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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
Q

how effective is medical dissolution of both sterile and infection-induced struvite uroliths?

A

highly effective

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26
Q

what are some other treatment options if the urolith cannot be bathed in modified urine or infection cannot be eliminated?

A

voiding urohydropropulsion
surgical removal
lithotripsy for lodged urethral calculi
percutaneous cystolithotomy or cystoscopy

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27
Q

are calcium oxalate calculi radiopaque?

A

yes

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28
Q

how common are calcium oxalate calculi in dogs and cats?

A

41% of canine uroliths
42% of feline uroliths

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29
Q

what are some predisposing factors for calcium oxalate calculi?

A

hypercalciuria
+/- hyperoxaluria
calcium oxalate crystallization inhibitors
acidification of urine
high protein diet

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30
Q

how can you prevent calcium oxalate stones?

A

decrease urine concentration
avoid urine acidification
avoid diets with excessive protein content

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31
Q

are cystine calculi radiopaque?

A

no

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32
Q

what cause cystinuria?

A

inherited proximal tubular transport defect
also includes ornithine, lysine, and arginine

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33
Q

what are the three possible mutations in amino acids transporter genes?

A

type Ia
type IIa
type IIIa

34
Q

which breeds get the type Ia mutation in amino acid transport?

A

newfoundland dogs
landseer

35
Q

how do you prevent cystine calculi?

A

neuter
decrease urine concentration
limit animal protein intake
limit sodium intake
increase urine pH
tiopronin: reduces urinary cystine excretion

36
Q

who does urate calculi occur most commonly in?

A

dalmations
english bulldogs
black russian terriers

37
Q

if a dog has urate calculi but is not a breed predisposed to them, what is your next differential?

A

liver disease: portosystemic shunts, chronic hepatic failure

38
Q

how do you treat and prevent urate stones?

A

treat liver disease/portosystemic shunt
decrease urine concentration
promote alkaline urine
limit purine intake
xanthine oxidase inhibitors if therapeutic diet fails

39
Q

are silica calculi radiopaque?

A

yes

40
Q

are urate calculi radiopaque?

A

often no

41
Q

are calcium phosphate carbonate-apatite calculi radiopaque?

A

yes

42
Q

what is the prevalence of FLUTD?

A

7-8% of all feline admissions to veterinary hospitals reported

43
Q

most FLUTD first occurs in cats between _____________ years of age

A

2 and 6

44
Q

what are the sings we see with a non-obstructed cat with lower urinary tract disease?

A

stranguria
dysuria
pollakiuria
hematuria
periuria
males and females

45
Q

how common is feline interstitial cystitis?

A

20-50%
uncommon in cats >10 years

46
Q

what percentage of cats presenting with feline lower urinary tract disease have feline interstitial cystitis?

A

20-50%

47
Q

who do we primarily see bacterial cystitis in with cats with feline lower urinary tract disease?

A

cats older than 10 years

48
Q

what is the primary cause of feline lower urinary tract disease in cats less than 10 years of age?

A

60-70% are idiopathic

49
Q

what is the primary cause of feline lower urinary tract disease in cats more than 10 years of age?

A

> 50% will have a UTI or urolithiasis

50
Q

what characterizes idiopathic feline lower urinary tract disease?

A

hematuria with minimal inflammatory cells in urine
acute or chronic
resolution in 5-7 days
functional
multifactorial

51
Q

what does a urethral plug form in response to potentially?

A

underlying inflammation of the bladder and urethra

52
Q

when is a workup to rule out infection and urolithiasis warranted with feline lower urinary tract disease?

A

recurrent
response to treatment does not work

53
Q

_________________ is most widespread and economically important urinary disease of ruminants

A

urolithiasis

54
Q

what are the predisposing factors of urolithiasis in small ruminants?

A

decreased salt or water intake
urinary stasis
urinary tract infection
high urine pH
increased calcium
increased phosphate (goats)

55
Q

what are the earlier signs of urolithiasis in small ruminants?

A

blood in urine
stranguria, dysuria
decreased urine production
dribbling urine
tail flagging
abdominal pain
rectal exam: feel pulsation of urethra

56
Q

what predisposes small ruminants to obstruction?

A

sigmoid flexure and urethral process
narrowness of male ruminant urinary tract

57
Q

what is the gold standard treatment of urolithiasis in small ruminants?

A

tube cystotomy

58
Q

what is the most common site of obstruction in sheep and goats?

A

urethral process

59
Q

what do you see with phosphate in ruminants who are blocked?

A

normophosphate or hypophosphatemia

60
Q

why do ruminants have a normal or low phosphate when they are obstructed?

A

secrete most phosphate into saliva and feces
less urine excretion of phosphorous

61
Q

what additional clinical signs might you see with hypophosphatemia with urinary tract disease in ruminants?

A

muscle weakness
rhabdomyolysis
bone pain
intravascular hemolysis
worse prognosis

62
Q

what makes up uroliths most commonly in ruminants?

A

phosphatic calculi (struvite or apatite)

63
Q

when can you get a calcium oxalate stone with regards to calcium?

A

when there is a low calcium diet
all species

64
Q

when might you see silica uroliths in ruminants?

A

pastured ruminants
>50% steers on range in Western Canada: depends on where silica levels are higher in soil

65
Q

in which species are uroliths uncommon?

A

horses

66
Q

what types of uroliths do horses get?

A

calcium carbonate or phosphate

67
Q

how does the initiation of a urolith happen?

A

formation of crystal nidus: nucleation

68
Q

what makes up the organic matrix in urinary calculi?

A

serum proteins
uromucoid and matrix substance A
lipids
polysaccharides
other cell derived material

69
Q

what inhibits stone formation?

A

citrate
magnesium
glycosaminoglycans
proteins

70
Q

what are some conditions that contribute to stone formation?

A

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
Q

what are the names of calculi based on location?

A

cystic calculi: bladder
nephrolithiasis: renal
ureterolithiasis: ureteral
urethreolithiasis: urethral

72
Q

what are the clinical signs of ureteroliths?

A

may have none
dogs: flank pain, hematuria
cats: hydronephrosis: anorexia, weight loss, vomiting

73
Q

what is the most common type of ureterolith?

A

calcium oxalate

74
Q

what clinical signs are associated with nephroliths?

A

asymptomatic
+/- hematuria
pyelonephritis signs
uremia signs

75
Q

should you treat nephroliths in a patient that is asymptomatic?

A

no

76
Q

are most struvite calculi in cats sterile?

A

yes

77
Q

can you dissolve calcium oxalate calculi?

A

no

78
Q

cystine calculi are more soluble in ____________ urine

A

alkaline

79
Q

what are the three possible mutations in amino acid transporter genes with cystine inheritence?

A

Ia: newfoundland dogs, ladseer
IIa: australian cattle dogs, border collie
IIIa: miniature pinschers

80
Q

what eliminates cystinuria in androgen-dependent cystinuria?

A

neutering

81
Q

what are some risks of xanthine oxidase inhibitors?

A

risk of xanthine urolith formation

Urinary Pathophysiology (11 decks)

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