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Exam 2
Equine Urinary
104
Veterinary Medicine
Professional
03/02/2017

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Term
What determines the BUN in a horse?
Definition
-age
-diet
-rate or urea pdn
-renal function
Term
What are some causes of inc BUN in the horse?
Definition
-inc protein cataboism
-dec renal blood flow or renal function
-GI dz
Term
How does BUN change in relation to fasting in the horse vs the pony?
Definition
-HOrse: inc protein catabolism = BUN inc
-Pony: inc fat catabolism = BUN dec
Term
From what is creatine produced?
Definition
-phosphocreatinine
Term
What is creatinine concentration, pdn, and excretion proportional to?
Definition
-muscle mass
-THE MORE MUSCLE THE HIGHER PHOSPHOCREATININE AND THUS HIGHER CREATININE
Term
Which horses naturally have a higher creatinine?
Definition
-halter horses
-stallions
Term
How is creatinine excreted?
Definition
-urine: also in sweat an dGI tract
Term
Describe creatinine levels in a foal.
Definition
-30-50% higher than mare in first few days of life
-don't necessarily put on fluids
-can be as high as 20-30 mg/dl in some premature or asphyxiated foals
-will drop lower than adults after first 5 days
Term
Why do foals have low creatinine?
Definition
-rapid growth + litle skeletal muscle
Term
What are some other things that can affect creatinine? Why?
Definition
-exercise, rhabdomyolysis, muscle wasting
-due to inc breakdonw of creatinine from m & dec creatinine clearance during exercise
Term
How much does a horse normally drink a day? When does this change?
Definition
-500 kg horse will drink 27-30 L/day
-drink most water in hour after eating & when lactating
-feral ponies only drink once or twice daily
Term
What is the typical blood flow & CO used in the kidneys?
Definition
-15-20% CO
-7,5-10 L/min
-high met rate second only to the heart
Term
How much whole body oxygen does the kidney use?
Definition
-10%
Term
Describe the standard state of the renal medulla.
Definition
-always in hypoxic state but highest ATP use and thus oxygen consumption
Term
How does the body protect the renal medulla from hypoxia? How is this clinically relevant?
Definition
-preferential red in cortical blood flow: redistribution to corticomedullary region
-pxn of PGE2, PGI2, and NO as vasodiltory substances
-CLINICAL RELEVANCE: NSAIDs block these prostaglandins
Term
Is it ever a good idea to give NSAIDs to a horse w/ dec perfusion?
Definition
-NO
-NEVER A PRN DRUG!!!
Term
The kidney has dopaminergic type I adrenoreceptors. Why is this clinically relevant?
Definition
-can give Dopamine to inc blodo flow via vasodilation
Term
What are the most common presenting complaints in equine patients w/ kidney dz? Others?
Definition
-wt loss and/or abnormal urination
-others: EXCESSIVE DENTAL TARTAR, urine scalding on pasterns (looks muddy in males), colic w/ repeated posturing tourinate, dysuria, hematuria, fever, anorexia, depression, ventral edema, oral ulceration
Term
What is pollakiuria? When is this common?
Definition
-frequent urination
-females in estrus, cystitis, cystic calculi
Term
What is polyuria? When is this common?
Definition
-inc urine pdn
-renal dz, PPID, behavior, DM or DI, psychogenic drinkers in stalled horses (boredom)
Term
What do we feel for on rectal exam w/ equine kidney dz?
Definition
-bladder size, wall thickness, masses, cystic calculi
-caudal pole of left kidney
-ureters only if abnormal
Term
Does pollakiuria or polyuria occur more frequently w/ kidney dz?
Definition
-polyuria
Term
Why would we see a leukocytosis on CBC w/ renal case?
Definition
-infeciton
Term
Why would we see an anemia on CBC w/ renal case?
Definition
-chronic dz: dec erythropoietin & shortened RBC lifespan
Term
True or False: We can diagnose renal dz in the horse based on BUN alone.
