Diseases of the urinary system in dogs. Diseases of the genitourinary system in dogs

Roman Leonard, President of the Russian Scientific and Practical Association of Veterinary Nephrologists and Urologists (www.vetnefro.ru), Head of the Ural Center for Veterinary Nephrology and Urology, Head of the School of Veterinary Nephrology and Urology, Chelyabinsk / E-mail: [email protected]

Introduction

Bacterial diseases of the urinary system (BZMS) are a group of pathologies characterized primarily by the colonization of its various parts by uropathogens, which should normally remain sterile.

Opinions on the prevalence of MZMS in dogs and cats vary widely. A number of authors indicate that this group of pathologies is rare, in less than 5% of cases of diagnosing various nephropathies and uropathy. Other experts claim that BZMS are detected in 15-43% of clinical cases of diseases of the urinary system. However, most experts agree that the incidence of BZMS is increasing in older animals and especially in patients with chronic kidney disease (CKD). This is due to a general decrease in the body's resistance and other chronic aseptic nephropathies, which are common especially among cats.

The author of the article believes that BZMS are rare (especially in cats, in relation to CKD, idiopathic urocystitis and urolithiasis) and are mainly the result of severe immunodeficiency and iatrogenic conditions (usually after bladder catheterization). Which, however, does not give grounds for this group of pathologies, which brings significant anxiety to animals suffering from them, and their owners, and is also a significant predisposing factor for the development or aggravation of the severity of renal failure (primarily for pyelonephritis), was left unattended.

The article will also consider the criteria for the rational use of uroseptics (including long-term use) and clinical cases in which the prescription of antibiotics for nephro- and uropathy is unreasonable or can even be considered as iatrogenic.

Ways of infection of the urinary system and their significance

PMMS include pyelonephritis, abscess and carbuncle of the kidney, apostematous nephritis (kidney and upper urinary tract infections), urocystitis and urethritis (lower urinary tract infections).

However, in some cases this subdivision is arbitrary, since the entire urinary tract is colonized to one degree or another. In the vast majority of patients, BZMS are caused by bacterial flora that enters the urethra from the gastrointestinal tract and / or from the skin, as well as during catheterization of the bladder (ascending type of infection). Moreover, in the latter case, the infectious process is usually more difficult, since it develops against the background of traumatization of the urethral mucosa and its seeding with nosocomial microflora, which is characterized by high resistance to antibacterial drugs. An additional problem (almost always in males) can be episodes of acute urinary retention, which occur as a result of mechanical trauma and subsequent edema of the delicate mucosa of the urethra and a significant narrowing of its lumen, which is already not too wide. The likelihood of the introduction of pathogenic microflora into the urinary tract increases with vaginitis and endometritis in females, and with balanoposthitis and prostatitis in males.

A number of authors, and not without reason, indicate that the ascending path of development of BZMS is more common in females, since their urethra is both wider and shorter than in members of the opposite sex. Although, on the other hand, it should be noted that males are much more likely to undergo catheterization procedures due to obstruction of the urethra. Or even for a long time, a urethral catheter is sutured, which is guaranteed to provide patients not only with a set of microflora of various virulence, but also often causes a pronounced obstruction of the urethra after extraction due to an acute inflammatory process in it, which has an autoimmune infectious etiology.

Diseases that significantly increase the risk of developing ascending type MZMS are diabetes mellitus and hyperthyroidism. Both pathologies lead to metabolic, hemodynamic and immunosuppressive disorders in the body of patients. In addition, hyperglycemia (both constant and intermittent) in diabetes mellitus often initiates glomerulonephritis, which develops according to the hyperfiltration type (glucose levels that exceed the physiological norm have a pronounced and persistent vasodilating effect on the afferent arteriole of the glomerulus), which rapidly modifies in CKD.

The hemato- and / or lymphogenous route of infection is another possible variant of the occurrence of MZMS. Initially, the renal parenchyma is primarily colonized, but with the inevitable and rapid involvement in the process and the lower parts of the urinary system. This type of lesion is recorded in dogs and cats much less frequently than ascending. And there are two main reasons for this. Firstly, for the implementation of such a scenario, a severe immunodeficiency state is necessary (for example, prolonged hypothermia or an acute viral infection), and secondly, animals exposed to the above factors most often die for a number of other reasons and before as a severe infectious lesion. kidneys, and even more so the lower urinary tract, is diagnosed. For example, acute coronavirus peritonitis in cats is often accompanied by apostematous (pustular) nephritis. But it usually does not reach the diagnosis of this condition in a patient. And, to tell the truth, doctors today do not have special opportunities to significantly affect, first of all, the etiological root cause of this process. And infectious multiple organ dysfunction (pericarditis, nephritis, enteritis, peritonitis, etc.), accompanied by an avalanche-like accumulation of clinical manifestations, rarely allows, even with timely medical assistance, to save the animal from death.

The hematogenous path of development of pyelonephritis can also be reproduced under experimental conditions. Thus, in one study, cats were intravenously injected with a culture of E. coli (from 0.83 to 6.4 × 108 per kg / f.m.), after which one of the ureters was ligated for 24 or 48 hours. Ultimately, all experimental animals developed unilateral renal parenchymal infections and 6 out of 10 cats died within 1 to 11 days of the procedure 1 .

Normally, the urinary tract remains sterile throughout its entire length (with the exception of the last third of the urethra). And in many cases, the possibility of bacterial colonization of the urinary system depends on the state of systemic and local immunity. The pathogenicity, virulence and antibiotic resistance of the microorganisms that caused the pathological process also play an important role in the development of BZMS. The bacterial flora that most often causes BZMS is shown in Table 1.

Table 1. Bacterial flora causing BZMS

pathogen	Percentage of total
	a	b	c
E. coli	37,8		20,1
Staphylococcus spp.	14,5		9,6
Proteus mirabilis	12,4		15,4
Streptococcus spp.	10,7		10,6
Klebsiella pneumoniae	8,1		3,4
Pseudomonas aeruginosa	3,4		6,9
Enterobacter spp.	2,6		3,3
Number of isolates	1,400		187

a— Ling, G.V. et al. (1980a). Vet Clin North Am 9: 617-630.
b— Kivisto, A.K. et al. (1997). J SmAnim Pract 18: 707-712.
c— Wooley, R.E. et al. (1976). Mod Vet Pract 57: 535-538.

The pathogenesis of the development of ascending BZMS

The likelihood of developing BZMS is directly dependent on the balance between the virulence and pathogenicity of bacteria that have colonized the urethra in the immediate vicinity of its mouth (or the bladder after the introduction of a urethral catheter) and tend to rise to the higher parts of the urinary tract, and the activity and effectiveness of the work of natural antibacterial properties and mechanisms of the urinary system as a whole.

Anatomical structures of MBT and BZMS

In cats and bitches, there is a high pressure zone in the urethra, the passage of urine through which prevents bacteria from migrating into the bladder. The peristalsis of the urethra in males and their marking of the territory, when urine is repeatedly ejected from the bladder under great pressure, has a similar effect. But the lack of such an opportunity in domestic cats may be one of the reasons (in addition to the high osmolarity of urine) partial or complete blockage of the urethra by urinary and other calculi.

A number of structural features of the ureters, as well as the vesicoureteral (ureterovesical) junction (fistula), which has a kind of valve mechanism and limits the retrograde flow of urine from the bladder into the ureters and further into the renal pelvis, both during urination and in the intervals between them, also prevents the development of an ascending type of MBC infection. A rich and intense blood supply to the urinary tract is an additional factor that reduces the risk of their colonization.

But anomalies in the structure of the ureters, as a result of which vesicoureteral reflux develops, as well as the bladder and urethra, are a significant predisposing factor in the development of BZMS and, if possible, should be subjected to surgical correction.

Physiological features of normal urination

Physiologically adequate urination should lead to complete emptying of the bladder. If, for one reason or another, urine is not completely evacuated, then the likelihood of bacterial colonization of the bladder and urethra increases. Stagnation can be caused by urethral stricture of various origins, prostate adenoma or cancer, disruption of the normal innervation of the muscular wall (detrusor) of the bladder and urethral sphincter 2 (as a result of a spinal cord injury, for example), benign and malignant neoplasms of the bladder, aseptic urocystitis, etc. d.

A separate problem in this respect is the stagnation of urine in urolithiasis (ICD). First of all, this pathology is characterized by partial or complete obstruction of the urethra, as well as overflow (usually very pronounced) of the bladder. The latter is fraught not only with the development of uremia, but also with a significant overstretching of the detrusor. And, despite the fact that ruptures of the bladder in dogs and cats with this pathology are quite rare 3 , violation of urination and urinary stasis are often observed even with restoration of urethral patency and urine evacuation. And the reason here is that prolonged stretching of the muscle layer of the bladder leads to a severe disruption of its normal blood supply and, as a result, to a significant decrease in its contractility, which usually takes a long time to recover. And since the problem does not have a neurogenic etiology, the appointment of parasympathomimetics (neostigmine methyl sulfate (Prozerin) or ipidacrine (Neuromidin, Axamon), etc.) usually not only does not lead to the desired results, but can also bring with it a deterioration in the general condition of the patient from due to a large number of significant side effects of these drugs.

Barrier properties of the mucous membrane of the urethra and bladder

The urothelium (stratified transitional cell epithelium) covers the urinary tract in the pelvis, ureters, and proximal urethra. A number of factors, such as the formation of surface antibodies, the intrinsic antibacterial properties of the urothelium and its intense desquamation, as well as the surface layer of glycosaminoglycans on the bladder mucosa, are normally actively involved in maintaining the sterility of the urinary tract. Glucosaminoglycans also prevent the irritating effect of urine on the urothelium 4 . Saprophytic flora in the distal part of the urethra is an additional obstacle to the deposition of uropathogens.

Therefore, violation of the integrity and / or barrier properties of the mucous membranes of the urinary tract of any origin, including during catheterization of the bladder, is a significant primary damaging factor in the etiopathogenesis of BZMS.

