Urolithiasis in carnivores. Urolithiasis in cats: factors of occurrence, symptoms and treatment. The main cause of urolithiasis is mechanical blockage of the urinary tract.

We talked about the main causes of the disease, as well as the methods of its diagnosis. In the sequel, we will focus mainly on the types of urinary stones and treatment of urolithiasis in cats and dogs.

Types of urinary stones

Type name urinary stone reflects its mineral composition. The most common stones are struvite (magnesium ammonium phosphate), calcium oxalates, urates, cysteates and silicas.

Struvites

The most common type of mineral found in dogs is magnesium ammonium phosphate hexahydrate, more commonly known as - struvite... This type of urinary stone accounts for about 50% of all urinary stones in dogs... Their prevalence in cats is about 30%. The Miniature Schnauzer, Miniature Poodle, Bichon Frize and Cocker Spaniel are the most susceptible dog breeds. Urinary tract infection is a major factor in the formation of struvite stones. With the enzymatic action of some bacteria in bladder dogs urea is produced, which increases it NS by making urine more alkaline and decreasing the solubility of crystals struvite... increases the amount of organic residues in the urine, which undergo gradual crystallization.

Calcium oxalate kidney stones

Detection rate in dogs calcium oxalate stones is about 35% of the total of all stones, while in cats this figure is higher and is 50-70%. Urinary stones extracted from a cat's kidneys or ureters have been diagnosed as calcium oxalates in 70% of cases. Among the dog breeds most commonly affected by calcium oxalates are Miniature and Standard Schnauzers, Miniature Poodles, Bichon Frize, Lhasa Apso, Yorkshire Terrier and Shih Tzu. Of the cats, these are Burmese, Persian and Himalayan cats.

The elderly are also highly prone to salt formation. calcium oxalate... In the kidneys of an animal, they are more common than struvite stones... The reasons leading to the formation oxalate stones still not thoroughly studied, but there is some relationship between the increase in the concentration of calcium in the urine after eating a certain food and the formation of these urinary stones. In cats that show accumulation of struvites, oxalate stones practically do not occur, and there is clearly a certain relationship in this. The results of epidemiological studies support the hypothesis that the developed special diets for urolithiasis to reduce struvite formation, possibly inadvertently increasing the likelihood of formation oxalate stones... Decreased urinary concentration of natural crystal inhibitor and increased intake of mineral-rich foods may also play a role in stone formation calcium oxalate... The appearance of oxalate stones is diverse and depends on what form of oxalate is involved in its formation. The figures show oxalate urinary stones which are formed most often.

Urata

Education urate stones in dogs is due to two different mechanisms. One of them is associated with high excretion of ammonium crystals in cases of pathology of portosystemic shunts. Dalmatian dogs have defects in the transport hepatic membranes of uric acid, and this also contributes to the formation of urat.

A retrospective study to assess the clinical signs and outcomes of surgical treatment in Dalmatians with urate stones showed that blood in urine is found in 85% of dogs, but crystals in only 54%. Most of the dogs affected are males. Contrast x-ray and ultrasound are the most useful diagnostic tools urat.

Cystine stones

Excessive cystine formation in urine is a hereditary transport disorder renal tubules and is considered the main reason cystine stones... With a high concentration of cystine in acidic environment(short NS), stones can form. Most often they form in male dachshunds from 3 to 6 years old.

Silicate stones

Formation mechanism silicate stones completely unknown, however it may be related to the consumption of silicates, silicic acids and magnesium silicate in food components. The formation of these stones is directly related to the consumption of large amounts of gluten in corn and soybeans, in which the concentration of silicates is quite high. Great Danes, Old English shepherd dogs, are most susceptible to their formation, golden retrievers and labradors. Average age morbidity from 6 to 8 years.

Treatment of urolithiasis in cats and dogs

Calcium oxalates, urata, cystine and silicate stones cannot be subjected to conservative therapy, they are insoluble, and require surgical treatment of urolithiasis... Most of them have a high relapse rate. Struvite stones sometimes they can be subject to dissolution with the help of special therapy and a diet specially developed for this purpose.

