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3. HM Companion Module > Urinary > Flashcards

Urinary Flashcards

1
Q

DER and RER calculation

A
  • RER = 70 x (BW in kg)0.75
    DER = RER X some factor
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2
Q

best way to measure food dose

A

weight, rather than volume

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3
Q

components of a good feeding plan (2)

A

Nutritional assessment performed
Diet history obtained

  • Identify key nutritional factors
  • Compare products and select best choice
  • Determine energy requirement
  • Calculate food dose
  • Recommend feeding managements strategies
  • Follow-up plan
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4
Q

what are uroliths, and basic pathogenesis

A
  • Condition where calculi form in the urinary tract (kidneys, ureters, bladder, urethra)

Urolith formation
* Result of multiple pathophysiologic processes resulting in high concentrations of poorly soluble crystalloids in the urine

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5
Q

common types of uroliths for dogs and cats

A
  1. calcium oxalate
  2. struvite
  3. urate
    others
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6
Q

systemic disorders that can lead to uroliths, and what type of urolith

A
  • Hypercalcemia (calcium oxalate)
  • Cushing’s disease (calcium oxalate, struvite)
  • Defects in purine metabolism e.g. portal vascular abnormalities (ammonium urate)
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7
Q

urinary tract disorders that can lead to uroliths, and what type of uroliths

A
  • Urease-producing bacterial infection (struvite)
  • Foreign material e.g. suture or catheters (struvite mainly, sometimes calcium oxalate)
  • Renal tubular acidosis (calcium oxalate)
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8
Q

what is crystalluria and how do we evaluate

A
  • Excretion of crystals in urine
  • Need to evaluate in fresh urine
    > Artifacts in stored/refrigerated urine
    > Restore to room temperature before examining
  • Trace crystals may be normal in highly concentrated urine (high USG)
  • Presence of crystals does not mean uroliths
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9
Q

what is RSS? what is its purpose?

A

RELATIVE SUPER SATURATION (RSS)

RSS is used to assess the DIET-SPECIFIC RISK of crystal/urolith formation in urine of dogs and cats
* i.e. How likely is the animal to form crystals/uroliths?

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10
Q

examples of what RSS looks at to assess urolith risk

A
  • Calculogenic ions
  • Urine pH
  • Urine volume
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11
Q

how is RSS measured?

A
  1. the formula of interest is fed to a minimum of 6 cats or dogs during a 7 day adaptation period
  2. the total urine produced is then collected for the next 3 days while the cats or dogs are still fed the formula
  3. the urine volume, pH and ionic composition are measured
  4. the solute activity is calculated - this is the concentration of the constituents that are free and available to form uroliths
  5. the activity product is then calculated - this represents the number of potential interactions or complexes between these constituents, and is obtained by multiplying all the solute activities relevant to a given urolith
  6. this activity product is then divided by a known constant thermodynamic solubility product fo a given urolith to determine the RSS
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12
Q

ZONES/LEVELS OF URINARY SATURATION from RSS

A

Undersaturated
* No crystal nidus formation or growth
* Dissolution possible

Metastable
* Nucleation possible but minimal growth
* Dissolution no longer possible

Oversaturated
* Spontaneous nucleation with maximal growth
* Dissolution not possible

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13
Q

RSS reccomendation to dissolve pure struvite urolith

A

RSS for struvite <1

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14
Q

pH effect on uroliths

A

different materials are soluble at different pH, and so the type of uroliths that can form are influenced pH

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15
Q

what is the composition of a struvite crystal?

A

MAGNESIUM AMMONIUM PHOSPHATE

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16
Q

pathogenesis of struvite crystal

A
  • UTIs with urease-producing bacteria→alkaline urine
  • Cats usually sterile, occasionally UTIs (e.g. diabetes)
  • Diet: magnesium, phosphorus, protein (ammonium)
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17
Q

struvite crystals most prevelant in what breeds…

A
  • Breed: Miniature schnauzers, Beagles, Bichon Frises, Shih Tzus, Pugs,
    Dachshunds
  • Age: younger cats
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18
Q

biologic behaviour of struvite crystals

A
  • Fast growth; smooth; dissolvable; alkaline environment; high recurrence rate (UTIs); radio-dense
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19
Q

STRUVITE – TREATMENT AND PREVENTION

A
  • Dissolution is possible
    > Removal only if necessary, with stone analysis and culture & sensitivity
  • Treat the underlying UTI with antibiotics
    > Requires long-term antibiotic therapy as stones dissolve because they hang on to the bacteria (e.g. months of treatment)
    > Ideally based on culture/sensitivity
20
Q

What nutrient is the most important to consider for ALL uroliths?

