Internal medicine Lectures for students, 9th semester Urinary - - PowerPoint PPT Presentation

Internal medicine

Lectures for students, 9th semester

Urinary diseases of ruminants

• Dr. Vörös Károly

Belgyógyászati Tanszék és Klinika

Structure of the lectures

Renal diseases

A) Non-purulent renal diseases I.

• Acute nephrosis
• Renal amyloidosis

B) Purulent renal diseases I.

• Non-purulent nephritis
• Contagious bovine pyelonephritis

Urolithiasis

Non-purulent renal diseases I.

Common characteristics:

• Subclinical course, usually not diagnosed in vivo
• Symptoms of underlying disease are dominant (common)
• Clinical signs of renal disease (rare)

Acute nephrosis

Cause: intoxication, Pb/As/Cu toxicosis, hemoglobin nephrosis, monensin, tannins (foliage of oak trees and acorns) unidenfied toxin of Amaranthus retroflexus, ochratoxin Characteristics:

• Rarely diagnosed clinically (no obvious signs)
• Urine: proteinuria, renal epithelial cells/cylinders (casts)

Renal amyloidosis

Cause: Chronic inflammatory (purulent) diseases of other organs immunological processes abnormal antigen- antibody reaction hyperglobulinemia amyloid protein deposition (systemic disease) Sequela: Renal enlargement, weight loss Nephrotic syndrome: massive proteinuria + edema formation Uremia: halitosis, uremic stomatitis, diarrhoea Differential diagnosis: perform rectal examination, urinalysis ! traumatic pericarditis, paratuberculosis

Non-purulent renal diseases II.

Renal amyloidosis in a bull (Blowey and Weaver, 1991)

Non-purulent nephritis

(= glomerulonephritis, interstitial nephritis)

• primary disease or component of systemic diseases
• immun-complex formation (glomerulonephritis)
• infectious diseases (interstitial nephritis, e.g. leptospirosis)

Characteristics:

• Rarely diagnosed clinically (no obvious signs)
• Can be detected by ultrasound-guided biopsy if necessary
• Urine: proteinuria, renal epithelial cells/cylinders (casts)

Non-purulent renal diseases III.

Purulent renal diseases I.

Purulent nephritis

(embolic nephritis) (embolic suppurative nephritis or renal abscess ) Occurrence and etiology: bacterial ( metastatic emboli ), hematogenous route from

• valvular endocarditis
• suppurative lesions in uterus, udder, navel (umbilicus)
• septicemias in calves/ lambs

Characteristics:

• rarely diagnosed clinically (no obvious signs)
• but: +/- rectal finding,
• urine: proteinuria, pyuria, (microsc.) hematuria, bacteruria

Treatment: antibiotics (sensitivity test; no nephrotoxic drugs)

Contagious bovine pyelonephritis 1.

Occurrence and etiology milking cows of 4-8 years, after calving, (atfter repeated antibiotics!), especially in autumn/winter Corynebacterium renale (C. bovis renalis), serotypes I. and III.

• urease pos.

NH3 production tissue necrosis

• attaches to the epithelium
• resistant to phagocytosis

(+ Arcanobacterium/Corynebacterium pyogenes, E. coli) usually ascending and rarely hematogenous route Cystitis, urethritis, pyelitis → nephritis (usullay bilateral)

Purulent renal diseases II.

Bovine contagious pyelonephritis

Necropsy findings

Contagious bovine pyelonephritis 2.

Clinical signs: subacute course, decreased milk production after calving; fluctuating fever, anorexia, dullness, weight loss, signs of renal pain: kyphosis, stranguria + colic rectal examination: painful, enlarged ( left ) kidney with abnormal consistency and irregular surface ( +/- enlarged ureter) ultrasound examination kidneys, bladder endoscopy Laboratory examination: Blood: anemia, neutrophilia, uremia Urine: macroscopic abnormalities: smell, color, debris, pus, mucus detection of free NH3 with HCl (hydrochlorid acid) pH: 8.0-9.0; detection of protein, blood, neutrophils (Donne-test) Detection of C. renale: microscope, IF method, culture

Purulent renal diseases III.

Bovine contagious pyelonephritis

Abnormal urine Glass stick probe with HCL: detection of free NH3 NH3 + HCL = NH3Cl „smoke”

Contagious bovine pyelonephritis 3.

Diagnosis: history, clinical signs, urinalysis, (ultrasonography) differentiate from RPT, other urinary diseases Treatment: indication of treatment (?), early diagnosis !

• antibiotics (resistance test): penicillin (+ streptomycin?)
• acidification 10-14 (21) days (sodium phosphate, 100 g/24h)
• nephrectomy (?!)

Prevention:

• good hygiene at calving,
• avoid catheterization and breeding with a bull

Prognosis: early phase: favourable later phase: questionable - poor

Purulent renal diseases IV.

Urolithiasis in ruminants I. Occurrence

feedlot bulls: in vivo 0 -10%, post mortem can be 75 - 80% feedlot lambs: in vivo 12 - 15%, post mortem can be 85 - 100%,

• nset: mainly between October – March

Uroliths: magnesium-ammonium-phosphate (struvit) = most common + Ca phosphate, Mg carbonate, Ca carbonate, silica, Ca oxalate stone formation: kidney (bladder) accumulation within the bladder urethral obstruction

Pathogenesis:

• (++) grain, i.e. minerals, (- -) water → (++) saturated urine
• effect of pH (crystal formation, stability of protective colloids)
• nidus formation: inflammation (adenovirus, bacteria)

vitamin A deficiency ?) estrogens (synchronization, clover) precipitation of solutes sand, stone formation Consequences: hydronephrosis, pyelitis?, cystitis? urethral obstruction, bladder rupture

Urolithiasis in ruminants II.

Urolithiasis in ruminants III.

Clinical signs:

• Maybe silent or can occur with abdominal pain
• Signs of cystitis ( several animals affected )
• Signs of urethral obstruction:

sudden colic, dysuria, stranguria, hematuria, cristals on preputium, sign of urethral dilatation in bulls at the perineum

• Rupture of the urethra:

infiltration with urine: abdomen, perineum

• Rupture of the bladder: uroperitoneum

uremia, +-/ undulation, abdominocentesis Uremia death

Urolithiasis in bulls

Urolithiasis in a male calf

Marked abdominal distension and infiltration of the preputium and ventral abdomen („water belly)

Urolithiasis in sheep

Signs of urethral obstruction 1.

Urolithiasis in sheep

Signs of urethral obstruction 2.

Diagnosis:

clinical signs, catheterization?, bladder ultrasonography

Treatment:

• obstruction → surgery or slaughter for salvage

(spasmolytics might be tried in partial obstruction)

• to dissolve struvit (?!): NH4Cl (10 g/sheep) per os

Prevention:

• change the feeding ( decrease of P, Mg ) after stone analysis
• struvit: feeding NH4Cl (45 g/steer and 10 g/sheep)
• decrease nidus formation and provide enough water

(e.g. vaccination against adenovirus in sheep herds )

• Provide vitamin A supplementation

Urolithiasis in ruminants IV.

Literature

Blowey, R.W.; Weaver, A.D.: A colour atlas of diseases and disorder

• f cattle. Wolfe Publishing Ltd, Aylesbury, 1991.

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