Urology Flashcards
What ketones do dipsticks detect
And which one predominates during DKA
Acetoacetate
Betahydroxybutyrate predominates during DKA but as ketosis improves acetoacetate increases causing a positive on dipsticks and making the ketosis look like it is worsening
Causes of milky white urine
Pyuria
Lipid (cats with hepatic lipidosis)
Crystalluria
Differentiating haematuria, myoglobinuria and haemoglobinuria
Check sediment for RBCs
Spin down blood plasma will be pink if haemolysis and clear if myoglobin
What are hyaline casts and why do they form?
Pure protein precipitates
Parallel sides and rounded ends
Occur with fever, exercise and renal disease
What are granular casts and why do they form
These represent degenerated epithelial cellular casts
Observed with renal tubular disease
What are waxy casts
Arise from degeneration of granular casts
Side effects of progestagens in treatment of canine BPH
Adrenal atrophy
Cushings
Diabetes
Hypothyroidism
Pyometra is mediated by what hormone
Progesterone
Antibiotics for chronic prostatitis
TMPS Erythromycin Clindamycin Chloramphenicol Flouroquinolones
Not usually anaerobic - gram positives and negatives
Drugs used in medical management of pyometra
Prostaglandin F
Dopamine agonists
Progesterone receptor antagonists (aglepristone (Alizin))
Antibiotics
(Prostaglandin and dopamine agonists combined therapy enhances luteolytic effects - progesterone levels fall within 24-48 hours and cervix opens in less than two days - cabergoline and cloprostenol. Resolution of signs in 10-13 days)
Prostaglandin F mode of action and dose
Luteolytic
Opens cervix
Promotes myometrial contraction
Natural - dinoprost 3-5x daily for 3-7days
Side effects: v/d/panting
Synthetic - cloprostenol - longer duration and less side effects
Neither licensed
Dopamine agonist
Cabergoline
Luteolytic
Progesterone antagonists and mode of action
Aglepristone
Opens cervix but doesn’t induce myometrial contractions
Can also combine with prostaglandin
Antiobiotics for pyometra
Potentiated amoxicillin
TMPS
Cephalosporins
Continue 10-14 days after resolution of clinical signs
Treatment of Cystic endometrial hyperplasia
Gnrh agonists eg deslorelin implant to prolong anoestrous but if implanted in anoestrous will bring bitch into oestrous
Causes of failure to cycle
Individual variations (4-12months)
Immaturity, intersex, ovarian aplasia, stress, systemic illness, endocrine dz
Silent heat
Luteal cysts
Senile or immune mediated ovarian failure
Ovarectomy
What to do if bitch fails to show oestrous
Measure progesterone to exclude ovulation Vaginal cytology initially then twice weekly House with other cycling bitches Gnrh stimulation test Ultrasonography Aerial serum progesterone Exploratory surgery Kayotyping if intersex
Treatment of Luteal cyst
Surgical removal or prostaglandin
Treatment of normal bitch who is failing to cycle
Cabergoline
Deslorelin
Infertility associated with abnormal oestrous cycles
Short interoestrous intervals - anovulatory cycles or CEH
Extended interoestrous intervals - ovarian failure, luteal cysts, progesterone secreting ovarian tumours (granulosa cell)
Persistent oestrous - follicular cyst
Vaginitis
Failure to conceive or early pregnancy failure
Physical abnormalities Miss timing Endometritis/ CEH Embryonic defects Herpes/brucellosis Hypoluteodism (progesterone insufficiency)
Clinical signs of cystic ovarian remnants in the bitch
Vaginal bleeding for several weeks Vulval swelling alopecia Dermal hyperpigmentation PU/PD Erythema on ventral abdomen Mammary gland enlargement Pollakiuria/strangurua Poor coat Weight loss Recurrent UTIs
Side effects of progestagens in queens for ovarian remnant syndrome
DM CEH Pyometra Mammary adenoma/fibrosarcoma Bone marrow toxicity Thyroid dysfunction
Contraindications of medical treatment of pyometra
Pyretic or hypothermic patients likely to have peritonitis
When to consider low dose aspirin for PLN
If albumin < 20g/l due to loss of antithrombin
Side effects of aluminium hydroxide
Microcytosis and muscle weakness
Neurological issues
Treatment of metabolic acidosis in CKD
Stabilise on renal diet
Oral potassium citrate or sodium bicarbonate
B
Causes of acute kidney injury
Ischaemia Toxins - lilies/grapes Drugs Infections (pyelonephritis, leptospirosis) Hypercalcaemia Sepsis Acute pancreatitis Renal lymphoma Obstruction
What will be found on urinalysis in AKI
Isosthenuria
Casts
Can see:
Haematuria
Glucosuria
May also see bacteruria/pyuria/crystals
