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Urinary tract disease 3 Flashcards

1
Q

Outline the clinical signs of lower UTI

A
  • May be none
  • Stranguria/dysuria, pollakiuria
  • Urine scalding
  • Pyuria, haematuria
  • Bladder may be painful on palpation, thickened
  • Abdominal pain
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2
Q

Outline the clinical signs of an upper UTI

A
  • May be none, often non-specific
  • May be pyrexic, abdominal pain
  • Kidney may be enlarged, painful
  • PUPD or signs of renal failure possible
  • Anorexia, inappetance
  • Sudden death in pigs
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3
Q

Discuss the diagnosis of a UTI

A

Urinalysis: cysto if poss

  • Dipstick: blood, WBC, alkaline pH (but not always)
  • Urine sediment: large no.s of WBCs, bacteriuria
  • Urine culture: definitive diagnosis, ideally prior to treatment
  • Antimicrobial sensitivity: ideal, but not always practical

Blood tests and imaging not so useful inless ruling out upper UTI

  • may or may not see signs of inflammation on haematology, may see evidence of renal compromise
  • Ultrasonography good for identifying pyelonephritis

Microbial identification

  • Not generally performed
  • MaldiTof may become more common
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4
Q

Outline the basic approach treatment of UTIs

A
  • Generally empirical therapy first (impractical to wait for results)
  • Empirical: TMPS, Beta lactams, fluoroquinolones
  • 7-14 day course for uncomplicated UTIs, 4-6 weeks if complicated (pyelonephritis, prostatitis, recurrent)
  • C+S at end before stopping
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5
Q

Discuss the advantages and disadvantages of using TMPS for treatment of a UTI

A
  • AD: good prostate penetration, achieves high concentrations in urine, cheap
  • Disad: crystals form in kidney if animal poorly hydrated/renal function compromised, immune mediate hypersensitivity reactions in Dobermann
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6
Q

Discuss the advantages and disadvantages of using betalactams for the treatment of a UTI

A
  • Ad: amoxyclav effective against most bacteria, good first line in most cases
  • Disad: widespread resistance in some areas, potential for penicillin allergy, not for use in hind-gut fermenters e.g. guinea pigs
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7
Q

Discuss the use of fluoroquinolones for the treatment of a UTI

A
  • Good penetration, may be first choice in entire males
  • But critically important in humans, avoid use where possible
  • May have effects on tendons, cartilage, CNS
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8
Q 
What antibiotics are most appropriate for empirical treatment of these scenarios?
A: cystitis in a dog
B: FLUTD
C: prostatitis
D: pyelonephritis
A

A: Amoxyclav, TMPS
B: None - usually not needed
C: TMPS, fluoroquinolones
D TMPS, fluroquinolones, amoxyclav

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9
Q

What are the main causes of recurrent UTIs?

A
  • Failure of initial therapy e.g. discontinued too early, antibiotic resistance
  • Re-infection (predisposing causes e.g. immunosuppression, anatomical abnormality)
  • Involvement of upper urinary tract
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10
Q

Outline your approach to a recurrent UTI

A
  • C+S
  • Assess for upper tract involvement: definitive rule out requires urine collection from ureter/renal pelvis, but may be seen on ultrasound as dilated renal pelvis, or on bloods as renal compromise
  • Follow therapy with C+S to assess success, must be negative before stopping
  • Consider nephrectomy if only one affected
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11
Q

Discuss the use of urinary acidification for the treatment of UTIs

A
  • Urease producing bacteria alkalinise urine
  • Unclear as tobenefit of acidification
  • Common in humans: ammonium chloride, vit C, cranberry juice
  • Best bet is to ensure adequate hydration (avoid diuresis with drugs, may predispose to infection)
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12
Q

Discuss potassium supplementation in cats and dogs and give examples of products

A
  • Oral or IV possible
  • IV: potassium chloride to IV fluids, must be well mixed and clearly labelled, do not infuse faster than 0.5mmol/kg/hr, monitor continuously with ECG
  • Oral: Ipakitine, Kaminox, safe if eating or feeding tube in place
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13
Q

Outline hypokalaemic nephropathy

A

HypoK leads to impaired responsiveness to ADH, leads to PU and further renal losses

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14
Q

At what level is hyperkalaemia a cause for great concern

A
  • When ECG abnormalities are evident
  • Or >6.5mmol/l (normal range 3.5-5.5mmol/l)
  • Myocardial toxicity occurs at 7.5mmol/l
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15
Q

Outline the treatment of hyperkalaemia

A
  • IV calcium gluconate (0.5-1.5ml/kg 10% soln over 5-10 mins)
  • Regular soluble insulin with dextrose
  • Sodium bicarb (rarely, only if acid base can be monitored)
  • Terbutaline (stimulates NaK ATPase to translocate K+ intracellularly_
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16
Q

Outline the treatment of hyperphosphataemia

A
  • Diet most effective way of controlling increased phosphate in CRF patients.
  • Calcitriol can be used once hyperphosphataemia has been resolved to help reduce PTH
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17
Q

What is the mechanism of action of benazepril hydrochloride?

