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Urology Flashcards

1
Q

cause of AKI

A

renal ischemia or exposure to nephrotoxins (NSAIDs)

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2
Q

pre-renal cause of AKI

A
  • Anything that causes decrease in effective blood volume
  • Arterial occlusion or stenosis of renal artery
  • Increase in: BUN, creatinine and high USG, fractional excretion of Na = low
  • USG measurement:
    o USG > 1.030 dogs or USG > 1.035 cats
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3
Q

renal cause of AKI

A
  • Ischemic events: shock, decreased CO, trauma, hyper(o)thermia, transfusion, DIC, NSAIDs
  • Primary renal disease: infection, immune mediated, neoplasia
  • Secondary disease with renal manifestation: infection, SIRS, sepsis, MOF, DIC, pancreatitis, hepatorenal syndrome
  • Nephrotoxins: exogenous toxins, drugs, exogenous toxins
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4
Q

post renal cause of AKI

A
  • Urinary leakage within tissue
  • Urinary obstruction and increased pressure
  • Azotaemia + variable USG + rapidly reversible  if drainage provided
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5
Q

pathogenesis of AKI

A
  • loss of ability to excrete water
  • loss of ability to maintain fluid
  • electrolyte disturbances
  • acid-base disorder
  • blood pressure changes
  • loss of endocrine function
  • Azotaemia – increase in concentration of nitrogen-containing substances in the blood
  • Uraemia – azotaemia + adverse clinical manifestation
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6
Q

signs of AKI

A

non specific) Usually <1 week of anorexia, lethargy, nausea and/or vomiting, diarrhoea, PUPD
- Dehydration generally good BCS, uremic halitosis, oral ulcers, unspecific abdo pain or renal pain, renal enlargement
- MM pallor

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7
Q

normal GFR

A
  • GFR
    o normal dogs: 3.5-4.5 ml/min/kg
    o normal cats: 2.5-3.5 ml/min/kg
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8
Q

diagnosis of aKI

A
  • abrupt serum creatinine and BUN (azotaemia)
  • urea and creatinine are “surrogate plasma/serum markers of GFR”
  • lab work – anaemia, stress response
  • Xray, US, CT, MRI
  • biomarkers
    o more sensitive than creatinine
    o faster and safer than GFR
    o can detect KI earlier
    o can distinguish AKI from CRF
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9
Q

treatment of AKI

A

If oliguric/anuric
- mannitol 0.25-1g/kg slow bolus
- loop diuretics: furosemide: boluses 2-6mg/kg IV
supportive therapy
- arterial hypertension: amlodipine
- GI complications: antiemetic (maropitant), PPI
- pain management
Renal replacement therapy
- indications: inadequate urine production, fluid overload, hyperkalaemia, progressive azotaemia
- methods:
o Intracorporeal (peritoneal dialysis: removes uremic toxins by diffusion from peritoneal cavity)
o extracorporeal
 removes toxins from blood stream by diffusion and or convection: both need vascular access and anticoagulation
 intermittent haemodialysis (IHD): rapid blood flow and rapid dialysate flow
 continuous renal replacement therapy (CRRT): slow flow of dialysate

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10
Q

monitoring of AKI

A
  • hydration, BP, PCV, total solids and central venous pressure
  • cardiac monitoring (HR, ECG, US)
  • Acid-base
  • urine output: N 1-2ml/kg/h, casts
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11
Q

prognosis of AKI

A

oliguria/anuria that persists or develops during treatment is associated with a poor prognosis

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12
Q

definition of ureic syndrome

A

Clinical manifestation of cumulative metabolic derangements which ensue as the result of renal failure: clinical picture of endogenic intoxication

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13
Q

cause of uremic syndrome

A

chronic kidney disease (in association with prerenal, renal or postrenal causes for azotaemia)

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14
Q

signs of ureic syndrome

A

vomiting, lethargy, weight loss, dehydration, oral ulcers, melena

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15
Q

diagnosis of ureic syndrome

A

medical history, physical exam, urinalysis, CBC, biochemistry, abdominal Xray, urinary ultrasound

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16
Q

treatment of ureic syndrome

A

fluid, if uremic haemorrhagic gastritis (cimetidine, famotidine), renal replacement therapy

