CS: Urolithiasis Flashcards Preview

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Flashcards in CS: Urolithiasis Deck (32):
1

CS - upper urinary tract uroliths

- variable
- haematuria
- CS compatible with acute kidney injury secondary to ureteral obstruction

2

Normal canine USG

1.015 - 1.045
Varies with fluid intake, hydration

3

Normal feline USG

1.035-1.060
Varies with fluid intake, hydration

4

What are the 2 most radioopaque crystals

calcium oxalate and struvit

5

What urine pH favours struvite and calcium oxalate formation?

- STRUVITE: alkaline
- CALCIUM OXALATE: acidic to neutral

6

T/F: uroliths >1cm likely to be struvite

True

7

T/F: sterile struvite uroliths rarely form in dogs

True - common in cats

8

Why do you need a stone sample?

detect what mineral type and whether different mineral layers are present.

9

What should you do if urine culture is negative in a dog with struvite uroliths?

the stone and/or bladder mucosa can also be cultured to be certain that a bacterial pathogen is not present

10

What is medical management of struvite sotnes?

dissolution and prevention of stone reformation (aim to reduce concentrations of ammonium, magnesium and phosphate in urine

11

Advantages - sx tx of struvite bladder stones

 Most direct
 Healing may commence say day

12

Disadvantages - sx tx of struvite bladder stones

 Those inherent to sx (anaesthetic risk, post-op pain)
 Risk of contaminating abdomen with infected urine
 Incomplete removal nidus for recurrence
 Bladder stitches not holding

13

Indications - sx removal of struvite bladder stones

- immediate/ emergency removal (e.g. blocked animal)

14

What is VUH?

= voiding urohydropulsion
- anaesthesia
- for small stones
- fill bladder via urinary catheter (sterile saline), agitating bladder so stones float freely in urine. Hold animal upright, remove catheter, then generating a high pressure urine stream to force stones out

15

What is cystoscopy?

- if stones small enough and avoiding sx is key
- cystoscope passed into bladder and stones retrieved with special basket (or fragmented via laser lithotripsy)

16

Advantages/ disadvantages of cystoscopy

o DISADVANTAGES: Special equipment, referral, generally more expensive than sx
o ADVANTAGES: recovery much faster

17

Outline medical management of struvite bladder stones

- dietary
o Uroliths should decrease in size within 3-4 weeks (if good owner compliance)
o Only feed until stone dissolved
o ABs needed as long as stones present in bladder (bacteria encrusted in stone and as stone dissolves they are released).

18

Reasons for tx failure when medically managing struvite bladder stones

- poor compliance with diet / ABs
- stone has layers of calcium phosphate in form of appatite or may not contain struvite

19

Disadvantages - medical management of struvite bladder stones

o DISADVANTAGES: long tx time, possibility of UT obstruction as stone gets smaller, v high in fat and salt and low in protein (not for patients with hx of pancreatitis, heart disease, kidney insufficiency or high BP)

20

CI - medical management of struvite bladders stones

urethroliths causing obstruction or if patient’s CS are severe.

21

Prevention - struvite stones

- high moisture diets
that produces a urine pH

22

What is a typical crystal appearance for ammonium urate?

'thorn-apple' appearance

23

Why is it often not possible to count the # of urate stones?

there are so many and range in size from grain of sand to ball bearing

24

How do you image a dalmation's bladder after urate stone removal?

- ULTRASOUND as urate stones are radiolucent to faintly radioopaque so unlikely to be detected with radiography

25

What is the medical management for urate bladder stones?

- Allopurinol for dissolution for 4 weeks (this reduces uric acid)
- DIET: low protein, high moisture, urine-alkalising, high value protein
- CI: GCs, immunosuppressive drugs, renal failure, PSS

26

Why may xanthine stones form treating urate stones with allopurinol?

Because xanthine is a metabolite in the pathway to uric acid. Allopurinol stops this pathway to reduce the amount of uric acid (and hence reduce urate stone formation) but increases the amount of xanthine metabolite hence potentially causing xanthine stones. TO prevent keep on the low protein, high moisture diet.

27

What is detected in genetic tests for dalmations with tendency of forming urate stones?

- SLC2A9 gene is mutated in dalmations (this causes altered transport of uric acid in hepatic/ renal transport)
- homozygous recessive mutation
- buccal swab to collect DNA

28

What is recurrence rate of urate crystals?

variable, 33-50%

29

How to monitor efficacy of urate stone medical management?

- UA every 3 months
- imaging every 6 months

30

T/F: all damations are homozygous recessive for hyperuricosuria

True

31

What are low uric acid dalmations?

when a purebred dalmation has been crossed with another breed

32

How to reduce prevalence of urolithiasis in dalmations

- Increase water intake
- Low protein low purine diet
- Let outside regularly to toilet
- Exercise to prevent stagnant urine
- Allopurinol (competitive inhibitor of xanthine oxidase)