Renal Urinary Disorders

Front 1

what percentage of cardiac output goes to the kidneys?

Back 1

20% - therefore susceptible to blood borne toxins and to ischaemia due to hypotension/hypoxia

Front 2

what components are filtered into the glomerular filtrate?

Back 2

urea, water and sodium

Front 3

what hormone does the kidney release?

Back 3

erthropoietin

Front 4

what is erthropoetin responsible for?

Back 4

stimulation of the bone marrow to produce red blood cells - therefore damage can affect RBC levels

Front 5

urine travels from the kidney to the bladder via the....

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Ureters

Front 6

urine is voided from the bladder via the...

Back 6

urethra

Front 7

diagnostics for renal/urinary disorders

Back 7

Bloods – Urea, Creatinine, Phosphorus, Potassium andother electrolytesUrinalysis– methods of collection (free catch, bladder expression, katkor, catherisation, cystocentesis – pros/cons?)
Tests– dipstick, specific gravity, microscopyImaging– radiography/ultrasound/contrast studiesBiopsies

Front 8

define Azotamia

Back 8

a rise in urea and creatinine in the blood.

further classified as pre-renal(before kidney - dehydration), renal (kidney damage) or post-renal (afterkidney – bladder obstruction)

Front 9

a cause of Pre-renal azotaemia is...

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dehydration

Front 10

a cause of post renal azotaemia is...

Back 10

bladder obstructions

Front 11

ingestion of lilies is a cause of...

Back 11

renal azotaemia

Front 12

what is the most reliable urine collection method for culture?

Back 12

cystocentesis

Front 13

is finding haematuria normal in urine samples?

Back 13

no

Front 14

urine SG of 1.003 indicates?

Back 14

very dilute urine (weak urine)

Front 15

kidney is better visualised on an x-ray or ultrasound?

Back 15

ultrasound

Front 16

upper urinary tract disorders can be caused by

Back 16

-circulatory problems
-toxins
-infections
-congenital abnormalities
-idiopathtic

Front 17

ARF?

Back 17

Acute renal failure

Front 18

AKI?

Back 18

Acute kidney injury

can be reversible if diagnosed and treated quickly

–Ischaemia–Toxins–Bacterialinfection (pyelonephritis)–Urinaryobstruction

Ishaemia –hypotension/hypovolaemia due to shock, anaesthesia, decreased cardiac output/thrombosisToxins– NSAIDs, Ethylene glycol, lilies

Front 19

ARF signs

Back 19

•Suddenonset•Lethargy•Inappetance•Vomitting/Diarrhoea•Dehydration•Oliguria/Anuria(polyuria in later stages)•Enlarged,painful kidneys•Bradycardia(if hyperkaleamic)•Tachycardia(if hypovolaemic)•Pyrexia(pyelonephritis)

Front 20

ARF treatment and nursing

Back 20

antibiotics if bacterial involvement

IVFT to correct dehydration and for ongoing losses
Monitor urine output

monitor BP
monitor appetite

In dogs a possible cause is leptospirosis – consider isolationand barrier nursing for AKI which no history of toxin ingestion and poor vacchistory.

Front 21

CRF?

Back 21

chronic renal failure

Front 22

CRF

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•Slowonset and progression••Bodyis able to adapt and compensate••Clinicalsigns not apparent until >70% of renal function is lost••Couldbe caused by toxins/ischaemic damage/infections or idiopathic

Front 23

CRF signs

Back 23

Pu/pd – kidneys no longer able to concentrateurine and Pd inresponse to excessive urinationUlcers – nitrogenous waste products inblood lead to ulceration causing nausea and anorexiaWeight loss – poor appetite, musclewastage and protein loss from kidneys
Rubber jaw (not common) or secondaryrenal hyperparathyroidism (high phosphate levels from reduced excretion resultin the body producing extra parathyroid hormone and this in turn withdrawscalcium from bones, leading to soft and rubbery bones (especially of the jaw).

