Urolithiasis in cats: causes, symptoms and treatment. Types of kidney stones - classification, chemical composition, features of education and treatment

Moscow Veterinary clinic "Alisavet"

One of the leading places in the structure of urological morbidity in animals is occupied by ICD.

Urolithiasis (urolithiasis) in cats and dogs - a disease manifested by the formation of stones in the organs of the urinary system.

Urolithiasis refers to polyetiological diseases with complex physicochemical processes that occur not only in the urinary system, but also in the whole organism, both congenital and acquired.

The causes of urolithiasis are not fully understood and are not fully understood.

The following factors are involved in the development of urolithiasis: Risk factors for the development of KSD, a description of which can be found in the writings of Hippocrates. Currently, they are divided into three main groups - demographic, environmental factors and pathophysiological. Urolithiasis is characterized by endemicity of distribution.

More than 200 conditions are known that can potentially lead to the formation of a stone in the urinary system.
For example:

hypodynamia (home lifestyle of cats and dogs)
hypoxia
small amount of liquid intake (mixed food, various treats affect the animal's fluid intake)
violation of the regular normal flow of urine through the urinary tract
oversaturation of urine with salts
change in urine pH
the appearance of sparingly soluble salts
urinary tract infections
consumption of foods with an excess of substances that contribute to stone formation
Stress, etc.

Modern urology has many ways to treat patients with urolithiasis. In human medicine, open methods of removing stones are increasingly being used less and less. They are inferior to the method of remote shock wave lithotripsy and endoscopic methods of treatment: contact endoscopic and through the skin removal of kidney and urinary tract stones. The introduction of new minimally invasive technologies has undoubtedly made a significant contribution to the efficiency of urinary stone removal, minimizing the number of traumatic complications. However, none of these methods is a method of treating KSD and does not guarantee a complete recovery, and often introduces additional negative factors for the development of a relapse of the disease.

Etiology and pathogenesis of KSD

One of the important reasons urolithiasis in animals is a violation of water-salt metabolism. Metabolic (dysmetabolic) nephropathy combines a group of diseases in which there is a metabolic disorder, accompanied by changes in the kidneys. These are toxic diseases such as shock, dehydration, drug damage, electrolyte disturbances; chronic, hereditary and acquired (sugar diathesis, hypovitaminosis, hypervitaminosis) diseases.

Of great importance is also a change in the chemical composition of the blood, occurring in infectious diseases, intoxication, diseases of the liver and gastrointestinal tract (hepatitis, gastritis, colitis). In the formation of urolithiasis, diseases of the endocrine glands, such as the thyroid gland, parathyroid gland, pituitary gland, play a role.

Main hypothesis The basis of urolithiasis in animals (stone formation) is a decrease in the content of protective colloids in the urine. Under these conditions, a group of molecules is formed - a micelle, which can become the core of the future stone. It is joined by fibrin, blood cells, bacteria, remnants of epithelial cells, and, finally, sparingly soluble salts when they are in excess in the urine.

Stones are formed in the collecting ducts. If at the same time the urine is oversaturated with salts and the pH of the urine changes, then crystallization and retention of calculi in the mouths of the tubules increase. Violation of urodynamics will contribute to the formation of large stones - single and multiple. The sizes of stones can vary from 0.1 to 10-15 mm or more, and their number sometimes reaches several hundred.

Urinary stones are observed, as a rule, in one of the kidneys (more often in the right) and only in 15-30% of patients they are bilateral. In the practice of the ALISA veterinary clinic over the past five years, this fact of the medical hypothesis has not been conclusively confirmed. In the course of collecting data and summarizing the available material, we established the fact, as a rule, of bilateral formation of stones, in both kidneys at once. It is not uncommon for the formation of stones in the non-pelvic, not intratubular lumens, but in the intracapsular localization of calcifications, which in turn complicates the treatment, surgical treatment in such cases is completely excluded.

With sharp and frequent fluctuations in pH, uncontrolled use of litholytic (dissolving stones) preparations, complex in composition, the so-called "coral-like" stones are formed. Calculi injure the kidneys and urinary tract, contribute to their infection, further disrupt the outflow of urine.

Small stones located in the renal pelvis or ureter prevent the outflow of urine from the kidney, cause its gradual expansion and subsequent death of the kidney tissue that produces urine.

Often large stones exist for a long time without causing significant lesions.

The process of stone formation can be explained by the matrix theory. She claims that there is a protein composition of a certain dead cell, then salts are deposited on it. The core of the stones is always an organic substance, which can either be the material for the formation of the entire stone (cystine stones) or, as we most often note, only a matrix on which various salts settle.

Numerous factors contributing to the formation of stones can be divided into exogenous and endogenous, and the latter can be divided into general (characteristic of the whole body) and local (associated directly with changes in the normal state of the kidney and urinary tract). Exogenous pathological factors include climatic, geochemical conditions, nutritional characteristics etc. An important role is played by temperature, air humidity, the nature of the soil, the composition of drinking water and its saturation with mineral salts. Of great importance is the nature of feeding dogs and cats, which in turn affects the composition of urine and its pH. Vegetable and dairy foods contribute to the alkalization of urine, meat - to its oxidation. Drinking water, supersaturated with lime salts, reduces the acidity of the urine and causes an excess of calcium salts in the body. Endogenous factors contributing to the occurrence of urolithiasis include hyperfunction of the parathyroid gland (hyperparathyroidism), causing disturbances in phosphorus-calcium metabolism. The presence of vascular abnormalities of the liver, usually in the form of shunts between the portal vein and the common venous system, is important, which affects the synthesis of purines, resulting in increased production of lactic acid. An important role in the pathogenesis is played by local endogenous factors - a change in the normal state of the kidney and urinary tract, primarily factors leading to stagnation of urine, impaired secretion and reabsorption of its constituent elements, and the development of uropathogenic infection. Inflammatory processes in the kidney also contribute to the process of stone formation. This is confirmed by studies that have established the presence of a number of microorganisms capable of breaking down urea, which leads to its alkalization and precipitation of salts - phosphates. Depending on the chemical composition of the salts that form stones in urolithiasis, there are:

urates
calcium oxalates
calcium phosphates
calcium carbonates
urolith
Mixed
Matrix

Causes of lower urinary tract disease in cats without urethral obstruction (statistics over 3 years)

Cause % percentage of cases

Idiopathic 64.2

Stone in the urinary tract 12.8

Stone in the urinary tract

+ their infectious lesion 1.8

Urinary tract infection 0.9

Neoplasms 1.8

Anatomical deviation 9.2

Conduct disorder 9.2

You can start treating urolithiasis after establishing the nature of the accumulating salts, since inadequate dietary and therapeutic measures can contribute to the formation of complex stones.

Surgical removal of stones, as well as remote lithotripsy (crushing) do not provide recovery and do not eliminate the causes and conditions of stone formation. These methods are applicable in life-threatening situations, for example, when blockage of the ureter by a large stone, which cannot be eliminated by urgent conservative therapy and threatens the development of hydronephrosis and anemia.

Approximate algorithm of the doctor's actions during the examination of an animal with a problem of the urinary system.

Contrast cysto and pyelography, cystourethroscopy

Laboratory diagnostics of OKA, General biochemistry + potassium, phosphorus, calcium

Urinalysis, if necessary, the ratio of protein / creatinine in the urine

Tank. Urine culture (centesis only)

Urine density with refractometer only

In older cats, a T4 level is desirable

Treatment of urolithiasis should be complex, individual.

The regimen should help restore the tone of the smooth muscles of the urinary tract. (avoid hypothermia). Attention should be paid to the regular emptying of the bladder.

