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CVSOH BVSc4 > Urinary - medicine > Flashcards

Urinary - medicine Flashcards

1
Q

What is azotemia?

A

Increased urea +/- increased creatinine in the blood

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2
Q

What is uraemia?

A

The clinical syndrome arising from azotemia

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3
Q

What causes a pre-renal azotemia?

A

Reduction in renal blood flow - less filtration

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4
Q

What causes a renal azotemia?

A

Fewer functional nephrons

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5
Q

What causes a post renal azotemia?

A

Urinary tract obstruction - back pressure
Urinary tract rupture - urine leakage and reabsorption of waste products

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6
Q

How do you identify a uroabdomen?

A

Creatinine in the abdominal fluid is higher than creatinine in the blood serum

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7
Q

How do you tell an azotemia is pre-renal?

A

Azotemia with concentrated urine (still have the nephrons to concentrate it)
USG >1.030

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8
Q

How do you tell it is a renal azotemia?

A

Azotemia with dilute urine
USG < 1.030

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9
Q

How do you tell that it is a post renal azotemia?

A

Evidence of urinary obstruction or rupture - on imaging or clinically

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10
Q

What is the most common result of severe acute kidney injury?

A

Anuria/oliguria - epithelial cells slough into tubules and block them

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11
Q

What are the physiological consequences of acute kidney injury?

A

Failure of excretion of nitrogenous waste products
Acid base disturbances
Electrolyte disturbances - hyperkalaemia

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12
Q

What is the clinical presentation of acute kidney injury?

A

Uraemic
Dehydrated
Lethargic
Nauseous
Diarrhoea
Tremors - hypocalaemia

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13
Q

What are the 3 main aetiologies of acute kidney injury?

A

Toxic
Ischaemia
Infectious - lepto, pyelonephritis

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14
Q

What is an acute kidney injury disease that is accompanied by skin lesions?

A

Cutaneous and renal glomerular vasculopathy - alabama rot

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15
Q

What are some specific urinalysis findings of acute kidney injury?

A

Dilute urine
Casts and crystals in sediment exam
Cytology - inflammatory cells, bacteria

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16
Q

What can be seen on imaging for acute kidney injury?

A

Exclude post renal causes - pelvic dilation or free fluid
Renal size
Radio-opaque uroliths

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17
Q

What infectious disease should you test for on acute kidney injury?

A

Leptospirosis

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18
Q

How do you manage acute kidney injury?

A

Remove underlying cause eg. stop nephrotoxic drugs
Supportive care - fluids

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19
Q

What are the risks with fluids in cases of acute kidney injury?

A

Anuria/oliguria cases - may cause volume overload as cant excrete fluid

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20
Q

What is the normal urine output for a dog or cat on fluids?

A

1-2ml/kg/hr

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21
Q

How do you determine an anuria/oliguria vs polyuria?

A

Measure fluid ins and outs - closed urinary catheter system or weigh urine

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22
Q

How do you manage hyperkalaemia?

A

Restore renal perfusion
Calcium gluconate - IV (redistributes potassium intracellularly)
Glucose/insulin

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23
Q

What specific drug can you give for NSAID induced acute kidney injury?

A

Misoprostol

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24
Q

What specific drug can you give for pyelonephritis induced acute kidney injury?

A

Amoxyclav

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25
Q

What specific drug can you give for lepto induced acute kidney injury?

A

Amoxyclav and then doxycycline

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26
Q

What specific drug can you give for ethylene glycol induced acute kidney injury?

A

Ethanol

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27
Q

What can you give if there is persistent anuria?

A

Frusemide - diuretic
(if no obstruction and is euvolaemic)

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28
Q

What are the indications for euthanasia/renal replacement following acute kidney injury?

A

Persistent anuria
Volume overload
Unmanageable hyperkalaemia

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29
Q

What is chronic kidney disease?

A

Gradual progressive irreversible nephron loss

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30
Q

What species is CKD very common in?

A

Cats

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31
Q

What percentage of nephrons can be lost before any clinical disease is detected?

A

67%

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32
Q

What disease is caused by a subclinical toxic injury that happened a while ago causing CKD?

A

Chronic interstitial nephritis

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33
Q

What breed are predisposed to polycystic kidney disease

A

Persian cats - autosomal dominant

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34
Q

What is the pathogenesis of chronic kidney disease?

A

Asymptomatic/undiagnosed initial insult reduces glomerular filtration rate
Compensatory hypertrophy of remaining loss - more susceptible to damage, so progressive nephron loss

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35
Q

What are the three major differentials for cats with PUPD and weight loss?

