Urinary Internal Medicine

Question 1

what are the 4 stages of AKI

Answer 1

initiation: may be clinically silent, damage starts immediately after injury

extension phase: may be clinically silent, ischaemia, hypoxia, inflammatory response, cell injury and death

maintenance phase: stablisation of GFR, see azotaemia, uraemia, variable urine production, days to weeks

recovery phase: up to 3 months, azotaemia improves, tubules uncdergo repair, marked polyuria in this stage.

Question 2

low BP, dehydration, blood clot in renal artery = decreases in renal blood flow
toxins: gentamicin, NSAIDs, ethylene glycol, lilies in cats, grapes in odgs, renal diseases eg lepto and pyelonephritis

can cause what?

Answer 2

AKI

Question 3

AKI or CKD?

good BCS
enlarged/ painful kidneys 
\+/- hyperkalaemia 
casts in urine sediment 
good hair coat 
disproportionally sick for degree of azotaemia 
history of toxin exposure
acute onset of signs

Answer 3

AKI

Question 4

AKI or CKD
weight loss
previous history of PUPD/ poor appetite
non regen anaemia 
small firm kidneys
suprisingly well for degree of azotaemia 
normal or low potassium
poo hair coat

Answer 4

CKD

Question 5

define azotaemia

Answer 5

azotaemia = abnormal concentration of urea, creatinine and other nitrogenous compounds in the blood

Question 6

what may you see on ECG with AKI

Answer 6

hyperkalaemia: tall spikey t waves

Question 7

how would you tx AKI

Answer 7

treat underlying cause
correction of Acid base and fluid: just enough to get kidneys working normally again. do not over flood the kidneys. get to urine flow >2mls/kg/hr maintenance asap.

if need to continue fluid, add furosemide to protect against fluid overload

if not helping- dialysis (referral) or euthanasia

Question 8

risk factor for UTI

Answer 8

female- v early neutering?
dog
neutered male> intact male

Question 9

define the 5 classes of UTIs in dogs and cats

Answer 9

sporadic bacterial cystitis = bacterial infection +cx, rare

recurrent bacterial cystitis= >3 episodes per year

pyelonephritis= infection of renal parenchyma

bacterial prostatitis= in prostate. male intact dogs should be assumed to have prostatic infection

subclinical bacteriuria= + bacteria culture -ve cx, older animals

Question 10

an intact male dog with clinical signs of a UTI should be presumed to have which classification of UTI

Answer 10

bacterial prostatitis

Question 11

are the following clinical signs for lower UTI or upper UTI

dysuria
pollakuria
haematuria
incontinence 
generally well

Answer 11

lower UTI

Question 12

are the following clinical signs for lower UTI or upper UTI
abdominal pain
renal failure
septicaemia

Answer 12

upper UTI

Question 13

which UTI classification is asc with systemic signs of fever and anorexia

Answer 13

actue bacterial prostatitis

Question 14

would a lower UTI show any abnormalities on haematology?

Answer 14

likely none

Question 15

would an upper UTI show any abnormalities on haematology

Answer 15

neutrophilia with left shift, +/- elevated urea and creatinine

Question 16

treatment for sporadic bacterial cystitis

Answer 16

ABs (amoxicillin, cephalexin or trimethoprim) 3-5 days, NSAIDs,

DO NOT USE: fluroquinolones or extended release cephalosporins

Question 17

treatment for recurrent bacterial cystitis

Answer 17

look for predisposing factors (endocrine, kidney disease, obesity, abnormal vulva conformation, congen eg ectopic ureter, prostatic disease, urolithiasis etc)

tx abs as for sporadic but perhaps longer 7-14 days if needed

amoxicillin, cephalexin or trimethoprim

Question 18

treatment for pyelonephritis

Answer 18

ABs 14 days

amoxicillin, cephalexin or trimethoprim

Question 19

tx bacterial prostatitis

Answer 19

ABs then penetrate prostate blood barrier

sulphonamides, fluoroquinolones

4 weeks

Question 20

tx subclinical bacteruria

Answer 20

tx not recommended