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Urinary Relative Supersaturation and Urolithiasis Risk
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Introduction
Urinary stones represent 18% and 15% of all lower urinary tract diseases in dogs and cats respectively (1). In various veterinary stone analysis laboratories, dogs account for 72-81% of total stone submissions, much more than cats (2-4). Struvite and calcium oxalate (CaOx) uroliths represent 80-90% of all stones in both species, but data from North America and Europe show that relative proportions of each type have varied over the years. Struvite predominated in the 1980s, but was progressively outnumbered by calcium oxalate in the mid-1990s. An inverse shift has now been reported in the last few years (2,5-7).
Veterinarians in practice have limited access to urine samples and tools when it comes to assessing the risk of an animal forming uroliths. Urine specific gravity (USG) and pH, as well as microscopic examination of the sediment to visualize crystals, are frequently performed on “spot” urine samples, and while they can be informative, such tests are unfortunately imperfect when considering the risk of various types of urolithiases. For instance, stones can be present when visualized crystals are absent (and vice-versa), and urine pH varies greatly over the course of the day (8). This paper reviews the relationship between urinary relative supersaturation (RSS) and the risk of urolithiasis in dogs and cats, and identifies recent advances in this area.
Key Points
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Relative supersaturation (RSS) remains to date the best tool to assess the risk of crystal formation in urine. It is used to optimize diet formulations, but is unfortunately too cumbersome to be measured in a clinical setting.
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Data obtained in healthy dogs and cats show that urinary pH is an important determinant of struvite RSS, but not calcium oxalate RSS.
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Urinary pH should be interpreted with caution by practitioners when assessing patients at risk for urolithiasis, due to within-day variability and the poor correlation with calcium oxalate RSS.
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Increasing dietary sodium or moisture is effective in decreasing RSS of both struvite and calcium oxalate. Urine specific gravity can be used by practitioners to monitor patients at risk of urolithiasis.
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