Urinary Flashcards
Renal functions
- eryhthropoetin production, produces rbc
- regulating arterial pressure
- Acid/base balance
- Water and electrolytes balance
- Glucose synthesis
- Excretion-metabolic waste products and foreign chemicals
- Calcium excretion
- Production of vit d
Acute renal failure
- Pre renal- hypovolaemia, decreased BP due to amaesthesia
- Intrinsic renal- poison affecting kidney cells themselves eg. Ethylene glycol, lilies, e. Coli pyelonephritis. This is usually ascending from lower tract.
- Post renal- blockage in ureter(stone) blocked bladder, blocked urethra, rupture of ureters or urethra
- Acute deterioration of chronic KF
ARF clinical signs
Anorexia, lethargy, depression, uraemic breath
- Oliguria at start then polyuria and polydipsa
- Dehydration
- Vomiting and diarrhoea
ARF DIAGNOSTICS
-blood biochem esp BUN/Urea, crea (both raised) electrolytes PHOS raised and potassium abnormally low as in ARF and CRF the kidneys lose potassium rather than conserve it.
-urinalysis - SG, dipstick and sediment for suspected crystals and stones
Abdominal radiographs- R lat and VD including contrast media (air/iodine bases contrast media e.g Conray) for urethrography
Ultrasound
ARF
Tx- Ivft to rehydrate, flush blood clear of toxin build up, re establish urine output
Anti emetics
Urine output cant be restarted with frusemide/mannitol if fluid therapy doesn’t do it alone
Peritoneal dialysis can be used to remove waste products in persistently oliguric patients
ARF can be reversible if patient survives initial crisis
Chronic renal failure
Overt clinical signs noticeable only after 75% of nephrons already lost.
Unlike ARF, crf is not reversible
Causes, progression of ARF, toxins, bacterial infection, idiopathic, polycystic kidney disease and ischaemic damage (post GA/Nsaid administration)
CrF signs
Polyuria
Polydipsia
Nocturia, uraemia, weight loss, dehydration, uraemic breath, oral ulceration, non regenerative anaemia rubber jaw (result of renal hyperparathyroidism) and hight bp
End stage is seizures
CRF treatment
Fluids usually subcut or iv if hospitalised
Drug therapy, ACE inhibitors to reduce hypertension, Tx of underlying cause eg. Antibiotics
Nutrition management-suitable controlled protein, low phosphorous diet. Encouragement to eat, hand fed, palatable food. No extra chicken or fish due to extra protein.
Phosphate binders eg. Ipakitine
Other drug therapy: Anti emetics, vitamin b, eryhthropoetin, electrolyte supplements usually potassium
Lower urinary tract disease
Cystitis Urinary calculi (urolithiasis) Urinary incontinence Feline lower urinary tract disease (flutd) Prostatic disease
Cystitis
Clinical signs
Frequent attempts to urinate with small amounts
Sometimes blood tinged- pollakiuria with haematuria and straining(tenesmus) and dysuria
Incontinence or inappropriate locations
An ascending bacterial infection is a common cause in female - E. Coli, staphylococcus, streptococcus and pseudomonas
Encourage water intake and urination
Administer meds
Urinary calculi (urolithiasis)
Stones (calculi) can form in any available space in the kidneys and urinary tract
Causes - high dietary intake of some minerals, breed disposition e.g urate uroliths in Dalmatians, uti, systemic disease
Clinical signs–as for cystitis but can have distended bladder too and can get obstructed (emergency)
Treatment–dietary dissolution for struvite, urate and cysteine uroliths
-surgical removal for oxalate uroliths
Then dietary management to prevent recurrence
Urinary incontinence
May be intermittent or continuous
Urine seen around perineum, may scald, clip fur short and apply barrier cream.
Urethral sphincter incompetence is most common cause-treated with phenylpropanolamine(propalin syrup) OR oestrogen
Bladder neck tumours fairly common-transitional cell carcinomas. Very guarded prognosis. May have chemo/surgery.
Ectopic ureters-discharge straight into vagina. Incontinence noticed at early age. Congenital and more common in females. Surgery to treat.
Cystisi can cause incontinence.
Lastly prostatic disease can cause it, castration or hormone therapy will help
Feline lower urinary tract disease
Highest occurrence is in male overweight 2-7 years old indoor cats fed on dry food.
Crystal’s form in urine can be obstructive or remain non obstructive.
The design of male urethra predisposes it to become blocked more easily a urethral plug made of a clump of crystals and mucous in or a uroliths, blocks distal end of urethra, this is emergency
Can affect females too, bacterial infections/idiopathic
Feline lower urinary tract disease
Highest occurrence is in male overweight 2-7 years old indoor cats fed on dry food.
Crystal’s form in urine can be obstructive or remain non obstructive.
The design of male urethra predisposes it to become blocked more easily a urethral plug made of a clump of crystals and mucous in or a uroliths, blocks distal end of urethra, this is emergency
Can affect females too, bacterial infections/idiopathic
Care of Flutd cats
Blood tested (urea/crea/phos/potassium) then VS should depressurise bladder via cystocentesis.
Stabilise patient Ivft with no potassium(not hartmanns). Hyperkalaemia is a side effect of glomerular filtration ceasing due to back pressure of urine inside kidney.
Once stable, GA not sedation, clip and surgical prep the urethral area, and vs will Catheterise: retrograde flushing with saline and massage. Urethral spasm may be a problem. Once empty bladder will be rinsed with saline
Usually an indwelling catheter is fitted with either a bung or closed collection system for urine to prevent ascending infection, patients must be fitted with a buster collar and the perineum kept scrupulously clean. Barrier cream as needed.
Measure urine output–need to achieve 1-2ml/kg/hr. Administer meds, abx, pain relief, not nsaids where renal impairment. And anti inflammatories.
Flutd
Pheromone therapy.
Environment
Glycosaminoglycan long term therapy e. G nutracys, cystaid-promotes bladder lining health, also sometimes used: short term nsaids eg loxicam to reduce inflammation
Px diet, urinary acidification is required to dissolve crystals/prevent them forming