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17
Q

prognosis of ureic syndrome

A

depends on severity of renal damage

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18
Q

cause of urethral obstruction

A

formation of struvite or cysteine stones

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19
Q

pathogenesis of urethral obstruction

A

functional (eg reflex dyssynergia, urethral spasm) or autonomic (urolithiasis, granulomatous urethritis)

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20
Q

signs of urethral obstruction

A

stranguria, pain, nausea, anorexia, ataxia, reluctance to move, prepuce may be red/inflamed from licking, urinary bladder may be distended

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21
Q

diagnosis of urethral obstruction

A

radiography, US, CBC (azotaemia, hyperphosphatemia, metabolic acidosis, hyperkalaemia), urinalysis (show haematuria and crystals)

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22
Q

treatment of urethral obstruction

A

urinary catheterisation, cystotomy, midazolam to relax, ATB

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23
Q

prognosis of urethral osbtruction

A

good if noticed quick enough

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24
Q

differential urethral obstruction

A

blockage by neoplasia of tissue surrounding the urethra, include prostate hyperplasia, cysts

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25
Q

cause of haematuria

A

inflammation, trauma or neoplasia, strenuous exercise, heat stroke or renal infarcts

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26
Q

signs of haematuria

A

can be gross (macroscopic haematuria) or occult (microscopic haematuria)

PUPD, stranguria, inability to urinate, vocalising in litterbox, bruising on the skin, bleeding from nose/gums, bloody vomit or faeces

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27
Q

diagnosis of haemturia

A
  • history and physical exam
  • CBC, biochemistry and urinalysis (maybe test for leptospirosis)
  • urine culture is UTI suspected
  • abdominal X-ray/ US
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28
Q

treatment of haematuria

A

depending on cause, UTI (ATB), kidney/bladder stones (therapeutic diet)

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29
Q

disorders of micturition definition

A

inappropriate passage of urine

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30
Q

cause of disorders of micturition

A

congenital abnormalities or acquired disorders

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31
Q

urinary incontinence

A
  • involuntary escape of urine during the storage phase
  • distended/small/normal urinary bladder
  • palpation of UB: size, wall thickness, possibility of expression
  • causes:
    o urethral sphincter mechanism incompetence
    o anatomic abnormality in the termination of the urethra
    o inability of bladder to expand in capacity
    o spasms of the bladder
    o nerve damage
  • Paradoxal: induced by bladder or urethral obstruction – some urine is leaking around the blockage
  • overflow: bladder cannot contract but will fit until urine flows passively
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32
Q

urinary retention

A
  • apparent reduction in the frequency of urination
  • occurs temporarily in partial obstruction
  • spasm of external sphincter
  • inability to adopt normal posture for urination
  • Gross distension of bladder
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33
Q

diagnosis of disorders of micturition

A

history
physical exam
x-ray

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34
Q

treatment of disorders of micturition

A

NSAIDs

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35
Q

cause of PUPD

A

multifactorial, corticosteroids, diuretics

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36
Q

pathogenesis of PUPD

A

typically occur simultaneously, PD usually occurs as a response of PU

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37
Q

signs of PUPD

A

water consumption greater than 80-100ml/kg/day and urine production greater than 40-50ml/kg/day

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38
Q

diagnosis of PUPD

A
  • owner can measure animals (dog) urine intake at home
  • routine urinalysis
  • USG (normal values in dog 1.050-1.076 and in cat 1.047-1.087), (>1.040 = dehydration)
  • CBC, biochemistry, serum thyroxine (cats)
  • renal US
  • measurement of serum symmetric dimethylarginine (SDMA), or estimation of GFR
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39
Q

differentials of PUPD

A

kidneys disease, DM, hyperadrenocorticism, hypoadrenocortism, hepatic disease, hypercalcaemia, bacterial cystitis, pyelonephritis etc

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40
Q

normal intake for dogs and cats

A

dogs 60-90mL/kg/day,
cats 45mL/kg/day

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41
Q

normal urine production

A

dogs and cats is 26-44mL/kg/day

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42
Q

when is is PD

A

water intake >100ml/kg/day

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43
Q

when is it PU

A

urine output >50ml/kg/day

44
Q

cause of proteinuria

A

renal proteinuria: glomerular capillary wall lesions, tubular lesions, both

45
Q

signs of proteinuria

A

discoloured urine (prerenal proteinuria), polyuria, stranguria, discoloured urine – pink/red (postrenal proteinuria), acute dyspnoea, hypothermic, often no clinical signs