Prevention of urolithiasis in cats and dogs

Prevention of urolithiasis with struvite stones

Prevention of education struvite stones depends on the restriction in the diet of protein, calcium, phosphorus and magnesium, and an increase in the amount of salts that acidify the urine. Timely treatment urinary tract infection is also important and is a preventive measure.

Prevention of urolithiasis with calcium oxalate stones

Feeding protein- and sodium-restricted, alkalizing diets may reduce recurrence of formation oxalate stones... Potassium citrate can be used to neutralize and slightly alkalize urine. Sometimes high doses of B6 are used for prophylaxis in combination with diuretics.

Prevention of urolithiasis with cystine stones

Meals with low content protein and alkalizing diet are very successful in preventing the formation of cystine stones. ph urine should be above 7.5. Potassium citrate and D-penicillamine are sometimes used for additional alkalinization.

Prevention of urolithiasis with urate stones

Education urat can be prevented by using a low-protein and alkalizing diet. Allopurinol is one drug that helps prevent the formation of uric acid and is sometimes used to prevent urate. Allopurinol should not be given to cats. Urate stones can be prevented in 80% of dogs and 95% of cats.

Prevention of urolithiasis in silicate uroliths

Alkalinization of urine and a low silicate diet are the only methods to prevent urine formation.

Treatment of urinary tract obstruction

Urinary stone obstruction urethra a very dangerous situation. The blockage of the urinary tract must either be removed with the removal of calculus and the emptying of the bladder, or cystocentesis must be performed (puncture of the filled bladder with a needle through abdominal wall) if the calculus cannot be removed.

Urinary stones trapped in the urethra can be displaced and pushed back into the bladder using a technique called retrograde flushing.

The blockage can also be overcome with a technique called urinary flushing. (fig. 1). After the stones blocking the canal are removed, the stones remaining in the bladder are removed surgically.

Figure 1 - Urination washout

Surgical treatment of urolithiasis in cats and dogs

Surgical removal procedure urinary stones depends on where exactly in the urinary tract they are located. The procedure for removing them in the bladder is called cystotomy... When stones are located in the urethra and urethra, - urethrotomy... Sometimes, if the urethra is completely obstructed, a urethrostomy is performed to create a complete and permanent outflow and prevent possible obstruction. A perineal urethrostomy is often done in cats with blockages.

Laser lithotripsy- the least invasive removal method urinary stones, which has been tested and applied relatively recently. This procedure requires advanced laser and endoscopic equipment and high performance techniques. In some cases, the procedure is performed through the urethra, but sometimes a small incision is made in the bladder, and a laser fiber endoscope is inserted through this canal into the urinary tract and then into the upper part of the animal's urethra. Laser lithotripsy most applicable for blockage of the urethra with no a large number cystic stones.

Urinary stones that form in the kidneys can be removed with nephrotomy... Most veterinarians are quite professional in performing cystotomy, however, urethrostomy, urethrotomy, and nephrotomy require special surgical preparation and not every specialist can handle it. It should be performed by a surgeon with at least 5-7 years of experience in this area.

Urolithiasis disease(urolithiasis)

Urolithiasis disease(urolithiasis) – the disease is characterized by the formation of urinary stones and sand in the kidneys and urinary tract... Animals of all kinds are sick, but most often young sheep, cattle and minks.

The disease often takes on a massive spread among bulls in specialized cattle fattening complexes. Sick animals are difficult to treat and must be discarded.

Etiology . The main cause of urolithiasis is a violation of vitamin and mineral metabolism in the body, especially a lack of retinol and a violation of the drinking regimen.

Desquamated epithelium with hypo- and avitaminosis A serves as the basis for the crystallization of salts in it and the formation of stones. These violations are usually observed with a concentrate type of feeding with the inclusion in the diet of a large amount of meat and bone or fish meal and various mineral premixes.

Symptoms . Clinical signs depend on the location of the stones and their size. With the formation of small stones and sand, painlessly leaving the urethra, there are no pronounced symptoms. Vivid clinical signs of the disease appear when stones cover an area of the urinary tract. With partial blockage, there is periodic pain when urinating, urine is excreted intermittently, in a thin stream or drops. With complete blockage, severe colic is noted, animals groan, gnash their teeth.

In urine with urolithiasis, leukocytes, erythrocytes, deflated epithelium, small stones, urine sand are found.

