1
Q
What is FGF-23?
A
a phophotonin that works in concert with a-klotho to regulate phosphate when phosphate is increased.
2
Q
Where is FGF-25 secreted from?
Why?
A
Osteoblasts and osteoclasts.
Response to high filtered load of phosphate in the nephron (secondary to increased phosphate absorption from the GIT)
3
Q
What is the role of FGF-25?
A
Binds FGF-1 receptror and a-Klotho to down regular 2 Na-Phos transporters in the prox tubule (NPT2a and NPT2c) => reduced reabsorption of filtered phosphate => increased urinary excretion of phosphate . (dependant on GFR and plasma phos conc)
- inhib phosphate absorption from GIT via inhim conversion of 25-OHcholecalciferol to calcitriol via effections on both the calcitrol synthesising (CYP27B1) and catabolising (CYP24A1) enx.
- inhib phosphate absorption from both via inhib PTH secretion.
4
Q
in regards to renal disease, when does increases in FGF-25 start to occur?
A
Early renal disease prior to onset of azotaemia (Stage 1) and increases proportionately with the stage of CKD (consistent with reduced GFR given it is renally excreted).
However can be excessively increased compared to plasma phosphate targets for given stage.
5
Q
What is FGF-25 a marker for in cats?
A
- the stage of feline CKD
- predictive of progression of the development of azoaemia
- phsophate overload and potentially thus whether phosphate restriction may be beneficial
- all cause mortality.
6
Q
Is FGF-25 affected by dietary phosphate restriction?
A
yes - causes reduction.
7
Q
What is Klotho?
A
a paracrine and endocrine, transmembrane protein.
8
Q
Where is it expressed and in what forms?
A
a-Klotho: transmembrane protein
- distal renal tubules
- PTH gland
- Choroid plexus
- Vascular tissues.
Soluble Klotho: - body fluids inc CSF, blood and urine from the shedding of membrane Klotho
B-Klotho: fibroblast growth factor for bile acid synthesis and lipit metabolism.
- liver
- pancreas
- adipose tissue
9
Q
What does Klotho do?
A
- A-Klotho = Obligate co-receptor for FGF-23 => reduce circ phosphorus
- inactivate Na-P cotransporters type 2 (NaPi-2) = > inhib renal phos reabsorption
- reduce 1a-hydroxylase and increase 24-hydroxylase => reduced calcitriol - Soluble Klotho:
- activates TRPV5 and TRPV6 calcium channels in distal tubles => increased renal calcium reabsorption
- down reg NaPi-3 cotransporters to mediate phosphate uptake
- Activates ROMK1 K+ channels => increased K+ excretion in kidneys
- up reg NO production
- Increase Na+’K+ATPase in kidney , PTH gland and choroid plexus => Na and Ca+ homeostasis.
- Inhib insulin and IGF1 => insulin resistance
10
Q
What decreases Klotho expression?
A
- ATII
- Oxidative stress/inflam cytokines (TNF-a)
- CKD
- Immune med glomerulopathy
in CKD:
- hyperphosphateamia
- hyper calcaemia
- reduced calcitriol
- inflam cytokines
- dyspilidaemia
- activated RAAS
11
Q
What increases Klotho?
A
Age - younger = higher
- healthy = higher
- Calcitrol
- ARBs
12
Q
What is the prevalence of hypernatraemia in dogs and cats?
does this affect prognosis?
A
Dogs - 5.7%
Cats 8%
hypernatraemia assocaited with 20-28% risk of death with higher Na associaed with higher case fataily.
Ueda JVIM 2015
13
Q
What is hyperchloremic metabolic acidosis?
What are the causes?
A
- decrease pH
- decrease HCo3- or base excess
- increase chloride
- decreased in strong ion difference
- normal anion gap
Causes:
- Excessive sodium loss ralative to chrloide
- excessive gain of chloride relative to sodium (0.9% NaCl, salt poisoning, TPN with AA containing fluids)
- Chloride retention (early CKD, hypoA, spironolactone, corection of DKA, RTA)
Funes VCNA 2017
14
Q
What are the causes of hyperkalaemia?
