1. DISEASES OF THE URINARY SYSTEM Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

2. THE URINARY SYSTEM and ITS FUNCTIONS
Functions of the kidneys
Excretion:
produce urine
Maintain homeostasis
Blood filtration, reabsorption, secretion
Fluid balance regulation
Acid-base balance regulation
Hormone production

3. DISEASES OF THE URINARY SYSTEM
URINARY SYSTEM IS NORMALLY STERILE AND RESISTANT TO BACTERIAL INFECTION B/C OF:
Voiding of urine
Urethral/ureteral peristalsis
Glycosaminoglycans in the surface mucosal layer
pH (6.0 – 6.3)
Glycosaminoglycans are large protein/sugar complexes that have anti-inflammatory properties; can be given as supplements

4. URINARY SYSTEM DISORDERS
Clients abandon pets or want pet put down because of inappropriate elimination
About 4 million cats a year are destroyed or abandoned for “elimination problems”.

5. DISEASES OF THE URINARY SYSTEM
Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

6. Feline Idiopathic (Interstitial) Cystitis
aka FUS/ FLUTD
Feline Urologic Syndrome or Feline Lower Urinary Tract Disease
Most common cause of UTI in cats; rarely associated with bacteria
FACTS:
Occurs in cats almost any age
Occurrence in males > females
cause unknown, multi-factorial, virus(?)
not caused by bacterial infection
recurrence is likely

7. Feline Idiopathic (Interstitial) Cystitis
Clinical Signs
pollakiuria
Hematuria
Dysuria
Periuria (sinks, tubs, carpet, etc.)
Pollakiuria – passing small amounts of urine very frequently
Polyuria – passing large amounts of dilute urine; usually associated with polydipsia

8. Feline Idiopathic (Interstitial) Cystitis
Diagnostics
Urinalysis/culture to rule out bacteria as cause
Only 1%-3% of all feline cystitis is caused by bacteria
Radiographs to rule out calculi

9. Feline Idiopathic (Interstitial) Cystitis
Treatment
Avoid unnecessary antibiotics
Change diet from dry to moist
or add water to dry food
Reduce stress from other cats, kids, etc
Provide hiding places
Pheromonotherapy
Behavior modification drugs (may also have pain reducing effects
Amitryptilline (tri-cyclic antidepressant)
Clomipramine
Glycosaminoglycan replacement
Cosequin for cats
Adequan
We underuse GAGs in cats

10. Feline Idiopathic (Interstitial) Cystitis
Client info
Disease is self-limiting
As many as 85% of cats will have resolution of clinical signs in 7-10 days
May be recurring problem
No definitive cure, but diet change is the most effective (Hill’s c/d Stress)
Reduce stress
Any treatment instituted will look like it works bc it clears up on its own
Cats need to have hiding spots and “safe” places; and access to litter boxes in safe space

11. Canine Bacterial Cystitis
Cause: Ascending bacteria up the urethra
Signs
↑ frequency of urination
Hematuria
Dysuria
Cloudy urine, abnormal color
Frequent licking of vaginal/urethral area

12. Canine Bacterial Cystitis
Diagnostics
Urinalysis:
↑WBC’s, bacteria
Common bacteria: E.coli, Proteus spp.
Urine culture/sensitivity
Collect by cystocentesis or mid-stream collection

13. Canine Bacterial Cystitis
Treatment
Antibiotics according to culture/sensitivity results
Treat acute infections x d
Subsequent infections x 4-6 w
Avoid trauma to urinary tract during surgery
Patients needing indwelling catheters should have a closed system
Can cut urethra during neuter; myths about tying off ureters during OHE; stabbing full bladder through skin incision when entering abomen

14. Closed Urinary Catheter System

15. Canine Bacterial Cystitis
Client info
Many uncomplicated UTI’s resolve without treatment
Give antibiotics as directed for the time prescribed
Prostate may be source of recurring infections in male dogs
Urine cultures should be repeated during treatment to assess effect
Urine cultures are expensive

16. DISEASES OF THE URINARY SYSTEM
Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

17. Feline Uroliths and Urethral Plugs
“Plugged” or “Blocked” male cats are commonly seen in small animal practice and can be fatal if not relieved

18. Feline Uroliths & Urethral Plugs
The two most common causes of urethral blockage are uroliths and urethral plugs
UROLITHS: composed predominantly of minerals
URETHRAL PLUGS: composed predominantly of matrix (mucoprotein, rbcs, wbcs, epithelial cells, etc.)

