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Etiology & Pathophysiology of Acute Kidney Failure

Sudden decline of kidney function; rapid damage to renal parenchyma **Maintenance Phase:** CRITICAL PHASE; Oliguria / anuria + azotemia + ↑ CK + BUN

Clinical Signs of Acute Kidney Failure

Oliguria / Anuria, Vomiting, Dehydration, Hypothermia, Halitosis; uremic breath, Neuro signs, Abdominal pain

Diagnostic Test Findings for Acute Kidney Failure

**Chem:** kidney values + hyperkalemia + met acidosis,**UA:** isosthenuria + proteinuria + casts/crystals,**US:** enlarged + hypoechoic kidneys

Treatments for Acute Kidney Failure

Fluids: Isotonic crystalloids, Diuretics: Furosemide, Hyperkalemia: Calcium Gluconate, Hyperphosphatemia: Aluminum Hydroxide, Other: Dialysis (refractory), Enteral nutrition, Amlodipine

Nephrotoxins to avoid (Client Education)

NSAIDs + aminoglycosides + ethylene glycol + lilies

Conditions causing Ischemia that can lead to Acute Kidney Failure

Hypovolemic shock + dehydration + hypotension

Infectious causes of Acute Kidney Failure

Pyelonephritis + FIP + lepto

Common sequela to Acute Kidney Failure

Hypertension

Etiology & Pathophysiology of Chronic Kidney Disease (CKD)

IRREVERSIBLE; deterioration of renal function\nPUPD (polyuria/polydipsia)

Clinical Signs of Chronic Kidney Disease (CKD)

Weight loss + MM wasting\nDehydration\nVomiting\nOral ulcers\nRetinal detachment + hypertension signs\nPale MM

Diagnostic Test Findings for Chronic Kidney Disease (CKD)

Chem: ↑ kidney values + SDMA

UA: low USG (isosthenuria)

Etiology & Pathophysiology of FLUTD

Any condition affecting the lower urinary tract (bladder + urethra)\nIncludes: Urolithiasis, urethral plug, bacterial cystitis, FIC, neoplasia

Predisposing Factors for FLUTD

Stress + Obesity + Indoor living + Middle-aged (4-10 years)

Clinical Signs of FLUTD

STRANGURIA (straining to urinate)\nPollakiuria (frequent urination)\nHematuria (blood in urine)\nPeriuria (urinating outside the box)\nOvergrooming perianal area

Diagnostic Tests for FLUTD

UA + Culture (Cystocentesis)\nRadiographs (look for stones/obstruction)\nUltrasound (assess bladder wall thickness/masses)\nCBC/Chem (rule out concurrent diseases)

Treatment for FLUTD (General)

Increase water intake (canned food/water fountain), Analgesia (Buprenorphine)

Obstruction: Cath (relieve, flush, suture), IV fluids, manage hyperkalemia (Calcium gluconate)

Treatment for FLUTD (Recurrence)

Stress reduction (environmental enrichment), Nutrition (dissolution/prevention diet)

Etiology & Pathophysiology of Idiopathic Cystitis

Sterile inflammation of bladder without underlying cause\nRisks: indoor only + male + young - middle age (2-7 y/o) + multicat + previous urinary problems

Clinical Signs of Idiopathic Cystitis

Pollakiuria (frequent urination)\nStranguria (straining to urinate)\nDysuria (painful urination)\nHematuria (blood in urine)\nPeriuria (urination outside litter box)\nLicking genitals

Diagnostic Test Findings for Idiopathic Cystitis

UA: hematuria + proteinuria +/- crystalluria

Culture: rule out cystitis (NO BACTERIAL GROWTH)\nUS: thickening of bladder wall

Cystoscopy: petechial hemorrhage of wall\nDIAGNOSIS OF EXCLUSION

Treatment for Idiopathic Cystitis

Acute episode resolve spontaneously\nReduce stress (environmental enrichment)\nMultiple litter boxes\nCanned food (increase water intake)\nAnalgesics: Buprenorphine + Gabapentin\nAntispasmodics: Prazosin + Phenoxybenzamine\nAnti-Anxiety: Amitriptyline + Fluoxetine

Client Education & Prevention for Idiopathic Cystitis

Recurrence common, Resolves in 3-7 days

Etiology & Pathophysiology of Urolithiasis

Presence of calculi (stones) in the urinary tract

Often accompanied by: FIC, UTI, metabolic problems, nutrition

Clinical Signs of Urolithiasis

STRANGURIA (straining to urinate)\nHematuria (blood in urine), Pallakiuria (frequent urination), Inappetence, Vomiting

Diagnostic Tests for Urolithiasis

UA (crystalluria)\nRadiographs: Struvite (radiopaque) + Oxalate (radiopaque)\nUS: assess size + location

