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Urinary Pathophysiology > Urolithiasis and FLUTD > Flashcards

Urolithiasis and FLUTD Flashcards

1
Q

what is a urolith?

A

urinary calculus/stone
primarily inorganic or organic crystalloids
organic matrix

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2
Q

is crystalluria synonymous with urolithiasis?

A

no

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3
Q

what is crystalluria?

A

microscopic crystals in urine

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4
Q

does crystalluria cause clinical signs?

A

no

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5
Q

what is initiation of urolith formation dependent on?

A

supersaturation of urine with lithogenic crystalloids

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6
Q

what are the theories of urolith initiation?

A

precipitation-crystallization
matrix nucleation
crystallization inhibition

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7
Q

kidney/bladder stones form by a combination of _________________________________

A

many small crystals into a larger conglomerate

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8
Q

what factors affect supersaturation?

A

increased excretion of stone constituent molecules can lead to crystalluria
reduced urine volume
alteration in urine pH

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9
Q

what things inhibit stone formation?

A

citrate
magnesium
glycosaminoglycans
proteins

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10
Q

what things facilitate stone formation?

A

low urine volume or abnormal pH
high calcium, sodium, oxalate, and urate

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11
Q

what are the steps of stone formation and growth?

A

supersaturated urine
nucleation and crystal growth
small crystals
growth and aggregation
large crystals
crystal aggregates

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12
Q

what are the consequences to urolithiasis?

A

trauma to bladder wall: polyps
incomplete urine voiding
sequestration of bacteria
obstruction

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13
Q

what can calculi be classified by?

A

location
composition

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14
Q

what are renal calculi?

A

nephrolithiasis

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15
Q

what are the clinical signs of urolithiasis in the urethra?

A

dysuria, stranguria
paradoxical incontinence
signs of uremia if blocked
obstruction most common in males

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16
Q

what are the clinical signs of urolithiasis in the bladder?

A

pollakiuria
stranguria
dysuria
hematuria
inappropriate urination

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17
Q

what are the clinical signs of urolithiasis in the ureters?

A

may have no clinical signs
dogs: flank pain, painless hematuria
cats: clinical signs associated with hydronephrosis (anorexia, vomiting, weight loss)

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18
Q

what are the clinical signs of urolithiasis in the kidney?

A

asymptomatic
signs of pyelonephritis
signs of uremia

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19
Q

what stones are common as nephroliths?

A

calcium oxalate
struvite

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20
Q

how are uroliths named?

A

mineral if single type
mixed if two or more minerals
compound if different minerals are separated into distinct bands or layers

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21
Q

are struvite calculi radiopaque?

A

yes

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22
Q

how do dogs get most struvite calculi?

A

UTIs

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23
Q

how does urease producing bacteria lead to struvite calculi?

A

hydrolysis of urea leads to increased ammonium ions which increases the urine pH
change in ionization state of phosphorous
high pH leads to precipitation of struvites

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24
Q

struvite crystalluria occurs in ___________________ of healthy dogs, including animals without urinary tract infections

