement membrane disorders, tubular disorders

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4
Q

What is a nephrotomy

A

Removal of renal calculi

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5
Q

Nephrectomy key points

A

Ligate vein and artery
2 ligations on ureter and divide between ligatures

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6
Q

Complications of renal surgery

A

Renal pain
Haemorrhage - haemoabdomen, haematuria
Retroperitoneal/peritoneal urine leakage
UTI
Compromised renal function

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7
Q

Points for removing calculi

A

Place stay sutures to hold bladder
Incise into ventral wall
Handle as little as possible
Close with absorbable monofilament
4/0 or 3/0 in cats and 4/0,3/0 or 2/0 in dogs
Single layer full thickness inverting or two later
Atraumatic needs
Drape omentalise

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8
Q

Complications of bladder surgery

A

Haemorrhage
Peritoneal urine leakage
Urinary tract infection
Urothelial oedema
Dysuria
Small bladder volume
Reflex dyssynergia

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9
Q

Indications for tube cystotomy

A

Functional or mechanical bladder/urethral obstruction
Excessive urine retention
Post bladder/urethral surgery

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10
Q

Sites of urethral obstruction

A

Kidney
Ureter
Bladder
Urethra

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11
Q

What is a SUBS

A

Submucosal urethral bypass system

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12
Q

Urethral obstruction in the dog

A

Dalmatians struggle with urate stones
Get stuck in caudal ospenis
Treated by retrograde urethral flushing
Cystotomy and further flushing

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13
Q

Neoplasms of the kidney

A

Most common malignant is renal carcinoma
Cystoadenocarcinomas in GSD
Benign tumours uncommon
Middle aged/older animals
Male more common
Nephroblastoma usually unilateral, can get very large
Metastatic can be unilateral or bilateral

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14
Q

Clinical signs of kidney neoplasms

A

Haematuria
Dysuria
Stranguria
Pollakiuria
May show abdominal pain, large palpable kidney, uraemia may be apparent
Bladder wall can be thickened, can palpate caudally

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15
Q

Diagnosis of kidney neoplasia

A

History
Clinical signs
Ultrasonography
Urinalysis
Radiography - excretory urogram
CT

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16
Q

Treatment of kidney neoplasia

A

Surgical removal except lymphosarcoma
Lymphosarcoma combination chemotherapy

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17
Q

Clinical findings for lower urinary neoplasia

A

Chronic obstruction to urine flow - secondary hydronephrosis
Urethral more like to cause acute obstructive uropathy
Reflex dyssynergia

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18
Q

Diagnosis of lower urinary tract neoplasia

A

History and clinical signs
Haematuria on urinalysis
Neoplastic cells in sediment
cysto/retrograde urethrogram

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19
Q

Categories of acute kidney injury

A

Haemodynamic - volume responsive
Intrinsic renal - damage to kidneys
Postrenal - urethral obstruction

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20
Q

What is haemodynamic AKI

A

Reduced renal blood supply common causes include hypovolemia, anaesthetia and use of NSAIDs
Rapidly resolved by correcting the cause, if not corrected progresses to intrinsic renal damage ischaemia and hypoxia

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21
Q

Intrinsic renal AKI

A

Renal damage caused by ischaemia, hypoxia or toxins
Ischaemia causes - hypovolemia, common following bitch spays, deep/prolonged anaesthesia, thrombosis/DIC, hyperviscosity/polycythemia, NSAIDs - normally in relation to overdose
Primary renal disease - infection, immune mediated or neoplastic
Secondary disease - infection, malignant hypertension, hepato renal syndrome, sepsis
Nephrotoxins

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22
Q

Post Renal AKI

A

Urinary obstruction - ureteral or urethral obstruction
Urinary leakage - ureteral, bladder or proximal urethra damage

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23
Q

Intrinsic AKI phases

A

1 - asymptomatic with azotaemia starting towards the end
2 - hypoxia and inflammatory responses propagating renal damage
3 - change in urine output, either improves or gets worse, lasts ~ 3 weeks
4 - recovery phase, weeks-months, can result in severe polyuria and can return to phase 1

