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3. Equine 2 > Urinary Tract Disorders > Flashcards

Urinary Tract Disorders Flashcards

1
Q

history related to renal system issues

A

– Nonspecific (eg weight loss, depression, etc)
> May be mistaken as colic
– Volume of water intake, volume of urine produced
– Anuria, oligouria, polyuria vs pollakiuria
– Posture, dysuria or stranguria
– Appearance of urine

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2
Q

what components of the urinary tract can we feel with trans-rectal palpation

A

– Bladder, region of ureters
– Caudal pole of left kidney

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3
Q

what sampling methods do we use for urinalysis?

A

– Free catch midstream sample
– Catheterization of bladder
– (Cystocentesis in neonatal foals)

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4
Q

urinalysis - gross appearance considarations

A

– Colour: straw coloured (may be quite dark yellow)
– Clarity: may be turbid (calcium carbonate crystals and
mucus)
– Odour

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5
Q

should we use our whole urine sample for urinalysis? why?

A
  • Split the sample (for later culture if indicated)
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6
Q

how much renal loss for isosthenuria? what can give false elevations of SG?

A

– >75% of renal function loss before isosthenuria is
detected
– False elevations in presence of excessive proteinuria

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7
Q

what test to confirm proteinuria? why is this needed?

A
  • False positive trace protein in alkaline urine
  • Sulfosalicylic acid (SSA) test to confirm
  • Differentiate glomerular disease vs. urinary tract
    infection/hemorrhage/inflammation
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8
Q

what dipstick values are unreliable in horse?

A

– Dipstick leukocytes and specific gravity are unreliable

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9
Q

threshold for glucosuria?

A

– Glucosuria (renal threshold: 9-10mmol/L)

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10
Q

“blood” in urine may be:
- how to tell?

A
  • Erythrocytes
  • Hemoglobin
  • Myoglobin
    – Evaluate by sediment microscopy and/or protein
    electrophoresis
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11
Q

Urinalysis
* Sediment Examination values:

A

– RBCs < 5/hpf
– WBCs < 5/hpf
– Bacteria: scant only
– Epithelial cells: occasional only
– Crystals > calcium carbonate, struvite, calcium oxalate
– Tubular casts (protein or cellular debris) > evaluate sample soon after collection and frequently

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12
Q

cbc can reveal what urinary tract issues?

A

– Inflammatory leukogram may be seen with renal
infection (not lower regions of UT)

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13
Q

serum biochem values that help us evaluate urinary system?

A

– Urea
– Creatinine
– Electrolytes and trace minerals

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14
Q

Urine Fractional Excretions
- what are these for?

A

Evaluation of renal tubular function
– Simultaneous evaluation of urine electrolytes or trace
minerals and blood values:
* Na, K, Cl, Ca, Mg, Phos
* Need to consider dietary influences
<><><><>
FEa = ([urinea] x [serum creatinine]) x 100/
([seruma] x [urine creatinine])

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15
Q

ultrasonography methods of evaluating the urinary tract, and what they are good for?

A
  • Trans-rectal
    > Bladder, prostate, ureters
  • Trans-abdominal:
    > Kidneys: Size, shape, Architecture, echogenicity, corticomedullary differentiation
    > Urachus (foals)
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16
Q

how to do a renal biopsy? complications?

A
  • Ultrasound guidance
  • Possible complications:
    > Subcapsular hemorrhage
    > Hematuria
    > Intestinal perforation
17
Q

Water Deprivation Test
- purpose
- what is it? when to do it?

A
  • Evaluates concentrating ability of the kidneys
  • Serial evaluation of urine specific gravity in the
    presence of induced dehydration
    > Choose patients judiciously (not azotemic) and monitor closely during and after the test
    > Stop once s.g>1.025 or 5% body weight loss observed
18
Q

cystoscopy - how to perform? what can we see?

A
  • Sedation
  • Sterilization of endoscope
  • Clean opening to urethra
  • Lots of lube!
  • Visualization of:
    – Urethra (tears, inflammation, strictures, accessory sex glands)
    – Bladder (stones, sabulous debris, neoplasia, ruptures)
    – Ureteral openings (assess urine production from each kidney, sample each)
19
Q

how can we assess bladder integrity?

A
  • Catheterization of bladder to infuse dye, then
    abdominocentesis
    – eg. ruptured bladder in foals
20
Q

common disorders of the kidneys in horses

A

– Renal failure (acute / chronic)
– Diabetes insipidus
– Psychogenic Polydipsia
– Pyelonephritis

21
Q

common disorders of the ureters in horses

A
  • ectopic ureters
22
Q

common disorders of the bladder in horses

A

– Bladder rupture
– Cystitis
– Neoplasia

23
Q

common disorders of the urethra in horses

A

– Obstruction, rupture
– Accessory sex glands

24
Q

acute vs chronic renal failure in horses
- what is the difference?

A
  • Acute RF:
    – Loss of renal function occurring over hours to
    days
    – Toxic or hypoxic/ischemic causes
    <><><><>
  • Chronic RF:
    – Loss of renal function occurring over weeks to months
    – Uncommon in horses
25
Q

Acute Renal Failure
* Results in:

A

– Failure to excrete nitrogenous wastes
– Failure to maintain homeostasis of body fluids and
electrolytes

26
Q

Causes of ARF:

A

– Vasomotor (decreased renal perfusion)
* Dehydration, hypotension
<><><><>
– Nephrotoxic compounds:
* Aminoglycosides
* NSAIDs
* Vitamin D
* Pigments: myoglobin, hemoglobin
* Cantharidin (Blister beetle toxicosis)
<><><><>
– Interstitial glomerulonephritis

27
Q

ARF – Clinical Signs

A

ARF is usually secondary, and signs are more
related to the primary disorder
– Depression
– Anorexia
– Dehydration, tachycardia
– Hyperemic mucous membranes
– Oliguria or anuria
– Colic?

28
Q

ARF – Diagnosis

A

Combine urinalysis with serum biochemistry
– Azotemia without urine concentration
– Blood electrolyte disorders:
* Hyponatremia, hypochloremia
* (Variable potassium)
* Hypocalcemia, hyperphosphatemia
* Metabolic acidosis
– Urine GGT/Creatinine?
+/- Hematuria, proteinuria, glucosuria, pyuria, casts
<><><><>
Trans-rectal palpation
– Caudal pole of L kidney
<><><><>
Ultrasonography
– Loss of corticomedullary differentiation
<><><><>
Monitor urine output
– Anuria, oligouria, polyuria

29
Q

ARF – Treatment

A
  • Improve renal perfusion: Fluid therapy
    – Correct both hypovolemia plus electrolyte disorders
    > Physiologic saline
    > Treat hyperkalemia (NaHCO3, Ca++ Borogluconate,
    dextrose)
    <><><><>
  • Discontinue nephrotoxic drugs or alter dosing
    interval (peak and trough drug concentrations)
    <><><><>
    If anuric/oliguric:
    – Diuresis
    > Furosemide
    > Mannitol
    – Renal Vasodilation
    > (Dopamine – low dose)
    <><><><>
    Monitor urine output and blood pressure
    – Body weight
    – Peripheral edema
    <><><><>
  • Wean off fluids slowly (several days)
  • Nutritional support
  • Treat underlying disease process
  • Peritoneal dialysis?
30
Q

ARF – Prognosis

A

Depends on:
– Inciting cause
– Duration of insult
– Response to treatment
> Anuria/oliguria → polyuria
> Monitor serum creatinine

3. Equine 2 (16 decks)

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