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Anatomical anomalies, particularly those that are congenital, increase the risk of UTI. Normal micturition is essential to prevent micro‑organisms accumulating within the urinary tract. This removes non‑adherent luminal micro‑organisms and sloughed mucosal cells (expelling adherent micro‑organisms). Additional defence mechanisms, including high urethral pressure and urethral length, influence migration of micro‑organisms along the lower urinary tract. Urethral peristalsis is essential for effective micturition and abnormal peristalsis increases the chance of bacterial ascent into the bladder. Conditions that alter micturition frequency, cause urine retention, incomplete voiding or altered urethral function increase the risk of UTI. The urothelium has a number of mechanisms to avoid colonisation by micro‑organisms. The production of glycosaminoglycans (GAG) coats the urothelium (and bacteria) providing a barrier to adhesion. Ovariectomy impairs this GAG production, increasing the risk of UTI in neutered females. Immunoglobulin (A and G) production serves to coat micro‑organisms and prevent adhesion to the endothelium. The production of cytokines by the urothelium is increasingly recognised as being crucial in the innate immune response in the urinary tract. The antimicrobial properties of prostatic secretions are also important defences in male dogs. Particular properties of urine also help resist infection. A high urine concentration is particularly important, along with urine solutes such as urea, organic acids, low‑molecular weight carbohydrates, antimicrobial peptides, lactoferrin (and its derivatives) and Tamm‑Horsfall mucoprotein. The role of urine pH is however unclear, as the pH extremes required to inhibit organism growth are rarely achievable in vivo. Systemic disease can alter these defence mechanisms and increase the risk of UTI. Those causing polyuria – particularly chronic kidney disease and endocrinopathies, increase the risk of UTI by reducing urine concentration and diluting the solutes. Conditions altering the local immune response including hyperadrenocorticism and diabetes mellitus also increase the risk of UTI. It is important in affected dogs to culture the urine at frequent intervals, given that infections are often occult and their persistence increases the risk for upper UTI. Various medications can increase the risk of UTI, particularly glucocorticoids and other immunosuppressives. Occult UTIs are particularly common in dogs treated chronically with glucocorticoids, and urine culture should be carried out periodically in these dogs, regardless of clinical signs. The absence of active sediment in animals receiving glucocorticoids cannot be used to rule out infection and a culture should always be performed. The choice and duration of antimicrobial therapy for UTI should account for any potential compromise in defence mechanisms, as well as being effective against the cultured micro‑organism. In summary, when selecting antimicrobials, it should be remembered they aid the innate defence mechanisms in clearing infections, not replace them. Urinary tract inections (UTI) are relatively common in dogs. In developing a UTI, the innate deence mechanisms must be overcome, compromised, or evaded. Consideration o these deence mechanisms and their potential derangement can help direct eective therapy. Innate deence mechanisms are critical to urinary tract health as the lower urinary tract is not sterile. The normal fora o the lower urinary tract helps to reduce colonisation by pathogenic micro-organisms. Probiotics may help reduce the development o UTI in susceptible individuals by supporting this normal fora, however evidence that this can help in dogs is limited at present. Mark Dunning MA VetMB PhD CertSAM MRCVS Clinical Associate Professor in Small Animal Internal Medicine, University of Nottingham Mark graduated from Cambridge Vet School in 1997 and spent time in both mixed and small animal practice before returning to Cambridge to complete a PhD in Experimental Neuroscience and a residency in small animal medicine. During this time, he completed the RCVS Certicate in Small Animal Medicine and the rst part of the European Diploma in Small Animal Internal Medicine. Mark then spent four years in a private specialist multidisciplinary practice in Hampshire, before joining the School of Veterinary Medicine and Science at the University of Nottingham in October 2011 as Clinical Associate Professor in Small Animal Internal Medicine. Urinary Tract Inection Foreword by Mark Dunning Focus On UTI 3465 Focus on UTI_ART_V2.indd 2 07/07/2014 13:48
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