Changes

[[Image:Renomegaly1.jpg|300px|thumb|right|'''Massive renomegaly in an iguana. Note the possibility of colonic obstruction.''' (Copyright © RVC)]][[Image:Kidney.jpg|200px|thumb|right|'''Histology of a normal iguana kidney. Note the clearly distinct cells of the glomerulus''' (Copyright © RVC)]]

[[Image:Renomegaly1.jpg|300px|thumb|right|'''Massive renomegaly in an iguana. Note the possibility of colonic obstruction.''' (Copyright © RVC)]][[Image:Kidney.jpg|200px|thumb|right|'''Histology of a normal iguana kidney. Note the clearly distinct cells of the glomerulus''' (Copyright © RVC)]]

[[Image:Dis_kid.jpg|200px|thumb|right|'''Histology of an iguana kidney with gout. Note the darker staining tophus and indistinct glomerulus''' (Copyright © RVC)]]

[[Image:Dis_kid.jpg|200px|thumb|right|'''Histology of an iguana kidney with gout. Note the darker staining tophus and indistinct glomerulus''' (Copyright © RVC)]]

Kidney disease in snakes and lizards is not uncommon; the main causes include gout, infectious agents and toxicoses. In an advanced state it may also be associated with metastatic soft tissue calcification, where [[Calcium|calcium]] is deposited in many tissues throughout the body leading to a renal osteodystrophy. Kidney disease is common in iguanas and is a frequent cause of death in captive iguanas; most fatalities occur between 2.6 and 5.8 years, with 4.2 being the mean age with equal sex ratios.

Kidney disease in snakes and lizards is not uncommon; the main causes include gout, infectious agents and toxicoses. In an advanced state it may also be associated with metastatic soft tissue calcification, where [[Calcium - Reptiles|calcium]] is deposited in many tissues throughout the body leading to a renal osteodystrophy. Kidney disease is common in iguanas and is a frequent cause of death in captive iguanas; most fatalities occur between 2.6 and 5.8 years, with 4.2 being the mean age with equal sex ratios.

Associated terms include: renal osteodystrophy, paradoxial metastatic calcification, metastatic mineralisation syndrome in [[Green Iguana|green iguanas]], and tubulonephrosis of iguanas.

Associated terms include: renal osteodystrophy, paradoxial metastatic calcification, metastatic mineralisation syndrome in [[Green Iguana|green iguanas]], and tubulonephrosis of iguanas.

*Physical examination  

*Physical examination  

*[[Lizard and Snake Haemotology|Haematology]] - elevated PCV if dehydrated, sometimes increased white cell count with heterophilia  

*[[Lizard and Snake Haemotology|Haematology]] - elevated PCV if dehydrated, sometimes increased white cell count with heterophilia  

*[[Lizard and Snake Biochemistry|Biochemistry]] - inverse [[Calcium|calcium]] to [[Phosphorus|phosphorus]] ratio; elevated phosphorus; [[Uric acid|uric acid]] elevates late in the disease  

*[[Lizard and Snake Biochemistry|Biochemistry]] - inverse [[Calcium - Reptiles|calcium]] to [[Phosphorus - Reptiles|phosphorus]] ratio; elevated phosphorus; [[Uric acid|uric acid]] elevates late in the disease  

*[[Lizard and Snake Imaging|Radiology]] - poor contrast in caudal abdomen may hamper detection of nephromegaly: metastatic mineralisation seen as increased density of soft tissues, especially smooth muscle of blood vessels (most noticeable in lung fields), intestine, bladder, oviducts  

*[[Lizard and Snake Imaging|Radiology]] - poor contrast in caudal abdomen may hamper detection of nephromegaly: metastatic mineralisation seen as increased density of soft tissues, especially smooth muscle of blood vessels (most noticeable in lung fields), intestine, bladder, oviducts  

*[[Lizard and Snake Imaging|Ultrasound]] - kidney enlargement  

*[[Lizard and Snake Imaging|Ultrasound]] - kidney enlargement  

Urea and [[Creatinine in lizards|creatinine]] blood levels are not useful in the diagnosis of renal disease in reptiles. Snakes are uricotelic and [[Uric acid|uric acid]] levels increase with kidney failure. However, it is not a sensitive test for renal disease since damage to two thirds of the kidney may be necessary before an increase will be seen.  

Urea and [[Creatinine in lizards|creatinine]] blood levels are not useful in the diagnosis of renal disease in reptiles. Snakes are uricotelic and [[Uric acid|uric acid]] levels increase with kidney failure. However, it is not a sensitive test for renal disease since damage to two thirds of the kidney may be necessary before an increase will be seen.  

[[Uric acid|Uric acid]] is also not a specific test for renal disease since other factors such as diet and ambient temperature also affect the levels. Increased plasma phosphate levels and a reversed [[Calcium|calcium]] to phosphate ratio are seen prior to changes in the [[Uric acid|uric acid]] level. [[lizard and Snake Imaging|Imaging]] may be useful and biopsy of the kidney gives the definitive diagnosis.

[[Uric acid|Uric acid]] is also not a specific test for renal disease since other factors such as diet and ambient temperature also affect the levels. Increased plasma phosphate levels and a reversed calcium to phosphate ratio are seen prior to changes in the [[Uric acid|uric acid]] level. [[lizard and Snake Imaging|Imaging]] may be useful and biopsy of the kidney gives the definitive diagnosis.

==Therapy==

==Therapy==

Correct diet and environmental conditions may limit the progression of the disease. Consider a low [[Phosphorus|phosphorus]] diet. Supportive therapy is especially important since there is often no specific treatment. The most important factors include fluid therapy and being kept within the  [[Preferred optimum temperature zone|preferred optimum temperature zone (POTZ)]]. Allopurinol and phosphate binders have been advised but are often ineffective.

Correct diet and environmental conditions may limit the progression of the disease. Consider a low [[Phosphorus - Reptiles|phosphorus]] diet. Supportive therapy is especially important since there is often no specific treatment. The most important factors include fluid therapy and being kept within the  [[Preferred optimum temperature zone|preferred optimum temperature zone (POTZ)]]. Allopurinol and phosphate binders have been advised but are often ineffective.

[[Lizard and Snake Euthanasia|Euthanasia]] is often the final outcome.

[[Lizard and Snake Euthanasia|Euthanasia]] is often the final outcome.

[http://www.cabi.org/cabdirect/FullTextPDF/2006/20063121825.pdf '''Renal diagnostics - diagnosing reduced renal function (not renal failure!).''' Hernandez-Divers, S. J.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Volume 20, Orlando, Florida, USA, 7-11 January, 2006, 2006, pp 1624, 4 ref. - '''Full Text Article''']

[http://www.cabi.org/cabdirect/FullTextPDF/2006/20063121825.pdf '''Renal diagnostics - diagnosing reduced renal function (not renal failure!).''' Hernandez-Divers, S. J.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Volume 20, Orlando, Florida, USA, 7-11 January, 2006, 2006, pp 1624, 4 ref. - '''Full Text Article''']

[[Category:Lizard_Urinary_Diseases|R]]

[[Category:Lizard_Urinary_Diseases|R]]

[[Category:Snake_Diseases]]

[[Category:Snake_Diseases]]