A
only really if kidneys not working to excrete.
- Extra-renal
- increased intake (only wiht concurrent issues kidney/adrenal/drugs)
- GI disease (trichuris, salmonela, perf duodenal ulcer)
- Chylothorax, plerual or peritoenal effusions (thrid space fluid loss) - Translocation from intracellular to extracellular fluid
- DKA/insulin deficiency
- Massive sittue break down/Tumour lysis syndrome/repurfusion injury
- Metabolic acidosis (acute mineral acidosis)
- Hyerkalemic periodic paralysis (NA+/K+ ATPase dysfunction)
- Drug induced/iatrogenic (propanolol - decreases liver/muscle uptake of K+) - Renal:
- AKI (decreased GFR => decreased K+ excretion)
- CKD end stage
- ureteral obstruction
- Ruptured bladder
- HypoA (decreased Na+/K+ ATPase activation due to reduced aldosterone)
- Drug induced - ACEi, ATII RB, Spironolactone, NSAIDs, Heparin, Cyclosporin, Tacrolimus, TMPS
- Hypoerninemic hypoaldosteronism
- Late pregnancy in greyhounds. (GI fluid loss?) - Spurious:
- Leukocytosis (>100,000 leukocytes/uL)
- Severe thrombocytosis
- haemolysis (Akita/Shiba)
- contaimination with IVFT, EDTA, oxalate
15
Q
What are the causes of hypokalaemia?
A
GIT or renal loss.
- Extra renal:
- decreased K+ intake - anorexia, diet, K+ free IVFT
- Increased K+ loss via GIT
2.Translocation extracellular to intracellular fluid:
- Glucose cotnaining fluid with or without insulin
- TPR solution
- Caecholamines (phaeo)
- Hypokalaemic periodic parlaysis - burmese, anomolous activation of Na+/K+ ATPase
Other - albuterol overdose, hypothermia
- Renal:
- CKD
- Distal (type I) RTA
- Proximal (type II) RTA
- DIet induced hypoaleamic nepropathy
- post obstructive diuresis
- osmotic diuresis (DKA)
- Drug induced: diuretics (loop, thiazide), amphotericin B
- hyperA
- hyperaldosteron
- hyperT4
- other: peritoneal dialsys, flurocortisone excess, penicillins, high sodium intake
Kogika VNCA 2017
16
Q
What is the prevalence of proteinuria in healthy geriatric dogs?
A
11-15%
Meindl JVIm 2018
17
Q
What is the sensitivity and specificity of Idex sedivue for the detection of:
- RBc/WBC
- CaOx dihydrate
- Struvite
- Squamous epithelial cells
A
1. RBc/WBC Sens: 85-90% Spec: 87-90% 2. CaOx dihydrate Sens: 75% Spec: 99% 3. Struvite Sens: 85-90% Spec: 84% 4. Squamous epithelial cells Sens: 33% Spec: 99%
Hernandez JVUM 2017
18
Q
What is the variability of first morning USG in dogs?
A
mean difference between min and max for individual dogs was 0.015
mean coefficience of variance 15.4%
- inherent intraindividual variability
Rudinsky JVIM 2019
19
Q
What mutation is associated with renal cystadenomocarcinoma and nodular dermatofibrosis?
- what breed?
- what is the inheritance pattern?
A
Folliculin - a tumour suppressor gene, mutation
German Shepherds
dominant inheritance.
20
Q
What can cause renal amyloidosis?
What does it look like cytologically?
What stain is best to see this?
A
- Inherited: Shar Pei
- reactive (serum amyloid A accumulation) in abyssinians, idiopthic, infectious, chronic inflam or neoplasia
Cytoogically - undulous, glassy swirls of amorpohous eosinophilic materia in close associated with glomeruli or renal tubular epithelial cells.
Stain with congo red, examine under polaized light => apple green stain
VCNA 2017
21
Q
What are melamed-Worlinska bodies?
