Urology and Nephrology Flashcards
1
Q
kidneys receive ______% cardiac output
A
25
2
Q
functional unit of kidney
A
nephron
3
Q
podocytes
A
responsible for filtering serum, must be able to dilate to achieve normal filtration
4
Q
proximal tubule
A
80% water absorption
reabsorption of water, potassium, bicarbonate, Na, Cl, nutrients
excretion of H+ and NH3+
5
Q
loop of Henle
A
reabsorbs more water to further concentrate urine
ascending limb: high levels of urea sit out outside to pull in water - low urea levels = medullary washout
descending limb: NaCl absorbed and water follows
6
Q
distal tubule
A
reabsorption of NaCl, water and bicarb, excretion of K+ and H+
7
Q
collecting duct
A
reabsorption of NaCl, urea and water
active reabsorption via ADH and aldosterone
- ADH opens aquaporins
- aldosterone opens Na channel
8
Q
how does kidney maintain BP
A
as blood enters afferent arteriole, glomerular apparatus measures pressure
- if not enough, increases BP by producing renin –> liver (ATI) –> lungs (ATII) –> constricts arteries at kidney + stims adrenals to release aldosterone, acts on distal tubule and collecting ducts, Na reabsorption = H2O reabsorption = increased blood volume
9
Q
Hormones produced by kidney
A
Renin - increase BP
EPO - RBC production
active vit D (1,25 dihydroxycholecalciferol) - increase Ca absorption from gut
10
Q
Hormones that act on the kidney
A
PTH - increase Ca absorption and P excretion
ADH - open aquaporins
Aldosterone - increase Na retention
11
Q
Azotemia
A
increase in concentration of NPN wastes in blood, can be renal, pre renal or post renal
12
Q
is azotemia uremia?
A
no, uraemia is a clinical condition because of an increase in urea
13
Q
____% nephrons are non-functional if the kidney is in failure
A
75%
14
Q
at _____% kidneys cannot concentrate urine
A
66%
15
Q
Renal failure
A
kidneys no longer able to maintain regulatory, excretory and endocrine function
metabolic acidosis
retention of nitrogenous solutes and derangements of fluid, electrolytes and acid/base status
>75% nephrons nonfunctional
16
Q
Renal disease
A
doesn’t equal azotemia or renal failure
morphological or functional lesions in one or both kidneys regardless of extent
17
Q
Uremia examples
A
uremic gastropathy, hyperparathyroidism (extra renal manifestations of renal failure_
18
Q
Gold standard to test glomerular function
A
accurate and direct technique
clearance of radioisotopes with renal scintigraphy or iohexal/inulin/creatinine clearance tests
though gold standard, they are not commonly used
19
Q
Indirect methods to test glomerular function
A
urea - subject to passive reabsorption in the tubules, clearance is not a reasonable estimate of GFR
creatinine - better indicator, produced at constant rate, dependent on muscle mass, less influenced by diet, excreted unchanged by kidneys
- better indicator of GFR but relationship is not linear
- limitations: azotemia doesn’t develop until GFR has decreased to 25%, doesn’t tell you why GFR has fallen
20
Q
Azotemia doesn’t develop until GFR has decreased to _____%
A
25%
21
Q
gold standard to measure urine concentration
A
osmolality (not used in practice)
22
Q
Urine specific gravity
A
measures urine concentration with a refractometer calibrate with distilled water glucosuria falsely increases measures concentration of urine relative to plasma - renal tubular test Hyposthenuria - 1.000-1.007 Isosthenuria - 1.008-1.012 minimally concentrated - 1.013-1.030 *adequately concentrated* - dog: >1.030 - cat: >1.035
23
Q
Adequately concentrated urine
A
Dog: >1.030
Cat: >1.035
24
Q
Sediment exam of cells
A
big cells - transitional cells
medium cells - tubular epithelial cells
small cells - RBC and WBC
25
calcium oxalate crystals
square stones, small breeds predisposed
26
calcium mono-oxalate
antifreeze
27
ammonium biurate
dalmations
28
cysteine crystals
bulldogs
29
struvite crystals
any, cats predisposed
30
Sediment exam
in house is better
31
UPC proteinuria values
Dog - >0.5 = proteinuric
| Cat - >0.4 = proteinuric
32
Partial water deprivation test
r/o hyperadrenocorticism first
maximal stim of ADH release will be present after 5% loss of BW
addition of DDAVP (vasopressin) - failure to concentrate = diabetes inspires or renal medullary washout
Fractional excretion of electrolytes - assess tubular dysfunction
33
fractional excretion of electrolytes
assess tubular dysfunction
fraction of electrolyte clearance relative to creatinine clearance
Na-Fractional excretion differentiates renal from pre-renal disease
if <1%, pre-renal dz
if >1%, renal dz
34
bladder tumor antigen test
41% specificity in dogs with UTI other than TCC
35
most common bacterial cause of UTI
E. coli
36
Hematuria
presence of blood/RBC in urine
gross or occult, or pseudohematuria (centrifuge to Ddx)
Causes: systemic disorders, renal, bladder/ureter/urethra, genital tract
37
where do you take a kidney biopsy from?