With the development of inflammation, symptoms of pyelitis, urocystitis, urethritis arise, the number of leukocytes in the urine increases.

Diagnosis and differential diagnosis . The diagnosis is based on the characteristic clinical symptoms and laboratory tests of urine, in necessary cases perform fluoroscopy and rectal examination.

Urolithiasis must be differentiated from nephritis, pyelitis and urocystitis.

Treatment . Small stones and sand can be removed with various diuretics and antispasmodics. In some cases, the removal of stones is facilitated by catheterization and flushing of the bladder and urethra. Large stones are removed surgically. In case of complication of urolithiasis by the inflammatory process, treatment is prescribed, as in pyelitis and urocystitis. In all cases, to prevent the re-formation of stones, it is necessary to organize full feeding and provide plenty of water.

Prophylaxis is based on adherence to the technology of feeding, drinking and keeping animals, providing them with active exercise. In addition, inflammatory diseases of the bladder and urinary tract should be promptly treated.

Moscow Veterinary clinic "Alisavet"

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

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

Urolithiasis refers to polietiologic diseases with complex physicochemical processes occurring not only in the urinary system, but also in the whole body, both congenital and acquired.

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

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

There are over 200 known conditions that can potentially lead to stone formation in the urinary system.
For example:

physical inactivity (domestic lifestyle of cats and dogs)
hypoxia
taking a small amount of liquid (mixed feed, various treats affect the animal's liquid intake)
disruption of the regular normal flow of urine through the urinary tract
oversaturation of urine with salts
change in urine pH
the appearance of difficultly soluble salts
urinary tract infections
eating foods with an excess of substances that contribute to stone formation
Stress, etc.

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

Etiology and pathogenesis of ICD

One of the important reasons urolithiasis in animals is a violation of water-salt metabolism. Metabolic (dysmetabolic) nephropathy unites a group of diseases in which metabolic disorders occur, 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.

Great importance also has a change in the chemical composition of the blood, which occurs with infectious diseases, intoxications, diseases of the liver and gastrointestinal tract (hepatitis, gastritis, colitis). In the formation of urolithiasis, diseases of the endocrine glands play a role, such as thyroid, parathyroid gland, pituitary gland.

Main hypothesis at the heart of animal urolithiasis (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 nucleus of a future stone. It is joined by fibrin, blood corpuscles, bacteria, remnants of epithelial cells and, finally, sparingly soluble salts when they are excessively present in the urine.

Concrements 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 mouth 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 and 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 one) 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 finally confirmed. In the course of collecting data and generalizing the available material, we established the fact, as a rule, of bilateral formation of stones, at once in both kidneys. It is not uncommon for stones to form in the non-canal lumen, not in the intratubular lumen, but in the intracapsular localization of calcifications, which in turn complicates treatment, surgery in such cases it is completely excluded.

With sharp and frequent fluctuations in pH, uncontrolled use of litholytic (dissolving stones) drugs, complex composition, the so-called "coral" stones, are formed. Concrements injure the kidneys and urinary tract, contribute to their infection, and 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.

Large stones often exist for a long time without causing significant lesions.

The process of stone formation can be explained by the theory of the matrix. 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 be either 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 - into general (characteristic of the whole body) and local (directly related to changes in the normal state of the kidney and urinary tract) .Exogenous pathological factors include climatic, geochemical conditions, dietary habits. 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. The nature of feeding dogs and cats is of great importance, which in turn affects the composition of the urine and its pH. Vegetable and dairy food promotes alkalinization of urine, meat food - its oxidation. Drinking water, supersaturated with calcium salts, reduces the acidity of urine and causes an excess of calcium salts in the body. Endogenous factors contributing to the occurrence of urolithiasis include hyperfunction parathyroid(hyperparathyroidism), cause disorders of phosphorus-calcium metabolism. The presence of vascular abnormalities of the liver, as a rule, in the form of shunts between the portal vein and the general venous system, is important, which affects the synthesis of purines, as a result, the formation of lactic acid increases. Local endogenous factors play an important role in pathogenesis - changes in the normal state of the kidney and urinary tract, primarily factors leading to urinary stagnation, 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 with urolithiasis, there are:

urata
calcium oxalates
calcium phosphates
calcium carbonates
Urolite
Mixed
Matrix

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

Cause% percentage of cases

Idiopathic 64.2

Stone in the urinary tract 12.8

A stone in the urinary tract -

+ their infectious lesion 1.8

Urinary tract infection 0.9

Neoplasms 1.8

Anatomical deviation 9.2

Conduct disorders 9.2

It is possible to start the treatment of urolithiasis after the nature of the accumulating salts has been established, since inadequate dietary and therapeutic measures can contribute to the formation of difficult stones.

