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Small Animal Med. I > Urolithiasis - Green > Flashcards

Urolithiasis - Green Flashcards

1
Q

Does the observation of individual crystal types in urine mean

the patient is at risk for developing Urolithiasis?

A

Not necessarily

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2
Q

What are the different types of urolithiasis?

A
  • Mixed
    • < 70 1 type of crystal
    • no identifiable nidus or shell
  • Compound
    • Nidus of 1 crystal w/ surrounding layers of another crystal (common)
  • Matrix urolith
    • matrix w/o appreciable crystalloid
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3
Q

What are the 2 most common types of stones in Dog & Cats?

A
  1. Struvite
  2. Oxalate
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4
Q

In struvite urolithiasis, where is the most common site for stones?

Does it recur?

A
  • Bladder (dogs & cats)
  • High recurrence (>20%)
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5
Q

What types of animals will you most commonly see struvite stones in?

A

Younger animals

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6
Q

What type of urine will you see struvite stones in?

A

Alkaline urine

due to decreased solubility

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7
Q

In dogs, what is the pathogenesis of struvite urolithiasis?

A

UTI w/ urease positive bacteria ⇒makes urine more alkaline

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8
Q

You would not normally remove stones from the kidney b/c of complications. What are the two exceptions to this rule?

A
  • Stone in kidney associated w/ infection
  • Stone in renal pelvis associate w/ recurrent pyelonephrits or obstruction
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9
Q

In CATS, does UTI play a primary role in struvite urolithiasis?

A

NO!

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10
Q

What must you do for every patient you dx w/ stones?

A

Urine Culture

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11
Q

Oxalate crystals are found where in dog?

Where in Cats?

A
  • Dogs→ Bladder
  • Cats→ Kidneys, ureters, bladder
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12
Q

Is UTI a predisposing factor or complication of Oxalate Urolithiasis?

A

A Complication

(oxalate stones have jagged edges)

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13
Q

What are risk factors for oxalate urolithiasis in dogs?

A
  • Breed: Mini schnauzer, Lhaso apso, Yorkie, Bichon frise, Shihtzu, Mini poodle
  • Age: > 4yrs (8-12 highest risk)
  • Neutered males
  • Overweight
  • Pet vs working
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14
Q

What are risk factors for oxalate urolithiasis in cats?

A
  • Exclusive acidifying diet
  • Middle-age to older: (over 20, any cat can get no other predispositions matter)
  • Males > females
  • Breed: Persian, Himalayan
  • Exclusive indoor cat
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15
Q

What is the pathogenesis of Oxalate Urolithiasis?

A
  • Hypercalciuria ( any cause of hypercalcemia)
    • Absorptive (GI) hypercalciuria
    • Renal leak Hypercalciuria
    • Resorptive (bone) hypercalciuria
      • Primary hyperparathyroidism
      • Chronic acidosis & acidifying diets
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16
Q

What other conditions are associated with Oxalate Urolithiasis?

A
  • Hyperadrenocorticism (dogs)
    • Increased risk of calcium containing stones
  • Idiopathic hypercalcemia of Cats (IHC)
    • 33% of cats w/ oaxalate stones have (IHC)
    • Hx of acidifying diets
  • Other causes of hypercalcemia
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17
Q

Urate Urolithiasis is most common in what two dog breeds?

A
  • Dalmations
  • English Bulldogs
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18
Q

If you have a dog with recurring urate urolithiasis (not a dalmation or Eng. Bulldog) and high post prandial bile acids what should be your top rule out?

A
  • Portosystemic shunt
    • these animals may also have struvite stones
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19
Q

Is UTI a complication or predisposing factor to Urate urolitiasis?

A

Complication

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20
Q

Where does Urate urolithiasis occur most commonly?

A
  • Bladder
  • Urethra
  • Males > Females
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21
Q

What is the recurrance rate for patients with Urate Urolithiasis?

A

30-50%

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22
Q

What is the predisposing factor of Dalmations to geting Urate urolithiasis?

