IPD 1: Sistem

Urinaria
DRH. YEREMIA YOBELANNO SITOMPUL, M.SC
yeremia.sitompul@staf.undana.ac.id
KRPN FKH UNDANA
CLINICAL FEATURES OF URINARY
TRACT DISEASE
Abnormal constituents of the urine
Proteinuria
Casts
Hematuria
Hemoglobinuria
Myoglobinuria
Pyuria
Bacteriuria
Crystalluria
Glucosuria
Ketonuria
CLINICAL FEATURES OF URINARY
TRACT DISEASE
Variations in daily urine flow
Polyuria
Oligouria/anuria
Pollakiuria
CLINICAL FEATURES OF URINARY
TRACT DISEASE
Abdominal pain, painful and difficult urination
Dysuria
Stranguria
CLINICAL FEATURES OF URINARY
TRACT DISEASE
Morphological abnormalities of kidneys and ureters
Enlargement or decreased size of kidneys may be palpable on rectal
examination or detected by ultrasonography.
In cattle, gross enlargement of the posterior aspect of the left kidney
may be palpable in the right upper flank.
Abnormalities of the kidneys such as hydronephrosis in cattle may also
be palpable on rectal exam ination.
Increases in the size of the ureter may be palpable on rectal
examination and indicate ureteritis or hydroureter.
CLINICAL FEATURES OF URINARY
TRACT DISEASE
Palpable abnormalities of the bladder and urethra
Abnormal Bladder palpable by rectal examination:
gross enlargement of the bladder,
rupture of the bladder,
a shrunken bladder following rupture,
cystic calculi
Abnormal urethra palpable by rectal examination:
enlargement and pain of the pelvic urethra and its external aspects in male
cattle with obstructive urolithiasis
obstruction of the urethral process of male sheep with obstructive urolithiasis.
CLINICAL FEATURES OF URINARY
TRACT DISEASE
Signs of Acute and chronic renal failure
Acute and chronic: Uremia, weakness, weight loss, anorexia
Acute: oliguria/anuria
Chronic: polyuria and polidipsia
Examination

Physical Examination
Urinalysis
Blood tests
USG
Renal biopsy
Endoscopy
radiography
Principle treatment of urinary tract
disease
Fluid therapy
Ruminants with acute / chronic renal failure
Hyponatremia, hypochloremia, hypocalcemia, hypokalemia, normal-
hypermagnesemia, normal-hyperphospatemia
Acute: marked hyperphospatemia
Horse with acute / chronic renal failure
Similar with in ruminants, except hypercalcemia and hypophosphatemia

In case of oligouria/anuria after fluid therapy administration, diuretic

is needed to prevent overhydration:
Furosemide (cheaper)
Mannitol
Principle treatment of urinary tract
disease
Vitamins B injection prevent deficiency
Dopamine increase renal blood flow
Antimicrobial agents:
Be active against the causal bacteria
Be excreted and concentrated in the kidney and urine
Be active at the pH of urine
Have low toxicity, particularly nephrotoxicity
Be easily administered
Be low in cost
Have no harmful interactions with other concurrently administered
drugs.
Diseases of the kidney

Glomerulonephritis
Etiology
a result of antigen-antibody complexes deposited in the glomeruli or specific
antibodies produced by the affected animal that attack glomerular
basement membranes
Clinical signs
Weight loss
decreased appetite and production
poor hair coat
ventral edema
Diseases of the kidney

Glomerulonephritis
Diagnosis
renal biopsy is essential to confirm the diagnosis.
If the nephrotic syndrome (i.e., ventral edema, hypoalbuminemia, and
proteinuria) is present, the condition probably is advanced and renal failure is
present.
proteinuria, and azotemia with isosthenuria
Ultrasonography generally is not helpful to the diagnosis but may be useful
during biopsy.
Laboratory data as regards serum urea nitrogen, and creatinine and
electrolyte levels may show mild abnormalities in early cases
Diseases of the kidney

Glomerulonephritis
Treatment
Early or acute cases may be treated by supportive care for renal failure and
specific therapy directed against any infections (e.g., mastitis, abscesses)
thought to be primary to the glomerulonephritis.
Diseases of the kidney