19. Feline Uroliths and Urethral Plugs
Signs
Hematuria
Dysuria
Periuria
Anorexia, vomiting
Collapse, death
Non-specific signs:
Hiding
Crying while urinating
Frequent trips to the litterbox
Anorexia/vomiting due to uremia and azotemia

20. Feline Uroliths and Urethral Plugs
Uroliths can be 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 (cystine) and require special imaging techniques to visualize
Struvites – MAP or triple phosphate crystals
Pneumocystogram

21. Feline Uroliths and Urethral Plugs
Uroliths damage bladder, making it more susceptible to bacterial infection, hematuria
Uroliths can cause blockage of the urethra of males
Bladder will fill with urine
Kidneys will stop working
Patient will become azotemic

22. Feline Uroliths and Urethral plugs

23. Feline Uroliths and Urethral Plugs
Diagnosis
Palpation of bladder
Obstructed bladders are full and tight
Radiographs may show uroliths
Ultrasonography
Urolith analysis is necessary to determine its constituents
EKG: atrial standstill, bradycardia, due to hyperkalemia
Bladder will feel like a huge rock

24. Feline Uroliths and Urethral Plugs
Treatment
Medical treatment (non-obstructed)
Dissolve struvite uroliths by acidifying urine and feeding diet low in Mg (Hill’s S/D, c/d)
Should resolve in 4-8 wk
Re-radiograph, and continue diet 1 mo after uroliths gone
Cystotomy to remove stones
Antibiotics according to culture/sensitivity
Struvites are made of Mg

25. Feline Uroliths and Urethral Plugs

26. Feline Uroliths and Urethral Plugs
Medical treatment (obstructed)
This is a medical emergency
Anesthetize
*USE LESS ANESTHESIA IN AZOTEMIC CATS*
Pass Tom cat catheter and back flush
Sew catheter in place for 1-3 d, using a closed system
What is azotemia?

27. Feline Uroliths and Urethral Plugs

28. Closed Urinary Catheter System

29. Feline Uroliths and Urethral Plugs
Surgical treatment (chronic obstructors)
Perineal urethrostomy (PU)
New opening for urethra is created proximal to narrowing
Urethral opening looks similar to female anatomy
*Goal of surgery is to decrease the likelihood of life- threatening obstruction*

30. Feline Uroliths and Urethral Plugs: Perineal Urethrostomy

31. Feline Uroliths and Urethral Plugs: Perineal Urethrostomy

32. https://youtu.be/2KcuW- trvPI
Feline Perineal Urethrostomy
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Dr. Martinez

33. CANINE UROLITHIASIS

34. Canine Urolithiasis
Uroliths damage mucosa of urinary tract making it susceptible to infection
Uroliths can obstruct urine flow in males

35. Canine Urolithiasis
The distal portion of the canine urethra is contained in the narrow canal of the os penis. This can be a common location for urethral stones to become lodged.

36. Canine Urolithiasis Clinical Signs pollakiuria Dysuria Hematuria Dx
Urinalysis
Crystalluria
↑ bacteria
Radiographs

37. Canine Urolithiasis

38. Canine Uroliths Struvite min sch female alkaline urine acidify urine
Urolith Breed Sex Contributing factors Rx
Struvite min sch female alkaline urine acidify urine
(Mg Ammonium Phos) cats bacteria→urease→↑pH antibiotics
minerals (diet) Hill’s s/d (dissolve)
↓protein (ammonia)
↑H2O intake (flush stones)
Calcium Oxalate cats males dietary protein Sx removal
(30-50% of min sch hypercalcemia ↓ dietary Ca
all stones) Lhasa, Yorkie
min poodle Hill’s u/d, w/d, k/d
Shih Tzu acid urine
Urates Dalmatians males ↑ uric acid from kidneys Allopurinol Eng bulldogs acid urine
min schnauzer K+ Citrate (↑ urine pH)
Shih Tzu Hill’s u/d,
Yorkshire terrier

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

40. Urolithiasis (Canine)
Treatment
Medical management - dissolve stones if Struvite
Prescription diets
Acidify urine
Urinary acidifiers ( Methogel (methionine))
↑ urine output
increase water intake
Antibiotics for bacterial infection
Surgical removal ( Ca Oxalate)
Some uroliths are not amenable to Medical Rx
Prevention is key
STONE ANALYSIS IS VITAL FOR APPROPRIATE TREATMENT

41. Canine Urolithiasis: Cystotomy for stone removal

42. Canine Urolithiasis What do you see?
Don’t miss the stones lined up in the urethra!

43. Canine Urolithiasis Client info Special diet may be required for life
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

44. EDUCATION
“It is possible to store the mind with a million facts and still be entirely uneducated.”
- Alec Bourne

45. DISEASES OF THE URINARY SYSTEM
Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

46. Renal Failure ~20% of Cardiac output 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 and glomerular filtration declines resulting in azotemia

47. AZOTEMIA Pre-renal Renal Post-renal dehydration
Primary kidney disorders
Post-renal
Urinary tract obstruction

48. Acute Renal Failure Three distinct phases:
Induction: the time from the initial insult until decreased renal function is apparent (hours to days)
Maintenance: the time period during which renal tubular damage occurs (weeks to months)
Recovery: the time during which renal function improves, existing nephrons hypertrophy and compensate for those damaged, and tubular repair occurs (when possible)

