Kidney Flashcards Based on Written 6-8

What are predisposing factors for upper urinary tract infections (pyelonephritis)?

Structural or functional abnormalities

Compromise of innate defense mechanisms

Immune compromise from comorbidities

What are the most common etiologic agents for pyelonephritis?

Proteus

Staph

Enterococcus

E. coli

What is on history for pyelonephritis?

Fever, PU/PD, anorexia, abdominal pain, vomiting or diarrhea

Concurrent urinary tract disease signs like pollakiuria, stranguria, hematuria, and periuria

What is on physical exam for pyelonephritis?

Fever, dehydration, cranial abdominal pain, renomegaly

What is on CBC with leptospirosis infection?

Thgrombocytopenia

What is on chem of pyelonephritis?

Azotemia or increase in creatinine by >0.3 mg/dL above baseline value

What is on urinalysis of pyelonephritis?

Isosthenuria

What is on imaging for pyelonephritis?

Pyelectasia

When is blood a good sample for pyelonephritis culture?

If patient is immune compromised or febrile

Where should urine be taken for culture if suspected pyelonephritis?

Renal pelvis and bladder via centesis

What are the parts of pyelonephritis treatment?

Manage AKI

Treat inciting cause

How do you do a antimicrobial susceptibility for pyelonephritis?

Breakpoints for serum and indicate pyelonephritis is suspected when submitting

What is a good first drug choice for pyelonephritis?

Fluoroquinolones or cefpodoxime

When should there be improvement when giving antibiotics for pyelonephritis?

Within 72 hours

How long do you treat pyelonephritis for?

10-14 days

What should be done on follow-up for pyelonephritis?

Physical exam, creatinine levels, urinalysis and culture 1-2 weeks after stopping antimicrobials

What are the classifications of urinary tract infections?

Sporadic

Recurrent

Subclinical bacteriuria

What is the occurrence of sporadic bacterial cystitis?

Common in dogs, but rare in intact males (look at prostate instead)

How do you diagnose sporadic bacterial cystitis?

C/S of pollakiuria, stranguria, hematuria, and periuria

Urinalysis with pyuria, bacteriuria, and hematuria

Positive culture results

How do you treat sporadic bacterial cystitis?

NSAIDs for a few days before trying antibiotics if C/S do not improve

Always wait for culture before treating cats because it is so rare

What is a good first drug choice for sporadic bacterial cystitis?

Amoxi/clav

How long should it take for improvement of C/S after treating sporadic bacterial cystitis?

Within 48 hours

What is recurrent bacterial cystitis?

>3 episodes of clinical cystitis in previous year or >2 in past 6 months

What are the underlying causes of recurrent bacterial cystitis?

Endocrinopathy, CKD, obesity, anatomical conformation abnormalities, congenital abnormalities (ectopic ureters), prostatic disease, urolithiasis, voiding problems, immune compromise

What are the subclassifications of recurrent bacterial cystitis?

Persistent

Relapsing

Reinfection

What is it called when the appropriate antimicrobial treatment fails to clear the infection?

Persistent infection

What do you need to do if there is a persistent LUTI?

Rule out incorrect dosage, poor compliance, and screen for systemic illness

What are reasons for persistent infections?

Bacterial resistance

Immune compromise

MUC was not 4x the MIC

What are the goals of treating persistent LUTI?

Address underlying condition

Change antimicrobials to a different absorption, metabolism, or excretion

Increase dose

What is it called when the urine was cleared of infection but the same pathogen came back?

Relapse infection

What do you do if there is a relapse infection?

Look for a nidus or reservoir in the kidney, prostate, uroliths, vagina, or urothelial cells

How do you treat a relapse infection?

Clear the reservoir of bacteria

Use an antibiotic with good tissue penetration

What is a reinfection LUTI?

New bacterial strain causing cystitis after the initial UTI was cleared

What should you do if you have reinfection after LUTI treatment?

Assess for mechanical or anatomical abnormalities causing there to be more risk of UTIs.

• Assess external genitalia

• Determine if there is urine retention

• Monitor for normal voiding

• Radiographs, contrast studies, US, or cystoscopy

How do you treat reinfection LUTIs?

Do a C&S before giving antibiotics because they are susceptible to resistant infections

If you have a reinfection LUTI after therapy and the culture is positive and clinical signs are present what do you do?

Re-evaluate compliance

Consider further diagnostics

DO NOT CHANGE ANTIMICROBIAL

What is subclinical bacteriuria?

Bacteria is in urine, but no C/S of infection are present

What do you usually do if there is subclinical bacteriuria?

Do not treat

When would you treat subclinical bacteriuria?

Suspected pyelonephritis

Looking for source of bacteremia/septicemia

Before surgery

If struvite urolithiasis is there in dogs

Diabetics

If patient has a LMN bladder

What are the common gram positive causes of prostatitis?

Step and Staph

What are the common gram negative causes of prostatitis?

E. coli, Klebsiella, Pseudomonas, Pasteurella

What is a zoonotic cause of prostatitis?

Brucella canis

What are C/S of acute prostatitis?