CORTEX NOT THE MEDULLA
38
Ddx between acute and chronic kidney disease
chronic look like shit, will be skinny and gross (acute haven't had time to lose weight)
39
key CS of lower urinary tract disease
inappropriate urination
40
Normal urine production
1-2ml/kg/hr
41
2 exam findings on animal with a micturition disorder
oral - uremic stomatitis
| rectal - prostate
42
when should you look at specific gravity or UPC
before giving fluids
43
Renal carcinoma
Dogs > cats
Unilateral renomegaly
polycythemia as paraneoplastic syndrome (decreased EPO prod)
can cause hypertrophic osteopathy as paraneoplastic syndrome
Dx w/ US
Tx by nephrectomy
44
Renal carcinoma
Dogs > cats
Unilateral renomegaly
polycythemia as paraneoplastic syndrome (decreased EPO prod)
can cause hypertrophic osteopathy as paraneoplastic syndrome
Dx w/ US
Tx by nephrectomy
45
Renal lymphoma
Cats > dogs
usually both kidneys - bilateral rnomegaly
caused by azotemia, can spread to CNS, some association with FeLV
Dx: US
Tx: multi-agent chemotherapy (COP or CHOP)
Px: good 60% in complete remission
46
#1 non-neoplastic cause of renomegaly
acute ureteral obstruction
47
Non-neoplastic causes of renomegaly
renal inflammation, amyloidosis, hydronephrosis, portosystemic shunts, acute ureteral obstructions
48
Polycystic kidney disease
multiple cysts in both kidneys, can cause renal failure in adulthood
Persians - can genetic test
mutation in PKD-1 gene, also in bull terriers, cair terriers, WHW terriers
49
Renal pain
present as acute abdominal pain
50
Acute renal injury
mild damage to severe damage with complete anuria, infers reversibility
51
acute renal failure
decreased GFR, retention of nitrogenous wastes
52
RIFLE criteria
Risk, Injury, Failure, Loss, End-stage kidney disease
- base grades on creatinine level (but we dont know baseline in vet med = problem)
- based on proportion of serum creatinine increase + urine output decrease
53
Pre-renal causes of acute kidney disease
insufficient blood flow (perfusion) to kidneys
- hypoxia, ischemia, dehydration, hypovolemia, hypotension, anesthesia, surgery, shock, trauma
Na urine fractional excretion <1%
54
Renal causes of acute kidney disease
affect kidney itself
- hypo perfusion, obstruction, thrombosis, vasoconstriction, infectious causes, immune mediated causes, neoplasia, secondary to systemic disease
- NEPHROTOXINS
55
examples of nephrotoxins that can cause acute kidney disease
ethylene glycol, NSAIDs, ahminoglycosides, TMS, sulfamethoxazole, methotrexate, cyclosporine, cimetidine
- endogenous: myoglobin
56
Post renal causes of acute kidney disease
obstruction or urine leakage
57
4 phases of acute renal failure
initiation, extension, maintenance, recovery
58
Initiation phase of acute renal failure
aka onset phase, without CS, triggered by ischemic event
defined by decrease in urine output or increase in creatinine
intervention is necessary
59
Extension phase of acute renal failure
continued hypoxia and inflammation, compromised Na:k pumps, loss of brush border or apical and basal cell surfaces
increased cytosolic Ca
60
Maintenance phase of acute renal failure
1-3w, urine output is increased or decreased urine is ultrafiltrate
61
Recovery phase of acute renal failure
heralded by PU, extreme Na loss, takes weeks/months to recover
62
Recovery phase of acute renal failure
heralded by PU, extreme Na loss, takes weeks/months to recover
63
Intrinsic renal failure
acute tubular necrosis/injury
intra-renal vasoconstriction - imbalance between vasoconstrictors (endothelin) and vasodilators (NO)
ATP cannot be formed, intracellular acidosis, intracellular hypercalcemia
Tubular dysfunction = obstruction from crystals or detached RTE cells, cytoskeletal injury, loss of tight junctions, necrosis