A
  • ACE inhibitor, blocks effects of angiotensin II and aldosterone
  • Prevents vasoconstrition, retention of sodium and water and remodelling effects in kidney
  • Normalises glomerular capillary pressure and reduces systemic blood pressure
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18
Q

Outline the initial approach to NSAID intoxication

A
  • Assess cardiovascular function
  • Take blood sample for haem and biochem (assess potassium status)
  • IVFT (0.9% NaCl)
  • Ideally urinary catheter to accurately measure urine output
  • Monitor blood pressure
  • If olig/anuric consider diuretics (mannitol, loop diuretics e.g. furosemide)
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19
Q

Outline some complications and contraindications that may occur as a result of diuretic use in an anuric/oliguric patient

A
  • Mannitol: may result in hyponatraemia, care in patients with electrolyte abnormalities. Contraindications include intracellular dehydration, hypovolaemia
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20
Q

What are the main causes of urinary incontinence in adult bitches?

A
  • USMI
  • Detrusor instability
  • Vaginal pooling
  • Lower UTI
  • Neurogenic disorders
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21
Q

What are the main causes of urinary incontinence in adult male dogs?

A
  • Prostatic disease
  • USMI
  • Detrusor instability
  • Neurogenic disorders
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22
Q

What are the main causes of urinary incontinence in juvenile dogs?

A
  • Ectopic ureter
  • Urethral or bladder hypoplasia
  • Congenital USMI
  • Vaginal anomalies
  • Intersex disorder
  • Patent urachus
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23
Q

What are the main causes of urinary incontinence in cats?

A
  • USMI
  • Overflow
  • Neurogenic disorders
  • FeLV associated
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24
Q

Identify the neurogenic causes of urinary incontinence

A
  • Sacral fracture
  • Pelvic nerve/plexus trauma
  • Lumbosacral disease e.g. IVDD, lumbosacral stenosis, neoplasia
  • Sacral malformation (Manx cat)
  • FeLV associated
  • Generalised peripheral lower motor neuron disease
  • Dysautonomia
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25
Q

Identify non-neurogenic causes of urinary incontinence

A
  • USMI
  • Urethral hypoplasia
  • Lower urinary tract inflammation
  • Detrusor instability
  • Ectopic ureter
  • Partial outflow obstruction e.g. uroliths, neoplasia, polyps
  • Patent urachus
  • Vestibulovaginal stenosis/septumm
  • Primary detrusor atony with overflow
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26
Q

What are the 2 treatment options for urinary sphincter mechanism incompetence?

A
  • Sympathomimetics (phenylpropanolamine e.g. propalin, urilin)
  • Oestrogens (estriol e.g. incurin)
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27
Q

Outline the mechanism of action of sympathomimetics for the treatment of USMI

A

Increases stimulation of alpha-adrenergic receptors to improve urethral tone

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28
Q

Outline the indications and contraindications for sympathomimetics for the treatment of USMI

A
  • Indications: males or females, dogs or cats, poor response to oestrogen
  • Contra: hypertension, some cardiac diseases, anxiety disoders
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29
Q

Give the administration frequency and residual effect duration of sympathomimetics used for the treatment of USMI

A
  • Administer q4-24 hours

- Short residual effects

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30
Q

Outline the adverse effects of sympathomimetics used for the treatment of USMI

A
  • Hyperactivity
  • Hypertension
  • Anxiety
  • Tachycardia
  • Anorexia
  • Weight loss
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31
Q

Compare the effectiveness of sympathomimetics and oestrogens for the treatment of USMI

A

Sympatho 75-90% excellent results, oestrogens 40-65% excellent results
Can be used together

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32
Q

Describe the mechanism of action of oestrogens for the treatment of USMI

A

Sensitise alpha adrenoceptors to adrenaline and result in better closure pressure of sphincter

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33
Q

Give the indications and contraindications for oestrogens for the treatment of USMI

A
  • Indications: bitches, combination with alpha-agonists, recurrent UTI or vaginitis
  • Contra: males dogs, intact bitches, cats, pregnancy
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34
Q

Give the administration frequency and residual effect duration of oestrogens used for the treatment of USMI

A
  • Q2-14 days

- Residual effects possibly prolonged

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35
Q

Outline the adverse effects of oestrogens used for the treatment of USMI

A
  • Behavioural change
  • Bone marrow toxicity (rare)
  • Oestrus
  • Exacerbation of immune mediated disease
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36
Q

What are sweet or fishy odours in urine indicative of?

