UTIs & Stones (Marin)

Question 1

who are the only ones who are “allowed” to get UTIs

Answer 1

female dogs

Question 2

what is the most common agent in UTIs?

Answer 2

E coli or staph

Question 3

clinical signs of a UTI include

Answer 3

hematuria, stranguira, pollakiuria, dysuria, urge incontinence, stinky urine, cloudy urine

if pyelonephritis, will have systemic signs like fever

Question 4

if you have an active sediment +/- bacteria AND you have clinical signs of a UTI, then…

Answer 4

you likely have a UTI

Question 5

if you have a recurrent/complicated UTI, the two categories of why this happens are…

Answer 5

relapse/persistent/refractory: the same organism is causing the infection and something is causing that bacteria to stick around (hooded vulva, wrong antibiotic, compliance issue, etc)

reinfection: a new organism is causing signs likely due to a suppressed immune system (cushings, CKD, diabetes, prednisone use, obesity, neoplasia, etc)

Question 6

Princess Barkarella the 5yo FS dog comes to you with hematuria, stranguria, and seemingly needing to pee way more often per the owner. You do a urinalysis and find active sediment. the dog has never had a UTI before. what antibiotic do you want to prescribe? which ones should you avoid?

Answer 6

amoxicillin or TMS for 2-5 days

DO NOT USE: fluoroquinolones, 3rd gen cephalosprins, cefovecin

Question 7

when is generally the most appropriate time to culture the urine?

Answer 7

you dont need to culture if it seems to be a sporadic cystitis in a female dog, but for recurrent bacterial cystitis, then you need a culture FO SHO

Question 8

Princess Barkarella the 5yo FS dog was sent home with amoxicillin for 5 days, but she comes back with what seems like recurrent cystitis. besides a urine culture, what should you screen her for?

Answer 8

endocrinopathies, CKD, pyelonephritis, uroliths, abnormal vulvar conformation, neoplasia

Question 9

a recessed or hooded vulva can be responsible for

Answer 9

recurrent cystitis/UTIs

Question 10

what is the proper way to treat recurrent/complicated UTIs, either from chronic disease like cushings or from pyelonpehritis, etc?

Answer 10

4-6 weeks of the proper antibiotic based on culture, and a recheck culture 1 week after to make sure negative, then 3-5 days at the end of treatment

Question 11

why do we need to repeat urine cultures when treating recurrent/complicated cystitis?

Answer 11

because we don’t want the animal on an antibiotic that doesn’t work! this would just be wasteful and could cause resistance

Question 12

Wiggles McSlobberpants seems to have recurrent cystitis and you decide to do a urine culture. The report comes back as E coli and enterococcus. whats the deal with enterococcus?

Answer 12

it’s usually a contaminant and not a true pathogen, especially when it’s one of two bacteria that was cultured.

Question 13

you have a female dog named Captain Snifflebutt with clinical signs of a UTI and no stones but the culture is coming back negative. do you believe it?

Answer 13

heck no, cultures are not 100% sensitive! treat her anyway you dinkus

Question 14

Wiggles McSlobberpants has recurrent cystitis so you send her home with an antibiotic based on culture results. how should you monitor her after treatment is completed?

Answer 14

once the treatment is completed, do a recheck urinalysis every 3 months (this is approximate and can change depending on the case)

Question 15

the two types of urinary stones most common in dogs and cats are

Answer 15

struvite and calcium oxalate

Question 16

how do crystalluria and urolith differ?

Answer 16

crystalluria simply means crystals in the urine and it can sometimes be harmless and not clinically relevant

urolith=one or more crystallized minerals + organic matrix. Nidus is the nucelus, and then they have a shell.

Question 17

male dogs like to get which stones?
female dogs like to get which stones?
who likes to get urate stones?

Answer 17

male dogs: oxalate>struvite
female dogs: struvite>oxalate, can be associated with UTIs

dalmations and bulldogs: urates

Question 18

male cats like to get which stones?
female cats like to get which stones?

which cats like to get urates?

Answer 18

male cats: more calcium oxalates
female cats: 50/50, but struvite stones usually sterile

siamese: urates

Question 19

Meowington von Purrface comes in with hematuria, stranguria, and some urinary incontinence. On PE she has a thickened bladder wall. Her CBC is normal and her chem panel is also normal. her UA shoes an INACTIVE sediment. what do you suspect? what diagnostics would you like to perform?

