Urinary 3 Flashcards by Millie Dinan

What viraemic cause can lead to renal haemorrhage and what does it look like macroscopically

Canine herpes virus 1
See multifocal red areas on surface indicating haemorrahge

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What organism can cause septicaemia and renal haemorrhage

Salmonella

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What does cortical necrosis look like grossly and microscopically

Gross: pale, swollen areas that stop sharply at corticomedullary junction

Histologically: necrosis of tubular epithelium and glomeruli

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What part of the kidney is very sensitive to ischaemia

Cortex due to high metabolic demand

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Appearance (gross + histo) of acute tubular necrosis

Cortex is pale, moist
See patchy necrosis of the prox and distal tubules but glomeruli are spared

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How does having acute tubular necrosis caused by ischaemic vs toxic causes affect regeneration

Regneneration is dependent on intact basemement membrane
- is intact with Toxic causes but not with ischameic

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When do we get renal medullary necrosis as well as cortical

Response to ischaemia if
- More than 2 hours ischaemia
- Urinary obstruction
- NSAIDs given which inhibit vasodilation + dehydrated pateitn
- Pyelonpehirits
- Amyloidosis

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How can renal medullary necrosis predipose to calculi

Necrotic tissue sloughs into ureter and can provide nidus for calculi to form on

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What do necrotic cells look like in acute tubular necrosis

Brightly eosinophilic, separated from neighbours

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are What two toxic causes of acute tubular necrosis

Antibiotics (aminoglycosides, tetracyclines, amphotericin)
Ethylene glycol

Others are lillies, heavy metals etc

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What do kidneys with ethylene glycol toxicity look like grossly and histologically

Gross = swollen, pale kidneys with radial streaks
Histo = tubulointerstitial necrosis, calcium oxalate crystals are pale and radiation in the tubular lumen

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What do we see in acute intersittial nephritis

Enlarged pale kidney with streaking and small white nodules throughout cortex
= white spotted kdiney

Histo: oedema and neutrophil infiltrate, tubular epithelium degeneration and necrosis

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What does white spotted kidney mean

Inflammation focussed on interstitium

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What do we see in chronic interstitial nephritis

Interstitial fibrosis
Fibrosis and atrophy of tubules too
Chronic inflammatory cells; lymphocytes, macrophages, plasma cells packing the space between the (degenerating) tubules

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two infectious causes of interstitial nephritis in dogs

Canine adenovirus 1
Leptospirosis

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What serovars of leptospirosis cause interstitial nephritis in dogs

 L interogans serovars canicola (more chronic) and icterohaemorrhagiae (more acute)

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When do we see white spotted kidney in lepto cases

In those whih have survived acute septicaemia so disease focus moves from liver to kidneys to cause acute inflamation in the interstitium

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When is acute leptospirosis most significant in dogs

In leptospiraemic phase in puppies

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Acute leptospirosis signs

Widespread haemorrhages, hepatic lesions, subcapsular real haemorrhages
ANiaml may be icteric, dehydrated, fever etc

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Diagnosing leptospirosis

Best is immunoflourescence on urine or tissue
Also PCR

[Used to use silver stain called Warthin starry but less common now]

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What is the gross and microscopic pathology of leptospirosis (more chronic form)

White spotted kidney
Acute diffuse interstitial nephritis; starting with odema, etc then get lymphocytes, plasma cells and fibrosis as it becomes chronic

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What infectious agents can cause granulomatous interstitial nephritis

cats

FEline infectious peritonitis *****
Fungi
Mycobacteria

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Appearance of kidney of cat affected by dry FIP

+histo

White spot lesions with fluffy edges that may coalesce and are centred on blood vessels
= sign of interstitial nephritis

HIsto: pyogranulomatous nephritis and vasculitis, neutrophils, macrophages

Clinical history suggestive of FIP e.g uveitis; tends to be dry form

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LEsions and Histopath of pyelonephritis

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Dilated tubules full of neutrophils

ULcers, dilation abscessation of pelvis (this is where lesion starts)
In chronic cases can get scarring and contraction

What organisms are commonly involved in pyelonephritis

Gram -ve enterics via ascending UTI - E coli, staph, strep, pseudomonas, proteus

WHat does kidney lymphoma look like

White nodules on cortex; well circumscibed (c/f FIP lesions) Affects older cats compared to FIP

What is the most common ureteral abnormality

Ectopic ureters MOre common in females

What are females vs males more prone to in terms of lower urinary tract issues

Females to UTI due to shorter urethra Males to obstruction due to convuluted urethra