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24
Q

Diagnosis of AKI

A

History - <1 week anorexia, V+, PUPD, lethargy, D+
Clinical exam - fluid loss, concurrent illness, specific signs - renal pain, uremic halitosis, jaundice
Biochemistry - azotaemia, hyperphosphataemia, hyperkalemia (dangerous), hypo also possible, hypocalcemia
Urinalysis - inappropriate USG, proteinuria, glucosuria
Ultrasound - POCUS, can appear normal/enlarged, peri-renal free fluid, hydronephrosis
Radiography/CT - obstructions/stones

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25
Q

Leptospirosis AKI

A

Always causes renal damage
Sometimes hepatic damage/DIC
Often leptospira pulmonary haemorrhage syndrome
Findings include thrombocytopenia, anaemia and electrolyte disturbances
Imaging - lung patterns, hepatomegaly, splenomegaly, free fluid in abdomen
SNAP for lepto

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26
Q

Treatment for AKIv

A

Underlying cause
Fluid therapy - match losses and avoid volume overload
Monitor body weight
Time!

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27
Q

Classification of Oliguria and anuria

A

Oliguria <1ml/kg/hour urine in the hydrated and perfused patient
Anuria little to no urine
Treat with diuretics but high risks of causing AKI
Renal replacement dialysis best
Peritoneal dialysis possible in first opinion

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28
Q

Complications of AKI

A

UTI - amoxy-clav first line, doxycycline for lepto
Metabolic acidosis - Hartmann’s
Tachyarrythmia - ECG, consider lidocaine
Hyperkalemia - glucose, insulin, bicarbonate
Hypertension
Nutrition - feeding tube

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29
Q

Prognosis for AKI

A

Good depending on finances and practices facility for 24/7 care

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30
Q

CKD presenting signs

A

PUPD
Anorexia
Weight loss
Dehydration
Pallor
V+/D+
Mucosal ulcers
Uraemic breath

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31
Q

Predispositions for CKD

A

Breed - dogs - westie, shar pei, bull terrier, cocker, ckcs. Cats - Persian, Abyssinian, Siamese, ragdoll, Burmese, Russian blue, Maine coon
Age - older animals but can be young with familial disease
Co-morbidities - hyperthyroidism, hypercalcemia, heart disease, peritoneal disease, cystitis, urolithiasis, diabetes
Nephrotoxic drugs

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32
Q

Pathophysiology of CKD

A

nephron loss causes other nephrons to compensate leading to increased pressure and further damage
this can lead to a uraemic crisis due to build up of normally excreted products

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33
Q

Diagnosis of CKD

A

early stage rarely picked up soon
- abnormal renal imaging, known renal insult
- persistent elevation/increasing creatine or SDMA
- persistent renal proteinuria
Later stages
- consistent clinical signs
- azotaemia, persistently elevated creatinine/SDMA
AND usg <1.035 cats or <1.030 dogs
Does not have to be isosthenuric to be at inappropriate concentrations

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34
Q

Treatment of CKD

A

treat underlying cause
recommendations around controlling proteinuria, hypotension and hyperphosphataemia
Diet is important
Later stages treating anaemia/acidosis/nausea, maintaining hydration and adequate nutrition

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35
Q

What is a uraemic crisis

A

build up of urea and other toxins usually excreted by kidneys to intolerable levels
CS - V+/nausea, anorexia, lethargy, depression, oral ulcers, melaena, anaemia, weakness, hypothermia, muscle tremors, seizures

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36
Q

Treatment of ureamic crisis

A

ivft hartmann’s
assess/treat acidosis if present
Treat nausea/GI ulceration
Nutritional support - appetite stimulants, feeding tube

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37
Q

Treatment of renal hypertension

A

ACEi - benazepril, enalapril
Angiotensin receptor blocker - telmisartan, spirolactone
Calcium channel blockers - amlodipine

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38
Q

Pyelonephritis

A

bacterial infection of the renal pelvis and parenchyma
Diagnosis - clinical signs - fever, abdo pain, PUPD. Left shift neutrophilia. Ultrasound - renal pelvis dilation , hyperechoic mucosa
Treatment - renally excreted antibiotics - amoxycillin/amoxyclav best