46
Q

diagnosis of proteinuria

A

semiquantitative methods: dipstick colorimetric test, sulfosalicylic turbidimetric test, interpreted in light of USG and urine sediment, urinalysis

47
Q

treatment of proteinuria

A

eliminating the underlying cause, if glomerular proteinuria can be managed using renal diet

48
Q

definition of azotemia

A

increased concentrations of urea and creatinine in the blood

49
Q

cause of azotemia

A

reduced GFR, uroabdomen, increased absorption of nonprotein nitrogenous compounds, increased protein catabolism

50
Q

signs of azotemia

A

depression, lethargy, poor coat quality, poor appetite, and nausea, ataxia, stupor, PUPD, uremic

51
Q

diagnosis of azotemia

A

biochemistry, USG, urinalysis, CBC, Total T4

52
Q

treatment of azotemia

A

IV therapy, gastric protectants (sucralfate), specific treatment for underlying cause

53
Q

predisposition of renomegaly

A

more common in cats

54
Q

cause of renomegaly

A

edema, acute inflammation, diffusely infiltrating neoplasia, unilateral compensatory hypertrophy, trauma, perirenal cysts, hydronephrosis, haematoma, polycystic kidney disease

55
Q

pathogenesis of renomegaly

A

can be unilateral or bilateral enlargement by symmetric or asymmetric, can be acute / chronic in onset
- acute Renomegaly is uncommon – when occurs, presentation is acute abdomen
- chronic Renomegaly is moderate - severe but occasionally mild
- unilateral renal enlargement occurs because of compensatory hypertrophy in animals with a solitary kidney or with severe end-stage disease in contralateral kidney

56
Q

signs of renomegaly

A

lethargy, anorexia, vomiting, diarrhoea, weight loss, oral ulcers, dehydration, discoloured urine, pale MM, halitosis, abdominal pain, one/both kidney palpable, PUPD

57
Q

diagnosis of renomegaly

A
  • physical exam or by abdominal imaging
    o C: 2.5-3 x length of L2
    o D: 2.5-3.5x length of L2
  • renal excretory function, quantification of proteinuria, bladder/urethral function, bacterial antibiotic sensitivity testing, diagnostic imaging
  • US
58
Q

treatment of renomegaly

A
  • treating underlying cause
  • IV fluids
59
Q

definition of Chronic kidney disease

A

structural and/or functional abnormalities of one/both kidneys that have been continuously present for 3 months or longer, irreversible and incurable

60
Q

cause of chronic kidney disease

A

Hereditary and congenital (renal hypoplasia, polycystic kidneys, familial nephropathy), acquired (neoplasia, amyloidosis, nephritis, glomerular), idiopathic (hyperglycaemia, hypokalaemia, toxins, kidney stones)

61
Q

stages of chronic kidney disesase

A

1 – reduced GFR to 30%, other functions preserved
2. Further decrease of GFR to 15%
* Reduced excretion leading to azotaemia
* Reduced urine concentration
* Anaemia due to reduced erythropoietin
* Hypertriglyceridemia due to reduced lipoprotein lipase activity
3 – severe anaemia, severe arterial hypertension, disorders of cardiovascular, digestive and nervous system
4 – significantly reduced GFR to <5%, terminal uraemia leading to uremic syndrome

62
Q

signs of chronic kidney disease

A

PUPD, weight loss, inappetence, vomiting, diarrhoea, lethargy/depression, messy hair coat, blindness, dehydration, pale MM, teeth problems

63
Q

diagnosis of chronic kidney disease

A

CBC (non regenerative anaemia which can be masked by dehydration so look at haematocrit with total protein concentration), Biochem, urine analysis + urine protein, BP, X-ray and US, kidney biopsy, USG, UPCR, creatinine, BP, rectal examination (evaluate for evidence of melena or haematochezia which may indicate uremic ulcers)