Bacteriostatic properties of urine

A high amount of urea, organic acids, light carbohydrate chains and phagocytes in the urine of normal density for dogs and cats is a significant limiting factor in the growth of pathogenic flora. In addition, in the urine of healthy animals, a certain amount of humoral immunity factors such as IgG and IgA are present, the conglomerate of which with uropathogens prevents the latter from attaching to the urothelium, and glycoprotein immunoglobulin (or, more simply, protein) Tamm-Horsfall (uromucoid). The latter is actively synthesized by the cells of the epithelium of the wide ascending knee of the loop of Henle and the distal segment of the renal tubules and has not only immune properties, but is also one of the significant factors preventing salt aggregation. Table 2 shows the mechanisms of local self-defense of the urinary system.

Table 2. Factors and mechanisms of antibacterial self-defense of the urinary system

Full urination

Adequate urinary output

Frequent and full bladder emptying

Anatomical / physiological features of the structure of the urinary system (URS)

High pressure of urine in the urethra when urinating

Antibacterial properties of the urothelium

Peristalsis in the ureters and urethra

Antibacterial properties of the prostate

Long urethra (in males)

Barrier properties of the ureterovesical fistula

Protective and barrier properties of the mucous membranes of the urinary tract (MWT)

Antibody production

Layer of glucosaminoglucans on the bladder mucosa

Own antibacterial properties of mucosal cells

Bacterial interference (in the last third of the urethra)

Exfoliation (exfoliation) of cells

Antibacterial properties of urine

High urine pH levels (acidic or alkaline)

Hyperosmolarity (especially in cats)

High urine concentration (up to 1.035 in dogs and up to 1.085 in cats)

organic acids

Mechanisms of renal self-defense

The ability to phagocytosis and other immune responses of intraglomerular mesangial matrix cells

Colossal blood supply to the kidneys (up to 25% of cardiac output) even in a state of normal physiological stress and, as a result, a very high rate of intrarenal blood flow

Pathogenicity and virulence of bacterial flora and BZMS

Even a small amount of flora from the gastrointestinal tract can cause MZMS. The virulence of uropathogens depends on their mobility and ability to be fixed (including as a result of receptor interactions) on urothelial cells, as well as on the fact that bacteria have effective mechanisms for introducing their toxins into the mucous membrane of the urinary tract. An important factor of virulence and pathogenicity, which significantly increases the rate and area of ​​colonization, is the ability of uropathogens to produce urease. This enzyme, which catalyzes the hydrolysis of urea to ammonia and carbon dioxide, has a direct and pronounced toxic effect on urothelial cells, and also causes paralysis of the smooth muscle wall of the urinary tract.

Some strains of bacteria of the genus Escherichia are capable of producing colicins, protein substances capable of killing microorganisms of the same genus that form the saprophytic flora of the external genitalia and distal urethra.

Certain highly pathogenic bacteria produce aerophagin and hemolysins. These substances of lipid and protein nature are capable of causing destruction of cell walls, including erythrocytes. Significant hemolysis in the body under the influence of aerophagin and hemolysin does not occur, but the uropathogens producing them get easy access to organic iron, which is the most important element necessary for the growth of bacterial cells.

The type of MZMS flow largely depends on the virulence and pathogenicity of microorganisms. But even if the process is latent, it can cause the development of urolithiasis (usually struvite), prostatitis (including abscessing) and deterioration of renal function, leading to the formation of chronic kidney disease or to a significant aggravation of its severity. Therefore, medical manipulations that predispose to damage and / or contamination of the urinary tract, as well as the identification, including in laboratory diagnostics (primarily in the study of urine), signs of their bacterial damage require immediate clarification of the diagnosis and initiation of therapy.

Clinical manifestations

BZMS can be accompanied by clinical manifestations or be asymptomatic. An increase in temperature above the norm (with febrile phenomena of varying severity), which is typical for humans and usually allows you to fix the onset of the disease, is not typical for dogs and cats. Even acute pyelonephritis and urocystitis in these animal species occur without hyperthermia, of course, except when these diseases develop against the background of viral infections. But even in this case, the greatest pyrogenic effect is caused not by the bacteria themselves and not even by viral agents, but by the hyperactivation of the interferon system 5 .

But even if clinical phenomena such as pollakiuria, dysuria, stranguria, hematuria (more pronounced in the last portions of urine) and periuria occur, they are not pathognomonic and can be attributed to any other diseases of the MVS.

A specific exception may be called bacterial urocystitis, primary or resulting from pyelonephritis 6 , in which frank pyuria is added to frequent urination. And it is the expiration of an unusual consistency, smell and color from the pet that makes the owners wary. And the process itself can be equally classified as acute, due to the severity of clinical manifestations, and chronic, since it is complicated by hyperplasia of the mucous membrane and fibrosis of the muscular wall of the bladder. Because of this, it becomes unusually dense, loses its effective volume (the urge to urinate occurs when it is slightly less than normal) and decreases relatively little in size after urination. In addition, even a general blood test will not necessarily be “acute”, and the disease itself usually takes a long time and against the background of a relatively good state of health in the patient as a whole.

When the inflammatory process is limited to urethritis, the pain that occurs during urination can cause the bladder to overflow and empty it in small portions. And the animal itself, when urinating, will take postures that are uncharacteristic for the species / gender. Some patients may react painfully to palpation of the bladder and kidneys.

Imaging research methods for BZMS

Ultrasound of organs in BZMS, on the one hand, is not very difficult and can (and, according to the deep conviction of the author, should) be carried out by a veterinary therapist / nephrologist-urologist directly during the initial appointment, and on the other hand, it should be performed as quickly as possible, since animals with this group of pathologies often require emergency care, including due to pain. Referring the animal for consultation to an imaging specialist only makes sense in clinically difficult cases. If neoplasia of the urinary system is suspected, consultation with an oncologist is also required.

Ultrasound of the bladder can reveal uneven / uniform thickening and / or thickening of its wall and its bypass, as well as the presence of neoplasms (polyps, tumors). In the lumen of the bladder, a suspension, salts, large and small stones can be visualized.

If the bladder is poorly filled / not filled, then to increase the information content of the study, it is necessary to introduce a sterile saline solution of NaCl into it (if possible, urine is taken before this for examination by the method of transperitoneal urocystocentesis). Moreover, for this diagnostic manipulation (primarily in males), in order to avoid aggravation of the patient's condition, the introduction / placement of a urethral catheter is not required. For the procedure, in most cases, it is rational to use peripheral venous catheters (the thinner, the better) with the needle previously removed from them. The catheter is inserted 1/2-1/3 into the urethra, after which the glans penis is pinched with the fingers and a liquid / drug begins to be injected under a slight pressure.

To reduce the pain of manipulation before filling the bladder, a 0.5% solution of lidocaine is injected into the urethra / bladder or, if urine for bacteriological examination has already been obtained, uroantiseptics with an analgesic effect, for example, Cathejell containing lidocaine and chlorhexidine gel.

Since the volume of bladder filling in case of urocystitis (both bacterial etiology and not) can significantly decrease, the introduction of solutions under high pressure into it should be avoided, since this usually leads to an additional violation of the integrity of its mucous membrane and detrusor and, as a result, to aggravation of the severity of at least macrohematuria and pain syndrome. Although such complications may occur after the introduction of small volumes of fluid under low pressure, which the owners of the animal should be informed in advance.

With ultrasound, the diagnosis of "pyelonephritis" can only be made as a preliminary one and needs to be clarified, since the subjectivity in assessing the images obtained is very high.

The need for excretory urography to clarify the diagnosis in animals with suspected MZMS is rare. It is usually carried out to exclude any anatomical defects in the structure of the organs of the urinary system, contributing, for example, to stagnation of urine. It should also be taken into account that all contrast agents used for this (including renotropic radiopaque water-soluble low molecular weight ones, such as iohexol, iodixanol, ioxaglic acid, ioversol, etc.) have nephrotoxicity, especially pronounced in cats.

The presence of a bacterial nature of nephropathy/uropathy in dogs and cats must be proven. Only on the basis of anamnesis, blood tests (a general analysis, even in animals with acute BZMS, as a rule, is unchanged) and a general clinical examination of urine (leukocyturia) and visual diagnostic methods, it cannot be set.

In certain cases (aggressive and / or stress-resistant animal / owner, as well as patients with severe pain, etc.), it is rational to carry out diagnostic and treatment procedures in cats and dogs with suspected MZMS (as well as many other nephropathies and uropathy) under sedation. And especially in cats, in populations of which chronic kidney disease is widespread throughout the world and in all age groups, it is advisable to use propofol for this. This drug for general anesthesia (although many experts tend to classify it as a pure hypnotics) causes short-term anesthesia and, most importantly, is excreted from the body by almost 100% through the liver. Its last property greatly reduces the risks of its use in patients with reduced glomerular filtration rate, which is typical for most nephropathies. And for the prevention of apnea episodes observed in some patients with its administration, analeptics such as nikethamide (Cordiamin) and Sulfocamphocaine (procaine + sulfocamphoric acid) are used. These drugs are administered before the introduction of propofol: 15-20 minutes (in / m) or immediately before giving it (in / in).

It is irrational to carry out invasive methods for examining the kidneys with BZMS. Situations can be called a definite exception when there are good reasons to assume that the patient has combined, infectious and aseptic nephropathy, and only after all possible non-invasive diagnostic methods and therapeutic tactics have been exhausted.

Diagnosis Criteria

The primary clinical diagnosis of UTI is carried out based on the data of the anamnesis, examination, urine tests (initially, a study carried out on a device that works on urinary test strips directly at a therapeutic appointment is sufficient) and ultrasound data. To confirm the diagnosis in the vast majority of cases, a bacteriological study of urine obtained by transperitoneal urocystocentesis is required. The sampling of material for research is also carried out at the initial appointment, and ideally before the start of antibiotic therapy. However, especially at the initial diagnosis in a patient with MHMS and / or if there is reason to believe that the process is acute, the start of a course of broad-spectrum antibiotics (monotherapy, combination therapy) can be done immediately.

Obtaining samples for bacteriological examination, collected during natural urination, or even more so after the introduction of a urethral catheter, is counterproductive and greatly complicates the interpretation of the results. And in the latter version, it also leads to traumatization and seeding of the urethra (in other words, it is iatrogenic).

Urinalysis in patients with MZMS, as a rule, reveals proteinuria (mainly due to the protein contained in erythrocytes, leukocytes and epithelial cells), hematuria, leukocyturia (the predominant subpopulation in the sediment is granulocytes 7), bacteriuria, a large number of various epithelial cells from various parts of the urinary tract.

