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45 Cards in this Set
- Front
- Back
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Systemic host defenses leading to UTI
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Humoral immunity
-Immunosuppression Cellular immunity -Neutrophil dysfunction Urine composition -Diabetes mellitus -Renal failure -Cushing’s disease |
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Occurrence of UTI in dogs
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2-3% (more often in female dogs)
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Occurrence of UTI in cats
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<1%
>40% in cats 10 yrs or older |
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Conditions for a bacterial UTI
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A bacterial urinary tract infection occurs when there is a break (temporary or permanent) in the host defenses and a virulent bacterium in sufficient numbers is allowed access to the urinary system, adheres, and multiplies
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Lower vs. Upper UTIs
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Lower: Dysuria, Pollakiuria, Impaired ability to void, Usually BAR, No pain - except prostate or bladder, Asymptomatic
Upper: Febrile, Depressed, Anorexic, PU/PD, Abdominal pain near kidneys, Asymptomatic |
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Most common bacteria w/ UTI in dogs and cats
Second most? Others? |
E.coli
Gram positives (Staph and Strep) Klebsiella, Proteus, Pasteurella, Enterobacter, Pseudomonas, Corynebacterium, Mycoplasma |
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Diagnosis of UTI
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Hematuria (>5-10 RBC/hpf)
Pyuria (>5 WBC/hpf) Bacteria -Rods >10,000 cfu/mL -Cocci >100,000 cfu/mL -Stained much more reliable that unstained Cellular casts Urine culture is the Gold Standard |
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Desired Characteristics of an Antibiotic
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Easy to administer
Few side effects Cheap Can reach 4 X MIC in urine or tissues Unlikely to affect fecal flora |
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Criteria for complicated UTI
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Intact male or female dog
Predisposing systemic and/or local factor(s) Recent previous UTI’s (>3/yr) Cat |
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Rule-outs for proteinuria
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Inflammation (sediment/UA)
Infection (sediment/UA) Hemorrhage (sediment/UA) Glomerular disease |
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Proteinuria false positives (dipstick)
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Alkaline urine (pH >7.5)
Contamination w/ ammonia compounds (cleaners) Prolonged contact w/ urine Pigmenturia |
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Proteinuria false negatives (dipstick)
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Very dilute urine
Very acidic urine Abnormal proteins (Bence-Jones) |
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Ranges of protein detection:
Dipstick Sulfosalicylic acid Microalbuminuria |
Dipstick: 30-30,000 mg/dL
Sulfosalicylic acid: 5-5,000 mg/dL Microalbuminuria: 1-30 mg/dL |
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Pre-renal proteinuria
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Physiologic (exercise, stress, fever, etc.)
Overload (hyperproteinuria, myoglobinuria, hemoglobinuria) |
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Renal proteinuria
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Glomerulonephritis
Amyloidosis Congenital glomerular disease Tubular dz (Fanconi Syndrome) Glomerular: moderate to large quantity Tubular or interstitial: small quantitiy |
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Clinical signs of proteinuria
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Albumin 1.5-3 g/dL: polyuria, weight loss, lethargy
Albumin <1.5 g/dL: Above, plus muscle wasting, edema/ascites Thromboembolism from loss of antithrombin 3 |
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Causes of glomerulonephritis (glomerulopathy)
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Familial
Neoplastic Infectious Inflammatory Miscellaneous (DM, Cushing's, steroid therapy, hypertension) Most classified as idiopathic |
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Treatment of proteinuria
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Diet-Low protein, low sodium, ???