Two Main Types of Urinary Stones in Cats

Struvite (Magnesium Ammonium Phosphate) and Calcium Oxalate

Struvite Urolithiasis

pH: Alkaline

Etiology: secondary to UTI (uncommon in cats)

Treatment: Dietary dissolution (low protein + low minerals + acidification)

Prevention: Diet

Calcium Oxalate Urolithiasis

pH: Acidic\nEtiology: metabolic\nTreatment: Surgical removal (cystotomy) or Retrograde Urohydropulsion (small stones)\nPrevention: Diet

Etiology & Pathophysiology of Urethral Obstruction

Partial or complete blockage of the urethra; most common in male cats\nCommonly caused by: Urethral plugs + Urolithiasis + Strictures + Neoplasia

Clinical Signs of Urethral Obstruction

STRANGURIA (straining to urinate) with NO urine production\nLethargy + Vomiting\nPainful on abdominal palpation (distended bladder)\nCollapse\nHypothermia

Diagnostic Tests for Urethral Obstruction

Chem: Hyperkalemia (critical) + Azotemia + Metabolic Acidosis\nUA + Culture: Rule out UTI\nRadiographs: Uroliths\nUS: Bladder + kidney assessment

Initial Treatment for Urethral Obstruction

De-obstruct: Urethral cath (relieve obstruction) + Flush bladder

Correct Metabolic Derangements: IV fluids (Isotonic crystalloids) + Hyperkalemia (Calcium Gluconate)

Analgesia: Buprenorphine

Post-Obstruction Treatment for Urethral Obstruction

Manage post-obstructive diuresis (IV fluids)\nPrevention: Diet + Stress reduction + Water

Complications of Urethral Obstruction

Recurrence, Post-obstructive diuresis, Bladder rupture

Etiology & Pathophysiology of Pyelonephritis

Bacterial infection of the kidney (renal pelvis + parenchyma)\nAscending infection: Bacteria from lower urinary tract migrate up the ureters\nPredisposing factors: CKD, Ureteroliths

Clinical Signs of Pyelonephritis

FEVER\nPU/PD (Polyuria/Polydipsia)\nAnorexia + Lethargy\nAbdominal/Renal pain (painful kidneys)\nVomiting

Diagnostic Tests for Pyelonephritis

Chem: ↑ Kidney values\nUA: Pyuria (WBCs) + Bacteriuria + Proteinuria

Definitive Dx: Positive BACTERIAL CULTURE from a CYSTOCENTESIS sample

US: Dilated renal pelvis/ureters + Renomegaly

Treatment for Pyelonephritis

Antibiotics: start IV broad-spectrum, then switch to oral based on culture/sensitivity and Fluids (IV)

Client Education for Pyelonephritis

Need: Long course of ABX (4-6 weeks)\nMonitor: Kidney values + repeat US

Etiology & Pathophysiology of Hepatic Lipidosis

Acute, severe liver failure

Triggers: Anorexia, stress, underlying disease, Excessive mobilization of fat to the liver

Clinical Signs of Hepatic Lipidosis

Anorexia (History of fast for > 2-3 days)\nObesity (often)\nJaundice/Icterus (yellow discoloration)\nVomiting\nLethargy

Diagnostic Test Findings for Hepatic Lipidosis

Chem: ↑ ALP (markedly) + ↑ Bilirubin (high) + Normal or slightly ↑ ALT/AST\nCBC: Anemia (Non-regenerative)

Coag: ↑ PT/APTT\

US: Diffusely HYPERECHOIC liver (bright)

Definitive Dx: Cytology/Histopathology (fine needle aspirate)

Treatment for Hepatic Lipidosis

Critical: Aggressive NUTRITIONAL SUPPORT (e.g., E-tube, J-tube)\nFluids + Electrolytes\nAppetite stimulants: Mirtazapine\nAnti-emetics: Maropitant\nVitamin K (for coagulopathy)\nDenamarin/SAMe (Liver support)

Client Education for Hepatic Lipidosis

Mortality: High

Long-term: Address underlying disease

Etiology & Pathophysiology of IBD

Chronic GI signs due to mucosal inflammation\nImmune-mediated response to dietary or bacterial antigens

Clinical Signs of IBD

CHRONIC VOMITING (MC sign for cats), Diarrhea (small or large bowel), Weight loss, Inappetence, Thickened bowel loops on palpation

Diagnostic Test Findings for IBD

CBC/Chem: Rule out concurrent disease

Fecal: Rule out parasites

B12/Folate: low (B12) if small intestine affected; high (Folate) if small intestine affected

US: Thickened intestinal walls

Definitive Dx: ENDOSCOPIC BIOPSY (shows inflammation)