In the case of pyelonephritis, urinalysis usually reveals a more pronounced leukocyturia (and often pyuria) than with other BZMS, and a large number of granular and leukocyte casts. Although these changes are not pathognomonic for this particular disease.

The absence of bacteria in the urine sediment, especially with granulocytic leukocyturia, especially pyuria, still requires a doctor to conduct a bacterial study.

You should also correlate the density of urine with the level of other changes observed with BZMS. Density reduction in patients who are not taking diuretics and/or infusion therapy at the time of the study is always a negative prognostic sign. And even relatively low levels of proteinuria, leukocyturia, etc., in this case should be regarded as significant.

Selection of antibiotic therapy

Conducting a bacteriological study of urine in case of suspicion / diagnosis in a patient with BZMS without fail involves determining the sensitivity of the microflora to antibacterial drugs. Preferred in this case is the method that detects the minimum inhibitory concentration (MIC) of antibiotics. Modern laboratory methods/apparatuses 8 (so far only common in human medicine 9) make it possible to conduct such studies within up to 4 days with an extended antibiogram (from 30 to 60 drugs), which is important, since many BHMS are characterized by a chronic course, and the microflora, their causing, often changes the sensitivity to antibiotics.

When selecting antibiotic therapy, it is crucial how high concentrations can be achieved in the urine (and not in plasma) when using a particular drug. To achieve a therapeutic effect, the weighted average concentration of an antibiotic in the urine (when used in standard doses) must be at least four times its minimum inhibitory concentration. Antibiotics that meet these requirements, their doses and routes of administration are listed in Table 3.

The use of antibacterial drugs that do not meet these requirements is rational only if it allows to achieve the required bactericidal / bacteriostatic concentration in the urine with an increase in the standard recommended dose by no more than two times.

Table 3 Antibacterial drugs used to treat MZMS, their doses and concentration in urine

A drug	Dose	Method of administration	Average concentration in urine µg/ml	MIC, µg/ml
Ampicillin	25 mg/kg three times a day	inside	309 (± 55)
Amoxicillin	11 mg/kg thrice daily	inside	202 (± 93)
Enrofloxacin	2.5 mg/kg twice a day	inside
Tetracycline	15 mg/kg three times a day	inside	138 (±65)
Chloramphenicol	33 mg/kg thrice daily	inside	124 (± 40)
Cefalexin	18 mg/kg thrice daily	inside	500 (?)	125
Sulfizoxazole	22 mg/kg thrice daily	inside	1.466 (± 832)	366
Nitrofurantoin	5 mg/kg three times a day	inside	100 (?)
Trimethoprim-Sulfa	12 mg/kg twice a day	inside	246 (± 150)
	22.2 mg/kg twice a day		55 (±19)
Kanamycin	6 mg/kg twice a day	Injection	530 (± 151)	132
Gentamicin	1.5 mg/kg thrice daily	Injection	107 (±33)
Amikacin	5 mg/kg three times a day	Injection	342 (± 143)
Tobramycin	1 mg/kg three times a day	Injection	145 (± 86)

Localization of the infectious process

Differential diagnosis, which allows to determine the area of ​​the urinary system in which the primary/prevailing focus of the bacterial inflammatory process is located, is often difficult. Hypostenuria, severe granulocytic/mixed leukocyturia, expansion of the renal pelvis and an increase in its echogenicity on ultrasound against the background of non-sterile urine may indicate pyelonephritis. In some cases, to clarify / confirm the diagnosis, it is required to obtain urine for bacteriological examination directly from the renal pelvis (nephropyelocentesis).

Indirect confirmation that the patient has such an intractable disease as pyelonephritis is the development of recurrent urocystitis / urethritis and prostatitis (usually in uncastrated males). In this case, the listed pathologies are rapidly aggravated after the abolition of antibiotic therapy, against which their persistent remission was observed.

The chronic course of pyelonephritis itself is due to the fact that in the renal pelvis, firstly, there are many areas into which antibacterial drugs do not penetrate, even if their concentration in the urine is high enough. And, secondly, it is in the renal pelvis that the so-called phenomenon is observed. bacterial films. The bacteria that form them are not only tightly fixed on the underlying tissues, but are also in a state of a kind of suspended animation, leveling the effect of antibacterial drugs on them. It is this bacterial layer that is an excellent springboard for securing the next generations of pathogenic microflora (often of the same species). And in the case of the total destruction of this surface microflora, it is from the bacterial films that new regenerations of pathogens then appear. This usually happens after antibiotic therapy is discontinued.

It should be borne in mind that in cats, the development of BZMS, as a rule, occurs against the background of various kinds of aseptic nephropathies (glomerulonephritis, chronic kidney disease). On the one hand, this complicates the differential diagnosis of pathologies, since leukocyturia is observed in both cases (the difference is only in subpopulations of white blood cells, which is often not paid due attention), and on the other hand, it significantly complicates the selection of therapy with antibacterial agents, since this group of drugs has nephrotoxicity, the severity of which depends on the stage of the disease (the lower the GFR, the higher the expected negative effect), and on the specific subgroup of these drugs. The highest nephrotoxicity is in aminoglycosides (even short-term use of antibiotics in this group can lead to the development of acute tubular necrosis), and lower (precisely lower, and not completely absent) in penicillins in combination with beta-lactamase inhibitors (for example, amoxicillin + clavulanic acid) and fluoroquinolones.

Despite the fact that chronic kidney disease in any scenario is neither a bacterial nor an autoimmune disease (the pathologies leading to it may have an immune-mediated or toxic etiology, as well as be virus- or bacterio-induced 10), in which the prevailing pathological process in the renal parenchyma is sclerosis, it is antibiotics and steroids that are most often prescribed for its “treatment”.

Until recently, the selection of effective antibiotic therapy in the treatment of MZMS, especially if the disease was diagnosed for the first time, was possible on the basis of data obtained from general clinical examination and microscopy of the urine sediment (appearance of bacteria, pH, etc.). Today, primarily due to the development of antibiotic resistance in the microflora all over the world (especially in nosocomial strains), empirical selection of drugs, bypassing sensitivity tests, increasingly fails.

The duration of antibiotic therapy in the treatment of urocystitis and urethritis should be at least 14 days. The exception is a uroseptic, a phosphonic acid derivative - fosfomycin (Monural, Urofosfabol, Fosfomycin-Esparma), whose high concentrations in the urine and the ability to be absorbed on the bladder mucosa, coupled with low resistance of uropathogens to it, allow the use of preparations containing it every 24-48 hours. only two or three times 11 . Dogs usually tolerate fosfomycin preparations well, and cats often vomit when using it (apparently due to the fact that they are disgusted by the fruity or minty smell used for flavoring). Therefore, the author of the article recommends administering drugs containing fosfomycin to cats through a nasoesophageal tube at a dose of 2 or 3 g. doses. For the prevention of bacterial complications after surgical interventions and non-invasive manipulations (catheterization) on the lower urinary tract, fosfomycin should be administered once in the dosages suggested above.

However, it should be noted that fosfomycin was nephrotoxic due to tubular damage in one study. Although the author of the article did not encounter such a reaction in patients and only once received information about the occurrence of AKI after the use of fosfomycin from colleagues, the likelihood of such a development of events exists and should be taken into account if possible. And as a preventive measure to reduce risks, it is advisable to force diuresis with crystalloids simultaneously with the introduction of fosfomycin.

One or two appointments of other uroseptics for the prevention of urethritis and urocystitis after bladder catheterization is undesirable, since it only delays the development of a bacterial infection of the lower urinary tract and contributes to the formation of its resistance to the antibacterial agent used.

For an intermediate assessment of the effectiveness of the treatment, it is necessary to examine the urine sediment for the microflora contained in it 3-5 days after the start of the treatment. Its complete absence or single cells indicate the effectiveness of therapy and the need for further use of the selected antibacterial agent.

It should be noted that the dosing regimen of the drugs listed in Table 3 differs from those used in the treatment of other bacterial pathologies. This is primarily due to the need to maintain a sufficient concentration of them in the urine.

Pyelonephritis (inflammation of the renal pelvis, and not purulent inflammation of the kidney, as this term is sometimes erroneously interpreted 12) today is one of the most significant and intractable problems of nephrology in general. The treatment of this recurrent (recurrent) nephropathy rarely ends with a complete recovery of patients for the reasons listed above (primarily because of the structural features of the renal pelvis itself) and therefore requires long-term (months to years, for life) antibiotic therapy. Owners of animals in which the diagnosis of "pyelonephritis" is confirmed should be informed about the features of its course and the need for long-term maintenance treatment.

In addition, the inevitable escape of the sensitivity of uropathogens that cause pyelonephritis to antibiotics in this case requires regular repeated tests. The need to change the type of antibacterial drug used for treatment is indicated by a significant increase in the bacterial flora in the urine sediment, and in some cases the development of reciprocal pyuria.

Long-term antibiotic therapy (and the need for it is due to the fact that uncontrolled pyelonephritis is guaranteed to lead to severe tubular dysfunction and progressive renal failure) is usually well tolerated by dogs and cats. Moreover, in the case of high sensitivity of the microflora to antibiotics, their maintenance doses can be reduced by half or three. At the same time, either the frequency of giving drugs, or directly their dose is reduced. The effectiveness of maintenance antibiotic therapy is also monitored by examining the urine sediment and, if necessary, checking it for sterility.

An important condition in the treatment of pyelonephritis is the continuity of antibiotic therapy, since even a slight interruption in treatment can lead to the active reproduction of resistant strains of uropathogens and rapidly negate the effect of previous treatment. If during therapy with uroseptics signs of re- or superinfection are observed, then it is rational to either start a new course of antibiotics, to which there was high sensitivity in the previous study, or add another antibacterial drug to the existing one, before obtaining the results of bakposev. And after receiving an antibiogram from the laboratory, it is mandatory to adjust the therapy based on new data on bacterial sensitivity.