Diet, pharmacotherapy and herbal medicine should be focused on a specific form of urolithiasis.

Treatment and prevention of struvite formation

Properly selected type of nutrition is one of the main, if not the main requirements for organizing activities aimed at preventing the possibility of struvite formation in the lower urinary tract of animals.

Acidification of urine
Increase in urine volume and decrease in its density (increase in urine volume also reduces the time for crystals to pass through the urinary tract and, therefore, the time for crystal growth)
Reduce the intake of potential sources of struvite crystals in the diet.

From theory and practice, it follows that urinary pH plays a significantly more important role in the formation of struvite than the amount of magnesium in the diet!!!

1a. Achieving a urine pH of 6.0-6.5 (preferably measured with a pH meter in fresh urine samples)

2a. Increased urine volume and density (preferably up to 1.035 and below)

3a. Reducing the intake of minerals with food (magnesium - up to 20-40 mg, phosphorus - up to 125-250 mg for every 100 kcal of metabolic energy)

Good food and watch the pH. (this varies greatly in cats), and then adjust the urine pH to the indicated values by adding one of the urine acidifiers (ammonium chloride or DL-methionine) to the feed. Unlike dogs, struvite uroliths are usually sterile in cats. Therefore, antibiotics are prescribed to cats only when a urinary tract infection concomitant with urolithiasis is detected.

Among all types of urolithiasis, calcium oxalate ranks first in frequency of occurrence and is found in 75-75% of cases of the disease.

Treatment and prevention of calcium oxalate urolith formation

The pathogenesis of KSD with calcium oxalate uroliths is much less studied than in the case of struvite. There is information obtained during clinical trials, but it should be borne in mind that in humans (unlike cats), calcium-containing stones (from calcium oxalate or calcium phosphate) in the urinary tract are more common.

In practice, we are increasingly faced with such problems in dogs and cats when urine pH, density, etc. are within normal limits, and stones in the bladder and kidneys form quickly. During the study of the stone, it turns out that it is calcium oxalate.

The crystal-forming agents are calcium and oxalate (oxalic acid).

Diets that promote urination and increase urine volume should prevent calcium oxalate crystallization in the urinary tract AFTER surgical removal of uroliths.

Most often, with nephrolithiasis, the following metabolic disorders are detected:

Hypercalciuria (36.7-60.9%) pathologically elevated urinary calcium

Hyperuricuria (23-35.85) high uric acid in the blood

Hypocitraturia (28-44.3%) Alkalosis, alkaline food excess

Hyperoxaluria-(8.1-32%) is one of the forms of anomalies in the metabolism of oxalic acid - oxalosis.

Hypomagnesium (6.8-19%) Magnesium metabolism disorders

As a rule, hypercalciuria is combined with hyperoxaluria. Moreover, the latter, along with hypocitraturia, is recognized by some authors as more important metabolic risk factors for the development of calcium oxalate urolithiasis than hypercalciuria.

We need to rethink the theory of urolith formation. For a very long time there is no clear doctrine of the treatment of this pathology. We must try to study all the mistakes of previous years, and understand a new direction in the etiology and pathogenesis of the disease.

Oxalate-type KSD usually occurs in animals aged five years and older. It affects both sterilized and non-sterilized animals. The pH of urine may be within the normal range, and may be less than 6.0.

The tactics of allopathic medicine and its possibilities at this stage do not give a visible result of the cure. So, it is necessary to look for ways of treatment and other planes of pharmacology.

Homeopathy, naturopathy, herbal medicine, nosodotherapy, peptidotherapy are probably the right way out of this situation.

Alisa Veterinary Clinic is constantly working on the methodical implementation of new algorithms for the treatment of urolithiasis in animals.

New trends in the treatment of oxalate-type uroliths.

Let us consider in more detail the metabolism of oxalate and the role of oxalobacter formigenes in the development of KSD.

In the human body, the contribution of alimentary oxalate to the total urinary excretion is 10-15%, the rest is accounted for by endogenous oxalate.

The effect of dietary oxalates on urinary oxalic acid excretion depends on calcium intake. Several population-based studies have found an inverse relationship between calcium intake and stone risk. Thus, according to a prospective study by Curhan G. et al. Including 45,000 men, low calcium intake (less than 850 mg/day) significantly increased the risk of kidney stones. The protective effect of calcium, according to the authors, is due to the fact that it binds oxalates and phosphates in the intestine, preventing their excessive excretion in the urine, which contributes to the formation of stones. One of the common methods of preventing the formation of calcium oxalate stones is to reduce the amount of oxalate that comes from food. However, dietary restriction of oxalate may not be a reliable method of preventing the development of calcium oxalate urolithiasis. In this regard, some authors have proposed a concept that is to reduce the absorption of oxalate in the gastrointestinal tract. Recently, results have been obtained indicating the effect of the gram-negative obligate anaerobe Oxalobacter formigenes on the concentration of oxalate in the urine. The human body is characterized by two groups of strains. This microorganism uses exogenous oxalate in the course of its life as an energy source for its survival. The habitat of the anaerobe is the large intestine.

Although not pathogenic to humans, O. formigenes establishes a symbiosis using oxalates as a source of nutrition, as a result of which the absorption of oxalates in the lumen of the colon is reduced in humans. O. formigenes has a unique role to play in the daily catabolism of 70-100mg of dietary oxalate. It has been proven that it is alimentary oxalate that is the substrate for maintaining the colonization of O. formigenes in the intestine when a diet with a low calcium content is observed.

The data of various authors show a direct relationship between the level of oxalate excretion in the urine and the colonization of O. formigenes. So Gnanandarajah J. et al. Fecal samples of healthy and patients with calcium-oxalate urolithiasis dogs were examined for colonization with anaerobes. The results showed that colonization was present in 25% of dogs with KSD versus 75% in healthy dogs. The authors suggested that the lack of O. formigenes colonization is a predisposing factor for the development of calcium oxalate urolithiasis.

In the experiment, the influence of the microbe on the severity of the level of oxalate excretion in colonized and non-colonized rats was studied, taking into account the calcium diet. The result also confirmed the hypothesis.

A number of antibiotics are known to affect the survival of O. formigenes.

The strain showed resistance to amoxicillin, ceftriaxone, doxycilin, gentamicin, levofloxacin, metranidazole and tetracycline.

But the combinations of antibiotics amoxicillin/clarithromycin, metronidazole/clarithromycin, destroy the colonization of O. formigenes.

The study of colonization of the colon by this microorganism and its correction may improve the results of anti-relapse therapy for oxalate urolithiasis.

Veterinary clinic "Alisavet" Moscow

Data on O. formigenes were kindly provided by the Military Medical Academy named after V.I. CM. Kirov, Department of Urology, St. Petersburg. A.Yu. Shestaev, M.V. Paronnikov, V.V. Protoshchak, P.A. Babkin, A.M. Gulko.

02 February 2017

Urolithiasis in dogs and cats

Cases of pet owners visiting veterinary clinics with symptoms of urolithiasis have recently become more and more frequent. What kind of disease is urolithiasis and what danger does it pose to animals? Which animals face the greatest suffering when this disease occurs? This is what we will explore in this article.

Urolithiasis currently has a fairly large number of definitions. In simple terms, stones are formed in the urine and urinary tract of animals, which occur as a result of metabolic disorders in the animal body. Stones in the language of doctors are called uroliths or calculi.

A complex solution is urine. In the animal body, it acts as a necessary medium for the removal of metabolic products from the body. Together with urine, metabolic products are excreted, as well as electrolytes, minerals and water. Homeostatic maintenance of acid-base balance affects such an indicator as urine pH. In the event of any abnormalities, urolithiasis may occur.

