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