Front 24

CRF diagnosis

Back 24

•Increasedblood urea, creatinine and phosphorus• Anaemia(non-regenerative)••Mayhave hypokalaemia• Urinalysis–Lowurine SG–Mayhave proteinuria–Sendfor culture to check for infection

Anaemia – erythopoeitin production is affectedHypokalaemia – due to PU, can cause neuromuscularsigns, ventroflexion of neck

Front 25

CRF treatment and nursing

Back 25

Encourage fluid intake – water fountains,flavoured water
Renal diet – Phosphate restriction (prevent 2ndaryhyperparathyroidism which can be fatal), protein restriction and highbiological value (reduce waste for kidneys to deal with), potassium and vit Bsupplemented as excess loss with PU, palatable and calorie dense (encourageweight gain as most CRF cats are underweight), reduced sodium (to minimisehypertension)

Medication
Monitoring

likely euthanasia

Front 26

Nephrotic syndrome (NS)

Back 26

presence of proteinuria, hypoalbuminemia, hyperlipidaemic and interstitial fluid accumulation.

•Dueto damage to glomerulus (glomerulonephropathy) •Proteinleaks into urine and leads to fluid moving out of the vasculature.• Compensatorymechanisms worsen condition

Front 27

NS signs

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•Oedema•Ascites•Lethargy•Weightloss•PD/PU•Proteinuria•Hypoalbuminaemia•Hypernatraemia andhypertension (compensatory mechanisms)

Front 28

NS treatment

Back 28

Treatment – underlying cause ?corticosteroids/anabolic steroids/antibiotics – to treat underlying cause ofnephropathy.
Ace-inhibitors (fortekor) help to reduce proteinuria and reduceretention of sodium and water and consequent hypertension.Dietarysodium reduction and high biological value protein.
Diuretics - if resp issues or abdo discomfortPlasmatransfusions – response will be short lived
Mobilityto help reduce odema via lympahtics

Front 29

Polycystic Kidney Disease (PKD)

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•diseasewhich causes large fluid-filled cysts to form within the kidney. •Congenitalabnormality (Persians) •Screeningprogramme for owners and breeders (ultrasound/DNA test)

Front 30

Ownerscomment during a nursing consult that their elderly cat has lost a lot ofweight, is drinking more and is having accidents in the house. This could be asign of acute or chronic RF?

Back 30

chronic

Front 31

Adog presents with sudden onset of lethargy, inappetence and reduced urination which is mostlikely? acute or chronic?

Back 31

acute

Front 32

hypoxia during anaesthesia could put a patient at risk of ...

Back 32

ARF

Front 33

hyperkalaemia is a sign of ...

Back 33

ARF
Due to lack of excretion in urine if patient is oliguric/anuric. Inchronic renal failure patients are hypokalaemic due to excessive loss because they are polyuric

Front 34

patient with palpably enlarged kidneys is more likely to have...

Back 34

ARF

Front 35

complete recovery is possible in ...

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ARF

Front 36

Lower urinary tract disorders involve the ...

Back 36

bladder and urethra

Front 37

what are lower urinary tract disorders caused by...

Back 37

–Bacterialinfections–Urinarystones–Anatomicaldefects–Neurologicaldeficits–Stress

Front 38

cystitis is the....

Back 38

inflammation of the lining of the bladder - caused by ascending bacteria

–Traumacaused by uroliths(stones)–Retentionof urine–Concurrentillness e.g. diabetes mellitus–Indwellingurinary catheter

Front 39

clinical signs of lower UTI

Back 39

Dysuria – difficulty passing urine
Pollakiuria – increased frequency
Stranguria – Straining to pass urine
Lossof house training/incontinence
Smallpainful thickened bladder (if blocked then full/distended bladder – EMERGENCY)
Bloodin urine/changes in urine

Front 40

lower UTI diagnosis

Back 40

•Cultureand sensitivity prior to antibiotic treatment - sample collected via cystocentesis••Inpractice for first occurrence, simple cases this may not be undertaken ,however essential for recurrent cases

Front 41

lower UTI treatment

Back 41

antibiotics, encourage urination, encourage fluid intake, prevent urine scalding

Front 42

Urolithiasis(urinary stones/calculi) is the...

