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SAM II > Urology and Nephrology > Flashcards

Urology and Nephrology Flashcards

1
Q

kidneys receive ______% cardiac output

A

25

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2
Q

functional unit of kidney

A

nephron

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3
Q

podocytes

A

responsible for filtering serum, must be able to dilate to achieve normal filtration

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4
Q

proximal tubule

A

80% water absorption
reabsorption of water, potassium, bicarbonate, Na, Cl, nutrients
excretion of H+ and NH3+

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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

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6
Q

distal tubule

A

reabsorption of NaCl, water and bicarb, excretion of K+ and H+

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7
Q

collecting duct

A

reabsorption of NaCl, urea and water
active reabsorption via ADH and aldosterone
- ADH opens aquaporins
- aldosterone opens Na channel

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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

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9
Q

Hormones produced by kidney

A

Renin - increase BP
EPO - RBC production
active vit D (1,25 dihydroxycholecalciferol) - increase Ca absorption from gut

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10
Q

Hormones that act on the kidney

A

PTH - increase Ca absorption and P excretion
ADH - open aquaporins
Aldosterone - increase Na retention

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11
Q

Azotemia

A

increase in concentration of NPN wastes in blood, can be renal, pre renal or post renal

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12
Q

is azotemia uremia?

A

no, uraemia is a clinical condition because of an increase in urea

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13
Q

____% nephrons are non-functional if the kidney is in failure

A

75%

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14
Q

at _____% kidneys cannot concentrate urine

A

66%

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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

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16
Q

Renal disease

A

doesn’t equal azotemia or renal failure

morphological or functional lesions in one or both kidneys regardless of extent

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17
Q

Uremia examples

A

uremic gastropathy, hyperparathyroidism (extra renal manifestations of renal failure_

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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

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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
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20
Q

Azotemia doesn’t develop until GFR has decreased to _____%

A

25%

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21
Q

gold standard to measure urine concentration

A

osmolality (not used in practice)

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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
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23
Q

Adequately concentrated urine

A

Dog: >1.030
Cat: >1.035

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24
Q

Sediment exam of cells

A

big cells - transitional cells
medium cells - tubular epithelial cells
small cells - RBC and WBC

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25
Q

calcium oxalate crystals

A

square stones, small breeds predisposed

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26
Q

calcium mono-oxalate

A

antifreeze

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27
Q

ammonium biurate

A

dalmations

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28
Q

cysteine crystals

A

bulldogs

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29
Q

struvite crystals

A

any, cats predisposed

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30
Q

Sediment exam

A

in house is better

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31
Q

UPC proteinuria values

A

Dog - >0.5 = proteinuric

Cat - >0.4 = proteinuric

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32
Q

Partial water deprivation test

A

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

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33
Q

fractional excretion of electrolytes

A

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

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34
Q

bladder tumor antigen test

A

41% specificity in dogs with UTI other than TCC

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35
Q

most common bacterial cause of UTI

A

E. coli

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36
Q

Hematuria

A

presence of blood/RBC in urine
gross or occult, or pseudohematuria (centrifuge to Ddx)
Causes: systemic disorders, renal, bladder/ureter/urethra, genital tract

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37
Q

where do you take a kidney biopsy from?

A

CORTEX NOT THE MEDULLA

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38
Q

Ddx between acute and chronic kidney disease

A

chronic look like shit, will be skinny and gross (acute haven’t had time to lose weight)

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39
Q

key CS of lower urinary tract disease

A

inappropriate urination

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40
Q

Normal urine production

A

1-2ml/kg/hr

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41
Q

2 exam findings on animal with a micturition disorder

A

oral - uremic stomatitis

rectal - prostate

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42
Q

when should you look at specific gravity or UPC

A

before giving fluids

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43
Q

Renal carcinoma

A

Dogs > cats
Unilateral renomegaly
polycythemia as paraneoplastic syndrome (decreased EPO prod)
can cause hypertrophic osteopathy as paraneoplastic syndrome
Dx w/ US
Tx by nephrectomy

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44
Q

Renal carcinoma

A

Dogs > cats
Unilateral renomegaly
polycythemia as paraneoplastic syndrome (decreased EPO prod)
can cause hypertrophic osteopathy as paraneoplastic syndrome
Dx w/ US
Tx by nephrectomy

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45
Q

Renal lymphoma

A

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

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46
Q

1 non-neoplastic cause of renomegaly

A

acute ureteral obstruction

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47
Q

Non-neoplastic causes of renomegaly

A

renal inflammation, amyloidosis, hydronephrosis, portosystemic shunts, acute ureteral obstructions