64
Q

treatment of chronic kidney diseasde

A

specific therapy, preventive, slowing the progression of CKD, dietary management, access to fresh water all the time, fluid therapy, calcitriol, H2 receptor blockers (famotidine)

65
Q

prognosis of chronic kidney disease

A

may live from months to years

66
Q

what are markers of renal fucntion

A

urea and creatinine

67
Q

extra renal factors affecting urea

A
  • Growth: dehydration, postprandial, GI bleeding, high protein intake, catabolic conditions
  • Drop: liver disease, low protein intake, non-renal polyuria
68
Q

extra renal factors affecting creatinine

A
  • Growth: animals with strong musculature, high protein intake, postprandial, extreme exercises
  • Drop: extremely weak musculature
69
Q

UTI

A
  • occurs in approx. 14% of dogs during their lifetime
  • spayed females, older dogs (7-8yr)
  • UTI is less common in cats 1-3%
  • female, old age, decreased BCD
  • signs: stranguria, pollakiuria, inappropriate urination, dysuria, haematuria
70
Q

predisposition of sporadic bacterial cystitis

A

intact male dogs: rare, animals have fewer than 3 episodes of cystitis in 12 months

71
Q

cause of sporadic bacterial cystitis

A

urinary tract abnormalities, systemic diseases, Corynebacterium urealyticum, clostridium

72
Q

pathogenesis of sporadic bacterial cystitis

A

complicated bacterial cystitis implies underlying comorbidity

73
Q

signs of sporadic bacterial cystitis

A

discomfort of caudal abdomen, small and thickened bladder, stranguria, haematuria, pollakiuria, peruria, dysuria

74
Q

diagnosis of sporadic bacteria cystitis

A
  • urinalysis: cystocentesis, ideal urine specimens should be palpated within 30 minutes of collection, or they should be refrigerated and processed within 24 hr
  • clinical signs
  • bladder palpation
  • quantitative aerobic bacterial culture (by cystocentesis)
  • CBC, Biochem, imaging not usually warranted
75
Q

treatment of sporadic bacterial cystitis

A
  • analgesics
  • duration of ATB 7-10 days (amoxicillin, trimethoprim-sulphonamides)
  • second time ATB (nitrofurantoin)
76
Q

prognosis of sporadic bacteria cystitis

A

good

77
Q

predisposition of recurrent bacterial cystitis

A

diagnosis of 3 or more episodes of clinical bacterial cystitis in 12 months or 2 or more episodes in 6 months, may result from relapsing or persistent infection or reinfection

78
Q

cause of recurrent bacterail cystitis

A

same as sporadic, deep seated infection, or resistant to chosen antimicrobial

79
Q

pathogenesis of recurrent bacterial cystitis

A

relapsing infection, reinfection, refractory infection or persistent infections

80
Q

signs of recurrent bacterial cystitis

A

urethra more prominent or more severely thickened (same as sporadic)

81
Q

diagnosis of recurrent bacterial cystitis

A

urinalysis, CBC, Biochem panel, US, cystourethrography, excretory urography
- not only urine bacterial culture, but diagnostic workup to evaluate the animal for predisposing factors, such as anatomical or structural defects

82
Q

treatment of recurrent bacterial cystitis

A
  • analgesics
  • duration of ATB: 4 weeks for persistent and potentially relapsing infections (3-4 days for reinfection)
83
Q

prevention of recurrent bacterial cystitis

A

prophylactic antimicrobial therapy isn’t recommended

84
Q

predisposition of urolithiasis

A

Calcium oxalate (N America, asia, Europe), Struvite (S America, Africa, Australia), males = calcium oxalate, females = struvite
- tends to be middle-older cats (7 years)

85
Q

cause of urolithiasis

A

mostly from UTIs (bacteria creates ureases)

86
Q

pathogenesis of urolithiasis

A

dogs: almost all struvite calculi are infection-induced. Cats: most struvite calculi are sterile, if evidence of bacterial cystitis = antimicrobial drugs

87
Q

signs of urolithiasis

A

bacterial urine cultures
Signs: bladder and urethral uroliths can often be palpated during abdo or rectal examination, full bladder/thickened, inflamed bladder wall may obscure small uroliths, haematuria

88
Q

diagnosis of urolithiasis

A

in male dogs with dysuria, urethra should be palpated subcutaneously from ischial arch to os penis, US or plain/contrast enhanced radiography
- elevated BUN and serum creatinine concentrations

