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Equine Medicine > Urinary disorders > Flashcards

Urinary disorders Flashcards

1
Q

What findings on a CBC indicate inflammation?

A

Neutrophilia
monocytosis
elevated fibrinogen
elevated total protein

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2
Q

What findings on CBC indicate dehydration?

A

Elevated PCV, RBC, and Hb

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3
Q

Prerenal vs renal vs postrenal azotemia?

A

prerenal
dehydrated, azotemia
High USG (concentrated)

renal
azotemia
isosthenuric (can’t concentrate or dilute)

postrenal
     azotemia
     USG normal
     anuric
     hyperkalemia (K accumulates)
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4
Q

Postrenal azotemia?
Dx?
Tx?

A 
Patient blocked
Dx: sedate + cystoscopy 
Tx:
Treat hyperkalemia first!!!
* Fluids w/ glucose
     for hyperK and dehydration
* urethrostomy
antibiotics
NSAIDs
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5
Q

Calculi?
signalment?
PF?

A 
Calcium carbonate stones
most common in bladder
complete or partial obstruction
Adult geldings
alfalfa diets
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6
Q

Renal uroliths?
Dx?
Tx?

A 
stone in kidney-ureter
hard to Dx
   * azotemia may be absent
   * colic rare
   * may miss on U/S
Tx: remove affected kidney if no azotemia
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7
Q

Bladder stones
Signs?
Dx?
Tx?

A 
Signs:
   * hematuria! (post exercise)
   * dysuria, incontinence
   * pyuria, colic
Dx: easy
   * sedate + cystoscopy
Tx
   * female: manual extraction
   * male: urethrostomy
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8
Q

Urethral stones
signs?
Dx?
Tx?

A 
Signs:
   * dysuria, pollakiuria
   * colic
Dx: endoscopy
Tx: urethrostomy
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9
Q

Methods for urolith diagnosis?

A 
Cystoscopy
      urethra, bladder, ureters
      requires sedation
Ultrasound
      bladder and kidneys
Rectal palpation
      feel bladder
      caudal pole of left kidney
      ureters NOT palpable
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10
Q

Important nephrotoxic drugs?

A

NSAIDs and gentamicin
both highly nephrotoxic

Gentamicin - toxin so corticol lesions

NSAIDs - lead to hypoxia and lesions in medulla, Especially if dehydrated!

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11
Q

hyposthenuria vs isosthenuria vs concentrated?

A

hyposthenuria: <1.008
isosthenuria: 1.008-1.015
concentrated: 1.015

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12
Q

Normal urine pH?

A

7-9

horse urine is alkalinic

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13
Q

What might positive blood results on U/A mean?

A

Presence of myoglobin, Hb, or rbc’s

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14
Q

What does bilirubin mean on U/A?

A

Hemolysis

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15
Q

What do ketones mean on U/A?

A

Don’t use this result, it’s unreliable

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16
Q

What enzymes might u find in urine, meaning?

A

GGT in urine indicates tubular damage

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17
Q

Describe blood supply in the kidney

A

blood supply enters thru cortex
most supply is in the cortex
least is in the middle
medulla is hypoxic

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18
Q

Affect of dehydration on kidney?

A

decreased perfusion to kidney -> natrually hypoxic medulal becomes more hypoxic

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19
Q

Affect of NSAIDS on kidneys?

A

Lead to ARF
kidney gets 25% of blood supply
when dehydrated, blood supply drops
kidney releases prostaglandins to widen afferent artery

NSAIDs (flunixin) inhibit COX -> block PGE’s -> less blood supply to kidney -> papillary necrosis

Flunixin is nephrotoxic, but especially if dehydrated

20
Q

Affect of gentamicin on kidneys?

A

Leads to ARF
Gentamicin enters kidneys thru blood, gets filtered, taken up by receptors, stays in tubules, results in tubular damage/necrosis

+/- elevated urine GGT

21
Q

ARF clinical signs?

A

None, look for azotemia or will miss
will see signs of the primary problem

mayyyyyy see oliguria, lethargy
but not usually

22
Q

ARF Dx?

A

blood work

  • azotemia
  • maybe: vNa, vCl, ^K

UA

  • isosthenuric
  • rbc
  • proteinuria
  • granular casts
  • GGT
23
Q

ARF Tx?

