Diseases of the Urinary System

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Diseases of the Urinary System

• Small Animal and Caged Bird Medicine
• Dr. Randy Ackman

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Urinary System

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

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Urinary System

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

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Urinary System

• Nephron
• Functional unit of the kidney
• Glomerulus
• Capillary
• Bowmans Capsule
• Proximal tubules
• Loop of Henle
• Distal tubule
• Collecting tubule

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Defense Mechanism of Urinary System

• Acidic pH
• Inhibits growth of bacteria
• Urethral and ureter peristalsis
• Urination
• Glycoaminoglycans protect surface mucosa

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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

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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

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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)

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Cystitis (bacterial)

• Diagnosis
• Urinalysis
• Elevated pH
• leukocytes
• blood
• Culture and Sensitivity
• Sediment
• RBCs
• WBCs
• Bacteria

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Urinalysis Sediment
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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

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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

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Interstitial Cystitis

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

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Interstitial Cystitis

• Diagnosis
• Urinalysis
• Similar to bacterial
• CS
• Negative for bacteria
• Sediment
• RBCs
• WBCs
• Bacteria absent

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Interstitial Cystitis

• Therapy
• Diet changes
• Increase volume of urine
• Amitriptyline
• Reduces pain and discomfort
• May reoccur

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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

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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

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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

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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

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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

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Uroliths

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

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Uroliths
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Uroliths
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Uroliths
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http//www.thepetcenter.com/sur/bladderstone.html

• Cystotomy
• Surgical excision of bladder stones
• Check urethral patency
• Retrograde flushing through catheter, as catheter
  is removed

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Acute Renal Faliure

• 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

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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

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Acute Renal Failure

• Painful kidneys
• Vomiting
• Dehydration
• Anorexia

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Acute Renal Failure

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

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Acute Renal Failure

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

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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

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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

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Chronic Renal Failure

• Clinical Signs
• Anorexia
• Weight loss
• Vomiting
• Constipation
• Dehydration
• PU/PD
• Stomatitis

• Clinical Signs
• Hypertension
• Lethargy
• Anemia
• Decreased erythropoietin
• Hyperphosphatemia
• Proteiunuria
• Hypokalemia
• Azotemia

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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

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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

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Chronic Renal Failure

• Important Points
• Irreversible
• Home treatment may be required
• Point where eating is more important than what
  they eat

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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

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Urinary Incontinence

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

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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