Diseases of the Urinary System

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)

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

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

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

7. 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

8. 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

9. 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)

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

13. Urinalysis Sediment

14. 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

15. 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

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

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

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

19. 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

21. 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

22. 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

23. 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

24. 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

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

26. Uroliths

27. Uroliths

28. Uroliths

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

30. 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

31. 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

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

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

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

35. 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

36. 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

37. 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

38. 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

39. 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

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

41. 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

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

43. 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