Definition
-FALSE, never ever ever look at equine BUN alone
Term
At what point of renal dz does creatinine inc?
Definition
-at least 75% nephrons are non-functional
Term
How do sodium and chloride change w/ equine renal dz?
Definition
-hyponatremia & hypochloremia
-also occurs w/ colitis
Term
How does potassium change w/ equine renal dz?
Definition
-inc w/ ruptured bladder
Term
How does calcium change w/ equine renal dz?
Definition
-can be either high or low
-most commonly hgih w/ CRF
Term
Why would we look at CPK & AST w/ renal case horse?
Definition
-if pigmenturia present may be helpful to differentiate myoglobinuria & hemoglobinuria
-if inc = myoglobinuria
Term
What value on chem panel is most useful in assessing renal function in horse?
Definition
-Creatinine NOT BUN
-b/c BUN cac be inc w/ other things like GI dz
Term
What is the most common cuase of inc creatinine in a neonate (<3d)?
Definition
-dec placental clearance
Term
What does equine urine look like on UA?
Definition
-pale yellow to deep tan
-often turbid due to Ca carbonate crystals and mucus (mares)
Term
What is the typical USG in the horse?
Definition
-normal adult: 1.030
-foal: < 1.012 (b/c diet is liquid)
Term
What is USG w/ CRF?
Definition
-lose ability to concentrate or dilute so typically have isothenuric urine
Term
What is typical pH of equine urine in adult and foal?
Definition
-adult: 7-9
-foals: 6-7
Term
How relevant are dipsticks in horses?
Definition
-DON'T USE THEM, mucus in urine will cause false positives
Term
How do we detect proteinuria in the horse?
Definition
-SSA: sulfosalicyclic acid precipitation
Term
What is the though process regarding glucose in equine urine?
Definition
-glucosuria in absence of hyperglycemia => suspect dysfunction
-more common w/ ARF than CRF
Term
What do we think w/ bilirubin on equine UA?
Definition
-IV hemolysis, hepatic necrosis, obstructive hepatopathies (cholelithiasis)
Term
What is special about the equine sediment?
Definition
-calcium carbonate crystals are normal
Term
What is the purpose of fractional excretion?
Definition
-used to measure tubular function
-draw blood and urine at the same time, prior to any fluid therapy
Term
True or FAlse: Alpha 2 agonists antagonize ADH causing diuresis in the horse.
Definition
-TRUE
Term
Describe presentation of renal agenesis.
Definition
-unilateral: no clinical signs probably ever
-bilateral: anuria & death early in life
Term
What is renal dysplasia?
Definition
-disorganized development of renal tissue not necessarily abnormal size
Term
What are some of the possible causes of renal dysplasia?
Definition
-anomaous differentiation
-intrauterine ureteral obstruction
-fetal viral infection
-teratogens
Term
What is the function of the urachus?
Definition
-conduit for urine to pass from bladdr into alantoic cavity
Term
What is a patent urachus?
Definition
-incompletely closed at birth
-tension on attachment to body wall = dilation
Term
What are the clinical signs of a patent urachus?
Definition
-persistently moist umbilicus after birth where urine leaks or drips
-2 streams of urine at once
Term
What is the traditional treatment for congenital patent urachus? Explain why it is traditional.
Definition
-use 7% iodine to cauterize wound
-doesnt really close it
Term
How do we really treat patent urachus?
Definition
-prophylactic abx to prevent ascending infection
Term
What is acquired patent urachus most commonly assoc w/?
Definition
-local or systemic septicemia
Term
How do we treat acquired patent urachus?
Definition
-BS abx
-resolves w/ systemic dz
-NEVER EVER USE CHEMICAL CAUTERIZATION
-if still open 5-7d after tx think about sx
Term
Who does acquired patent urachus have a worse prognosis if it is associated w/ umbilical vein?
