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URO Flashcards

1
Q

what diseases cause a reduced renal repose to ADH

A

Addisons, Cushing, diuretics, high salt diet, post-obstruction, HyperT

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2
Q

how does osmotic dieresis cause PU and common electrolytes

A

Solute in urinary tubules pulls fluid out into urine
Glucose: DM, renal glucosuria, Fanconis syndrome (allow with lots of that electrolytes in small dog breeds)
Sodium: Addisons, diuretics, high salt diet, post-obstruction

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3
Q

What causes a loss of concentration gradient

A

low salt diet
medullary washout (e.g. prolonged PUPD, prolonged aggressive fluid therapy)

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4
Q

how does Phaeochromocytoma cause PU

A

(Catecholamine producing tumour of the adrenal gland i.e. adrenaline)
Adrenaline = Primary sign is hypertension = high GFR = polyuria

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5
Q

What electrolytes are high with renal disease

A

Phosphorus is GFR dependent so slow GFR = high phosphorus
Potassium should also be cleared by GFR so is high

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6
Q

what molecules are high in blood with renal failure

A

urea and creatinine
SDMA

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7
Q

what is lost with a PLN

A

albumin

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8
Q

safer alternative to water deprivation test

A

trying to differinate between central and nephrogenic DI, and psychogenic

just do vasopressin trial xxx don’t dehydrate dogs on purpose

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9
Q

threee categories of AKI

A
  1. Haemodynamic = redcued renal perfusion
  2. Intrinsic Renal i.e. actual damage to the kidneys (ischeamia, infectious, immune-mediated, sepsis, nephrotoxic drugs)
  3. Postrenal i.e. urethral obstruction, uretral obstruction or urine leakage
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10
Q

signs of lepto

A

AKI and liver damage and dyspnoea
SNAP test in all AKI patients!!! zoonotic!
Treat with doxycycline

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11
Q

two treatment options for an AKI

A
  1. IVFT: match losses and maintain fluid status using very high fluid rates (up to 10x maintenance but avoid volume overload)
  2. Dialysis if no response to IVFT> Peritoneal catheter => infusion of dialyse solution (glucose) => left for 20mins-hours => drained and repeated
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12
Q

signs of CRF

A

○ PU/PD
○ Anorexia
○ Weight loss
○ Dehydration
○ Pallor
○ Vomiting and diarrhoea (due to uraemia)
○ Mucosal ulcers
Uraemic breath

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13
Q

How does nephron loss cause further renal damage

A

Nephron loss > other nephrons GFRs increased to compensate> glomerular capillary wall damage and more plasma protein filtration > further glomerular and tubulointerstitial damage.

Nephron loss > reduced total GFR> build up of products normally excreted (e.g. urea)> uraemic crisis.

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14
Q

How can anaemia develop from CRF

A

Reduced renal function > reduced Erythropoietin (EPO) production > nonregenerative anaemia

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15
Q

What is iris staging

A

Guidelines for treatment
Stage 1-4 based on
- Creatinine OR SDMA

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16
Q

which is more specific: SDMA or creatnine

A

creatine can come from muscle mass too
excreted by kidney so high in renal failure with 75% nephron loss

SDMA is most expensive but high with 40% nephron lost and kidney specific

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17
Q

key principles in CKD management

A

Diet very important stage II onwards

Later stages - more emphasis on
- Treating 2ndary anaemia/acidosis/nausea
- Maintaining hydration
- Ensuring adequate nutrition

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18
Q

stage 1 treatment

A
  • care with nephrotoxic drugs
  • fresh water always
  • Monitor SDMA and creatinine
  • Treat hypertension and proteinuria
  • Renal diet and phosphate binder
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19
Q

What is uraemic crisis

A

Build up of urea and other toxins usually excreted in kidneys to intolerable levels. Due to-
○ End stage Chronic Kidney Disease
○ Acute Kidney Injury
○ Acute on Chronic –AKI (e.g. ischemic or toxic insult) exacerbating existing CKD

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20
Q

uraemia crisis treatment

A

Work out if AKI, CKD or acute on chronic and treat as needed but in addition…

  • IVFT- Hartmann’s to Replace dehydration + ongoing losses
  • blood gases- assess for acidosis. Bicarb if pH <7.2
  • Treat nausea, Antiemetics e.g. maropitant
  • Treat GI ulceration: Omeprazole +/- H2 Blockers +/- sucralfate
  • Nutritional support- Important! Appetite stimulants( Mirtazapine) and Feeding tubes (Nasogastric so don’t have to GA)
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21
Q