The main cause of urolithiasis is a mechanical blockage of the urinary tract.

It should be noted that the formation of stones can occur not only in the urinary tract, but also in the kidneys. However, the clinical symptoms inherent in this disease are associated with stones in the urinary tract.

To diagnose this disease, ultrasound is performed to detect stones in fresh urine, in the bladder. Or they do x-rays. If the urine taken for analysis contains stones, then this does not give grounds to say that the animal has urolithiasis. And all because as a result of natural chemical reactions, precipitation of electrolytes can occur.

The composition of uroliths contained in the urine can vary greatly - from homogeneous, which are called cystins in medical language, to a complex mixture of minerals and other components. Often it also contains proteins. These formations differ from each other in appearance. They may be soft deposits with a protein-like shell. Such deposits, similar to plugs with mineral filling, can only be detected in cats. In addition to them, with urolithiasis, stones with a smooth or uneven surface can be found in the urine of animals. Minerals and matrices of small size mainly form their structure.

There are a number of reasons why stones form.

1. If there is a significant concentration of urolith components in the urine, which is higher than the possibility of their dissolution and excretion from the body without the formation of a crystal.
2. Some types of crystals are sensitive to urine pH. So, the formation of struvite occurs only in alkaline urine (PH> 7.0). Another type of crystals, oxalates, is generally not sensitive to urine pH.
3. Blockage of the urinary tract can lead to the formation of large crystals if they are produced quickly. In the case of their slow formation, the crystals are simply washed out of the bladder, thereby eliminating any harm to the animal's body.
4. The presence of a basis for the start of the formation of a large urolith. The basis may be the remains of cells or bacteria. There is evidence that viruses can be the cause of urolithiasis.
5. Some diseases can also lead to the development of urolithiasis. So, if the animal has any of the urinary tract infections, then later this can lead to the development of struvite-type urolithiasis. Mostly dogs suffer from this disease.

Clinical symptoms of urolithiasis

When electrolytes are present in the urinary tract, it can provoke clinical symptoms. Sometimes the pet owner may notice them. And sometimes they don't care at all. This applies primarily to cats. It is not always possible to see the act of urinating animals. The main clinical symptom, signaling the presence of urolithiasis in an animal, is the impossibility of the natural act of urination. Difficulty urinating can also speak of this ailment.

The animal often sits down to urinate. Dogs raise their paws, whining during intercourse, but the urine comes out in drops and often contains blood.
Palpation of the abdomen helps to establish that the animal's bladder is full. Almost always, this procedure can be performed in cats. As for dogs, it is difficult for them to do this, since they have powerful muscles in the abdominal wall that are constantly in a tense state.

There are several degrees of urolithiasis:

1. Subclinical urolithiasis.

Associated with the presence of uroliths in the urinary tract of the animal, the symptoms of this disease may be absent. Struvite uroliths, and besides them oxalate-calcium, as well as others containing calcium in their composition, are radioopaque. On x-rays, these formations are easily detected. A urinalysis may show an increased amount of crystals, and in addition, an atypical urine pH level. Struvites usually act as such uroliths. Sometimes these are calcium oxalates. In most cases, calcium oxalate stones have an uneven surface. Their presence in the urinary tract can lead to the development of inflammatory processes. In the presence of smooth struvites or cystines, no symptoms occur. Only in rare cases, nephroliths are accompanied by clinical symptoms. An exception is hematuria, which, having moved into the ureter, leads to blockage of the urinary tract, and subsequently causes hydronephrosis.

2. Mild symptoms of urolithiasis:

A slight increase in the frequency of urination;
- mild hematuria - urine stained with blood;
- urination time increases by a small amount;
- the occurrence of minor pain during urination;
- increased licking of the genitals.

3. Severe symptoms:

Pollakiuria - in this condition, cats spend a lot of time in the toilet. In dogs, on the other hand, weeping drops of urine can be observed, which occurs constantly;
- urinary tenesmus (must be distinguished as they are similar to constipation)
- severe hematuria - the presence of obvious blood in the urine;
- significant pain during urination - vocalization appears;
- during palpation, a strong distension of the bladder is revealed;
- polydipsia / polyuria in the presence of secondary renal failure in the animal;
- stay of the animal in a depressed state and anorexia.

4. Symptoms that threaten the life of the animal:

Anuria (a condition in which there is no urination)
- weakness/collapse
- dehydration
- when performing palpation of the bladder, it may not be detected if it burst or anuric (in all other cases it can be felt as a dense mass);
- uremic halitosis can be detected;
- vomit;
- convulsions;
- coma.

The veterinarian should be able to identify the degree of development of urolithiasis. In this case, you can prescribe the correct treatment.

Diagnosis of urolithiasis

Confirmation of urolithiasis are:

Clinical symptoms;
- palpation of uroliths present in the bladder in dogs (this procedure in cats is very difficult);
- X-rays, familiarization with them allows you to see radio-opaque uroliths;
- contrast radiographs, which show small and radiolucent uroliths;
- during urination in animals, uroliths are released, which can be collected in a grid.

X-ray must be used to determine radioopacity. It is also necessary to identify the places of deposition of uroliths and their size. In most cases, the stones are located in several places. Therefore, it is necessary to conduct an examination of all urinary tracts.

The course of urolithiasis in cats is accompanied by the formation of struvite

However, recently in sick animals in the urine, along with them, calcium scalings began to be detected. Cases have become more frequent when mixed-type urolithiasis is recorded in animals with suspicion of this disease. A feature of this disease is that with a neutral pH of urine, struvites and oxalates are detected in it during the tests. Many veterinarians refuse to use laboratory diagnostics, relying on the fact that struvite in the urine of cats is a common occurrence. This approach is erroneous, so it should be abandoned.

When urolithiasis occurs in dogs (UCD), its course occurs with the formation of all known uroliths. In this regard, it is relevant to determine the type of stones in a visual way. This helps in prescribing the right treatment for the sick animal. For analysis, dog urine in the amount of 10 ml is sufficient. It must be microscopically, and this must be done immediately after collection, since when the urine is cooled or evaporated, the process of crystal precipitation is accelerated. And this gives false results, which can even be considered paradoxical. Most of the crystals have a typical appearance in the urine of sick animals. If they are present in large numbers, conclusions can be drawn about the composition of the urolith or its outer layer.
Treatment of urolithiasis

Of great importance in getting rid of the animal from KSD is the choice of the correct treatment.

It is selected depending on where the uroliths are located:

Kidneys - resorting to the surgical method, the task of removing nephroliths is extremely difficult, only if one kidney acts as their place of concentration. In this case, a nephrectomy or, in simple words, removal of the kidney is possible. If the urinary tract of the animal contains nephroliths, then in this case the possibility of developing postrenal renal failure cannot be ruled out. The appointment of a special diet is an effective measure to achieve the dissolution of struvite uroliths.

Ureters - the location of uroliths, in addition to the kidneys, can also be the ureters. In this case, there is no difficulty in removing them. A surgical method is involved, but it must be remembered that there is a possibility of developing postrenal renal failure.

Bladder - When uroliths are located in the bladder, the choice of treatment largely depends on the type of uroliths. Dissolution is possible if struvite, urate, and in some cases cystine are present in the bladder. If calcium oxalates and other formations containing calcium and silicon dioxide are found, then there is no possibility for their dissolution. Therefore, in this case, they resort to a surgical method - their removal is carried out by means of cystotomy - the bladder is opened with the subsequent removal of stones.

Urethra – Several treatments can be used for this location of uroliths. Several types of treatment are possible.

