Urolithiasis in dogs. Urolithiasis of cats and dogs. Types of urinary stones, prevention, treatment

Urolithiasis (ICD)

Urolithiasis (Urolitiasis)- a disease accompanied by the formation and deposition of urinary stones or sand in the renal pelvis, bladder or urethra. Usually accompanied by painful urination, blood in the urine and frequent urination. The disease proceeds quickly and leads to the death of the animal. 

Causes of urolithiasis in different sick cats are different, that is, this disease is polyetiological.

At present, the number of diseased urolithiasis cats and relapses are observed in 50-70% of cases.

According to some researchers, most often one-year-old cats suffer from urolithiasis, according to others, it is more often observed at the 2-3rd year of life.

The disease is equally common in both cats and cats.. Cats are more prone to urolithiasis due to the specifics of the anatomical structure (narrowness of the urethra), and it is more difficult, as it is often complicated by obstruction of the bladder.

Factors leading to disease in animals

Exogenous factors ICD

There are several predisposing exogenous factors leading to the disease:

1. 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.

2. Ca:P ratio in the diet below 1

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

3. Feed moisture

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

4. 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.

5. overweight in cats

A predisposing factor leading a sedentary lifestyle.

Endogenous factors leading to ureteral disease:

1. Hyperfunction of the parathyroid glands

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

2. 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.

3. 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.

4. 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:

1. urinary colic
2. Violation of the act of urination
3. 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:

1. Elimination of mechanical interference with the outflow of urine - removal of sand and stones, excretion with drugs.
2. Treatment of identified infections.
3. Stabilization of urine pH from 5.5 to 6.0.
4. Increased fluid intake - urine density 1.015 g/cm3. Avoid thirst.
5. 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.
6. 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.

Urolithiasis - the formation of urinary stones in the kidneys, pelvis, bladder or their retention in the lumen of the ureters, urethra.

Urinary stones are found mainly in carnivores (dogs, cats), sheep, fur-bearing animals, and less frequently in cattle and horses.

The chemical composition of stones in different species of animals is not the same: in herbivores they consist mainly of calcium carbonate, magnesium carbonate and calcium oxalate.

Urate and phosphate stones are found in dogs and cats. Phosphate stones and sand form very quickly, especially in neutered cats.

Etiology urinary stones is still not entirely elucidated. It is believed that their formation in most cases is due to a violation of the regulation of salt metabolism from the central nervous system due to improper, monotonous feeding, as well as A-hypovitaminosis.

One of the leading factors in the formation of urinary stones is the imbalance between acid and basic feed equivalents. Microorganisms (staphylococci, streptococci, proteus) play an important role in the formation of stones in dogs and cats.

Stone formation is often due to the use of various medicinal substances, sometimes polyhypovitaminosis.

Essential in the formation of stones is the excessive use of feed products rich in phosphates, in particular, bran, bone meal, beets. The factors of stone formation include long-term periodic stagnation of urine with its subsequent alkalization, precipitation of salts and the formation of calculi.

A certain role in the development of the disease is played by the individual characteristics of the animal, climatic factors. The development of urolithiasis can also be associated with inflammation of the urinary tract.

A predisposing factor for stone formation may be a relatively small diameter of the urethra in bulls, valukhs, males and cats, especially neutered ones.

The occurrence of the disease is associated with metabolic disorders, which, in turn, results from irrational and unbalanced feeding of animals. This is noted in cases where in the diet of sick animals there is an excess of protein, phosphorus, calcium, silicon, magnesium, with a simultaneous lack of vitamins and carbohydrates.

Pathogenesis.

Currently, there are two theories of stone formation: crystallization and matrix. According to the crystallization theory, the primary basis of the stone is the crystallization core, on which sprouts of radially arranged crystals arise. Organic matter is incorporated into the rock as it grows.

According to the matrix theory, the primary basis of stones is organic matter - the core, consisting of carbohydrate and protein components.

The primary matrix of the stone - the core, is formed from urine proteins when its proteolytic properties change. The crystalline part of the stone is determined by the pH of the urine. It has been established that the formation of the crystalline part of the stones depends on the pH of the urine: uric acid - at pH up to 6; oxalate - up to 6-6.5; phosphate - at pH 7 and above.