Definition
-b/c becomes falciform ligament to liver thus cnanot be ligated due to proximity to liver and infection stays
Term
What are the early warning signs of patent urachus?
Definition
-patency on U/S
-frequent attempts to urinate
-wet umbilicus
-look for two streams
Term
What is the most common disorder of the neonatal bladder? Any sex predilection?
Definition
-ruptured bladder
-colts
Term
What are the clinical signs of rupture bladder in foals?
Definition
-repeated psoturing to urinate, stranguria
-easily misinterpreted as tenesmus (meconium impaction)
-may continue to void small amounts of urine making diagnosis tricky
Term
What lab abnormalities do we see w/ ruptured bladder?
Definition
-dec Na & Cl
-inc Creatinine & K
Term
How do we diagnose ruptured bladder?
Definition
-electrolyte abnormalities
-U/S
-abdominocentesis: abdominal creatinine 2X higher than serum
Term
How do we treat ruptured bladders?
Definition
-sx but stabilize first!!
-fluids: .45% NaCl, 5% dextrose
-supportive care
-BS abx
Term
Why do we give 5% dextrose to foals w/ ruptured bladder?
Definition
-inc blood glucose causes insulin release which drives K+ into the cells
Term
What are the general causes of acute renal failure?
Definition
-dec perfusion: dec CO, inc renal vascualr R
Term
What are the most common causes of dec CO?
Definition
-diarrha
-endotoxemia
-acute blood loss
-septic shock: babies
-prolonged exercise
Term
What is the most common cause of reversible azotemia in the horse?
Definition
-dec perfusion
Term
How does acute renal failure lead to azotemia?
Definition
-dec RBF, GFR, & urine output
Term
What are the two major sites of injury due to acute renal failure in the horse?
Definition
-renal medullary crest necrosis: NSAIDs
-acute tubular necrosis: aminoglycosides, ischemia, other toxins (myoglobin/hemoglobin)
Term
What are the two most common sites of injury w/ equine acute renal failure?
Definition
-renal medullary crest necrosis: NSAIDs
-acute tubular necrosis: ischmia & nephrotoxins
Term
What are the clinical signs of acute renal failure in horses?
Definition
-dehydration
-depression
-anorexia
-tachycardia
=pyrexia
-mild abdominal pain
-LAMINITIS
-OLIGURIA
Term
How do we diagnose acute renal failure in horses?
Definition
-inc creatinine
-rule out pre & post renal
-hyponatremia, hypochloremia, hyperkalemia
-proteinuria: SSA
-isosthenuria: loose ability to concentratie AND dilute
Term
How do we treat acute renal failure?
Definition
-remove inciting cause!!
-fluids: electrolyte correction
-TDM
-Furosemide CRI
Term
How do we treat acute renal failure in horses?
Definition
-correct initialfluid deficit in first 6h & continue until creatinine corrected
-avoid overhydration
-treat hyperkalecia: fix acid/base, give HCO3/glucose
-treat hypocalcemia
Term
How do we monitor overhydration in acute renal failure horse?
Definition
-Central Venous Pressure (CVP) best
-also use BW, HCT
Term
What do we do if acute renal failure is oliguric after 10-1212 hrs of fluid therapy? Any causes for caution?
Definition
-start dopamine: vasodialtor to inc blood flow to kidney
-be careful if hyperkalemic b/c causes VPCs
Term
What is the general prognosis for equine acute renal failure?
Definition
-depends on underlying cause, DURATION OF RENAL FAILURE, response to treatment and development of secondary complications
Term
What are some poor prognostic indicators w/ acute renal failure?
Definition
-early intervention is not taken
-prolonged (>12h) oliguria or anuria
Term
How common is chronic renal failure found in horses?
Definition
-infrequent
Term
What is the most common presenting complaint w/ equine chronic renal failure? Other clinical signs?