A

Diabetes mellitus
Hyperthyroidism
Chronic kidney disease

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36
Q

What is the main sign of hypokalaemia?

A

Neck ventroflexion - head down

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37
Q

Why does chronic kidney disease cause renal secondary hyperparathyroidism?

A

Increased serum phosphate
PTH secretion increases to encourage more phosphate excretion at the kidneys
But PTH also causes bone resorption

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38
Q

How do you diagnose chronic kidney disease?

A

Azotemia with submaximally concentrated urine

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39
Q

What do you use to measure urine concentration?

A

Refractometer

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40
Q

What are the two ways of measuring renal filtration?

A

GFR
SDMA

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41
Q

What changes are seen on serum biochemistry in chronic kidney disease cases?

A

Azotemia - high urea, creatinine
Increased phosphorus
Increased calcium
Decreased potassium (euthanased before increased potassium like in acute kidney disease)

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42
Q

What size are the kidneys in chronic kidney disease?

A

Small and irregular

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43
Q

What do you use to know how to treat CKD?

A

IRIS staging

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44
Q

What is IRIS staging?

A

Use to know how to treat CKD, only once reversible problems have been addressed so there is no active underlying component

1 - CReatinine
2 - substage by proteinuria
3 - substage by blood pressure

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45
Q

How do you delay progression of CKD?

A

Feed renal diet
Control hypertension, proteinuria, hyperphosphataemia, hypokalaemia
Avoid further insults eg. keep hydrated
Maropitant/mirtazapine

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46
Q

What should you avoid in caloric management of CKD?

A

Avoid protein calorie malnutrition - must eat enough calories
Avoid introducing prescription diets in the hospital - will associate with hospital so wont eat
Avoid syringe feeding

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47
Q

What do renal diets have?

A

Restricted protein, phosphorus and sodium
Potassium supplement

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48
Q

What should you examine to monitor hypertension other than bp?

A

Retinal exam
For oedema and haemorrhage on retina

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49
Q

What is the prognosis of CKD?

A

Depends on the IRIS stage and whether it is being managed properly
Cats do much better than dogs

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50
Q

What are the two main regulators of blood pressure?

A

Baroreceptors
Renin-angiotensin-aldosterone system

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51
Q

What are the main causes of systemic hypertension in cats and dogs? What species is more common for each one?

A

Primary - rare (no high salt diet)
Secondary -
Kidney disease (most common in cats)
Endocrinopathies (most common in dogs)
Situational hypertension - stress
Increased intracranial pressure

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52
Q

What are the main consequences of systemic hypertension?

A

Ocular
Renal - CKD progression
Cardiac - LV concentric hypertrophy
Neurological - stroke

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53
Q

What is the normal systolic blood pressure?

A

120-140mmHg

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54
Q

Above what systolic blood pressure is considered hypertensive?

A

160mmHg and above
Above 180mmHg is severe

55
Q

How can you measure blood pressure?

A

Doppler
Oscillometric - automated inflation and deflation

56
Q

When should you treat hypertension?

A

If BP >180mmHg
If BP >160nnHg with evidence of target organ disease or is sustained

57
Q

What is the medical treatment for systemic hypertension in cats? How does it work?

A

Amlodipine first choice
Calcium channel blocker so causes vasodilation

58
Q

What is the medical treatment for systemic hypertension in dogs? How does it work?

A

Benazepril
ACE inhibitor, prevents production of angiotensin II

59
Q

What are some causes of proteinuria?

A

Pre-renal -
Increased proteins in the blood
Pyrexia
Muscles - post exercise, seizure

Renal -
Intrinsic renal disease

Post renal -
Inflammatory or neoplastic disease in urinary tract
Urinary tract haemorrhage
Repro tract disease

60
Q

How do you diagnose proteinuria?

A

Urine protein:creatinine ratio
(Dipstix - qualitative, not fully reliable)

61
Q

What is a normal urine protein:creatinine ratio?

A

Less than 0.2

62
Q

What is a proteinuric (abnormal) urine protein:creatinine ratio?

A

> 0.4 - cat
0.5 - dog

63
Q

What is a renal proteinuria? What is it due to?

A

Protein losing nephropathy
Marked renal proteinuria (>2) is due to GLOMERULAR disease

64
Q

What are the consequences of glomerular disease?

A

NOT necessarily azotemic and may retain urine concentrating ability - tubules still intact
Progressive proteinuria - hypoalbuminaemia, oedema
Hyperchloesterolaemia

65
Q

What causes secondary glomerular disease?

A

Immune complexes fighting inflammation elsewhere in the body get stick in the glomerulus
Amyloid deposition
Drug/toxin

66
Q

What breed is predisposed to amyloidosis?