Surgical removal of stones, as well as distance 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, with blockage of the ureter by a large stone, which cannot be eliminated by urgent conservative therapy and threatens the development of hydronephrosis and anemia.

An approximate algorithm for 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, urine protein / creatinine ratio

Tank. Urine culture (centesis only)

Density of urine with a 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 regular emptying of the bladder.

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

Treatment and prevention of struvite formation

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

Acidification of urine
An increase in urine volume and a decrease in its density (an increase in urine volume also reduces the time it takes for crystals to pass through the urinary tract and thus the time for crystals to grow)
Reduced consumption of potential sources of struvite crystals in feed.

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

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

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

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

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

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

Treatment and prevention of the formation of uroliths from calcium oxalate

The pathogenesis of urolithiasis with calcium oxalate uroliths has been much less studied than in the case of struvite. There is information obtained during clinical trials, however, 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. indicators are within normal limits, and stones in the bladder and kidney are formed quickly. During the study of the stone, it turns out that it is calcium oxalate.

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

Diets that stimulate urine production and increase the volume of urine should prevent crystallization of calcium oxalate 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 increased urinary calcium

Hyperuricuria (23-35.85) increased content uric acid in the blood

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

Hyperoxaluria - (8.1-32%) one of the forms of oxalic acid metabolism anomaly - oxalose.

Hypomagniuria (6.8-19%) Disorders of magnesium metabolism

As a rule, hypercalciuria is combined with hyperoxaluria. Moreover, the latter, along with hypocitraturia, some authors recognize 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 for the treatment of this pathology. We must try to study all the mistakes of previous years, and understand the new direction in the etiology and pathogenesis of the disease.

Oxalate-type ICD, as a rule, appears in animals aged five years and older. Both sterilized and non-sterilized animals are ill with it. The urine pH may be within the normal range or less than 6.0.

The tactics of allopathic medicine and its capabilities at this stage do not give a visible result of the cure. This means that we should look for ways of treatment and other planes of pharmacology.

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

Veterinary clinic Alisa leads continuous work on the methodological 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 ICD.

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 excretion of oxalic acid depends on calcium intake. Several population studies have found an inverse relationship between the amount of calcium consumed and the risk of stone formation. So 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 calculi. One of the most common methods of preventing the formation of calcium oxalate stones is to reduce the amount of oxalate taken from food. However, dietary restriction of oxalate cannot be reliable method prevention of 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. V recent times results were obtained indicating the effect of the gram-negative obligate anaerobe Oxalobacter formigenes on the concentration of oxalate in 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.

Not being pathogenic for the human body, O. formigenes establishes symbiosis using oxalates as a food source, as a result of which the absorption of oxalates in the lumen of the colon decreases in humans. O. formigenes has a unique role 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 following a diet low in calcium.

Data from various authors show a direct relationship between the level of urinary oxalate excretion and O. formigenes colonization. So Gnanandarajah J. et al. Stool samples from healthy dogs and those with calcium oxalate urolithiasis were examined for colonization by anaerobes. The results showed that colonization occurs in 25% of dogs with ICD versus 75% in healthy dogs. The authors suggested that the absence of colonization by O. formigenes is a predisposing factor for the development of calcium oxalate urolithiasis.

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

It is known that a number of antibiotics affect the safety of O. formigenes.

The strain has demonstrated resistance to amoxicillin, ceftriaxone, doxycillin, gentamitsin, levofloxacin, metranidazole and tetracycline.

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

The study of colonization of the large intestine by this microorganism and its correction, possibly, will improve the results of anti-relapse therapy of oxalate urolithiasis.

