Small Animal Clinical Nutrition: Urinary Module

Small Animal Clinical Nutrition, 6th Edition: Canine Uroliths

Explore canine uroliths in the following digital chapters of the Small Animal Clinical Nutrition (SACN) 6th edition provided by the Mark Morris Institute (MMI). This content is completely free, and includes access to specific articles from top experts, written for Clinician's Brief and relevant to the provided chapters of SACN. Last but not least, test your knowledge at the end with a handy RACE-approved quiz.

Summary of Chapters

Canine Uroliths

The 5 Powerful Roles of Nutrition

Organic and inorganic solutes are normally found in urine; however, once the solubility product of a solute is exceeded, supersaturation occurs, resulting in precipitation and aggregation of urinary crystals that lead to urolith formation.1 Understanding the composition of a urolith is of paramount importance for the management of patients with urolithiasis, as several types of stones have a high recurrence rate.

Although nonclinical uroliths may not require removal,2 every patient diagnosed with urolithiasis should undergo a comprehensive examination to evaluate overall systemic health and to determine potential underlying cause(s) to plan appropriate treatment and prevention strategies. Some uroliths respond to medical dissolution whereas others require physical removal via minimally invasive techniques or traditional surgical approaches.

Calcium Oxalate Urolithiasis

The majority of canine uroliths are composed of calcium oxalate or magnesium ammonium phosphate (struvite).3 The frequency of calcium oxalate urolithiasis has increased dramatically,3 and, unfortunately, this type of stone can be the most frustrating to treat. Calcium oxalate uroliths are not amenable to dissolution, and the risk for recurrence is high, especially in predisposed breeds.4 Causes of calcium oxalate uroliths are multifactorial, involving genetic, dietary, and environmental factors, in addition to systemic disease (eg, hyperparathyroidism). Medical versus surgical intervention is selected based on the presence of clinical signs and the location and size of the uroliths in the urinary tract. Prevention of calcium oxalate uroliths involves a combination of high moisture foods (ie, canned formulations), dietary mineral adjustments, and in recurring cases, medications (eg, urinary alkalinizers, thiazide diuretics) are required.

Struvite Urolithiasis

Struvite stone formation in dogs occurs most commonly in the presence of urinary tract infections. Treatment of the infection during the entire time of stone dissolution is crucial for successful outcomes and to prevent recurrence. Diets high in moisture with reduced levels of protein, phosphorus, and magnesium promote formation of a dilute, more acidic urine and help prevent struvite urolithiasis. Medical dissolution for both infection-induced and sterile struvite uroliths is highly effective. Recurrence of infection-associated struvite urolithiasis warrants further investigation as to underlying causes for the infection (eg, anatomical abnormalities, endocrine disorders).

Purine Urolithiasis

Purine (ie, urate) urolithiasis occurs less commonly in the overall canine population, but certain breeds (eg, Dalmatian, bulldog) are predisposed to hereditary hyperuricosuria.2 In small- and toy-breed dogs, purine uroliths commonly occur as a result of hepatic dysfunction caused by portovascular anomalies (eg, portosystemic shunt, microvascular dysplasia). These uroliths are amenable to medical dissolution; however, any portovascular anomaly must be addressed for successful management. Diets low in purine with high moisture content help minimize urolith reoccurrence. Dogs with reoccurring purine uroliths may require additional medical intervention with xanthine oxidase inhibitors (ie, allopurinol).

Silica Urolithiasis

Silica urolithiasis is rare in dogs and may be associated with geographical location. This type of urolith often contains other minerals (eg, calcium oxalate) as well. Silica uroliths tend to occur in high numbers, are not amenable to medical dissolution, and require surgery or other less invasive methods for removal. Predisposing causes of this stone type are unclear; diets with large quantities of plant-based ingredients may be a risk factor and should be avoided.

Compound Urolithiasis

It is important to note that approximately 10% of uroliths are compound in nature. That is, the urolith is composed of 2 or more types of minerals. Preventive measures should focus on the mineral contents of the stone’s nucleus (ie, nidus), rather than the components of the overlying shells of the urolith. Compound uroliths can pose unique challenges in patient management and urolith prevention, and they illustrate the critical importance of stone analysis for successful outcomes.

Further Reading

Canine urolithiasis encompasses a broad range of patient and environmental predisposing factors. Explore our library of educational resources to understand the complicated nature of urolith development and the central role nutrition plays in treatment and prevention.

References

TEST YOURSELF

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The 5 Powerful Roles of Nutrition in Urolith Management

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Which of the following is of utmost importance in the management and prevention of uroliths, regardless of stone type?

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The 5 Powerful Roles of Nutrition in Urolith Management
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Calcium oxalate stones are the __________ type of urolith in dogs.

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Regarding calcium excretion, which of the following would occur with ingestion of a diet high in protein?

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In dogs, what is the recurrence rate of calcium oxalate uroliths after 12 months? 

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Which of the following is not a goal when adjusting patient diet to prevent formation of calcium oxalate uroliths?

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In dogs with portosystemic vascular anomaly, which type of urolith is concurrently diagnosed most often?

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Which of the following is not a dog breed overrepresented for development of purine (urate) uroliths?

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Regardless of the cause for hyperuricosuria, diets that are __________ and __________ should be avoided.

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Which of the following uroliths is not amenable to dietary dissolution?

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Which of the following would be appropriate in the treatment and dietary management of a dog with purine (urate) urolithiasis not associated with liver disease?

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