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48
Q

Polycystic kidney disease

A

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

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49
Q

Renal pain

A

present as acute abdominal pain

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50
Q

Acute renal injury

A

mild damage to severe damage with complete anuria, infers reversibility

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51
Q

acute renal failure

A

decreased GFR, retention of nitrogenous wastes

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52
Q

RIFLE criteria

A

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
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53
Q

Pre-renal causes of acute kidney disease

A

insufficient blood flow (perfusion) to kidneys
- hypoxia, ischemia, dehydration, hypovolemia, hypotension, anesthesia, surgery, shock, trauma
Na urine fractional excretion <1%

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54
Q

Renal causes of acute kidney disease

A

affect kidney itself

  • hypo perfusion, obstruction, thrombosis, vasoconstriction, infectious causes, immune mediated causes, neoplasia, secondary to systemic disease
  • NEPHROTOXINS
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55
Q

examples of nephrotoxins that can cause acute kidney disease

A

ethylene glycol, NSAIDs, ahminoglycosides, TMS, sulfamethoxazole, methotrexate, cyclosporine, cimetidine
- endogenous: myoglobin

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56
Q

Post renal causes of acute kidney disease

A

obstruction or urine leakage

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57
Q

4 phases of acute renal failure

A

initiation, extension, maintenance, recovery

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58
Q

Initiation phase of acute renal failure

A

aka onset phase, without CS, triggered by ischemic event
defined by decrease in urine output or increase in creatinine
intervention is necessary

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59
Q

Extension phase of acute renal failure

A

continued hypoxia and inflammation, compromised Na:k pumps, loss of brush border or apical and basal cell surfaces
increased cytosolic Ca

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60
Q

Maintenance phase of acute renal failure

A

1-3w, urine output is increased or decreased urine is ultrafiltrate

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61
Q

Recovery phase of acute renal failure

A

heralded by PU, extreme Na loss, takes weeks/months to recover

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62
Q

Recovery phase of acute renal failure

A

heralded by PU, extreme Na loss, takes weeks/months to recover

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63
Q

Intrinsic renal failure

A

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

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64
Q

Prevention of acute renal failure

A

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

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65
Q

Prevention of acute renal failure

A 
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
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66
Q

Diagnosis of AKI

A

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

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67
Q

Treatment of Acute Renal Failure

A

FLUIDS FLUIDS FLUIDS

Tx shock in time he gives, calculate all the fluids, make sure to reweigh before giving. maintenance dose

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68
Q

Oliguria

A

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)

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69
Q

Mannitol

A

Osmotic diuretic
increases circulatory volume, decreases cell swelling
blunts influx of Ca intracellularly
Contraindicated with anuria and dehydration

70
Q

Furosemide

A

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
Q

Dopamine

A

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
Q

Fenoldopam

A

increases urine output

73
Q

Calcium channel blockers

A

pre-glomerular vasodilation
prevent Ca moving intracellularly, renoprotective post-transplant
standard of care in leptospirosis

74
Q

Definitive treatment of Acute renal failure

A

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
Q

Specific therapies for causes of acute renal failure

A

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
Q

Tx for hyperkalemia associated with ARF

A

calcium gluconate, insulin and dextrose infusion
- monitor BG
correct metabolic acidosis

77
Q

tx for acidosis associated with ARF

A

IV bicarbonate (but not when increased CO2 or else paradoxical CNS acidosis)

78
Q

Tx of hypocalcemia associated with ARF

A

10% calcium gluconate

79
Q

Tx of hypercalcemia associated with ARF

A

diuresis: furosemide/glucocorticoids, calcitonin, biphosphonates

80
Q

Tx of hyperphosphatemia associated with ARF

A

no specific tx, reduce intake by protein restricted diet (renal diet) and oral P binders, aluminum hydroxide/carbonate w/ food

81
Q

Tx of hypertension associated w/ ARF

A

Cats - amlodipine, Dogs hydralazine

AVOID ACE inhibitors because cause arterial vasoconstriction and will worsen azotemia

82
Q

Tx of GI problems associated with ARF

A

uremic gastropathy - omeprazole, pantoprazole, famotidine, ranitidine
pro kinetics: ondansetron, metaclopramide
anti-emetics: metoclopramide, maropitant