Veterinary clinic "Alisavet", Moscow

Data on O. formigenes are kindly provided by GOU VPO " Military-medical Academy them. CM. Kirov ", Department of Urology, St. Petersburg. A.Yu. Shestaev, M.V. Paronnikov, V.V. Protoschak, P.A. Babkin, A.M. Gulko.

02 February 2017

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Introduction

Disease of the lower urinary tract in cats is a major problem in modern veterinary medicine for small animals. The most serious disease of the urinary tract is recognized as urolithiasis and associated complications, for example, feline urological syndrome. Urolithiasis is widespread, difficult to treat, persistently relapses, accompanied by high mortality. In cats, urolithiasis was first described in the early 20th century. Since then it has been found that cats urological diseases occur 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 proportionate mortality rate from urolithiasis than humans and dogs. That's why this problem goes beyond veterinary medicine and becomes socially significant. Unfortunately, until now it has not been possible to give unambiguous answers to questions about the causes of the development of the disease and its pathogenesis. Although a lot of research has been devoted to urolithiasis in both humane and veterinary medicine. A large number of proposed various methods of treatment, developed by scientists and practicing veterinarians, testifies not only to the urgency of this problem, but also to the dissatisfaction of many specialists with the results of treatment of urolithiasis in cats.

1. Definition of disease

Urolithiasis (Urolithiasis) 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

The 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;

· absence free access to drinking water (or poor water quality);

· Urinary tract infections (especially streptococcal and staphylococcal).

Most of these reasons 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 testes, can lead not only to hormonal imbalance, but also to the narrowing of the already narrow urethra (urethra).

Cats of breeds such as the Persians have a genetic predisposition to urolithiasis, most of all to the formation of triple phosphates. In castrated cats, phosphate stones form very quickly. In addition to Persians, long-haired Himalayan and Burmese cats are most susceptible to oxalate urolithiasis, which occurs in about 25% of cases of KSD disease. In general, ICD is detected in about 7% of cats admitted to veterinary clinics.

The urethra in cats is already quite narrow, and with high content in the diet of fish and dairy products, crystals of phosphorus and calcium salts fall out in the urine, which leads to spasms and urinary retention, with the subsequent occurrence of a urinary tract infection and the development of acute renal failure. Males are most susceptible to ICD, since 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 provides a change in the acidity (pH) of urine. These can be calcium phosphates, calcium carbonates, calcium oxalates, urates, and struvite (complex salts of ammonium, magnesium, phosphorus and calcium). Urates consist mainly of uric acid salts (on the surface of these stones there are spines that injure the vascular walls, contributing to inflammation), and phosphates - from calcium and magnesium phosphate. Phosphate and struvite stones form mainly in alkaline urine and grow very quickly. The hardest stones are oxalates, they are formed from salts of oxalic acid and are found, like urates, mainly in acidic urine. This is why normalizing the pH of urine slows down the formation of crystals and dissolves existing ones. Carbonates are formed from salts of carbonic acid, they are soft, easily crumble and make up the bulk of the sand in urine.

Uroliths are formed by the aggregation of mineral crystals. But the urethral plugs are composed of a protein matrix, which usually contains many mineral crystals. Both uroliths and urethral plugs can lead to inflammation and obstruction of the lower urinary tract.

Many feline uroliths 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 the 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 urine shifts to the acidic side for urates, oxalates and to the alkaline side for phosphates (the norm is 6.5 - 7), the density of urine increases. The animal refuses to eat, is depressed, often licks the perineum. With a blockage of the urinary tract, urinary colic is observed, the animal is restless, makes restless sounds when urinating, during urination it takes an unnatural posture (hunches over), lingers in it for a long time, the pulse rate, respiration rate, and temperature increase. The animal experiences pain when touched on the stomach, goes to the toilet more often (or vice versa, it can urinate anywhere), the amount of urine decreases, urine may be cloudy or mixed with blood (hematuria), urination is difficult (or vice versa, very frequent and painful) or may be absent altogether.

4. Diagnosis

Anamnesis. In the course of the survey, it is usually possible to find out the main events in the development of the disease preceding the patient's admission to the veterinary specialist: when the first signs of the disease appeared, whether there were such disorders before, whether there was an appetite, whether the patient is taking 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 the anamnesis, a general clinical study is started.

