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Diseases of Urinary System

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Title: Diseases of Urinary System


1
Diseases of Urinary System

2
Urinary System
  • Anatomy/Location
  • Kidneys
  • Ureters
  • Bladder
  • Urethra
  • Function
  • Remove waste
  • Maintain homeostasis
  • acid/base
  • electrolytes
  • fluid balance
  • Hormone production
  • erythropoietin

3
Urinary System
  • Infections usually due to ascending organism
  • Usually resistant to bacterial infection
  • Frequent urination flushes bacteria
  • Urethral/ureteral peristalsis
  • Glucosaminoglycans in mucosa
  • pH

4
Feline Cystitis
  • Cause unknown virus suspected usually not
    bacterial recurrence likely
  • Self-limiting (7-10 d), so any appropriate
    treatment appears to help
  • Signs
  • Frequent urinations (sm vol)
  • Hematuria
  • Dysuria
  • Inappropriate urination (sinks, tubs are a
    favorite)
  • Dx
  • Urinalysis/culture to r/o bacteria as cause
  • X-rays to r/o calculi contrast studies show
    thickened wall

5
Feline Cystitis
  • Rx
  • Avoid unnecessary antibiotics
  • Change diet from dry to moist
  • Salt food to ? water intake
  • Reduce stress from other cats, kids, etc (hiding
    places)
  • Client info
  • Disease is self-limiting
  • May be recurring problem
  • No definitive cure
  • Reduce stress

6
Canine Cystitis (Bacterial Cystitis)
  • Signs
  • ? frequency of urination
  • Hematuria
  • Dysuria
  • Cloudy urine abnormal color
  • Frequent licking of urethral area
  • Dx
  • Urinalysis ?WBCs, bacteria
  • Urine culture/sensitivity
  • Collect by cystocentesis(?)
  • Mid-stream collection

7
Canine Cystitis (Bacterial Cystitis)
  • Rx
  • Avoid unnecessary use of indwelling urinary
    catheters
  • Use closed system
  • Antibiotics according to sensitivity
  • Treat acute infections x 10-14 d
  • Subsequent infections x 4-6 w
  • Avoid trauma to urinary tract during surgery
  • Client info
  • Many uncomplicated urinary tract infections
    resolve without Rx
  • Give antibiotics as directed for the time
    prescribed
  • Relapses are common due to inadequate treatment
  • Prostate may be source of recurring infections in
    male dogs
  • Urine cultures should be repeated during
    treatment to assess effect

8
Close system
9
Feline Uroliths and Urethral Plugs
  • Plugged male cats are commonly seen in SA
    practice
  • Will be fatal if not relieved
  • Uroliths (bladder stones) 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 and require double contrast
    (air, dye)
  • Uroliths damage bladder, making it more
    susceptible to bacterial infection, hematuria
  • Uroliths can form plugs in urethra of males
  • Bladder will fill with urine
  • Kidneys will stop working
  • Blood/body will become toxic (azotemic)

10
Feline Uroliths and Urethral Plugs
  • Signs (more severe if obstruction has occurred)
  • Hematuria
  • Dysuria/ frequent urination
  • Urinating in strange places (sink, tub)
  • Straining to urinate
  • Vomiting
  • Collapse, death

11
Feline Uroliths and Urethral Plugs
  • Dx
  • Palpation of bladder (obstructed is full and
    tight)
  • X-rays may show uroliths on routine films
  • Double contrast studies may be indicated
  • Ultrasonography can locate position of urolith
  • Urolith analysis to determine its constituents
  • Double contrast cystogram (with
    stones) pneumocystogram

12
US of bladder stone
13
Feline Uroliths and Urethral Plugs
  • Rx
  • Medical treatment (chronic, non-obstructed)
  • Dissolve struvite uroliths (most common 60) by
    acidifying urine and feeding diet low in Mg (Vit
    C, S/D)
  • Should resolve in 4-8 wk
  • Re x-ray, and continue diet 1 mo after uroliths
    gone
  • Antibiotics according to culture/sensitivity

14
Feline Uroliths and Urethral Plugs
  • Medical treatment (obstructed)
  • Anesthetize (short acting)
  • USE LESS ANESTHESIA IN AZOTEMIC CATS
  • Pass silver needle (soft metal, atraumatic) or
    Tom cat catheter and back flush
  • Sew catheter in place for 1-3 d (??)

