Urinary disorders

Canine Renal Biopsy | Renal biopsy in dogs

The biopsy and histopathologic evaluation of renal tissue is a valuable diagnostic and prognostic tool. Renal biopsy in dogs and cats should be considered if the diagnosis is in question (e.g., immune complex glomerulonephritis versus amyloidosis in dogs with proteinuria), if treatment may be altered on the basis of results (e.g., confirmation and culture of bacterial pyelonephritis), or if the prognosis may be altered on the basis of results (e.g., evidence of reversible tubular lesion in a dog or cat with acute tubular necrosis). A specific diagnosis is required in order to implement specific treatment in most animals with renal disease, and for a specific diagnosis to be obtained, frequently a biopsy must be done. In addition, the prognosis for animals with renal disease is most accurate if based on three variables: the severity of disfunction, the response to treatment, and the renal histopathologic findings.

Renal biopsy in dogs and cats should be considered only after less invasive tests have been done and the blood clotting ability has been assessed. Contraindications to renal biopsy include a solitary kidney, a coagulopathy, severe systemic hypertension, and renal lesions associated with fluid accumulation (e.g., hydronephosis, renal cysts and abscesses). In addition, renal biopsy should not be attempted by inexperienced clinicians or in animals that are not adequately restrained.

Renal biopsy specimens can be obtained percutaneously using the keyhole technique or under laparoscopic or ultrasonographic guidance. Frequently the best way to obtain a specimen is at laparatomy when both kidneys can be visualized, because postbiopsy hemorrhage can then be accurately assessed and treated, and an adequate biopsy specimen assured. The cortical region of the kidney should be biopsied to obtain an adequate number of glomeruli in the specimen and to avoid renal nerves and major vessels in the medullary region. Most animals will have microscopic hematuria for 1 to 3 days after the biopsy procedure, and overt hematuria is not uncommon. Severe hemorrhage occurs less than 3% of the time and is almost always the result of faulty technique.

Urinary tract infection in dogs and cats

Bacterial infections of the urinary tract occur more frequently in dogs than cats. Although inflammation of the lower urinary tract is common in cats, bacterial infections are rare. Fewer than 2% of the cases of lower urinary tract inflammation (LUTI) in cats are caused by a primary urinary tract infection in dogs and cats. Most of the UTIs in dogs involve bacterial inflammation of the lower urinary tract (bladder, urethra); however, the ascension of bacteria into the ureters and kidneys is a potential sequela of lower UTIs. Compared with the incidence of bacterial UTIs, mycoplasmal, chlamydial, viral, and fungal UTIs are rare in dogs. Most bacterial infections of the lower urinary tract respond quickly to appropriate antibiotics treatment; however, UTIs associated with defects in the host immune system often fail to respond to antibiotic therapy, or the infection relapses shortly after antibiotic withdrawal.

Inflammation of the lower urinary tract often results in pollakiura, stranguria, and gross or microscopic hematuria. Urinalysis findings compatible with a lower UTI include bacteriuria, hematuria, pyuria, and increased numbers of transitional epithelial cells in the urine sediment. In addition, an increased urine protein concentration and alkaline urine may be observed. Cystocentesis constitutes the best way to collect urine for urinalysis and bacterial culture, because it prevents urine from being contaminated by bacteria inhabiting the distal urethra.

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Clinical signs of acute renal failure symptoms (ARF) are often nonspecific and include lethargy, depression, anorexia, vomiting, diarrhea, and dehydration; occasionally uremic breath or oral ulcers may be present. A diagnosis of renal failure is confirmed if azotemia with concurrent isosthenuria or minimally concentrated urine persists. Prerenal dehydration and azotemia superimposed on an inability to concentrate urine ) e.g., Addison’s disease, hypercalcemia, or overzealous use of furosemide) initially mimics renal failure; however, in these cases, volume replacement results in resolution of the azotemia.

Acute renal failure occurs within hours or days of exposure to the insult. Unique clinical signs and clinicopathologic findings associated with ARF include enlarged or swollen kidneys, hemoconcentration, good body condition, an active urine dediment (e.g., granular casts, renal epithelial cells), and relatively severe hyperkalemia and metabolic acidosis (especially in the face of oliguria). Clinical signs in an animal with ARF tend to be severe relative to those seen in animal with Chronic Renal Failure (CRF) and the same magnitude of azotemia. Renal ultrasonographic findings in dogs and cats with acute renal failure are usually nonspecific, with normal to slightly hyperechoic renal cortices. In animals with calcium oxalate nephrosis associated with ethylene glycol ingestion, the renal cortices can be very hyperechoic. The prevention of trauma (car accident for instance), that may lead to shock and the development of renal ischemia or exposure to nephrotoxicants outside the hospital relies on owner education and environmental control, an important aspect of the prevention.

Canine and Feline renal failure diagnostic plan:

History
Physical examination
Abdominal palpation
Urinalysis
Blood work
Abdominal x-rays
Kidney biopsy

Canine and Feline renal failure treatment:

Fluid therapy
Diuretics
Phosphate binders
Sodium bicarbonate
Drugs to control stomach acidity
Peritoneal dialysis

Canine and Feline renal failure diatery plan:

A diet with controlled and appropriate levels of protein, phosphorus, sodium and calories. We recommend this natural balanced real-meat dog food and natural dietary supplement for recovery.

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Micturition is the normal process of the passive storage and active voiding of urine. Disorders of micturition encompass problems with urine storage (incontinence) and bladder emptying (urine retention). Urinary incontinence is the inappropriate passage of urine during the storage phase of micturition.

The most common forms of urinary incontinence are detrusor hyperreflexia or instability, and urethral sphincter mechanism incompetence. Urine retention can occur in patients with decreased detrusor muscle contractility or with increased urethral resistance. Armed with an understanding of bladder and urethral neuroanatomy, as well as the mechanism of action of the currently available drugs, clinicians are able to effectively control many disorders of micturition.

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Renal enlargement is usually detected by physical examination or by abdominal radiography or by ultrasonography. A quick rule of thumb is that the kidney length on abdominal radiographs should be approximately equivalent to 2.5 to 3.0 times the length of the second lumbar vertebra in cats and 2.5 to 3.5 times length of the second lumbar vertebra in dogs. Enlarged kidneys with a normal shape can be caused by edema, acute inflammation, diffusely infiltrating neoplasic disease, unilateral compensatory hypertrophy, trauma (intracapsular hemorrhage), or hydronephrosis. Enlarged, abnormally shaped kidneys may be caused by renal neoplasia, cysts, abscesses, hydronephrosis, or hematomas.

Ultrasonography and intravenous urography can be used to further define kidney shape and reveal internal details. Ultrasonography is particularly useful for evaluating enlarged kidneys associated with fluid accumulation (e.g., hydronephrosis, abscesses, and perirenal and parenchymal cysts), and can also be used to guide fine-needle aspiration or needle biopsy of the affected kidney. Kidney biopsy is often necessary to confirm the cause of the renomegaly; however, biopsy is contraindicated if only one kidney is present or if a bleeding disorder, hydronephrosis, a cyst, or an abscess is suspected.

Canine renomegaly diagnostic plan:

History
Physical examination
Abdominal palpation
Urinalysis
Blood Work
Blood pressure measurement
Abdominal x-rays
Kidney biopsy

Canine renomegaly treatment:

Fluid therapy
Sodium bicarbonate
Drugs to control stomach acidity
Phosphate binders
Blood transfusions
Anabolic steroids
Dialysis peritoneal

Canine renomegaly diatery plan:

A diet with controlled and appropriate levels of protein, phosphorus, sodium, and calories.

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