When selecting therapy for ICM, the following general rules should be followed:

• the microflora that caused the disease should have a high sensitivity to the selected antibacterial drugs (supposed or established by laboratory);
• when used, the antibiotic(s) should accumulate in the urine in high concentrations (information about whether this is the case or not can be gleaned, for example, from the annotation to the drug, etc.);
• it is preferable if, at the beginning of therapy, the dose of the drug used was 15-25% higher than that recommended by the manufacturer or other reference materials for the treatment of other pathologies (it is better to overdo it a little than underdose);
• under all equal conditions, preference should be given to uroseptics with a low level of nephrotoxicity;
• the appointment of aminoglycoside antibiotics can be made only if there is no sensitivity to other groups of uroseptics in the pathogenic flora, and the owners should be warned in advance that when using these drugs, the animal may most likely develop acute renal failure (and possibly occur death of the patient) associated with acute tubular necrosis;
• when prescribing combination antibiotic therapy (the need for this especially often arises if two or more pathogens are involved in the colonization of the urinary system), it is necessary to verify the compatibility / synergy of the selected drugs (for example, the simultaneous administration of bacteriostatic and bactericidal antibiotics usually leads to leveling of their activity);
• if the patient has certain diseases of the gastrointestinal tract, including those that can affect the absorption of antibiotics, then it is necessary to prescribe an uroseptic by injection;
• in order to achieve compliance when choosing antibiotic therapy, it is necessary to make sure that all the characteristics of the patient and the possibilities of its owners were taken into account (for example, in one case it is more expedient to prescribe an injectable form of an antibiotic, since vomiting occurs in an animal after its oral administration 13 , and in another , on the contrary, tableted, etc.).

The need to prescribe pro- and prebiotic agents, phytopreparations and immunostimulants to patients who take antibiotics for a long time due to pyelonephritis remains an open question. But if the owners readily follow the doctor's prescriptions, are actively interested in the possibility of using certain drugs for the complex therapy of the disease, and for them this is not difficult (financial, time-consuming to give additional drugs, etc.), then these drugs should / may be assigned.

Also, the question of the advisability of prescribing drugs that improve urodynamics and stimulate/force diuresis (loop or osmotic 14 diuretics and/or infusion solutions) to patients with pyelonephritis and other BZMS also requires further study. On the one hand, these drugs, by increasing the rate of urination and urination (which is especially important for cats with normal high-density urine), thereby accelerate the elimination of uropathogens from the body and reduce the toxic effect of both their waste products and those used to treat the underlying disease. antibacterial drugs and on the renal parenchyma, and on the body as a whole (we are talking primarily about aminoglycosides). On the other hand, such tactics can lead to a decrease in the concentration of antibiotics in the urine, below a level sufficient for effective action. A possible compromise is to increase the dose of antibacterial agents in the period when drugs that increase the level of urine formation will be prescribed.

More specifically, the drugs of first choice in a strategy aimed at stimulating diuresis in MZMS can be called crystalloid solutions (physiological saline solution, Ringer-Lactate, Ringer-Acetate, Hartman, Sterofundin, etc.) and such a loop diuretic (with properties of potassium-sparing and ACE 15), as torasemide (Diuver, Trigrim, Trifas, Britomar, Torasemid-Kanon). The last drug in terms of efficiency, duration and uniformity of the diuretic action during the day, as well as a significantly smaller number and lesser significance of side effects, significantly outperforms other diuretic drugs (primarily furosemide).

Notes

1 From the materials of the article it is clear that no treatment was carried out on experimental animals.

2 What is commonly referred to as the bladder sphincter is the urethral sphincter.

3 Mostly in case of mechanical injuries when falling from a height or as a result of executions that followed from the owners and persons equated to them, for too loud vocalization of their inner doubts.

4 Violation of the integrity of the layer of glucosaminoglycans (as well as high osmolarity of urine) is one of the reasons for the development of idiopathic urocystitis in cats.

5 The author of the article somehow came up with the idea of ​​strangling a herpes virus infection in the bud (or rather, on the lips). To fulfill the task, 5 million IU of interferon were administered intramuscularly. As a result of this action, after half an hour there was “obvious” (and not only) hyperthermia in the region of 40.5 ° C and all other classical manifestations of influenza, which then persisted for a day. The pinnacle of the composition was a herpetic rash on the lips, unprecedented in size even for experienced infectious disease specialists.

6 In this case, urocystitis usually takes a chronic/recurrent form, since the root cause of its appearance, pyelonephritis, is an incurable disease.

7 In CKD and other chronic aseptic nephropathies, the predominant subpopulations of leukocytes in the urine sediment will be monocytes and lymphocytes related to agranulocytes.

8 For example, the bacteriological automatic analyzer VITEK 2 compact 30 and VITEK 2 compact 60.

9 That, however, does not exclude the possibility of their use for research in veterinary medicine.

10 Precisely induced, not viral or bacterial. For example, a bacterial antigen can be included in circulating immune complexes (AG + AT + C3), which, in turn, cause an autoimmune reaction in the primary microcapillary network.

11 While there is no information on the rate of elimination of fosfamycin from the body of dogs and cats, therefore, the dose of the drug and the frequency of its use remain open questions.

12 Pyelonephritis (Greek - trough, tub; - kidney).

13 In dogs and cats, the gag reflex is controlled by consciousness, and they can burp an expensive drug simply out of harm.

14 Other drugs, classified by the modern pharmacopoeia as diuretics, in dogs and cats are not able to cause any significant increase in diuresis.

15 Angiotensin-converting enzyme inhibitor.

Literature

1. Bartges, JW (2003) Feline lower urinary tract cases. In: Congress Proceedings 21st ACVIM Forum, Charlotte, NC. pp. 579e581. Bartges JW (2004) Diagnosis of urinary tract infections. Veterinary Clinics of North America: Small Animal Practice 34.

2. Edinboro CH, Scott-Moncrieff JC, Janovitz E, Thacker L, Glickman LT (2004) Epidemiologic study of the relationships between consumption of commercial canned food and risk of hyperthyroidism in cats. Journal of the American Veterinary Medical Association 224, 879-886.

3. Geerlings S.E., Stolk R.P., Camps M.J., Netten P.M., Hoekstra JBL, Bouter P.K., Bravenboer B., Collet T.J., Jansz A.R., Hoepelman AIM (2000) Asymptomatic bacteriuria may be considered a complication in women with diabetes. Diabetes Care 23, 744-749.

4. Kelly D.F., Lucke V.M., McCullagh K.G. Experimental pyelonephritis in the cat: Gross and histological changes. Journal of Comparative Pathology. Volume 89, Issue 1, January 1979, p. 125-139.

5. Lees GE (1996) Bacterial urinary tract infections. Veterinary Clinics of North America: Small Animal Practice 26, 297-04.

6. Lees GE (1996) Bacterial urinary tract infections. Veterinary Clinics of North America: Small Animal Practice 26.

7. Mayer-Roenne Bettina, Goldstein Richard E, Hollis N Erb. Urinary tract infections in cats with hyperthyroidism, diabetes mellitus and chronic kidney disease. Journal of Feline Medicine and Surgery (2007) 9, 124e132 doi:10.1016/j.jfms.2006.09.004.

8. Nephrology and urology of small animals/edited by Joe Bartges, David J. Polzin. Willey-Blackwell, 2011.

9. Osborne C.A.: Three steps to the management of bacterial urinary tract infections: Diagnosis, diagnosis, diagnosis. Compend Contin Educ Pract Vet 17:1233, 1995. The role of diagnosis in the manage-ment of difficult cases of urinary tract infection is discussed.

10. Parsons, C.L. (1986). Pathogenesis of urinary tract infections. Bacterial adherence, bladder defense mechanisms. Urol Clin North Am 13(4): 563-568.

11. Polzin D.J., Osbornes C.A., Ross S. Chronic kidney disease. In: Ettinger S.J., Feldman E.C., editors. Textbook of Veterinary Internal Medicine. 6th ed. St. Louis, Missouri: Saunders (Elsevier); 2005.pp. 1756-1785.

12. Prescott J., Baggot J.: Antimicrobial Therapy in Veterinary Medicine. Ames, IA: Iowa State University Press, 1993, p 349. This is a review of antimicrobial use in urinary tract infections.

13. Rohrich, P.J., G.V. Ling, et al. (1983). In vitro susceptibilities of canine urinary bacteria to selected antimicrobial agents. JAm Vet Med Assoc 183(8): 863-867.

14. Modern course of veterinary medicine Kirk/Trans. from English / In two parts. Part 1 (S. 1-674). - M .: Aquarium Print LLC, 2014. - 674 p.: ill.

15. Fukata T, Imai N, Shibata S. Acute renal insufficiency in cats after fosfomycin administration. Vet Rec. 2008 Sep 13; 163(11):337-8.

SVM No. 6/2016

Diseases of the genitourinary system stones of the bladder and urethral canal (Calculi vesicourinarius et urethrales) are observed mainly in old obese dogs (mainly in males, less often in females). In the bladder, several stones of various sizes are usually recorded, but sand is more common. In the urethral canal, stones, as a rule, are localized behind the bone of the penis, since, due to the impossibility of expanding the urethral canal, stones of significant size do not pass in this area.

Etiology. The main reasons for the formation of stones are considered to be metabolic disorders, which lead to an increase in the concentration of salts in the urine. Contribute to their formation catarrh of the bladder, limited movement, arteriosclerosis.

Clinical signs are manifested by difficulty urinating, excretion of urine in drops, the appearance of blood at the end of urination. Palpation of the bladder through the abdominal wall reveals its overflow with urine. When a stone gets stuck in the urethral canal, it can be detected by palpation after the penis has been brought out. The location of the stone is also determined by catheterization. The catheter can only be advanced to the stone.

If urine is retained for more than four days, the bladder ruptures and the animal dies from uremia. The most accurate diagnosis is established by x-ray examination, which establishes the localization, size and shape of the stones.

The prognosis can be favorable with timely medical care.

Dog treatment. Operative removal of stones. If they are present in the bladder, the latter is opened (cystotomy). This operation is performed with the animal in the dorsal position after preliminary neuroleptanalgesia. In males, prompt access to the bladder is carried out in front of the pubic fusion on the side of the prepuce at a distance of 1 cm, bypassing the rectus abdominis muscle.

The skin and deeper tissues up to 8-10 cm long are dissected in layers. In females, the dissection of tissues is carried out parallel to the white line, departing from it 0.5-1 cm. After opening the pelvic cavity with a finger brought under the bladder, lift it above the level of the wound, isolate from the latter with gauze pads and aspirate urine with a syringe.