64
Prevention of acute renal failure
manage risk factors (Tx shock, dehydration, avoid nephrotoxic drugs in compromised patients)
renoprotective drugs - amlodipine (Ca channel blocker), Dopamine (vasodilation), Fenoldopam (prevent vasoconstriction, EPO analogues
65
Prevention of acute renal failure
```
manage risk factors (Tx shock, dehydration, avoid nephrotoxic drugs in compromised patients)
renoprotective drugs - amlodipine (Ca channel blocker), Dopamine (vasodilation), Fenoldopam (prevent vasoconstriction, EPO analogues
Address BP, ensure >80mmHg, address circulatory volume, avoid hyperkalemia induced bradyarrhythmias
fluid bolus (10-15ml/kg crystalloids in oliguric patients, or 2-5ml/kg colloids) to correct electrolyte abnormalities
```
66
Diagnosis of AKI
ID predisposing causes, reduced urine output, azotemia, Fex Na >1%
Renal tubular biomarkers
- GGT:Creat - can see if injury is getting better or worse
- NAG: Creat - similar to above
67
Treatment of Acute Renal Failure
FLUIDS FLUIDS FLUIDS
| Tx shock in time he gives, calculate all the fluids, make sure to reweigh before giving. maintenance dose
68
Oliguria
produce <0.5ml/kg/hr
correct renal perfusion to see if it is physiological or pathological
Tx w/ fluids and drugs (mannitol, furosemide, dopamine, fenoldopam, Ca channel blockers)
69
Mannitol
Osmotic diuretic
increases circulatory volume, decreases cell swelling
blunts influx of Ca intracellularly
Contraindicated with anuria and dehydration
70
Furosemide
Loop diuretic
inhibits Na-K-2Cl symporter in thick ascending LOH
increases urine production w/o increasing GFR, renoprotective
Contraindicated with dehydration, lethargy, tachycardia, ototoxicity
71
Dopamine
may convert to non-oliguria, not effective in cats
| only benefit as a pressor when ARF is secondary to cardiac output failure or severe hypotension
72
Fenoldopam
increases urine output
73
Calcium channel blockers
pre-glomerular vasodilation
prevent Ca moving intracellularly, renoprotective post-transplant
standard of care in leptospirosis
74
Definitive treatment of Acute renal failure
extracorporeal renal replacement therapy/diuresis
indications: fluids overload with pulmonary edema, hyperkalemia, progressive azotremia, acute toxicity
peritoneal dialysis - successful but mean survival short
complications: dialysis disequilibrium syndrome - blockage of peritoneal drain by omentum
75
Specific therapies for causes of acute renal failure
ethylene glycol toxicity - 4-methylprazole
NSAIDs - misoprostal
Leptospirosis - penicillins and Doxy
Pyelonephritis: culture, fluoroquinolone or TMS
Aminoglycoside toxicity ticarcillin IV
TMS toxicity: urinary alkalization
76
Tx for hyperkalemia associated with ARF
calcium gluconate, insulin and dextrose infusion
- monitor BG
correct metabolic acidosis
77
tx for acidosis associated with ARF
IV bicarbonate (but not when increased CO2 or else paradoxical CNS acidosis)
78
Tx of hypocalcemia associated with ARF
10% calcium gluconate
79
Tx of hypercalcemia associated with ARF
diuresis: furosemide/glucocorticoids, calcitonin, biphosphonates
80
Tx of hyperphosphatemia associated with ARF
no specific tx, reduce intake by protein restricted diet (renal diet) and oral P binders, aluminum hydroxide/carbonate w/ food
81
Tx of hypertension associated w/ ARF
Cats - amlodipine, Dogs hydralazine
AVOID ACE inhibitors because cause arterial vasoconstriction and will worsen azotemia
82
Tx of GI problems associated with ARF
uremic gastropathy - omeprazole, pantoprazole, famotidine, ranitidine
pro kinetics: ondansetron, metaclopramide
anti-emetics: metoclopramide, maropitant
83
Prognosis for animals with ARF
Good outcome: dialysis, leptospirosis, obstructive + ineffective
