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Equine Medicine Final > Urinary Tract Disorders > Flashcards

Urinary Tract Disorders Flashcards

1
Q

Blocked horse signs

A
  • Lethargic, mild colic
  • Usually relatively acute
  • Can have scrotal-prepuce swelling (will feel cold, no pain)
  • Cannot see if urinating
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2
Q

Differentials for scrotal swelling, lethargy, and history of mild colic?

A
  1. Blocked (urethral obstruction)
  2. Testicular torsion
  3. Inguinal hernia
  4. Trauma
  5. Edema
  6. Others: parasites, neoplasia, ascites, foreign body, etc.
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3
Q

Diagnostic tests for the donkey that had a urethral obstruction

A
  1. Palpation under sheath WNL (no neoplasia, foreign body)
  2. Testicular ultrasound showed edema
  3. Abdominal ultrasound was WNL
  4. Rectal examination: full bladder, normal accessory reproductive glands
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4
Q

What drug do you need to be careful with with stallions?

A
  • Acepromazine

- Downside is priapism

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5
Q

Potential signs on CBC with urethral obstruction

A
  1. Hemoconcentration (dehydrated, lethargic)

2. Mild inflammation (mature neutrophilia and hyperfibrinogenemia - relatively non-specific)

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6
Q

Potential signs on chemistry with urethral obstruction

A
  1. SEVERE HYPERKALEMIA*** (VERY SIGNIFICANT)
  2. Mild hypochloremia
  3. Mild hyponatremia
  4. Azotemia
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7
Q

Pre-renal azotemia evidence

A
  • High USG

- High PCV, high TP

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8
Q

Renal azotemia evidence

A
  • Should have a low USG
  • Should be isosthenuric
  • Rest of electrolytes depend on chronicity
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9
Q

Post-renal azotemia evidence

A
  • Should be normal urine but can’t show up
  • Bloodwork will show hyperkalemia
  • Block in the bladder or a ruptured bladder
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10
Q

Colic vs dysuria stance

A
  • See on slides
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11
Q

First Treatment priority for Urethral Obstruction

A
  • DEAL WITH HYPERKALEMIA FIRST
  • fluids with glucose to get potassium inside of the cells
  • Don’t want to give too many fluids because you can risk rupturing the bladder
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12
Q

Treatment options for relieving urethral obstruction (after hyperkalemia resolved)

A
  • Cystoscopy: urethral urolith and tear (long scope)
  • Remove with forceps (difficult)
  • Perineal urethrostomy** (most cases)
  • Will want to give a few days of antibiotics as well as anti-inflammatory medication due to trauma
  • Fluid therapy to resolve hemoconcentration and hyperkalemia
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13
Q

Which signalment of horse is most likely to get a calculi?

A
  • Geldings are 75% of cases
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14
Q

What is the most common type of calculi found in a horse?

A
  • Calcium carbonate***
  • MUST REMEMBER THIS
  • They are very spiculated
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15
Q

Most common locations for horses do get calculi

A
  • Bladder (60%)
  • Urethra (24%)
  • Kidneys (12%)
  • Ureters (4%)
  • Can lead to complete (more likely with a urethral obstruction) or partial obstruction (more common with bladder stone)
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16
Q

What type of diet is associated with urolith formation?

A
  • Alfalfa
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17
Q

Diagnosis of renal uroliths

A
  • DIFFICULT
  • Colic is rare
  • Ultrasound (but difficult to see)
  • May not be azotemic if the other kidney is functioning
  • Microscopic hematuria
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18
Q

Treatment for renal uroliths

A
  • Remove affected kidney if no azotemia
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19
Q

What is the most common sign of a bladder stone?

A
  • Hematuria (post-exercise)!!!!
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20
Q

Other clinical signs for bladder stones

A
  • Dysuria
  • Pyuria
  • Incontinence
  • Colic
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21
Q

Diagnosis of bladder stones

A
  • Rectal palpation (depends on fullness of bladder - won’t feel in a full bladder)
  • Cystoscopy (easy to see)
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22
Q

Treatment for a female with a bladder stone?

A
  • Manual extraction
  • Can take it out with your hand
  • They can put the stone in a bag and hammer to collect it
  • Also exploratory laparotomy
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23
Q

Treatment for a male with a bladder stone?

