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Small Animal Medicine > Renal - Urolithiasis > Flashcards

Renal - Urolithiasis Flashcards

1
Q

What is urolithiasis?

A

The general term referring to a stone in the urinary tract

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2
Q

What is a nephrolith?

A

a stone in the kidney

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3
Q

What is a ureterolith?

A

A stone in the ureter

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4
Q

What is a cystolith?

A

A stone in the urinary bladder

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5
Q

What is a urethrolith?

A

A stone in the urethra

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6
Q

True or false: Crystalluria = urolithiasis

A

NOOOOOOO - the presence of crystals is usually not always a problem

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7
Q

What storage method can cause crystal formation?

A

refrigeration

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8
Q

What crystals can be problematic?

A

ammonium urate - breed? liver dz?
Cystine - breed? Proximal tubular dz?
Struvite + bacteriuria - supports stone presence

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9
Q

What is needed to for stone formation?

A

High solute concentration

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10
Q

What are the multifactorial causes of stone formation?

A

Increased excretion of metabolites, decreased inhibitors of urolith formation, urine pH, and stone retention

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11
Q

True or False: Clinical signs often reflect location of urolithiasis

A

True

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12
Q

What clinical signs are associated with lower urinary tract urolithiasis?

A

hematuria, pollakiuria, stranguria, and obstruction

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13
Q

What clinical signs are associated with upper urinary tract uroliths?

A

systemic signs (uremia) abdominal pain

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14
Q

What do you do if you suspect a patient has urolithiasis?

A

IMAGING!!! - Rads or ultrasound

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15
Q

What are the benefits for radiographs in urolith diagnosis?

A

View of entire urinary tract
Better resolution of stone number/size/shape
Identification of stone helps predict stone composition

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16
Q

What are the cons for radiographs in urolith diagnosis?

A

Cannot see radiolucent stones

Cannot reliable see soft tissue changes

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17
Q

What are the benefits for ultrasounding in urolith diagnosis?

A

Identification of radio-opaque/lucent stones

identification of soft tissue abnormalities

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18
Q

What are the cons to ultrasounding in urolith diagnosis?

A

Limited visualization of the urethra
Poor capacity to determine stone number/size/shape
Cannot use imaging to predict stone composition

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19
Q

What uroliths are radio-opaque?

A

Struvites, calcium oxalate, and silica

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20
Q

What uroliths are radio-lucent?

A

Cystine and urate stones

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21
Q

What sized stones may be missed on standard radiographs?

A

small stones (<2mm)

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22
Q

What imaging techniques can be used for urolith diagnosis aside from radiographs and ultrasounding?

A

contrast cystourethrograms

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23
Q

Does a urinalysis allow for the diagnosis of urolithiasis?

A

No

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24
Q

How can pH help in diagnosing a urolith?

A

It can assist in determining the type

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25
Q

How can crystalluria help in diagnosing a urolith?

A

It can assist in determining the type of you know a stone is present

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26
Q

How is USG important in urolithiasis?

A

High USG can be a risk factor and it is an important monitoring component of therapy

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27
Q

What additional testing can be done for urolith diagnosis?

A

Testing for Azotemia, portosystemic shunt, and pyelonephritis

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28
Q

Why can predicting stone composition be useful?

A

Determine the optimum treatment - surgery or dissolution? Concurrent surgical procedures?

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29
Q

Why is stone analysis important?

A

It is the only way to definitively identify the stone type
Helps determine optimum therapy
Helps identify concurrent diseases

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30
Q

How is stone analysis done?

A

Chemical/optical analysis of the stone

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31
Q

What is the most common canine urolith (it is the 2nd most common in cats)?

A

Calcium oxalate (CaOX) uroliths

32
Q

What breeds are predisposed to CaOX uroliths?

A

Miniature Schnauzer, Shih Tzu, Bichon Frise, and yorkies

33
Q

What is the etiology of CaOx uroliths?

A

Poorly characterized - genetics, increased Ca an doxalate excretion, and diet acidification

34
Q

What will CaOx uroliths look like on radiographs?

A

Radioopaque and can be round or spiculated

35
Q

What will you see on UA in patients with CaOX uroliths?

A

Form in acidic urine (<6.5)
May or may not be crystals
Pyuria/bacteriuria can present as a consequence NOT A CAUSE

36
Q

How are CaOX stones treated?

A

They cannot be resolved - so removal is the only option

37
Q

What is the prevention plan for CaOX uroliths?

A

Canned food, avoid high Na and high protein
+/- medications: potassium citrate and hydrochlorothiazide
Monitor - USG and pH
Repeat imaging every 3-6 months

38
Q

When should you consider CaOX to be a chronic disease?

A

If they recur in 2 years - treat the contributing pathology (hypercalcemia)

39
Q

What are the goals of CaOX tharpy?

