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EDUCATION

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

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EDUCATION

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

  2. CystitisCystic calculiUrinary obstructionARF & CRFIncontinence

  3. 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______________

  4. AZOTEMIA • Pre-renal • Renal • Post-renal

  5. 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)

  6. Stages of Kidney disease

  7. 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

  8. 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

  9. Acute Renal Failure • Dx • Urinalysis—urine sediment/casts; ______________ sp gravity (unable to concentrate urine) • CBC—dehydration (↑PCV), acidosis • Chem panel • ↑ BUN, Creatinine • ↑ __________, ______________

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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____________)

  16. 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

  17. 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

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