A
large magenta inclusions within epithelial cells associated with TCC.
VCNA 2017
22
Q
Are UPC usually higher on home or in clinic samples?
A
50% higher in clinic samples
Duffy JVIM 2015
23
Q
Is creatinine or SDMA influence by lean body mass?
A
SDMA - no
Creatinine - yes. lower LBM => reduced creatinine and risk of falsely overestimating gfr.
Hall JVIM 2015
24
Q
What proportion of dogs presenting to a cademic medical center have evidence of kidney injury?
In what sub groups was the relative risk higher?
A
11.5%
geriatric dogs
Babyak JVIM 2017
25
What proportion of geriatric dogs had persistently UPC >0.2?
| Is UPC measurement by free catch suitable?
19% had UPC >0.2
strong corrleation betwen free catch and cysto UPC.
Marynissen JVIm 2017
26
Can SDMA detect AKI?
| Can SDMA detect difference between CKD and AKI?
Yes - median SDMA in AKI 39ug/dL
Cannot detect difference between CKD and AKI in dogs
Dahlem JVIM 2017
27
Does storage medium or time affect UPC values?
Storage emdium - doesn't affect
time did not have any significant effect, however should be avoided storing at 4C for more than 12h as may increase UPC ratios.
Moyle JVIM 2018
28
What proportion of cats become azotaemic post I131 therapy?
16%
Peterson JVIM 2018
29
What is the sensitivity and specificity of SDMA to predict post I131 treatment (masked) CKD?
What does this mean clinically?
SDMA
Sens:33%
Spec 97%
Suggestive that few false positives but likely to fail to predict azotaemia in most hyperhtyroid cats
Peterson JVIm 2018
30
What is the within dog coefficient of variation for:
- Serum cystatin C
- Urinary retinol binding protein
- Urinary neutrophil gelatinase associated lipocalin
- Urinary IgG
over 1.5years.
- Serum cystatin C: 8%
- Urinary retinol binding protein 33%
- Urinary neutrophil gelatinase associated lipocalin 87%
- Urinary IgG 88%
Liu JVIM 2018
31
What is the :
- Index of individuality
- critical difference
- number of samples needed for haemostatic set point at 95% CI
for SDMA and creatinine?
Based on this, which is better for population based intervals?
What should be used to assess sequential measurements?
SDMA:
- Index of individuality: 0.87 (intermediate)
- critical difference 1.34 ug/dL
- number of samples needed for haemostatic set point at 95% CI: 45
Creatinin:
- Index of individuality: 0.28 (low)
- critical difference: 0.89 umol/L
- number of samples needed for haemostatic set point at 95% CI: 12
SDMA - better for population based reference intervals due to higher IOI.
Critical difference should be used to evaluate if changes are significant or due to biological variability.
Kopke JVIM 2018
32
```
What is the Sensitivity and specificity for:
- SDMA at 14ug/dL
- creatinine at 115umol/L
- Cystatin C at 0.49mg/L
for the dectection of decreased GFR?
What does this mean clinically?
```
- SDMA at 14ug/dL
Sens: 90%
Spec: 87%
- creatinine at 115umol/L
Sens: 90%
Spec: 90%
- Cystatin C at 0.49mg/L
Sens: 90%
Spec:72%
Cystatin C is inferior to SDMA or serum creatining for detection of decreased GFR.
Pelander JVIM 2018
33
What is the sensitivity, specificity, PPV and NPV of SDMA in cat to detect a 30% decrease from median mGFR?
How much sooner does this increase compared to serum creatinine?
```
SDMA:
Sens - 100%
Spec 91%
PPV 86%
NPV 100%
```
Increases 9 months sooner than creatinine
Yerramilli VCNA 2017
34
What is clusterin?
| What is its limitation as a biomarker for kidney disease?
Clusterin/Apolipoportein J - extracellular chaperone.
Expressed by lots of tissues.
- increased in urine with renal tubular damage and reduces as damage resolves.