A
  • Perineal urethrostomy

- Also exploratory laparotomy

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24
Q

Clinical signs of urethral stones

A
  • Dysuria, pollakiuria, colic
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25
Q

Diagnosis and of urethral stones

A
  • Clinical signs

- Endoscopy

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26
Q

Treatment of urethral stones

A
  • Endoscopy

- Removal and perineal urethrostomy

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27
Q

Cystoscopy overview

A
  • urethra, bladder, and ureters
  • Sedation
  • Empty bladder
  • Should see urine coming out on both sides
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28
Q

Ultrasonography Overview

A
  • Bladder and kidneys (kidneys VERY DIFFICULT TO IMAGE)

- Transrectal or transabdominal

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29
Q

What can you visualize with ultrasonography of the bladder?

A
  • Urine
  • Mass
  • Ruptured bladder
  • Stone
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30
Q

What can you visualize with ultrasonography of the kidneys?

A
  • Size, echogenicity, masses, cyst, etc.
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31
Q

Palpable structures for rectal exam (urinary system)

A
  • Bladder: size, wall thickness, masses, calculi, tone
  • Palpate empty
  • Caudal pole of the left kidney
  • Ureters are NOT NORMALLY palpable
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32
Q

Where do obstructions and calculi normally form?

A
  • Anywhere in the urinary tract (usually bladder followed by urethra)
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33
Q

At what point in the disease do clinical signs appear for calculi?

A
  • Pretty late
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34
Q

Why do you want to reduce alfalfa in the diet for calculi?

A
  • Leads to formation of calcium carbonate crystals
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35
Q

Renal azotemia

A
  • Azotemia + isosthenuria
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36
Q

Blood work from a horse in acute renal failure

A
  • Hemoconcentration and hyperproteinemia
  • Marked neutropenia
  • Moderate azotemia
  • Hyponatremia and hypochloremia
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37
Q

Urinalysis from a horse in acute renal failure

A
  • Isosthenuria (<1.008)
  • Protein +
  • Sediment: granular casts and few RBCs
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38
Q

Urinalysis collection for ARF

A
  • First in stall (collect your sample)
  • Observe urination
  • Color: timing
  • Turbid: Ca2+ carbonate
  • USG
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39
Q

Hyposthenuria

A
  • <1.008

- indicates that you have renal function still

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40
Q

Isosthenuria

A
  • 1.008 - 1.015

- can go up to 1.020

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41
Q

Concentrated

A
  • > 1.015
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42
Q

Urinalysis tests

A
  • pH
  • glucose
  • blood
  • bilirubin
  • ketones
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43
Q

Normal horse urine pH

A

7-9

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44
Q

Normal glucose levels in horse urine

A
  • None

- If there’s glucose that indicates tubular dysfunction

45
Q

What can blood signify on the urinalysis strip?

A
  • myoglobin, hemoglobin, RBC
46
Q

What does bilirubin indicate on the urinalysis strip?

A
  • Hemolysis
47
Q

Ketones on the UA

A
  • Not used
48
Q

How quickly to measure urine sediment?

A

<1 hr

49
Q

Sediment exam

A
  • WBC, RBC (should be low)
  • Bacteria (normal in free catch)
  • Casts (none)
  • Crystals
50
Q

Normal horse crystals

A
  • calcium carbonate and phosphate
51
Q

High GGT on a horse urine meaning

A
  • High GGT could indicate tubular damage
52
Q

Fractional clearance electrolytes

A
  • measure in urine and serum

- don’t do this a lot

53
Q

Which part of the kidney is most sensitive to hypoxic injury?

A
  • Medulla (10-20%)

- e.g. with flunixin

54
Q

Which part of the kidney is most susceptible to toxins?

A
  • Cortex (80-90%)

- e.g. with gentamicin

55
Q

NSAID toxicity effect on the kidneys

A
  • Afferent artery gets 20-25% of blood supply regardless
  • Local release of prostaglandin E2 keeps the artery wide open
  • Flunixin is a COX inhibitor and blocks prostaglandin
  • If you have a dehydrated animal and give flunixin, the kidney will get significantly less blood
  • GGT may be high here but you would have blood in the urine (?)
56
Q

Gentamicin toxicity effect on the kidneys

A
  • Nephrotoxic but different mechanism
  • Tubules of the kidney
  • Giving gentamicin IV, receptors in the tubules on the surface that pick up the gentamicin
  • Uptake by tubules through those receptors
  • Might see GGT high in the urine due to tubular damage
57
Q

What is the dosing of gentamicin to reduce nephrotoxicity?