poor outcome: No ECRR when indicated, decreased urine production, hypothermia, hyperkalemia, toxin
hyperkalemia - every unit above baseline = 57% higher chance of death
84
Chronic kidney disease
all stages from at risk to renal failure and uraemia
progressive and irreversible
prolonged proceed, smolders before it becomes clinically apparent
is incurable
85
Causes of chronic kidney disease
```
D - degenerative or developmental
A - auto-immune
M - metabolic (hypercalcemia)
N - neoplatic
I - infectious (pyelonephritis, lyme, leptospirosis)
T - trauma
```
86
why is CKD progressive
once CKD develops, secondary processes activated that contribute to renal damage
87
Clinical presenting signs of CKD
```
PU/PD - nocturia
GI signs - vomiting, anorexia, weight loss, etc
Mental - depression, lethargy
Ocular - sudden onset blindness (rare)
skeletal - pathologic fractures (rare)
```
88
USG of chronic kidney disease patients?
unable to concentrate urine
cats 1.008-1.030
dogs 1.008-1.022
89
How can you tell a CKD patient has GI hemorrhage?
check urea and creatinine levels. If very high urea without an increase in creatinine, you can assume azotemia due to something other than just the kidneys, could be a high protein diet but likely GI bleeding
90
CKD and hyperphosphatemia
reduced renal function - phosphate retention
Stage I and II - phosphate loss due to compensatory mechanisms
Stage III and IV - compensatory mechanisms fail = phosphate increases
unlikely to cause direct CS, only issue if also increase Ca = metastatic calcification
Tx by reduced intake + give phosphate binders
91
CKD and hypokalemia
reduced intake and increased potassium losses
| results in neuromuscular weakness
92
calcium and CKD
often unchanged or slightly decreased
| hypercalcemia can cause renal failure or be secondary to it
93
CKD and metabolic acidosis
due to decreased excretion of protons by the kidney
94
Chronic kidney disease hematology
non regenerative anemia, normocytic, normochromic anemia
multifactorial: EPO deficiency, decreased RBC lifespan, effect of PTH on BM and RBCs, anemia of chronic disease, GI hemorrhage
- lethargy, inappetence
95
Urinalysis in CKD
look for evidence of concurrent UTI (dilute urine = bacteria can survive)
Proteinuria - may be due to underlying cause of CRF, but CRF can cause it too
- tx w/ ACEi (benazepril) or ARB (telmisartan)
culture + sensitivity bc risk of infection
96
Abdominal imaging in CKD
Rads - renal size, tissue mineralization (cats more)
| US - renal size, can ID cause, FNA
97
Blood pressure and CKD
oscillometric or doppler (cats and small dogs)
- chicken or egg - BP and kidney Dz can cause and be the result of each other
leads to ocular, cerebral, and CV damage
98
When Dx of CKD is suspected, what 3 things should you measure for IRIS staging?
Blood pressure
creatinine levels
proteinuria
99
Goals of CKD management
```
Stage 1 - ID primary Dz and start specific Tx to eliminate if possible
Stage 2 and 3 - renoprotective therapy to try to slow progression
Stage 4 (and late stage 3)- symptomatic therapy
```
100
What is proteinuria
protein in the urine
101
Causes of proteinuria
Physiological - strenuous exercise, seizures, fever, stress
Pre-renal - abnormal concentration of proteins presented to kidneys
Renal - defective renal function or inflammation of renal tissue (glomerular or tubular)
Post - renal - inflammation in ureter, bladder, urethra or prostate
102
Diagnosis of proteinuria
1st - dipstick
false positive: alkaline urine or contamination
false negatives: acidic urine or hence jones proteinuria
+1 not much issue, +3 or +4 = big deal
24 hour urine protein measurement = gold standard but hard so not done clinically, instead...