- kidney specific urinary clusterin increases earlier and is more sensitive than creatinine for active kidney injury.
Limitation:
- much higher (nos-pecific) in serum than in urine, thus any blood contamination => false positives.
Thus need to use kidney specific urinary clusterin.
Yerramilli VCNA 2017
35
What percentage of cats with AKI have normal renal size and architeture on ultrasound?
What are the common renal u/s findings in cats with AKI?
6% have normal kidney size and architecture
Common renal u/s findings in cats with AKI
= renomegaly
- pyelectasia
- increased renal echogenicity
Cole JFMS 2019
36
What prognostic factors are associated with ultrasound abnormalities in cats with AKI?
- retroperitoneal fluids was associated with oliguria/anuria
- increase number ultrasound abnormalities is associated with poorer long term prognosis
Cole JFMS 2019
37
In dogs with AKI what changes during hospitalization were associated with markers of renal recovery?
- increased GFR
- increased urine production
- decreased fractional clearance of sodium.
were increased in surviving dogs.
Brown JVIM 2015
38
what is UNCR?
| Compared to creatinine, what is the benefit of this?
Urinary NGAL to urinary creatinine ratio
AKI diagnosed earlier than changes in creat based on a 7 fold increase in UNCR.
- initial decreased in UNCR was 2 days earlier than decreased in creat consistent with renal recovery.
Palm JVIM 2016
39
Does AKI cause changes in spec CPL, lipase or TLI?
What about in patients undergoing haemodialysis?
not usually.
only 12% had increased spec cPL
4% had increased lipase
34% had increased TLI
Hulsebosch JVIM 2016
However high prevalence of spec cPL >400 in dogs with AKI treated with haemodialysis (62%)
CPL not associated with outcome or requirement for dialysis.
Takada JVIM 2018
40
What is the mortality rate for patients presenting with heatstroke?
What proportion of patients presenting with head stroke had AKI?
Mortality rate - 35%
AKI 55%
Segev JVIM 2017
41
How much fractional excretion of electrolytes be used in AKI cases in dogs?
1. Differentiate between volume responsive and intrinsic AKI - higher in intrinsic
2. Increased fractional excretion of electrolytes associated with non-survivors/poorer outcome
Troia JVUM 2017
42
What proportion of dogs with AKI have volume response vs intrinsic AKI?
What is the overall fatality of AKI?
What are risk factors for death in dogs with AKI?
Volume response - 39%
intrinsic - 51%
Mortality - 41%
Risk factors:
- AKI IRIS grade
- higher fractional excretion of electrolytes
- urinary output
Troia JVIM 2017
43
What changes to haemostatic function are noted in dogs with AKI grade III or above?
- increased platelet cound
- decreased collagen activated platelet aggregation
- increased vWF Ag to collagen binding activity ratio => consistent with a type II vWF disease like phenotype.
=> increased bleeding
McBride JVIM 2018
44
What changes in iron status are seen in cats with CKD and anaemia?
- no difference in iron conc, ferritin conc
however:
- total iron binding capacity lower in cats with CKD
- percent transferrin saturation was lower in cats with CKD and aeamies
=> suggests iron deficiency does exist in cats wiht CKD and anaemia, however more likely functional than absolute.
Gest JVIm 2015
45
What factors may be associated with increased risk of development of CKD in cats?
- annual/frequent vaccination
- moderate to severe dental disease
Finch JVIM 2016
46
What changes with serum and urinary cystatin C are seen in cats with CKD?
Serum - can't distinguish between healthy and CKD.
Low sensitivity.
rinary Cystatin C couldn't be detected in all cats iwth CKD
=> not a reliable marker of reduced GFR in cats.
Or in hyperthyroid cats (Williams JVIM 2016)
Ghys JVIM 2016
47
What changes are seen in healthy older cats fed a moderately protein and phosphate restricted diet on their calcium/phophate homeostasis?
- increased urinary fractional excretion of phosphate
- reduced PTH compared to controls
- increased iCa++
48
Weight loss in cats with CKD can be seen, how long before diagnosis?