89
Q

treatment of urolithiasis

A

medical dissolution or urohydropropulsion, basket retrieval, laser lithotripsy, percutaneous cystolithotomy, cystotomy

90
Q

prognosis of urlothiasis

A

12-month survival rate after medical treatment is around 66%

91
Q

predisposition of feline urethral obstruction

A

10-20% of wats with LUTS, cats: crystalline-matrix urethral plugs and uroliths, most common struvite and calcium oxalate

92
Q

cause of feline urethral obstruction

A

physical obstructions (urethral plugs, urinary stones, strictures or tumours)

93
Q

pathogenesis of feline urethral obstruction

A

abnormalities in the structure and/or function of the urinary tract  caused by impairment of the normal flow of urine and resulting in local and systemic effects of that impairment

94
Q

signs of feline urethral obstruction

A

large/non-existent bladder (+/pain), bradycardia, hypothermia, prolonged CRT, pale MM, hyperpnea, halitosis, tip of penis (dark purple to almost black and swollen)

with complete obstruction, uraemia usually occurs within 24hours. dysuria, haematuria, pollakiuria, inability to pass urine, pain

95
Q

consequence of feline urethral obstruction

A

Detrusor atony, urethral injury, urethral and bladder mucosal damage, UTI, urethral and/or bladder rupture

96
Q

diagnosis of feline urethral obstruction

A
  • Survey abdo x-ray (contrast urethrocystography), abdominal US
  • blood: CBC, biochemistry, blood gases and electrolytes
  • urine: urinalysis and urine culture
  • cystocentesis: yes/no
97
Q

treatment of feline urethral obstruction

A

Emergency stabilisation
- depressed patients: oxygen and IV catheter
- fluid therapy
o estimate degree of shock and dehydration (isotonic replacement)
- hyperkalaemia
o ECG alterations: P-R interval, S-T segment and T waves, 3rd degree heart block
- metabolic acidosis
o often present in acute urethral obstruction
- hypocalcaemia
o if present should be treated with Ca-gluconate
Relieving the urethral obstruction
- butorphanol, morphine, propofol, ketamine, diazepam or acepromazine
- cystocentesis: G 22, decompress the bladder and get samples
o pull in caudal-dorsal direction  straightening the urethra , flushing with sterile solution

98
Q

prognosis of feline urethral obstrucion

A

1/3 re-obstruct again, clinical signs recur in ½, 20% euthanasia
- perineal urethrostomy: stricture formation, urine leakage, recurrent bacterial UTI

99
Q

complications of feline urethral obstruction

A

bacterial infections, micturition dysfunction, post obstructive diuresis, intrinsic renal failure

100
Q

predisposition of feline idiopathic cystitis (FIC)

A

~5% cats older than 1yr have: bladder/ UT problems, overweight, M>F 2- 7 years, multi cat household, nervous and fearful, diet, increased in: persian, manx, Himalayan, decreased: siamese

101
Q

cause of FIC

A

neuroendocrine abnormalities

102
Q

pathogenesis of FIC

A

it’s a problem that involves the bladder, isn’t directly a bladder problem.
- changes in sensory nerve function (increase in substance P immunoreactivity)
- abnormalities in dorsal root ganglion and of the central stress response system  activation of sympathetic system  acute increase in epithelial permeability and increased levels of catecholamine circulation

103
Q

signs of FIC

A

periuria, dysria, stranguria, haematuria, vomiting, diarrhoea, inappetence, fever, lethargy, decreased generally activity, somnolence, decreased social interaction, painlike behaviours

104
Q

diagnosis of FIC

A

X-ray, contrast (cystogram, urethrogram), US abdomen, urinalysis, cystoscopy

105
Q

treatment of FIC

A
  • MEMO (multimodal environmental modification)
    o offer more litter boxes, organised time for play, different food
  • feline facial pheromone
    o Feliway + valerian, analgesia (buprenorphine, acepromazine)
  • supplements and therapeutic food for stress
  • pharmacologic therapy
    o amitriptyline and clomipramine, NSAID, GAG
106
Q

prognosis of FIC

A

normal life if management is correct and carried out

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