Then, the bladder is fixed in front and behind the proposed incision with the help of ligatures-holders, without calcining the mucous membrane. Its wall is opened with a scalpel with a cut length that allows you to remove stones with a finger or forceps. The sand is removed with a special spoon. To establish the patency of the urogenital canal in males, a catheter is inserted into its end part and a 0.25% solution of novocaine is passed through it.

The bladder wound is sutured with a two-story serous-muscular suture. The wound of the abdominal wall with a three-story serous-muscular suture. The wound of the abdominal wall - with a three-story suture in layers: first with continuous sutures of the peritoneum from the inside of the sheath of the rectus abdominis muscle, then its outer plate (with the capture of the rectus abdominis muscle) and then with an interrupted interrupted suture of the skin.

When the stone is localized in the urethral canal, it is opened - urethrotomy. The urethral canal is opened along the white line behind the bone of the penis, focusing on the position of the previously inserted metal probe. The length of the incision is 2-3 cm. The stone is removed using anatomical tweezers or a blunt spoon, after which a significant amount of bloody urine is released from the canal. The operation is completed by lubricating the edges of the wound with antiseptic ointment; the wound is usually not sewn up, its healing occurs in 12-15 days.

Inflammation of the prepuce in dogs

Inflammation of the prepuce (Posthitis) is a consequence of irritation of the inner leaf of the prepuce during coitus, accumulated in the preputial sac of smegma, which decomposes under the action of urine, and microflora. The disease proceeds chronically and is accompanied by discharge from the prepuce of a liquid, gray, greenish-yellow purulent fluid of a mucous consistency. There is an increase in temperature and swelling of the prepuce, soreness, difficulty urinating.

The incidence of urinary tract infection (UTI) in dogs with diabetes mellitus (DM) and hyperadrenocorticism (HAK) is much higher than in other dogs. Only 15% of dogs without endocrine disorders develop UTI compared to 40-50% of dogs with DM and HAC. The morbidity rate in dogs chronically prescribed glucocorticoids is also 50%.

The pathogenesis of urinary tract infection

It is very difficult for healthy animals to get UTI due to the normal functioning of the urinary tract defense mechanisms. With the exception of the distal urethra, the urinary tract of healthy dogs remains sterile. Microorganisms that inhabit the lower genital tract and distal urethra prevent UTIs by inhibiting the attachment and growth of pathogenic bacteria. Frequent and complete urination physically removes bacteria from the urinary tract. Anatomical factors that cause one-way urine flow and prevent UTI penetration are ureteral motility, vesicoureteral valves, prostate secretions, urothelial surface properties, urethral length, urethral peristalsis, and urethral sphincter contraction. The properties of the mucous membrane, which produces antibodies and has its own antibacterial properties, and the surface layer of glycosaminoglycans also prevent the proliferation of bacteria in the urinary tract. Urine has its own antibacterial properties - very acidic or alkaline urine pH, hyperosmolality and high concentration of urea. Finally, systemic humoral and cellular immunity also protect healthy animals from UTIs.

Most UTIs are the result of bacteria entering the distal genitourinary tract and establishing themselves in the urethra or bladder, and possibly also in the ureters and kidneys. The bacteria that cause UTIs are the same bacteria that colonize the distal urogenital tract and perineum in healthy dogs. Any disorder that interferes with normal defense mechanisms and causes urinary tract dysfunction (low-density urine production or the presence of stones) predisposes the animal to UTI. Bitches are more likely to get UTIs, possibly because their urethra is shorter and they don't have prostate secretion.

Several mechanisms appear to predispose dogs with DM and HAC to UTIs. Both endocrine disorders cause polyuria and decreased urinary osmolality, which may increase the likelihood of UTIs. Excessive cortisol production in dogs with HAC may cause immunosuppression or a decrease in the normal inflammatory response to infection. Also, dogs with spontaneous OAC that have been treated with prednisone for a long time often develop UTIs. Glucosuria in diabetes can cause neutrophil dysfunction, which in fact predisposes to infections, including those of the urinary tract.

UTIs in dogs with DM and HAC are caused by the same organisms as in healthy dogs. Escherichia coli isolated in 65% of dogs, other isolated microorganisms are species Klebsiella(15%), kinds Streptococcus(7%), kinds Enterobacter(7%), kinds Staphylococcus(7%), kinds Enterococcus(7%) and types Proteus(7%). Approximately 80% of dogs with UTI, DM, and HAC are infected with one microorganism, and 20% with two or more organisms.

Clinical symptoms

Most dogs with UTIs, DM, or HAC are older dogs with an average age of 9 years. Miniature Schnauzers, Cocker Spaniels, and Poodles are predisposed to UTIs, while Golden Retrievers, Labrador Retrievers, and Métis are less prone to UTIs.

The clinical symptoms of UTIs are stranguria, dysuria, hematuria, and pollakiuria and are seen in less than 10% of dogs with DM and HAC. This may be due to the anti-inflammatory effects of excess cortisol in dogs with HAC. This is also due to the fact that owners are more likely to notice polyuria, which is common in dogs with DM and HAC. The absence of stranguria, dysuria, and pollakiuria in dogs with DM and HAC is indicative of kidney and ureteral infection, which may or may not be symptomatic of a urinary tract infection. General examination findings are typical of dogs with DM and HAC—cataract, skin lesions (pyoderma, skin thinning, alopecia, skin calcification), hepatomegaly, and abdominal enlargement.

Diagnostic evaluation

The results of routine laboratory tests are characteristic of DM and HAC - stress leukogram, hyperglycemia, elevated liver enzymes, hypercholesterolemia and glycosuria. The specific gravity of urine varies, but most dogs have less than 1.020. The pH of urine is normal - 6-7. Proteinuria occurs in two-thirds of dogs with DM and HAC, whether they have a UTI or not. Urinary sediment analysis reveals hematuria in 45%, pyuria in 60%, and bacteriuria in 65% of dogs with UTI, DM, and HAC. Therefore, even with good urine sediment results, a UTI cannot be ruled out.

Because of the incidence of UTIs in dogs with DM and HAC and their lack of symptoms, urine cultures should be done in any case. Urine collected by cystocentesis should be sent for bacterial culture per mL of urine because low bacterial counts (less than 100 CFU/mL) may show contamination during specimen collection and transport. However, if an animal with a UTI received antibiotics 3-7 days prior to urinalysis, the number of bacteria may be less than expected. Urine culture results should be interpreted according to clinical symptoms and urinary sediment findings. Animals with stranguria, pollakiuria, pyuria, bacteriuria, or hematuria and few bacteria on culture are likely to have a UTI.

Treatment

If a significant growth of bacteria is detected during sowing, treatment with antibiotics is indicated. Since in animals with DM and HAC UTI will be complicated and may interfere with the treatment of endocrine disorders, the choice of antibiotics should be based on the results of urine culture and antibiotic susceptibility testing. Antibiotics that are most effective against bacteria that cause UTIs can be given while waiting for culture results (Table 1).

Table 1. Antibiotics for the treatment of urinary tract infection in dogs with hyperadrenocorticism and flaccid dyspnea, or both. Information based on minimum inhibitory concentration
Microorganism	Recommended drugs	Alternative drugs
Escherichia coli	trimethoprim sulfa Amoxicillin-clavulanic acid	Nitrofurantoin Chloramphenicol
species of Klebsiella	Enrofloxacin or norfloxacin trimethoprim sulfa Cephalexin or cefadroxil	Amoxicillin-clavulanic acid
Streptococcus species	Ampicillin or amoxicillin Amoxicillin-clavulanic acid Erythromycin	Cephalexin or Cefadroxil Chloramphenicol
Staphylococcus species	Ampicillin or amoxicillin Cephalexin or cefadroxil Erythromycin	trimethoprim sulfa Chloramphenicol
Enterobacter species	Enrofloxacin or norfloxacin	trimethoprim sulfa
Enterococcus species	Enrofloxacin or norfloxacin trimethoprim sulfa	Chloramphenicol Tetracycline
Proteus species	Ampicillin or amoxicillin Enrofloxacin or norfloxacin	Amoxicillin-clavulanic acid Cephalexin or cefadroxil

If the animal has not received antibiotics, the susceptibility of most bacteria that cause UTIs will be predictable. However, variations are possible with long-term treatment of UTIs in animals with DM and HAC.
For each animal, the choice of the appropriate antibiotic should be based on several factors. First, at the minimum inhibitory concentration (MIC) of the pathogenic organism by the drug in the urine. The effective antibiotic will be the one whose concentration in the urine will be four times the MIC (table 2).

Table 2. Rules for antibiotic treatment of urinary tract infections in dogs
A drug	MIC	Dosage
Ampicillin Amoxicillin Amoxicillin-clavulanic acid Cefadroxil Cefalexin Chloramphenicol Enrofloxacin Nitrofurantoin Tetracycline trimethoprim sulfa	Not less than 64 mcg/ml Not less than 32 mcg/ml Not less than 32 mcg/ml Not less than 32 mcg/ml Not less than 32 mcg/ml Not less than 16 mcg/ml Not less than 8 mcg/ml Not less than 16 mcg/ml Not less than 32 mcg/ml At least 2 mcg/ml (at least 16 mcg/ml	25 mg/kg po every 8 hours 11 mg/kg po every 8 hours 16.5 mg/kg po every 8 hours 10-20 mg/kg po every 8 hours 30-40 mg/kg po every 8 hours 33 mg/kg po every 8 hours 2.5 mg/kg po every 12 hours 5 mg/kg po every 8 hours 18 mg/kg po every 8 hours 15 mg/kg po every 12 hours

Although quinolones, including enrofloxacin (Baytril, Haver) and norfloxacin (Noroxin, Merck), are effective for most UTIs, they should not be given empirically because they can selectively grow resistant organisms for which there are no antibiotics. In the case of a polybacterial infection, an antibiotic that is effective against all bacteria should be chosen. If this is not possible, each type of bacteria should be dealt with sequentially rather than a combination of antibiotics. Despite the fact that bacteriostatic drugs (chloramphenicol, nitrofurantoin, erythromycin, tetracycline) are effective against UTIs, bactericidal drugs are recommended in animals with DM and HAC due to the violation of protective mechanisms. Uncastrated males are prone to prostate infection, so they should be given antibiotics that reach the required concentration inside the prostate (chloramphenicol, trimethoprim-sulfa, erythromycin, tetracycline, and quinolones).