A

Defective uric acid metabolism

23
Q

Describe how defective uric acid metabolism predisposes Dalmations & Eng Bulldogs to Urate urolithiasis.

A
  • Urate derived from metabolism of purines
  • Converted to allantoin by uricase in normal dogs
  • Dalmations: Impaired transport of urate into hepatocytes (where the uricase lives so it cant get converted properly)
  • Urate reabsorption decreased and secretion increased in the dalmation kidney = more urate in the urine
24
Q

Is cyctine urolithiasis common in dogs and cats?

A
  • Dogs ⇒ Uncommon
  • Cats ⇒ Rare
25
Q

What are the high points of Cystine Urolithiasis?

(4)

A
  • Usually in Bladder & Urethra
  • UTI is complication not predispoing factor
  • High recurrence (47-75%)
  • Cystinuria decreases in severity w/ age (>5yrs) in some dogs
26
Q

Which stones look like “jacks”?

What is their prevelance?

A
  • SIlicate stones
  • Dogs ⇒ Uncommon
  • Cats ⇒ extremely rare
27
Q

What is the “textbook” history of a dog with Struvite Urolithiasis?

A
  • Mini Schnauzer, Bichon frise, Lhasa apso, Shih tzu, Mini Poodle
  • Female > Male
  • Younger
28
Q

What is the “textbook” history of a dog with Oxalate urolithiasis?

A
  • Mini Schnauzer, Bichon frise, Lhasa apso, Shih tzu, Yorkie, Mini Poodle
  • Male > Female
  • Older
29
Q

What is the “textbook” history of a dog with Urate urolithiasis?

A
  • Dalmation, English bulldog
  • Male > Female
  • Middle aged (unless PSS, then can be young)
30
Q

What is the HX of a dog with urolithiasis in the Kidney?

A
  • No signs - very common seen on x-rays taken for another reason
  • Flank Pain
  • Painless Hematuria
  • Signs of infection
  • Signs of renal failure
31
Q

What is the History of a dog/cat with urolithiasis in the Ureter?

A
  • None (cats especially)
  • Flank pain (acute uretal obstruction)
  • Signs of post renal azotemia (if bilateral obstruction or rupture)
32
Q

What is the History of a dog with urolithiasis in the Bladder?

A
  • None
  • Dysuria
  • Pollakiuria
  • Hematuria
33
Q

What is the History of a dog with urolithiasis in the Urethra?

A
  • Signs of obstruction
  • Signs of post-renal azotemia
  • Dysuria
  • Pollakiuria
  • Hematuria
  • None (uncommon)
34
Q

What are the physical findings of urolithiasis in the Kidney or ureter?

A
  • Renomegaly, if hydronephrosis or pyonephrosis present
  • Abdominal pain
  • None, if kidneys are not enlarged or palpable
35
Q

What are the physical findings of urolithiasis in the bladder?

A
  • Palpable stones
  • Thickened bladder wall (palpable only if severe)
36
Q

What are the physical findings of urolithiasis in the Urethra?

A
  • Large distended bladder suggestive of obstruction
  • Stone palpable on rectal or perineal exam
37
Q

What are the laboratory findings of urolithiasis with urinalysis?

A
  • Urine pH variable
    • Struvite: Alkaline if urease(+) UTI
      • Staph, proteus, klebsiella, pseudomonas
    • Cystine: acidic
      • Finding cystin crystals is ABNORMAL & DIAGNOSTIC ALWAYS, other crystals not diagnostic
    • Oxalate, Urate, Silicate variable
38
Q

What are the laboratory findings of urolithiasis in urine culture?

A
  • Staph or Proteus in dogs w/ struvite urolithiasis & urease (+) UTI
  • Usually NEGATIVE in cats - Still culture!
  • UTI may complicate metabolic stone types
    • Oxalate, Urate, Cystine, Silicate
39
Q

What are the laboratory findings of urolithiasis in Stone analysis?

