Urinary diseases - Kidney Flashcards
List some nephrotoxic drugs
- Neomycin
- Sulphonamides
- Tetracycline
Define renal insufficiency
A degree of relative loss of renal function, but is survivable
Define renal failure
Complete loss of renal tissue function - cannot recover or survive
What can cause ACUTE renal failure?
- Haemodynamic causes
- Toxic causes
- Immunological disorders
- Acute inflammation and/or obstruction
List some haemodynamic causes of ACUTE renal failure
- Endotoxaemia and/or sepsis
- Complement-mediated coagulopathies
- Systemic hypotension and/or arteriole constriction
In renal failure, how much function must be lost before uraemia is shown?
>2/3 - 66%
How does urinary tract disease usually manifest?
- Abnormalities of urine composition
- Abnormalities in daily flow of urine
- Pain and dysuria
- Uraemia
- Rupture of the urinary bladder, renal pelvis and urethra
- Defects in nervous control of urination
- Urachal leakage of urine
When would proteinuria occur?
- Haemoglobinuria, myoglobinuria and haematuria
- Glomerulonephritis
- Renal infarction
- Nephrosis
- Amyloidosis
- Congestive heart failure
What are “casts”?
Organised tubular structures which vary in appearance depending on their composition. They only occur when the kidneys are part of the disease process.
They are indicators of inflammatory or degenerative changes in the kidney.
What cells may be found in the urine?
- Red blood cells
- White blood cells
- Epithelial cells
What are some pre-renal causes of haematuria?
- Vascular damage
- Septicaemia
- Trauma
What are some renal causes of haematuria?
- Acute glomerulonephritis
- Pyelonephritis
- Toxic damage, e.g. sulphonamides
- Embolism or renal vascular anomaly
- Renal infarction
What are some post-renal causes of haematuria?
- Urolithiasis
- Urethritis
- Cystitis
- Enzootic haematuria (bracken fern toxicity)
What is the likely diagnosis if blood is EQUALLY DISTRIBUTED THROUGHOUT URINE?
Kidney damage
What is the likely diagnosis if blood is AT THE BEGINNING OF URINATION?
Urethral damage
What is the likely diagnosis if blood is AT THE END OF URINATION?
Vesicular damage
What is the likely diagnosis if blood is AFTER EXERCISE?
Cystic calculi
What are the most common urinary crystals in ruminants?
Calcium carbonate
Triple phosphate crystals
What can cause haemoglobinuria?
- Bacilliary haemoglobinuria
- Babesiosis
- Copper intoxication
- Water intoxication
What is urachal leakage of urine?
When there is an incomplete urachal closure in newborn animals
What causes urachal leakage of urine?
- Inflammatory disease opening the orifice after birth
- Incomplete closure before birth
What are the clinical signs of urachal leakage of urine?
Visible dripping of urine from the ventral abdomen
Swelling of the umbilical area
How do we treat urachal leakage of urine?
Surgical removal of the infected urachus and/or umbilical vessels
What is renal ischaemia?
A sudden reduction or decline in the blood flow through the kidneys, usually due to circulatory failure.
Is renal ischaemia permanent or reversible?
Initially it is reversible, by restoring renal blood flow.
If ischaemia is prolonged or severe, the renal damage becomes permanent.
What would renal ischaemia look like on lab analysis?
URINALYSIS - proteinuria
SERUM - high levels of BUN and CK (bad prognostic)
How do we treat renal ischaemia?
- Correct acid base balance and fluid/electrolyte imbalances
- Correct underlying disease
- Supportive
What is pyelonephritis?
Bacterial inflammation of the kidneys and renal pelvis
What usually causes pyelonephritis?
Usually an ascending infection from the lower urinary tract:
- E. coli - most common
- Corynebacterium renale
- Pseudomonas aeruginosa
When does pyelonephritis most commonly occur?
Within 90 days of parturition
What does the development of pyelonephritis depend on?
- Common presence of UTI
- Stagnation of urine
- Reflux of urine from the baldder
What can cause urine stagnation?
- Blockage of ureters by inflammatory swellings or debris
- Pressure from uterus in pregnant females
- Obstructive urolithiasis
What are the clinical signs of pyelonephritis?