Nephrosis
Etiology
degenerative and inflammatory lesions primarily affecting the renal tubules,
particularly the proximal convoluted tubules. This condition leads to interstitial
nephritis
renal ischemia: any condition that predisposes the animal to marked
hypotension and release of endogenous pressor agents
Acute: General circulatory emergencies such as shock, dehydration, acute
hemorrhagic anemia, acute heart failure; calf diarrhea; embolism of renal artery in
horses, extreme ruminal distension in cattle.
Chronic: Chronic circulatory insufficiency such as congestive heart failure
Diseases of the kidney

Nephrosis
Etiology
Toxic nephrosis: Damage to the renal tubules by toxins, certain drugs, and
physiologic events linked to hemoconcentration, endotoxemia, and
ischemic changes may cause tubular degeneration, inflammation, and in
some instances interstitial nephritis. Usually both kidneys are affected equally
nephrotoxic antibiotics (aminoglycosides, tetracycline, and sulfa drugs)
Overuse of NSAIDS, especially in dehydrated patients reduced renal
prostaglandins which are “cytoprotective” because they help maintain renal
perfusion through small vessels during times of hypotension or dehydration
Metals: mercury, arsenic, cadmium, selenium, organic copper compounds
Diseases of the kidney

Nephrosis
Clinical signs
nonspecific signs, including depression, anorexia that varies from mild to
absolute, dehydration, and potentially recumbency
Signs of primary diseases may mask the existence of nephrosis
Diseases of the kidney

Nephrosis
Diagnosis
Urinalysis: isosthenuric range (<1.022) despite obvious dehydration. RBCs,
WBCs, granular casts, and proteinuria
Rectal palpation: enlargement of affected kidney(s); ureteral enlargement in
female
USG
Azotemia, anemia
History of drug administration: previous use of aminoglycosides, NSAIDs
History of sickness: severe dehydration in a patient with salmonellosis
Renal biopsy
Diseases of the kidney

Nephrosis
Treatment
attempt to reestablish renal function and to correct primary disorders that may
have contributed to nephrosis.
Previous use of nephrotoxic drugs should be discontinued and other potentially
nephrotoxic drugs avoided in the therapy.
Aggressive fluid therapy to ensure adequate renal perfusion and accomplish
diuresis: NaCl with supplemental KCl added at 20 to 40 mEq/L is frequently used.
Unless the patient is anuric, large volumes of IV fluids are required to address
existing dehydration, allow for anticipated fluid losses, and establish diuresis.
In case of anuric or oliguric following an initial 20 to 40 L of IV fluids, 250 to 500 mg
of furosemide may be administered IV one or more times at 15- to 30-minute
intervals in an effort to initiate diuresis
Hypocalcemia IV calcium or subcutaneous (SQ) calcium borogluconate
Diseases of the kidney

Pyelonephritis
Etiology
Pyelonephritis usually develops by ascending infection from the lower urinary
tract

Clinical signs
Fever (acute rather than chronic)
Anorexia
Colic, arched stance
Stranguria, polyuria
Abnormality of urine: pyuria, hematuria
Diseases of the kidney

Pyelonephritis
Diagnosis
Accompanied by cystitis and/or urethritis
Urinalysis: RBCs, WBCs, protein, and bacteria may be present
Azotemia, anemia
Urine culture to determine causative bacteria and antimicrobial resistance
Diseases of the kidney

Pyelonephritis
Treatment
At least 3 weeks antimicrobial drug
Therapy for renal failure
Nephrectomy in nonazotemic animals
Diseases of the kidney

Embolic Nephritis
Etiology
Septicemia, endocarditis bacteria lodge in renal tissue bacterial emboli
focal suppurative lesion infarction

Clinical signs
Fever
Nonspecific signs, masked with the primary disease
Diseases of the kidney

Embolic Nephritis
Diagnosis
Urinalysis: hematuria, pyuria, proteinuria
Rectal palpation: enlarged kidney
Diseases of the kidney

Embolic Nephritis
Treatment
Focus on the primary disease treatment
The use of non nephrotoxic drugs
Diseases of the kidney

