EDUCATION“It is possible to store the mind with a million facts and still be entirely
uneducated.”- Alec Bourne
CystitisCystic calculi
Urinary obstructionARF & CRFIncontinence
Renal Failure• ________ of Cardiac output
– Filtered by renal corpuscle
– Reabsorbed by kidney tubules
– _______________ as urine
• Renal Failure due to:– ↓ blood flow (hypoperfusion)
– Damage to nephron and glomerular filtration declines resulting in______________
AZOTEMIA
• Pre-renal
• Renal
• Post-renal
Acute Renal Failure
• Three distinct phases:– ________________: 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 (___________________)
– Recovery: the time during which renal function improves, existing nephrons __________________ and compensate for those damaged, and tubular repair occurs (when possible)
Loss of Renal Reserve - Early signs of PU/PD PU= polyuria (increased urination) PD= polydipsia (increased drinking)
Renal Insufficiency - Early warning signs, such as increased thirst, may begin to appear
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
Stages of Kidney disease
Acute Renal FailureAn abrupt decrease in glomerular filtration → azotemia (↑ toxins in blood)• Causes
– Damage to nephron (damaged nephrons________________; other nephrons will hypertrophy)
Any part of nephron may be damaged (when 1 part of nephron is lost, it is all lost)• Nephrotoxic drugs
– _______________________ (gentamicin, streptomycin)– Chemotherapeutic agents– Antifungal medications– Analgesics (acetaminophen)– Anesthetics (methoxyflurane [Metafane])– Toxins: Ethylene glycol (antifreeze), grapes
• Infections (pyelonephritis):___________________• Immune-mediated diseases (Glomerulonephritis)• Metabolic: Hypercalcemia; Addison’s
Acute Renal Failure
– ↓ Renal perfusion• Shock• Hypovolemia/dehydration• Hypotension
• Signs (non-specific)– Kidneys are ____________
and
painful on palpation
– Signs of +/- azotemia• Anorexia, dehydrated
• Vomiting/diarrhea
• Weakness
– Fever CAT Kidney
Acute Renal Failure
• Dx– Urinalysis—urine sediment/casts; ______________ sp
gravity (unable to concentrate urine)
– CBC—dehydration (↑PCV), acidosis
– Chem panel• ↑ BUN, Creatinine
• ↑ __________, ______________
Acute Renal Failure
• Rx (aim is to restore renal hemodynamics)• Relieve tubular obstruction
• Discontinue any toxic drugs
– IV fluids (start with normal saline)• ___________________________________
• Correct acid/base (sodium bicarb) and electrolyte imbalance
• Client info– Renal function ______________ be like it was before
injury
– Prognosis is guarded especially with _______________
– Care must be taken to avoid events that may precipitate further damage to kidney
• Appropriate diet
• Adequate water access
Chronic Renal Failure
Common in older pets; cats appear to be more affected than dogs
Irreversible and progressive decline in renal function (nephron damage)
Dogs > 8 yrs
Cats > 10 yrs
Chronic Renal Failure
• Progressive
– 1st function lost: Ability to ____________________
• PU, PD, nocturia
– Loss of ADH response
– Other functions lost: Ability to cleanse blood
• Azotemia (toxemia)
– Begins ___________________ of nephron loss
– ↑ BUN, Creatinine
• Anemia: ___________________ secreted by kidneys
Chronic Renal Failure• Signs
– Dull, lethargic, weak
– Anorexia, wt loss
– Cat: constipation
– PU/PD____________________• Hypokalemia (feline polymyopathy)
– Sudden blindness
• Dx– Acidosis
– Anemia– ↑ BUN, Creatinine
– Hyperphosphatemia, ___________________,
– Proteinuria
Chronic Renal Failure• Rx
– Fluids for dehydration (IV, SQ)– ________________ , calcium carbonate for electrolyte
imbalances– Phosphorous binders:___________________– Sodium bicarb for pH adjustment– Hormones
• ___________________– Vit B supplements
• Client info– CRF is progressive and __________________– 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
ARF (large size)
CRF(small size)
PCV Inc. Dec.
Azotemia: Bun and Creatine
Inc. Inc.
Phosphorous Inc. Inc.
Potassium Inc. Dec.
Other Acidosis, proteinuria
Urinary IncontinenceLoss of voluntary control of micturition
• Causes– ________________—loss of normal neural function
causing a paralyzed bladder
– Ectopic ureters
– Patent urachus
– Endocrine imbalance (after____________)
Urinary Incontinence• Signs
– Urine leakage when pet is _____________ or exercising
– Perianal area of pet is always wet
– Concurrent ____________________
• Dx– Urinalysis
– X-rays/cystography
– Chem panel to r/o PU from endocrine disease
Urinary Incontinence• Rx (based on specific cause)
– Surgical correction
– Endocrine deficiency in spayed female• _______________________ (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 _________________________________________________ several times a day