15
Feline Uroliths and Urethral Plugs
  • Surgical treatment (chronic obstructers)
  • Perineal urethrostomy
  • New opening for urethra is created proximal to
    narrowing
  • Urethral opening looks like a female
  • E collar till sutures removed

16
Urolithiasis (Canine)
  • Smaller incidence in dogs than cats
  • Uroliths damage mucosa of urinary tract making it
    susceptible to infection
  • Uroliths can obstruct urine flow in males
  • Signs
  • Dysuria
  • Hematuria
  • Dx
  • Urinalysis
  • Crystalluria
  • Hematuria
  • ? bacteria
  • X-rays (double contrast ?)
  • Do stone analysis

17
Canine Uroliths
  • Urolith Breed Sex Contributing factors
    Rx
  • Struvite min sch female (80) alkaline
    urine acidify urine
  • (Mg Ammonium Phos (MAPtriple phosphate)
  • (50 of all stones) cats bacteria?urease??pH
    antibiotics
  • minerals (diet) Only Hills s/d (dissolve)
  • ?Na, ?protein (ammonia)
  • ?H2O intake (flush stones
  • acidy urine
  • Calcium Oxalate cats males diet high in
    protein Sx removal (only Rx)
  • (30-50 of min sch hypercalcemia ? dietary Ca
    (milk)
  • all stones) Lhasa, Yorkie Cushings Dis ?
    dietary Na
  • min pood use of cortisone Hills u/d, w/d,
    k/d
  • Shih Tzu acid urine
  • Urates Dalmatians males ? uric acid from
    kidneys Allopurinol
  • E bulldogs acid urine (gout in humans)
  • min schnauzer K Citrate (? urine pH)
  • Shih Tzu Hills u/d, ? dietary salt
  • York terrier

18
Canine Uroliths
  • Struvite Calcium Oxalate Urate
  • Type of stone cannot be determined by appearance
    chemical analysis is required

19
Urolithiasis (Canine)
  • Rx
  • Medical (objective is to dissolve stones)
  • ? mineral intake in diet?? minerals in urine
  • ? urine acidity (nor for urates)
  • Vit C
  • methionine (Methogel)
  • ? urine output
  • Add salt to diet
  • Furosemide
  • Antibiotics for bacterial infection
  • Surgical removal
  • Some uroliths are not amenable to Medical Rx
  • However, the cause of uroliths must be dealt with
    medically (prevention)

20
Urolithiasis (Canine)
What do you see? How many?
  • Client info
  • Special diet may be required for life-time
  • 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

21
Urolithiasis (Canine)
What do you see? Flush toward bladder (8
times)
Saline flush
One in bladder, 2 in urethra
22
Urolithiasis (Canine)
  • What do you see?

23
Urolithiasis (Canine)
What do you see?
24
Urolithiasis (Canine)
25
Renal Failure
  • 20 of CO
  • Filtered by renal corpuscle
  • Reabsorbed by kidney tubules
  • Waste excreted as urine
  • Renal Failure due to
  • ? blood flow (hypoperfusion)
  • Damage to nephron