Inspection. Many urological sick cats and cats, even in a new environment for themselves, at the doctor's appointment, take a forced position of the body for urination, sometimes releasing a small amount of turbid or bloody urine. Tousled, matted hair, sunken eyes, dry mucous membranes, shortness of breath indicate a long-term disease. With acute urinary retention in patients, severe neurological disorders can be found: nystagmus, muscle twitching, forced position of the head - flexion of the occipital-atlas articulation, "glance from under the brows." Rarely enough, the overflow of the bladder is visually determined: a sagging asymmetric abdomen. When examining the perineum, you can find dried fragments of urethral plugs, salt crystals, blood clots, in cats "forced" paraphimosis.

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

Palpation. When palpation examination of a urological patient, it is necessary to determine the state of the bladder. In most patients, the walls of the organ are moderately or severely painful, thickened. When acute delay urine soreness increases, and the filling of the bladder rarely exceeds 350 ml, and the bladder fills a larger volume abdominal cavity... Palpation should be performed before and after obstruction and bladder emptying. 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 crepitus of calculi. If the kidneys are available for examination (in obese animals, the kidneys are poorly accessible for palpation), their location, shape, soreness, and size are determined. This provides valuable information to rule out kidney disease not associated with feline urolithiasis. By palpation, in general clinical conditions, it is possible to determine the degree of dehydration and impaired hemomicrocirculation in urological patients.

Study of the urethra. Palpation of the urethra in cats is of considerable clinical interest. It is passed through the skin of the penis from the level of the sciatic arch to the head of the penis, often revealing urethral uroliths or the site of localization of other obstacles to the outflow of urine. Having exposed the head of the penis, they examine the state of the mucous membrane of the preputial sac, the head and the urethra, often find a hyperemic mucous membrane of the urethral opening, urethral plugs of various composition. In some patients, the urethral plug is extremely firmly "soldered" with the mucous membrane. In severely dehydrated cats, dry necrosis of a portion of the glans penis may occur. Light massage 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 obstruction of the urethra and parietal calculi. It should be noted that the more proximal the obstacle is, the less organic matrix it contains, the more difficult and traumatic the procedure for eliminating the obstruction 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. Probes are used for ultrasound of the urinary tract of cats high frequency 5-7.5 MHz, providing the most reliable image of the internal organs. To ensure full contact of the probe with the patient's skin, shave off the hair from the area of interest. The bladder is scanned in the transverse and longitudinal planes, changing the position of the patient's body, that is, using a polypositional study.

· Radiographic examination - is of secondary importance in the diagnosis of feline urolithiasis. Stones in the bladder and urethra in cats are usually small and correspond in density to soft tissues... However, it is impractical to completely abandon radiography, since in addition to overview shot, it is possible to perform a contrast radiograph, including with double contrast, urethrocystography and emergency urography, allowing not only to diagnose urolithiasis, but also to carry out differential diagnostics.

Laboratory research methods:

Biochemical examination of urine using diagnostic strips is a simple and rather effective method of express diagnostics, with the help of which the following urine parameters can be determined within 1-1.5 minutes: pH, specific gravity, amount of protein, ketone content, content of bile pigments , microhematuria, microhemoglabinuria. The method has a significant drawback - with severe macrohematuria, the indications are significantly distorted and do not represent diagnostic value.

· Studies of urine sediment are carried out by microscopy under low and medium magnification. To obtain a sediment, freshly obtained urine is centrifuged at 1000-1500 rpm for 5-7 minutes. The non-sedimentary liquid is decanted, the sediment is placed on a glass slide and covered with a cover. 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, and cylinders. Significant gross hematuria interferes with obtaining a "readable" urine sediment. In such cases, it is reasonable to conduct microscopy of urethral plugs and calculi to approximately determine the type of crystals. Microscopic findings of urine sediment and urethral contents are almost always the same.

5. Treatment and prevention

Treatment is aimed at eliminating pain syndrome, increasing the solubility of salts, loosening stones, 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-kure, enrofloxacin, albipen LA), sulfonamides (urosulfan, sulf-120), the drug "Erwin Cat" (in case of 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 supersaturation with calcium and phosphorus salts. To stimulate the smooth muscles of the urinary bladder, gamavit or catazole are recommended, to eliminate urethral plugs - catheterization and washing the urethra with Erwin Cat (16 ml per dose), hot baths (40єC) when the cat is immersed to half the body, anti-inflammatory therapy - dexafort ...