What renal and extra renal conditions predispose to CKD

A
  • Renal diseases
    ○ Glomerular disease
    ○ Fanconi’s syndrome
    ○ Polycystic Kidney Disease
    ○ Pyelonephritis
    ○ Nephrotoxin exposure
    ○ Neoplasia

Extrarenal issues
○ Hypertension
○ Cardiac disease
○ Hyperthyroidism
○ Diabetes
○ Urolithiasis/ obstruction
○ Cystitis
○ Neoplasia
○ Hypercalcaemia

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22
Q

how to renal disease and hypertension drive eachother

A
  • Renal injury stimulates sympathetic pathways
    • Renin release and angiotensin conversion
    • Vasoconstriction and aldosterone release so more sodium reabsorption
    • This drives hypertension
      This drives renal injury
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23
Q

treatment of renal hypertension

A

○ ACE inhibitors (ACEi) e.g. Benazepril, Enalapril
○ Angiotensin receptor blockers (ARB) e.g. Telmisartan, Spironolactone
○ Calcium Channel Blocker (CCB) stop vasonstriction e.g. Amlodipine

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24
Q

What is Pyelonephritis

A

bacterial infection of the renal pelvis and parenchyma

CS: Fever, abdo pain, PUPD
US: renal pelvis dilatation with hyperechoic mucosa, altered cortex/ medulla echogenicity.

