What is the anatomy of the urinary system?
What are the functions of the urinary system?
- waste removal
- eryhtropoietin production
- water and electrolyte balance
What are the different urinary system diseases?
- feline cystitis
- canine cystitis
- transitional cell carcinoma
- renal failure - acute and chronic
- spay incontinence
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
What are the clinical signs of feline cystitis?
- vocalizing during urination
- licking genitalia
- inappropriate urination
What are the clinical signs of a cat that is obstructed?
- inability to urinate
- straining in the litter box - owner's may report constipation
- painful abdomen
How do we diagnose feline cystitis?
- clinical signs
- urinalysis - assess for crystals
- urine culture - negative
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
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
What causes canine cystitis?
- usually bacterial
- Escherichia coli, Staphylococcus intermedius, Streptococcus spp, Proteus, Klebsiella, Pseudomonas
What are the natural defense mechanisms for canine cystitis?
- frequent voiding of urine
- urethral/ureteral peristalsis
- glycosaminoglycans in mucosa
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
What are the clinical signs of canine cystitis?
- frequent voiding of small amounts of urine
- cloudy urine, abnormal color
- frequent licking at urethral area
- abnormal urine
How do we diagnose canine cystitis?
- urinalysis - sediment and dipstick (bacterial, increased WBCs)
- urine culture and sensitivity
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
What is TCC?
transitional cell carcinoma
What is transitional cell carcinoma?
What is the most common malignant bladder tumor of dogs?
transitional cell carcinoma
Is TCC more common in males or females?
Is TCC more common in dogs or cats?
What are the clinical signs of transitional cell carcinoma?
- hematuria, pollakiuria, dysuria
- signs of urethral obstruction
- chronic UTI - urinary tract infection
- signs of metastasis
How do we diagnose transitional cell carcinoma?
- rectal palpation may reveal changes
- urine sediment
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
What is the prognosis for transitional cell carcinoma?
- prognosis is good if surgically removed, benign
- prognosis is poor if tumor has invaded surrounding tissues
What causes leptospirosis?
- Leptospira interrogans bacteria
- Leptospira canicola
- Leptospira icterohemorrhagica
- Leptospira pomona
- Leptospira grippotyphosa
How is Leptospirosis usually transmitted?
through infected urine
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
What are the clinical signs of Leptospirosis?
- acute renal failure, with or without hepatic involvement
- dehydration, vomiting, fever, thirst
- reluctance to move (myositis)
- petechial hemorrhages
- peracute shock and death
How do we diagnose Leptospirosis?
- serum titers
- polymerase chain reactions (PCR) - can identify the serovar
How do we treat Leptospirosis?
- supportive therapy
How do we educate clients about Leptospirosis?
- adequate sanitation of the kennel
- decrease exposure to wild or domestic carriers
How long do animals shed the leptospirosis virus in their urine?
for up to 6 months
How do humans usually get leptospirosis?
from contact with cattle or wild rodents
Is renal failure acute or chronic?
can be either
What is the job of the kidneys?
filtration and waste management
Approximately _____ of the total cardiac output passes through the kidney at any one time.
What can a reduction in blood flow to the nephrons cause?
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
When does renal failure occur?
when 75% of the nephrons cease to function
What is acute renal failure?
abrupt decrease in filtration
What does acute renal failure result in?
What are the causes of acute renal failure?
- hypoperfusion - dehydration, hemorrhage
- toxins - AMGs - gentamicin, Metofane, ethylene glycol
What are the clinical signs of acute renal failure?
- maybe fever
- polyuric or oliguric
- kidneys painful on palpation
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
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
What is CRF?
chronic renal failure
What is considered chronic renal failure?
persistent azotemia for more than 2 weeks
What is chronic renal failure a loss of?
nephrons and filtration
Chronic renal failure causes a decreased production of what?
the hormone erythropoietin - anemia
What are the clinical signs of renal failure?
- history of weight loss
- oral ulceration
- non-regenerative anemia
- small irregularly shaped kidneys
How do we diagnose chronic renal failure?
- clinical signs
- increased BUN, creatinine
- USPG under 1.020, proteinuria
- non-regenerative anemia
- hypokalemia, abnormal blood Ca
- metabolic acidosis
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
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
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
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
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
How do we treat spay incontinence?
- identify and treat urinary tract infection if present
- drugs - PPA, DES
What is PPA?
- stimulates smooth muscle contractions of the urethral muscle
- used as a decongestant in humans
- removed from human market due to potential to cause stroke
What is DES?
- estrogen drug
What are the side effects of PPA?
- GI upset
What are the side effects of DES?
causes bone marrow suppression