- Pyruria, dysuria and stranguris
- Suppurative nephritis, cystitis and urethritis
- Toxaemia, uraemia and haematuria
- Colic
- Anorexia, fever, loss of condition
What will you feel on rectal examination if the cows are suffering from pyelonephritis?
- Bladder - thickened and contracted
- Enlargement of BOTH ureters
- Left kidney - enlarged, with the absence of lobulation
KIDNEYS ARE PAINFUL TO PALPATE, AND COWS ARE LIKELY TO TRY AND KICK YOU!
How do we distinguish between pyelonephritis and amyloidosis on the farm?
Rectal examination
- Amyloidosis - kidneys feel hard
- Pyelonephritis - kidneys are super painful and try to kick!
How do we diagnose pyelonephritis?
- Urinalysis - haematuria, proteinuria and pH >8.5
- Bacteriological culture
- Decreased albumin and increased gammaglobulinuria
- Increased BUN and CK in serum
How do we treat pyelonephritis?
- Penicillin for >3 weeks
- Acidification of urine - monobasic sodium phosphate
- Unilateral nephrectomy (in valuable animals)
What is the prognosis of pyelonephritis?
Fatalities - 18%
Cull rate - 33%
What is glomerulonephritis?
An infection primarily involving the glomerulus, then may extend to involve the interstitial tissue and rarely the blood vessels
What is the pathogenesis of glomerulonephritis?
It is an IMMUNOLOGICAL DISEASE, in which there is deposition of Ag-Ab complexes in the capillary walls, resulting in impaired glomerular filtration and enhanced permeability of plasma proteins
What are the types of glomerulonephritis?
- SPONTANEOUS PROLIFERATIVE GLOMERULONEPHRITIS
- GLOMERULONEPHRITIS OF PREGNANCY TOXAEMIA IN SHEEP
- MESANGIOCAPILLARY GLOMERULONEPHRITIS
What are the clinical signs of glomerulonephritis?
- Weight loss, chronic diarrhoea and generalised oedema
- Marked oliguria and anuria
- Proteinuria
- Low albumin in blood
- Anaemia
- Azoaemia
How do we treat glomerulonephritis?
Plasma transfusions and anabolic steroids
What is the prognosis of glomerulonephritis?
Bad - treatment is typically unrewarding
When do embolic nephritis (renal abscesses) occur?
After any episode of septicaemia and bacteraemia, due to bacteria lodging in the renal tissue
What is interstitial nephritis?
NON-SUPPURATIVE inflammation of the renal interstitial connective tissue
What are the types of interstitial nephritis?
- Acute diffuse interstitial nephritis
- Chronic focal interstitial nephritis
What causes acute diffuse interstitial nephritis?
Immunological reactions to certain drugs, e.g. sulphonamides and methicillin
What causes chronic focal interstitial nephritis?
- Ureteral obstruction
- Pyelonephritis
- Exposure of the kidneys to toxins
- Certain systemic diseases, e.g. leptospirosis
What are the clinical signs of interstitial nephritis?
Either acute or chronic renal insufficiency
How do we treat interstitial nephritis?
- Correct underlying disease
- Restore water and electrolyte balances
- Systemic antibiotics
What is nephrosis?
Degenerative and inflammatory lesions of the renal tubules
What are the most common causes of nephrosis?
NEPHROTOXINS
- Mercury, selenium and organic copper
- Oxalates in plants and fungi
- Thiabendazole anthelmintics
- Sulphonamide intoxications
What factors can increase the development of nephrosis?
Dehydation - by concentrating the toxins in the tubules
How do we treat nephrosis?
REMOVE TOXINS
What is renal amyloidosis?
The deposition of amyloid substances within the glomeruli, interfering with glomerular filtration and permeability
What causes renal amylodiosis?
Long-standing suppurative conditions, e.g. streptococcal infections or abscesses of the liver and lungs
What are the clinical signs of renal amyloidosis?
- Gradual loss of body weight
- Profuse watery dairrhoea
- Urine with low SG
- Depressed appetite and dehydration
- Submandibular swelling
- Proteinuria & hypoproteinaemia
- Kidneys feel hard on palpation
