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Diseases of the Urinary System

Diseases of the Urinary System. Small Animal and Caged Bird Medicine Dr. Randy Ackman. Urinary System. Urinary System Kidneys (paired) Ureters (paired) Bladder Urethra Os penis (dog). Urinary System. Functions Concentrate nitrogenous waste RBC production Water Electrolyte balance

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Diseases of the Urinary System

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  1. Diseases of the Urinary System Small Animal and Caged Bird Medicine Dr. Randy Ackman

  2. Urinary System • Urinary System • Kidneys (paired) • Ureters (paired) • Bladder • Urethra • Os penis (dog)

  3. Urinary System • Functions • Concentrate nitrogenous waste • RBC production • Water Electrolyte balance • Regulate Blood pressure • Regulates pH of plasma

  4. Urinary System • Nephron • Functional unit of the kidney • Glomerulus • Capillary • Bowman’s Capsule • Proximal tubules • Loop of Henle • Distal tubule • Collecting tubule

  5. Defense Mechanism of Urinary System • Acidic pH • Inhibits growth of bacteria • Urethral and ureter peristalsis • Urination • Glycoaminoglycans protect surface mucosa

  6. Diseases of the Urinary System • Cystitis (bacterial) • Inflammation of the urinary bladder • Result of ascending infection • More frequent in females • Recurring infections in male • Prostrate may be source

  7. Cystitis (bacterial) • Signs and symptoms • Febrile +/- • Hematuria • Dysuria • Small quantities • Increased frequency • Inappropriate places • Pain on urination • Licking of urethral region • Cloudy or abnormal odor color of urine

  8. Cystitis (bacterial) • Methods of urine collection • Voided free catch • Ok for urinalysis not for C & S • Expressed • Ok for urinalysis, but may have iatrogenic blood • Not for C& S • Catheter • Sterile technique • Ok for urinalysis and C & S • Cystocentesis • Ok for urinalysis and C & S (ideal)

  9. Cystitis (bacterial) • Diagnosis • Urinalysis • Elevated pH • + leukocytes • + blood • Culture and Sensitivity • Sediment • RBC’s • WBC’s • Bacteria

  10. Urinalysis Sediment

  11. Cystitis (bacterial) • Treatment • Based on C & S (ideal) • Empirical antibiotics • Those that reach adequate urine concentrations • Ampicillin, Amoxicillin, Fluoroquinolones, Sulfas, Cephalexin • Treat 10 days to 2 weeks • Poor owner compliance greatest reason for resistance and ineffective therapy

  12. Idiopathic (Interstitial) Cystitis • AKA • FUS –Feline urologic syndrome • FLUTD- Feline Lower Urinary Tract Disease • Unsure etiology • Possibly Viral • Difficult to distinguish from bacterial cystitis • C & S negative • Lack of bacteruria

  13. Interstitial Cystitis • Often self limiting in cats • Can be controlled without antibiotics • But usually treated as bacterial cystitis • Hematuria • Dysuria • Inappropriate urination

  14. Interstitial Cystitis • Diagnosis • Urinalysis • Similar to bacterial • C+S • Negative for bacteria • Sediment • RBC’s • WBC’s • Bacteria absent

  15. Interstitial Cystitis • Therapy • Diet changes • Increase volume of urine • Amitriptyline • Reduces pain and discomfort • May reoccur

  16. Feline Urethral Plugs • Plugged tomcats • Medical emergency • Severe • Causes • Neutered males most likely • Can occur in females and intact males • Urethral Plug • Mucus and crystalline matrix blocked narrowed distal urethra

  17. Feline Urethral Plugs • Symptoms • Inability to urinate despite frequent attempts • Lethargic • Distended bladder • Painful abdomen • Azotemia • ECG abnormalities • Comatose • hyperkalemia • Death • If not corrected 2-4 days

  18. http://www.thepetcenter.com/exa/uo.html • Treatment • Sedation – careful dosing if animal is depressed • Sterile technique • Pass urethral catheter • Massage distal urethra (rarely works) • Retropulse plug with saline • Diuresis • Fluid therapy to dilute crystalline material • Antibiotics