WHich breeds of dogs have familial inheritance of ectopic ureters

Husky Labrador

what drug can cause sterile haemorrhagic cystitis

Cyclophosphamide

Predisposing factors for cystitis

urine stasis, incomplete voiding, bladder trauma, glucosuria (in diabetes mellitus; glucose can act as nidus for infection), dilute or alkaline urine, anatomy

What species often cause cystitis

E coli Proteus

Post renal causes of azotaemia

Blockage Urinary tract rupture

Pre renal causes of azotaemia

Hypovolaemia Reduced cardiac output e.g in heart failure, general anaesthetic

Renal causes of azotaemia (= most common type)

- Toxins; ethylene glycol, lillies, grape/raisin, NSAIDs, hypercalcaemia - Infection: leptospira, FIP, pyelonephritis - Ischaemia - Neoplaisa; mostly lymphoma - Systemic disease

Clinical signs of acute kidney injruy

Vague - Anorexia, lethargy, vomting etc Fever Dehydration Most have reduced urine output Uraemic breath

What will USG be like depending on whether AKI cause is pre-renal or renal

Pre-renal will be concentrated; >1.030 in dogs >1.035 in cats Renal will be suboptimlly concentrated; <1.030 in dogs <1.035 in cats

Signs of tubular damage in urine sedimentation

Proteinuria, glucosuria, casts Calcium oxalate = typical of ethylene glycol toxicity

Treating leptospirosis as cause of AKI

Amoxicillin for 2 weeks then doxy for 2 weeks Or just 4 weeks doxycyclien

Treating ethylene glycol as cause of AKI

- Emesis if recent - Fluids - Antizol - Ethanol to compete with alcohol dehydrogenase enzyme to stop metabolism of EG to toxic compounds - Dialysis

Dealing with NSAID toxicity as cause of AKI

EMesis ACtivated charcoal Antacids Misoprostol (to act as prostaglandin analogue)

What is normal urine output

2ml/kg/hr

How to correct hyperkalaemia in AKI

Calcium gluconate Glucose/insulin Sodium bicarbonate Fluids to encourage exretion

What is peritoneal dialysis

Using osmotic gradients to remove excess water or solutes from plasma; membrane = peritoneal = expensive but can buy time to deal with AKI

How does ethylene glycol cause AKI

The metabolites of EG are nephrotocins + get calcium oxalate crystals in tubules causing obstruction

What might more echogenic kidneys on ultrasound suggest is the cause of AKI

= due to calcium deposits - Calcium oxalate from ethylene glycol toxicity

Diagnosis of ethylene glycol toxicity

Calcium oxalate crystalluria Azotaemia, hyperkalaemia, hypocalcaemia because the oxalate is binding the calcium , metabolic acidosis Test within first 24hrs

When do EG patients usually present

Once in AKI - 30 mins post ingestion get ataxia, hypersalivation, vomiting but then look better - Not until. a day later that see severe AKI signs; anorexia, lethargy, vomiting, seizure, uraemic halitosis

Signs of urethral obstruction

Straining to urinate, vocalisation, enlarged painful bladder Male

What do we do first to stabilise acute urethral obstruction before going into sugery

Use IV fluids to deal with hyperkalaemia (can get bradycardia and death under GA) Calcium gluconate is cardioprotective

What is urohydropropulsion

Can be done if catheterisation unsuccessful in blocked cat - Advance catheter up to obstruction point; another person puts finger in rectum and pressed ventrally to occlude urethra - inject fluid rapidly along cathter to cause urethral dilation - Release finger from anus to allow uroliths to be flushed back into bladder

What urethral muscle relaxants do we use in cats post-catheter removal

Dantrolene for skeletal muscle PRazosin for smooth muscle

What issues to catheters left in predispose to

AScending infection Traumatisation and urethrospasm leading to re-obstruction when removed

When might we do perineal urethrostomy

* Obstruction than cannot be relieve * Trauma to penile urethra * Strictures that occur post-catheterisation * Neoplasia * Recurrent episodes of obstructive FLUTD

Do we recommend prophylactic antibiotics for UTI prevention after removing urethrolith

No Can predispose to becoming infected with persistent, antibiotic resistant bacteria

What would be some differentials for bilateral renomegaly in a cat

Obstruction at level of bladder/urethra and hydronephrosis Lymphoma metastasis to both Nephritis Dry FIP AKI

Urinary 3 Flashcards

(58 cards)