Treatment for IBD

Diet: Hypoallergenic (novel protein or hydrolyzed protein) or highly digestible\nImmunosuppressives: Prednisolone (steroid)\nOther: Metronidazole (antibiotic/anti-inflammatory), B12 injections (if low), Fiber (if large bowel/colitis)

Client Education & Prognosis for IBD

Requires chronic management\nIf steroid-resistant, try Chlorambucil

Definition of Triaditis

Simultaneous inflammation of the: Pancreas (Pancreatitis) + Liver (Cholangitis/Cholangiohepatitis) + Intestine (Inflammatory Bowel Disease/IBD)

Etiology & Pathophysiology of Triaditis

Inflammation in the intestine (IBD) allows bacteria to migrate up the short pancreatic and bile ducts, leading to inflammation in the liver and pancreas

Clinical Signs of Triaditis

Anorexia + Lethargy, Vomiting, Weight loss + Muscle wasting, Jaundice/Icterus

Diagnostic Test Findings for Triaditis

Chem: ↑ ALP + Bilirubin (Cholangitis); ↑ ALT/AST\nPancreas: ↑ fPLI (Feline Pancreatic Lipase Immunoreactivity)\nDefinitive Dx: Biopsies of all three organs (Intestine, Liver, Pancreas)

Treatment for Triaditis

Fluids (IV), Nutrition (Tube feeding if anorexic)

Immunosuppression: Prednisolone

Antibiotics: Metronidazole + Amoxicillin (due to ascending infection)

Other: Anti-emetics (Maropitant) + B12 (if low)

Client Education & Prognosis for Triaditis

Complex, requires long-term management\nGuarded prognosis

Etiology & Pathophysiology of Pancreatitis

Inflammation of the pancreas (often self-digestion)

Etiology: Often idiopathic (unknown) in cats; can be trauma, infectious, hypercalcemia

Clinical Signs of Pancreatitis

ANOREXIA + Lethargy (most common), Hypothermia (not always present), Vomiting (less common than in dogs), Abdominal pain (often subtle)

Diagnostic Test Findings for Pancreatitis

Chem: ↑ ALT/AST; Hypocalcemia; Hyperglycemia

Specific Test: ↑ fPLI (Feline Pancreatic Lipase Immunoreactivity)

US: Hypoechoic pancreas + peripancreatic fluid

Definitive Dx: Histopathology (biopsy)

Treatment for Pancreatitis

Fluid therapy (IV), Analgesia: Buprenorphine, Anti-emetics: Maropitant, Nutrition: Aggressive NUTRITIONAL SUPPORT (e.g., tube feeding)

Client Education & Prognosis for Pancreatitis

Prognosis: Guarded (can be severe)\nLong-term: May require pancreatic enzyme supplementation (EPI) or insulin (DM)

Etiology & Pathophysiology of Diabetes Mellitus

Insulin deficiency or resistance → Persistent hyperglycemia\nType 2 DM (Insulin Resistance) is the most common form in cats

Predisposing Factors for Diabetes Mellitus

Obesity + Old age + Pancreatitis + Glucocorticoid use

Clinical Signs of Diabetes Mellitus

PUPD (Polyuria/Polydipsia)\nPolyphagia (Increased appetite) with Weight loss\nPlantigrade stance (walking on hocks) due to diabetic neuropathy\nLethargy

Diagnostic Test Findings for Diabetes Mellitus

Chem: Hyperglycemia + Hypercholesterolemia + ↑ ALP/ALT\nUA: Glucosuria (glucose in urine) + Ketonuria\nDefinitive Dx: Persistent hyperglycemia in blood + glucosuria in urine\nConfirming Dx: Fructosamine (gives 2-3 week average)

Treatment for Diabetes Mellitus

Insulin Therapy: Long-acting insulin (Glargine or PZI), Diet: High protein + Low carbohydrate (to mimic prey), Weight management

Client Education & Prevention for Diabetes Mellitus

Need for chronic management\nAim for diabetic remission (possible in cats)

Etiology & Pathophysiology of DKA

LIFE-THREATENING form of uncontrolled Diabetes Mellitus\nAbsolute insulin deficiency → body breaks down fat for energy → accumulation of ketones

Clinical Signs of DKA

Severe depression + Weakness\nAnorexia + Vomiting\nSevere dehydration\nFruity breath (acetone)\nProfound shock

Diagnostic Test Findings for DKA

Chem: Hyperglycemia + Acidosis (metabolic)\nUA: Glucosuria + Ketonuria (CRITICAL)\nBlood Gas: ↓ pH + ↓ Bicarb\nDx Criteria: Hyperglycemia + Acidosis + Ketones

Treatment for DKA (Initial/Critical)

Fluids: IV fluids (0.9% NaCl)\nInsulin: Regular (short-acting) insulin (CRI or IM)\nElectrolytes: Potassium (often low) + Phosphorus (often low)