The choice of a specific one largely depends on how the uroliths lie:

1. Manipulation - often resort to manual massage, which is in particular used by specialists to treat cats that have sand plugs in the urinary tract. In addition to massage, catheterization can be used. For this procedure, a small polyurethane catheter is used. In particular, a Jackson catheter for cats can be used. Or you can use a medical subclavian catheter with a diameter of 0.6 - 0.8 mm.

Although in most cases specialists resort to this method to displace or break uroliths in cats, as well as in some breeds of dogs, it should be said that its use poses a great danger to the life of the animal.

And here are the reasons why:

When it is used, tissue injury occurs, resulting in the occurrence of fibrosis and scarring, which leads to a subsequent narrowing of the urethra;
- Infection occurs in the urinary tract.

2. Another treatment is retrograde flushing of the urethra followed by dissolution(struvites, urates and cystines) or a cystotomy procedure is performed. This method is the only one that can be used to treat urethral urolithiasis.

Method: retrograde washout of urethral stones

It all starts with the fact that the animal is given general anesthesia. Or strong sedatives may be used.

After that, in a certain order, the following actions are performed:

Through the procedure of cystocentesis, which involves puncturing the bladder through the abdominal wall, the bladder is emptied;
- through the rectum with the help of fingers, the urethra is squeezed opposite the pubis below the location of the urolith. To carry out this action, the presence of an assistant is required;
- the catheter, which was previously sterilized, is inserted into the distal part of the urethra;
- fix the penis part of the urethra around the catheter;
- perform the introduction of a sterile saline solution into the catheter, for which a syringe is used;
- the assistant removes the fingers and releases the urethra when the translucent pressure reaches the desired point inside;
- the return of the urolith to the bladder occurs under the pressure of saline;
- The procedure can be repeated several times.

Recurrence of obstruction after retrograde lavage is rare. This method is not applicable to cats. And for males, experts recommend it for frequent use.

3. For males, a procedure such as urethrotomy is used.

It is resorted to in the case when the use of manipulations or retrograde washing has not ended with success. This procedure creates a permanent opening in the urethra. The use of this method is resorted to in cases of recurrent obstruction of the penile part of the urethra in cats.

Sometimes it is used in males. This method is the only one that is used in animals with permanent urethral obstruction. However, when using it, experts must be careful. There is evidence that in 17% of cases of feline urethrostomy leads to postoperative urinary tract infection. Urethrostomy and dietary changes lead to this disappointing result in 10% of cats. At the same time, urinary tract infections in cats treated with a special diet, nothing like this is observed.

Dissolution

Struvite, urate and cystine stones can be dissolved. In animals suffering from urolithiasis, this method is not recommended for use, since it does not pose a threat to their lives. When identifying stones formed in the kidneys or bladder, resort to this method.
In the presence of a urinary tract infection, which was identified based on the results of a urine culture and after a sensitivity test, a course of antibiotics is prescribed as part of the treatment. How the treatment should be carried out will be discussed below.

Struvites (magnesium ammonium phosphate, tripel phosphates). If struvite-type stones were found in the urinary tract of a sick animal, then in order to get rid of them, the animal must be kept on special veterinary diets. In any veterinary clinic, you can offer diets for your pet. Often in the course of such diets, Purina (UR) and Hills (s / d, c / d) are used. The use of these feeds by sick animals leads to acidification of the urine, resulting in the dissolution of struvites. A feature of these diets is the high content of sodium in their composition, which stimulates diuresis (urination). And this ensures the washing of the bladder. The accumulated salts come out pretty quickly.

If the KSD is not complicated by bacterial infections, then positive results can be seen as early as 4-5 days.

Note that for a speedy recovery, it is necessary to consult a doctor as soon as possible. If the disease is diagnosed at an early stage and its treatment is started immediately, this can eliminate the occurrence of possible relapses. Compliance with the owner of the feeding regimen of the animal is extremely important. It should be remembered that in the course of treatment, in addition to the feed provided for by the diet, the animal should not be given anything.

Through laboratory studies, the quality of treatment is monitored. X-ray diagnostics is also used, which allows to detect the presence of stones in the bladder. Treatment is considered effective if there are no stones on the pictures and their content in the urine is not detected. In the future, the task of the owner of the animal is to conduct a mandatory urine test. This must be done at least once every six months. It is optimal to take tests every three months.

Urine pH should also be assessed, which is carried out in the laboratory. In addition, evaluation and analysis of urine sediment is necessary. Also in the laboratory, the type and number of urinary crystals should be determined.

Treatment of insoluble uroliths

calcium oxalates

Calcium oxalate uroliths are more common in certain dog breeds. In particular, Yorkshire terriers and miniature schnauzers. Recently, cases of their detection in cats have become more frequent.

Note that a crystal of this type cannot be dissolved, therefore, the treatment of KSD of this type is carried out surgically. In some cases, to rid the animal of this disease, 3-4 operations per year are required. The need for such a frequency of surgical intervention arises if oxalates are formed quickly enough.

In order to prevent relapses, it is necessary to achieve a decrease in the concentration of animal calcium and oxalates in the urine. Prevention can be provided by special diets (Hills x/d, Eucanuba Oxalat Urinary Formula, etc.).

calcium phosphates

Crystalluria of a phosphate-calcium nature can manifest itself in different forms. In particular, in amorphous (calcium phosphates). In addition, it can be presented in the form of calcium hydrophosphates (brushite). Mixed uroliths often contain these minerals, supplemented with struvite, urate, or calcium oxalate. Most calcium phosphate crystals are highly sensitive to urine pH. Their formation occurs in alkaline urine. The technique for dissolving these uroliths has not yet been developed. Therefore, the surgical method is mainly used. In addition, hypercalciuria is prevented. Alkalinization of urine is not carried out.

Silicon dioxide (silicates)

In dogs, silicate uroliths are rare. They are called "Jack Stones". So far, it has not been possible to fully elucidate the etiopathogenesis of these uroliths. But it is generally accepted that the risk of these uroliths increases markedly if the dog eats soil or vegetables that are contaminated with soil - rutabaga, beets.

Removal of stones by surgery is the only method of treatment in the presence of clinical symptoms. As a preventive measure, it is necessary to monitor the animal so that it does not eat the earth.

In contact with

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru

Introduction

Lower urinary tract disease in cats is a major problem in modern small animal veterinary medicine. The most serious disease of the urinary tract is recognized as urolithiasis and its associated complications, for example, feline urological syndrome. Urolithiasis is widespread, difficult to treat, persistently recurs, and is accompanied by high mortality. In cats, urolithiasis was first described in the early 20th century. Since then, it has been found that urological diseases occur in cats almost 3 times more often than in dogs, and 4 times more often than in humans. Although not all patients with urologic disorders develop urolithiasis, cats have a higher proportionate mortality from urolithiasis than humans and dogs. Therefore, this problem goes beyond the scope of veterinary medicine and becomes socially significant. Unfortunately, it is still not possible to give unambiguous answers to questions about the causes of the development of the disease and its pathogenesis. Although urolithiasis is devoted to a lot of research in both humane and veterinary medicine. A large number of proposed various methods of treatment, developed by scientists and practicing veterinarians, indicates not only the relevance of this problem, but also the dissatisfaction of many specialists with the results of treating urolithiasis in cats.

1. Definition of disease

Urolithiasis (UCD) is a chronic disease of all types of domestic and wild animals, as well as humans, characterized by a violation of acid-base balance, mineral, protein, carbohydrate, vitamin, hormonal metabolism and the formation of single or multiple urinary calculi (stones) in the kidney. parenchyma, pelvis or bladder.