ACE inhibitors (enalapril, benazapril)-dilate efferent arteriole Fish oils Low dose aspirin Diuretics (thiazide, furosemide) to decrease sodium and fluid retention |
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Prognosis for glomerulonephritis
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Poor; most dead within 1-2 months
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UTI signalment
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2-3% in dogs
-More common in females -More common in older dogs <1% of cats -Very rare in cats <10 yrs ->40% in cats >10yrs |
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Relapse of UTI
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Recurrence with same organism
Usually occurs in days to weeks after discontinuing antimicrobials -From inappropriate drug, inappropriate dosage, frequency, or duration, complicating factors |
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Reinfection (UTI)
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Recurrence with different organism
Usually occurs weeks to months after discontinuing antimicrobial 3/yr cutoff for complicated vs. uncomplicated |
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Complicating factors for recurrent UTIs
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Recessed vulva
Deep-seated infection (neg. urine culture w/ pos. bladder wall or urolith culture) Anatomic defects (ectopic ureter) Indwelling catheter Complicating disease (DM, Cushing's, hyperthyroidism, renal failure) Bacterial factors (resistance, unusual) |
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Minimizing UTI with catheter placement
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Use intermittent catheterization when possible
Remove indwelling catheter ASAP Use closed collection system Avoid antimicrobial therapy |
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Treatment of resistant E. coli UTI
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Fluoroquinolones at high dosage
Aminoglycosides (Amikacin less nephrotoxic than Gentomycin) Potentiated beta lactams -Amoxicillin-clavulanic acid at higher dosage!! Penems (Meropenem) 3rd Generation cephalosporins |
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Treatment of resistant Staph UTI
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Chloramphenicol
Linezolid Vancomycin!!! -Discouraged due to potential for inducing resistance |
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Treatment of Enterococcus UTI
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Not treating may be better than treating
Not associated with clinical signs |
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Prophylactic treatment for frequent UTIs
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Choose based on culture and susceptibility testing
1/2 to 1/3 of daily therapeutic dose Re-culture urine every 4-6wks May develop resistant bacteria |
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Methenamine
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Hydrolyzed to formaldehyde at acidic pH
Often given with acidifiers May cause systemic acidosis; don't give with renal failure Antiseptic; not antibiotic! |
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Mechanism of action of cranberry
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Proanthocyanidins bind adhesins that are involved with binding of bacteria to uroepithelial cells
Not on all E. coli (25-50%) and not on all bacteria |
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Factors contributing to urolith formation
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Urine pH
State of saturation Inhibitors and promoters of urolith formation Complexors Macrocrystalline matrix |
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Factors considered in guesstimation
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Urine pH
Crystalluria Bacterial UTI Radiographic characteristics Serum and urine biochemical analysis Signalment |
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Urine pH of uroliths:
Sterile struvite, infection induced struvite, calcium phosphate, urate, calcium oxalate, cystine |
6.5 and up, basic, basic, acidic to neutral, acidic to neutral, acidic
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Long-haired cats have higher risk of _________
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calcium oxalate
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Cats less than 10 years more commonly have ____________
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struvite stones (sterile)
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Most common type of struvite stones in dogs
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infection-induced struvites
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Most common struvite stones in young adult cats
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Sterile struvites
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Most common struvite stones in kittens and cats >10yrs
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Infection-induced struvites
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Guesstimation consistent with struvite stones
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pH: alkaline
crystals: struvite UTI: Staph, proteus, if infection induced Radiographic appearance: radiodense Size: sterile small (<5-10mm) infection-induced larger Smooth; infection-induced are pyramidal |
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Pathophysiology of struvite stones
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matabolism of urea to ammonium and carbonate
Alkaline pH Changes ionization state of phosphorus Struvite less soluble when urine pH is >6.8 |
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Pathophysiology of sterile struvite stones
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Post-prandial alkaline tide
-HCl secreted into gastric lumen results in metabolic alkalosis |
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Struvitolytic/calculolytic diet
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Low protein
Low magnesium Low phosphorus Acidifying Diuresis (high salt) |
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Dissolution of urate stones
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With liver disease, unsuccessful
Without: Diet- Ultra-low protein, alkalinizing, diuresis (u/d) Allopurinol Dissolution in 4-8 wks or not at all No protocol in cats |
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Prevention of urate stones
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Feed ultra low protein diet
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Allopurinol mechanism of action
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Inhibits xanthine oxidase
Prevents conversion of xanthine to uric acid |
