The aim of learning is not knowledge but action.

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The aim of learning is not knowledge but action.

• Wish Id said that..
• Jill McClure, DVM, MSDiplomate, ACVIM, ABVP

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Educational Objectives

• to recognize clinical problems which may suggest
  renal disease
• to recite a list of differentials (rule-outs) for
  selected clinical problems
• to recite a diagnostic and/or treatment plan for
  selected specific disease of the urinary system

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Educational Objectives

• to identify problems from a history and set of
  clinical and/or laboratory data
• to interpret clinical and laboratory data by
  following an algorithm in order to arrive at a
  presumptive diagnosis

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Problem-oriented approach

• Recognize a problem
• Know what tests to request
• Know how to interpret he results
• Know how to manage the diagnosis

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What is the problem?????

• oliguria/anuria
• polyuria
• polydipsia
• dysuria
• abnormal urine
• edema

• chronic weight loss
• diarrhea
• colic
• metabolic lameness

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Oliguria/Anuriadecreased / no urine output

• Normal urine output 1-2 ml/kg/hr
• 15 l /1000 horse/day
• affected by environment, water intake, diet

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Decreased urine output

• Failure to form
  (renal failure)
• Failure to pass (obstruction or
  diversion)

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What is a minimum data base?

• pieces of information to collect BEFORE starting
  to think
• problem-specific

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Minimum data base for oliguria/anuria

• History
• previous disease
• drugs therapy
• toxins
• feed

• Physical exam
• document problem
• urethral patency
• injury preventing posturing
• hydration status
• rectal exam

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Minimum data base for oliguria/anuria

• Lower tract patent
• suspect ARF
• CBC
• BUN, Cr
• Electrolytes
• Minerals
• Albumin, protein
• UA
• FE

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Expanded Data Base for oliguria/anuria

• Patent lower tract
• renal biopsy
• toxin analysis
• cantharadin
• heavy metals

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What is an algorithm?

• logical pathway used to interpret findings in
  order to arrive at a diagnosis
• a road map for diagnosis

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Oliguria/Anuria
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Oliguria/Anuria
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Rule-outs for oliguria/anuria with patent lower
tract

• Toxic
• antibiotics
• aminoglycosides
• drugs
• NSAIDS
• bugs
• cantharadin
• pigments
• myoglobin

• Vascular
• hypovolemia
• Toxic
• heavy metals

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Oliguria/Anuria
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Oliguria/Anuria
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Oliguria/Anuria
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Rule-outs for oliguria/anuria with lower tract
obstruction

• Traumatic
• ruptured bladder

• Idiopathic
• urolithiasis
• smegma accumulation

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Expanded Data Base for oliguria/anuria

• Patent lower tract
• renal biopsy
• toxin analysis
• cantharadin
• heavy metals

• Obstructed lower tract
• abdominocentesis
• urethroscopy
• biopsy
• urolith analysis
• radiography

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Minimum data base for oliguria/anuria

• Lower tract patent
• suspect renal
• CBC
• BUN, Cr
• Electrolytes
• Minerals
• Albumin, protein
• UA
• FE

• Lower tract obstructed
• CBC
• BUN, Cr
• Electrolytes
• Minerals
• UA