A

Chinese shar pei

67
Q

What causes amyloid production?

A

Chronic inflammatory disease - production of serum amyloid A which is deposited in tissue and polymerises to insoluble state

68
Q

What is the standard therapy for glomerular disease?

A

Treat underlying disease
Treat the proteinuria - ACE inhibitors
Renal diet
Treat hypertension
Treat hypercoagulability - anti-platelets eg. clopidogrel

69
Q

What is the name of proximal tubular disease and what is the main feature?

A

Fanconi syndrome
Glucose high in urine but not high in the blood
Not diabetes mellitus

70
Q

What structures are involved in lower urinary tract disease?

A

Bladder nad urethra

71
Q

What is pollakiuria?

A

Increased frequency of urination

72
Q

What is stranguria?

A

Straining to urinate

73
Q

What is periuria?

A

Voiding in inappropriate places - eg. cats not wanting to use litter tray as associate it with pain

74
Q

What is the most common disease of lower urinary tract disease in cats?

A

Feline idiopathic cystitis

75
Q

What is the most common disease of lower urinary tract in dogs (male and female)?

A

Bacterial UTI - most common in female dogs
Prostatic disease - most common in male dogs

76
Q

What are the two main diseases of the lower urinary tract in cats?

A

Feline idiopathic cystitis
Urolithiasis

77
Q

What are the 4 main diseases of the lower urinary tract in dogs?

A

Bacterial UTI
Prostatic disease
Urolithiasis
Neoplasia

78
Q

What cats are predisposed to feline idiopathic cystitis?

A

Younger
Indoor
Overweight
Dry food diet - more calorific
Multi-cat household

79
Q

What dogs are affected by prostatic neoplasia?

A

Almost exclusively neutered male dogs

80
Q

What complications are associated with urinary obstruction?

A

Hyperkalaemia - bradydysrhythmias
Back pressure on kidneys - post renal azotemia

81
Q

What tube do you use for sediment/crystal examination of urinalysis?

A

Plain tube

82
Q

What crystals are square with a cross on for urinalysis?

A

Calcium oxalate dihydrate

83
Q

What crystals are coffin shaped on urinalysis?

A

Struvite

84
Q

When should you treat bacteriuria?

A

Only if there are clinical signs - common to find bacteria in the urine with no adverse reactions

85
Q

How do you treat a bacterial UTI?

A

Ideally on culture and sensitivity
Amoxicillin or trimethoprim sulphonamide
NSAIDs
Lots of water
Clean vulva

86
Q

What is the most common bacteria found in UTIs?

A

E. coli

87
Q

What are the possible complications of UTIs?

A

Struvite uroliths - from bacteria breaking down urea into ammonia
Pyelonephritis
Polypoid cystitis

88
Q

What count as complicated UTIs?

A

Recurrent cases, male dogs, cats

89
Q

What can cause urethral obstruction?

A

Urethral spasm
Urethral plug

90
Q

What is feline idiopathic cystitis?

A

Lower urinary tract disease in stressed cats - from neuroendocrine modulation

91
Q

What is the emergency management of hyperkalaemia?

A

Alleviate obstruction - urinary catheterisation
Fluid therapy
Calcium gluconate, glucose, insulin
Analgesia

92
Q

What is the medical management of feline idiopathic cystitis?

A

Analgesia - buprenorphine, NSAIDs
Gabapentin - anxiolytic
Feliway
Encourage water intake
Avoid obesity
Address stressful cat - cat interactions
Antispasmodics - prazosin, dantrolene

93
Q

What is a urolith?

A

Macroscopic urinary stone - organised crystal aggregates of minerals in small amounts of organic matrix

94
Q

What is crystalluria?

A

Crystals in the urine - microscopic mineral precipitate
Can occur with uroliths or separately - not necessarily the same constituents

95
Q

What are promotors of crystal formation?

A

concentration of a compound in urine
USG
Urine pH
Urine stasis

96
Q

What is the term for when it is no longer possible to hold the compound in solution?

A

Formation product (Kf)

97
Q

What is the term for how saturated the urine is with a compound?

A

Solubility product

98
Q

When can uroliths be symptomatic of lower urinary tract disease?

A

Urethroliths - obstruction
Cystoliths - cause cystitis

99
Q

When can uroliths be symptomatic of upper urinary tract disease?

A

Nephroliths - pain, pyelonephritis
Ureteroliths - obstruction

100
Q

What are the sizes of the kidneys when blocked with a ureterolith?

