Transcript UrinaryDis2016 - Catherine Huff`s Site

ADVERSITY
“No pressure, no diamonds.”
-Mary Case
DISEASES OF THE URINARY SYSTEM
Cystitis
Cystic calculi
Urinary obstruction
ARF & CRF
Incontinence
THE URINARY SYSTEM and ITS
FUNCTIONS
 Functions of the kidneys
 Excretion:
 produce urine
 Maintain homeostasis
 Blood filtration, reabsorption, secretion
 Fluid balance regulation
 Acid-base balance regulation
 Hormone production
DISEASES OF THE URINARY SYSTEM
 URINARY SYSTEM IS NORMALLY STERILE
AND RESISTANT TO BACTERIAL
INFECTION B/C OF:
 Voiding of urine
 Urethral/ureteral peristalsis
 Glycosaminoglycans in the surface mucosal
layer
 pH
URINARY SYSTEM DISORDERS
About 4 million cats a year are destroyed or
abandoned for “elimination problems”.
DISEASES OF THE URINARY SYSTEM
Cystitis
Cystic calculi
Urinary obstruction
ARF & CRF
Incontinence
Feline Idiopathic (Interstitial) Cystitis
aka FUS/ FLUTD
 FACTS:
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Occurs in cats almost any age
Occurrence in males > females
cause unknown, multi-factorial, virus(?)
not caused by bacterial infection
recurrence is likely
Feline Idiopathic (Interstitial) Cystitis
 Clinical Signs
 pollakiuria
 Hematuria
 Dysuria
 Periuria (sinks, tubs, carpet, etc.)
Feline Idiopathic (Interstitial) Cystitis
 Diagnostics
 Urinalysis/culture to rule out bacteria as cause
 Only 1%-3% of all feline cystitis is caused by bacteria
 Radiographs to rule out calculi
Feline Idiopathic (Interstitial) Cystitis
 Treatment
 Avoid unnecessary antibiotics
 Change diet from dry to moist
 or add water to dry food
 Reduce stress from other cats, kids, etc
 Provide hiding places
 Pheromonotherapy
 Behavior modification drugs (may also have pain reducing
effects
 Amitryptilline (tri-cyclic antidepressant)
 Clomipramine
 Glycosaminoglycan replacement
 Cosequin for cats
 Adequan
Feline Idiopathic (Interstitial) Cystitis
 Client info
 Disease is self-limiting
 As many as 85% of cats will have resolution of clinical signs
in 7-10 days
 May be recurring problem
 No definitive cure, but diet change is the most
effective (Hill’s c/d Stress)
 Reduce stress
Canine Bacterial Cystitis
 Cause: Ascending bacteria up
the urethra
 Signs
 ↑ frequency of urination
 Hematuria
 Dysuria
 Cloudy urine, abnormal color
 Frequent licking of
vaginal/urethral area
Canine Bacterial Cystitis
 Diagnostics
 Urinalysis:
 ↑WBC’s, bacteria
 Common bacteria: E.coli,
Proteus spp.
 Urine culture/sensitivity
 Collect by cystocentesis or
mid-stream collection
Canine Bacterial Cystitis
 Treatment
 Antibiotics according to culture/sensitivity
results
 Treat acute infections x 10-14 d
 Subsequent infections x 4-6 w
 Avoid trauma to urinary tract during surgery
 Patients needing indwelling catheters should
have a closed system
Closed Urinary Catheter System
Canine Bacterial Cystitis
 Client info
 Many uncomplicated UTI’s
resolve without treatment
 Give antibiotics as directed for
the time prescribed
 Prostate may be source of
recurring infections in male
dogs
 Urine cultures should be
repeated during treatment to
assess effect
DISEASES OF THE URINARY SYSTEM
Cystitis
Cystic calculi
Urinary obstruction
ARF & CRF
Incontinence
Feline Uroliths and Urethral Plugs
“Plugged” or “Blocked” male
cats are commonly seen in
small animal practice and can
be fatal if not relieved
Feline Uroliths & Urethral Plugs
 The two most common causes of urethral
blockage are uroliths and urethral plugs
 UROLITHS: composed predominantly of minerals
 URETHRAL PLUGS: composed predominantly of
matrix (mucoprotein, rbcs, wbcs, epithelial cells,
etc.)