83
Q

Prognosis for animals with ARF

A

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
Q

Chronic kidney disease

A

all stages from at risk to renal failure and uraemia
progressive and irreversible
prolonged proceed, smolders before it becomes clinically apparent
is incurable

85
Q

Causes of chronic kidney disease

A 
D - degenerative or developmental
A - auto-immune
M - metabolic (hypercalcemia)
N - neoplatic
I - infectious (pyelonephritis, lyme, leptospirosis)
T - trauma
86
Q

why is CKD progressive

A

once CKD develops, secondary processes activated that contribute to renal damage

87
Q

Clinical presenting signs of CKD

A 
PU/PD - nocturia
GI signs - vomiting, anorexia, weight loss, etc
Mental - depression, lethargy
Ocular - sudden onset blindness (rare)
skeletal - pathologic fractures (rare)
88
Q

USG of chronic kidney disease patients?

A

unable to concentrate urine
cats 1.008-1.030
dogs 1.008-1.022

89
Q

How can you tell a CKD patient has GI hemorrhage?

A

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
Q

CKD and hyperphosphatemia

A

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
Q

CKD and hypokalemia

A

reduced intake and increased potassium losses

results in neuromuscular weakness

92
Q

calcium and CKD

A

often unchanged or slightly decreased

hypercalcemia can cause renal failure or be secondary to it

93
Q

CKD and metabolic acidosis

A

due to decreased excretion of protons by the kidney

94
Q

Chronic kidney disease hematology

A

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
Q

Urinalysis in CKD

A

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
Q

Abdominal imaging in CKD

A

Rads - renal size, tissue mineralization (cats more)

US - renal size, can ID cause, FNA

97
Q

Blood pressure and CKD

A

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
Q

When Dx of CKD is suspected, what 3 things should you measure for IRIS staging?

A

Blood pressure
creatinine levels
proteinuria

99
Q

Goals of CKD management

A 
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
Q

What is proteinuria

A

protein in the urine

101
Q

Causes of proteinuria

A

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
Q

Diagnosis of proteinuria

A

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
Q

Causes of renal proteinuria

A

defective renal function
either glomerular pathology or tubular pathology

inflammation of renal parenchyma - pyelonephritis or acute tubular necrosis

104
Q

Glomerular renal proteinuria

A

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
Q

Tubular renal proteinuria

A

due to decreased tubular protein reabsorption

UPC <2.0

106
Q

Chronic renal failure as a cause of renal proteinuria

A

low level proteinuria due to adaptive changes to nephron loss
CKD can be caused by primary glomerular pathology - more significant protein losses

107
Q

Causes of Glomerulonephritis

A

dogs>cats
chronic antigenic stimulation
many cases unknown (50% idiopathic)
Genetic causes
- familial nephropathy basement membrane - Samoyeds
- alport syndrome of English cocker spaniels

108
Q

Investigating glomerulonephritis

A

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
Q

hyper coagulability and glomerulonephritis

A

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
Q

hypercholesterolemia and glomerulonephritis

A

liver senses protein loss so goes into overdrive to make more proteins and also makes more lipoproteins/cholesterol

111
Q

Clinical signs of protein losing nephropathy

A

early: no CS, loss of conditions, lethargy, anorexia
later: nephrotic syndrome, loss of third space, effusions, subcutaneous pitting edema
very late: uremic syndrome

112
Q

What IRIS stage is kidney biopsy contraindicated? When else is it contraindicated

A

IV - not enough time to biopsy, patient will die

coagulopathy - risk patient bleeding out

113
Q

what part of the kidney should you biopsy?

A

CORTEX NOT MEDULLA

114
Q

What is nephrotic syndrome

A

group of findings which include proteinuria, hypoalbuminemia, ascites, edema, hypercholesterolema
often also have systemic hypertension and hypercoagulablity

115
Q

First choice immunosuppressive agent to tx nephrotic syndrome?

A

Mycophenolate

116
Q

Treatment of PLN

A

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
Q

Diameter of feline and canine ureters?