2. Etiology

Causes of urolithiasis can be:

Improper feeding (excess of proteins and lack of carbohydrates, excessive feeding of fish containing large amounts of phosphates and magnesium salts);

lack of vitamins A and D;

· sedentary lifestyle;

Imbalance of acid-base balance of blood and lymph;

breed predisposition;

· overweight;

early castration;

Lack of free access to drinking water (or poor water quality);

Urinary tract infections (especially streptococcal and staphylococcal).

Most of these causes lead to metabolic disorders, in which there is an excessive excretion of various metabolic products in the urine. So, for example, too early castration of a cat, accompanied by the removal of the testicles, can lead not only to hormonal imbalance, but also to narrowing of the already narrow urethra (urethra).

Cat breeds such as Persians have a genetic predisposition to urolithiasis, most of all to the formation of tripel phosphates. Neutered cats develop phosphate stones very quickly. Long-haired Himalayan and Burmese cats are most predisposed to oxalate urolithiasis, which occurs in about 25% of urolithiasis cases in cats, in addition to Persians. Overall, KSD is detected in approximately 7% of cats admitted to veterinary clinics.

The urethra in cats is already quite narrow, and with a high content of fish and dairy products in the diet, crystals of phosphorus and calcium salts fall out in the urine, which leads to spasms and urinary retention, followed by urinary tract infection and the development of acute renal failure. Males are most susceptible to KSD because their urethra is longer and narrower than that of females.

3. Pathogenesis and symptoms of the disease

With KSD, various sparingly soluble salts accumulate in the kidneys and urinary tract, which ensures a change in the acidity (pH) of urine. These can be calcium phosphates, calcium carbonates, calcium oxalates, urates, as well as struvites (complex salts of ammonium, magnesium, phosphorus and calcium). Urates consist mainly of uric acid salts (there are spines on the surface of these stones that injure the vascular walls, contributing to inflammation), and phosphates are made of calcium and magnesium phosphate. Phosphate and struvite stones form mainly in alkaline urine and grow very rapidly. The hardest stones are oxalates, they are formed from salts of oxalic acid and are found, like urates, mainly in acidic urine. That is why the normalization of urine pH leads to a slowdown in the formation of crystals and to the dissolution of existing ones. Carbonates are formed from salts of carbonic acid, they are soft, crumble easily and make up the bulk of the sand in the urine.

Uroliths are formed by the aggregation of mineral crystals. Urethral plugs, on the other hand, are made up of a protein matrix that usually contains many mineral crystals. Both uroliths and urethral plugs can lead to inflammation and obstruction of the lower urinary tract.

Many uroliths in cats form in the bladder and can damage the lining of the bladder. Depending on their size, uroliths can partially or completely block the bladder neck. And the urethra of cats can be blocked by both uroliths and urethral plugs.

Both blockage of the urethra and damage to its mucous membrane leads to stagnation of urine and the development of a secondary ascending urinary tract infection. As a result, catarrhal-purulent inflammation of the bladder (urocystitis) and renal pelvis (pyelonephritis) develops.

Symptoms. The disease develops slowly - without obvious clinical signs, but the results of a urine test can give a fairly reliable prognosis. The pH of the urine shifts to the acid side for urates, oxalates and to the alkaline side for phosphates (normal 6.5 - 7), the density of the urine increases. The animal refuses to eat, is depressed, often licks the perineum. When the urinary tract is blocked, urinary colic is observed, the animal is restless, makes restless sounds when urinating, takes an unnatural posture (hunches over) during urination, lingers in it for a long time, the pulse rate, respiration, and temperature increase. The animal experiences pain when it is touched on the stomach, goes to the toilet more often (or vice versa can urinate anywhere), the amount of urine decreases, the urine may be cloudy or bloody (hematuria), urination is difficult (or vice versa very frequent and painful) or may be absent altogether.

4. Diagnosis

Anamnesis. During the survey, it is usually possible to find out the main events in the development of the disease prior to the patient's admission to the veterinary specialist: when did the first signs of the disease appear, whether such disorders had occurred before, whether there is an appetite, whether the patient takes water, the presence of vomiting and its intensity, what is the frequency of urination and the amount of urine excreted, the presence of blood in the urine, the duration of urinary retention. In addition, it is appropriate to find out the structure of the diet, the method and amount of water taken, the conditions for keeping a sick animal. After collecting an anamnesis, they proceed to a general clinical study.

Inspection. Many urologically ill cats and cats, even in a new environment, at a doctor's appointment, take a forced position of the body for urination, sometimes excreting a small amount of cloudy or bloody urine. Tousled, matted hair, sunken eyes, dryish mucous membranes, shortness of breath indicate a long-term disease. With acute urinary retention in patients, pronounced neurological disorders can be detected: nystagmus, muscle twitching, forced head position - flexion of the occipito-atlantic joint, "look from under the brows." Quite rarely, overflow of the bladder is visually determined: a pendulous asymmetrical abdomen. When examining the perineum, it is possible to detect dried fragments of urethral plugs, salt crystals, blood clots, in cats "forced" paraphimosis.

Thermometry. The general body temperature of patients with urolithiasis is almost always within the physiological norm of 38-39.5ºC. However, if the urological syndrome develops, the patient's body temperature steadily decreases and after 24-48 hours it can reach critical levels of 34-35ºC.

Palpation. During palpation examination of a urological patient, it is necessary to determine the condition of the bladder. In most patients, the walls of the organ are moderately or severely painful, thickened. In the case of acute urinary retention, the soreness increases, and the filling of the bladder rarely exceeds 350 ml, and the bladder fills a larger volume of the abdominal cavity. Palpation should be performed before and after removal of obstruction and emptying of the bladder. In cats and cats, it is extremely rare to palpate the presence of uroliths in the bladder, but with luck, it is possible to identify foreign inclusions and characteristic crepitation of stones. If the kidneys are available for examination (in obese animals, the kidneys are not easily accessible for palpation), their location, shape, pain, and size are determined. This provides valuable information for excluding kidney pathology unrelated to feline urolithiasis. By palpation, in general clinical conditions, it is possible to determine the degree of dehydration and hemomicrocirculation disorders in urological patients.

Examination of the urethra. Palpation of the urethra in cats is of considerable clinical interest. It is carried out through the skin of the penis from the level of the ischial arch to the head of the penis, often revealing urethral uroliths or the location of other obstructions to the outflow of urine. Having exposed the head of the penis, they study the state of the mucous membrane of the preputial sac, head and urethra, often find hyperemic mucous membrane of the urethral opening, urethral plugs of various composition. In some patients, the urethral plug is extremely strongly “soldered” with the mucous membrane. In severely dehydrated cats, dry necrosis of part of the glans penis may occur. Light massage of the urethra is performed in order to obtain urethral contents. Sometimes with the help of massage it is possible to eliminate the obstruction of the urethra. Examination of the urethra: palpation, probing and catheterization - make it possible to establish the absence or presence of urethral obstruction and parietal calculi. It should be noted that the more proximal the obstruction is, the less organic matrix it contains, the more difficult and traumatic the obstruction elimination procedure will be.

Special research methods:

Ultrasound examination (ultrasound) - gives information about the thickness of the walls of the bladder; about the presence of sediment, calculi, neoplasms; about the condition of the kidneys. For ultrasound of the urinary tract of cats, high-frequency sensors of 5-7.5 MHz are used, which provide the most reliable image of the internal organs. To ensure full contact of the sensor with the patient's skin, hair from the area under study should be shaved off. The bladder is scanned in the transverse and longitudinal planes, changing the position of the patient's body, that is, a polypositional study is used.