Cats should not be used medical drugs containing glycerin and essential oils - urolesan, cystenal, pinobin, phytolysin, as this can be fatal. You can use avisan, tsiston, but the dosage of these drugs is designed for a person, therefore, it is necessary to take into account not only the weight of the cat, but also its sensitivity to the plants that are part of 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 method of treatment is the most dangerous for the following reasons:

* it injures tissue, which leads to fibrosis and scarring, followed by narrowing of the urethra;

* introduces infection into the urinary tract.

2) Retrograde lavage of the urethra.

Retrograde urethral lavage followed by dissolution (struvite, urate, and cystine) or cystotomy (calcium oxalate, other calcium and silica-containing uroliths) is the only treatment for urethral urolithiasis.

The technique of retrograde flushing of urethral calculi. The animal is given general anesthesia or strong sedatives. Then the following actions 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 (an assistant is needed for this).

* A sterile catheter is inserted into the distal urethra.

* Fasten the penile urethra around the catheter.

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

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

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

* You can repeat the procedure several times.

Relapses of obstruction are very rare after retrograde lavage. In cats, this method, as a rule, is not used; in males, this low-traumatic method is often recommended for use.

3) Urethrostomy.

Urethrostomy is used in males when manipulation or retrograde lavage has not been successful. 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 persistent urethral obstruction, it must be used with caution because some reports indicate that 17% of male urethrostomy cases result in postoperative urinary tract infection. In 10% of cats, urethrostomy and dietary changes also result in postoperative infection, while none of the cats treated with a diet has a urinary tract infection.

4) Dissolution.

You can dissolve struvite, urate and cystine calculi. This is the only non-life threatening method of stone removal in animals with urolithiasis. Dilution is used for kidney or bladder stones. If a urinary tract infection is present, antibiotics are given as part of treatment based on urine culture and susceptibility testing. Details of the treatment are discussed below.

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

These foods will acidify the urine, causing the struvite to dissolve. In addition, the increased sodium content of these diets stimulates diuresis (urination), which helps to flush the bladder and eliminate accumulated salts as quickly as possible. With uncomplicated bacterial infections urolithiasis treatment special diets brings positive results already 4-5 days after the start of treatment. It should be noted that the earliest possible visit to the veterinarian and early staging the diagnosis of urolithiasis contributes to the speedy recovery of the animal and minimizes possible relapses of the disease. It is of great importance that the owner adheres to the feeding regime 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 in the images, the treatment is recognized as effective and the owner's task in the future is a mandatory urine test at least once every six months. The optimal time for control tests is 3 months.

The pH of urine is assessed in a laboratory, as well as the presence and analysis of urine sediment, determination of the type and amount of urinary crystals.

5) Treatment of insoluble uroliths.

Calcium oxalates.

Oxalatocalcium uroliths are more common in certain dog breeds ( yorkshire terriers and miniature schnauzers), and in last years they became more common, especially in cats.

Unfortunately, this type of crystal is completely insoluble, and the treatment of this type urolithiasis is performed exclusively surgically, by removing stones from the bladder. Sometimes 3-4 operations are required per year if the rate of formation of oxalates is very high.

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

Calcium phosphates.

Phosphate-calcium crystalluria is manifested in different forms: both amorphous (calcium phosphates) and calcium hydrogen phosphates (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 sensitive to urine pH and are formed 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 oxalate urolithiasis) is recommended, but not alkalinization of the urine.

6) Pulsed magnetic field.

Also, in practice, they use a method for treating KSD using a pulsed magnetic field, not only promoting the dissolution of uroliths, but also providing anti-inflammatory and local analgesic effects. Relief comes in all but the most neglected cases.

7) Homeopathic treatment.

Monitoring the condition of the mucous membrane of the bladder and urethra in cats with ICD is of great importance.

For this purpose, long-term therapy with the use of preparations berberis-homaccord and mucose compositum. Medicines can be given with drinking water 2-3 times a week.