25
Antibiotic choice fir UTI or pyelonephritis with CKD
- Amoxicillin +/- Claw: Really excreted so high cons in urine - Can use TMPS but beware adverse effects - Nephrotoxic antibiotics: Aminoglycocides (anything -mycin) and enrofloxacine
26
Common neoplastic mets to the kidney
Carcinoma Lymphoma
27
What is polycystic kidney disease
hereditary fluid filled cysts present from birth in some cats start effecting kidney function at ~7 years DX: ultrasound shows cavities, genetic screening
28
What is falcon sydrome
Disease of proximal tubule > reduced resorption of solute Can be idiopathic, hereditary or from chicken jerky or Gentimycin Loss of Na, K, P, albumin, bicarbonate, glucose, amino acids DX: increased ^^ in urine despite normal blood levels Tx: Remove cause, Supplements
29
Signs of glomerular disease and dx
Secondary to CKD or can worsen CKD Damage = albumin and anti-thrombin lost into urine (PLN) Dx: hypoproteinaemia and proteinuria (HAS to be present) Definitve = renal biopsy (only sample cortex)
30
Causes of glomerular disease n cats and dogs
cats = neoplasia and systemic infection (FeLV, FIP, FIV) dogs = often from renal disease - Immune-mediated glomerulonephritis when immune complexes form in glomerular walls - Amyloidosis when chronic inflammation results in protein deposition in the glomerulus
31
treatment of glomerular disease
Treat underlying cause - Manage Nephrotic syndrome if present - Limit proteinuria with ACEi (or ARBs) - If glomerular inflammation at biopsy consider Immunosuppressives e.g. mycophenolate, azathioprine, cyclophosphamide, cyclosporine Monitor and manage CKD as per IRIS staging
32
what is nephrotic syndrome
Result of a PLN, pathogenic of glomerular disease Signs: Pitting odema, low albumin, high lipids (excessive protein loss leads to TAG mobilisation for energy) (excessive protein loss decreases oncotic pressure = fluid leakage)
33
treatment of nephrotic syndrome
anti-proteinurics: Ace inhibitor like Benazapril Anticoagulant like Aspirin or clopridical (risk of clots as antithrombin lost alongside albumin) fluid removal if severe side effects
34
How can spinning samples tell apart haemaglobin and myoglobin in urine
○ Blood sample and centrifuge ○ Plasma likely to be red with haemoglobinaemia ○ Plasma likely clear with myoglobinaemia
35
common causes of H and M in urine
Haemoglobinaemia - Haemolysis - See pre-hepatic jaundice Myoglobinaemia - Usually secondary severe muscle damage - With high AST/CK, History, exam.
36
where can disease be localised to with stranguria and pollakiuria
lower urinary tract
37
How to narrow differentials of stranguria
Ultrasound bladder to see size Big Bladder - Obstructive disease - Failure of bladder to empty (neuromuscular) - Detrusor atony – overstretch and damage – flaccid, easy to express - UMN bladder (Thoraco-lumbar disease) – urethral sphincter tone remains high preventing urination, difficult to express - Inflammatory, infectious, iatrogenic can all have a big bladder. Small Bladder – non-obstructive disease - Anatomical – e.g. ectopic ureters - Neuromuscular – e.g. USMI - Inflammatory, infectious, iatrogenic or idiopathic - FIC
38
Stranguria + big bladder approach
OFTEN EMERGENCY biochem: azotemiae and hyperkalaemia pocus: check for uroabdomen and stones catheterise: release obstruction and drainage bladder. If not do cystocentesis
39
Stranguria + small bladder approach
Non-obstructive disease history. History key ○ Environmental changes – FIC in cats - Description of the urination – is it incontinence being misinterpreted? Is there nocturia, bed wetting, etc. - Age – young (congenital/anatomical) vs middle aged (idiopathic) vs old (neoplasia, neuromuscular e.g. USMI) - Acute – infectious/inflammatory vs chronic – neoplasia, neuromuscular, anatomical
40
difference between cat and dogs struvite uroliths
dogs = associated with UTI and urease producing bacteria cats = often sterile
41
second most common stone and risk factors
calcium oxalate acidic diets and oral calcium supplements given outside of meal times
42
Signalment and risks for urate crystals
Dalmations and Black Russian terriers often associated with PSS
43
Tx for the 3 main crystals
Really important to find out type first All need pain relief Struvite: often have UTI so give antibiotics. Acidifying diet Urate: often treated with allopurinol. Manage shunt if present. Alkalinising diet Calcium oxalate: Diet cannot dissolve but can prevent in future. High moisture Alkalinising diet
44
Most common bladder cancer
transitional cell carcinoma highly invasive with common mets
45
Dx of bladder neoplasia
A cystourethrogram or ultrasonography to determine the location and extent of the tumour Biopsy of the tumour is required for definitive diagnosis
46
What is FLUTD
Feline Lower Urinary Tract Disease – group of conditions Causes of FLUTD – ○ FIC – Feline Idiopathic Cystitis = most common. Very commonly stress related, and often very frustrating for both owners, and you as the vet, to manage ○ UTI – normally in older cats with co-morbidities causing dilute urine eg CKD, diabetes ○ Urolithiasis ○ Urethral plugs – occur if there is severe inflammation/infection, can cause obstruction ○ Neoplasia – uncommon
47
Management for feline idiopathic cystitis
manage pain manage stress (L-tryptophan and a-casozepine can reduce anxiety) increase water intake urinary diet (acidic for struvite, alkaline for CO and urate, restrict phosphorus, magnesium and calcium)
48
Urination process
- Detrusor has stretch receptors which sends sympathetic message to spinal cord (via hypogastric nerve) - Urethral sphincter relaxes and detrusor contracts
49
what is USMI
urethral sphincter mechanism incontinence Non-neurogenic incontinence in dogs - leak urine when relaxed or excited - commonly females, spayed, older, overweight
50
Tx of USMI
Aim to improve urethral sphincter tone Phenylpropanolamine - Propalin, urolin - Mimics the sympathetic nervous system to allow bladder filling - Detrusor relaxation and sphincter contraction (SNS) Oestrogens (Incurrin) - mimic hormonal influence in urethra (for tone) - only in spayed bitchesss Can be used together
51
UMN bladder vs LMN bladder
UMN = large and hard LMN = flaccid and soft. can be manually emptied
52
Tx for high urethral tone
Sympatholytics lie prazosin and phenoxybenzamine skeletal muscle relaxants like bentos, ACP
53
renal diet
low protein low phosphate and phosphate binders Potassium and Vitamin. supplements High calories and water (wet best) cats need high protein and low carbohydrates. feed higher value protein
54
suture pattern to use with cystotomy
absorbable monofilament long lasting (10-14 days) No knots on inside - continuous inverting or simple continuous
55
signs of ectopic ureters
young Doug constant leaking of urine
56
what is detrusor instability
causes urge incontinence Bladder irritation (often UTI or stones) makes animal feel like they need to urinate and overstimulates detrusor reflex
57
4 causes of neurogenic incontince
UMN injury LMN injury Detrusal-urethral dyssynergia (bladder doesn't empty fully which can lead to UTI or detrusor atony) Detrusor atony - Bladder has overstretched and stretch receptors give up sending signals to the brain
58
what drug can help with detrusor dysfunction
Bethanecol (parasympathomimetic)

Small animal (11 decks)

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