With the exception of quinolones and trimethoprim sulph, which are effective when given twice daily, other UTI antibiotics should be given three times daily. To maintain the optimal concentration of the antibiotic in the urine, the owner should give the drug immediately after urination. The ideal duration of treatment for UTIs in animals with DM and HAC is not known, but it makes sense to prescribe antibiotics until the underlying endocrine disorder has been resolved. The recommended duration of treatment is 4-6 weeks, although some animals may require longer therapy.

It is very important to monitor the effectiveness of treatment, as well as possible relapses. Because most animals with UTIs, DM, and HAC are asymptomatic and most have normal urinary sediment results, a quantitative and qualitative urine culture should be performed 3-5 days after the start of treatment and again 7 days after antibiotics have been discontinued. . If bacterial growth is detected at culture, then therapy is adjusted according to the results of the antibiotic susceptibility test and culture is repeated to ensure that the new antibiotic is effective. Since the duration of treatment for UTI remains unknown, it is recommended that a urine culture be performed every month until negative results are obtained. Animals with DM and HAC are characterized by recurrence of UTIs throughout their lives, so for these patients it is necessary to constantly (every 3-6 months) perform a urine culture.

Cystitis is an inflammation of the lining of the bladder. Often occurs with inflammation of the urethra - urethritis.

Cystitis in dogs can occur in acute and chronic forms.

By the nature of the inflammatory process, it can be catarrhal, purulent, diphtheritic and phlegmonous.

The disease is promoted by low mobility and unbalanced feeding of the dog.

Microorganisms enter the bladder cavity in various ways: ascending - from the urethra (urethral), descending (from the kidneys), lymphogenous - from neighboring pelvic organs, hematogenous - from more distant inflammatory foci. In dogs, the ascending route of infection to the bladder is more common. In bitches, due to their anatomical structure of the genitourinary system (the urethra in females is wider, shorter and closer to the anus), cystitis is more common.

Pathogenesis. The products of inflammation of the walls of the bladder cause a change in the composition of urine, pus appears in the urine, bladder epithelium, red blood cells and pieces of necrotic tissue. As a result of pathogenic microflora entering the bladder, the urine quickly rots. In a sick dog, the body temperature rises, the neuroreflex excitability of the inflamed mucous membrane increases, which causes frequent contraction of the bladder and frequent urination in small portions.

The absorbed products of inflammation lead to shifts in the metabolic processes of the body, which is manifested by an increase in the number of leukocytes, especially neutrophils.

Clinical picture. In the acute form of cystitis, the owner notices a change in the behavior of his dog, usually clean, he begins to leave puddles in the corners or defiantly stains furniture, sometimes he suddenly starts whining. The dog becomes lethargic and lethargic or, conversely, overly aggressive, the dog develops increased thirst and frequent urination in small portions. Whining immediately after or at the end of urination. There are purulent, bloody or mucous discharges from the genitals. A clinical examination reveals a slight increase in body temperature, the abdomen becomes tight on palpation, sometimes it is possible to establish an enlarged bladder, the dog avoids touching the abdomen. The urine is cloudy and has an unpleasant odor. Males have discomfort when urinating (males usually raise their paw and begin to sit down). Occasionally, a sick dog may experience nausea and vomiting. When examining urine in a veterinary laboratory - a high content of leukocytes, erythrocytes, microbial bodies and salt crystals. An ultrasound scan reveals sand, stones, inflammation of the mucous membrane in the bladder.

Diagnosis put on the basis of the clinical picture (frequent painful urination) and urine analysis (with microscopy of the sediment - a high content of leukocytes, erythrocytes, desquamating epithelium, microbial bodies, ammonium urate crystals). Blood test (general and biochemical). Pap smear for genital infections. An ultrasound is performed (stones, sand, the condition of the kidneys and bladder are detected). X-ray examination.

Differential Diagnosis. When conducting differential diagnosis, they exclude, etc.

Treatment. We provide a sick dog with complete rest, drink plenty of alkaline water, prescribe dietary feeding - a milk and vegetable diet (oatmeal and millet porridge, milk), exclude dry food, fried and spicy food from the table.

In the absence of blockage of the urethra, in order to accelerate the release of inflammation products from the bladder, the dog is given decoctions of herbs that have a slight diuretic and anti-inflammatory effect (lingonberry leaf, corn stigma, bearberry leaves, horsetail).

After it is possible to restore the outflow of urine or when the outflow of urine did not stop, they begin to wash the bladder with antiseptic solutions (potassium permanganate, boric acid, furacillin, ichthyol, etc.) or saline (0.9% sodium chloride) in order to release the accumulated mucus, blood clots, fine sand and other cellular elements.

If the dog whines and does not allow to palpate the abdomen, we prescribe an analgesic (analgin, cyston, noshpa). If there is blood in the urine, hemostatic agents (calcium chloride, vikasol, gelatin, dicynone) are prescribed.

If the inflammatory process in the bladder was the result of infection with pathogenic microflora after testing the isolated pathogen for antibiotic sensitivity in a veterinary laboratory, antibiotics are used (Baytril, Cephalotoxime, Ciftriaxone and others).

To reduce the detrimental effect of antibiotics on the intestinal microflora, a course of sorbents, probiotics and hepatoprotectors is prescribed.

In the event of infectious complications, sulfanilamide preparations (furagin, urolex, furodonin, furosemide, children's biseptol) are used.

In some cases, a sick dog needs to be treated using immunocorrectors (Gamavit, Anandin, Vestin, Immunofan, Roncoleukin, Ribotan, Fosprinil, etc.).

If a sick dog has symptoms of intoxication, a dropper is used.

Drug treatment of cystitis is best done in a complex manner, taking into account the reaction of urine; in case of an acid reaction, hexamethylenetetramine is prescribed; in an alkaline reaction, salol is prescribed. To accelerate the release of inflammation products from the bladder, ammonium chloride, potassium acetate and phyto-remedies are used inside.

In the treatment of cystitis, the use of stop cystitis for dogs is effective, which has a pronounced antimicrobial, anti-inflammatory, antiseptic, antispasmodic, diuretic and saluretic effect. It is used in the form of a suspension or in tablets, the tablets are used with food or administered to the root of the tongue for therapeutic purposes 2 times a day at a dose according to the instructions for the use of stop-cystitis.

In the treatment, you can use the drug phytoelite, "Healthy kidneys" and "Cat Erwin".

When an infectious agent is isolated from the bladder, the underlying disease that caused cystitis in a dog is treated.

Prevention. Prevention of cystitis in dogs should be aimed at preventing the causes leading to the development of cystitis. Dog owners should protect them from drafts and hypothermia, treat dogs with gynecological pathology (vaginitis, endometritis) in a timely manner. Bough during estrus should not be walked in places where tramps walk.

A male dog cannot be bred with an untested bitch. In long-haired dogs, it is necessary to cut the hair under the tail in order to prevent feces from entering the genitals. Observe the hygiene of the animal and its habitats. Make sure your dog is properly fed. See the article on our website. Take your dog for walks regularly.

Periodically conduct preventive examinations in a veterinary clinic. For preventive purposes, give the dog cranberry juice, which prevents the formation of bladder stones and has antibacterial properties.

DISEASES OF THE URINARY SYSTEM

The main function of the kidneys is to filter and excrete metabolic decay products and maintain the water-salt balance.
organism. Violation of these functions leads to a decrease in the filtration and functional ability of the kidneys, the accumulation of toxic substances in the blood, and intoxication of the body. That is why the primary picture of kidney disease, as a rule, has the character of metabolic disorders - vomiting, diarrhea, hair loss, lethargy, loss of appetite, etc. and only at a later date does the picture of kidney damage actually begin to appear - a violation of urination. However, it is observed with already significant damage to kidney tissues - destruction can affect up to 75% of functional units, which makes this group of diseases especially dangerous and difficult to treat. It has been established that about 80% of adult animals have various pathologies of the kidneys, and in terms of the number of deaths, this disease is in 2nd place after oncological ones, since the damaged areas are not restored. Because of this, it is very important to identify kidney disease in time and start its treatment.

Other diseases of the genitourinary system are most often manifested by edema, a change (both a decrease and an increase) in the amount of urine excreted, a change in its color, soreness in the kidneys or bladder, the presence of blood or mucus in the urine, clouding of the urine. It is strictly forbidden to treat a dog on your own in all such cases. You should immediately contact a veterinarian.

Phytotherapy of diseases of the genitourinary system
A number of herbal medicines are used in urology. Among them, it is advisable to single out aquaretic (diuretic) and disinfectants for the urinary tract, which are used for urination disorders.

Aquatic (diuretic) agents cause increased urination and are therefore used as adjunctive treatment for inflammatory diseases of the urinary tract (eg, cystitis) or as support for the removal of urinary stones. Diuretics of plant origin provide a gradual increase in diuresis on the 3-7th day of admission. Their advantages are: excretion of toxic metabolites and underoxidized products of carbohydrate metabolism from the body, the absence of electrolyte imbalances - a potassium-sparing effect. Caution is required when using diuretic therapy for kidney disease. It is unacceptable to use plants that irritate the tissue of the kidneys.

Herbal urinary tract disinfectants cannot replace antibiotics or chemotherapeutic agents and are therefore not indicated for acute cystitis or urinary tract infections with fever. Due to the presence of water-soluble phenyl glycosides and essential oils in them, they have a bacteriostatic effect, and therefore are suitable for use as supportive agents in chronic forms of cystitis, for example, when the pathogen is not detected.

For the treatment of kidney diseases, cystitis and urolithiasis of dogs, the drug Phytoelita has been developed - healthy kidneys, which is a tableted extract of the following medicinal herbs: St. birch leaf, dandelion root, bean leaves, centaury herb, golden rod herb and flowers, nettle herb, tricolor violet herb, burdock root, barberry root bark, horsetail herb, echinacea purpurea flowers, hop cones, Caucasian hellebore roots and rhizomes, flowers meadowsweet, mullein petals, orthosiphon staminate leaf, small agrimony grass.

For the treatment and prevention of urolithiasis in dogs, you can use the drug KotErvin, which is a herbal tea of ​​the following plants: grass of the mountaineer bird, grass of the horsetail, herb of the knotweed grass, harrow root, stigmas and columns of corn, birch leaves, strawberry leaves, madder dye roots, herbs and parsley root, fennel fruit, birch buds, orthosiphon herb, echinacea purpurea herb.