A

greater than 50%

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25
how effective is medical dissolution of both sterile and infection-induced struvite uroliths?
highly effective
26
what are some other treatment options if the urolith cannot be bathed in modified urine or infection cannot be eliminated?
voiding urohydropropulsion surgical removal lithotripsy for lodged urethral calculi percutaneous cystolithotomy or cystoscopy
27
are calcium oxalate calculi radiopaque?
yes
28
how common are calcium oxalate calculi in dogs and cats?
41% of canine uroliths 42% of feline uroliths
29
what are some predisposing factors for calcium oxalate calculi?
hypercalciuria +/- hyperoxaluria calcium oxalate crystallization inhibitors acidification of urine high protein diet
30
how can you prevent calcium oxalate stones?
decrease urine concentration avoid urine acidification avoid diets with excessive protein content
31
are cystine calculi radiopaque?
no
32
what cause cystinuria?
inherited proximal tubular transport defect also includes ornithine, lysine, and arginine
33
what are the three possible mutations in amino acids transporter genes?
type Ia type IIa type IIIa
34
which breeds get the type Ia mutation in amino acid transport?
newfoundland dogs landseer
35
how do you prevent cystine calculi?
neuter decrease urine concentration limit animal protein intake limit sodium intake increase urine pH tiopronin: reduces urinary cystine excretion
36
who does urate calculi occur most commonly in?
dalmations english bulldogs black russian terriers
37
if a dog has urate calculi but is not a breed predisposed to them, what is your next differential?
liver disease: portosystemic shunts, chronic hepatic failure
38
how do you treat and prevent urate stones?
treat liver disease/portosystemic shunt decrease urine concentration promote alkaline urine limit purine intake xanthine oxidase inhibitors if therapeutic diet fails
39
are silica calculi radiopaque?
yes
40
are urate calculi radiopaque?
often no
41
are calcium phosphate carbonate-apatite calculi radiopaque?
yes
42
what is the prevalence of FLUTD?
7-8% of all feline admissions to veterinary hospitals reported
43
most FLUTD first occurs in cats between _____________ years of age
2 and 6
44
what are the sings we see with a non-obstructed cat with lower urinary tract disease?
stranguria dysuria pollakiuria hematuria periuria males and females
45
how common is feline interstitial cystitis?
20-50% uncommon in cats >10 years
46
what percentage of cats presenting with feline lower urinary tract disease have feline interstitial cystitis?
20-50%
47
who do we primarily see bacterial cystitis in with cats with feline lower urinary tract disease?
cats older than 10 years
48
what is the primary cause of feline lower urinary tract disease in cats less than 10 years of age?
60-70% are idiopathic
49
what is the primary cause of feline lower urinary tract disease in cats more than 10 years of age?
>50% will have a UTI or urolithiasis
50
what characterizes idiopathic feline lower urinary tract disease?
hematuria with minimal inflammatory cells in urine acute or chronic resolution in 5-7 days functional multifactorial
51
what does a urethral plug form in response to potentially?
underlying inflammation of the bladder and urethra
52
when is a workup to rule out infection and urolithiasis warranted with feline lower urinary tract disease?
recurrent response to treatment does not work
53
_________________ is most widespread and economically important urinary disease of ruminants
urolithiasis
54
what are the predisposing factors of urolithiasis in small ruminants?
decreased salt or water intake urinary stasis urinary tract infection high urine pH increased calcium increased phosphate (goats)
55
what are the earlier signs of urolithiasis in small ruminants?
blood in urine stranguria, dysuria decreased urine production dribbling urine tail flagging abdominal pain rectal exam: feel pulsation of urethra
56
what predisposes small ruminants to obstruction?
sigmoid flexure and urethral process narrowness of male ruminant urinary tract
57
what is the gold standard treatment of urolithiasis in small ruminants?
tube cystotomy
58
what is the most common site of obstruction in sheep and goats?
urethral process
59
what do you see with phosphate in ruminants who are blocked?
normophosphate or hypophosphatemia
60
why do ruminants have a normal or low phosphate when they are obstructed?
secrete most phosphate into saliva and feces less urine excretion of phosphorous
61
what additional clinical signs might you see with hypophosphatemia with urinary tract disease in ruminants?
muscle weakness rhabdomyolysis bone pain intravascular hemolysis worse prognosis
62
what makes up uroliths most commonly in ruminants?
phosphatic calculi (struvite or apatite)
63
when can you get a calcium oxalate stone with regards to calcium?
when there is a low calcium diet all species
64
when might you see silica uroliths in ruminants?
pastured ruminants >50% steers on range in Western Canada: depends on where silica levels are higher in soil
65
in which species are uroliths uncommon?
horses
66
what types of uroliths do horses get?
calcium carbonate or phosphate
67
how does the initiation of a urolith happen?
formation of crystal nidus: nucleation
68
what makes up the organic matrix in urinary calculi?
serum proteins uromucoid and matrix substance A lipids polysaccharides other cell derived material
69
what inhibits stone formation?
citrate magnesium glycosaminoglycans proteins
70
what are some conditions that contribute to stone formation?
high concentration of salt or other constituent in urine retention of these salts and crystals in urinary tract for a certain period of time optimal pH that favors salt crystallization scaffold for crystal formation decrease in body's natural inhibitors of crystal formation
71
what are the names of calculi based on location?
cystic calculi: bladder nephrolithiasis: renal ureterolithiasis: ureteral urethreolithiasis: urethral
72
what are the clinical signs of ureteroliths?
may have none dogs: flank pain, hematuria cats: hydronephrosis: anorexia, weight loss, vomiting
73
what is the most common type of ureterolith?
calcium oxalate
74
what clinical signs are associated with nephroliths?
asymptomatic +/- hematuria pyelonephritis signs uremia signs
75
should you treat nephroliths in a patient that is asymptomatic?
no
76
are most struvite calculi in cats sterile?
yes
77
can you dissolve calcium oxalate calculi?
no
78
cystine calculi are more soluble in ____________ urine
alkaline
79
what are the three possible mutations in amino acid transporter genes with cystine inheritence?
Ia: newfoundland dogs, ladseer IIa: australian cattle dogs, border collie IIIa: miniature pinschers
80
what eliminates cystinuria in androgen-dependent cystinuria?
neutering
81
what are some risks of xanthine oxidase inhibitors?
risk of xanthine urolith formation

Urinary Pathophysiology (11 decks)

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