PRESENTATION
BROCHURE
Pet Owner Educational Atlas
NEPHROLOGY AND UROLOGY Texts and review: Shelly Vaden
PET OWNER EDUCATIONAL ATLAS
Pet Owner Educational Atlas
NEPHROLOGY AND UROLOGY Texts and review: Shelly Vaden
Nephrology and Urology
eBook
available
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Visual atlas describing general concepts and details of the main diseases affecting the urinary tract of dogs and cats. This atlas is a tool to facilitate communication between the veterinary practitioner and pet owners.
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TARGET AUDIENCE:
✱ Small animal vets. Nephrology / Urology ✱ Veterinary nurses RETAIL PRICE ✱ Veterinary students FORMAT: 22 × 28 cm NUMBER OF PAGES: 68 NUMBER OF SHEETS: 60 BINDING: hardcover, wire-o ISBN: 978-84-17640-23-1
€75
Texts and review SHELLY VADEN Faculty member of the College of Veterinary Medicine at North Carolina State University. Diplomate of the American College of Veterinary Internal Medicine.
KEY FEATURES:
➜ Simple and graphical approach. ➜ Detailed and highly accurate drawings. ➜ Designed to facilitate communication between veterinarians and pet owners.
Presentation of the book Nephrology and urology are closely related veterinary specialties dealing with structures that are often affected by the same disorders. The presentation and management of animals with these disorders can be complex and oftentimes difficult for the pet owner to fully comprehend during initial discussions. The purpose of this book is to provide veterinarians with a tool to facilitate communication with their clients about disorders of the upper and lower urinary tract that are affecting their pet dogs or cats. The text and the illustrations will help the veterinarian explain pathophysiologic processes as well as provide a basis to support their diagnostic and therapeutic recommendations. The most common disorders of the kidney and lower urinary tract, as well as a section on medical procedures, are presented in the many chapters. Most chapters in this atlas are either disease or problem based, each providing the most relevant information about clinical signs, diagnosis, treatment and prognosis. Because dogs or cats with diseases of the urinary tract may have more than one of the problems contained in this book, the veterinarian may utilize several chapters to help fully explain a pet’s condition. The text and images will help the owner gain confidence in the veterinarian’s recommendations. Dr. Shelly Vaden
Nephrology and Urology
Texts and review Shelly Vaden She graduated in veterinary medicine from the University of Georgia, USA, in 1985 and obtained the status of Diplomate of the American College of Veterinary Internal Medicine in 1989 after completion of a residency in small animal internal medicine at North Carolina State University, North Carolina, USA. She completed her PhD at the same university.
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Since 1991, she has been a faculty member of the College of Veterinary Medicine at North Carolina State University, where she currently oversees a clinic focused on dogs and cats with diseases of the urinary tract. She is author of more than 100Â articles published in international scientific journals, and has also authored several book chapters. She has been a speaker at national and international congresses. Her main interest area is diseases of the urinary tract in dogs and cats.
Table of contents Anatomy and physiology of the urinary tract 1. 2.
Anatomy of the urinary tract Renal physiology
Diseases of the kidney Acute kidney injury 3. 4. 5. 6. 7.
Acute kidney injury (AKI). General Leptospirosis Ethylene glycol toxicity Drug-induced nephrotoxicity Lily nephrotoxicity
Chronic kidney disease 8. 9. 10. 11. 12.
Chronic kidney disease (CKD). General Polycystic kidney disease (PKD) Fanconi syndrome Hydronephrosis Juvenile renal disease
Glomerular disease 13. Glomerular disease. General 14. Amyloidosis 15. Immune complex-mediated glomerulonephritis 16. Leishmaniasis 17. Lyme nephritis 18. Nephrotic syndrome
Complications of kidney disease 19. 20. 21. 22. 23. 24. 25. 26. 27.
Anemia Secondary mineral and bone disorders Hypertension Renal proteinuria Uremic stomatitis and halitosis Uremic gastroenteropathy Metabolic acidosis Polyuria and polydipsia Hypercoagulability and thromboembolism
Urolithiasis 37. 38. 39. 40. 41. 42. 43.
Infection-induced struvite uroliths Sterile struvite uroliths Calcium oxalate uroliths Cystine uroliths Urate uroliths Nephrolithiasis Ureterolithiasis
Micturition disorders 44. Urethral sphincter mechanism incompetence (USMI) 45. Detrusor–urethral dyssynergia 46. Ectopic ureter 47. Pelvic bladder
Miscellaneous 48. 49. 50. 51. 52. 53. 54. 55.