· X-ray examination - is of secondary importance in the diagnosis of urolithiasis in cats. Bladder and urethra stones in cats tend to be small and soft tissue in density. However, it is not advisable to completely abandon radiography, since in addition to an overview image, it is possible to perform a contrast radiograph, including double contrast, urethrocystography and emergency urography, which allow not only to make a diagnosis of urolithiasis, but also to carry out differential diagnosis.

Laboratory research methods:

Biochemical examination of urine using diagnostic strips is a simple and fairly effective method of rapid diagnostics, with which the following urine parameters can be determined within 1-1.5 minutes: pH, specific gravity, protein content, ketone content, content of bile pigments , microhematuria, microhemoglobinuria. The method has a significant drawback - with severe gross hematuria, the readings are significantly distorted and do not represent a diagnostic value.

· Studies of urine sediment are carried out by microscopy under low and medium magnification. To obtain a sediment, fresh urine is centrifuged at 1000-1500 rpm for 5-7 minutes. The undesired liquid is drained, the precipitate is placed on a glass slide and covered with a coverslip. Microscopy determines the type of crystals, the number of erythrocytes and leukocytes in the field of view, the epithelium of various parts of the urinary system, cylinders. Significant gross hematuria is an obstacle to obtaining a "readable" urine sediment. In such cases, for an approximate determination of the type of crystals, it is reasonable to conduct microscopy of urethral plugs and calculi. The results of microscopy of urine sediment and urethral contents are almost always the same.

5. Treatment and prevention

Treatment is aimed at eliminating the pain syndrome, increasing the solubility of salts, loosening stones, and preventing further formation of urinary stones. It is possible to alleviate the condition of the animal with the help of antispasmodics (baralgin, spazgan), treatment of detected infections with antibiotics (cefa-cure, enrofloxacin, albipen LA), sulfonamides (urosulfan, sulf-120), the drug "Cat Ervin" (with obstruction of the urinary tract, it can be administered directly into the bladder, after pumping out the contents of the latter), as well as with the help of a special diet that prevents oversaturation with calcium and phosphorus salts. To stimulate the smooth muscles of the bladder, gamavit or katazol are recommended, to eliminate urethral plugs - catheterization and washing the urethra with Ervin the Cat (16 ml per dose), hot baths (40ºC) when the cat is immersed to half of the body, anti-inflammatory therapy - dexafort .

Cats should not use medications containing glycerin and essential oils - urolesan, cystenal, pinobine, phytolysin, as this can be fatal. Avisan, cystone can be used, however, the dosage of these drugs is designed for a person, so it is necessary to take into account not only the weight of the cat, but also its sensitivity to the plants that make up the drugs.

1) Manual massage:

Manual massage (often used for cats with sand plugs) or catheterization with a small polyurethane catheter (for example, a special Jackson catheter for cats or a medical subclavian catheter with a diameter of 0.6 - 0.8 mm).

Although catheterization is often used to dislodge or break up uroliths in cats and some dog breeds, this treatment is the most dangerous for the following reasons:

* it injures tissues, leading to fibrosis and scarring, followed by narrowing of the urethra;

* introduces infection into the urinary tract.

2) Retrograde washing of the urethra.

Retrograde flushing of the urethra followed by dissolution (struvites, urates, and cystines) or cystotomy (calcium oxalates, other uroliths containing calcium and silicon dioxide) is the only treatment for urethral urolithiasis.

Method of retrograde washing out of urethral calculi. The animal is given general anesthesia or strong sedatives. Then the following steps are performed:

* Empty the bladder by cystocentesis (puncture of the bladder through the abdominal wall).

* Through the rectum, fingers squeeze the urethra opposite the pubis, below the urolith (this requires an assistant).

* A sterile catheter is inserted into the distal part of the urethra.

* Secure the penis part of the urethra around the catheter.

* Sterile saline is injected into the catheter through a syringe.

* When intraluminal pressure reaches the desired point, the assistant removes the fingers and releases the urethra.

* Under the pressure of saline solution, the urolith returns back to the bladder.

* You can repeat the procedure several times.

After retrograde lavage, recurrences of obstruction are very rare. In cats, this method is usually not used; in males, this low-impact method is often recommended for use.

3) Urethrostomy.

Urethrostomy is used in males when manipulation or retrograde lavage has failed. A urethrostomy creates a permanent opening in the urethra. This method is used for recurrent obstruction of the penile urethra in cats and sometimes in males. Although this is the only treatment for animals with permanent urethral obstruction, it must be used with caution because some reports indicate that 17% of feline urethrostomies result in postoperative urinary tract infections. In 10% of cats, urethrostomy and dietary changes also lead to postoperative infection, while none of the diet-treated cats has a urinary tract infection.

4) Dissolution.

Struvite, urate and cystine stones can be dissolved. This is the only non-life threatening method of removing stones in animals with urolithiasis. Dissolution is used for kidney or bladder stones. If a urinary tract infection is present, antibiotics are given as part of the treatment based on the results of the urine culture and sensitivity test. The details of the treatment are discussed below.

Struvites (magnesium ammonium phosphate, tripel phosphates). To dissolve struvite stones, it is enough to strictly adhere to special veterinary diets.

These foods contribute to acidification of the urine, causing the struvite to dissolve. In addition, the high sodium content in these diets stimulates diuresis (urination), which helps flush the bladder and remove accumulated salts as soon as possible. With urolithiasis not complicated by bacterial infections, treatment with special diets brings positive results as early as 4-5 days after the start of treatment. It should be noted that the earliest possible visit to the veterinarian and early diagnosis of urolithiasis contributes to the speedy recovery of the animal and minimizes possible relapses of the disease. Of great importance is the owner's compliance with the feeding regimen of the animal.

Quality control of treatment is carried out by laboratory tests of urine and x-ray diagnostics of the presence of stones in the bladder. In the absence of stones in the urine and on the pictures, the treatment is recognized as effective, and the task of the owner in the future is to conduct a mandatory urine test at least once every six months. The optimal term for the control delivery of analyzes is 3 months.

The laboratory evaluates the pH of urine, as well as the presence and analysis of urine sediment, determining the type and number of urinary crystals.

5) Treatment of insoluble uroliths.

calcium oxalates.

Calcium oxalate uroliths are more common in certain breeds of dogs (Yorkshire Terriers and Miniature Schnauzers), and in recent years they have become noticeably more common, especially in cats.

Unfortunately, this type of crystal is completely insoluble, and the treatment of this type of urolithiasis is carried out exclusively by surgical removal of stones from the bladder. Sometimes 3-4 operations per year are required if the intensity of oxalate formation is very high.

To prevent relapse, it is necessary to reduce the concentration of calcium and oxalates in the urine. Prevention is possible with special diets.

calcium phosphates.

Phosphate-calcium crystalluria manifests itself in various forms: both in amorphous (calcium phosphates) and in the form of calcium hydrophosphates (brushite). These minerals are often present in mixed uroliths along with struvite, urate, or calcium oxalate. Most calcium phosphate crystals (with the exception of brushite) are pH sensitive and form in alkaline urine.

A medical protocol for dissolving these uroliths has not yet been developed, so surgical removal and prevention of hypercalciuria (as in the case of calcium oxalatocalcium urolithiasis), but not alkalinization of the urine, is recommended.

6) Pulsed magnetic field.

Also in practice, a method is used to treat KSD using a pulsed magnetic field, which not only promotes the dissolution of uroliths, but also has an anti-inflammatory and local analgesic effect. Relief occurs in all but the most neglected cases.

7) Homeopathic treatment.