The change in the pH of urine largely depends on the state of the acid-base balance of the body. Violation of it entails changes in redox processes, mineral metabolism (increased excretion of calcium, phosphorus, magnesium, sodium, potassium, chlorine, etc.) by the kidneys.

In the kidneys and bladder, inflammatory-dystrophic processes develop, the pH and relative density of urine change, which leads to disruption of the colloid-crystalline balance in the urine, salt precipitation and the formation of urinary stones. Predisposing factors are the presence of foreign bodies in the urinary tract or kidneys in the form of epithelial cells, cylinders, blood clots, pus, fibrin, necrotic tissue, etc. Under such conditions, crystal salts, protein-like substances precipitate.

Urinary stone is a colloidal matrix (base) with crystals of mineral salts deposited around the matrix on its surface.

The process of urinary stone formation proceeds in two phases. First, peptides, proteins and mucoproteins form the organic material of the stone. Having both positive and negative ions, the matrix attracts and binds both anions and cations. In the second stage, crystals of mineral salts are deposited on the matrix, its mass increases and stones of various sizes are formed, consisting of a mixture of phosphates, magnesium and ammonium. . Large stones located in the renal cavities sit tightly. Small and medium stones of the renal pelvis or bladder can change their position, enter the ureter, urethra and cause blockage.

Bladder stones by chemical composition are urate, phosphate and oxalate (see Appendix, Fig. 3). Phosphates are soft, white or grayish in color, rounded, with a smooth or slightly rough surface, Urates are dense, brick-colored, rounded. Oxalates are also dense, have an awl-shaped tuberous surface. The softest are cystine stones of light yellow color.

Urinary stones often cause mechanical damage to the mucous membrane of the urinary tract, causing bleeding. The development of urolithiasis may also be associated with inflammation of the urinary tract.

Blockage, damage to the mucous membrane by urinary stones is accompanied by stagnation of urine, penetration into the urinary tract along the ascending line of a secondary infection, resulting in the development of catarrhal-purulent inflammation of the bladder (urocystitis), renal pelvis and kidneys (pyelonephritis). Symptoms. The clinical picture of the disease depends on the location of urinary stones, their size, surface condition and mobility (see Appendix, Fig. 4),

The main signs are pain and hematuria. The pain can be constant and at times manifested by sharp bouts of colic. Urination is frequent and painful. With the formation of a stone in the renal pelvis, symptoms characteristic of pyelitis appear, and subsequently pyelonephritis.

During this period of the disease, there may be an increase in body temperature by 0.5-1.0 ° C. In the urine, a large amount of inorganic sediments, protein, leukocytes, epithelium of the renal pelvis, microbes. Frequent, painful urination, interrupted by false urges.

When the urinary tract is blocked, the disease is manifested by the classic triad of symptoms: urinary colic, a violation of the act of urination, and a change in the composition of the urine.

Flow.

Urolithiasis proceeds for a long time and tends to relapse. Its course depends on the size of the stone, the painful and inflammatory phenomena that it causes, as well as on the effectiveness of the treatment.

When the bladder ruptures, peritonitis develops and the animal usually dies.

pathoanatomical changes.

The mucous membrane of the pelvis, ureter or bladder is hyperemic, edematous, often covered with hemorrhages. The integrity of its endothelial cover is broken. Edema gradually spreads deep into the underlying tissues, leading to damage to the kidney parenchyma and atrophy.

With blockage of the urinary tract, hydronephrosis is noted. Often there is pyelonephritis.

The number of stones can be from one to several hundred. Small erosions with the phenomena of purulent urethritis are noted.

Diagnosis.

Take into account anamnestic data (feeding, watering), clinical signs (pain, hematuria) and laboratory tests of urine (acidity and alkalinity, urine sediment). In some cases, X-ray examinations and ultrasound are performed.

Despite the characteristic signs of the disease, it should differentiate from pyelitis, cystitis and chronic hematuria in cattle (see Appendix, Table 1).

Forecast.

In cases where the urinary tract contains only sand, the prognosis is favorable, and when the urethra is blocked, it is often unfavorable, since a bladder rupture is possible.

Treatment.

The most acceptable symptomatic therapy using painkillers and antispasmodics, physiotherapy, probing and surgical removal of stones.

