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Frequently Asked Questions: Urolithiasis
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Frequently Asked Questions: Urolithiasis
Q | A | |
A dog with signs of cystitis has cystic calculi on abdominal radiography. What is the next approach? | (1) Culture the urine to look for UTI. Primary UTI may predispose to struvite urolithiasis, and other stones may result in a secondary UTI resulting in a struvite shell around the primary stone. Treatment of the UTI will be helpful in both situations. (2) Assessment of the type of crystals in the urine may help to suspect which stones are present. (3) Spontaneous voiding, aspiration through a urethral catheter, voiding urohydropropulsion or surgical removal will identify the stone type, enabling specific therapy. Note: Urate and cystine stones are usually radiolucent, and require positive contrast studies or ultrasound for demonstration. They are therefore less likely when stones are radiographically visible. | |
How do I treat renal calculi? | Nephroliths are generally treated by surgical removal, although medical dissolution may be possible for struvite uroliths. Lithotripsy may be available in some cases. Benign neglect is possible in uninfected and non-obstructing nephroliths. | |
What is the best way to manage a dog with both renal and cystic calculi? | First, find out what the composition of the stones is. Calcium oxalate, calcium phosphate and silica uroliths cannot be dissolved medically and need to be surgically removed before protocols to prevent recurrence are implemented. Adjunctive medical management is indicated when UTI is present, the urolith type is poorly amenable to dietary changes, or when there is further urolith growth. | |
How do I handle a dog with struvite calculi? | Struvite uroliths are generally sensitive to medical dissolution using a calculolytic diet in association with antibiotic therapy. Commercial calculolytic diets are aimed to acidify and to reduce urine concentrations of urea, phosphorus and magnesium. They should be given for at least one month after removal or dissolution of struvite uroliths, because uroliths too small for radiographic detection may still be present. Dogs can then be changed to a normal diet. Urinary acidifying agents such as ammonium chloride are not necessary provided a calculolytic diet and antimicrobials are given. | |
What diet should I feed to a dog after surgery for calcium oxalate uroliths? | Calcium uroliths have a high incidence of recurrence, so preventative therapy is important. First, identify and treat any underlying causes that may have contributed to calcium urolithiasis, such as hyperparathyroidism and hyperadrenocorticism. Subsequently risk factors should be minimized by dietary adaptation. It will help to feed wet diets or special sodium-enriched dry diets that promote diuresis, and to avoid drugs that promote calciuresis, e.g., furosemide and urinary acidifiers. The diet should contain normal levels of protein, calcium and phosphorus. | |
How to manage a Dalmatian dog with suspected ammonium urate urolithiasis? | Since this is a Dalmatian, the most likely diagnosis is ammonium urate stones. A presumptive diagnosis can be achieved by looking for urate crystals in the urine. As a first choice, low-purine diets (e.g., vegetables, eggs and dairy products) that promote the formation of dilute alkaline urine should be fed. As with all urolith types, feeding a canned diet or adding supplemental water to the food helps to increase urinary volume. Allopurinoltherapy will help to further reduce urinary urate excretion. |
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Affiliation of the authors at the time of publication
1Waltham Centre for Pet Nutrition, USA.2Dept Veterinary Clinical Sciences, The Royal Veterinary College, United Kingdom
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