Renal and Urinary Tract Disease

What is dysuria?

Abnormal or difficult urination

What is pollakiuria?

Frequent urination but small volume

What is polyuria?

Increase amount of urination

What is stranguria?

Difficulty/straining in urination

What is oliguria?

Decreased urine production

What is anuria?

Total lack of urine production

What is a non-urinary cause of pollakiuria?

Colic

What are your ddx for polyuria?

Renal failure

Psychogenic water drinker, hot weather, eating the salt block, endocrine like hyperglycemia or diabetes insipidous

What is on clin path for renal dz?

Azotemia (increase in BUN and creatinine)

USG: pre-renal failure >1.035

Acute renal failure <1.020

Why can equine urine be cloud?

Normal from mucus or crystals

Especially if concentrated

What can cause hyperglycemia and glucocuria?

Disease (PPID or shock)

Drugs like alpha 2 agonist, steroids

What usually causes hematuria?

Lower urinary disease

How do you identify hemoglobinuria?

No intact RBC on urine sediment exam

Intravascular hemolysis present (pink plasma and anemic)

How do you identify myoglobinuria?

No intact RBC on UA

No anemia and plasma is yellow

High muscle enzymes

What can cause casts?

Infection, inflammation, toxin

Why do you need to examine for casts soon?

Unstable in alkaline urine

What are C/S of AKI?

Anorexia, depression, dehydration

PU/PD

Azotemia with low Na, Cl, and Ca2+

Rank toxicity of aminoglycosides?

Neomycin

Gentamycin

Amikacin

What is aminoglycoside toxicity related to?

Trough concentration of the drugs

How do aminoglycosides cause toxicity?

Accumulate in tubular cells, once a day dosing is used to reduce accumulation

When do you use high dose oxytet?

Contracted tendons in foals

What does NSAID toxicity cause?

Medullary crest necrosis

Papillary crest necrosis

How does NSAID toxicity work?

Decrease renal blood role by inhibiting prostaglandins

What is a specific cox-2 like firocoxib not better for kidneys?

Cox-2 does housekeeping in the kidney

It is safe for GIT though

What does ischemia to the kidney cause?

Initially pre-renal azotemia with dehydration, endotoxemia, shock but leads to renal azotemia

How do you treat AKI?

Induce a diuresis with 1-2x maintenance fluid therapy

How do you assess concerns of overhydration?

Are shavings wet, weigh animal daily, C/S like chemosis and edema, central venous pressures

What should you do if an animal is not making urine?

Furosemide, mannitol, but poor prognosis

What are signs of chronic renal failure?

Chronic, severe weight loss, lethargy, anorexia, PU/PD, ventral edema, oral ulcers/dental tartar

What is the #1 cause of chronic renal failure?

Idioapthic

How does glomerulonephritis cause chronic renal failure?

Loss of albumin via glomerulus due to type 3 hypersensitivity reaction blocking the glomerulus

How do you treat chronic renal failure?

Water, low Ca diet (avoid alfalfa), IV fluids, supportive care

Poor prognosis

What is in the LUT?

Bladder

Ureter

Urethra

What are the C/S of LUT?

Dysuria

Stranguria

Pollakiuria

Urine dribbling

Urine scalding

Smells bad

What causes cystitis?

Usually secondary from cystic calculi, canthardin, sorghum, or urinary incontinence

Often have a 2nd bacterial infection

What are signs of a cystitis?

Pyuria and hematuria with bacteria

Describe creatinine

Freely filtered by glomerulus and inverselt proportional to GFR

Will have a larger change with chronic renal disease

Where can BUN come from?

Dietary protein, liver, less specific indicator for AKI

How do you get urine in horses?

Free catch

Catheterization (need sedation with alpha-2s)

T/F cystocentesis are used in horses?

False

What is normal on urine test strips?

Alkaline pH

False + protein

Proteinuria greater than 1 can indicate glomerular disease and pyuria

What can you see on a sediment exam?

RBC, WBC

Bacteria

Casts (renal disease)

What is on microscopic evaluation of horse urine?

Crystals are normal

A few bacteria are normal (usually free catch)

What can a rectal palpation and ultrasound be good for?

Bladder size

Stone

Mass

Palpate caudal pole of left kidney (no right)

How do you know if there is a pre-renal azotemia?

Resolved after rehydration

How do you identify a renal azotemia?

Azotemia present after rehydration

What are causes of AKI?

Drugs, pigments (hemo or myoglobin), prolonged decreased renal blood flow, bacteria (rare)

What pigments cause nephropathy?

Myo and hemoglobin

When combined with dehydration, will cause renal disease

how do you treat AKI?

IV fluids to correct dehydration and electrolytes

Need to keep up with losses

What is on clin path for CKD?

Azotemia (higher the Cr the worse prognosis)

Isosthenuria

Weight loss

Hyponatremia, hypochloremia, hyperkalemia

Hypoalbuminemia

Anemia

What is unique on clin path for horses with CKD?

They are hypercalcemia and hypophosphatemia

Other animals are flipped

What is the prognosis of CKD?

Poor

How do you diagnose cystitis?

Quantitative culture

Follow up with sensitivity

What are signs of lower motor bladder?

Paralytic

Atonic

What can cause an upper motor bladder?

Spinal cord disease

West Nile

What is a myogenic urinary incontinence?

Not neurogenic secondary to prolonged obstruction and accumulation of sabulous sediment

How do you treat sabulous urolithiasis?

Temporary PU

NSAID

Antibiotics

Bethanecol

What are signs of urolithiasis?

Hematuria, stranguria, pollakiuria

What is the signalment for urolithiasis?

Middle to aged hroses

How do you diagnose urolithiasis?

Rectal palpation

US

Endoscopy