A
  • Fishy: bacterial infection

- Sweet: ketones (diabetes mellitus or ketosis)

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37
Q

What may cause falsely positive protein results on urinalysis?

A

Contamination of sample with alkaline cleaning products, or alkaline urine

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38
Q

How many erythrocytes, leucocytes and epithelial cells are considered normal on urine sediment examination from a cysto sample?

A
  • Eryth: 0-3/hpf
  • Leuco: 0-3/hpf
  • Epith: small numbers normal
39
Q

How many casts are considered normal on urine sediment examination from a cysto sample?

A

Small number of hyaline (-2/hpf) and granular (0-1/hpf) is normal

40
Q

Briefly describe the formation of urinary casts and how these may occur abnormally

A
  • Formed by protein or cellular deposits in the renal tubules, dissolve in alkaline urine
  • Large numbers indicate renal tubule disease
41
Q

Briefly describe struvite crystals incl. composition and appearance

A
  • Normal: occasionally seen in cold, concentrated alkaline urine
  • magnesium ammonoium phosphate
  • 3-8 sided prisms, often look like coffin lids
42
Q

Briefly describe cacium oxalate crystals incl. appearance and cause

A
  • Found in acidic or neutral urine, small no. normal in dogs and horses
  • Dihydrate: small squares with an X
  • Monohydrate: long rectangular, or dumbbell shaped
  • Large no. indicate ethylene glycol toxicosis
43
Q

In which species are calcium carbonate crystals normally found and describe their appearance

A
  • Normal in horse and rabbit

- Round or granular

44
Q

Describe the appearance of urates/uric acid crysals

A
  • Urates: brown/yellow coloured spheres or amorphous structures
  • Uric acid: diamond shapes
45
Q

Describe the appearance of cystine crystals

A

Flat colourless hexagons, presence indicates genetic defect in renal cystine handling

46
Q

Describe the appearance of sulphonamide crystals

A
  • Often needle shaped dark crystals, can take various shapes

- Found in animals treated with sulphonamide

47
Q

What radiographic finding is typical for FIP and multicentric neoplasia?

A

A hypoechoic marginal band around the kidney

48
Q

Compare the radiographic features of a bladder polyp vs a mucosal tumour

A

Polyp often more homogenous, hyperechoic and relatively narrow base

49
Q

Define periuria

A

Urination at inappropriate locations

50
Q

List the key differentials for dysuria in a small animal

A
  • Inflammation of LUT or genital tract
  • Infection resulting in inflammation
  • Narrowing/obstruction of urethra (physical or functional)
51
Q

What anatomical sites and possible causes should be considered where haematuria is identified in a small animal?

A
  • Renal: trauma, neoplasia, calculi idiopathic
  • Post-renal: inflammation, infection, calculi, neoplasia, iatrogenic
  • Genital: oestrus, prostate disease
52
Q

How may the source of blood in urine be identified?

A
  • Timing of blood in stream
  • Appears at the end: prostatic origin
  • Appears early on: urethral
53
Q

Compare the appearance of haematuria, haemoglobinuria and myoglobinuria

A
  • Haematuria: when spun, supernatant is clear
  • Haemoglobin: when spun, the plasma is pink
  • Myoglobin: red/brown urine
54
Q

List the possible causes of haemoglobinuria in small animals and how these can be differentiated

A
  • Pre rena: intravascular haemolysiss e.g. IMHA

- Post-renal: haemolysis in hypotonic urine (blood plasma may be normal)

55
Q

List the possible causes of myoglobinuria in small animals, and give the appearance of spun blood and urine

A

Systemic disease causing extensive muscle destruction e.g. ischaemic necrosis, rare in small animals

  • Urine: coloured supernatant
  • Blood: plasma clear
56
Q

Compare lower urinary tract neoplasia in dogs, horses and ruminants

A
  • Dogs: 90% are TCC, westies, scotties, shelties predisposed
  • Horses: SCC most common in bladder, also sarcoids of urethra, external genital tract, sheath
  • Ruminants: acute bracken poisoning
57
Q

What conditions do UTIs commonly occur secondary to?

A
  • Systemic disease leading to low USG e.g. hyperT4 in cats
  • Anatomic defects e.g. ectopic ureters
  • Urinary calculi
  • Neoplasia
58
Q

What obstructive causes may lead to dysuria in small animals?