Treatment for DKA (Ongoing)

Treat underlying disease (e.g., Pancreatitis, UTI)\nTransition to long-acting insulin after stabilization

Client Education & Prognosis for DKA

CRITICAL emergency; requires 24/7 care\nGuarded prognosis

Etiology & Pathophysiology of Hyperthyroidism

Overproduction of thyroid hormone (T4)\nUsually due to a benign adenoma of the thyroid gland\n↑ Metabolism + Tachycardia + Hypertension

Clinical Signs of Hyperthyroidism

WEIGHT LOSS (despite polyphagia), Polyphagia (Increased appetite), PUPD (Polyuria/Polydipsia), Tachycardia + Heart murmur + Gallop rhythm, Hyperactivity/Restlessness

Diagnostic Test Findings for Hyperthyroidism

Chem: ↑ ALP + ALT (mild)\nDefinitive Dx: ↑ Total T4 (Thyroxine)\nConfirmatory (If T4 equivocal): Free T4 or T3 Suppression Test

Treatment Options for Hyperthyroidism

1. Medical: Methimazole (inhibits T4 production)\n2. Surgical: Thyroidectomy (requires monitoring for hypocalcemia)\n3. Radioactive Iodine (I-131): Cure; preferred for stable patients\n4. Dietary: Iodine-restricted diet

Complications of Hyperthyroidism

Hypertension, Secondary Heart Disease (Hypertrophic Cardiomyopathy), CKD (may be unmasked after treatment)

Etiology & Pathophysiology of Cataracts

Opacities of lens → impeded transmission of light in retina

Clinical Signs of Cataracts

Cloudy/white appearance of lens\nDecreased vision / blindness\nAbsent PLR

Diagnostic Tests for Cataracts

Ophthalmic exam, US

Treatment for Cataracts

Surgical removal; Phacoemulsification - Treatment Of Choice

Etiology & Pathophysiology of Conjunctivitis

Inflammation of conjunctiva and inner surface of eyelids\nMost common: HEPERS VIRUS 1 + CHLAMYDIA + Mycoplasma\nOther causes: Allergies + irritants + immune mediated

Clinical Signs of Conjunctivitis

Hyperemia, Chemosis, Ocular discharge, Blepharospasm

Diagnostic Tests for Conjunctivitis

Ophthalmic Exam\nStaining (rule out ulcers)\nCytology\nPCR (Herpes + Chlamydia + Mycoplasma)

Treatment for Conjunctivitis

Topical Antivirals (Idoxuridine + Cidofovir)\nTopical Abx (Tetracycline + Chloramphenicol + Doxycycline)\nSystemic Antivirals (Famciclovir; for severe herpes)

Notes on Conjunctivitis

Mostly kittens; immature immune system\nSee intracytoplasmic inclusion bodies with chlamydia

Etiology & Pathophysiology of Corneal Ulcers

Corneal epithelium is damaged → exposes stroma\nCauses: Trauma + infection + chemical irritation\nHERPES 1; causes dendritic ulcers

Clinical Signs of Corneal Ulcers

Blepharospasm\nEpiphora\nCorneal opacity\nPhotophobia\nVisible ulcer

Diagnostic Tests for Corneal Ulcers

Staining\nOphthalmic exam\nCulture

Treatment for Corneal Ulcers

Topical abx (Ciprofloxacin + Tobramycin)\nTopical / Systemic Antivirals\nAtropine\nE-Collar\nSurgical (Conjunctival graft; for non-healing ulcers)

Etiology of Feline Herpes Keratitis

Herpes 1

Clinical Signs of Feline Herpes Keratitis

Dendritic ulcers + conjunctivitis + corneal inflammation

Treatment for Feline Herpes Keratitis

Idoxuridine + Trifluride + Cidofovir\nFamciclovir\nOxytetracycline (prevent bacterial infection)

Etiology of Corneal Sequestrum

BRACHYCEPHALICS\nNecrosis of corneal stroma in dark pigmented cornea\nChronic irritation to cornea → necrosis

Treatment for Corneal Sequestrum

Keratectomy\nConjunctival/Corneal Graft\nChloramphenicol (post op)\nNSAIDs + opioids

Etiology of Feline Eosinophilic Keratitis

Immune-Mediated (IM)

Clinical Signs of Feline Eosinophilic Keratitis

Raised white/pink corneal plaques

Diagnosis of Feline Eosinophilic Keratitis

Cytology (shows eosinophils)

Treatment for Feline Eosinophilic Keratitis

Prednisolone Acetate + Dexamethasone\nCyclosporine + Tacrolimus

Etiology & Pathophysiology of Bullous Keratopathy

Endothelial dysfunction → fluid accumulation in cornea → corneal edema + bullae (blisters)

Secondary to trauma + surgery