A

neutral pH and low USG

40
Q

What is the second most common canine urolith (most common in a cat)?

A

struvite uroliths

41
Q

What breeds are most commonly affected by struvites?

A

Min Schnauzer, Shih Tzu, Bichon Frise, and Dachshunt

42
Q

What is almost always the cause of struvites?

A

UTI - they are almost always secondary to them because of urease-producing bacteria causing an increased pH

43
Q

True or False: Struvites are almost always sterile.

A

True

44
Q

What will you see radiographically with a struvite?

A

Radioopaque and smooth/rount

45
Q

What will a UA show in a patient with struvites?

A

Alkaline pH, crystals may or may not be resent, Pyuria/bacteriuria can be present

46
Q

How are struvites treated?

A

Dissolution - medical dissolution should be the first line treatment in non-obstructed cases

47
Q

What diet can aid in treatment of struvites?

A

Canned dissolution diet - lower protein diets, USG <1.020 and a pH of <6.5

48
Q

If you use an antibiotic to treat a struvite, what do you want to target? For how long

A

The underlying cause - until complete dissolution

49
Q

How are struvates monitored?

A

Repeat radiographs every 2-4 weeks during dissolution (complete dissolution 6-8 weeks for sterile and 8-12 weeks for infection)
Aggressive treatment of UTIs

50
Q

What is the 3rd most common urolith type for both cats/dogs?

A

Urate uroliths

51
Q

What breeds most commonly get urate uroliths? Why?

A

Dalmations, English Bulldogs, Black Russian Terriers

Altered hepatic urate transporter

52
Q

What anatomic abnormalities (not in the urinary tract) can lead to urate uroliths?

A

Portosystemic shunts - increased urinary excretion of uric acid an dammonia

53
Q

What do urate uroliths look like on radiographs?

A

Radiolucent to mildly radioopaque

Round shapte

54
Q

What will you find on UA in patients with urate uroliths?

A

Acidic urine (pH <6.8)
+/- ammonium biurate crystals
+/- secondary bacterial infection

55
Q

What initial diagnostics can be done for urate uroliths?

A

Consider serum bile acids and other Dx when found in breeds that are not predisposed to urates

56
Q

How are urate uroliths treated?

A

Surgical removal because dissolution is rarely effective

57
Q

What are the goals of treatment for urate urolithiasis?

A

Decreased USG to <1.020

pH >6.6

58
Q

What diets can be used to manage urate uroliths?

A

Low purine diets (Hill’s U/D)

59
Q

What additional therapies can be used to treat urate uroliths?

A

Urine alkalization - potassium citrate
Allopurinol
PSS repair

60
Q

Cystine uroliths are most common in what breed of dog? Sex?

A

English Bulldogs, Newfoundland, Mastiff

98% of cases are males

61
Q

What causes cystine uroliths?

A

A defect in proximal tubular reabsorption of cystine - autosomal recessive mutation identified

62
Q

What will you see on radiographs in patients with cystine uroliths?

A

Radiolucent to mildly radioopaque

Smooth/round shape

63
Q

What will you find on UA in patients with cystine uroliths?

A

Acidic pH (<7)
Crystals may or may not be present
Pyuria/bacteriuria can be present

64
Q

How are cystine uroliths treated?

A

Medical removal +/- dissolution

65
Q

Aside from medical removal, what can be done for cystine uroliths?

A

Low protein diets
+/- castration reduces cystine excretion in some dogs
+/- potassium citrate
+/- 2-MPG: cystine chelator

66
Q

What are the goals of therapy for cystine uroliths?

A

pH >7.5 and USG >1.020

67
Q

What are the removal options (general) for urolith removal?

A

Benign neglect, surgery, and minimally-invasive options

68
Q

What surgical options are there for urolith removal?

A

cystotomy and urethrotomy

69
Q

What minimally-invasive options are there for urolith removal?

A

Voiding urodydropropulsion
Cystoscopy + laser lithotripsy and removal
Percutaneous cystolithotomy

70
Q

When is benign neglect reasonable?

A

When there are no clinical signs

71
Q

What is the most commonly used surgical removal technique for stone removal?

A

cystotomy - do post op rads after

72
Q

What should you do instead of a urethrotomy?

A

Retropulse stones into the bladder instead or consider cystoscopy

73
Q

What is urohydropulsion?

A

Place the patient in a verticle position under anesthesia
Manual bladder expression
Have a container for stone/urine collection - max size 4mm

74
Q

What is cystoscopy + laser lithotripsy?

A

Visualize, fragment with a laser (lithotripsy), and remove via urohydropropulsion

75
Q

What is percutaneous cystolithotomy?

A

Make a small incision in the abdomen and bladder. Go in with a scope and remove the stone that way

Small Animal Medicine (100 decks)

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