A
  • Gentamicin once a day high dose

- Gentamicin comes in and gets absorbed; rest is peed out and doesn’t get into the tubules

58
Q

Clinical signs of Acute Renal Failure

A
  • Signs usually related to the clinical problem, NOT acute renal failure
  • Not suspected unless renal function evaluated (azotemia, urinalysis*****)
  • Identify patients at risk
  • Associated with oliguria - anuria (rare)
  • may be lethargic
59
Q

Blood work signs of acute renal failure

A
  • +/- hyponatremia, hypochloremia, and hypernatremia
60
Q

Urinalysis results with ARF depend on what?

A
  • Portion of the kidney affected
61
Q

Urinalysis in ARF

A
  • USG: ISOTHENURIA!
  • RBC
  • Proteinuria
  • Granular casts
  • GGT
62
Q

Treatment of Acute Renal Failure

A
  • Treat the primary cause
  • Fluids!
  • Dopamine to increase blood pressure
63
Q

What fluid rate should horses in ARF be on?

A
  • 2x maintenance
  • AT LEAST 2L/HR
  • Usually $500 a day on fluid alone
64
Q

Monitoring for acute renal failure

A
  • check on/off fluids
  • Check creatinine again 24 hours after stopping fluid
  • If it’s still high, can indicate permanent renal damage
65
Q

Prognosis of ARF

A
  • varies with damage
66
Q

Is ARF reversible or not?

A
  • Yes, reversible
67
Q

Clinical signs in a horse with chronic renal failure

A
  • VERY nice
  • Submandibular mass (bigger while on pasture, smaller in stall) - EDEMA
  • BCS: 2.5/9
  • Rough hair coat
68
Q

Paraphemosis in a horse with CRF

A
  • Scrotum is big
  • Penis is prolapsed
  • Too weak to hole the penis in place :(
  • Polyuric
69
Q

Dfdx for Polyuria

A
  • Renal failure
  • Psychogenic
  • PPID
  • Endotoxemia
  • Diabetes
  • Drugs
70
Q

What is the most common cause of PU/PD in horses?

A
  • Psychogenic
71
Q

Ventral edema causes

A
  1. Decreased oncotic pressure
  2. Increased hydrostatic pressure
  3. Decreased lymphatic drainage
  4. Increased capillary permability
72
Q

What are the three most likely causes of weight loss in horses?

A
  1. Parasites
  2. Nutrition
  3. Dentition
73
Q

Polyuria in horses definition

A
  • > 50 mL/kg/day of urine

- ~25 L urine/day in a 500 kg horse

74
Q

Diagnosing polyuria in a horse

A
  • DIFFICULT
  • 24 hr urine collection
  • Water consumption: polydipsia
75
Q

Polydipsia things to consider

A
  • Diet
  • Environmental temperature
  • Workload
76
Q

What would USG be if you were psychogenically drinking?

A
  • VERY DILUTE

- OVER-diluted (hyposthenuric)

77
Q

Polydipsia amount in horses

A
  • > 100 mL/kg/day (4x more than they should be)

- ~50L/day for 500kg horse (normal is approximately 25 L)

78
Q

Polydipsia due to primary psychogenic disease features

A
  • Large volumes of water
  • Low USG (<1.005)
  • Normal PE

MOST COMMON CAUSE BY FAR*

79
Q

Polydipsia due to secondary psychogenic disease features

A
  • Renal failure: azotemia
  • USG will be isosthenuric
  • Often very skinny
  • Diabetes is a much less common cause
80
Q

CBC in a horse with chronic kidney disease

A
  • Mild anemia
81
Q

Chemistry panel in a horse with chronic kidney disease

A
  • Hypoproteinemia/Hypoalbuminemia
  • Azotemia SEVERE
  • Hypercalcemia
  • Hyponatremia and hypochloremia
  • Hyperkalemia
82
Q

What ratio of urea to creatinine is suggestive of CKD?