What % is lost in the 12m prior to diagnosis?
What prognositc factor is associated with weight and CKD?
weight loss noted 3 years prior to diagnosis
9% body weight loss in the year before diagnosis
cats <4.2kg at diagnosis had shorter survivals
Freeman JVIM 2016
49
What cut offs and sens and spec can be used to predict CKD progression in cats for
- uNGAL
- UNCR
What was the MST for cats with UNCR higher than the cut off?
urinary NGAL:
Cut off: 2,06ng.mL
Sens: 76%
Spec: 75%
```
UNCR:
Cut off: 04.08 x 10^-6
Sens: 76%
Spec:79%
MST - 19 days if higher than UNCR
```
Wang JVIM 2017
50
What is Beraprost sodium?
| What is its effect in cats with CKD?
Beraprost sodium: prostacyclin analog
- inhib expression of inflam factors
- inhib apoptosis of renal microvs edothelial and tubular epithelial cells
- inhib tubulointerstitial fibrosis.
In cats with CKD:
- inhib increase in serum creatinine
- inhib increase in P to Ca ratio
Takenaka JVIM 2018
51
How can contrast enhanced ultrasound examination of renal perfusion assict in evaluation of CKD?
Cats with CKD had longer time to peak and shoert mean transit times in renal cortex
=> consisten with decreased blood velocity, likely secondary to increased vascular resistance in CKD.
Stock JVIM 2018
52
What is prognosic importance of plasma magnesium in cat with CKD?
- hypomagensemia seen in 12%
- associated with increased risk of heath
- inversely related to plasma FGF2 conc
van den Broek JVIM 2017
53
What is the odds of cats with DM having CKD?
odds ratio: 4.47
Perez-Lopez JVIM 2018
54
What changes in the faecal microbiome are expected in cats with CKD?
- reduced diveristy and richness
- increased indoxyl sulphate (colonic derived uraemic toxin) concentration with CKD (stage2-4)
Sumner JVIM 2018
55
What GFR measurement method was SDMA evaluated against in dog initially?
How much of a decreased in GFR was noted earlier with SDMA?
iohexol clearance
20% decreased
JVIM 2015
56
What does the fractional excretions of IgM and IgG correlate most strongly with in dogs with proteinuric CKD?
- glomerular damage
Hokamp JVIM 2016
57
What do Urine IgM/creatinine and urine NAG/creatinine assist in the detection of in dogs with proteinuric CKD?
What was the sensitivity and specificity of these?
- detection of immune complex glomerulonephritis
- Sens: 75%
- spec 78%
Hokamp JVIM 2016
58
In dogs with proteinuric CKD what is associated with survival time?
- serum creatinine
- fractional excretion of IgM
- glomerula damage based on transmission electron microscopy
Hokamp JVIM 2016
59
What changes are seen with plasma FGF23 in CKD in dogs?
- increases with severity - higher in stage 3/4
- more frequently increased than pth or phosphate
- creat and phosphate were independent predictors of FGF 23 concentration.
Harkes JVIM 2017
60
What changes in Vit D levels are expected is different stages of CKD?
Does this correlate with any other changes in calcium homeostasis levels?
Vit D reduced in IRIS stage 3 and 4
Negatively correlates with PTH, FGF-23 and phosphorus
Parker JVIM 2017
61
What changes to bone are seen in dogs with CKD?
- mild
- smaller lacunae
- increased resorptive cavity density
- higher porosity
unlikely to manifest clinically.
Shipov JVIM 2018
62
What risk factors and their hazard ratio for survivial are their for dogs with CKD?
- increased creat: HR 1.3
- BCA <4/6: HR 1.5
- muscle atrophy: HR 2.3
- increased FGF-23: HR 2.6
- increased UPC: HR 3.19
- hyperphosphataemia: HR 3.2
Rudinsky JVIM 2018
63
What can urinary NGAL be used for?
uNGAL:Creat
- higher in dogs with progressive CKD than stable
- lower in pre-renal azotaemia and CKD/AKI
- may be able to differentiate progressive from stable CKD
Kim JVIM 2018
64
What percentage of dogs with CKD (inc IRIS stage 1) have bacteruria?