26
Acute Renal Failure
  • An abrupt decrease in glomerular filtration ?
    azotemia (? N toxins in blood)
  • Causes
  • Damage to nephron (damaged nephrons do not
    regenerate other nephrons will hypertrophy)
  • Any part of nephron may be damaged (when 1 part
    of nephron is lost, it is all lost)
  • Nephrotoxic drugs
  • Aminoglycosides (gentamicin, streptomycin)
  • Cephalosporins (cephalexin, cephalothin)
  • Sulfanamides (Albon, Di-Trim)
  • Chemotherapeutic agents
  • Antifungal medications
  • Analgesics (acetaminophen)
  • Anesthetics (methoxyflurane Metafane)
  • Ethylene glycol (antifreeze)
  • Infections (nephritis)
  • Immune-mediated diseases (Glomerulonephritis)
  • ? Renal perfusion
  • Shock
  • Hypovolemia/dehydration
  • Hypotension

27
Acute Renal Failure
  • Signs (non-specific)
  • Kidneys are enlarged and painful on palpation
  • Signs of azotemia
  • Anorexia, dehydrated
  • Vomiting/diarrhea
  • Weakness
  • Fever
  • Dx
  • Urinalysisurine sediment/casts low sp grav
    (unable to conc urine)
  • CBCdehydration (?PCV), acidosis
  • Chem panel
  • ? BUN, Creatinine
  • ?K, Phosphorus

28
Acute Renal Failure
  • Rx (aim is to restore renal hemodynamics)
  • Relieve tubular obstruction
  • Discontinue any toxic drugs
  • IV fluids (start with normal saline)
  • Correct dehydration
  • Correct acid/base (sodium bicarb) and electrolyte
    imbalance
  • Diuretics to increase urine output
  • Client info
  • Renal function may never be like it was before
    injury
  • Px is guarded
  • Care must be taken to avoid events that may
    precipitate further damage to kidney
  • Appropriate diet
  • Adequate water access

29
Chronic Renal Failure
  • Common in older pets cats appear to be more
    affected than dogs
  • Irreversible and progressive decline in renal
    function (nephron damage)
  • Progressive
  • 1st function lost Ability to concentrate urine
  • PU, PD, nocturia
  • Loss of ADH response
  • Other functions lost Ability to cleanse blood
  • Azotemia (toxemia)
  • Begins at 75 of nephron loss
  • ? BUN, Creatinine
  • Anemia erythropoietin secreted by kidneys

30
Chronic Renal Failure
  • Signs
  • Dull, lethargic, weak
  • Anorexia, wt loss
  • PU/PD cervical ventroflexion
  • hypokalemia
  • Sudden blindness
  • Dx
  • Acidosis
  • Anemia
  • ? BUN, Creatinine
  • Hyperphosphatemia
  • Hypokalemia
  • Proteinuria

31
Chronic Renal Failure
  • Rx
  • Fluids for dehydration (IV, SQ)
  • Potassium gluconate, calcium carbonate for
    electrolyte imbalances
  • Sodium bicarb for pH adjustment
  • Diuretics (Furosemide)
  • Hormones
  • Epoetin
  • Vit B supplements
  • Client info
  • CRF is progressive and irreversible
  • Rx is aimed at slowing its progress
  • SQ fluids at home are required to maintain
    hydration
  • Warm foods to improve palatability
  • Quality of life will decrease euthanasia may
    have to be considered

32
Urinary Incontinence
  • Loss of voluntary control of micturition
  • Causes
  • Neurogenicloss of normal neural function causing
    a paralyzed bladder
  • Ectopic ureters
  • Patient urachus
  • Endocrine imbalance (after spay)

33
Urinary Incontinence
  • Signs
  • Urine leakage when pet is sleeping or exercising
  • Perianal area of pet is aslways wet
  • Concurrent urinary tract infection
  • Dx
  • Urinalysis
  • X-rays/cystography
  • Chem panel to r/o PU from endocrine disease

34
Urinary Incontinence
  • Rx (based on specific cause)
  • Surgical correction
  • Endocrine deficiency in spayed female
  • Diethylstilbestrol (PO or inj)
  • Phenylpropanolamine (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
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