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39
Q

Renal neoplasia

A

commonly metastatic
benign primary - adenoma/lipoma/fibroma often incidental findings
Malignant primary - carcinoma, multicentric, lymphoma

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40
Q

Polycystic kidney disease

A

hereditary condition - fluid filled cysts from birth in the kidney, size and number increase with age
similar presentation to CRF with large irregular kidneys. Diagnosed on ultrasound.
Screen pre-breeding

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41
Q

Fanconi’s syndrome

A

disease of proximal tubules leading to reduced resorption of solutes
idiopathic/hereditary/gentamycin nephrotoxicosis
Signs - PUPD, weight loss, lethargy

Treat - remove cause
oral nacl, k+ and bicarb

42
Q

Glomerular disease

A

can be primary or secondary
signs - CKD/uraemia
Diagnosis - haematology/biochemistry similar to crf, likely hypoproteinaemia
urinalysis - proteinuria, hyaline casts common

43
Q

Indications for renal biopsy

A

protein losing nephropathy
AKI
mass lesions

44
Q

contraindications for renal biopsy

A

late stage ckd
severe anaemia/azotaemia
uncontrolled hypertension/coagulopathy
severe hydronephrosis/large mass cysts
pyelonephritis/perirenal abscesses
recent NSAIDs

45
Q

Nephrotic syndrome

A

results of protein losing nephropathies - pathognomonic for glomerular disease
CS - pitting oedema, ascites, pleural effusion, hypoalbuminaemia, hyperlipidaemia
Treatment - antiproteinurics - acei - benazepril/enalapril. anti-coagulents - aspirin/clopidogrel. fluid removal - abdominal/pleural tap, diuretics

46
Q

what does iris staging allow

A

identification of CKD
advise treatment focussing on nutrition/hydration, control of hypertension, minimising proteinuria, controlling serum phosphate

47
Q

Definition of polyuria

A

> 50ml/kg/day urine

48
Q

definition of polydipsia

A

> 100ml/kg/day intake in dogs and >50ml/kg/day intake in cats

49
Q

Primary polydipsia causes

A

altered thirst
centrally mediated disease
- neoplasia
- seocndary to osmolarity/endocrine effects
loss compensation
Physiological
- salt toxicity, exercise, high temperature

50
Q

Causes of polyuria

A

Central diabetes insipidus
Reduced ADH sensitivity/response
Osmotic diuresis
Glucose - diabetes mellitus
sodium - post obstructive diuresis/addisons
reduced medullary/interstitial tonicity
mixed/unknown cause - crf/aki

51
Q

Initial treatment for blocked bladded

A

pain relief

52
Q

initial diagnostics for blocked bladder

A

potassium
acidosis
post renal azotaemia/AKI
ECG

53
Q

Types of catheter for bladder

A

jackson tomcat - rigid with metal stylet
slippery sam - soft but no suitable adapter
Katkath - soft, adjustable length and suitable

54
Q

Care with urine

A

must look at within 15-20 mins or crystals will form
doesn’t strongly suggest stones/not

55
Q

what are struvite crystals

A

magnesium ammonium phosphate supersaturation of urine turns into a urolith

56
Q

Struvite Uroliths in dogs

A

associated with UTIs
females higher tendency
40% of urinary stones
risk factors - abnormal urine retention, conditions predisposing to UTIs, lack of movement, breeds (mini schnauzer/shih tzu, bichon)

57
Q

Struvite uroliths in cats

A

90% sterile
50% of stones in LUT
Risk factors - abnormal urine retention (not going out when its cold), formation of concentrated urine, urine alkalising metabolites in diet

58
Q

calcium oxalate uroliths

A

poorly understood
risk factors - acidifying diet, oral calcium outside of mealtimes, excessive protein in diet
hypercalciuria - increased intestinal reabsorption of calcium/reduced renal reabsorption
hypercalcaemia - renal tubular mechanisms over whelmed

