2. 5 kg, 8 year old, mc DSH
Recently rehomed
Previous history of Urinary Tract Disease
Free fed veterinary therapeutic food to
manage struvite urolithiasis
Indoor/Outdoor
Recently urinated blood
3. WNL
BCS 4/5
Bladder not palpable
U/A- blood 3+, protein 2+, pH 7.0
4. Urolithiasis
Urinary Tract infection
Idiopathic
Atypical UTI
Trauma to bladder or urethra
Urethral Stricture
Inflammation
Neoplasia
Iatrogenic
Neurogenic
5. Type of Crystals
◦ Struvite - Magnesium Ammonium Phosphate
Forms in Alkaline Urine
◦ Calcium Oxalate
Forms in Acidic to neutral urine, dependent on the
presence of Oxalate
Others
◦ Amonium Urate, Calcium Phosphate, Uric Acid,
Cystine, Xanthine and Matrix
6. More common in Geriatric cats (12 yr +)
Causes
◦ Bacterial
E.coli, Staph/Strep, Proteus/Klebsiella, etc…
◦ Viral
Can predisposes animals to crystal formation
◦ Not common in cats (70% sterile)
7. Most common in neutered, sedentary,
overweight, castrated male cats
Consuming dry foods
Young adult (1-10 years)
Likely stress related
Frequency of feeding???
9. Depending on the findings, urinary tract
disorders can be treated by:
◦ Nutritional
◦ Medication
Anti-inflammatory
Antibiotics – Useful in UTIs only!!!
◦ Decrease Stress
◦ Surgery
◦ Benign Neglect – Useful in idiopathic only!!!!
10. The most important therapeutic is Antibiotics.
Anti-inflammatories are also helpful.
Idiopathic Cystitis Treatment
• The best treatment is to prevent it
– concentrate on decreasing stress
– increase their water consumption.
11. Urinalysis showed struvite crystals, ph>6.5:
◦ Infection present?
Treat with antibiotics
◦ Do radiographs to look for uroliths,
if present begin calculolytic diet (ex: s/d).
◦ Recheck at 2 weeks
◦ Recheck rads to evaluate for resolution of uroliths
If present, continue feeding food for 1-2 month
12. ◦ If resolution is obtained
continue dissolution for 2-3 months with monthly
monitoring
Then, switch to a preventative diet because the
calculolytic diet has too much NaCl and too acidifying
for long term use
◦ if there is no change in size after 2 months.
Surgery should be considered
Switch to preventative diet (ex: c/d)
◦ Monitor every 6 months with a U/A.
13. Urinalysis revealed calcium oxalate crystals,
acidic pH
◦ Culture urine and treat infection if needed.
◦ Radiograph to look for uroliths,
Make sure to check kidneys and bladder
◦ If present, the only option is surgical removal.
Do post-op radiograph and submit uroliths for
quantitative analysis.
◦ Treat hypercalcemia, if present
14. ◦ Start a diet which prevents calcium oxalate urinary
precipitates (ex: UR St/Ox Urinary by purina).
◦ Avoid vitamin and mineral supplements, urinary
acidifiers, high salt treats and hair ball pastes.
◦ Encourage water consumption.
◦ Recheck urinalysis at 2 weeks and then at monthly
intervals.
15. ◦ If urinary pH is < or equal to 6.5,
add potassium citrate.
◦ If between 6.5-7.5, and no crystals are present,
continue with the therapeutic food and monitor.
◦ If average pH is >7.5,
look for a bacterial urinary tract infection.
◦ If crystals recur, consider vitamin B6
supplementation, restart treatment and continue to
monitor.
16. Water
◦ To flush the bladder of crystals
◦ To prevent supersaturation and crystal
aggregation/formation
Sodium Chloride
◦ Restricted for Calcium oxalate and other crystals
◦ Increased for Struvite, to increase thirst and water
consumption
17. Acidifying agent
◦ To lower the pH to 6.1 for dissolution, and 6.2-6.4
for maintainance
◦ for example Phosphoric Acid
Mineral restrictions
◦ Mg, P, Ca and Oxalate are restricted in the diet to
lower the urine concentration and potential for
supersaturation and formation of crystals
18. Protein - Restricted to 30-45% dry matter
◦ Struvite: prevents the urine pH from being too
acidic, restrict the ammonia in the urine,
preventing struvite synthesis
◦ Calcium Oxalate: minimizes the excretion of
Calcium , Uric Acid and Oxalate
Vitamin D
◦ Restricted to 5,000 IU (max) to lower the
production of Calcium Oxalate
19. Potassium
◦ Increase in K+ affects ammonium synthesis
◦ The acidifying diets increase the excretion of K+
Fat
◦ Moderate levels reduces the overall mineral intake
Fiber
◦ Higher level reduces the amount of Calcium
absorbed
20.
21. NSAIDs
◦ To decrease the inflammation in the bladder that
facilitates the formation of crystals
Environmental enrichment
◦ Reduce stress
Fluids
◦ To correct any dehydrations, only used in server
cases
22. Monthly Urinalysis until resolution of the
urolithiasis
Have the owner monitor for signs of Blocking
◦ Straining to urinate
◦ Painful urination
◦ Persistent or increased blood in the urine
◦ Listlessness, depression, anorexia
Monitor for any weight gain or loss
23. Increase water consumption
Strictly follow the proposed diet plan
◦ Only offer the therapeutic food
◦ Eliminate treats, unless they are safe for urinary
tract health
Decrease the BCS to a normal weight
Decrease the amount of stress