Routine evaluation of AKI
Bloods
Acid base
Urinalysis
Urine culture
Normal kidney size
2-3x L2 in cats
2.5-3.5 x L2 in dogs
What crystals form with ethylene glycol toxicity
Calcium oxalate monohydrate
Antidote for antifreeze toxicity
4-methylpyrazole or Ethanol
Needs to be given within 8 hours of ingestion
Prognosis poor if already azotaemic or oliguric
Treatment of NSAID toxicity
Misoprostol for at least 3 days
Synthetic prostaglandin analogue
Prognostic factors for dogs in AKI
Severe azotaemia (crea >900) Hypocalcaemia Anaemia Anuria If azotaemia doesn’t improve with treatment or wors an Other disorders (sepsis/pancreatitis)
Prognostic factors for cats with AKI
Hyperkalaemia
Low albumin
Decreased bicarbonate at presentation
(Azotaemia or changes in calcium/phosphate did not predict survival)
Infectious causes of acute kidney injury
Primary:
Leptospirosis
Pyelonephritis
Borreliosis (lymes nephritis)
Secondary: FIP babesiosis Leishmaniasis Bacterial endocarditis
When not to use mannitol in AKI
When anuric as this can cause volume overload
Works by solute diuresis
Why is there increased risk of thromboembolic events with protein losing nephropathy
Loss of antithrombin III
Also changes in vessel walls and blood stasis etc
Treatment of metabolic acidosis in ckd (iris stages 1-4)
Renal diet (pH neutral) Alkalinising salts (sodium bicarbonate or potassium citrate)
Use if bicarb or CO2 is <16mmol/l
Assess response by rechecking blood gases after 10-14 days
Choice of potassium supplementation in ckd cats
Potassium gluconate or potassium citrate
Potassium chloride is acidifying so don’t use this
What should be administered alongside darbepoeitin
Iron dextran
Can cause anaphylaxis so needs monitored
Sometimes one injection is all that is required
When to use calcitriol therapy
In dogs with CKD stages three and four.
Proven benefit
Need to monitor PTH and calcium levels
Radiolucent urinary stones
Cysteine
Urate
Xanthine
Fluid of choice in blocked cats
Hartman’s as saline is acidify
Hartman’s potassium level is negligible
Prazosin
Smooth muscle relaxant (proximal third of urethra) Alpha1 antagonist (so is phenoxybenzamine but prazosin is more effective - quicker and more selective for alpha one)
Why do medications like steroids and furosemide increase risk of calcium oxalate urolithiasis
Decrease tubular reabsorption of calcium and increase calcitriol
Treatment of ureteroliths and nephroliths
Extracorporeal shock wave lithotripsy
Surgery (ureteral bypass or nephrectomy)
Fluid diuresis and urinary smooth muscle relaxants : amitryptyline, prazosin, phenoxybenzamine, metoclopramide or cisapride
What to avoid with calcium oxalate urolithiasis
Glucocorticoids
Furosemide
Vitamins D and C
Urinary acidifiers used for struvite dissolution and side effects
Acetonydroxamic acid (AHA) - inhibits urease
Renal excreted so cant use in renal dz Haemolytic anaemia Anorexia Vomiting Hyperbilirbuinaemia Bilirubinaemia Predisposition to calcium oxalate formation
Allopurinol mechanism of action
Side effects
Contraindications
Xanthine oxidase inhibitor
Formation of xanthine crystals if a low protein diet isn’t fed
Haemolytic anaemia
Trigeminal neuropathy and
Skin eruptions if given with ampicillin
CI in renal dz
Metastatic potential of TCCs - how many and where to
60% metastasise
Lungs and lymph
How to reduce sterile haemorrhaging cystitis with cyclophosphamide usage
Give with furosemide
Treatment of BPH
Osaterone
Deslorelin implant
5-alpha reductase inhibitors (finasteride)
Causes of detrusor atony
Treatment
Injury to sacral spinal cord s1-s3 or pelvic nerves
Direct damage due to overdistension
Bethanecol (for overdistension damage as the pelvic nerve is intact)
Metoclopramide, cisapride
Lower motor neuron bladder
S1-s3 lesion
Easily expressive bladder that may empty with minor increases in abdominal pressure
Can use bethanecol
What is bethanechol
A parasympathomimetic that affects only muscarinic receptors with no effect on nicotinic
Side effects of oestrogen
Myelosuppression
Attractiveness to males
Mammary/vulvar swelling
Behaviour changes
Causes of glucosuria without hyperglycaemia
Leptospirosis (acute kidney injury)
Primary renal glucosuria
Fanconis
Causes of acquired fanconis syndrome
Dried meat jerky treats Drugs: tetracyclines, cisplatin, aminoglycosides, streptazotocin Copper-associated hepatopathy Pyelonephritis Hypoparathyroidism/vitamin D deficiency
Monoclonal gammopathies
Neoplasia
