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Urology > Urinary Diseases of Exotic Pets > Flashcards

Urinary Diseases of Exotic Pets Flashcards

1
Q

Basic kidney functions

A

Nitrogenous waste excretion
Osmotic balance
Acid-base balance
Endocrine Functions

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2
Q

Nitrogenous waste excretion

A

Ammonia (NH3) is a byproduct of amino acid metabolism
NH3 -> NH4+ (ammonium) at physiologic pH
Both NH3 and NH4+ are toxic
Animals can be classed as:
- Ammonotelic (excrete NH3 or NH4+ unchanged)
- Ureotelic (excrete Urea)
- Uricotelic (excrete Uric Acid)

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3
Q

Small herbivores

A 
Rabbits and rodents 
Kidneys are unipapillate 
1 papilla and 1 calyx enter ureter directly 
Ureters to bladder to urethra 
Urinary bladder 
- Flaccid in rabbits 
- 3x more distensible than cats 
Urethra 
- Experimental model - same size as 1 year old boy
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4
Q

Rabbit calcium metabolism

A

Absorption of dietary calcium is passive
- Independent of vit. D
Calcium homeostasis regulated by kidneys
- Urine route of Ca excretion
- 45-60% ( <2% in other SM)
- Increased dietary intake, inc urinary excretion
Total blood calcium high, variable

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5
Q

Herbivore urine

A 
Alkaline (pH > 8.0) 
- Herbivores  
Precipitates 
- Calcium carbonate -rabbit  
- Calcium oxalate - GP  
Turbidity 
- Hydration, health, dietary  calcium, age, repro status 
Color 
- Red, orange, yellow, brown
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6
Q

Calciuria

A 
Calcium N in urine 
Hypercalciuria 
- Large amount of sand or sludge in the bladder 
- Cystitis, urethral irritation 
Urolithiasis 
- Calculi in the urinary system 
- Cystic, urethral, renal, and ureteral 
- Contributing factors, but the cause isn't fully understood
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7
Q

Urolithiasis and urinary sludging

A 
Predisposing factors 
May be unrelated to calciuria 
Non-obstruction 
- Genetics 
- Dehydration 
- Inactivity 
- Obesity  
- Urine retention  
- Cystitis  
- Changes in pH  
- Diet  
- Lack of latrine  
- Cystitis - Strep. pyogenes (GP) 
Obstruction 
Anything that causes  
urine retention 
- Adhesions 
- Abscesses 
- Tumors 
- Urine sludging
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8
Q

Typical Hx for Urolithiasis and urinary sludging

A

Limited exercise, obesity
Diet of pellets and alfalfa hay free-choice
- high in digestible calcium

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9
Q

CS of Urolithiasis and urinary sludging

A 
Depression 
Lethargy 
Anorexia/ Weight loss 
Hematuria/Polyuria/Stranguria 
Hunched posture 
Teeth grinding 
Urinary incontinence 
Perineal dermatitis 
Pasty urine
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10
Q

Dx of urolithiasis and urinary sludging

A

Physical Examination
Palpation UB
Nephromegaly
- Hydronephrosis

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11
Q

Diagnostic testing for urolithiasis and urinary sludging

A 
Imaging
- Radiography 
- Ultrasonography 
Hematology 
- CBC 
 . Infection, anemia 
- Chemistry panel 
 . Renal function, hepatic health, blood calcium
Not terribly useful
Urinalysis 
- SG 1.003-1.0036 
- Trace protein, glucose 
- Crystals, RBCs, WBCs 
- Bacteria 
 . Culture 
- R/O reproductive origin 
 . Cysto collection
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12
Q

Tx of urolithiasis and urinary sludging

A 
ID and correct causes 
Supportive care 
- Wound management 
 . Soothing shampoos 
 . Dry completely 
 . Protect skin 
- Fluid therapy 
- Antibiotics 
 . Enrofloxacin, TMS 
- Analgesia 
 . Opiods, NSAIDS
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13
Q

Mgmt or urinary sludging and stones

A 
Management of Urinary Sludging (and 
small stones) 
- Manual expression of bladder 
 . Sedation or anesthesia 
- Diuresis IV/SQ fluids 
 . Re-hydration 
 . Dilute urine 
 . Increase volume 
- Urohydropropulsion
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14
Q

Tx of Urolithiasis

A 
Urolithiasis 
Stabilization
Surgery 
- Cystotomy 
 . Surgical spoon 
 . Flush/suction 
 . Culture bladder wall/stone 
- Nephrectomy 
 . Renal pelvic calculus 
 . PX guarded 
 . Risk post-surgical complications
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15
Q

Prevention

A 
Dilute urine 
\+ Increase water intake 
 . Succulent greens 
 . Fruit juices (sugar-free) 
 . Flavored water 
Bowl vs. sipper bottle 
Limit dietary calcium 
- Grass hay pellets 
- No supplements 
Body condition 
- Exercise 
- Grazing 
- Promotes micturition
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16
Q