Back 42

•Formationof stones within the urinary tract••Causedby a combination of factors that allow for the precipitation of solutes and thegrowth of crystals••Factorsinclude:–Saturationof the urine–pHof urine–Presenceof UTIs–Breed–Diet

Front 43

Back 43

struvite (alkaline pH)

Front 44

Back 44

calcium oxalate (acidic pH)

Front 45

Back 45

urate (found in Dalmatians)

Front 46

Lower UTI diagnosis

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•Radiography/ultrasound - Contrast study•Urinalysisand pH measurement•Completediagnosis should include stone analysis where appropriate

Front 47

lower UTI treatment

Back 47

Short term•Surgicalremoval of stone•Dietto dissolve (struvite)•Antibioticsto treat any UTI•Nursingcare and monitoring post op

Long term•Dietto prevent reoccurrence•Encouragewater intake•Regularurinalysis/urine sediment exam to monitor

Diets – promote solubility and volume ofurine, wet diet is better for increases water intake. Alter pH and dietary components. Aim for pH6.7-7 to prevent both struvite and calcium oxalate

Front 48

FLUTD

Back 48

Feline Lower Urinary Tract Disease

Front 49

Feline lower urinary tract disease

Back 49

involve bacterial infection or uroliths

feline idiopathic cystitis (FIC)
55% are suggested to be of unknown causeCertainfactors may increase risk as well such as obesity/dry diet

Stress– environmental factors including multicat households where there is conflictpresent may reduce water intake and urine elimination.

Front 50

FLUTD signs

Back 50

•Clinicalsigns are cystitis like signs – haematuria, dysuria, pollakiuria••Mayhave obstruction (blocked bladder) which could result in renal failure orbladder rupture–Clinicalsigns in these cases are urinary tenesmus and vocalisation–Anuria–Large,painful bladder•EMERGENCYCASES! - A cat showing signs of obstruction should be seen immediately

Front 51

'blocked cat' treatment

Back 51

•Assessmentof cardiovascular system (hyperkalaemia caused by blockage can have markedaffect on CV system)•Relieveobstruction (retrograde hydropulsion)•Catheterisebladder and flush urethra and bladder to remove any crystals/debris

If hyperkalaemia is symptomatic then stabilisation(fluids/meds) is required prior to any sedation/GAIf can not relieve obstruction (or need to stabilise first)bladder size may be reduced in the short termvia cystocentesis (carries risk of rupture) while nextstep is considered such as urethrostomy/cytostomy tube.

Front 52

FLUTD long term management

Back 52

•Diet(wet diet/specific prescription diet)•Increasewater intake•Considerhome environment –availabilityof resources–environmentalenrichment–pheromonetherapy•Medications•Monitorfor signs of relapse/blockage

Front 53

what is non neurogenic incontinence?

Back 53

associatedwith anatomical/functional disorders of the urinary tract - ectopic ureter, urethal sphincter mechanism incompetence (USMI)

Front 54

what is neurogenic incontinence?

Back 54

involvessacral spinal cord and likely to be combined with other neurological signs - spinal cord injury/disease

Front 55

incontinence signs

Back 55

•‘Wetpatch’ on bed•Urinationwhilst walking•Urinescalding

Front 56

incontinence treatment

Back 56

•Preventscalding with barrier creams•Frequentopportunity to urinate•Surgeryfor anatomical defectsMedicationfor USMI

Front 57

urine retention

Back 57

•Possibleafter spinal injury/RTA (neurogenic)•Mayshow signs of incontinence (over-flow)•Unproductivestraining (dysuria/stranguria)Treatment- medications to relax/contract muscles - Timing of medications is important toensure co-ordinated contraction and relaxation

Front 58

dysuria means...

Back 58

difficulty urinating

Front 59

Pollakiuria means...

Back 59

protein in the urine

Front 60

stone to form in alkaline urine is...

Back 60

struvite