What percentage of these showed clinical signs?
What was the most common isolate?
In what dogs was it more likely and the odd ratio for this?
% dogs with CKD and bacteruria - 32%
- clinical signs - 8%
- Ecoli most common
- more likely in:
- females OR 3.2
- isostheuric uring OR 2.5
Lamoureux JVIM 2018
65
Is SDMA useful in monitoring patients with IRIS stage 4 CKD undergoing haemodialysis?
- yes:
- able to detect progression of CKD and les influenced by post dialysis rebound effect
- reduction in urea by 10% corresponded with reduction SDMA.
Le Sueur JVIM 2018
66
What impact does benazepril have on proteinuria and survival times in dogs with CKD?
- proteinuria significantly decreased
- no change in survival but insufficient numbers to confirm
Kind JVIM 2017
67
What is the efficacy of darbopoietin at increasing PCV in dogs with CKD and anaemia based on what targets?
Targets:
- PCV >30 - 85%
- increase PCV by > 10% - 67%
Fiocchi JVIM 2017
68
How frequently does darbopoeitin need to be given in dogs with CKD and anaemia?
what are possible afverse effects in dogs?
More often that q21d as ineffective less than this
Adverse effects inc:
- Pure red cell aplasia
- hypertension,
- seizures
- V+
- D+
Fiocchi JVIM 2017
69
What can be used to help differentiate tubulointerstitial vs glomerula proteinuria?
UPC: >2 - likely globmerula, <2 likely Tubulointerstitial
Urine sodium-dodecyl sulfate polyacrylamide gel electrophoesis:
- predominantly low molecular weight protien - likely tubulointerstitial
- intermiedate to high molecular weight proteins - likely glomerula.
VCNA
70
WHat are the proposed mechanisms by which ACEi may reduce proteinuria?
- decreased efferent glomerular arteroilar resistance => normalize/decreased transcapilary hydraulic pressure
- reduce loss of glomerula heparin sulfate
- decrease isze of glomerular capirlaly endothelial pores
- improve lipoportien metabolism
- slow glomerular mesangial growht and porlifer
- inhib bradykinin degradation.
71
Dogs with borrelia burgdorferi associated C6 antigen seropositive PLN area ssociated with what clinicopathological changes?
More likely to have:
- thrombocytopenia
- azotaemia
- hyperphosphataemia
- anaemia
- neutrophilia
- haematuria, glucosuria and pyuria with a negative urine culture.
Borys JVIM 2018
72
For cats with familial amyloidosis, what changes may assist in earlier detection of this disease? what does not?
increased urine SAA +/- proteinuria seen before onset of clinical signs.
Serum amyloid A and UPC not assocaited with famillial amyloidosis.
Paltrinieri JVIM 2015
73
what is fenoldopam?
| What is its effect in healthy dogs?
Fenoldopam - selective dopamin agonist.
CRI =>
- increased fractional excretion of sodium
- increased GFR
Kelly JVIM 2016
74
What percentage of dogs and cats with azotaemia have hypothermia? Does this change with dialysis?
Dogs - 20%
cats 38%
Temp increased in dogs and cats >5kg when receiving dialysis
Kabatchnick JVIM 2016
75
What is a circumcaval ureter?
What side does it occur on most frequently?
What proportion of cats with obstruction have this?
Does this impact survival in cats with obstruction?
what is the prefered treatment options?
- embryological malformation causing ventral displacemen of the CVC crossing the ureter and potentially causing stricture.
- more common on right side (80%)
- occured in 17% of ureteral obstructions
- doesn't impact survival post decompression but reobstruction more common if using stent
- SUB prefered as less reobstruction.
Steinhaus JVIM 2015
76
What types of inflammation are seen with proliferative urethritis in dogs?
What additional testing beyond culture and histopath should be performed?