Prevention continued

A 
Potassium citrate 
- Rabbits (33 mg/kg PO q 8 h) 
- GPs (10-30 mg/kg PO q 12 h) 
- Citrate salt highly soluble 
- Complexes with calcium 
- Reduces formation of calcium oxalate 
- Urine alkalinizer 
 . Increasing solubility of calcium oxalate 
Monitoring 
- UA, rads q 6 months
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17
Q

Ferrets

A 
x True carnivores 
x Not prone to crystaluria 
x Urinary calculi NOT 
common 
x Bacterial cystitis 
occasionally seen
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18
Q

Urethral Obstruction in male ferrets

A

Secondary to adrenal
disease
Paraprostatic cysts
Prostatic hyperplasia

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19
Q

Diagnosis of ferret urethral obstruction

A

Abdominal US/radiography
+/- contrast
UA - culture and sensitivity testing

20
Q

Tx of ferret urethral obstruction

A

Historically treated with
perineal urethrostomy
- Obstruction is proximal to perineal urethra
- Not indicated

Must manage underlying adrenal disease 
Medical management 
- GnRH analog 
Surgical management 
- Adrenalectomy 
- Prostatic cyst drainage/marsupialization 
Manage post-renal obstruction 
Heavy sedation/anesthesia 
Catheterization
- 3 fr 
- Tomcat cath = too big 
- Urethra fragile 
- Leaking into cysts?
21
Q

Bird urinary tract

A

Urinary tract

  • Anatomically simple
  • Mammalian and reptilian function
22
Q

Bird urinary system

A

URINARY SYSTEM
2 kidneys
- Dorsal body wall - renal fossa of synsacrum
- 3 lobes
- No demarcation between cortex and medulla
- No renal pelvis
- Collecting ducts drain lobules into ureters
- Ureters to urodeum

23
Q

Bird urinary system continued

A

URINARY SYSTEM
Lobules
- Large area of cortical tissue
. Reptilian and mammalian nephrons
- Small area of medullary tissue
. Loops of Henle, collecting ducts, capillary network
Reptilian nephrons (90%)
- Excrete uric acid through proximal convoluted tubular
excretion
Mammalian nephrons (10%)
- Located in cortical area but loops of Henle in medullary area
- Forming and concentrating urine through glomerular
filtration

24
Q

More bird urinary system

A

Renal portal blood undergoes tubular
secretion, clear urates
- Glomerular filtration does not clear urates
Urine product contains urine and urates
- Insoluable waste uric acid vs. ammonia
- Independent of hydration status*

25
Q

Bird urinary disorders

A 
Clinical signs 
- Polyuria 
- Polydipsia 
- Oliguria/anuria 
- Uric acid deposition in tissues 
-Hind limb paresis/paralysis 
- Systemically ill 
 . Lethargy 
 . Ruffled feathers 
 . Anorexic 
 . Dehydrated
26
Q

Diagnostic testing for bird urinary disorders

A 
Diagnostics for Urinary Disorders 
- Multi-modal 
- Hematology 
 . CBC 
* Inflammation 
* Infection 
 . Plasma Chemistry
27
Q

Diagnostic testing for bird urinary disorders

A

Plasma Chemistry
- Elevated uric acid (>10 mg/dl psittacines)
. 70% of renal tissue affected
. Other causes: high protein meal, muscle catabolism, dehydration (mild elevation)
- Inc phosphorus, dec calcium (Normal - 1.5-2 Ca:l Pin)
- BUN, creatinine - non- diagnostic for renal disease
. May be indicators of
dehydration and renal
perfusion
- Potassium
. Increase in acute renal disease
. Sample processing
. Cell leakage
- Sodium and chloride
. Dehydration
- AST/CK
. Muscle wasting if chronically debilitated

28
Q

More diagnostic testing for bird urine

A 
Urinalysis 
Fecal contamination  
unavoidable 
Collect on wax paper 
- Separate urine 
Sediment evaluation 
limited to casts 
- granular, cellular, hyaline 
- uric acid crystals  
Specific gravity 1.005- 
1.020 g/uL
- Polyuria secondary to renal disease = isosthenuric 
- Polyuria secondary to  
hepatic disease = 
hyposthenuric 
pH 6.5-8.0 
- protein 
- glucose
29
Q

Other bird diagnostics

A

Rads
Culture
Endoscopy

30
Q

Bird Tx

A 
Renal disease 
- Treat etiology 
- Manage the renal failure 
 . Birds often require critical care and hospitalization 
Goals of therapy 
- Dec uric acid in body 
 . Decrease production 
 . Enhance elimination
31
Q

Bird tx continued

A 
Fluid therapy 
- Little effect on uric acid level 
 . Support patient 
 . Perfuse kidneys 
Feed diet low in protein 
Phosphorus binders 
- Aluminum hydroxide 
Calcium carbonate 
Na restricted diets 
contraindicated 
- Na inc solubility of uric acid 
Allopurinol 
- 10-15 mg/kg BID 
- Inhibits uric acid formation 
Colchicine/probenicid 
combo 
- Dec inflammation, and dec uric acid 
Omega 3 FA
32
Q