59
Q

Urate uroliths

A

made of uric acid/sodium/ammonium urate
impaired conversion of uric acid to allantoin increases concentration in serum and urine
dalmatians/black russians are pre-disposed
associated with porto-systemic shunt
risk factors - high purine intake (offal), persistent aciduria in pre-disposed

60
Q

cysteine uroliths

A

inborn metabolic error caused by defective tubular resorption of cysteine and amino acids
Breed - newfoundland, labradors, australian cattle dogs, mastiffs, bulldogs
Intact males
urine retention increases chances

61
Q

Calcium phosphate uroliths- rare

A

often minor component of struvite and calcium oxalate uroliths
risk factors - excessive dietary calcium, primary hyperparathyroidism, UTI

62
Q

Xanthine uroliths

A

impaired xanthine oxidase activity leading to hyperxanthinaemia/xanthinuria
risk factors - genetic - ckcs, acidic/concentrated urine, urine retention, allopurinol treatment

63
Q

Clinical signs of urolithiasis

A

Lower urinary tract signs - dysuria, haematuria, pollakiuria
+/- urinary obstruction signs

64
Q

Diagnosis of urolithiasis

A

urinalysis - not massively useful, pH good
imaging key - radiopaque uroliths - calcium oxalate, struvitem calcium phosphate. Xanthine radiolucent. Urate/cysteine variable
ultrasound sound acoustic shadowing

65
Q

treatment of urolithiasis

A

analgesia
antibiotics - if UTI present
specific treatments and diets
surgery for calcium oxalate, calcium phosphate and large struvite

66
Q

diets for uroliths

A

all types high moisture
all alkalinising except struvite (acidifying) and calcium phosphate

67
Q

treatment of lower urinary tract neoplasia

A

excision most beneficial
transitional cell commonly at trigone requires reconstruction surgery
prognosis poor
urethral stenting can be useful

68
Q

causes of urethral obstruction

A

intraluminal - plugs, uroliths, sloughed tissue
mural/extraluminal - neoplasia, strictures, anomalies, reflex dyssynergia

69
Q

complications of perineal urethrocystotomy

A

haemorrhage
wound dehiscence
subcut urine leakage
urinary incontinence
UTO
urethral stricture

70
Q

what is true urinary incontinence

A

patient is unaware they are leaking urine normally due to poor sphincter function

71
Q

what is urge incontinence

A

patient is aware of the need to urinate but has a lack of control can be caused by bladder irritation

72
Q

what is overflow incontinence

A

patient usually unaware they are urinating, urine pressure in the bladder higher than than of urethral sphincter

73
Q

most common presentation of urethral sphincter mechanism incontinence

A

female
spayed
older
large breed
overweight

74
Q

glucose related PUPD

A

diabetes mellitus
primary renal glycosuria
fanconi’s syndrome (basenjis) genetic

75
Q

sodium related PUPD

A

post obstructive diuresis
high salt diet
addisons
diuretics

76
Q

diagnosis of PUPD

A

history/signalment
clinical exam important - BCS, dehydration, neurological disease, endocrinopathic signs

77
Q

USG in PUPD

A

> 1.030 normal hydration - nromal or polydipsia driving polyuria (or intermittent)
1.030 with dehydration - check for glucosuria, diabetes mellitus indication/fanconis
<1.030 normal hydration - primary polydipsia consideration, expect consistency
< 1.030 dehydrated - primary polyuria/intrinsic renal disease or extrinsic effects on renal function
<1.006 - diabetes insipidus/primary polydipsia, hypercalcaemia, hypoadrenocorticism. kidneys actively diluting

78
Q

primary polyuria suspected

A

history
rule of pyometra, addisons, aki, DM, diabetic ketoacidosis, haemangiosarcoma
Triage (pocus, elecs, bg etc)

79
Q

intrinsic renal disease suspected

A

further urinalysis
biochemistry
imaging
rnal biopsy

80
Q

extrinsic renal disease suspected

A

further urinalysis
haematology/biochemistry
imaging
physiological assessment

81
Q

azotaemia

A

elevated urea and creatinine

82
Q

pre-renal

A

fluid loss and haemoconcentration
must be hypovolaemic
phosphorus likely high
rapid response to fluids

