1. Diseases of Urinary System

2. Urinary System Anatomy/Location Function Kidneys Ureters Bladder
Urethra
Function
Remove waste
Maintain homeostasis
acid/base
electrolytes
fluid balance
Hormone production
erythropoietin

3. Urinary System Infections usually due to ascending organism
Usually resistant to bacterial infection
Frequent urination flushes bacteria
Urethral/ureteral peristalsis
Glucosaminoglycans in mucosa pH

4. Feline Cystitis Signs Dx Frequent urinations (sm vol) Hematuria
Cause unknown; virus suspected; usually not bacterial; recurrence likely
Self-limiting (7-10 d), so any appropriate treatment appears to help
Signs
Frequent urinations (sm vol)
Hematuria
Dysuria
Inappropriate urination (sinks, tubs are a favorite) Dx
Urinalysis/culture to r/o bacteria as cause
X-rays to r/o calculi; contrast studies show thickened wall

5. Feline Cystitis Rx Client info Avoid unnecessary antibiotics
Change diet from dry to moist
Salt food to ↑ water intake
Reduce stress from other cats, kids, etc (hiding places)
Client info
Disease is self-limiting
May be recurring problem
No definitive cure
Reduce stress

6. Canine Cystitis (Bacterial Cystitis)
Signs
↑ frequency of urination
Hematuria
Dysuria
Cloudy urine; abnormal color
Frequent licking of urethral area Dx
Urinalysis: ↑WBC’s, bacteria
Urine culture/sensitivity
Collect by cystocentesis(?)
Mid-stream collection

7. Canine Cystitis (Bacterial Cystitis)Rx
Avoid unnecessary use of indwelling urinary catheters
Use closed system
Antibiotics according to sensitivity
Treat acute infections x d
Subsequent infections x 4-6 w
Avoid trauma to urinary tract during surgery
Client info
Many uncomplicated urinary tract infections resolve without Rx
Give antibiotics as directed for the time prescribed
Relapses are common due to inadequate treatment
Prostate may be source of recurring infections in male dogs
Urine cultures should be repeated during treatment to assess effect

8. Close system

9. Feline Uroliths and Urethral Plugs
“Plugged” male cats are commonly seen in SA practice
Will be fatal if not relieved
Uroliths (bladder stones) found anywhere in urinary tract
Formed from minerals in diet
Some are radiopaque (Ca++ oxalate, urate, struvite) and can be seen on x-ray
Some are radiolucent and require double contrast (air, dye)
Uroliths damage bladder, making it more susceptible to bacterial infection, hematuria
Uroliths can form plugs in urethra of males
Bladder will fill with urine
Kidneys will stop working
Blood/body will become toxic (azotemic)

10. Feline Uroliths and Urethral Plugs
Signs (more severe if obstruction has occurred)
Hematuria
Dysuria/ frequent urination
Urinating in strange places (sink, tub)
Straining to urinate
Vomiting
Collapse, death

11. Feline Uroliths and Urethral PlugsDx
Palpation of bladder (obstructed is full and tight)
X-rays may show uroliths on routine films
Double contrast studies may be indicated
Ultrasonography can locate position of urolith
Urolith analysis to determine its constituents
Double contrast cystogram (with stones) pneumocystogram

12. US of bladder stone

13. Feline Uroliths and Urethral PlugsRx
Medical treatment (chronic, non-obstructed)
Dissolve struvite uroliths (most common; ~60%) by acidifying urine and feeding diet low in Mg (Vit C, S/D)
Should resolve in 4-8 wk
Re x-ray, and continue diet 1 mo after uroliths gone
Antibiotics according to culture/sensitivity

14. Feline Uroliths and Urethral Plugs
Medical treatment (obstructed)
Anesthetize (short acting)
***USE LESS ANESTHESIA IN AZOTEMIC CATS***
Pass ‘silver needle’ (soft metal, atraumatic) or Tom cat catheter and back flush
Sew catheter in place for 1-3 d (??)

15. Feline Uroliths and Urethral Plugs
Surgical treatment (chronic obstructers)
Perineal urethrostomy
New opening for urethra is created proximal to narrowing
Urethral opening looks like a female
E collar till sutures removed

16. Urolithiasis (Canine)
Smaller incidence in dogs than cats
Uroliths damage mucosa of urinary tract making it susceptible to infection
Uroliths can obstruct urine flow in males
Signs
Dysuria
Hematuria Dx
Urinalysis
Crystalluria
↑ bacteria
X-rays (double contrast ?)
Do stone analysis

17. Canine Uroliths Urolith Breed Sex Contributing factors Rx
Struvite min sch female (80%) alkaline urine acidify urine
(Mg Ammonium Phos (MAP—triple phosphate)
(~50% of all stones) cats bacteria→urease→↑pH antibiotics
minerals (diet) Only Hill’s s/d (dissolve)
↑Na, ↓protein (ammonia)
↑H2O intake (flush stones
acidy urine
Calcium Oxalate cats males diet high in protein Sx removal (only Rx)
(30-50% of min sch hypercalcemia ↓ dietary Ca (milk)
all stones) Lhasa, Yorkie Cushing’s Dis ↓ dietary Na
min pood use of cortisone Hill’s u/d, w/d, k/d
Shih Tzu acid urine
Urates Dalmatians males ↑ uric acid from kidneys Allopurinol
E bulldogs acid urine (gout in humans)
min schnauzer K+ Citrate (↑ urine pH)
Shih Tzu Hill’s u/d, ↑ dietary salt
York terrier