- lymphplasmacytic
- lymphoplamsacytic-neutrophilic
- pleocytosis
- neutrophilic
FISH as well as 5 dogs had negative culture but were FISH positive.
Borys JVIM 2018
77
What cytokines may be increased in cats with idiopathic cystitis?
CXCL12
IL-12
IL-18
Flt3L (fms -related tyrosine kinase 3 ligand)
Parys JVIM 2018
78
What are some of the pathophysiological changes that may be associated with idiopathic cystitis in cats?
1. Bladder abnormalities:
- increase urothelial permeability due to decreased concentration of urinary GAG => increased irritation of mucosa by protons and K+ in urine => stim sensory neurons
- - exacebated by reduced urine volume and urinations (cat/envrinomental factors)
2. Neuroendocrine changes:
- chronic stress => increased CRF => increased ACTH and blunted cortisol response
+ increase catecholamine release.
=> increased sensory stim and altered urothelial permability.
* may see other stress related co-morbidities.
Forrester VCNA
79
What risk factors are their for the development of USMI in female dogs?
- dogs over 25kg that are desexed earlier in their first year of life.
- age of neutering doen't affect dogs <25kg
Byron JVIM 2017
80
What are the treatment options for USMI in female dogs?
- Phenylpropanolamine: non selective adrenergic agonis that increase urethral tone. Rsolution in 85%
- Oestriol (incurin): increases responsiviness of apharecetprs in symp NS thus increasing urethral tone. 80% improvement.
- Endoscopic bulking agents 66-68% continence with 5.2 to 16 months effective.
- hydraulic urethral occluder
- surgical slings
VCNA 2019
81
What are the treatment options for USMI in male dogs?
- Phenly propanolamin- 44%
- Testosterone +/- alpha adrenergic agonist - 38% respond, but 50% dont
- endoscopic bulking agents
- hydraulic occluder
VCNA 2019
82
What medications may be useful for management of detrusor instability?
- anticholinergics such as:
- oxybutnin
- flavoxate hydrochloride
- dicyclomine
- imipramine
83
What are the high risk breeds for CaOx uroliths?
- Bichon Frise
- Griddon
- Cairn terrier
- Chihuahua
- JRT
- Japanese Chin
- Lhasa Apso
- Mini pinscher
- Mini schnauzer
- Pomeranian
- Yorkie
Hunprasit JVIM 2018
84
Struvites:
1. Radio-opaque or lucent?
2. crystal shape?
3. Stone shape?
4. risk factors?
5. Dissolution possible? with what type of diet?
6. medications recommended?
```
Struvites:
1. Radio-opaque
2. crystal shape: - prism or rectangle with a cross
3. Stone shape: round to faceted
4. risk factors?
- urease producing organisms in dogs - staph, proteus, enterococcus.
(Sterile in cats)
- female dogs
- shih tzu, MN Schnauzer, Dachshund, pug, bichon
5. Dissolution possible? with what type of diet?
- restricted Mg, P and protein
- induced aciduria (pH <6.8)
- wet food
- smaller, more frequent meals
- increased urine vol
6. medications recommended?
- Appropriate antibioitcs
- D-L-methionine (urinary acidifier)
```
85
CaOx:
1. Radio-opaque or lucent?
2. crystal shape?
3. Stone shape?
4. risk factors?
5. Dissolution possible? with what type of diet?
6. medications recommended?
```
CaOx:
1. Radio-opaque
2. crystal shape?
Mono hydrate: dumbell
Dihydrate: box with a cross.
3. Stone shape?
- round, irregular, spiculated or star shaped. smaller.
4. risk factors?