83
Q

post renal

A

POCUS
hyperkalaemia can develop rapidly

84
Q

renal disease

A

aki/crf
poorly concentrated but not dilute urine
phosphorus likely high
albumin and upcr - protein losing nephropathy
non-regenerative anaemia with CKD

85
Q

neurogenic incontinence

A

cerebral - rare, loss of voluntary control, empties normally at inappropriate times
brainstem to l7 - umn bladder, absence of voluntary micturition, hard to express, increased sphincter tone, high volume of retention
S1-s3 or nerve root - lmn bladder (paralytic) - absent voluntary micturition, atonic, flaccid and easy to express, absent detrusor, can have overflow incontinence - empty for them

86
Q

USMI aetiology

A

low urethral tone
hormonal - lack oestrogens/change in urethral structure
breeds - irish setterm doberman, bearded collie, rough collie, dalamatian

87
Q

management of USMI

A

sympathomimetic agents - mimic storage of urine phase, rapid response, can cause restlessness, aggression,tachycardia, weightloss
Estriol - cannot use in entire, can appear in season
surgery (referral)

88
Q

anatomical incontinence

A

intersex
ectopic ureters
detrusor instability (urge incontinence)

89
Q

detrusor atony

A

over distension of the bladder leading to uncoordinated contraction attmeps
secondary condition

90
Q

LMN disorders

A

detrusor atony/sphincter areflexia
causes - cauda-equina syndrome, si luxation, IVDD, tail pull, neoplasia
management - bethanecol
nursing care/manual expression , cleaning and monitoring

91
Q

UMN bladder

A

uninhibited spincter spasticity
often paralised hind limbs
impossible to empty in early disease
later becomes automatic - empties when capacity is reached
treatment - urethral smooth muscle relaxants and skeletal muscle relaxants
monitor for UTI

92
Q

idiopathic reflex dyssynergia

A

loss of coordination between setrusor contraction and sphincter release
cause - inflammation
can cause incomplete emptying, overstretch, atony
treatment - prevent over distension in short term, help restore detrusor contraction (parasympathomimetic agents)
commonly male large breed

93
Q

non-neurogenic urinary retention

A

blockage
functional obstruction - urethral spasm
trauma to ureters/bladder
detrusor atony - overdistension

94
Q

bladder issue treatment overview

A

behavioural - pheromones/psychotrophic
pain - analgesia
high urethral tone - sympatholytics (prazosin)/muscle relaxants (benzodiazepines)
Low urethral tone - alpha-adrenergic agonists (phenylpropanolamine), orstrogen analogues
detrusor dysfunction (bethanecol)

95
Q

colour of myoglobinuria

A

brown

96
Q

diagnosis for red/brown urine

A

dipstick - dots = blood, homogenous = myo/haemoglobin
sediment exam - RBC = precipitate cytology confirms, haemo/myoglobin = no precipitate
haemoglobin/myoglobin likely - blood sample and centrifuge - red plasma = haemoglobin, clear = test muscle markers

97
Q

orange urine testing

A

USG - >1.040 reduces but doesnt rule out bilirubin
dipstick - -ve for RBC/Hb, +for bilirubin
blood biochem - hyperbilirubinaemia, jaundice

98
Q

further diagnostics

A

assess for trauma
urolithiasis - sediment, ultrasound, xray
uti - urine cytology/ultrasound
inflammation
neoplasia - cbc
CBC for coagulopathy/neoplasia
AST/CK for myoglobinuria

99
Q

diagnostic approach to big bladder

A

electrolytes/biochemistry
pocus
history
CE - pain, discharge, rectal exam
urinalysis - crystalluria, wbcs, c+s
imaging
urinary catheter to relieve pressure/can treat
cystocentesis - quick but risks rupture

100
Q

normal bladder wall thickness

A

1.4-2.3mm dog
1.3-1.7mm cat

Year 4 small animal (18 decks)

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