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What is the anatomy of the urinary system?
- kidneys
- ureters
- bladder
- urethra
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What are the functions of the urinary system?
- waste removal
- eryhtropoietin production
- water and electrolyte balance
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What are the different urinary system diseases?
- feline cystitis
- canine cystitis
- transitional cell carcinoma
- leptospirosis
- renal failure - acute and chronic
- spay incontinence
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What are the different types of feline cystitis?
- FLUTD - feline lower urinary tract disease
- FLUTI - feline lower urinary tract inflammation
- FUS - feline urologic syndrome
- feline interstitial cystitis
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What are the clinical signs of feline cystitis?
- hematuria
- pollakiuria
- dysuria
- stranguria
- vocalizing during urination
- licking genitalia
- inappropriate urination
- obstruction
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What are the clinical signs of a cat that is obstructed?
- inability to urinate
- straining in the litter box - owner's may report constipation
- hiding
- painful abdomen
- depression
- weakness
- anorexia
- dehydration
- hypothermia
- acidosis
- electrolye
- disturbances
- bradycardia
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How do we diagnose feline cystitis?
- clinical signs
- urinalysis - assess for crystals
- urine culture - negative
- radiographs
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How do we treat an unobstructed feline cystitis?
- most will be asymptomatic in 5 - 7 days without treatment
- 70% of cats with idiopathic FLUTD respond to placebo therapy
- antibiotics only if bacteria are present - culture and sensitivity
- diet change - canned food, add water to dry food to achieve more dilute urine
- alkaline urine with struvite crystals - struvite prevention diet
- alkaline urine with no crystals - tranquilizers, antispasmodics, amitriptyline
- reduce stress
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How do we treat obstructed feline cystitis?
- relieve the obstruction
- pass urethral catheter - avoid leaving in - can cause ascending bacterial infection
- fluid and electrolyte therapy
- perineal urethrostomy (PU) if needed
- nutrition - acidifying diet
- may obstruct again
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What causes canine cystitis?
- usually bacterial
- Escherichia coli, Staphylococcus intermedius, Streptococcus spp, Proteus, Klebsiella, Pseudomonas
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What are the natural defense mechanisms for canine cystitis?
- frequent voiding of urine
- urethral/ureteral peristalsis
- glycosaminoglycans in mucosa
- pH
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What are the causes of canine cystitis?
- ascending infection most common
- may descend from kidney, or come from prostate
- microorganisms must adhere to and colonize the mucosal lining
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What are the clinical signs of canine cystitis?
- frequent voiding of small amounts of urine
- dysuria
- hematuria
- cloudy urine, abnormal color
- frequent licking at urethral area
- abnormal urine
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How do we diagnose canine cystitis?
- urinalysis - sediment and dipstick (bacterial, increased WBCs)
- urine culture and sensitivity
- radiographs
- ultrasound
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How do we treat canine cystitis?
- antibiotics - clavamox, baytril, trimethoprim sulfa, cephalexin
- give 10 - 14 days for first time treatment
- chronic infection - 4 - 6 weeks
- diagnose and treat underlying disease - neoplasia of the bladder, diabetes mellitus, pyometra
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What is TCC?
transitional cell carcinoma
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What is transitional cell carcinoma?
bladder neoplasia
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What is the most common malignant bladder tumor of dogs?
transitional cell carcinoma
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Is TCC more common in males or females?
females
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Is TCC more common in dogs or cats?
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What are the clinical signs of transitional cell carcinoma?
- hematuria, pollakiuria, dysuria
- signs of urethral obstruction
- chronic UTI - urinary tract infection
- signs of metastasis
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How do we diagnose transitional cell carcinoma?
- rectal palpation may reveal changes
- urine sediment
- radiographs
- ultrasound
- biopsy
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How do we treat transitional cell carcinoma?
- surgical excision is the best treatment but is often not possible
- chemotherapy or radiation therapy - short remission - weeks to months
- antibiotics
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What is the prognosis for transitional cell carcinoma?
- prognosis is good if surgically removed, benign
- prognosis is poor if tumor has invaded surrounding tissues
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What causes leptospirosis?
- Leptospira interrogans bacteria
- Leptospira canicola
- Leptospira icterohemorrhagica
- Leptospira pomona
- Leptospira grippotyphosa
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How is Leptospirosis usually transmitted?
through infected urine
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Where does leptospirosis usually enter the body?
- through mucous membranes, multiple in renal tubules
- inflammation int he kidney is due to multiplication of the organisms and toxic by products
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What are the clinical signs of Leptospirosis?