  19. Feline Urethral Plug • Dietary change • Decrease acidity of urine • Prevents formation of crystalline material • c/d, s/d • OTC • “for urinary tract health” • Urine acidifiers • Antibiotics

  20. Uroliths • Bladder Stones • Identified by there chemical composition of urolith • Struvite – Magnesium amonium phosphate • Most common • Form in alkaline urine • Dissolution with s/d • Calcium oxalate • High calcium • Surgery only treatment • u/d prevents formation

  21. Uroliths • Urates • Common in Dalmatians • Allopurinol • Decreases uric acid production • u/d used to prevent and dissolve

  22. Uroliths

  23. Uroliths

  24. Uroliths

  25. http://www.thepetcenter.com/sur/bladderstone.html • Cystotomy • Surgical excision of bladder stones • Check urethral patency • Retrograde flushing through catheter, as catheter is removed

  26. Abrupt decrease in glomerular filtration Causes Toxins Ethylene glycol Plants Lilly, Rhubarb etc Drugs Aminoglycosides Sulfanomides Cephalsporins Acetaminophen Causes continued Hypotension Shock Immune mediated Heavy metals Acute Renal Faliure

  27. Acute Renal Failure • Decreased glomerular filtration results in • Azotemia • Renal increased BUN and creatinine • Oliguria • Little urine production • Anuria • No urine production • Polyuria • Increased urine production

  28. Acute Renal Failure • Painful kidneys • Vomiting • Dehydration • Anorexia

  29. Acute Renal Failure • Diagnosis • Urinalysis • Low specific gravity • Sediment • Casts • Depends on initiating factor • Elevated BUN, creatinine, PCV, potassium and phosphorous

  30. Acute Renal Failure • Therapy • IV fluids • Isotonic saline • Eliminate toxin or drug • Prevent uremic gastritis • Antiemtics (Reglan) • Protectants (sucralfate) • Anti-histamine (Cimetidine)

  31. Acute Renal Failure • Treatment • Sodium bicarbonate if acidotic • Diuretics • Furosemide • Dopamine • Mannitol • Must get anuric animals to urinate • May get through episode but persistent kidney damage persists • Guarded prognosis

  32. Chronic Renal Faliure • Common in older pets • Irreversible decline in nephron function • Kidneys may compensate until 2/3 to 3/4 nonfunctional nephrons • Clinical signs • Insidious onset • Congenital or hereditary predisposition

  33. Clinical Signs Anorexia Weight loss Vomiting Constipation Dehydration PU/PD Stomatitis Clinical Signs Hypertension Lethargy Anemia Decreased erythropoietin Hyperphosphatemia Proteiunuria Hypokalemia Azotemia Chronic Renal Failure

  34. Chronic Renal Failure • Treatment • Not a cure • Slow progression of disease • IV or SQ fluids • Maintain hydration and electrolytes • Diuresis – remove accumulating wastes • Antibiotics if necessary • Potassium supplementation • GI protectnats • Metocloprmide, cimetidine, surcalfate

  35. Chronic Renal Failure • Treatment • ACE inhibitors – reduce renal hypertension • Dietary change • k/d, u/d • Low protein, high quality protein (more important) • Anabolic steroids • Erythropoietin

  36. Chronic Renal Failure • Important Points • Irreversible • Home treatment may be required • Point where eating is more important than what they eat

  37. Urinary Incontinence • Loss of voluntary control of micturition or urination • Neurogenic • Result of spinal cord disease • Nonneurogenic • Ectopic ureters • Estrogen deficiency – OHE animals • Juvenile - submissive

  38. Urinary Incontinence • Diagnosis • Urination while sleeping, walking • Urinalysis • Normal • R/O • Urinary disease • Metabolic or endocrine disease

  39. Urinary Incontinence • Therapy • DES – diethylstilbestrol • Daily initially • Weekly maintenance • Monitor CBC for bone marrow suppression • PPA – Phenylpropanolamine • Antihistamine • Increase urethral sphincter tone • Daily dosing BID to TID

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