Urinary Diseases

Question 1

What are the aetiologies of Chronic Kidney Disease?

Answer 1

Most common - idiopathic degeneration of renal function, most commonly in geriatric cats

Can also be due to:
-previous renal damage e.g. injury, toxin
- neoplasia
- polycystic kidney disease
- chronic infection 
concurrent conditions e.g. diabetes

Question 2

What is the pathophysiology of Chronic Kidney Disease?

Answer 2

The kidney is unable to filter nitrogenous waste from the blood leading to increased nitrogenous waste in the blood (called azotaemia).
Then:
- deterioration in renal function causes pH and electrolyte imbalance (potassium and phosphate)
- reduced production of erythropoietin leads to reduced erythrocyte formation in bone marrow (as not stimulated to do so without erythropoietin)

Question 3

What are the clinical signs of Chronic Kidney Disease?

Answer 3

• Polyuria (cant reabsorb water properly), Dehydration
• Polydipsia (losing too much water)
• Vomiting, inappetence, anorexia, weight loss, depression (increase in nitrogenous waste in the blood makes animal feel ill)
• Oral ulcers and halitosis (bad breath)
• seizures (if acute obstructive renal failure)
• anaemia (lack of erythropoietin)
• end stage may be anuria
• can lose protein in urine which will reduce body and muscle condition

Question 4

What should be done to diagnose chronic kidney disease?

Answer 4

Use a combination of blood tests and urinalysis.
Blood tests
- Look for elevated levels of urea and creatinine in the plasma (high levels of either suggest renal failure)
- Can test for SDMA (amino acid), meant to be more sensitive to early changes in the kidney for disease
- check electrolytes - check phosphate levels to check for low potassium levels (hypokalaemia)

Urinalysis
- Urine Specific Gravity (USG): used to identify loss of concentrating ability
(early detectant, cheap, can be carried out in-house)
- Normal USG is >1.030 in dogs and 1.035 in cats
- Test for urine protein levels, the presence of blood, rule out infection

Blood pressure (if high, too much sedum retained)
Ultrasound to examine kidney

Question 5

What are the aetiologies of FLUTD?

Answer 5

Most common idiopathic!

• uroliths (stones)
• Crystals (can form urethral plug)
• Infection (rare)
• multi cat house / stress
• Underactive, overweight, neutered cats
• spasm of urethra

Question 6

What is the pathophysiology of FLUTD?

Answer 6

Irritation or inflammation of the bladder wall/ urethra
May get recurrent bouts of cystitis
Uroliths or urethral plugs may cause urinary obstruction

Trauma or iatrogenic damage may result in bladder wall dysfunction or rupture of the urinary tract e.g. rough handling, palpation of bladder too hard

Inability to void urine leads to azotaemia and signs associated with acute renal failure

Question 7

What are the clinical signs of Urolithiasis?

Answer 7

Abnormal micturition: Dysuria, haematuria, oliguria, stranguria…
Azotemia signs - weight loss, anorexia, vomiting, depression, inappetence.
Licking external genitalia as sore urethra.

Question 8

How can urolithiasis be diagnosed?

Answer 8

History and clinical signs - + physical examine can help
Urinalysis - dipstick to assess pH - interested in the composition as opposed to the concentration
Ultrasound to visualise uroliths and bladder wall.
Can use radiography to visualise larger uroliths.
Can test blood for urea and creatnine.