BALANOPOSTIT

Balanoposthitis is a combined bacterial inflammation of the glans penis (balanitis) and prepuce (postitis), resulting from stagnation of urine and death in the preputial sac. The disease is quite common.

Symptoms: discharge of drops of yellowish-green pus, sometimes bloody, with a follicular form, small dense nodules can be felt.

Treatment: cut off the sticky hair at the end of the prepuce, thoroughly rinse the preputial sac with a pale solution of warm potassium permanganate, then also inject a slightly warmed synthomycin or neomycin emulsion into the cavity. Repeat the procedure 3-6 times during the day. For ulcers, treat sores with swabs moistened with 2% silver nitrate solution. Effective treatment with cycloferon liniment 2 times a day for 3-5 days.

homeopathic treatment
Cantharis compositum, Traumeel and Echinacea compositum. Any of these complex agents can be effective in the treatment of balanoposthitis. It is not advisable to use two or all three drugs at the same time. It is advisable to choose the most effective and use it for possible exacerbations in the future.

GLOMERULONEPHRITIS

Glomerulonephritis is an inflammatory disease of the kidneys, characterized by a predominant lesion of the glomerular apparatus of the nephron. It is mainly infectious-allergic in nature, most often develops after an infection caused by hemolytic streptococcus. Distinguish between acute and chronic glomerunofrits - the latter in dogs are much more common.

The provoking factor is often hypothermia and keeping in a damp room.

Symptoms: possible hematuria (excretion of blood in the urine), edema, rapid pulse, with acute nephritis - oliguria (decrease in the formation and excretion of urine). The diagnosis is established by a veterinarian based on the history, results of a clinical examination and urine tests.
Treatment: the dog should be kept in a dry and warm room, put on a diet (milk, bread, cereals from oatmeal and pearl barley, boiled vegetables). The veterinarian will prescribe antibiotics (effective albipen-LA, neopen, etc.), novocaine blockade, corticosteroids, symptomatic therapy.

homeopathic treatment
The main drugs in the treatment of this disease will be: Berberis-Homaccord, Engystol and Liarsin. In this case, injectable forms of drugs can be administered orally with drinking water.

Treatment in all cases is long-term. It is very important to remember that glomerulonephritis almost always develops with pyometra, so even after surgery for pyometra, the animal should be observed by a doctor for a long time.

Phytotherapy
Bearberry leaves, rose hips, juniper - infusions and decoctions.

diet therapy
Hill's Prescription Diet Canine g / d, Canine t / d and t / d Mini, Canine k / d (Canine Treats)

CRYPTORCHISM

Cryptorchidism is a developmental anomaly: the absence of one or both testicles in the scrotum, caused by a delay in their intrauterine movement from the retroperitoneal space. There are inguinal cryptorchidism, in which the testicle is located in the inguinal canal, and abdominal cryptorchidism, in which the testicle is located in the retroperitoneal space. If one testicle is not descended (monorchism), the dog retains the ability to reproduce; if both testicles are undescended, the male is sterile.

Symptoms: absence of one or both testicles in the scrotum.

Treatment. As a rule, cryptorchids are sterilized, due to the fact that the disease is inherited. In the treatment, the drug horulon is used (100-500 IU, 2 times a week, for 6 weeks), vitamin A is added to the diet, while reducing the content of vitamin E.

UROLITHIASIS DISEASE

Urolithiasis - the formation of single or multiple urinary stones (stones) in the renal parenchyma, pelvis or bladder. Dogs of such breeds as: Cocker Spaniel, Labrador Retriever, German Shepherd, Boxer, German Shorthaired Pointer, Poodle, Dalmatian, Dachshund, Pekingese, Scotch Terrier, Fox Terrier, Maltese, Spaniel, etc. have an increased tendency to this disease. Some authors associate this with a congenital disorder of phosphorus-calcium metabolism inherent in animals of chondrodystrophic, dwarf and other breeds mentioned. Other causes of urolithiasis can be: improper feeding (excess of proteins and lack of carbohydrates), lack of vitamins A and D, an imbalance in the acid-base balance of blood and lymph, and urinary tract infections (especially streptococcal and staphylococcal). With all such metabolic disorders, there is an excessive excretion of various metabolic products in the urine. The risk of kidney stones is increased in dogs fed dairy products and fish, especially raw fish. The urethra in dogs is already quite thin, and with a high content of fish and dairy products in the diet, crystals of phosphorus and calcium salts fall out in the urine, which leads to spasms and urinary retention, with possible subsequent infection of the urinary tract and the development of acute renal failure.

With urolithiasis, various hardly soluble salts accumulate in the kidneys and urinary tract. These can be calcium phosphates, calcium carbonates, calcium oxalates, urates. Damage to the mucous membrane of the urethra or its blockage leads to stagnation of urine and the development of an ascending urinary tract infection. As a result, catarrhal-purulent inflammation of the bladder (urocystitis) and renal pelvis (pyelonephritis) develops. If urgent measures are not taken, the dog may die from uremia (blockage of the urethra).

Symptoms: the dog refuses to eat, is lethargic, barks or whines plaintively when unable to urinate or has pain when urinating, the amount of urine decreases, the urine may be cloudy or bloody (hematuria), urination is difficult (or, conversely, very frequent and painful) or may be completely absent.

You can start treatment only after establishing the nature of the formed salts, therefore, first of all, you need to show the dog to the veterinarian. If possible, collect some urine in a clean bottle for laboratory analysis.

The treatment aims to eliminate the pain syndrome, increase the solubility of salts, loosen the stones, and prevent the formation of urinary stones. Prescriptions are preferred, including herbal remedies of various therapeutic directions.

Treatment: you can alleviate the dog's condition with the help of antispasmodics (no-shpa, baralgin), as well as with the help of a special diet that prevents oversaturation with calcium and phosphorus salts. In violation of the metabolism of calcium and phosphorus, the vitamin and mineral supplement SA-37 is indicated.

homeopathic treatment
Of great importance is the control of the mucosa of the bladder and urethra in dogs with urolithiasis.

For this, long-term therapy is prescribed with the use of Berberis-Homaccord and Mucosa compositum. Medicines can be given with drinking water 2-3 times a week.

In acute inflammation and pain, Traumeel is prescribed subcutaneously 2-3 times a day or in the form of drops every 15-30 minutes. Traumeel is also prescribed after surgery (cysto- or urethrotomy).

If urolithiasis develops against the background of chronic pyelonephritis, then the main treatment is best carried out with the help of drugs Cantharis compositum and Berberis-Homacquord.

Phytotherapy
The use of Phytoelita Healthy Kidneys and KotErvin is recommended. From herbs: a decoction of bearberry leaves (bear ears), an infusion of half-pala (herva woolly), parsley rhizomes, highlander, watercress, etc.

diet therapy
Feed Hill's Prescription Diet: Cystins - destruction: Canine u / d + thiopronin (2-MPG)
prophylaxis: Canine u/d Oxalates prophylaxis: Canine u/d

Struvite - dissolution: Canine s/d prophylaxis:
with accompanying diseases - Canine c/d (Canine Treats), with obesity - Canine w/d, Urate dissolution: Canine u/d + allopurinol prophylaxis: Canine u/d

ORCHITIS

Orchitis is inflammation of the testicles. This disease can occur as a result of trauma (more often a bite or bruise, frostbite or burn) of one or both testicles, and also as a consequence of a urinary tract infection, in which bacteria (more often streptococcus, staphylococcus aureus or Pseudomonas aeruginosa) can penetrate from the urethra into the testicles through vas deferens. With purulent orchitis, abscesses may form, followed by their opening into the scrotal cavity.

Symptoms: an increase in the size of the testicle, hardening and soreness, the scrotum is edematous, the skin is hyperemic. The dog moves with its hind legs wide apart and its belly drawn in. At a later stage, the testis shrinks, hardens and decreases in size.

Treatment is prescribed by a veterinarian. Antibiotic therapy (albipen, neopen, gentamicin, intramycin, etc.) after determining the type and sensitivity of microflora, novocaine. Superficially: ointments with antibiotics.

homeopathic treatment
Belladonna-Homaccord is the most successful choice in the treatment of orchitis in the very early stages. In this case, 1-2 injections are enough to stop this process.

In subacute cases, it is better to use Traumeel and Traumeel C gel.

ACUTE RENAL FAILURE

Widely used for the treatment of chronic renal failure St. Possessing a complex, sometimes completely unclear mechanism of action on the regulation of the neuroendocrine, autonomic nervous system, they have beneficial trophic, homeostatic, sedative effects, improving the adaptive capabilities of the diseased organ and the body as a whole.

If these symptoms are detected, the dog should be urgently delivered to the nearest veterinary clinic.

First aid: the dog should be placed in a warm, well-ventilated room, ensure complete rest, limit fluid and salt in case of swelling.

Treatment should be prescribed by a veterinarian.

diet therapy
Hill's Prescription Diet Canine k / d, Canine u / d

pyelonephritis

Pyelonephritis is an inflammatory disease of the renal pelvis that occurs most often as a consequence of a bacterial infection, or as a result of mechanical irritation during urolithiasis. Distinguish between acute and chronic disease.

Symptoms: the general condition is depressed, with an acute illness, the body temperature is sharply increased, urination is frequent and painful, the dog experiences pain in the lumbar region.

The diagnosis is made by a veterinarian based on the history, results of a clinical examination, urine and blood tests.

Treatment: antispasmodics (no-shpa), antibiotic therapy (albipen, neopen, etc.), sulfonamides and other antibacterial drugs (sulf-120 or sulf-480), diuretics, gamavit. With a purulent form - corticosteroids.

homeopathic treatment
Treatment of pyelonephritis requires especially careful selection of funds. The most commonly used are Kantharis compositum and Berberis-Homaccord. In the most classic version, both drugs are administered simultaneously as injections for a long time (1.5-2 months).

However, the choice of drugs in acute forms of inflammation, in which much depends on the effectiveness of the treatment started, is of greater importance. In this case, a positive result should be obtained as soon as possible.

Primary drug of choice may be:

Traumeel - urine with blood, frequent urge to urinate
. Echinacea compositum - high fever, drowsiness
. Cantharis compositum - frequent and painful urination
. Belladonna-Homaccord - high fever, depression, water refusal
. Berberis-Homaccord - suspicion of urolithiasis, with pale mucous membranes and diarrhea.
. Engystol - is added to any of the listed drugs to enhance the effect or introduced into the course of therapy after the removal of acute symptoms.