Etiologies of Bird problems

A 
Bacterial nephritis 
- Ascending infections from cloaca 
- Reproductive activity 
- Hematogenous spread 
- Inflammatory leukogram 
- Antimicrobial therapy 
 . Avoid Sulfas** 
   - Excretion via same route as uric acid 
 . Avoid nephrotoxic drugs 
   - Aminoglycosides
33
Q

More etiologies of bird problems

A 
Gout 
- Articular 
 . Uric acid tophi deposited in joints 
   - Chronic renal failure 
 . Very painful 
 . Analgesia 
 . Consider euthanasia 
- Visceral 
 . Uric acid deposited in viscera 
   - Acute renal failure 
   - Difficult to diagnose and treat
34
Q

Renal neoplasia of birds

A 
Neoplasia, budgies over-represented 
Avian kidney has 3 lobes, ischiatic nerve 
between cranial and middle lobes 
Presenting signs include: lameness, 
abdominal distension 
Biopsy and histopathology diagnostic 
Radiography - must differentiate between 
gonad and cranial pole of kidney
35
Q

Reptiles

A 
Kidneys:
- Paired 
- Lobulated, Elongated 
 . Squamates 
- Location 
 . Pelvic canal 
 . Coelomic cavity
36
Q

Reptile Urinary system

A 
Ureters 
Urodeum 
Urinary bladder 
- Absent in crocodilians and snakes 
- Chelonians water 
resorption 
Urine flow
37
Q

Reptilian urinary disorders

A 
Clinical signs 
- Muscle tremors 
- Dehydration 
- Wasting (CRF) 
 . Anorexia 
- Weak and depressed 
- Palpable kidneys 
 . Digital- cloaca 
 . Externally 
 . Constipation 
- Edema
38
Q

Diagnostic testing of reptiles

A 
Similar to birds 
Hematology 
- CBC 
* PCV 
   - Dehydration 
* Leukocytosis 
   - Reference ranges?
39
Q

Diagnostic testing of reptiles

A 
Urinalysis 
Cystocentesis or catheter 
Sample not sterile 
- Culture: + or - 
Color- clear to straw 
- Green- biliverdin (liver) 
Specific gravity 
- 1.003-1.014 (low normally) 
- Increased with renal disease 
pH: herbivore- alkaline; carnivore- acidic 
Bilirubin, ketones: 
negative 
Glucose, protein: none to low 
Bacteria- common 
Crystals- amorphous 
urates normal; calcium 
oxalates: renal disease 
Cells- few RBC, few renal tubular, squamous, transitional 
Casts- renal compromise**
40
Q

Other diagnostic tests of reptiles

A 
Radiographs 
- Cranial extension of kidney from pelvic canal 
- Negative contrast 
 . Air into coelomic cavity 
   . (10ml/kg) 
Ultrasound 
- Scales 
 . Ultrasound gel or water bath 
Biopsy 
- Transcutaneous tru-cut 
- Exploratory coeliotomy: cranial
41
Q

Tx goals in reptiles

A

Stabilize patient
Correct problems
Protect remaining functional kidney

42
Q

Tx of reptiles

A 
Correct environment and diet 
Fluid therapy 
- Support, not diuresis 
 . Assess dehydration: maintenance plus deficit 
 . Maintenance: 25-40 ml/kg/day 
 . Route: PO, SQ, 10, IV 
   - Shock: up to 5 ml/kg/hr 
- Acute renal failure 
 . May cause cardiac overload b/c delayed return to function
43
Q

Tx of reptiles continued

A

Hypocalcemia
- Treatment for secondary Hyperparathyroidism
. IO/IV: calcium gluconate (400 mg/kg/day)
. Oral preferred when stabile
- Calcium glubionate
Phosphate binders Allopurinol (Reduce uric acid)
Colchicine/Probenecid
Reduce protein catabolism
Lower protein diet

44
Q

Therapy for reptiles

A 
Vitamin D 
- Controversial 
- Humans used to reduce PTH 
 . Reduce renal toxicity without hypercalcemia 
Antimicrobials 
- Culture and Sensitivity 
Omega 3 FA 
- Anti-inflammatory effect
45
Q

Suspected etiologies of reptiles

A 
Gout 
- Limit uric acid secretion 
- Overwhelming production 
- Severe dehydration 
Bacterial diseases 
- Gram-negative 
opportunists
 . Microthrombi 
Other infectious 
- Fungal 
- Parasitic 
 . Protozoa 
   - Cryptosporidiosis 
 . Trematodes 
 . Nematodes 
Viral 
- IBD- snakes 
Neoplasia
46
Q

More suspected etiologies of reptiles

A 
Nutritional 
- High protein diets 
- Limited water, humidity 
- Hypervitaminosis D 
Toxic compounds (e.g., aminoglycosides) 
Amyloidosis 
- Low molecular weight amyloid 
- Chronic antigenic stimulation 
Trauma

Urology (5 decks)

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