A

> 10:1 urea:creatinine

83
Q

Calcium and chronicity of CKD

A
  • Higher calcium indicates CHRONIC renal failure
  • The higher the calcium, the poorer the prognosis
  • They have a lot of calcium carbonate in the diet, so calcium builds up quickly if the kidney isn’t working well
84
Q

Urinalysis for CKD

A
  • Easy to obtain because of frequency
85
Q

USG for CKD

A
  • 1.012
86
Q

Sediment abnormalities in CKD

A
  • may be no abnormalities at this point
87
Q

Urinalysis strip common abnormalities with CKD

A
  • Proteinuria (+++) due to glomerular filtration problem

- Glucosuria (+++) due to proximal renal tubule problem

88
Q

Where is the problem with proteinuria? (kidney anatomy)

A
  • Glomerulus
89
Q

Where is the problem with glucosuria? (kidney anatomy)

A
  • Proximal renal tubule
90
Q

Potential mechanisms for edema in CKD

A
  • Decreased oncotic pressure (losing albumin through the kidneys)
  • Increased hydrostatic pressure (Renin release and elevated blood pressure –> hydrostatic pressure)
91
Q

Congenital causes of CKD

A
  • <5 years old
  • No acute renal failure or others
  • Renal agenesis, hypoplasia, dysplasia
92
Q

Acquired causes of CKD

A
  • Most common***
  • Previous injury
  • Cause may be unknown
  • Flunixin/Gentamicin is a common cause
93
Q

Why do horses with CRF look bad?

A
  • Uremic signs (accumulation of nitrogenous waste)
  • A lot of the nitrogenous waste goes to the gut –> converted to ammonia –> crosses BBB
  • Nitrogenous wastes can cause anorexia, lethargy, ammonia
  • Ammonia is toxic to the mucosa, especially of the large colon so can lead to soft manure and ulceration
94
Q

Protein losing enteropathy with renal failure

A

Ammonia is toxic to the mucosa, especially of the large colon so can lead to soft manure and ulceration

95
Q

Tartar and oral ulcers and CKD

A
  • AMmonia changes urea in the mouth
  • Build up of tartar
  • Horses don’t usually build a lot of tartar, so if you see this, check bloodwork
96
Q

What percentage of horses with CKD get edema?

A

~43%

  • Due to decreased oncotic pressure (hypoalbuminemia)
  • Endothelial toxicity secondary to elevated urea and increased vascular permeability
  • Increased hydrostatic pressure due to renin release
97
Q

What % of horses with CKD are PU/PD?

A
  • approximately 40% (??? I THINK)
98
Q

Pathophysiology of anemia in chronic kidney disease

A
  • Less synthesis of erythropoietin and toxic things in the blood stream decrease life span
  • Decreased half life due to friable membrane
  • Less synthesis due to decreased erythropoietin
99
Q

Odor of horses with CKD

A
  • May have a uremic odor
100
Q

Can CKD be cured?

A
  • No
101
Q

Things to consider with CKD treatment

A
  • Must consider quality of life
102
Q

What is the creatinine cut point for a horse being able to live a relatively normal life with CKD?

A
  • Creatinine <5 mg/dL
103
Q

Water and diet recommendations for CKD

A
  • Water - fresh and AT ALL TIMES

- Diet to maintain body condition: good quality grass, no alfalfa (high calcium), fat, omega-3 fatty acids

104
Q

Bicarbonate in horses with CKD

A
  • Can supplement if low (<20 mEq/L)
  • Orally
  • Do the calculations
105
Q

Breeding in a horse with CKD

A
  • DO NOT DO IT
  • Pregnancy can shift the fluids around the body
  • If a stallion, probably not an issue
  • In a mare, pregnancy is too much for them
106
Q

Prognosis

A
  • Not so great

- Terminal illness

107
Q

Monitoring CKD

A
  • Measure CBC/Chemistry
  • In 10 days/6 months/2-3 times a year
  • If stable, 1x per year
108
Q

How do you differentiate psychogenic polydipsia from diabetes insipidus?

A
  • Remove the water and retest to see if they can concentrate
  • Have to overcome the medullary washout that has happened due to polydipsia
  • Have to measure first in 24 hours how much they are drinking, then cut that in half for a few days, then in half again
  • Takes a LONG TIME
  • MUST monitor for dehydration
  • Tacky mucous membranes
  • Take a body weight daily (if they lose more than 5%, they’ll stop the water deprivation test)*****

Equine Medicine Final (10 decks)

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