A

Treat primary cause
FLUIDSSS (2x maintenance)
monitor azotemia on and off fluids

give fluids, check creat in 24 hrs, if good stop fluids, check again in 24 hrs, if not good, more fluids
if creat can’t stay low, there’s permanent damage

24
Q

Acute renal failure summary

A 
common in horses
often caused by genta or flunixin
no clinical signs
treat early w/ FLUIDS
REVERSIBLE
25
Q

Most common reason for prolapsed penis?

A

In skinny horses, retractor muscle too weak to hold penis in place

26
Q

Most common cause of polyuria?

A

psychogenic polydipsia

27
Q

Psychogenic polydipsia?

A

Etiology unknow
horses drinks a lot, causes medullary wash out, can no longer concentrate so can’t stop peeing diluted urine, drink even more

28
Q

Polyuria differentials?

A

psychogenic polydipsia
renal failure
Pituitary Pars Intermedia Dysfxn-PPID
Diabetes - rare in horses

29
Q

How does renal failure cause polyuria?

A

Horse can’t concentrate urine so it pees more, and thus drinks more

30
Q

how to differentiate renal failure and psychogenic polydipsia?

A

PP: diluted urine (hyposthenuria)

renal failure: azotemia + isosthenuria

31
Q

How to Dx polyuria?

A

50ml/kg/day of urine
difficult to measure
need 24 h urine collection
water consumption easier to monitor

32
Q

Causes of polydipsia

A 
high protein diet
hot outside
workload (sweating)
Primary
    *psychogenic (low USG<1.005)
Secondary
    * renal failure (azotemia)
    * Diabetes (rare)
33
Q

Polydipsia?

A

water intake above 60ml/kg/day

34
Q

CRF CBC findings?

A

mild anemia

less EPO production

35
Q

CRF chemistry findings?

A 
low albumin (being lost in urine)
severe azotemia
   * Urea:creatinine ration >10:1
   * indicates chronicity
hypercalcemica (indicates chronicity)
hypoNa, hypoCl
hyperK
36
Q

CRF U/A findings?

A 
isosthenuria (1.008 - 1.015)
Protein ++++
    * filtration problem
Glucose ++++
    * proximal tubules not absorbing it
37
Q

CRF signs?

A

Poor BCS!
lethargy
polyuria-polydipsia (50%)
ventral edema (50% of horses)
CRF uremia
* can’t clear toxins > ammonia and
urea accumulate >cross BBB and toxic to
mucosa > oral/stomach ulcers and colon
ulcers > diarrhea
* ammonia changes bacteria in mouth >
tartar buildup

38
Q

What causes ventral edema in CRF?

A 
Decreased oncotic pressure
    * protein lost in urine
Increased hydrostatic pressure
    * chronic anemia>poor perfusion>hypoxic 
      kidney> renin release>increased bp
Endothelial damge from high ammonia
39
Q

ESRD/CRF Tx?

A

If creatinine > 5 mg/dl
Can’t fix it, low QOL, slow death
so euthanasia

if creatinine <5 mg/dl
    No alfalfa (high Ca)
    2 teacups of oil/day
    NOT olive oil -> fatal colitis
    oil is to keep weight on
    or powdered fat
    no high protein supplements
    Water access at all times!!!!!
   Ride w/ care! dehydration w/o h20 acces
   Don't breed!!!
  MONITOR - recheck first at 2 wks, then
        at 6 months 3x, then yearly
40
Q

ESRD diagnosis?

A

if you want 100% confirmation: biopsy

reveals fibrosis

41
Q

CRF causes

A 
Acquired - most common
     * from previous injury
     * cause may be unknown
Congenital
     * <5yo
     * renal agenesis, hypoplasia, dysplasia
42
Q

CRF prognosis?

A

Poor: creat >5 mg/dl
creatinine <5mg/dl - can live normally!
* no clinical signs

43
Q

Types of diabetes insipidus?

A

Central: no production of ADH
Nephrogenic: not responding to ADH

44
Q

how to differentiation psychogenic PD from diabetes insipidus?

A

Water deprivation test
DI: will concentrate urine
PPD: won’t concentrat b/c medullary washout

**it’s PPD until proven differently

45
Q

Water deprivation test?

A

measure water intake in 24 hrs
give half that amount for a few days
then half of THAT for few days
e.g. 140 -> 70 -> 35

***DON’T do on azotemic animal
if azotemia present it’s a renal problem no PPD or DI

Takes a long time
can’t cut h20 off abruptly, will cause dehdyration. measure body weight multiple times a day, if greater than 5% weight loss, stop the test! moving too quickly.

Equine Medicine (2 decks)

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