A

feline - only 0.4mm!

canine - 1-3mm

118
Q

Acute unilateral ureteral obstruction

A

clinically silent, no azotemia

cats present w/ acute abdominal pain

119
Q

Acute bilateral ureteral obstruction

A

uncommon, bilaterally enlarged and painful kidneys, progressive azotemia, oliguria or anuria

120
Q

Big kidney Little kidney syndrome

A

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
Q

Bilateral chronic kidney disease w/ concomitant ureteral obstruction

A

common, carries most guarded prognosis bc even w/ resolution of obstruction, global renal function severely compromised

122
Q

Presenting complaint of ureteral obstruction

A

severe acute uraemia - urea + N products in urine
ureterocolic signs
syndrome prevalent in cats >7y

123
Q

Diagnosis of ureteral obstruction

A

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
Q

Managing ureteral obstruction

A

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
Q

Dx of Urethral obstruction

A

enlarged bladder, signs of urinary urgency, difficulty expressing urine

126
Q

Emergency Tx of hyperkalemia in a blocked cat

A

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
Q

Relieving urethral obstruction in cat

A

penile massage, anesthesia, cystocentesis, penis extrusion, catheterization,

128
Q

Ongoing management of blocked cat

A

indwelling Ucath placement w/ e collar

monitor urine production, analgesia, anti-spasmodics

129
Q

If owner can’t afford Tx for blocked cat

A

euthanize or no indwelling catheter, just unblock cat and give anti-spasmolytic, repeated cystocentesis
anti-spasmodics - prazosin, phenoxybenzamine, destress w/ feliway

130
Q

Urethral rupture

A

dogs HBC, cats urethral obstruction or traumatic catheterization
use positive contrast, retrograde urethrogram

131
Q

Uroabdomen

A

trauma or obstruction

Sx once stable

132
Q

Clinical signs of lower urinary tract dz

A

dysuria, stranguria, pollakiuria (bladder irritation)

133
Q

Diagnostic approach to LUTF

A

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
Q

signalment of UTIs

A

most commonly seen in female dogs

135
Q

Microbial factors associated with UTIs

A

adherence factors
enzymes (hemolysin, urease)
protective factors
resistance factors

136
Q

Microbial isolates associated with UTIs

A

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
Q

Treating an uncomplicated UTI

A

CULTURE

amoxicillin and cephalosporin, 10-14d

138
Q

Treating a complicated UTI

A

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
Q

Tx a recurrent UTI

A

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
Q

Urolithiasis

A

formation and growth of uroliths

141
Q

crystalluria

A

urine has been supersaturated

doesn’t urolithiasis

142
Q

Dx of urolithiasis

A

urinalysis, culture, rads, IS, advanced imaging

143
Q

Tx of urolithiasis

A

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
Q

Struvite crystals

A

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
Q

Calcium oxalate crystals

A

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
Q

Ammonium urate and xanthine - purine

A
  • 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
Q

Cystine Calculi

A

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
Q

Calcium/P uroliths

A

secondary to primary hyperparathyroidism

149
Q

silica uroliths

A

plant sources

150
Q

Melamine and cyanic acid

A

Chinese put into food to increase protein content but causes acute renal failure

151
Q

ethology of feline LUTD

A

idiopathic, if >10 maybe bacterial, behavioural, feline interstitial cystitis

152
Q

how many litter boxes is enough

A

one per cat plus one

153
Q

Feline idiopathic cystitis

A

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
Q

Clinical signs of feline idiopathic cystitis

A

hematuria, stranguria, pollakiuria, large firm bladder, blocked

155
Q

Diagnosis of feline idiopathic cystitis

A

Exclusion - negative culture and imaging

156
Q

Tx of feline idiopathic cystitis

A

environmental modification/enrichment

157
Q

Vaginal prolapse

A

estrogen effect - wall gets so thick it prolapses, lubricate so it involutes then perform OHE

158
Q

Neoplasia of female genital tract

A

leiomyoma, TVT

159
Q

Benign prostatic hyperplasia

A

normal aging change

CS: asymptomatic, constipation

160
Q

Acute prostatitis

A

SICK dog
Dx: UA shows evidence of UTI
all intact male dogs w/ UTI have prostatitis

161
Q

chronic prostatitis

A

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
Q

Prostatic neoplasia

A

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
Q

Neoplasia of lower urinary tract

A

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
Q

Nerves of bladder

A

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
Q

UMN bladder

A

detrusor areflexia and sphincter hyperreflexia
bladder small and hard to express
lesion above sacral segment
Tx: baclofen

166
Q

LMN bladder

A

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
Q

detrusor = sphincter reflex dyssynergia

A

phenoxybenzamine

168
Q

Dysautonomia

A

GI, heart, ANS signs

169
Q

Detrusor antony

A

from overfill, obstruction
large flaccid bladder, gets damaged from over stretching
manual expression
normal neuro exam

170
Q

Urge incontinence

A

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

171
Q

Most common ethology of urinary incontinence

A

urinary sphincter mechanism incompetence

SAM II (3 decks)

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