Stiff hindlimb gait, fever, anorexia, abdominal pain, lethargy, vomiting

What are C/S of chronic prostatitis?

Intact males with recurrent UTIs

How do you diagnose prostatitis?

C&S of prostatic fluid or urine

Serologic test for Brucella canis

How do you treat prostatitis?

Supportive care with IV fluids and analgesia

Draining abscesses

Empirical treatment with FQs, trimethoprim-sulfonamide

Treat for 4-6 weeks

When should you castrate a dog with prostatitis?

5-7 days after antibiotics are started

What are the C/S of BPH?

Hematuria, dysuria, urinary incontinence, tenesmus, constipation

What does a large, symmetrical, non-painful prostate indicate?

BPH

how do you treat BPH?

Castration

What can cause squamous metaplasia in the prostate?

Exposure to estrogen, usually from an estrogen-secreting testicular tumor

What are C/S of squamous metaplasia?

Bilateral alopecia

Hyperpigmentation

Gynecomastia

Anemia from estrogen bone marrow suppression

How do you treat squamous metaplasia?

Castration

What are the most common prostatic neoplasias?

Adenocarcinomas and carcinomas

How do you diagnose prostatic neoplasia?

FNA and histopathology of biopsy

How do you treat prostatic neoplasia?

Poor prognosis but chemotherapy and NSAIDs

How do you treat prostatic cysts?

Surgical correction and castration

What can cause the formation of uroliths?

Increase in solute concentration

Changes in urine pH

Diet

Presence of bacteria

Presence of foreign material in UT

Increased residual urine volume

Decreased natural crystallization inhibitors

What are the most common types of uroliths?

Calcium oxalate

Struvite

Urate

Cystine

What uroliths form in alkaline urine?

Struvite

What uroliths are radiolucent?

Cystine, purine

What is the most common urolith in cats?

Calcium oxalate

What are the risk factors for calcium oxalate formation?

Hypercalciuria

Hypercalcemia

Genetic predisposition

What dogs are predisposed to calcium oxalate formation?

English bulldogs

How do you diagnose calcium oxalate stones?

Ionized calcium concentration measurement

How do you treat calcium oxalate stones?

Surgery

How do you prevent calcium oxalate stones?

Dietary management

Increase water intake

Thiazide diuretics to increase calcium reabsorption (only if hypercalcemia has been ruled out as a cause)

What is the most common urolith in dogs?

Struvite

What causes struvite crystals in dogs only?

UTIs from urease-producing bacteria

How do you treat struvite crystals?

Medical dissolution and antimicrobials in dogs

What causes ammonium urate/biurate crystals?

Hepatic dysfunction

What breeds are predisposed to ammonium urate/biurate crystals?

Dalmations, English Bulldogs, Black Russian terrier

What causes xanthine crystals?

Defects in purine metabolism or secondary to allopurinol administration

How do you treat purine crystals?

Medical dissolution

Allopurinol in dogs with hereditary defects

What are the types of purine crystals?

Urate and xanthine

What urolith is highly recurrent in cats?

Cystine

What is the mechanism of cystine urolith formation?

Hereditary disorder that causes a defect in PCT reabsorption of protein and excretion of amino acids

How to do you treat cystine crystals?

Medical dissolution with low protein diets in cats and dogs

Can also castrate dogs

How do you monitor cystine crystal recurrence in cats?

Imaging every 2-6 months

What are C/S of urolithiasis?

LUT signs like pollakiuria, stranguria, periuria, hematuria

What is on physical exam of urolithiasis?

Large firm painful bladder

Cystoliths can be palpable on abdomen or rectal exam

What crystals can occur in healthy animals without urolithiasis?

Struvite and calcium oxalate

What crystals are always abnormal?

Cystine and urate

What is the best method to diagnose any urolith?

Contrast radiography

T/F recurrent stones do not need to be sent out for analysis?

False

What are the general types of uroliths?

Mixed and compound

When should uroliths be removed?

If they are causing C/S, obstruction or recurrent infections

How are some minimally invasive techniques to remove uroliths?

Voiding urohydropropulsion

Basket removal

Lithotripsy

What usually causes ureterolithiasis?

Nephrolithiasis that shifts to the ureter causing an obstruction

How do you diagnose nephrolithiasis or ureterolithiasis?

Combination of radiography and ultrasound

What are nephroliths usually composed of?

Calcium oxalate

How do you treat nephroliths or ureteroliths?

Medical expulsion therapy

Ureteral stents

SUB devices

Ureteral surgery

Shock wave lithotripsy

What are indications to treat nephroliths and ureteroliths?

Obstruction

Increase in size/number

Chronic hematuria

Recurrent infections

Decline in renal function

What is medical expulsive therpay?

IV fluids with diuretics are used to move ureteroliths into the bladder to pass

Where is the pelvic nerve located?

S1-S3

What type of nerve is the pelvic nerve?

Parasympathetic

What does the pelvic nerve innervate?

Detrusor muscle

What happens when the pelvic nerve is stimulated?

Bladder contraction and emptying

What happens when the pelvic nerve is blocked?

Bladder relaxation and filling

Where does the hypogastric nerve come out?

L1-L4