18. Canine Uroliths Struvite Calcium Oxalate Urate
Type of stone cannot be determined by appearance; chemical analysis is required

19. Urolithiasis (Canine)Rx
Medical (objective is to dissolve stones)
↓ mineral intake in diet→↓ minerals in urine
↑ urine acidity (nor for urates)
Vit C
methionine (Methogel®)
↑ urine output
Add salt to diet
Furosemide
Antibiotics for bacterial infection
Surgical removal
Some uroliths are not amenable to Medical Rx
However, the cause of uroliths must be dealt with medically (prevention)

20. Urolithiasis (Canine)
What do you see? How many?
Client info
Special diet may be required for life-time
Table scraps/treats should be limited
Long-term antibiotics may be required
Uroliths may recur at any time
Always provide plenty of fresh water
Allow plenty of bathroom time and frequency

21. Urolithiasis (Canine)
What do you see? Flush toward bladder (8 times)
Saline flush
One in bladder, 2 in urethra

22. Urolithiasis (Canine)
What do you see?

23. Urolithiasis (Canine)
What do you see?

24. Urolithiasis (Canine)

25. Renal Failure ~20% of CO Renal Failure due to:
Filtered by renal corpuscle
Reabsorbed by kidney tubules
Waste excreted as urine
Renal Failure due to:
↓ blood flow (hypoperfusion)
Damage to nephron

26. Acute Renal Failure Causes
An abrupt decrease in glomerular filtration → azotemia (↑ N toxins in blood)
Causes
Damage to nephron (damaged nephrons do not regenerate; other nephrons will hypertrophy)
Any part of nephron may be damaged (when 1 part of nephron is lost, it is all lost)
Nephrotoxic drugs
Aminoglycosides (gentamicin, streptomycin)
Cephalosporins (cephalexin, cephalothin)
Sulfanamides (Albon, Di-Trim)
Chemotherapeutic agents
Antifungal medications
Analgesics (acetaminophen)
Anesthetics (methoxyflurane [Metafane])
Ethylene glycol (antifreeze)
Infections (nephritis)
Immune-mediated diseases (Glomerulonephritis)
↓ Renal perfusion
Shock
Hypovolemia/dehydration
Hypotension

27. Acute Renal Failure Signs (non-specific) Dx
Kidneys are enlarged and painful on palpation
Signs of azotemia
Anorexia, dehydrated
Vomiting/diarrhea
Weakness
Fever Dx
Urinalysis—urine sediment/casts; low sp grav (unable to conc urine)
CBC—dehydration (↑PCV), acidosis
Chem panel
↑ BUN, Creatinine
↑K+, Phosphorus

28. Acute Renal Failure Rx (aim is to restore renal hemodynamics)
Relieve tubular obstruction
Discontinue any toxic drugs
IV fluids (start with normal saline)
Correct dehydration
Correct acid/base (sodium bicarb) and electrolyte imbalance
Diuretics to increase urine output
Client info
Renal function may never be like it was before injury
Px is guarded
Care must be taken to avoid events that may precipitate further damage to kidney
Appropriate diet
Adequate water access

29. Chronic Renal Failure Progressive
Common in older pets; cats appear to be more affected than dogs
Irreversible and progressive decline in renal function (nephron damage)
Progressive
1st function lost: Ability to concentrate urine
PU, PD, nocturia
Loss of ADH response
Other functions lost: Ability to cleanse blood
Azotemia (toxemia)
Begins at ~75% of nephron loss
↑ BUN, Creatinine
Anemia: erythropoietin secreted by kidneys

30. Chronic Renal Failure Signs Dx Dull, lethargic, weak Anorexia, wt loss
PU/PD cervical ventroflexion
hypokalemia
Sudden blindness Dx
Acidosis
Anemia
↑ BUN, Creatinine
Hyperphosphatemia
Hypokalemia
Proteinuria

31. Chronic Renal Failure Rx Client info Fluids for dehydration (IV, SQ)
Potassium gluconate, calcium carbonate for electrolyte imbalances
Sodium bicarb for pH adjustment
Diuretics (Furosemide)
Hormones
Epoetin
Vit B supplements
Client info
CRF is progressive and irreversible
Rx is aimed at slowing its progress
SQ fluids at home are required to maintain hydration
Warm foods to improve palatability
Quality of life will decrease; euthanasia may have to be considered

32. Urinary Incontinence Causes
Loss of voluntary control of micturition
Causes
Neurogenic—loss of normal neural function causing a paralyzed bladder
Ectopic ureters
Patient urachus
Endocrine imbalance (after spay)

33. Urinary Incontinence Signs Dx
Urine leakage when pet is sleeping or exercising
Perianal area of pet is aslways wet
Concurrent urinary tract infection Dx
Urinalysis
X-rays/cystography
Chem panel to r/o PU from endocrine disease

34. Urinary Incontinence Rx (based on specific cause) Client info
Surgical correction
Endocrine deficiency in spayed female
Diethylstilbestrol (PO or inj)
Phenylpropanolamine (for loss of sphincter tone)
Client info
Doses will have to be adjusted for individual animals
Paralytic bladder incontinence may require manual expression or catheterization several times a day