Feline Uroliths and Urethral Plugs
 Signs
 Hematuria
 Dysuria
 Periuria
 Anorexia, vomiting
 Collapse, death
 Non-specific signs:
 Hiding
 Crying while urinating
 Frequent trips to the
litterbox
Feline Uroliths and Urethral Plugs
 Uroliths can be found
anywhere in urinary tract
 Formed from minerals in
diet
 Some are radiopaque (Ca++
oxalate, urate, struvite) and
can be seen on x-ray
 Some are radiolucent
(cystine) and require special
imaging techniques to
visualize
Pneumocystogram
Feline Uroliths and Urethral Plugs
 Uroliths damage bladder, making it more
susceptible to bacterial infection, hematuria
 Uroliths can cause blockage of the urethra of
males
 Bladder will fill with urine
 Kidneys will stop working
 Patient will become azotemic
Feline Uroliths and Urethral plugs
Feline Uroliths and Urethral Plugs
• Diagnosis
 Palpation of bladder
• Obstructed bladders are full and tight
 Radiographs may show uroliths
 Ultrasonography
 Urolith analysis is necessary to determine its constituents
 EKG: atrial standstill, bradycardia, due to hyperkalemia
Feline Uroliths and Urethral Plugs
 Treatment
 Medical treatment (non-obstructed)
 Dissolve struvite uroliths by acidifying urine and
feeding diet low in Mg (Hill’s S/D, c/d)
 Should resolve in 4-8 wk
 Re-radiograph, and continue diet 1 mo after uroliths
gone
 Cystotomy to remove stones
 Antibiotics according to culture/sensitivity
Feline Uroliths and Urethral Plugs
Feline Uroliths and Urethral Plugs
 Medical treatment (obstructed)
 This is a medical emergency
 Anesthetize
 *USE LESS ANESTHESIA IN AZOTEMIC CATS*
 Pass Tom cat catheter and back flush
 Sew catheter in place for 1-3 d, using a closed system
Feline Uroliths and Urethral Plugs
Closed Urinary Catheter System
Feline Uroliths and Urethral Plugs
 Surgical treatment (chronic obstructors)
 Perineal urethrostomy (PU)
 New opening for urethra is created proximal to
narrowing
 Urethral opening looks similar to female anatomy
*Goal of surgery is to decrease the likelihood of lifethreatening obstruction*
Feline Uroliths and Urethral Plugs:
Perineal Urethrostomy
Feline Uroliths and Urethral Plugs:
Perineal Urethrostomy
CANINE UROLITHIASIS
Canine Urolithiasis
 Uroliths damage mucosa of urinary tract making it
susceptible to infection
 Uroliths can obstruct urine flow in males
Canine Urolithiasis
The distal portion of the canine urethra is contained
in the narrow canal of the os penis.
This can be a common location for urethral stones
to become lodged.
Canine Urolithiasis
 Clinical Signs
 pollakiuria
 Dysuria
 Hematuria
 Dx
 Urinalysis
 Crystalluria
 Hematuria
 ↑ bacteria
 Radiographs
Canine Urolithiasis
Canine Uroliths
Urolith
Breed
Struvite
min sch
cats
(Mg Ammonium Phos)
female
Contributing factors
alkaline urine
Rx
acidify urine
bacteria→urease→↑pH
minerals (diet)
antibiotics
Hill’s s/d (dissolve)
↓protein (ammonia)
↑H2O intake (flush stones)
Calcium Oxalate
(30-50% of
all stones)
Urates
Sex
Eng bulldogs
cats
min sch
Lhasa,Yorkie
min poodle
Shih Tzu
males
dietary protein
hypercalcemia
Hill’s u/d, w/d, k/d
acid urine
males ↑ uric acid from kidneys
acid urine
min schnauzer
Shih Tzu
Yorkshire terrier
Dalmatians
Sx removal
↓ dietary Ca
Allopurinol
K+ Citrate (↑ urine pH)
Hill’s u/d,
Canine Uroliths
Struvite
Calcium Oxalate
Type of stone cannot be determined by appearance; chemical analysis is required
Urate
Urolithiasis (Canine)
• Treatment
 Medical management - dissolve stones if Struvite
• Prescription diets
• Acidify urine
– Urinary acidifiers ( Methogel (methionine))
• ↑ urine output
– increase water intake
 Antibiotics for bacterial infection
 Surgical removal ( Ca Oxalate)
• Some uroliths are not amenable to Medical Rx
• Prevention is key
• STONE ANALYSIS ISVITAL FOR APPROPRIATE TREATMENT
Canine Urolithiasis: Cystotomy for stone
removal
Canine Urolithiasis
What do you see?
Canine Urolithiasis
 Client info
 Special diet may be required for life
 Table scraps/treats should be limited
 Long-term antibiotics may be required
 Uroliths may recur at any time
 Always provide plenty of fresh water
 Allow plenty of bathroom time and frequency
EDUCATION
“It is possible to store the mind with a
million facts and still be entirely
uneducated.”