Phytotherapy
Collection: wild strawberry (leaves) 10 g, stinging nettle (leaves) 20 g, drooping birch (leaves) 20 g, linseed 50 g. Give the infusion in a warm form 2-3 times a day.

PROSTATITIS

Prostatitis is an inflammation of the prostate gland in males, usually developing after an infectious disease. This condition is common in males over 10 years of age. The disease can worsen with stress, hypothermia, urolithiasis. Enlarging in size, the prostate gland can interfere with the normal outflow of urine, and also compresses the rectum, preventing normal bowel movement.

Symptoms: frequent, sometimes ineffectual urge to urinate, the act of defecation is lengthened, the dog may whine, painfully reacts to touching the abdominal wall. The back may be hunched.

Treatment is prescribed by a veterinarian. Shown antibiotic therapy (albipen, neopen, clamoskil, etc.), sulf-120 or sulf-480, vitamin C, B vitamins, vitamin E, diet.

homeopathic treatment
Acute prostatitis responds well to treatment with Traumeel, which is injected subcutaneously 2 times a day until the symptoms disappear (usually 3-5 days).

Chronic prostatitis is a very big problem in terms of its effective solution. Therefore, it is very important to diagnose the onset of the disease in time and, if possible, achieve the maximum effect in the treatment of the disease.

Phytotherapy
Tykveol (oil), black poplar, marshmallow.

SPASM OF THE URINARY BLADDER

Spasm of the bladder is the cessation of normal urination due to reflex contraction of the sphincter of the bladder. Spasm can occur with urolithiasis, with inflammation of the mucous membrane of the bladder.

Symptoms: urination stops completely, or urine is separated in small portions, while the bladder is full and greatly enlarged, the dog's behavior is restless.

Treatment: the veterinarian must first of all remove the spasm, for which no-shpa, baralgin, morphine or chloral hydrate are used. After the passage or pumping of urine, the introduction of the drug Kotervin into the bladder is indicated. To relieve the pain reaction, a novocaine blockade of the lower back is made with a 0.25% solution of novocaine, 1 ml / kg.

Showing acupuncture, Su Jok therapy.

homeopathic treatment
Depending on the frequency and strength of bladder contractions, various homeopathic remedies are used.

Most often, with spasms, Cantharis compositum is used, which can be used both in the form of injections and in the form of drops. When taken orally, the drug is given every 10-15 minutes until the urge to urinate stops, but not longer than two hours.

CHRONIC RENAL FAILURE

Chronic renal failure (CRF) is a non-specific diagnosis, it is understood as a gradually manifesting progressive incurable clinical syndrome due to the limited ability of the kidneys to excrete certain substances in the urine, regulate acid-base balance and perform renal endocrine functions.

With chronic renal failure, permanent irreversible damage to the kidney tissue occurs - normal tissue is gradually replaced by scar tissue.

In the first stage, the disease is asymptomatic, as the remaining nephrons ensure functioning without overload. However, as 50% of nephrons and more are destroyed, the phenomena of intoxication of the body begin to appear - dyspepsia, skin pathology. However, at this stage in the development of renal failure, various external influences - stress, dietary changes, hypothermia - can cause a sudden transition to the stage of uncompensated delay with various symptoms. At the same time, pet owners tend to believe that the disease began at that moment, and associate it with the adverse effect that preceded the onset of symptoms. Unfortunately, the disease is already "in its prime" and is almost irreversible. You can only alleviate the condition of the animal and slow down the transition of the disease to the critical phase of terminal uremia.

Symptoms: in the second stage of chronic renal failure, there is a smell from the mouth, erosion and brown plaque appear on the tip of the tongue, the mucous membranes lose their color and look pale due to anemia. Diarrhea is noted only in a part of animals suffering from uremia and is associated with impaired blood flow, primarily in the large intestine. Vomiting is common and sometimes contains blood. Disorders of the nervous system are often observed, which manifest themselves in the form of depression, numbness, coma, tremors, irritability, tetany or epileptic seizures - while almost always we are talking about the final stage of the disease. Also, at the final stage, the ability of the kidneys to concentrate urine is impaired, that is, symptoms of polyuria and polydipsia appear. Disorders of the nervous system are possible.

Subclinical disorders are: demineralization of the skeleton, increased blood pressure, acidosis and deepening of breathing. In addition, there are immune depression, soft tissue calcification, impaired wound healing and blood clotting, endocrine disorders (infertility), pancreatic disorders (hyperamylasemia), vitamin deficiency, iron deficiency.

Since the disease is chronic, its treatment should be long-term comprehensive and begin as early as possible. To reduce the impact of various factors on the kidneys, the use of herbal medicine is most appropriate, since it can be used for a long time without the risk of side effects. In addition, since the causes of this disease are most often not known, in this case a holistic systemic approach to treatment is needed, here it is necessary to treat the patient, not the disease. It is phytotherapy that provides a regulatory, rather than suppressive, substitution, symptomatic principle in maintaining and mobilizing various autoprotection systems - immune, endocrine, detoxifying, neuroregulatory. All symptomatic appointments can only be made by the attending physician.

The drug of choice in this case may be Phytoelita Healthy Kidneys, containing only natural herbal extracts. The composition of the drug includes extracts of horsetail, barberry root, birch leaf, echinacea, nettle, tricolor violet, St. Horsetail is used for diseases of the kidneys and bladder, the active substance is silicic acid salts, the mechanism of action is the formation of a stable colloid of urine, which prevents the aggregation of salts and the formation of stones. Barberry roots - the active substance berberine, affects trophic processes and, first of all, the state of purine metabolism. One of the indications for the use of barberry is pain and immobility of the joints of the hind limbs associated with excess uric acid. Polyprenols of pine and spruce needles have anti-inflammatory and reparative properties, act as uncouplers of salts and
prevent the formation of stones of various origin and localization. Birch leaves and sap are diuretics that do not irritate the kidneys, have immunotropic and hypoazotemic properties, and are also active against microorganisms and viruses. They have anti-inflammatory properties, relieve spasms. Echinacea is a powerful herbal immune stimulant. Violet tricolor has immunotropic, diuretic, hypoazotemic and antihypoxic properties. Madder dye - a means of a very wide spectrum of action, mainly associated with the normalization of the acid-base balance. Lespedeza capitate - a means of removing nitrogenous slags, preventing uremia. It should be noted that the concentrations of active substances in the preparation are such that it can be more likely attributed to homeopathic, that is, to self-healing stimulants. Therefore, the presence of horsetail extract, barberry roots in the preparation should not be considered a contraindication in the treatment of kidney diseases.
Treatment of chronic renal failure should be carried out according to the scheme - 1 dose 3 times a day. For dogs, the dose of the drug is 1 tablet for every 10 kg of weight. The duration of treatment depends on the condition of the animal. However, it must be remembered that in the treatment of chronic diseases, the duration of treatment should be practically equal to the duration of the disease.
In addition, it is necessary to replenish calcium, phosphorus and vitamin D3 in the animal's body. For this purpose, it is also necessary to use vitamin preparations with high bioavailability of active ingredients. This goal is met by phytomineral preparations - Phytomins, restorative and vitamin supplements of the Gamma series with seaweed.
Special measures in the treatment of chronic renal failure are the avoidance of stressful situations or the use of sedative herbal tea KotBayun, the constant availability of fresh water, complex feeding with sufficient intake of B and C vitamins, moderate protein restriction in food, reduced phosphorus intake, the use of anemia mitigating agents.

diet therapy
Feed Hill's Prescription Diet:

• early stages - Canine g/d, Canine t/d and t/d Mini, Canine k/d, (Canine Treats),
• renal failure - Canine k / d, Canine u / d.

CYSTITIS

Cystitis is an inflammation of the bladder, most often due to a bacterial infection of the urinary tract. This is probably the most common urinary tract disease and is caused by various types of bacteria. The mucous membrane of the bladder is resistant to infection, so the infection causes cystitis if there are other factors: the process of emptying the bladder is disturbed, blood circulation in the walls of the bladder is impaired, the body's resistance to infection is reduced. The course of the disease can be either acute or chronic.

Symptoms: in acute cystitis, urination is frequent, pain in the bladder area, in the last portions of urine there is an admixture of blood, an admixture of pus is possible, sometimes an ammonia smell comes from the urine, a sharp rise in body temperature is possible. The stronger the inflammation in the bladder, the more often the urge to urinate and the more intense the pain. In severe forms of cystitis, urination can be every 20-30 minutes, accompanied by severe pain.

The diagnosis should be made by a veterinarian to exclude urolithiasis, pyelonephritis and some other diseases.
Treatment: complete rest, diet (oatmeal and millet porridge, milk, meat broth), sulfonamides (sulf-120, sulf-480), antibiotics (intramycin), no-shpa, cystone, herbal decoctions.

homeopathic treatment
Depending on the frequency and strength of bladder contractions, various homeopathic remedies are used, in
in particular - Cantharis compositum, which can be used both in the form of injections and in the form of drops. When taken orally, the drug is given every 10-15 minutes until the urge to urinate stops, but not longer than two hours.

An alternative method may be the simultaneous subcutaneous administration of Atropinum compositum and Mucosa compositum. With very strong urges that are not relieved by the listed means, Nux vomica-Homaccord is used.

Phytotherapy
Collection: drooping birch (leaves) 25 g, bearberry (leaves) 25 g, corn stigmas 25 g, licorice (root) 25 g.

JUVENILE VAGINITIS

Vaginitis is an inflammation of the vagina caused by bacteria or fungi. As a rule, it is observed with a decrease in the natural resistance of the body, or after a traumatic sexual intercourse.

Symptoms: the dog often licks the vulva, there may be local discharge, both watery and colorless (with catarrh), and mucous with an admixture of pus.

Treatment: antimicrobial and anti-inflammatory drugs in the form of ointments (vedinol) and liniments - topically, washing the vagina with weakly disinfecting or astringent solutions.

homeopathic treatment
Well controlled by injection of Cantharis compositum or Gormel. Injections are prescribed in short courses until the discharge stops completely.

Phytotherapy
Ointment Phytoelita anti-inflammatory.