Removal of spasm of smooth muscles or re-irritation of the mucous membrane with stones;

Displacement of the stone located in the center with a catheter;

Elimination of pain attacks;

Washing the bladder with anti-inflammatory drugs;

Destruction and removal of urinary stones and sand from the urinary tract.

Removal of spasm of the urinary tract is achieved by intramuscular administration of no-shpa, analgin, spasmolitin, baralgin, etc.

In case of blockage of the urethra, a 0.5% solution of novocaine from 2 to 10 ml is injected through the catheter and then, after a few minutes, the stone is displaced by the catheter into the bladder.

The catheter is advanced into the bladder, and subsequently an isotonic solution of sodium chloride (50-150 ml) is injected through the bliss in combination with penicillin at a dose of 5000-6000 IU / kg of body weight. If the solution does not flow out through the catheter, then it is sucked off with a syringe. Washing is repeated the next day.

Pain reactions can be eliminated with the help of lumbar novocaine blockade with a 0.25% solution at a dose of 1 ml per 1 kg of live weight.

To relieve the inflammatory reaction in the urinary tract, the use of penicillin preparations, sulfonamides is indicated.

In combination with these substances, drugs that disinfect the urinary system can be prescribed: a decoction of bearberry leaves, couch grass roots, parsley root; as well as trichopol, biseptol, urosulfan, furalonin, etc.

For the destruction and removal of urinary stones and sand, sgrodan, cystone are used inside. In urgent cases, urinary stones are removed in an onerative way (cyetotomy, urethrotomy), depending on the indications.

Prevention is reduced to improving the maintenance, feeding and watering of animals. Avoid long-term use of monotonous fodder rich in spruce, as well as hard drinking water. Rations are enriched with vitamins. Carry out a systematic exercise. In some cases, studies of urine sediment are carried out in order to identify diseases of the kidneys (pyelonephritis), bladder (cystitis) and early stages of urolithiasis (presence of sand).

The classification of kidney stones according to various criteria is the main criterion for choosing a further method for treating urolithiasis.

Diagnosis of the chemical composition of solid formations, their number, shape helps the doctor to make an accurate picture of the pathology and prescribe the most effective course of therapy.

In addition, the belonging of a calculus to a certain group implies the appointment of a specific diet.

Classification

Stones are formed from a mixture of minerals and organic substances. Modern medicine offers four main groups of kidney stones:

– Oxalates and phosphates. This is the most common category of education. Stones are diagnosed in 70% of patients diagnosed with urolithiasis. The basis of formations of inorganic origin is calcium salts.

– Struvite and phosphate-ammonium-magnesium stones. This type of stone is formed in 20% of patients. The cause of the appearance of formations are diseases of the urinary tract of an infectious nature. That is why they are called infectious.

– Urats. They are diagnosed in 10% of all patients. The cause of the appearance is an excess of uric acid and some pathologies of the digestive tract.

– xanthine and cystine stones. Quite rare formations. Occurs in 5% of patients. Experts associate their appearance with congenital pathologies and genetic disorders.

It is quite difficult to detect stones that are pure in composition; mixed-type formations are diagnosed in half of the patients.

What are kidney stones

There are many classification criteria.

1. By number: half of the patients are diagnosed with single stones, often one has to deal with the formation of two or three calculi in the kidneys, the least rare case is also multiple formations in the kidneys.
2. By location in the body: unilateral and bilateral.
3. In shape: round, flat, with edges, spikes, coral.
4. In size: the size of the formation can vary from the eye of a needle to the size of the entire cavity of the kidney.
5. At the place of dislocation: calculi are formed in the kidney, bladder or ureter.

Types of kidney crystals

The most common classification of solid formations by chemical composition. If earlier doctors assumed that the formation of stones is associated with the quality of the water that the patient consumes, the climate and geographical features of the area where he lives, today there are many supporters of a different hypothesis among specialists. It is generally accepted that the process of urolithiasis begins in the body when the ratio of salts and urine colloids is disturbed.

The classification of stones by chemical composition is as follows:

• oxalates - are formed from salts of oxalic acid;
• phosphates - are formed from calcium phosphate;
• urates - the main component is salts of uric acid;
• carbonates - are formed from calcium salts of carbonic acid;
• struvites are formed from ammonium phosphate.