A

WATER
>goal is increasesed consumption

21
Q

what helps cats drink water, reduces RSS for struvite?

A

increased sodium intake through diet

22
Q

KNFS FOR STRUVITE, summary

A
  • Protein – Restrict (dogs; less in cats)
    > protein = high ammonia
    >lower BUN helps promote polyuria
    >Restrict significantly for dissolution and moderately for prevention
  • Magnesium – Restrict
  • Phosphorus – Restrict
23
Q

diet acidifiers to help dissolve struvite

A

-DL-methionine
-Ammonium chloride

24
Q

CALCIUM OXALATE uroliths characteristics: radiology, pH, dissolution?

A
  • Radio-opaque
  • Not pH dependent like some other stones
  • Not amenable to dissolution
25
Q

CALCIUM OXALATE RISK FACTORS

A

-Males > females
-Middle aged to older
Dogs: Small breeds (Lhasa Apso,
Bichon Frise, Pomeranian, Miniature Poodle, Miniature Schnauzer, ShihTzu,Yorkie)
Cats: Burmese, Persian, Himalayan, Siamese

26
Q

CALCIUM OXALATE RISK FACTORS

A
  • High USG/low urine volume
  • Excess solute excretion
  • Excess supplementation of vitamin C, vitamin D
  • Diseases (hypercalcemia, Cushing’s, obesity)
  • Drugs: steroids (promote urinary calcium excretion)
27
Q

CALCIUM OXALATE TREATMENT AND PREVENTION

A
  • Dissolution is not the solution!
  • Surgical removal
  • Stone analysis
  • Prevention
    > Therapeutic urinary diet with RSS testing
28
Q

KNFs FOR CALCIUM OXALATE

A
  • WATER
  • Calcium - Restrict?
  • Recall, Ca2+ efficiently and tightly regulated (homeostasis)
    > Low serum [Ca2+]→↑ absorption of Ca2+ and bone resorption
    > High serum [Ca2+]→hypercalciuria (i.e. more Ca2+ in urine)
    > Answer: moderate restriction
  • Oxalates – Restrict?
  • Absorption affected by serum [Ca2+]:
    > If ↓serum [Ca2+]→oxalate hyper-absorption from GIT to accompany Ca2+ hyper-absorption→hyperoxaluria
  • Answer: avoid high oxalates and balance with moderate calcium restriction
  • Vitamin C - Restrict
    > Precursor for oxalate
    > Limit to prevent oxalate formation (especially supplements)
  • Protein
  • Excessive protein (i.e. >40% DM for dogs) contributes to hypercalciuria
  • Excessive protein contributes to hypocitraturia
    > Citrate (negatively charged) in urine binds Ca2+ →↓ Ca2+ available to complex with oxalate
  • Also promotes oversaturated urine
  • Phosphorous
    > If severely restrict can get ↑ Ca2+ absorption from GIT and more
    resorption from bone→hypercalciuria
  • Magnesium
  • Can inhibit calcium oxalate formation by binding both Ca2+ and oxalates→prevent complexing
  • However, too much can promote hypercalciuria
29
Q

URINE ALKALINIZING AGENTS

A
  • Potassium citrate
30
Q

how do we manage recurrence of calcium oxalate uroliths? is it common?