Urothelial carcinoma Urethral obstruction Feline idiopathic cystitis Idiopathic renal hematuria Urachal remnants Capillariasis Idiopathic hypercalcemia in cats Benign prostatic hyperplasia (BPH)
Procedures 56. Kidney biopsy 57. Cystoscopy 58. Extracorporeal blood purification therapies. Hemodialysis and plasmapheresis 59. Subcutaneous ureteral bypass (SUB) 60. Stenting
Diseases of the lower urinary tract Urinary tract infections 28. Acute cystitis 29. Recurrent urinary tract infection 30. Urinary tract infection caused by a recessed vulva 31. Subclinical bacteriuria 32. Pyelonephritis 33. Prostatitis 34. Polypoid cystitis 35. Emphysematous cystitis 36. Fungal urinary tract infection
Editorial Servet
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Plaza Antonio Beltrán Martínez, 1 Centro Empresarial El Trovador planta 8, oficina 50002 Zaragoza, Spain
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+34 976 461 480
Pet Owner Educational Atlas
NEPHROLOGY AND UROLOGY Texts and review: Shelly Vaden
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PET OWNER EDUCATIONAL ATLAS. NEPHROLOGY AND UROLOGY
CHRONIC KIDNEY DISEASE
11 Hydronephrosis It is when the renal pelvis becomes dilated with urine secondary to obstruction of the ureter. A dilated ureter (hydroureter) often accompanies hydronephrosis. While a stone in the ureter is the most common cause in cats, the most common causes in dogs are congenital anomalies (such as ectopic ureter), a stone in the ureter, and cancer. If the obstruction persists for weeks or longer, there is loss of nephrons and eventual chronic kidney disease.
Clinical signs ■
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Diagnosis
Signs may be absent in cases of chronic hydronephrosis of one kidney. Abdominal pain and distension in acute cases. Cats may hide or stay in one place. The enlarged kidney might be seen up against the abdominal wall when the animal is resting.
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Renal ultrasound or contrast radiographs to identify a fluid-filled renal pelvis. Other tests, such as computed tomography or endoscopy, may be needed to confirm the cause of the obstruction.
Right ureter
Ectopic left ureter
Bladder
Hydronephrosis Hydroureter
Stone obstructing the ureter
Treatment Relief of the obstruction as soon as possible.
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Prostate Rectum Urethra
Ectopic left ureteral orifice
Tumor obstructing the right ureteral orifice
Complete recovery is possible if the obstruction is relieved within a few days.
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29
DISEASES OF THE KIDNEY
COMPLICATIONS OF KIDNEY DISEASE
22 Renal proteinuria Proteinuria, meaning protein in the urine, from kidney disease is due to either glomerular or tubular disease. The magnitude of proteinuria is highest with glomerular disease, which can lead to decreased serum protein (albumin) concentration.
Clinical signs ■ ■
Diagnosis
Foamy urine. Reduced serum albumin concentration may lead to edema or fluid retention.
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Proteinuria can be detected by urinalysis. Calculating the urine protein:creatinine (UPC) ratio is needed to determine how much protein is being lost and monitor treatment.
ACE inhibitors and ARBs open up the vessel leaving the glomerulus
HMW: high-molecular weight protein ALB: albumin LMW: low-molecular weight protein
Glomerular damage
Protein degradation and reabsorption impaired due to tubular dysfunction
Glomerular capsule
Proteinuria
Proteinuria is associated with more rapid progression of renal disease.
Treatment ■ ■ ■
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Managing the underlying cause. Managing hypertension. Feeding a renal diet. Dogs with very heavy protein loss may benefit from careful protein supplementation (e.g., egg whites or amino acids).
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Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are indicated to reduce the magnitude of proteinuria. Follow-up blood tests and UPC ratio and blood pressure measurements will be required to verify that the drug is working without adverse effects.
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35
DISEASES OF THE LOWER URINARY TRACT
URINARY TRACT INFECTIONS
28 1 Acute cystitis
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Also called sporadic, simple, or uncomplicated cystitis, it is an infection of the bladder that occurs commonly in dogs and occasionally in cats. Most of the time, acute cystitis is caused by bacteria that enter through the urethral opening. The infection can also affect the urethra.
Clinical signs ■ ■ ■ ■ ■
Urinary accidents. Frequent urination. Straining to urinate or painful urination. Foul-smelling or bloody urine. Excessive licking of the genital area.
Diagnosis ■
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Detection of white blood cells, red blood cells, and bacteria in the urine. Urine should be cultured in most dogs and all cats suspected of having acute cystitis. A positive culture result in a urine sample collected by puncturing the bladder (cystocentesis) will confirm the presence of bacteria. Urine samples obtained by voiding or catheterization should only be cultured if cystocentesis is contraindicated.
Keeping dogs well-groomed and allowing them to urinate at least once every 8–10 hours can help prevent urinary tract infection.
Treatment ■
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Antimicrobial drugs, ideally selected on the basis of urine culture results, should be given for a short duration. Empirical therapy, without culture, can be tried in dogs with no prior history of urinary tract infection. Anti-inflammatory drugs may be needed to help control clinical signs during the first 48–72 hours.
Prognosis ■ ■
Clinical signs should resolve in 48–72 hours. Full recovery is expected.
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DISEASES OF THE LOWER URINARY TRACT
URINARY TRACT INFECTIONS
32 Pyelonephritis Sometimes called upper urinary tract infection, it is the infection of the kidneys. Although pyelonephritis is typically caused by bacteria that have moved through the urinary tract from the bladder, it sometimes occurs when circulating blood delivers bacteria to the kidneys. The risk of developing this infection might increase with factors such as corticosteroid therapy, chronic kidney disease, incontinence, ectopic ureter, or kidney and ureteral stones.
