Feline Urinary ICVA Diseases

Acute Kidney Injury: C.S

Oliguria/Anuria

Lethargy + Depression

Vomit

Anorexia

Dehydration

Hypothermia

Uremic Breath

Neuro Signs

Abdominal Pain

Acute Kidney Injury: D.X

Bloodwork: Azotemia, Hyperkalemia, Met. Acidosis, hyperphosphatemia

Urinalysis: Isosthenuria, Proteinuria, Urine sediment

Imaging

Urine culture

Blood pressure

Acute Kidney Injury: T.X

Fluid therapy

Lyte Management: For hyperkalemia=calcium gluconate,insulin dextrose, bicarb( if acidosis) and Phosphate binder: Aluminum hydroxide

Dialysis: refractory or referral cases

Nutritional Support: Enteral Food

Treat underlying causes

Management of anti hypertension

Chronic Kidney Disease: C.S

PU/PD

Weight loss + Muscle wasting

Dehydration

Vomit + Anorexia

Oral ulcers + Uremic breath

Hypertension

Pale MM

Chronic Kidney Disease: D.X

Chem: Azotemia

SDMA: more sensitive than creatinine, detect 25% nephron damage

U/A: Low urine specific gravity, UPC( glomerular damage)

CBC: Normocytic Normochromic non-regen anemia

Blood Pressure: Hypertension

Imaging: Small irregular, hyperechoic

Chronic Kidney Disease: T.X

Dietary Management: Low phosphate, restrict protein(only high quality) Omega 3, hydration

Control of hypertension: Amlodipine

Phosphate Binder:Aluminum hydroxide,lanthanium carbonate

Manage protein: ACE or ARBs (benazepril or telmisartan)

Manage G.I: Antiemetics, appetite stimulants

Tx of secondary hyperparathyroidism: Calcitriol

Feline Lower Urinary tract Disease: C.S

Dysuria

Pollakiuria

Hematuria

Periuria: urinate outside litterbox

Vocalization

Licking genital area

Feline Lower Urinary tract Disease: D.X

Exam: Palpate bladder, observe straining

BW: Post-renal azotemia + hyperkalemic if obstructed

U/A: USG, hematuria, crystalluria, pH of urine, Bacteria + WBC

Urine culture

Imaging

Feline Lower Urinary tract Disease: T.X

Urethral obstruction: Cauterization, Fluids, Hyperkalemia management post care

Urolithiasis: Dietary dissolution (struvites), sx(calcium oxalate)

Bacteria Cystitis: ABX

Neoplasia: SX or chemo

Idiopathic Cystitis: C.S

Pollakiuria

Stranguria

Dysuria

Hematuria

Periuria

Behavioral

Licking of genital area

Idiopathic Cystitis: D.X

U/A: Hematuria, +/- proteinuria, NO BACTERIAL INFECT

Urine Culture: to rule out bacterial cystitis

Imaging: rule out uroliths, see thickening of bladder wall

Idiopathic Cystitis: T.X

Enrichment, reduce stress, wetfood, nsaids, antispasmodics

If refractory: Antidepressants

Kidney Lymphoma: C.S

PU/PD: tubular dysfunction

Weight loss

Lethargy + Anorexia

Vomit + Diarrhea: due to uremia or metastasis

Abdominal distenion

Hypertension

Peripheral Edema/ Ascites

Peripheral Lymphadenopathy: if systemic

Kidney Lymphoma: D.X

CBC: Anemia of chronic dz, neutropenia, thrombocytopenia etc

CHEM: Azotemia, Hypercalcemia of malignancy

U/A: Proteinuria, +/- low USG

U/S: Bilateral renal enlargement, mottled/hypoechoic appearance in parenchyma

FNA/Biopsy: Monomorphic population of large lymphocytes

Bone marrow aspiration

Kidney Lymphoma: T.X

CHOP 6-8wks

L'asparginase + Lomustine (CCNU) as adjuncts or in cases of resistance

Supportive therapy

Prognosis: poor, 2-6 month w/tx

Polycystic Kidney Disease: C.S

PU/PD

Vomit

Weight loss

Lethargy + weakness

Anorexia + Dehydration

Hypertension

Palpable renal enlargement with masses on kidney

Polycystic Kidney Disease: D.X

U/S*: Detect anechoic cysts

Genetic testing: PKD1 mutation

CBC/Chem: Non-regen anemia, azotemia, hyperphosphatemia, hypokalemia

U/A: Isosthenuria, Proteinuria,Pyuria or bacteriuria

Blood pressure

Polycystic Kidney Disease: T.X

No cure for PKD just management

Dietary modification: decrease protein, phosphorus,sodium

Fluid therapy + Phosphate binders

ACE inhibitors

Antihypertensives

Potassium supplementation

Monitoring + supportive care

Pyelonephrits: C.S

Acute: fever,lethargy,anorexia,vomit,PU/PD, abdominal pain

Chronic: weight loss, recurrent UTI, renal insufficiency

Unusual urination

Pyelonephritis: D.X

CBC/CHEM: Leukocytosis, Azotemia

U/A: Pyuria, bacteriuria, hematuria, proteinuria

Urine culture

U/S: Kidney enlargement, ^ echogenicity

Pyelonephritis: T.X

Aggressive antibiotics therapy based on culture

Initial broad-spectrum abx: fluoroquinolones, cephalosporins

Supportive care

Transitional Cell Carcinoma: C.S

Hematuria

Dysuria

Pollakiuria

Urinary incontinence

Systemic signs

Transitional Cell Carcinoma: D.X

U/S + urine culture: hematuria + pyuria, BRAF mutation test

Imaging

Biopsy

Transitional Cell Carcinoma: T.X

Surgical resection

Chemo: Mitoxantrone + Carboplatin, Piroxicam, combination therapy

Radiation therapy

Palliative Care: Urethral stenting or urinary diversion, pain management

Urinary tract Obstruction: C.S

Straining

Pollakiuria

Painful vocalization

Hematuria

Licking genital area

Distended, firm bladder

Urinary tract Obstruction: D.X

Palpation of a distended bladder

U/A: Hematuria,crystalluria,pH

Rads or U/S

Blood test: Hyperkalemia etc

ECG

Urinary tract Obstruction: T.X

Stabilize: IV fluids

Urethral catheterization

SX: perineal uresthestomy: refractory

Flush bladder

Pain+anti-inflammatory meds

ABX if infection

Urolithiasis: T.X