- acute renal failure, with or without hepatic involvement
- dehydration, vomiting, fever, thirst
- reluctance to move (myositis)
- jaundice
- petechial hemorrhages
- peracute shock and death
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How do we diagnose Leptospirosis?
- serum titers
- polymerase chain reactions (PCR) - can identify the serovar
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How do we treat Leptospirosis?
- supportive therapy
- antibiotics
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How do we educate clients about Leptospirosis?
- immunization
- adequate sanitation of the kennel
- decrease exposure to wild or domestic carriers
- zoonotic
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How long do animals shed the leptospirosis virus in their urine?
for up to 6 months
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How do humans usually get leptospirosis?
from contact with cattle or wild rodents
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Is renal failure acute or chronic?
can be either
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What is the job of the kidneys?
filtration and waste management
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Approximately _____ of the total cardiac output passes through the kidney at any one time.
20%
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What can a reduction in blood flow to the nephrons cause?
renal failure
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What causes renal failure?
- nephrons are damaged
- filtration declines
- build-up of toxins in the body - azotemia
- azotemia produces the clinical signs of renal failure
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When does renal failure occur?
when 75% of the nephrons cease to function
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What is acute renal failure?
abrupt decrease in filtration
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What does acute renal failure result in?
azotemia
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What are the causes of acute renal failure?
- hypoperfusion - dehydration, hemorrhage
- toxins - AMGs - gentamicin, Metofane, ethylene glycol
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What are the clinical signs of acute renal failure?
- lethargy
- depression
- vomiting
- diarrhea
- anorexia
- dehydration
- maybe fever
- polyuric or oliguric
- kidneys painful on palpation
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How do we diagnose acute renal failure?
- physical exam, history - potential exposure to a nephrotoxin
- urinalysis, blood chemistries
- increased BUN and creatinine
- renal biopsy - definitive but usually not done
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What is the treatment for acute renal failure?
- IV fluids - induce diuresis - to increase blood flow and infiltration in the kidneys
- discontinue nephrotoxic drugs
- supportive care for GI sings
- provide adequate and high quality nutrition
- if acute renal failure is reversible, nephron repair and compensation occur within 10 - 21 days
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What is CRF?
chronic renal failure
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What is considered chronic renal failure?
persistent azotemia for more than 2 weeks
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What is chronic renal failure a loss of?
nephrons and filtration
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Chronic renal failure causes a decreased production of what?
the hormone erythropoietin - anemia
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What are the clinical signs of renal failure?
- history of weight loss
- PU/PD
- weakenss
- dullness
- lethargy
- anorexia
- vomiting
- diarrhea
- oral ulceration
- non-regenerative anemia
- small irregularly shaped kidneys
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How do we diagnose chronic renal failure?
- clinical signs
- increased BUN, creatinine
- USPG under 1.020, proteinuria
- non-regenerative anemia
- hyperphosphatemia
- hypokalemia, abnormal blood Ca
- metabolic acidosis
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How do we treat chronic renal failure?
- severity of clinical signs can be reduced with proper treatment
- fluid therapy - owners can be taught to give SQ fluids at home
- phosphate binder - Amphojel
- postassium supplemtn - Tumil - K
- sodium bicarbonate
- erythropoientin injections for anemia
- GI medications for nausea, vomiting and diarrhea - ranitidine - Zantac - H2 blocker
- nutritional support with high quality, low quantity protein diet
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How do we educate clients about chronic renal failure?
- chronic renal failure is progressive and irreversible
- fluids may be required at home
- eventually the pet will experience a decrease in quality of life
- may have to consider euthanasia
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What causes spay incontinence?
- estrogen deficiency
- urethral incontinence - loss of smooth muscle tone of the urethra
- allows leakage of urine from the bladder
- responsive to reproductve hormones
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What are the clinical signs of spay incontinence?
- medium to large breed dogs
- urine leakage when sleeping
- perineal area stays moist
- older spayed female dog
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How do we diagnose spay incontinence?
- history and physical exam
- urinalysis and urine sediment
- work up for underlying disease such as the ones that cause PU/PD
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How do we treat spay incontinence?
- identify and treat urinary tract infection if present
- drugs - PPA, DES
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What is PPA?
- phenylpropanolamine
- stimulates smooth muscle contractions of the urethral muscle
- used as a decongestant in humans
- removed from human market due to potential to cause stroke
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What is DES?
- diethylstilbestrol
- estrogen drug
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What are the side effects of PPA?
- anxiety
- hyperactivity
- tachycardia
- GI upset
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What are the side effects of DES?
causes bone marrow suppression
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