In case of 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 chronic pyelonephritis, then the main treatment is best done with the drugs Kantaris compositum and Berberis-homaccord.

8) Herbal medicine.

Assign when chronic course 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 micro-urolite crystals. It is recommended to use phytoelite preparations " Healthy kidneys"And" Erwin the Cat ". From herbs: decoction of bearberry leaves (bear ears), half-pala infusion (erva woolly), parsley rhizomes, bird knotweed, watercress, etc.

9) Diet therapy.

At present, feeds are more effective in preventing struvite uroliths, thus the percentage of oxalate uroliths inevitably increased.

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

The increased incidence of oxalate urolithiasis in cats has contributed to the development of Hill's Prescription Diet Feline x / d, which was formulated specifically to prevent calcium oxalate urolith formation and recurrence of calcium oxalate urolithiasis. Carefully selected and tightly controlled calcium levels inhibit crystal formation. D helps to avoid excessive absorption of calcium from the intestine.The increased content of potassium citrate, which can form soluble salts with calcium, contributes to the partial breakdown of oxalates, and soluble fiber promotes the binding of calcium in the intestine.

Both struvite and oxalate are most commonly found in overweight, domesticated cats with little water intake - the first two interfere with urinary frequency and lead to urinary retention, while the latter increases the concentration of minerals in the urine. However, if struvites are more common in young animals (up to 5 years old), then the risk of developing oxalate uroliths is greater in older cats (over 7 years old).

Although there are general principles for preventing both types of ICD, 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 tightly controlled. Hence, there is no diet that is appropriate for controlling both types of stones.

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

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

· Maintaining adequate water intake to ensure an adequate amount of urine. Increasing water intake will increase the volume of urine produced and dissolve the crystal forming substance. The volume of urine is usually higher in cats on a canned diet. Also, if the feed is easily digestible, then this reduces the amount of dry matter in fecal matter, which requires less water. In this way, faecal water loss is reduced, which allows water to be excreted in the urine.

Avoiding excessive consumption of those minerals that are constituent parts urolite, 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 just one of these may mean that the other is free to be absorbed and then 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 the restriction in the intake of calcium and oxalate occurs for a long time and together. There should be no strong reduction in calcium intake and absorption can be reduced by binding to soluble fiber.

Prevention.

Prevention consists primarily of controlling 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 mature cats (6-9 years old), the likelihood of developing phosphate stones (struvite) decreases, but the risk of developing oxalate stones increases, especially if the urine is too acidic. In order to limit their formation, it is recommended to apply measures to reduce the acidity of urine. But in older cats (over 10 years old), the formation of oxalate crystals should be most of all feared: urine with a neutral acidity index when potassium citrate is added limits the danger of their formation. For the prevention and dissolution of urate stones, allopurinol (a xanthine oxidase inhibitor) is used. Shown is cranberry juice, which lowers the pH of urine and prevents the formation of uroliths. Lovely prophylactic is a phytopreparation "Cat Erwin". To restore the body of postoperative intervention, a trace element preparation gamovit-plus is shown.

Conclusion

urethral urethral cat chronic

Currently, urolithiasis is very common, the incidence is widespread. Both domestic and wild animals are at risk of developing ICD, 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 treat completely and the risk of its recurrence is high. Therefore, the ICD is an extensive field for the study and development of new modern methods treatment.

It should be noted that feeding with specialized feeds can reduce the risk of MCD, since such feed has a balanced composition, suitable for the characteristics of the organism. a separate kind animals.

Literature

1. E.M. Kozlov Feline urolithiasis. N .: MAG TM, 2002 .-- 52p.

2. Ed. A.F. Kuznetsova Veterinary Medicine Handbook - St. Petersburg: Publishing House "Lan", 2004. - 912s.

3. S.V. Starchenkov Diseases of small animals: diagnosis, treatment, prevention. Series “Textbooks for universities. Special literature ". - SPb .: Publishing house "Lan", 1999. - 512s.

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 add. - Rostov n / a: ed. "Phoenix", 2002. - 448s.

5. A. Sanin, A. Lipin, E. Zinchenko Veterinary reference book of traditional and non-traditional methods of treatment of dogs. - 3rd ed., Revised and added. - M .: ZAO Tsentrpoligraf, 2007 .-- 595s.

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