Of great importance is the control of the condition of the mucous membrane of the bladder and urethra in cats with KSD.

For this, long-term therapy is prescribed with the use of Berberis-homaccord and Mucosa compositum. Medicines can be given with drinking water 2-3 times a week.

In acute inflammation and pain, traumeel is prescribed subcutaneously 2-3 times a day or in the form of drops every 15-30 minutes. Traumeel is also prescribed after surgery (cysto- or urethrotomy).

If urolithiasis develops against the background of chronic pyelonephritis, then the main treatment is best carried out with the help of preparations cantharis compositum and berberis-homaccord.

8) Phytotherapy.

Assign in the chronic course of the disease. Decoctions and infusions of urological preparations have an antiseptic and anti-inflammatory effect, contain compounds that play the role of a protective colloid that prevents the agglomeration of microurolith crystals. The use of phytoelite preparations "Healthy Kidneys" and "Cat Erwin" is recommended. From herbs: a decoction of bearberry leaves (bear ears), an infusion of half-pala (herva woolly), parsley rhizomes, highlander, watercress, etc.

9) Diet therapy.

Currently, foods are more effective at preventing struvite uroliths, thus inevitably increasing the percentage of oxalate uroliths.

Over-acidification of some cat foods or the use of acidifying diets in conjunction with urine acidifiers results in demineralization of the bones, releasing calcium to provide a buffer.

An increase in the incidence of oxalate urolithiasis in cats contributed to the development of the new Hill's Prescription Diet Feline x / d diet, which was created specifically to prevent the formation of calcium oxalate crystals and uroliths and prevent recurrence of calcium oxalate urolithiasis. Carefully selected and strictly controlled calcium levels slow down crystal formation. Reduced vitamin content D helps to avoid excessive absorption of calcium from the intestines.The increased content of potassium citrate, which is able to form soluble salts with calcium, contributes to the partial destruction of oxalates, and soluble fibers contribute to the binding of calcium in the intestines.

Both struvite and oxalate are most common in overweight, indoor cats with low water intake - the first two factors interfere with urinary frequency and lead to urinary retention, and the last factor increases the concentration of minerals in the urine. However, while struvite is more common in young cats (under 5 years of age), the risk of developing oxalate uroliths is greater in older cats (over 7 years of age).

While there are general principles for preventing both types of KSD, recommendations for specific nutrients vary considerably. For optimal control of a specific type of urolith, the most appropriate level of each individual nutrient must be strictly controlled. Therefore, there is no diet that is suitable for controlling both types of stones.

The presence of a urinary tract infection with urease-producing bacteria will worsen the development of struvite uroliths. But infection rarely appears as the primary cause of urolithiasis in cats, more often as a secondary or concomitant microflora.

The basic principles of nutrition to prevent urolithiasis are a number of rules:

· Maintain adequate water intake to ensure adequate urine output. Increasing your water intake will increase the amount of urine produced and dissolve the crystal-forming substance. Urine volume is usually greater in cats fed a canned diet. Also, if the feed is highly digestible, this reduces the amount of dry matter in faecal matter, which requires less water. Thus, faecal water loss is reduced, allowing water to be excreted in the urine.

· Avoiding excessive consumption of those minerals that are constituents of urolith, thereby reducing their concentration in the urine.

Calcium and oxalate in the intestinal lumen form an insoluble complex that is not absorbed (just as they form an insoluble complex in the bladder). Dietary reduction in only one of these may mean that the other is free for absorption and will then be excreted in the urine (where it can bind to oxalate or calcium, which are released from body tissues to form calcium oxalate). It is recommended that calcium and oxalate restriction occur long-term and together. There should not be a large reduction in calcium intake, and its absorption may be reduced by binding to soluble fibers.

Prevention.

Prevention is primarily to control the acidity of the urine. Depending on the age of the animal, the types of stones differ, and quite significantly. So, in young cats (up to 5 years old), phosphates are most often detected. Acidification of urine prevents their occurrence. In older cats (6-9 years), the chance of phosphate stones (struvites) is reduced, but the risk of oxalate stones is increased, especially if the urine is too acidic. In order to limit their formation, it is recommended to take measures to reduce the acidity of urine. But in older cats (over 10 years), the formation of oxalate crystals should be most feared: urine with a neutral acidity index when potassium citrate is added limits the risk of their formation. Allopurinol (a xanthine oxidase inhibitor) is used to prevent and dissolve urate stones. Cranberry juice has been shown to lower urine pH and prevent the formation of uroliths. An excellent prophylactic is the phytopreparation "Cat Erwin". To restore the body after surgery, the microelement preparation Gamovit-plus is indicated.

Conclusion

urolithiasis urethral cat chronic

Currently, urolithiasis is very common, the incidence is ubiquitous. Both domestic and wild animals are at risk of developing KSD, therefore, the conditions of keeping and feeding do not play a major role in the occurrence of this disease.

At the moment, the disease is difficult to fully treat and the risk of its recurrence is high. Therefore, the ICD is an extensive field for the study and development of new modern methods of treatment.

It should be noted that feeding with specialized feeds can reduce the risk of urolithiasis, since such feed has a balanced composition that is suitable for the characteristics of the body of a particular animal species.

Literature

1. E.M. Kozlov Urolithiasis of cats. N .: MAG TM, 2002. - 52s.

2. Ed. A.F. Kuznetsova Handbook of veterinary medicine - St. Petersburg: Publishing house "Lan", 2004. - 912p.

3. S.V. Starchenkov Diseases of small animals: diagnosis, treatment, prevention. Series “Textbooks for universities. Special Literature. - St. Petersburg: Publishing house "Lan", 1999. - 512 p.

4. S.S. Lipnitsky, V.F. Litvinov, V.V. Shimko, A.I. Gantimurov Handbook of Diseases of Domestic and Exotic Animals - 3rd ed., Revised. and additional - Rostov n / a: ed. "Phoenix", 2002. - 448s.

5. A. Sanin, A. Lipin, E. Zinchenko Veterinary reference book of traditional and non-traditional methods of treating dogs. - 3rd ed., corrected and supplemented. - M.: ZAO Tsentrpoligraf, 2007. - 595p.

Hosted on Allbest.ru

...

Factors leading to disease in animals

Exogenous factors ICD

There are several predisposing exogenous factors leading to the disease:

Crystallization

Requires a high concentration of magnesium in the urine and an alkaline urine reaction (pH above 6.8).
Normally, cat urine is slightly acidic.. Alkalinization of urine can occur with the consumption of certain foods and urinary tract infections. Theoretically, acidic urine prevents crystallization processes and has antibacterial properties. But with a high concentration of ions involved in the formation of stones, it can also begin in an acidic environment.

It occurs when eating food rich in magnesium salts, with psycho-emotional retention of urination in a dirty toilet tray, with physical inactivity, in the absence of water or its low quality, which is why the cat restricts itself in water.

Ca:P ratio in the diet below 1

As a result, the relative content of phosphorus in the diet is increased.

Feed moisture

Affects the formation of stones only when, when consuming dry food, there are restrictions in drinking water;

Low energy saturation of feed

Reduced energy value of feed can become a risk factor. Such a non-physiological composition of the feed stimulates its consumption in excess, which can lead to a critically high intake of minerals.

overweight in cats

A predisposing factor leading a sedentary lifestyle.

Endogenous factors leading to ureteral disease:

Hyperfunction of the parathyroid glands

There is a release of calcium and an increase in its concentration in the blood and urine.

Increasing the content of Ca in the blood serum

Occurs with bone trauma, osteomyelitis, osteoporosis, peripheral neuritis, and therefore these diseases are often complicated by urolithiasis.