- Alec Bourne
DISEASES OF THE URINARY SYSTEM
Cystitis
Cystic calculi
Urinary obstruction
ARF & CRF
Incontinence
Renal Failure
 ~20% of Cardiac output
 Filtered by renal corpuscle
 Reabsorbed by kidney
tubules
 Waste excreted as urine
 Renal Failure due to:
 ↓ blood flow
(hypoperfusion)
 Damage to nephron and
glomerular filtration
declines resulting in
azotemia
AZOTEMIA
Pre-renal
dehydration
Renal
Primary kidney disorders
Post-renal
Urinary tract obstruction
Acute Renal Failure
 Three distinct phases:
 Induction: the time from the initial insult until decreased
renal function is apparent (hours to days)
 Maintenance: the time period during which renal tubular
damage occurs (weeks to months)
 Recovery: the time during which renal function improves,
existing nephrons hypertrophy and compensate for
those damaged, and tubular repair occurs (when possible)
Stages of Kidney disease
Loss of Renal Reserve - Early signs of PU/PD
Renal Insufficiency - Early warning signs,
such as PU/PD
Renal Failure (Azotemia) - Kidneys cannot
eliminate waste efficiently, causing signs of
illness
Advanced Kidney Failure (Uremia) - Severe
signs of illness appear; eventually, collapse and
death result
Acute Renal Failure
 An abrupt decrease in glomerular filtration
→azotemia
 Causes
 Damage to nephron
 Nephrotoxic drugs
Aminoglycosides (gentamicin, streptomycin)
 Chemotherapeutic agents
 Antifungal medications
 Analgesics (acetaminophen)
 Anesthetics (methoxyflurane [Metafane])
 Ethylene glycol (antifreeze)
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Acute Renal Failure
 More causes:
Infections (pyelonephritis)
Immune-mediated diseases
(Glomerulonephritis)
↓ Renal perfusion
 Shock
 Hypovolemia/dehydration
 Hypotension
Acute Renal Failure
 Signs (non-specific)
Kidneys are enlarged and painful on palpation
Signs of azotemia
 Anorexia, dehydrated
 Vomiting/diarrhea
 Weakness
Fever
Acute Renal Failure
 Diagnosis
 Urinalysis
 urine sediment - casts
 low sp. gravity (unable to concentrate urine)
 CBC
 dehydration (↑PCV)
 Chem panel
 ↑ BUN, Creatinine
Acute Renal Failure
 Tx (aim is to restore renal hemodynamics)
 Relieve any urinary obstruction
 Discontinue any toxic drugs
 IV fluids
 Correct dehydration
 Correct acid/base imbalance
Acute Renal Failure
 Client info
 Renal function may never be like it was before injury
 Prognosis is guarded especially with older pets
 Care must be taken to avoid events that may
precipitate further damage to kidney
 Appropriate diet
 Adequate water access
Chronic Renal Failure
 Common in older pets; cats
appear to be more affected
than dogs
 Irreversible and progressive
decline in renal function
(nephron damage)
Chronic Renal Failure
 Progressive
 1st function lost: Ability to concentrate urine
 PU, PD, nocturia
 Loss of ADH response
 Other functions lost: Ability to filter blood
 Azotemia
 Begins at ~75% of nephron loss
 ↑ BUN, Creatinine
 Anemia: erythropoietin secreted by kidneys
Chronic Renal Failure
 Signs
 Dull, lethargic, weak
 Anorexia, wt loss
 PU/PD, cervical ventroflexion
 hypokalemia
Chronic Renal Failure
 Diagnosis
Look for abnormal blood work
associated with kidney function
 Anemia
 ↑ BUN, Creatinine
 Proteinuria
Chronic Renal Failure
 Treatment
 Fluids for dehydration(IV, SQ)
 Correct electrolyte imbalances
 Hormones
 Epoetin
Chronic Renal Failure
Client info
CRF is progressive and irreversible
treatment is aimed at slowing its progress
SQ fluids at home are required to
maintain hydration
Quality of life will decrease; euthanasia
may have to be considered
ARF
(large size)
Inc.
CRF
(small size)
Dec.
Azotemia: Bun
and Creatine
Phosphorous
Inc.
Inc.
Inc.
Inc.
Potassium
Inc.
Dec.
PCV
Other
Acidosis,
proteinuria
DISEASES OF THE URINARY SYSTEM
Cystitis
Cystic calculi
Urinary obstruction
ARF & CRF
Incontinence
Urinary Incontinence
Loss of voluntary control of micturition
 Causes
 Neurogenic—loss of normal neural function causing a paralyzed bladder
 Ectopic ureters
 Patent urachus
 Endocrine imbalance (after spay)
Urinary Incontinence
 Signs
 Urine leakage when pet is sleeping or exercising
 Perianal area of pet is always wet
 Concurrent urinary tract infection
 Dx
 Urinalysis
 X-rays/cystography
 Chem panel to r/o PU from endocrine disease
Urinary Incontinence
 Treatment (based on specific cause)
 Surgical correction
 Endocrine deficiency in spayed female
 Diethylstilbestrol
 Phenylpropanolamine (PROIN: for loss of sphincter tone)
 Client info
 Doses will have to be adjusted for individual animals
 Paralytic bladder incontinence may require manual
expression or catheterization several times a day
References
 Alleice Summers, Common Diseases of Companion Animals
 http://veterinarymedicine.dvm360.com/vetmed/article/article
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Detail.jsp?id=738082
http://ahdc.vet.cornell.edu/clinpath/modules/index.htm
http://www.vetmed.wsu.edu/ClientED/anatomy/dog_ug.aspx
http://veterinarynews.dvm360.com/dvm/article/articleDetail.j
sp?id=533210
http://www.walthamusa.com/articles/c-kidney.pdf