A
  • Qualitative analysis not recommended b/c
    • Xanthine & silicate not detected
    • Oxalate frequently not detected
    • False + results for urate & cystine
    • Cannot tell which crystals are primary or secondary
  • Quantitative Analysis (optical crystallography)
    • University of Minnesote & UC Davis
    • Commercial medical Labs
40
Q

List the stones/crystal types from most radiopague to most radiolucent.

(6)

A
  1. Calcium Phosphate
  2. Calcium Oxalate
  3. Silicate
  4. Struvite
  5. Cystine
  6. Urate
41
Q

What are the general principles of managing a pt w/ Urolithiasis?

A
  • Relieve obstruction
  • Correct fluid, electorlyte, &/or acid-base issues
  • Non-surgical retrieval OR
  • Surgical removal (if ness) OR
  • Medical dissolution of uroliths
  • Preventative therapy - increase water intake (wet food)
42
Q

What are the requirements for nonsurgical removal of uroliths (voiding urohydropropulsion)?

A
  • Stones must be small
    • < 7mm female dog
    • <5mm male dog or female cat
  • General Anesthesia
  • Distend bladder with saline via cystoscope
    • then manually express bladder externally
  • Radiograph afterward
43
Q

What are the nonsurgical methods of urolith removal?

A
  • Voiding Urohydropropulsion
  • Catheter-assisted retrieval
  • Lithrotripsy
44
Q

What are the two types of lithotripsy?

A
  • Electrohydraulic shock wave lithotripsy
    • Shock wave generated in close proximity to urolith in bladder under cytoscopic visualization
  • Extracorporeal schock wave lithotripsy
    • Shock wave generated outside of the body and transmitted to patient through water (nephroliths & ureteroliths
45
Q

What types of crystals can be medically dissolved?

A
  • Struvite
  • Urate
  • Cystine
46
Q

What are the general principles of managing polyuria during urolithiasis via NaCl?

A
  • Decrease USG <1.025
  • Allow animal to void frequently
  • 0.5-10g salt perday
  • No controlled studies for this recommendation
47
Q

What are the general principles of eradicating UTI during urolithiasis?

A
  • UTI may predispose or complicate urolithiasis
  • Culture urine to ID UTI
  • Treat w/ appropriate antibiotics
  • Follow up to document eradication of infection
48
Q

How do you medically manage struvite urolithiasis?

A
  • Eliminate UTI (#1)
  • If urine pH still alkaline search for another reason
    • Diet
    • Metabolic (distal renal tubular acidosis
  • Calculolytic diet
49
Q

What will a calculolytic diet do for Struvite urolithiasis?

A
  • Disolve stove - takes 2-3mths
  • SE:
    • PU/PD (from excess Na)
    • Decreased BUN, serum phosphorus & albumin
    • Increased SAP
    • Possible passage of nephrolith into ureter
50
Q

Can you dissolve oxalate urolithiasis with diet?

A

NO! Must surgically remove

(can modify diet to prevent recurrence)

51
Q

How do you medically manage Oxalate urolithiasis after surgical removal?

A
  • Potasium Citrate PO
  • Hydrochlorothiazide (not common in vet med)
  • Vit. B6
  • Diet
    • Low Ca & Oxalate
    • Less animal protien
    • Citrate
    • Avoid Vit. C
    • Do not restrict, phosphorus, magnesium or Na
52
Q

How does giving dogs allopurinol help medically manage Urate Urolithiasis?

A
  • Competitive inhibitor of xanthine oxidase
    • Feed low prurine diet to reduce risk of xanthine stone formation!
53
Q

How does alkalinization help medically manage urate urolithiasis?

A
  • Uric acid moresoluble in alkaline urine
  • Alkalinizatio ndecreases urniary NH4 & H concentrations
  • Potassium citrate may be better than NaHCO3 b/c natriuresis may enchance calciuresis
54
Q

What are some of the complications fo urolithiasis?

A
  • Dogs: recurrence rate is highest for metabolic stones & lowest for struvite
  • Post renal azotemia and associated electrolyte, acid base imbalances
  • Drug & special diet SE
  • UTI

Small Animal Med. I (18 decks)

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