Definition
-wt loss
-CS: excessive dental tartar, ginigivitis, oral ulcers, PU/PD
Term
What lab findings do we see w/ equine chronic renal failure?
Definition
-mild anemia
-hypoalbuminemia
-hyponatreia
-hypophosphatemia
-metabolic acidosis
Term
What is the prognosis of chronic renal failure in horses?
Definition
-grave
Term
How do we treat chronic renal failure in horses?
Definition
-palliative
Term
Is cystitis typically a primary or secondary problem? Explain.
Definition
-secondary
-ex: urolithiasis, bladder paralysis, catheterization, bladder neoplasia, sorghum cystitis
Term
HOw do we diagnose equine cystitis?
Definition
-UA
-endoscopy
-U/S
-urine culture
Term
How do we treat equine cystitis?
Definition
-correct primary problem
-may be prolonged
Term
Describe the prevelance of equine urolithiasis. Typical signalment?
Definition
-common in older males
Term
What are some predisposing factors for equine urolithiasis?
Definition
-prolonged urine retention
-genetic tendencies to excrete more calcium, uric acid, or oxylates
-tissue damage
Term
What are the clinical signs of equine urolithiasis?
Definition
-dysuria
-hematuria
-stranguria
-pollakiuria
-pyuria
-incontinence
Term
How do we diagnose equine urolithiasis?
Definition
-rectal
-U/S
-don't forget the kidneys
Term
How do we treat equine urolithiasis?
Definition
-sx
-abx
-NSAIDs
-dietary management: no alfalfa
Term
True or False: To correct equine urolithiasis, urinary acidification is suggested practice.
Definition
-FALSE, cannot acidify the urine of the horse like you can small rums
Term
What is sabulous cystitis?
Definition
-aka sabulous sludge
-abnormal accumulation of sediment in the bladder
-typicallly accompanied by cystitis
Term
Why does cystitis usually accompany sabulous cystitis in horses?
Definition
-irritation of mucosa by sludge
-ammoniagenesis
Term
What are some of the causes of sabulous cystitis in the horses?
Definition
-EHV-1
-EHV-4
-EPM
\-EDM
-sorghum cystitis
-CSM
-neoplasia
-sacral vertebral trauma
Term
Why is sabulous cystitis a vicious cycle?
Definition
-bladder dysfunction leads to inadequate emptying
-irritation and stretching of bladder wall detrimental to detrusor muscle function
Term
How do we treat equine sabulous cystitis?
Definition
-lavage
Term
What is the typical prognosis of equine sabulous cystitis?
Definition
-historically been poor but recent reports of successful management
Term
What are our major equine differentials for equine hematuria?
Definition
-vascular malformation
-UTI
-urolithiasis
-neoplasia
-exercise induced
-idiopathic
-pyelonephritis
-cystitis
Term
Where and in whom do we find equine urethral defects causing hematuria?
Definition
-geldings & stallions
-weak sports
-proximal urethra/level of ischial arch: hematuria at end of urniation
-QH/QH crosses
Term
How do we treat equine hematuria?
Definition
-may resolve spontaneously, if present > 1mo may need to do PU
-complete sexual rest
Term
Describe idiopathic renal hematuria in horses.
Definition
-sudden onset of gross, often life-threatening hematuria
-one or both kidneys
-passage of blood clots in urine
Term
What breed is predisposed to equine idiopathic renal hematuria?
Definition
->50% arabians
Term
How do we treat equine idiopathic renal hematuria?
Definition
-no long term treatment
-can be fatal
-can give amino caproic acid to strengthen the clot in the short term
Term
What do we see on cytoscopy w/ Exercise Assoc Hematuria?
Definition
-bladder erosions or ulcers
Term
What causes exercise associated hematuria?
Definition
-abdominal contents pounding bladder against pelvis during exercise
Term
What are the clinical signs of cantharadin toxicosis?
Definition
-pollakiruria
-hematuria
-dilute urine in the face of dehydration
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