Felis ISSN 2398-2950

Therapeutics: urinary system

Contributor(s): Linda Horspool, Melissa Wallace

Renal failure

*Indicates drug not licensed for 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 erythopoietin and 1,25 dihydroxy vitamin D3 (calcitriol).
  • In renal (or kidney) failure, the kidneys fail to function adequately     →   consequences in many body systems due to decrease in glomerular filtration rare resulting in abnormal fluid levels in the body, deranged acid levels, abnormal levels of 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 renal failure  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  aims to minimize the biochemical (proteinuria   Urinalysis: protein  , hyperphosphatemia   Hyperphosphatemia  , and metabolic acidosis   Acid base imbalance  ) and clinical consequences (including dehydration, systemic hypertension and hyperparathyroidism   Primary hyperparathyroidism  ).
  • Anemia of chronic renal failure is due to lack of erythopoeitin, but iron and folate deficiency may contribute; if hypertension present- must correct before treating with human recombinant erythropoietin.
  • Initial IV fluid therapy 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*   Famotidine  , or ranitidine *   Ranitidine  . Antiemetics may be necessary, eg metoclopramide*   Metoclopramide  .
  • 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   ACE inhibitors: overview  ) inhibitor therapy at standard dose rates. Increasing the dose may imporve the antihypertensive effect. The calcium channel blocker amlodipine*   Amlodipine  and hydralazine*   Hydralazine  can be added to treatment if the response is insufficient.
  • Oral vitamin D3 (calcitriol) can be used to control renal secondary hyperparathyroidism   Renal secondary hyperparathyroidism  . Phosphorus and calcium must be normal and must be monitored closely. 
  • Adjunctive therapy includes enteric phosphate binders such as aluminium hydroxide or calcium carbonate; anderythropoietin alfa and beta* if anemia (due loss of erythropoietin, iron and folate deficiency) affecting quality of life.
    Major risk - antierythropoietin antibodies.
  • Avoid nephrotoxic drugs, eg aminoglycosides, sulphadiazine   Sulfadiazine  , amphotericin B*   Amphotericin B  .
  • Care with drugs that are excreted exclusively via the kidney, eg aminoglycosides, enalapril   Enalapril  (dosage adjustment may be required).

Cystitis

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Urinary retention and incontinence: provided urethra not obstructed

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Urolithiasis

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers
  • Recent references fromPubMed.
  • Kidder A C, Chew D (2009)Treatment options for hyperphosphatemia in feline CKD: what's out there? J Feline Med Surg11(11), 913-924PubMed.
  • Lulich J P  et al(2009)Paradigm changes in the role of nutrition for the management of canine and feline urolithiasis. Vet Clin North Am Small Anim Pract39(1), 127-141PubMed.
  • 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 Pract39(1), 183-197PubMed.
  • Wallius B M, Tidholm A E (2009)Use of pentosan polysulphate in cats with idiopathic, non-obstructive lower urinary tract disease: a double-blind, randomised, placebo-controlled trial. J Feline Med Surg11(6), 409-412PubMed.
  • van Duijkeren E, van Laar P, Houwers D J (2004)Cystocentesis is essential for reliable diagnosis of urinary tract infections in cats. Tijdschr Diergeneeskd129(12), 394-396PubMed.
  • Kraijer M, Fink-Gremmels J, Nickel R F (2003)The short-term clinical efficacy of amitriptyline in the management of idiopathic feline lower urinary tract disease: a controlled clinical study. J Feline Med Surg5(3),191-196PubMed.

Other sources of information


ADDED