1 / 58

Canine and Feline Urolithiasis

Canine and Feline Urolithiasis. Canine and Feline Urolithiasis. Magnesium ammonium phosphate Calcium oxalate Urate Cystine Calcium phosphate Silicate Mixed stones. Canine Urolithiasis Prevalence (%). 1986 1990 1994 Struvite 67.0 57.0 49.5

xanthe
Download Presentation

Canine and Feline Urolithiasis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Canine and Feline Urolithiasis

  2. Canine and Feline Urolithiasis • Magnesium ammonium phosphate • Calcium oxalate • Urate • Cystine • Calcium phosphate • Silicate • Mixed stones

  3. Canine UrolithiasisPrevalence (%) 1986 1990 1994 • Struvite 67.0 57.0 49.5 • Calcium oxalate 6.8 19.8 32.7 • Urate 5.1 5.5 8.0 • Cystine 2.4 1.6 1.0 • Calcium phosphate 3.0 1.6 0.6 • Mixed/Compound 11.9 12.6 7.4

  4. Feline UrolithiasisPrevalence (%) 1986 1990 1996 • Struvite 85.0 66.0 36.4 • Calcium oxalate 3.0 16.0 53.4 • Urate 1.8 6.1 4.9 • Cystine 0.0 0.1 0.1 • Calcium phosphate 2.0 2.9 0.6 • Mixed/compound 5.2 5.9 3.4

  5. Canine and Feline UrolithiasisPathogenesis • Concentration of building blocks • Urinary pH • Time

  6. labile region critical supersaturation increasing activity product metastabile supersaturation saturation, Ksp undersaturation Canine and Feline UrolithiasisPathogenesis

  7. Canine and Feline UrolithiasisPathogenesis Activity Product • Concentration of crystal constituents • Concentration of other solutes • Urine pH • Ionic strength

  8. Feline Lower Urinary Tract DiseasePathogenesis • Uroliths • Urethral plugs • Large quantity of matrix ( > 50% matrix) • Mixed with crystals or without crystals

  9. Canine and Feline UrolithiasisClinical Diagnosis • Age • Gender • Breed • Radiograhic findings • Crystalluria • Urinary pH • Presence of infection

  10. Canine and Feline UrolithiasisClinical Diagnosis • Urinary pH • Alkaline Struvite Calcium apatite • Acid to neutral Calcium oxalate Cystine

  11. Canine and Feline UrolithiasisClinical Diagnosis • Presence of Infection Urease producing micro-organisms Struvite • Dogs most cases UTI • Cats 1-2% UTI

  12. 2NH3+ CO2 NH2 =C=NH2 + H2O = O Urease NH3+ H2O + CO2 NH4++ HCO3- Canine UrolithiasisUrease producing bacteria

  13. Canine and Feline UrolithiasisTreatment & Prevention • Treatment Dietary & Medical dissolution Surgical Non-surgical retrieval • Prevention of recurrence Dietary modifications Water intake

  14. Canine and Feline UrolithiasisDietary management • Undersaturate the urine Excretion of building blocks Urine volume • Urinary pH favorable to stone dissolution

  15. Feline Lower Urinary Tract DiseaseStruvite & calcium oxalate • No single diet for both struvite and calcium oxalate • Conflicting actions of several key nutrients • Clinical diagnosis is essential

  16. pH Mg PO4 Na Canine and Feline Urolithiasis Lower Urinary Tract Disease Struvite Ca Oxalate

  17. Feline Lower Urinary Tract DiseaseStruvite Patient profile • Female • Younger cat, < 7 years • Obese • Indoor, multi-cat household • Low water intake • More alkaline urinary pH (> 6.5)

  18. Feline Lower Urinary Tract DiseaseCalcium oxalate Patient profile • Male (neutered) • Older cat > 4 years • Obese • Persian, Himalayan, Burmese • Indoor, urban • More acid urinary pH

  19. Feline Lower Urinary Tract DiseaseCalcium oxalate Medical history • History of calcium oxalate, documented by quantitative urolith analysis • No response to appropriate dietary struvite therapy • Inappropriate use of urinary acidifiers

  20. Feline Lower Urinary Tract DiseaseCalcium oxalate • Treatment Surgery • Prevention Avoid dietary and medical risk factors

  21. Feline Lower Urinary Tract DiseaseCalcium oxalate Dietary risk factors • Excess vitamin C & D • Acidification • Ad libitum feeding • Moderate protein = protective • Very low protein = risk factor • Low fiber • Feeding dry • Excessive Ca & P restriction

  22. Feline Lower Urinary Tract DiseaseCalcium oxalate Nutrient profile • Potassium citrate • Urinary pH 6.6-6.8 • Increased moisture • Pyridoxine (vitamin B6) • Soluble fiber • Moderate magnesium

  23. Feline Lower Urinary Tract DiseaseStruvite Mg - NH4 - PO4 . 6H20 • Magnesium • Ammonium • Anionic phosphate

  24. Feline Lower Urinary Tract DiseaseStruvite Dietary management • Reduced magnesium Less than 20 mg/100 kcal ME Less than 0.1% (dry matter) • Increased diuresis Water Sodium