Violation of the normal function of the gastrointestinal tract (chronic gastritis, colitis, peptic ulcer)

This is also due to the influence of hyperacid gastritis on the acid-base state of the body, as well as a decrease in excretion from the small intestine and the binding of calcium salts in it.

Infection

Infection can enter the body of the animal from external sources, such as sexual organs, intestines, or the urethra.

The main types of stones formed: Struvites(trivalent phosphates), Oxalates(salts of oxalic acid)

Clinical signs and symptoms of urolithiasis in cats

Signs of ICD

Before the emergence blockage of the urinary tract the disease proceeds without pronounced clinical signs, but the results of laboratory tests of urine and blood indicate its occurrence. In the latent period of the course of urolithiasis, symptoms can be detected that indicate not only its development, but also presumably the localization of the stone.

In animals, appetite decreases, depression and drowsiness may appear. Salt crystals are deposited on the hair of the prepuce. At times, hematuria is found, especially after active movements. The presence of stones in the bladder is manifested by frequent urge to urinate, kneading, raising and lowering the tail. The animal lies down gently.

With blockage of the urinary tract, the disease manifests itself with the classic triad of symptoms:

urinary colic
Violation of the act of urination
Changes in the composition of urine

Suddenly there are bouts of intense anxiety. Sick animals lie down and quickly get up, step over the pelvic limbs, look back at the stomach, take a pose for urination. The duration of the attacks can reach several hours. Between attacks, the animal is sharply depressed, lies indifferently, rises with difficulty, carefully, hunched back.

During an attack, the pulse and respiration rate will melt, but the body temperature rarely rises to subfebrile. Urination is frequent and painful. Urine is excreted with difficulty, in small portions and even drops.

Hematuria is very common. It can be microscopic, when there are 20-30 erythrocytes in the urine sediment, and macroscopic. Macroscopic hematuria caused by a kidney stone or a stone in the ureter is always total.

With complete blockage of the urethra, anuria appears. Palpation of the kidneys and bladder is painful. Sometimes it is possible to feel stones in the bladder, in cats they are usually infringed at the end of the urethra.

As pressure builds up in the upper urinary tract, the kidneys stop producing urine. In the blood, toxic metabolic products accumulate, leading to uremia. The cat may vomit. The patient's abdomen increases in volume, becomes hard and painful. If no help is given, he falls into a coma and dies.

Bladder rupture can occur in a cat, leading to peritonitis and uremia. When the urethra ruptures, urine infiltrates the subcutaneous tissue of the abdominal cavity, pelvic limbs, perineum, and uremia also develops.

In most animals, the course of the disease is complicated by an associated infection, which aggravates the disease and worsens the prognosis. The most common infection is Escherichia coli, Staphylococcus, Proteus. Therefore, pyuria (pus in the urine) is a common symptom of KSD.

In a sick animal, the urine is turbid with an admixture of urinary sand, which quickly precipitates. The color of the urine is dark with a reddish tint caused by the admixture of blood.

The course of the disease from the moment of the blockage is no more than 2-3 days.

A good example of ICD in a cat

Diagnosis of diseases of the urinary system

Diagnosis of urethral stones is not difficult. The stone can also be detected using a catheter that encounters an obstruction in the urethra. Diagnosis of bladder stones also does not cause any particular difficulties.

General clinical examination methods can reveal signs of damage to the kidney and urinary tract: pain and palpation in the kidney area.

Urinalysis is the main method for diagnosing urolithiasis, detects a small amount of protein, single cylinders, fresh red blood cells and salts. Leukocyturia appears when nephrolithiasis is complicated by pyelonephritis. The presence of crystals in the urine makes it possible to judge the type of urolithiasis, which is important when choosing means for treatment.

Animal urine sediment. Struvites.

Urine sediment after treatment of urolithiasis.

X-ray examination occupies a leading place in the recognition of kidney and ureter stones. The most common method is survey urography. With its help, you can determine the size and shape of the stone, as well as approximately its localization.

An overview urogram should cover the entire area of the kidneys and urinary tract on both sides. Not all stones cast a shadow on the overview image. The chemical composition of stones, size and localization are extremely diverse. In 10% of cases, the stones are not visible on the X-ray survey, as the density in relation to X-rays approaches the density of soft tissues.

In the diagnosis of stones, ultrasound scanning of the kidneys can be used. This method, based on the different ability of media to absorb and reflect ultrasonic waves, contributes to the successful detection of stones - formations, the density of which significantly exceeds the density of the surrounding tissues.

With severe clinical signs, it is not difficult to make a diagnosis.
It is important to diagnose urolithiasis in cats during the latent course, for which it is recommended to systematically selectively examine urine (titer density and alkalinity, calcium, phosphorus, urine sediment and the level of mucoproteins, which in healthy people does not increase 0.2 units of optical density) and blood (calcium, phosphorus and reserve alkalinity).

Treatment of urolithiasis

Bladder stones in a cat

Treatment for urolithiasis can be conservative and operative.
Conservative treatment is aimed at eliminating pain and inflammation, at preventing relapses and complications of the disease. A diet is prescribed that helps restore normal metabolism and maintain the cat's homeostasis. It is prescribed depending on the type of violation of salt metabolism.

Medical treatment It is aimed at eliminating the stagnation of urine and restoring the patency of the urinary tract of cats. Obturation can occur due to spasm of smooth muscles, due to irritation of the mucous membrane with a stone. In these cases, antispasmodic and sedatives (baralgin, atropine, platifillin, spasmolytin), heat and lumbar novocaine blockade are used. This manages to stop the attacks of urinary colic, restore diuresis and alleviate the condition of the sick animal.

An important role in the treatment of patients with nephroureterolithiasis belongs to drugs that are used to combat urinary infection. They are prescribed taking into account the results of urine culture of the sensitivity of its microflora to antibiotics and other antibacterial drugs.

Surgical treatment is the leading method for removing stones from the urinary tract. The operation is necessary, the stone causes pain, in violation of the outflow of urine, leading to a decrease in kidney function and hydronephrotic transformation; with attacks of acute pyelonephritis, with hematuria.

Treatment of sick animals with stones in the ureter may be conservative or operative. Conservative treatment is indicated in the presence of stones in the ureter that do not cause severe pain, do not significantly impair the outflow of urine, do not lead to hydroureteronephrosis and tend to pass on their own. In 75-80% of cases, stones from the ureter after conservative measures go away on their own. Treatment is aimed at strengthening the motility of the ureter and eliminating its spastic contractions.

The scheme of treatment and prevention of recurrence, phosphate ammonium-magnesian stones:

Elimination of mechanical interference with the outflow of urine - removal of sand and stones, excretion with drugs.
Treatment of identified infections.
Stabilization of urine pH from 5.5 to 6.0.
Increased fluid intake - urine density 1.015 g/cm3. Avoid thirst.
The right choice of food:
- the magnesium content is not higher than 0.1%.
- phosphorus content less than 0.8%.
- the Ca:P ratio is greater than 1.0 on a dry weight basis.
Regulation of the weight of cats no more than 3.5 kg cats no more than 4.5 kg.

Prevention of urolithiasis in cats

The right type of food is one of the main, if not the main, requirement in the organization of activities aimed at preventing and preventing the formation of stones in the lower urinary tract of cats. Diet therapy can also be used to prevent secondary formation of uroliths after removal, to weaken the protective crystallurgy in order to prevent recurrence of urethral plugs. In addition, it is used for resorption of uroliths in cases not accompanied by urethral obstruction.

Commercially available foods designed to meet these challenges are now readily available. Diet food is prescribed based on urinalysis.