Urine protein:creatinine ratio = correlates well w/ 24h protein excretion
103
Causes of renal proteinuria
defective renal function
either glomerular pathology or tubular pathology
inflammation of renal parenchyma - pyelonephritis or acute tubular necrosis
104
Glomerular renal proteinuria
due to increased glomerular permeability
leads to greater protein loss, tends to be UPC>2.0 once established
if >8 then consider amyloidosis
protein losing nephropathy (PLN) = causes severe proteinuria due to primary glomerular disease
105
Tubular renal proteinuria
due to decreased tubular protein reabsorption
| UPC <2.0
106
Chronic renal failure as a cause of renal proteinuria
low level proteinuria due to adaptive changes to nephron loss
CKD can be caused by primary glomerular pathology - more significant protein losses
107
Causes of Glomerulonephritis
dogs>cats
chronic antigenic stimulation
many cases unknown (50% idiopathic)
Genetic causes
- familial nephropathy basement membrane - Samoyeds
- alport syndrome of English cocker spaniels
108
Investigating glomerulonephritis
consider Hx and signalment (breed - cocker spaniel, samoyed, shar pei)
clinical exam and systolic BP
- look for evidence of end organ damage (kidneys, brain, eyes, heart), avoid white coat effect - take at least 5 readings
MDB - 1. R/o infectious causes, 2. r/o neoplasia
109
hyper coagulability and glomerulonephritis
measure with thromboelastography - shorter coat time, increased max amplitude, higher angle
- caused by mild thrombocytosis, increased platelet adhesion, loss of antithrombin
can lead to thromboembolism (often in pulmonary system)
110
hypercholesterolemia and glomerulonephritis
liver senses protein loss so goes into overdrive to make more proteins and also makes more lipoproteins/cholesterol
111
Clinical signs of protein losing nephropathy
early: no CS, loss of conditions, lethargy, anorexia
later: nephrotic syndrome, loss of third space, effusions, subcutaneous pitting edema
very late: uremic syndrome
112
What IRIS stage is kidney biopsy contraindicated? When else is it contraindicated
IV - not enough time to biopsy, patient will die
| coagulopathy - risk patient bleeding out
113
what part of the kidney should you biopsy?
CORTEX NOT MEDULLA
114
What is nephrotic syndrome
group of findings which include proteinuria, hypoalbuminemia, ascites, edema, hypercholesterolema
often also have systemic hypertension and hypercoagulablity
115
First choice immunosuppressive agent to tx nephrotic syndrome?
Mycophenolate
116
Treatment of PLN
Tx hypertension (ACE inhibitors - benazepril, enalepril, also amlodipine)
tx proteinuria
- ACE inhibitors (contraindicated if stage IV IRIS)
- ARB
- Renal diet
Tx hyper coagulability - aspirin or clopidogral
Do not drain abdominal effusion unless difficult breathing
Do not Tx w/ diuretics unless difficulty breathing
117
Diameter of feline and canine ureters?
feline - only 0.4mm!
