Canis ISSN: 2398-2942

Therapeutics: urinary system

Contributor(s): Linda Horspool, Lauren Trepanier, David Williams, P C W Williams

Renal failure

  • * Indicates drug not licensed for this use in this species.
  • Kidneys maintain and regulate fluid, acid-base, electrolyte balance.
  • Excrete waste products of protein metabolism, drugs and toxins.
  • Role in production of erythropoietin and 1, 25 dihydroxy vitamin D3.
  • In renal (or kidney) failure, the kidneys fail to function adequately → consequences in many body systems due to decrease in glomerular filtration rate resulting in potassium, calcium, phosphate, and (in the longer term) anemia.
  • Plasma creatinine concentration used to stage cases using International Renal Interest Society (IRIS) system, which also guides treatment and prognosis.
  • Treatment of acute renal failure Kidney: acute kidney injury (AKI) should aim to eliminate cause (eg infection - Leptospirosis, nephrotoxic drugs, intoxication); + drugs to improve tubular flow of urine often necessary.
  • Treatment of chronic renal failure Kidney: chronic kidney disease (CKD) aims to minimize the biochemical (proteinuria Proteinuria , hyperphosphatemia Hyperphosphatemia , and metabolic acidosis Acid base imbalance ) and clinical consequences (including dehydration, systemic hypertension and hyperparathyroidism Hyperparathyroidism (primary) ).
  • Initial IV fluid therapy Fluid therapy: for electrolyte abnormality necessary to control dehydration and ongoing fluid loss due to vomiting.
  • Unrestricted access to water.
  • Treat vomiting and/or gastritis with H2 receptor antagonist such as cimetidine Cimetidine , famotidine*, ranitidine* Ranitidine. Antiemetics may be necessary, eg metoclopramide* Metoclopramide or maropitant Maropitant citrate.
  • Diet needs to be tailored to individual Dietetic diet: for chronic kidney disease (CKD). Reduced phosphorus is essential (hyperphosphatemia → secondary hyperparathyroidism). Protein restriction should be considered. If metabolic acidosis persists, supplement with oral sodium bicarbonate or potassium citrate to effect to maintain blood bicarbonate/ total CO2 in the range of 18-24 mmol/l.
  • Reduce elevated systolic blood pressure using angiotensin converting-enzyme (ACE) inhibitor therapy ACE inhibitor: overview at standard dose rates. Increasing the dose may improve the antihypertensive effect. The calcium channel blocker amlodipine* Amlodipine and hydralazine* Hydralazine can be added to treatment if the response is insufficient.
  • Adjunctive therapy includes enteric phosphate binders such as aluminium hydroxide or calcium carbonate; oral vitamin D (calcitriol) to combat renal secondary hyperparathyroidism; multivitamins to compensate for loss of water soluble vitamins; and eythropoietin alfa and beta* if anemia (due ro loss of erythropoietin, iron and folate deficiency) affecting quality of life.
  • Avoid nephrotoxic drugs, eg aminoglycosides, sulphadiazine Sulfadiazine , amphotericin B Amphotericin B.
  • Care with drugs that are excreted exclusively via the kidney, eg aminoglycosides, enalpril Enalapril (dosage adjustment may be required).

Bacterial cystitis

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Urinary retention and incontinence - provided urethra not obstructed

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Urolithiasis

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Further Reading

Publications

Refereed papers

  • Recent references from VetMed Resource and PubMed.
  • Claeys S, Noël S, Hamaide A (2010) Acquired urinary incontinence in the bitch: Update and perspectives from human medicine. Part 3: The urethral component and surgical treatment. Vet J 186(1), 25-31 PubMed.
  • Noël S et al (2010) Combined pharmacokinetic and urodynamic study of the effects of oral administration of phenylpropanolamine in female Beagle dogs. Vet J 184(2), 201-207 PubMed.
  • Noël S, Claeys S, Hamaide A (2010 )Acquired urinary incontinence in the bitch: Update and perspectives from human medicine. Part 1: The bladder component, pathophysiology and medical treatment. Vet J 186(1), 10-17 PubMed.
  • Coit V A, Dowell F J, Evans N P (2009) Neutering affects mRNA expression levels for the LH- and GnRH-receptors in the canine urinary bladder. Theriogenology 71(2), 239-247 PubMed.
  • Kidder A C, Chew D (2009) Treatment options for hyperphosphatemia in feline CKD: what's out there? J Feline Med Surg 11(11), 913-924 PubMed.
  • Osborne C A et al (2009) Paradigm changes in the role of nutrition for the management of canine and feline urolithiasis. Vet Clin North Am Small Anim Pract 39(1), 127-141 PubMed.
  • Osborne C A et al (2009) Analysis of 451,891 canine uroliths, feline uroliths, and feline urethral plugs from 1981 to 2007: perspectives from the Minnesota Urolith Center. Vet Clin North Am Small Anim Pract 39(1), 183-197 PubMed.
  • Reichler I, Hubler M, Arnold S (2008) Urethral sphincter mechanism incompetence in spayed bitches: new insights into the pathophysiology and options for treatment. EJCAP 18(2),187-19 1http://www.fecava.org/files/ejcap/814.pdf.
  • Byron J K et al (2007) Effect of phenylpropanolamine and pseudoephedrine on the urethral pressure profile and continence scores of incontinent female dogs. J Vet Intern Med 21(1), 47-53 PubMed.
  • Reichler I M et al (2006) Effect of a long acting GnRH analogue or placebo on plasma LH/FSH, urethral pressure profiles and clinical signs of urinary incontinence due to Sphincter mechanism incompetence in bitches. Theriogenology 66(5), 1227-1236 PubMed.
  • Hoeijmakers M et al (2003) Pharmacokinetics of oestriol after repeated oral administration to dogs. Res Vet Sci 75(1), 55-59 PubMed.
  • Scott L, Leddy M, Bernay F and Davot J L (2002) Evaluation of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch. JSAP 43, 493-496 PubMed.
  • Mandigers R J, Nell T (2001) Treatment of bitches with acquired urinary incontinence with oestriol. Vet Rec 149(25), 764-767 PubMed.
  • Holt P E (1999) Diagnosis and management of canine urethral sphincter mechanism incompetence. Waltham Focus 9(4), 19-23 http://www.walthamusa.com/articles/wf94hol.pdf.

Other sources of information


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