Renal Amyloidosis
Etiology
Amyloidosis is an infrequent systemic disease characterized by extracellular
deposition of amyloid (abnormal deposits of glycoprotein) in the kidney, gut,
liver, adrenal gland, spleen, and other tissues.
amyloidosis (most commonly systemic AA type amyloid) has been
associated with chronic infections in various organ systems.
Clinical signs
Weight loss
Nephrotic syndrome: ventral edema, hypoproteinemia and azotemia
diarrhea
Diseases of the kidney

Renal Amyloidosis
Diagnosis
Blood test: hypoprotein/albuminemia, hypocalcemia
Urinalysis: proteinuria
Rectal palpation: enlarged kidney
Renal biopsy
Diseases of the kidney

Renal Amyloidosis
Treatment
No practical treatments exist
Fatal disease
Diseases of the kidney

Renal Neoplasm
Etiology
Primary tumors of the kidney are uncommon, metastatic neoplasms from
other organs
Renal carcinoma in cattle and horses, nephroblastoma in pig

Clinical signs
Weight loss
Anorexia
Abdominal pain
ascites
Diseases of the kidney

Renal Neoplasm
Diagnosis
Urinalysis: hematuria
Blood test: hypoglycemia
Rectal palpation: enlarged kidney
Renal biopsy
USG
Diseases of the kidney

Renal Neoplasm
Treatment
nephrectomy
Diseases of the kidney

Congenital defects of the urinary tract

Renal hypoplasia?
Renal dysplasia?
Polycystic kidneys?
Ectopic ureter?
Urethral atresia?
Hypospadias?
Diseases of the bladder, ureters,
and urethra
Cystitis
Etiology
Inflammation of the bladder is usually associated with bacterial infection
Bladder trauma caused by calculi, stagnation of the urine (blocked or
bladder paralysis) infection
Clinical signs
Stranguria, pollakiuria, oligouria
remains in the urination posture for some minutes after the flow has ceased,
often manifesting additional expulsive effort
Diseases of the bladder, ureters,
and urethra
Cystitis
Diagnosis
Clinical signs, absence of systemic sign
USG: thickening bladder wall
Culture and sensitivity of urine
Urinalysis: hematuria, urolith
Diseases of the bladder, ureters,
and urethra
Cystitis
Treatment
Antimicrobial drugs
Foley catheter
Diseases of the bladder, ureters,
and urethra
Enzootic Hematuria
Etiology
A progressive noninfectious cystitis with tissue metaplasia of the bladder
mucosa
Bracken fern toxicity
Clinical signs
Stranguria, hematuria, anemic mucosa
No fever
Diseases of the bladder, ureters,
and urethra
Enzootic Hematuria
Diagnosis
multiple animals are affected with similar signs following pasturing
Rectal examination: multiple masses within the bladder wall
Urinalysis: hematuria
Diseases of the bladder, ureters,
and urethra
Enzootic Hematuria
Treatment
Only supportive treatment: fluid therapy, thiamine injection to prevent
anemia worsen
Prevention from eating bracken fern
Diseases of the bladder, ureters,
and urethra
Urolithiasis
Etiology
High concentrate diets are thought to increase urinary mucoproteins and lead to
“solidification” of urine solutes
High phosphorous diets or improper calcium-phosphorous balance in a ration,
again usually associated with a high concentrate diet
Pastures containing large amounts of silica or oxalate
Vitamin A deficiency and excessive estrogens squamous metaplasia of mucosa
creating solid nidus formation, narrowing of the urethral lumen, and excessive
desquamation of epithelial cells
Hypervitaminosis D increased urinary calcium levels
Reduced water intake
Early castration of male animals contributes to reduced diameter of the distal
urinary tract
Diseases of the bladder, ureters,
and urethra
Urolithiasis
Clinical Signs
Same as cystitis
In case of rupture bladder abdominal distention
Diseases of the bladder, ureters,
and urethra
Urolithiasis
Diagnosis
Urinalysis: crystalluria, hematuria, epithelial cell, bacteria
Blood test: azotemia
USG
Radiography
Diseases of the bladder, ureters,
and urethra
Urolithiasis
Treatment
Surgical removal of calculi
Muscle relaxant
Antibiotic
Fluid therapy
Thank you