  25. Feline Lower Urinary Tract DiseaseStruvite Dietary management • Acid urine pH • Avoid over-acidification Metabolic acidosis Renal disease • Dissolution - urinary pH 5.9 - 6.1 • Prevention - normal acid urinary pH 6.2-6.4

  26. Canine and Feline UrolithiasisUrinary acidification • Decrease in urine pH from 8.5 to 5.5 • NH4+ - 1000 x Increase • PO4 3- - 13 000 x decrease • Moderately acid urine • pH : 6.2 - 6.4

  27. Contra-indicaties voor verzurend dieet • Nierinsufficiëntie • Groei (ontkalking) • Acidose • Ca-oxalaat stenen • Urineverzuurders toevoegen aan verzurend dieet

  28. Feline Lower Urinary Tract DiseaseStruvite Dietary management • Feed calculolytic diet exclusively • 1 - 2 months • Longer if UTI is present • If no reduction of calculi after 2 months, surgery should be considered

  29. Canine UrolithiasisStruvite Mg - NH4 - PO4 . 6H20 CrystalDiet • Magnesium Magnesium • Ammonium Protein • Anionic phosphate Phosphorus

  30. Canine UrolithiasisStruvite - Dissolution Nutrients • Minimize protein • Reduce magnesium • Reduce phosphorus • Stimulate water intake • Increase sodium Acidify urine

  31. Canine UrolithiasisStruvite - Dissolution % DM Normal Calculolytic FoodsDiet • Protein 15 - 60 7.6 • Magnesium 0.03 - 0.27 0.02 • Phosphorus 0.41 - 2.43 0.10 • Sodium 0.11 - 2.22 1.28 • Urinary pH 6.7 - 8.3 5.9 - 6.1

  32. Canine UrolithiasisStruvite - Dissolution • Feed calculolytic diet exclusively • Treat urinary tract infection • Continue treatment till 4 weeks after radiographic dissolution

  33. Canine UrolithiasisStruvite - Dissolution Monthly evaluation • Radiography • Serum urea nitrogen (SUN) • Urinalysis: crystals, culture bacteria Owner compliance • Struvite crystalluria • SUN > 10 mg/dl

  34. Canine UrolithiasisStruvite - Dissolution Reasons for failure • Insufficient time • Non-compliance by owner • Urinary tract infection • Non-Struvite urolith

  35. Canine UrolithiasisStruvite - Treatment Indications for surgery • Obstruction • Anatomical defects • No response to medical treatment • Diet is contraindicated

  36. Canine UrolithiasisStruvite - Treatment Diet contra-indications • Sodium retention Heart failure, hypertension, liver disease, nephrotic syndrome • Increased protein requirements Pregnancy, lactation, growth, cats • Acidifing diet Renal insuff., metabolic acidosis, growth, Ca-ox.

  37. Canine UrolithiasisStruvite - Prevention Prevention of recurrence • Urinary acidification • Moderate reduction of protein, Mg, P • Moderate sodium level

  38. Canine UrolithiasisCalcium oxalate Treatment • Surgery • Hydropropulsion

  39. Canine UrolithiasisCalcium oxalate Verminderen uitscheiding bouwstenen • Calcium Ca-opname + Calciurie Vitamine D3: Ca aborptie + indirect calciurie P: te laag: stimulatie Vit D3 Na: stimulatie calciurie Zure urine: stimulatie calciurie • Oxalaat: spinazie, rubarber, chocolade

  40. Canine UrolithiasisCalcium oxalate Verhogen inhibitoren • Magnesium • pH urine: Alkalinserend: vb. K-citraat Dierlijke eiwitten verzuren: hoge eiwitopname vermijden Andere: wateropname

  41. Canine UrolithiasisCalcium oxalate - Prevention Prevention of recurrence • Avoid excessive intake of protein • Low calcium intake • Low oxalate intake • Low sodium intake • Avoid urinary acidification • Potassium citrate

  42. Canine UrolithiasisCalcium oxalate Prevention of recurrence • Advanced renal failure diet

  43. Canine UrolithiasisAmmonium urate - Treatment Dissolution • Dietary management • Allopurinol • Urinary tract infection

  44. Meat diets Canine UrolithiasisAmmonium urate - Treatment Allopurinol  Xanthine + Xanthine oxidase Purine / Pyrimidine (Nucleic acids & Cell nuclei) Uric acid + Uricase (Defect in Dalmatians) Allantoin

  45. Canine UrolithiasisAmmonium urate - Treatment Dietary management • Ammonium - Low protein • Urate - Low purine Muscle & organ tissue = high in purines Egg & casein = low in purines • Alkalinize urine

  46. H+ NH4+ NH3 Canine UrolithiasisAlkalinize urine Decreases NH4+ concentration

  47. Canine UrolithiasisAmmonium urate - Treatment • Advanced renal failure diet • 8 - 11 weeks required for dissolution • Monitor for urethral obstruction

  48. Canine UrolithiasisAmmonium urate - Prevention Prevention of recurrence • Advanced renal failure diet Low in protein & purines Alkalinizing the urine • Allopurinol

  49. Canine UrolithiasisCystine - Composition = Cysteïne - Cysteïne Genetische afwijking: gestoorde reabsorptie van Cystine: weinig oplosbaar Ornithine Lysine wateroplosbaar Alanine

  50. Canine UrolithiasisCystine - Treatment Surgery Dissolution

More Related