EDUCATION “It is possible to store the mind with a million facts and still be entirely uneducated.” - Alec Bourne

Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence

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 Failure An 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 – 1 st 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) PCVInc.Dec. Azotemia: Bun and Creatine Inc. PhosphorousInc. PotassiumInc.Dec. OtherAcidosis, proteinuria

Urinary Incontinence Loss 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