| canine - 1-3mm
118
Acute unilateral ureteral obstruction
clinically silent, no azotemia
| cats present w/ acute abdominal pain
119
Acute bilateral ureteral obstruction
uncommon, bilaterally enlarged and painful kidneys, progressive azotemia, oliguria or anuria
120
Big kidney Little kidney syndrome
common presentation seen in cats w/ past unilateral ureteral obstruction that has caused kidney to progress to end fibrotic stage
contralateral, hypertrophied kidney becomes acutely obstructed by ureterolith
121
Bilateral chronic kidney disease w/ concomitant ureteral obstruction
common, carries most guarded prognosis bc even w/ resolution of obstruction, global renal function severely compromised
122
Presenting complaint of ureteral obstruction
severe acute uraemia - urea + N products in urine
ureterocolic signs
syndrome prevalent in cats >7y
123
Diagnosis of ureteral obstruction
Rads - not ideal
US - difficult to find acutely obstructed ureter
Advanced imaging
- antegrade pyelography or CT
*CT is preferred* - w/ contrast, less invasive vs pyelography
124
Managing ureteral obstruction
difficult to assess
medical - 20-30% spontaneously resolve, if oliguric - mannitol, can use prazosin or amitryptilline as ureteral relaxants
Lithotripsy - excellent for dogs, poor for cats
Ureteral stents - standard of care - soft polyurethane catheters with double pigtail design, multiple fenestrations
- cystoscopy to place (dogs retrograde, cats antergrade)
SUB - subcutaneous ureteral bypass system
- development of ureteral bypass using locking loop nephrotomy/cystotomy tube
125
Dx of Urethral obstruction
enlarged bladder, signs of urinary urgency, difficulty expressing urine
126
Emergency Tx of hyperkalemia in a blocked cat
Fluids - calc shock rate with dose 45ml/kg
calcium gluconate - 1ml/kg to protect heart
IV insulin (2 units/kg) + dextrose
bicarbonate (1-2mEq/kg)
127
Relieving urethral obstruction in cat
penile massage, anesthesia, cystocentesis, penis extrusion, catheterization,
128
Ongoing management of blocked cat
indwelling Ucath placement w/ e collar
| monitor urine production, analgesia, anti-spasmodics
129
If owner can't afford Tx for blocked cat
euthanize or no indwelling catheter, just unblock cat and give anti-spasmolytic, repeated cystocentesis
anti-spasmodics - prazosin, phenoxybenzamine, destress w/ feliway
130
Urethral rupture
dogs HBC, cats urethral obstruction or traumatic catheterization
use positive contrast, retrograde urethrogram
131
Uroabdomen
trauma or obstruction
| Sx once stable
132
Clinical signs of lower urinary tract dz
dysuria, stranguria, pollakiuria (bladder irritation)
133
Diagnostic approach to LUTF
Hx - frequency, effort, volume, etc
PE
Diagnostics - collect urine on free flow and cystocentesis, culture, cytology, etc
check appearance + colour
- yellow/oragne - billirubinemia (IMHA, hemolysis)
- hematuria - renal, LUT, reproductive, systemic
134
signalment of UTIs
most commonly seen in female dogs
135
Microbial factors associated with UTIs
adherence factors
enzymes (hemolysin, urease)
protective factors
resistance factors
136
Microbial isolates associated with UTIs
E. coli = most common
2nd most common = gram + cocci (streptococcus canis and staphylococcus pseudintermedius)
most infections are single species and due to ascending infections, hematogenous = uncommon
137
Treating an uncomplicated UTI
CULTURE
| amoxicillin and cephalosporin, 10-14d
138
Treating a complicated UTI
reinfection/superinfection: new/diff organism
- C/S positive >7d after last tx course = reinfection
- C/S positive @7d after starting antibiotics = superinfection
relapse: same organism/strain 7d after last tx
- inappropriate drug, dose, frequency, duration
+ perform MDB, rads, US of bladder
139
Tx a recurrent UTI
prophylactic therapy - last resort
- once infection eradicated, give nitrofurantoin once daily at bedtime, 30-50% original dose
if negative C/S for 6m, discontinue
Alternative Tx
- cranberry extract, probiotics
- polysulfated glycosaminoglycans, fosfomycin (monurol)
140
Urolithiasis
formation and growth of uroliths
141
crystalluria
urine has been supersaturated
| doesn't urolithiasis
142
Dx of urolithiasis
urinalysis, culture, rads, IS, advanced imaging
143
Tx of urolithiasis
voiding urohydropulsion
- if <6mm can squeeze out of urethra (in female dog have urethra 4-6mm)
- essentially use catheter to fill bladder with fluid and force uroliths out
max size is <5-15mm
retrograde hydropulsion
- flush stones into bladder and remove in Sx (male dogs)
144