A
  • Urinary calculi
  • Neoplasia
  • Urethral plugs
  • Rupture
59
Q

List the most common uroliths seen in dogs and cats and when these occur

A
  • Struvite (magnesium ammonium phosphate)
  • Calcium oxalate (dihydrate assocaited with hpercalcaemia, monohydrate with ethylene glycol)
  • Ammonium biurate in dogs with PSS, of normal Dalmatians and Bulldogs
  • Cystine
60
Q

Outline the relationship between UTIs and urolith formatioin

A
  • Lead to loss of inhibitors

- Urine more alkaline due to urease organisms often

61
Q

Describe the clinical signs of nephroliths

A
  • Asymptomatic, may be incidental finding on radiograph

- May be associated with pyelonephritis: pain, pyuria, pyrexia

62
Q

Describe the clinical signs of ureteroliths

A
  • Asymptomatic, incidental finding on radiograph
  • May have pyelonephritis: pain, pyuria, pyrexia
  • Renemegaly may develop, uni or bi latera +/- pain
  • Renal failure if bilateral: acute bilateral hydronephrosis
63
Q

Describe the clinical signs of cystoliths

A
  • True LUT signs: dysuria, pollakiuria, haematuria
  • rarely palpable on physical exam
  • Abdominal discomfort
  • Licking at penis/vulva
  • urethral obstruction leading to post-renal azotaemia, AKI
64
Q

Which calculi are radiopaque?

A
  • Struvite
  • Calcium oxalate
  • Calcium phosphate
65
Q

Which calculi are radiolucent and how are they diagnosed?

A
  • Urates
  • Cystine
  • Require +ve contrast radiography
66
Q

Evaluate the use of abdominal ultrasound for the diagnosis of uroliths

A
  • Not useful for urethra, only see abdominal portion
  • Easy to miss a stone
  • Look for hydronephrosis and proximal ureter in cas
67
Q

List the methods that can be used to collect a urolith

A
  • Voiding urohydropulsion (if not too big)
  • Catheter assisted retrieval (suck onto end of catheter)
  • Cystoscopy
  • Cystotomy (therapeutic and diagnostic)
  • Urethrotomy/urethrostomy (if required to relieve obstruction)
68
Q

Outline the treatment of nephroliths

A
  • Only need treating if problematic
  • Dissolution diets for struvite, manage UTI
  • Support kidneys if needed
  • Renal surgery not a good idea
  • May be best to leave alone
69
Q

Outline the treatment of ureteroliths

A
  • Prompt referral

- Surgery/stenting: ureteric stenting, subcut ureteral bypass or lithotripsy used

70
Q

Outline the treatment options for cystoliths

A
  • Medical dissolution diets
  • Voiding urohydropulseion
  • Cystoscopy
  • Cystotomy
  • Laser lithotripsy
71
Q

Outline the treatment of urethral obstruction

A
  • Treat as emergency
  • Stabilise patient, manage hyperK, fluid therapy
  • Decompress bladder vital
  • Retrograde urohydropulsion and treat as for cystolith if possible
  • Urethrotomy/urethrostomy if nothing else works and patient stable, best if urethra not oedematous/swollen
72
Q

What are the indications for medical treatment of uroliths?

A
  • Non-obstructive dsiease

- Struvite, cystine and urate stones

73
Q

Outline the general principles of medical management of uroliths

A
  • Increase water intake
  • Manipulate urine pH appropriate to the urolith identified
  • Decrease concentration of mineral components in the urine
  • Treat for 1 mo after radiograph shows resolution
  • Manage underlying cause where appopriate (e.g. UTI in dogs)
74
Q

Discuss the management of calcium stones in small animals

A
  • Most renal/ureteric stones contain calcium
  • No suitable means of dissolution
  • Little information re. management, specific diet may help (may occur as a result of acidifying diets)
75
Q

Describe the pathological changes that are seen on PM and histopath in the kidney due to lepto in a dog

A
  • Chronic interstitial nephritis, severe fibrosis and tubular atrophy
  • Inflammatory cell infiltrate
  • Grossly see depressed multifocal coalescing tan areas in the kidney, some extending into the medulla
76
Q

Describe urethral plugs in cats

A
  • Protein colloid matrix made up of mucoproteins, albumin, globulin, cells, blood clots +/- crystalline material
  • Can cause obstruction esp. in males
77
Q