Clinical signs ■ ■ ■ ■
Increased drinking and urination. Fever, lethargy, and reduced appetite. Flank pain. Vomiting.
Bacterial infection
Bacteria from the blood
Diagnosis ■
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Inflammation
Detection of white blood cells, red blood cells, and bacteria in the urine. A positive bacterial culture result in a urine sample collected by centesis will confirm the presence of bacteria. Blood tests may support the presence of kidney disease or inflammation. The kidneys may look abnormal on ultrasound.
Since bacteria are shed intermittently, urine culture results may be negative.
Bacteria
Bacteria from the bladder
Treatment ■
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Antimicrobial therapy should be started immediately and adjusted according to urine culture results. Treatment for underlying disorders may be needed. Recheck examinations are very important to make sure the animal is recovering as expected.
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Prognosis ■
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Full recovery is expected in animals with sudden (acute) pyelonephritis that receive prompt treatment. Animals with long-standing (chronic) pyelonephritis or other urinary tract disorders, such as chronic kidney disease or kidney stones, may be harder to treat.
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PET OWNER EDUCATIONAL ATLAS. NEPHROLOGY AND UROLOGY
URINARY TRACT INFECTIONS
35 Emphysematous cystitis Infection of the bladder caused by gas-producing bacteria, or rarely fungi, and characterized by the presence of gas within the bladder. Although rare, the kidneys can also be involved. The gas is formed when bacteria ferment glucose or other substances.
Clinical signs ■ ■ ■ ■ ■
Urinary accidents. Frequent urination. Straining to urinate or painful urination. Foul-smelling or bloody urine. Excessive licking of the genital area.
Diagnosis ■ ■
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Emphysematous cystitis occurs most commonly in animals with diabetes mellitus.
Urinalysis findings are typical of urinary tract infection. A positive bacterial culture result in a urine sample collected properly (by cystocentesis) will confirm the diagnosis. Radiographic imaging to detect the presence of gas in the urinary tract. Blood glucose regulation should be assessed in diabetic patients.
Gas in the bladder wall
Treatment ■ ■
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Antimicrobial drugs selected on the basis of urine culture results. Glucose regulation may need to be improved.
Prognosis The accumulation of gas (emphysema) will resolve with appropriate treatment of the urinary tract infection.
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PET OWNER EDUCATIONAL ATLAS. NEPHROLOGY AND UROLOGY
55 Benign prostatic
hyperplasia (BPH)
Noncancerous condition in which the prostate becomes enlarged over time. It occurs most commonly in male dogs that have not been castrated.
Clinical signs ■
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Bladder
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Ureter ■
Ductus deferens Ilium
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Enlarged prostate
Urethra (pelvic part)
Diagnosis ■
Ischium
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Bulb of the penis
Affected dogs may show no clinical signs (asymptomatic). Blood in the urine. Thick, sometimes bloody, discharge from the penis. Straining to defecate, ribbon-shaped feces. Walking with stiff back legs and short steps. Additional clinical signs, such as straining to urinate, may occur in dogs that develop other conditions to which BPH predisposed them (e.g., prostatitis or large prostatic cysts).
A rectal exam will confirm that the prostate is enlarged. Urine culture, blood tests, imaging studies, and cytological examination of prostatic fluid can help exclude other causes of prostatic enlargement.
Enlarged prostate compressing the colon Around 80 % of intact male dogs have some degree of benign prostatic hyperplasia by 5 years of age.
Treatment ■ ■
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Castration is the most effective treatment. Drugs that inhibit androgens, such as finasteride and progestogens, or pulsed electromagnetic field therapy can be tried in breeding dogs.
Prognosis The prostate should shrink by 50 % within 1 month of castration and will eventually shrink to 25 % of its original size.
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PET OWNER EDUCATIONAL ATLAS. NEPHROLOGY AND UROLOGY
59 Subcutaneous ureteral
bypass (SUB)
This device, made of two tubes (catheters) and a port, is surgically implanted to allow the urine to flow from the kidney to the bladder while bypassing an obstructed ureter. One tube goes from the kidney to the port and the other goes from the port to the bladder. The port is under the skin (subcutaneous), allowing for easy sampling of urine and flushing of the device.
Subcutaneous ureteral bypass is the preferred device by some veterinarians for treating cats with ureteral obstruction. Obstructed ureter Catheter from the kidney
Subcutaneous skin
Considerations ■
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Placement is generally permanent. Patients will rarely need to have the device removed or replaced. After placement, most patients will have a reduction in the magnitude of azotemia. Cats with severe persistent renal disease after SUB placement may have a shorter survival time, but this cannot be predicted before the procedure.
Port
Catheter to the bladder
Potential complications ■
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This device may be associated with fewer complications than traditional surgery or stents. Complications include kinking of the tube, urine leakage, reobstruction from mineralization of the device, and recurrent urinary tract infections. Regular flushing of the port (every 3–6 months) may reduce the risk of recurrent obstruction.
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