Struvite crystals
magnesium ammonium phosphate
breeds: schnauzer, cocker spaniels, lhasa aspo, bichons, shih tzu
- mainly LUT
related to UTI bc urease from bacteria --> ammonia
- big smooth, radio dense, look like tent
Tx - DIET - target pH as acidic, dilute urine SG
145
Calcium oxalate crystals
male dogs + obese animals
breeds: yorkies, schnauzer, lhasa apto, bichons, shih tau, poodles, but any breed
- radiopaque, small stones, spiny, rarely cause obstruction
- monohydrate - barbell, dihydrate = envelope
Tx - NOT DIET, use Sx, lithotripsy, cystoscopy
Prevention: diet + water, thiazide diuretics (hydrochlorothiazide), potassium citrate, avoid vitamins C and D
146
Ammonium urate and xanthine - purine
- caused by hepatic dz - "apples"
Breeds: Dalmatians, Black Russian terrier
males predisposed
decreased uptake of uric cid from hepatocytes
- radiolucent
Tx - allopurinol, diet (low protein), xanthine oxidase inhibitors in Dalmatians w/ low purine diet, support hepatic function
147
Cystine Calculi
Breeds: aussies, dachsunds, newfies, bulldogs
-radiopaque, hard to visualize in large breeds
- alkaline urine and low protein, DCM risk in large ebreeds
thiol drugs have risks
148
Calcium/P uroliths
secondary to primary hyperparathyroidism
149
silica uroliths
plant sources
150
Melamine and cyanic acid
Chinese put into food to increase protein content but causes acute renal failure
151
ethology of feline LUTD
idiopathic, if >10 maybe bacterial, behavioural, feline interstitial cystitis
152
how many litter boxes is enough
one per cat plus one
153
Feline idiopathic cystitis
mucosa - altered urinary glycosaminoglycan excretion, increased ion leakage across urothelium
submucosa - mast cell presence degranulation + inflammation
SNS abnormalities and C pain fibers - substance P and capsaicin lead to increased inflammatory response
154
Clinical signs of feline idiopathic cystitis
hematuria, stranguria, pollakiuria, large firm bladder, blocked
155
Diagnosis of feline idiopathic cystitis
Exclusion - negative culture and imaging
156
Tx of feline idiopathic cystitis
environmental modification/enrichment
157
Vaginal prolapse
estrogen effect - wall gets so thick it prolapses, lubricate so it involutes then perform OHE
158
Neoplasia of female genital tract
leiomyoma, TVT
159
Benign prostatic hyperplasia
normal aging change
| CS: asymptomatic, constipation
160
Acute prostatitis
SICK dog
Dx: UA shows evidence of UTI
*all intact male dogs w/ UTI have prostatitis*
161
chronic prostatitis
more common than acute
-non painful symmetrically enlarged prostate
- Dx: UA may or ma not show UTI, but if you have UTI you have prostatitis
Tx: if benign hyperplasia - orchidectomy, medical castration (deslorelin or finasteride)
- for prostatitis: fluoroquinolone, doxy, trimethoprim, rifampin, erythromcin
carbenacillin Tx 60% chronic cases
- cysts: US drainage and marsupialize
162
Prostatic neoplasia
rare, not related to neuter status
present with lameness and mass effect signs
mets present + local invasion
Dx: imaging of primary mass and mets, spondylosis, common bone metastasis
Tx: chemo, radiation, stents
poor prognosis
163
Neoplasia of lower urinary tract
transitional cell carcinoma
chemo mitoxantrone
scotties predisposed, can be in bladder or urethra
Dx: DO NOT DO FNA or anything. that can cause seeding, do sediment, imaging, or catheter suction
Tx: piroxicam, Sx, mitotxantone
164
Nerves of bladder
urine retention:
SNS - hypogastric on bladder wall + internal sphincter, norepinephrine
urine expression:
PSNS - pelvic n. on bladder wall
Somatic - pudendal n. on external sphincter
- acetylcholine
165
UMN bladder
detrusor areflexia and sphincter hyperreflexia
bladder small and hard to express
lesion above sacral segment
Tx: baclofen
166
LMN bladder
detrusor areflexia and sphincter areflexia
large easily expressed bladder that constantly leaks
lesson in sacral spinal cord or pelvic segment
Tx: manual expression, bethanecol
167
detrusor = sphincter reflex dyssynergia
phenoxybenzamine
168
Dysautonomia
GI, heart, ANS signs
169
Detrusor antony
from overfill, obstruction
large flaccid bladder, gets damaged from over stretching
manual expression
normal neuro exam
170
Urge incontinence
detrusor contraction during storage of urine or low compliance of detrusor mm
CS: pollakiuria, stranguria, dysuria
Tx: oxybutynin, imipramine, dicyclomine
careful of UTIs if using diapers
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Most common ethology of urinary incontinence
urinary sphincter mechanism incompetence