Classification of stones by chemical composition

In addition, it is necessary to isolate stones of organic origin. These include:

• cystine and xanthine;
• cholesterol;
• protein.

Did you know that open stone operations are being replaced by more gentle surgical treatments? , surgical and conservative treatment, as well as the causes of the formation of calculi.

You will find herbal recipes for various kidney diseases.

Urats

The main feature of urates is their ability to appear in various places of the urinary system.

The age of pathology varies from 20 to 55 years.

The age of the patient directly affects the localization of the stone in the body.

In children and elderly patients, urates are formed in the bladder, in middle-aged people, stones are diagnosed in the kidneys and ureter.

Among the main factors affecting the formation of urates, experts distinguish:

• poor water quality;
• unfavorable ecological situation;
• sedentary lifestyle;
• violations of metabolic processes;
• malnutrition: an excess of sour, salty foods, as well as fried foods;
• lack of B vitamins.

The shape of the stones is round, the surface is smooth, the structure is loose. The color range varies from yellow to brown.

Treatment of stones is associated with the elimination of the inflammatory process. Also, therapy involves the appointment of therapeutic nutrition, taking medications.

Urates or uric acid kidney stones are distinguished by their ability to dissolve quickly, which is why patients are prescribed plenty of fluids and a course of treatment with medicinal herbs.

Considering that urates are a fairly common type of stones and pathology can appear at any age, experts recommend adhering to the elementary rules of a healthy lifestyle: move and eat a balanced diet.

Such preventive measures will help to avoid problems with stones in the future.

Struvites

These formations are classified as phosphate stones.

The formations contain ammonium-magnesium phosphate and carbonate apatite.

Struvites can form only in an alkaline environment affected by infection.

Thus, the main reasons for the formation of struvite stones are:

• alkaline reaction of urine;
• the presence of certain bacteria in the urinary tract.

Struvites are characterized by the ability to rapidly increase in size, filling the entire cavity of the kidney and provoking complications such as sepsis and acute renal failure. It is also worth noting that struvite tends to form in women.

During therapy, it is important that the smallest particles of stones leave the body. Otherwise, the disease will reappear.

cystine stones

A rather rare type of stones, the cause of the formation of which is a genetic pathology - cystinuria.

Children and people at a young age are most susceptible to the appearance of cystine stones.

The main component of the stone is an amino acid.

The main feature of the symptoms of the disease, doctors call constant pain, even after the administration of painkillers.

Treatment of pathology is as follows:

• change in the acidity of urine with citrates;
• special diet;
• drug treatment;
• crushing stones;
• surgery if conservative therapy has failed.

In some cases, the only way to cure the patient is a kidney transplant.

mixed stones

They are formed mainly as a result of long-term use of certain drugs.

The stones combine the characteristics of salt and protein kidney formations.

Treatment in this case is determined individually in each clinical case, depending on the results of the tests and the severity of the course of the disease.

From the author

Five secrets of healthy kidneys.

1. Movement and active lifestyle.
2. Proper nutrition.
3. Kidneys should be warm.
4. Prevent the disease: drink kidney fees, brew half a palu.

And, of course, do not self-medicate. In this situation, any rash act can exacerbate the problem.

Related video

I had no idea there were so many different types of kidney stones. And each type of stone has its own reason. You need to contact a good doctor who will make the correct diagnosis and prescribe a treatment that will help with a particular type of stones.

• If you have not yet gone to the doctor with the question of what type of kami you have, then I warn you in advance that no one will determine this for you, the doctor will prescribe 2 or 3 drugs for good luck from different types of stones, so that during the reception you will guess which one to drink . And what kind of stones you have you will never know from a doctor. And the theory described above exists, only doctors do not use it in practice, at least in a simple clinic. Ha ha ha. ….. Thanks to the authors for the article, good.

  • Nina, what kind of heresy are you talking about? The doctor sends the patient to a biochemical laboratory, where the composition of the stone will be determined. After that, an appropriate diet is prescribed. Doctors are not dumber than you, believe me))

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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.

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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.

1. Acidification of urine
2. 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)
3. 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.