49. Stages of Kidney disease
Loss of Renal Reserve - Early signs of PU/PD
Renal Insufficiency - Early warning signs, such as PU/PD
Renal Failure (Azotemia) - Kidneys cannot eliminate waste efficiently, causing signs of illness
Advanced Kidney Failure (Uremia) - Severe signs of illness appear; eventually, collapse and death result

50. Acute Renal Failure
An abrupt decrease in glomerular filtration →azotemia
Causes
Damage to nephron
Nephrotoxic drugs
Aminoglycosides (gentamicin, streptomycin)
Chemotherapeutic agents
Antifungal medications
Analgesics (acetaminophen)
Anesthetics (methoxyflurane [Metafane])
Ethylene glycol (antifreeze)

51. Infections (pyelonephritis)
Acute Renal Failure
More causes:
Infections (pyelonephritis)
Immune-mediated diseases (Glomerulonephritis)
↓ Renal perfusion
Shock
Hypovolemia/dehydration
Hypotension

52. Kidneys are enlarged and painful on palpation Signs of azotemia
Acute Renal Failure
Signs (non-specific)
Kidneys are enlarged and painful on palpation
Signs of azotemia
Anorexia, dehydrated
Vomiting/diarrhea
Weakness
Fever

53. Acute Renal Failure Diagnosis Urinalysis
urine sediment - casts
low sp. gravity (unable to concentrate urine)
CBC
dehydration (↑PCV)
Chem panel
↑ BUN, Creatinine
Hyaline casts – clear, made of muco-protein, can be seen occasionally in healthy patients
Cellular – associated with acute disease, necrosis, infarction, ischemia
Granular casts – can be seen in healthy patient; can come from degeneration of cellular casts; not always indicative of disease
Fatty casts – associated with tubular degeneration
Waxy casts – clear and rectangular shaped (squared-off ends); associated with chronic kidney dz and always of pathological significance

54. Tx (aim is to restore renal hemodynamics)
Acute Renal Failure
Tx (aim is to restore renal hemodynamics)
Relieve any urinary obstruction
Discontinue any toxic drugs
IV fluids
Correct dehydration
Correct acid/base imbalance

55. Acute Renal Failure Client info
Renal function may never be like it was before injury
Prognosis is guarded especially with older pets
Care must be taken to avoid events that may precipitate further damage to kidney
Appropriate diet
Adequate water access

56. Chronic Renal Failure
Common in older pets; cats appear to be more affected than dogs
Irreversible and progressive decline in renal function (nephron damage)
The normal function of ADH (antidiuretic hormone: released from the brain) on the kidneys is to control the amount of water reabsorbed by kidney nephrons. ADH acts in the distal portion of the renal tubule (Distal Convoluted Tubule) as well as on the collecting duct and causes the retention of water, but not solute. Hence, ADH activity effectively dilutes the blood (decreasing the concentrations of solutes such as sodium).
ADH is secreted to prevent water loss in the kidneys

57. Chronic Renal Failure 1st function lost: Ability to concentrate urine
Progressive
1st function lost: Ability to concentrate urine
PU, PD, nocturia
Loss of ADH response
Other functions lost: Ability to filter blood
Azotemia
Begins at ~75% of nephron loss
↑ BUN, Creatinine
Anemia: erythropoietin secreted by kidneys

58. Chronic Renal Failure Signs Dull, lethargic, weak Anorexia, wt loss
PU/PD, cervical ventroflexion
hypokalemia
Hypokalemia causes generalized muscle weakness; K+ is also lost from excessive vomiting

59. Chronic Renal Failure Diagnosis
Look for abnormal blood work associated with kidney function
Anemia
↑ BUN, Creatinine
Proteinuria

60. Chronic Renal Failure Treatment Fluids for dehydration(IV, SQ)
Correct electrolyte imbalances
Hormones
Epoetin
Start with normal saline, 5% dextrose in water, LRS; add electrolytes to bag as needed

61. Client info Chronic Renal Failure CRF is progressive and irreversible
treatment is aimed at slowing its progress
SQ fluids at home are required to maintain hydration
Quality of life will decrease; euthanasia may have to be considered

62. Azotemia: Bun and Creatine
ARF
(large size)
CRF
(small size)
PCV
Inc.
Dec.
Azotemia: Bun and Creatine
Phosphorous
Potassium
Other
Acidosis, proteinuria

63. DISEASES OF THE URINARY SYSTEM
Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

64. Urinary Incontinence Loss of voluntary control of micturition Causes
Neurogenic—loss of normal neural function causing a paralyzed bladder
Ectopic ureters
Patent urachus
Endocrine imbalance (after spay)
Patent urachus- tube that carried fetal urine to umbilicus did not close; causes animal to dribble urine from naval area

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

66. Urinary Incontinence Treatment (based on specific cause) Client info
Surgical correction
Endocrine deficiency in spayed female
Diethylstilbestrol
Phenylpropanolamine (PROIN: 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
DES: Estrogen

67. References Alleice Summers, Common Diseases of Companion Animals
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