Outline the clinical signs of FLUTD

A
  • Dysuria
  • Pollakiurria
  • Haematuria
  • Stranguria
  • Periuria
  • Signs of urethral obstruction
  • Behavioural changes e.g. loss of house training, aggression, excessive grooming,
  • Constipation
  • Stilted gait
  • Abdominal pain
78
Q

Describe the typical signalment for FLUTD

A
  • Young -middle ages (generally <10yo)
  • Overweight
  • Inactive
  • Mainly indoor
  • Dry food diet
  • Multicat household
79
Q

Describe the pathophysiology of FLUTD

A
  • Interstitial cystitis
  • Neurogenic inflammation with chronic pain: vasodilation, vascular leakage, absence of mononuclear or neutrophilic infiltrate, increase mast cells
  • Neuroendocrine imbalance: may be combined with neurogenic inflammation, impaired ability to deal with stress (lack of -ve feedback)
  • Urine exacerbates inflammation
  • leads to bladder hyperirritability, altered GAG layer, pain, swelling
80
Q

Outline your approach to the diagnosis of FLUTD

A
  • Signalment, look for underlying causes
  • History: often recurrent, other features that may increase likely hood e.g. UTI, neoplasia, urolith
  • Physical examination: obstructed or non-obstructed?
  • Blood haematology and biochem:
  • Urinalysis: esp. sediment, rule out other causes of disease
  • Radiography and ultrasonography
81
Q

What signs may indicate that a cat has a urinary tract obstruction?

A
  • Bladder: distended or small tense bladder, firm, painful
  • Penis may be discoloured and swollen
  • Dehydrated
82
Q

Outline the typical management of a non-obstructed cat with FLUTD

A

Generally just leave and clinical signs subside within 5-7days without treatment, but must warn re. signs of obstruction

83
Q

In a non-obstructed cat where you suspect FLUTD, what other conditions must be ruled out and in what order?

A
  • Infection
  • Uroliths
  • Neoplasia
84
Q

Discuss the use of diagnostic imaging when investigating a cat with suspected FLUTD

A
  • Radiography better, look for calculi, assess bladder wall thickness/integrity with contrast.
  • Identification of urethra abnormalities e.g. stricture, urolithiasis, rupture on contrast radiography
  • Double contrast best for calculi
  • Ultrasonography good for bladder structure, identification of masses
85
Q

Discuss the use of blood biochem and haematology in the investigation of a cat you suspect has FLUTD

A
  • Look for concurrent disease e.g. CKD, DM, hyperT4
  • Consequences e.g. Fe deficiency anaemia with chronic bleeding tumour
  • Underlying cause for uroliths e.g. hypercalcaemia, PSS
86
Q

Describe the clinical signs of urethral obstruction that may occur with FLUTD

A
  • Anorexia
  • Vomiting
  • Depression
  • Circulatory shock
87
Q

Explain the development of obstructions with FLUTD

A
  • Urethral calculi may form
  • Functional obstruction from mucosal oedema, urethral spasm (neurogenic)
  • May occur as a result of inflammation
  • Formation of urethral plug (esp. male cats)
88
Q

Outline the procedure for unblocking a male cat

A
  • Stabilise with IVFT manage hyperkalaemia
  • Sedate/GA (GA allows better analgesia)
  • Cystocentesis to relieve back pressure
  • Extrude penis and massage gently in order to massage out any plug material
  • Straighten the urethra
  • Insert catheter and flush with saline as catheter is advanced-
  • Rectal palpation during retrograde hydropulsion helps
89
Q

Discuss the prognosis for FLUTD

A
  • Recurrence in 35-65% of cats with within 1-2 years of initial event
  • Some cats develop chronic persistent signs for weeks or months
90
Q

Outline the emergency treatment of a cat with FLUTD

A
  • Stabilise patient
  • Identify obstruction or bladder rupture and manage this
  • Manage stress
  • Buprenorphine shown best for pain relief in these cases
  • Flush bladder up to urohydrodistension
91
Q

Outline the long term management and prevention of FLUTD

A
  • Increase water intake
  • Avoid/mitigate stress e.g. multicat households
  • Consider pheromones to reduce stress, environmental enrichment
  • Glycosaminoglycans
  • Anxiolytics suggested
  • Muscle relaxants
92
Q

Discuss the use of GAGs in the management of FLUTD

A
  • Protect bladder lining
  • E.g. N-acetyl glucosamine, GAG precursor
  • No beneficial overall effect in controlled trial
93
Q

Discuss the use of anxiolytics in the management of FLUTF

A
  • E.g. amitriptyline
  • tricyclic antidepressant, anticholinergic, antihistaminic, anti-inflammatoyr, analgesic
  • Helpful in women, but controversial in cats due to side effects
  • Likely just sedates cat

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