A

Little - chronic kidney disease, non blocked
Big - ureteric obstruction, backup of fluid in renal pelvis

101
Q

How do you treat a urethral urolith?

A

Retropulsion to bladder, then removal

102
Q

How do you treat a ureteral urolith?

A

Place an artificial silicone ureter as a bypass - referral

103
Q

How do you treat cystoliths?

A

Dissolution - medical therapy
Cystotomy

104
Q

How do you treat nephroliths?

A

Dissolution if possible
Referral

105
Q

How should you manage longer term urolith formation/recurrence?

A

Classify stone composition - submit for analysis

106
Q

What type of uroliths are radioopaque?

A

Calcium oxalate
Struvite
(You can C/See them)

107
Q

What stones are radiolucent?

A

Urate

108
Q

How big do uroliths need to be to visualise on radiograph?

A

> 2-3mm

109
Q

How do you look for a radiolucent urolith?

A

Contrast/double contrast - radiograph
Or use ultrasound

110
Q

What is ultrasound useful for evaluating related to uroliths?

A

Can visualise both radio-opaque and radio-lucent - use Doppler, look like a disco ball)
Can evaluate renal pelvic dilation

111
Q

What do urate crystals look like on urinalysis?

A

Round holographic crystals

112
Q

What uroliths form in acidic pH?

A

Urate
(Calcium oxalate - acidic to neutral)

113
Q

What uroliths form in alkaline pH?

A

Struvite

114
Q

What uroliths form in acidic to neutral pH?

A

Calcium oxalate

115
Q

What is the most common urolith in dogs? What are the most common sites?

A

Struvite - infection associated
Cystoliths and urethroliths most common sites

116
Q

What is the most common urolith in cats? Where are they found?

A

Struvite most common
But calcium oxalate is most common in upper urinary tract
Increased incidence of ureteroliths and nephroliths

117
Q

What are the general principles for urolith management?

A

Dilute urine - so supersaturation is not possible
Encourage voiding
Avoid obesity

118
Q

What are the different classes of drugs used in the management of urinary tract disease?

A

ACE inhibitors
Diuretics
Drugs affecting bladder (detrusor muscle)
Drugs affecting urethral sphincter pressure

119
Q

What drugs are anti-proteinurics?

A

ACE inhibitors

120
Q

What does angiotensin II do?

A

Causes vasoconstriction of EFFERENT arterioles and stimulates aldosterone secretion - increases preload

121
Q

How do ACE inhibitors reduce proteinuria?

A

Block angiotensin II so prevents vasoconstriction of the efferent arterioles
Reduces transcapillary pressure in the glomerulus so reduces degree of proteinuria

122
Q

What does ACE stand for in ACE inhibitors?

A

Angiotensin converting enzyme inhibitors

123
Q

What are the 3 indications for ACE inhibitors?

A

Reduce glomerular pressure - proteinuria
Reduce pre/afterload in heart failure
Reduces blood pressure in hypertension

124
Q

When are ACE inhibitors contraindicated?

A

Hypovolaemia
Hypotenison
Acute kidney injury

125
Q

When are angiotensin receptor blockers given?

A

Reduces proteinuria in chronic kidney disease

126
Q

Which arm of the autonomic nervous system controls the detrusor muscle contracting to empty the bladder?

A

Parasympathetic
(P - Pee, S - storage)

127
Q

What drugs act on the bladder detrusor muscle? When are they needed

A

Parasympathomimetics
Used in bladder atony - when the bladder is distended for a long time so loses its elasticity in transitional epithelium

128
Q

What are the side effects of parasympathomimetics?

A

Cholinergic side effects
DUMBBELS
Diarrhoea
Urination
Myosis
Bradycardia
Bronchoconstriction
Emesis
Lacrimation
Salivation

129
Q

What muscles make up the urethra?

A

Smooth muscle internal sphincter
Skeletal muscle of urethra - urethralis muscle

130
Q

What phase of the autonomic nervous system controls storage of urine, keeps the internal urethral sphincter closed?

A

Sympathetic control
(P - Pee, S - storage)

131
Q

What drugs are used to treat urinary sphincter mechanism incompetence (common in spayed bitches)?

A

Alpha-adrenergic agonists
Sympathomimetics
Oestrogens

132
Q

What are the side effects of the drugs used to treat urinary sphincter mechanism incompetence?

A

Sympathetic effect - increased heart rate, overstimulation
Oestrogens - as if on heat

133
Q

What drugs are used to treat urethral spasm in cats?

A

Smooth muscle - alpha adrenergic antagonists - prazosin
Skeletal muscle - dantrolene, diazepam

CVSOH BVSc4 (86 decks)

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