A
  • Common!
  • Radiographs every 3-6 months first year
  • UA at 2 &4 weeks post op, then every 3 months for first year
  • USG within target (at-home monitoring)
31
Q

AMMONIUM URATE risk factors

A
  • Genetic mutation: Dalmatian, English Bulldog
  • Portosystemic vascular shunts: Yorkie (other toy breeds), Mini Schnauzer, Cats (less frequent)
  • Sex: Male>female
  • Age: <1 year
32
Q

difference between purine processing normally and in dogs with problems

A

uricase enzyme non-functional in some dogs, eg. dalmations
>cannot convert uric acid –> allantoin
-results in increased uric acid in urine (2-4x)
-small % of dogs actually form stones

33
Q

how do ammonium urate stones form in non-dalmations

A
  • Liver dysfunction:
    > Portal vascular anomalies
    > End-stage failure/cirrhosis
  • Inadequate conversion of uric acid→allantoin
  • Inability to convert ammonium→urea
  • End result: ↑ uric acid and ammonia in blood and urine
34
Q

KNFs FOR AMMONIUM URATE

A
  • Water - Increase
  • Purines (protein) - Restrict
    > Shellfish, fish, goose, heart, kidney, liver, gravies
    > Restrict at least within first 3 ingredients
    > No high purine treats
  • Sodium
  • Salt can help increase thirst and urine volume
  • May cause hypercalciuria
  • pH of 7.1-7.5 (canine) and 6.8-7.2 (feline)
    > Can use potassium citrate or sodium bicarbonate
    > pH >7.5 should be avoided as it could predispose to calcium phosphate crystals
35
Q

AMMONIUM URATE - TREATMENT

A
  • Presumes crystal character on UA = urolith type (e.g. ammonium urate crystals)
  • +/- Dissolution (dissolve, grow, or static)
  • Removal: surgery, lithotripsy, urohydropropulsion
  • Stone analysis
  • Medical management
    > Diuretics
    > Xanthine oxidase inhibitor (e.g. allopurinol) - DOGS
    > Urine alkalinizing agents (e.g. potassium citrate)
  • Need allopurinol (xanthine oxidase inhibitor) in addition to dietary change
36
Q

ALLOPURINOL - what is it, what is its use

A
  • Xanthine oxidase inhibitor
    > Decreases production of uric acid
    > Only prescribe if feeding low purine diet to minimize amount of xanthine formed
    > Otherwise can see ↑ xanthine uroliths

for ammonium urate treatment

37
Q

FELINE IDIOPATHIC CYSTITIS - what is it, what are symptoms and types

A
  • Most common cause of LUTD in cats (55-66%)
  • Similar clinical signs (stranguria, hematuria, pollakiuria)
  • Non-infectious
  • Inflammatory
  • Chronic, intermittent with acute flare ups
  • Diagnosis of exclusion
38
Q

main cause of feline idiopathic cystitis

A
  • STRESS
  • Leads to an exaggerated SNS response, blunted endocrine response
  • Affects bladder, as well as other body systems
39
Q

FIC - RESOLUTION

A
  • For most cats, resolves within 1 week – for some 2 to 3 days
  • Recurrence common (chronic condition)
  • Analgesics often required during flare up
40
Q

FIC-TREATMENT

A
  • Manage environment
  • Identify potential stressors
  • Litterbox placement
  • Routine – minimize changes
  • Other animals
  • Pheromone therapy, medications
  • Environmental enrichment
  • Nutrition?
41
Q

KNFs FOR FIC

A
  • WATER
    > May reduce irritation to bladder wall
  • “Calming nutrients”
    > Alpha-casozepine
    > L-tryptophan
42
Q

struvite summary: treatment

A
  • Dissolution → feed diet one month beyond resolution
  • Treat UTI (dogs) → culture & antibiotics
  • Surgical removal only if necessary (based on case)
43
Q

calcium oxalate summary: treatment

A
  • Surgical removal
  • Prevention of recurrence → high moisture, appropriate diet and/or urine alkalinizer
44
Q

ammonium urate summary: treatment

A
  • Dissolution → diet low in purines
  • Surgical removal (based on case)
  • Xanthine oxidase inhibitor (allopurinol) if indicated
45
Q

FIC treatment summary

A
  • Manage environmental stress
  • Dilute urine
  • Add calming agents

3. HM Companion Module (11 decks)

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