Answer 19

uroliths

either abdominal rads (the best choice) or ultrasound

Question 20

list some characteristics of calcium oxalate, struvite, and urate stones to help you differentiate which is which (by the way you are an absolute queen and I love you so much)

Answer 20

calicum oxalate: rough, rosette/star shaped, and opaque on rads

struvite: smooth, round, a little bit opaque on rads

urate: smooth, round, more radiolucent on rads

Question 21

what is the connection between struvite cyrstals and urase producing bacteria in DOGS?

Answer 21

for most stones when you do a urine culture, it comes back negative, but for struvite it comes back positive for urase producing bacteria, such as: staph, proteus, enterococcus. (this is for dogs). For these bacteria to grow there has to be an increase in pH.

Question 22

for struvite crystals in cats, what is special about them?

Answer 22

they are not infection related and are usually associated with sterile urine. it can be due to diets high in certain minerals and protein. they can also be normal in the urine IF the urine is concentrated and there’s few of them.

Question 23

risk factors for struvite crystals in female dogs is

Answer 23

UTIs

Question 24

struvite uroliths should me medically dissolved in dogs and cats UNLESS:

Answer 24

• medications or dissolution foods can’t be administered or are contraindicated
• the urolith cannot be adequately bathed in modified urine from the diet OR
• there is an ucontrollable infection

Question 25

Miss Poops-a-Lot is a dog that has been diagnosed with struvite uroliths. Her infection seems to be controlled for now. How will you treat her?

Answer 25

• urinary management diet for dissolution
• antibitoics the ENTIRE TIME (because as stone dissolves it releases bacteria into the matrix)

stone will take 2-6 weeks to resolve

recheck rads and culture every 2 ish weeks until you see the stones have dissolved

continute the diet and antibiotics for 2 weeks after rads show that the stone is fully dissolved

Question 26

a female cat named Lady Toot has been diagnosed with struvite crystals. How will you treat her?

Answer 26

dissolution urinary diets, and have the cat stay on this long term because they are good at prevention

NO ANTIBIOTICS are needed because in cats these are sterile

increase water consumption–>dont forget about FLUTD!

Question 27

why might your treatment of a UTI or stone fail?

Answer 27

you had the incorrect diagnosis, the UTI was not treated, lack of diet intake, and predisposing causes

Question 28

who is predisposed to getting calcium oxalate stones?

Answer 28

small breed male dogs, older dogs

Question 29

true or false: calcum oxalate stones rarely reoccur

Answer 29

FAKE NEWS B*TCH THEY REOCCUR ALL THE TIME

Question 30

a 8yo MN shitzu named GayBoi comes to you with stranguria. Based on his signlament, you suspect _____ and want to do ______ for diagnostics and you want to offer _______ for treatment.

Answer 30

calcium oxalate stones

UA: urine might be acidic and you might be able to see some of the crystals
Culture: sometimes a secondary UTI is present

rads: very opaque so will see them

treatment: cystotomy, or other minimally invasive techniques if there’s few stones

Question 31

GayBoi’s owner wants to know how they could have prevented his calcium oxalate stones. you say

Answer 31

urinary management diet FOR LIFE, and frequent rechecks/imaging every 3-6 months FOR LIFE

they WILL come back and prevention is very important

Question 32

Gayboi’s owner says they have another dog at home that is Gayboi’s brother and he is only 2 years old. He is also a shitzu.The owner asks, should I start him on a urinary diet too?? You say…. (remember Gayboi has calcium oxalate crystals)

Answer 32

I would put the 2yo brother on a urinary diet and start screening him at age 5 with urinalysis and imaging. I would also suggest the owners get pet insurance…cuz…yikes

Question 33

calcium oxalate cystoliths associated with or without clinical should should be removed by

Answer 33

minimally invasive procedures where possible (avoid urethrea surgery)

Question 34

should you send stones for analysis

Answer 34

yes beech what did you think the right answer was…geez

Question 35

what exactly is a “minimally invasive procedure” for calcium oxalate stones?

Answer 35

finger up the bung hole with a U cath thing

voiding hydropulsion: fill the bladder up, swish it around, and then squeeze the bladder so it all comes out, hopefully the stones come with it

Question 36

true or false: urate crystalluria is never normal

Answer 36

so tru bestie

Question 37

which stone type can be associated with signs of hepatic encephalopathy/portosystemic shunt?

Answer 37

urate

Question 38

in dalmations or bulldogs that do not have PSS and have urate stones, what is the treatment?

Answer 38

surgery/hydropulsion/laster blast

urinary diet

allopurinol: a xanthine oxidase inhibitor