- small dogs
- hypercalcaemia
- excessive GI absorption of Ca (MN Schnauzer)
- impaired renal absorption of calcium
- excesssive skeletal mobilization of calcium
- metabolic acidosis
- increased oxalates
- urine pH <6.5
increased USG
```
5. Dissolution possible? No
Diet recommendations:
- increase volume and reduce concentration to USG <1.040 (Cat) or < 1.030 (d)- eg. wet food, water flavouring
- avoid acidification (increases calciuria) target pH 6.6-7.5 thus need alkalysing diet
- no phosphate restriction and moderate Calcium restrictio n(provided not hypercalcaemia)
- avoid animal protein
- higher fibre (less acidify and may reduce GI Ca absorption)
- sodium restricted
6. medications recommended?
- potassium citrate if pH too acidic(=> increased urine bicarb) + increases soluble complexes with Ca
- thiazide diuretic if urine not dilute enough
- Vit B6?
86
Urate:
1. Radio-opaque or lucent?
2. crystal shape?
3. Stone shape?
4. risk factors?
5. Dissolution possible? with what type of diet?
6. medications recommended?
```
Urate:
1. Radiolucent to slightly radio-opaque
2. crystal shape?
- amorphous, speculated or globules
3. Stone shape?
round and smooth to mulberry
```
4. risk factors?
- Dalmation, bulldog (inborn error in metabolism SLC2A9)
- mini schnauzer, Shih tzu
- PSS/liver disease
5. Dissolution possible? yes if don't have underlying liver disease
with what type of diet?
- u/d or UC low purine (RC)
=> protein restricted, lower in purines
- alkalizing
- diuresing
* stay on long term for prevention
6. medications recommended?
- allopurinol (not cats)
87
Cystine:
1. Radio-opaque or lucent?
2. crystal shape?
3. Stone shape?
4. risk factors?
5. Dissolution possible? with what type of diet?
6. medications recommended?
Xanthine:
1. Radiolucent
2. crystal shape? globular
3. Stone shape? round to irregular. often multiple and small size (<5mm)
4. risk factors?
- liver disease or unrestricted dietary purines and allopurinol
- CKCS
```
5. Dissolution not possible.
Preventions with diet:
- protein restricted, eg low purines
- alkalizing
- adjust allopurinol
```
6. medications recommended?
- adjust allopurinol meds.
88
Cystine:
1. Radio-opaque or lucent?
2. crystal shape?
3. Stone shape?
4. risk factors?
5. Dissolution possible? with what type of diet?
6. medications recommended?
```
Cystine:
1. Radiolucent to marginally radio-opaque
2. crystal shape?
- hexagonal
3. Stone shape?
smooth and round to mulberry
4. risk factors?
- Bulldog
- prox tubular defect in reabsorption of AAs or altered intestinal transport of cystine
```
5. Dissolution possible? yes in dogs with what type of diet?
- low protein/low sulfa containing amino acids
- alkalinizing
- induces diuresis
=> U/d or RC UC
- renal diet in cats.
6. medications recommended?
2-mercaptopropionylglycine (2-MPG) binds cystine and prevents disulfide bones. (not catsd)
89
For chemotherapy for LUT carcinoma what methods can carboplatin be given?
What were the benefits of these?
Intravenous
Intra-arterial carbo to the tumour => greater decrease in size, less anamiea, lethargy and anorexia compared to IV carbo
Allstad JVIM 2015
90
What percentage of dogs with LUT TCC have UTI?
| what groups were more likely to have this?
55% - staph and ecoli
- female dogs
- urethral involvement more likely to have
budreckis JVIM 2015
91
What are risk factors for canine bladder TCC?
- female
- breed: scottie, shetland sheepdog, beagle, wire haired fox terrier, westie
- older insecticides
- obesity
Cannon VCNA 2015
92
What is the sensitivity of urine bladder tumour antigen tests?
88% but high number of false positives.
Cannon VCNA 2015
93
What are common first line chemotherapy agents for canine LUT TCC?
NSAID (piroxicam) (MST alone 4-6m) +
- mitoxantrone
- carboplatin
- vinblastine
response 35-38%
MST 8-11m
or
- doxorubicin
- gemcitabine
- metronomic chlorambucil
- intravesicular mitomcin C.
* screen for mets - LN, liver, lung, and bone. CT optimal
Cannon VCNA 2015
