Evaluation of a dry therapeutic urinary diet and concurrent administration of antimicrobials for struvite cystolith dissolution in dogs.

BACKGROUND: Struvite urolithiasis with bacterial urinary tract infection (UTI) is commonly reported in dogs; few data exist to describe successful dissolution protocols in dogs with naturally occurring disease. We hypothesized that a dry therapeutic urinary diet combined with targeted antimicrobial therapy can effectively dissolve presumptive struvite cystolithiasis in dogs with naturally occurring urease-producing bacterial UTI. RESULTS: Ten dogs with presumed infection-induced struvite cystolithiasis based on lower urinary tract signs (LUTS), radiodense cystoliths, and urease-producing bacterial UTI were enrolled. At enrollment, antimicrobials and dry therapeutic urinary diet were dispensed. In addition to lack of radiographic resolution of urolithiasis, dogs with persistent clinical signs were considered non-responders. There was no significant difference in pH between responders and non-responders; USG was significantly higher in the responder group. Recheck visits continued until radiographic dissolution or failure was documented. Five of the 10 dogs achieved radiographic dissolution of cystolithiasis within a median of 31 days (range 19-103). In the other 5 dogs, surgical urolith removal was necessary due to persistent LUTS (3 dogs within 2 weeks) or lack of continued dissolution noted radiographically (1 dog with numerous cystoliths failed at day 91; 1 dog failed by day 57 with questionable owner compliance). CONCLUSIONS: Dissolution of urinary tract infection induced struvite cystoliths can be accomplished in some dogs fed this dry therapeutic urinary diet in conjunction with antimicrobial therapy. Case selection could increase the likelihood of successful dissolution; however, if calcium phosphate is present, this could also prevent stone dissolution. If clinical signs persist despite diet and antimicrobials, stone removal is advised.

Use of Purina Pro Plan Veterinary Diet UR Urinary St/Ox to Dissolve Struvite Cystoliths.

The objective of this study was to determine the efficacy of feeding the commercially available diet, Purina Pro Plan Veterinary Diets UR Urinary St/Ox, for the dissolution of struvite cystoliths in cats with naturally occurring disease. Twelve cats with clinical signs of lower urinary tract disease and cystoliths confirmed via radiographs were enrolled. The cats were fed the study diet ad libitum and assessed by abdominal radiographs weekly. Cats with cystoliths that resolved based on radiographs and confirmatory ultrasound examination were considered diet successes. Cats with no change in cystolith size after 2-6 weeks underwent cystotomy for stone removal, aerobic culture and antimicrobial susceptibility testing, and analysis. All cats accepted the study diet, and weight loss was not noted over the course of the study. Total cystolith dissolution was achieved by week 2 for 5 cats, which were presumed to have struvite cystoliths. All other cats underwent cystotomy for stone removal after radiographic evidence of cystoliths were still present at 2 weeks (1 cat with severe signs), 4 weeks (5 cats), or 6 weeks (1 cat). The cystoliths that were surgically removed were calcium oxalate (5 cats) and mixed (2 cats) and would not be expected to dissolve with this diet. Follow-up radiographs from 6 cats fed the diet long term (3 presumed struvite and 3 with other cystoliths removed surgically) were collected from 1 to 6 months after beginning the study and showed no evidence of cystolith recurrence. While larger case numbers are needed, these results suggest that feeding Purina Pro Plan Veterinary Diets UR Urinary St/Ox can successfully dissolve cystoliths that are likely struvite and may lessen the risk of recurrence of struvite and calcium oxalate cystoliths.

Effects of two calculolytic diets on parameters of feline mineral metabolism.

OBJECTIVES: To evaluate the influence of two feline calculolytic diets on selected parameters of mineral metabolism. MATERIALS AND METHODS: Two dry commercial diets designed for struvite urolith dissolution were evaluated in 14 cats. The study was designed as a two-sequence, four-period crossover protocol with a baseline period, two 60-day "run-in" periods in which calculolytic diets (Diet 1 and Diet 2) were fed and one 30-day "wash-out" period. Data are expressed as median (range). RESULTS: Feeding the calculolytic diets for two months did not alter plasma concentrations of calcium, phosphorus, magnesium and parathyroid hormone. A significant (P < 0.05 in each case) decline in calcitriol was observed after administering both diets from 236.4 (122.4-429.6) to 170.4 (108.0-394.3) pmol/L (Diet 1) and from 278.4 (153.6-492.0) to 177.1 (87.6-392.4) pmol/L (Diet 2). Cats fed Diet 1 showed a significant increase in urine calcium concentration (from 0.3 (0.2-0.5) to 0.4 (0.3-0.7) mmol/L). Magnesium concentration in urine was significantly increased with both diets, from 1.4 (0.1-1.7) to 1.5 (1.3-2.4) mmol/L (Diet 1) and from 1.1 (0.4-1.9) to 2.0 (0.1-3.1) mmol/L (Diet 2). CLINICAL SIGNIFICANCE: Both diets resulted in an increased urinary concentration of magnesium, through different mechanisms: urine acidification (Diet 1) and increased sodium load (Diet 2).

Unusual presentation of celiac disease presenting with renal complications.

Celiac disease is a chronic inflammatory condition of small intestine resulting due to sensitivity to wheat protein gluten. Most patients in the childhood present with primary gastrointestinal complaints. The authors present here two young girls with renal complaints later diagnosed to have celiac disease.

A diet with a struvite relative supersaturation less than 1 is effective in dissolving struvite stones in vivo.

Magnesium ammonium phosphate (struvite) is one of the most common minerals found in feline uroliths. Previous studies have shown the efficacy of acidifying calculolytic diets (inducing urine pH < 6.5), in dissolving struvite stones in cats. Recent work in our laboratory found that wet and dry test diets induce a struvite urinary relative supersaturation (RSS) < 1 and that the urine of healthy cats fed the dry test diet dissolved feline struvite stones in vitro. The objective of the present study was to demonstrate the efficacy of those test diets on naturally occurring struvite urocystoliths in cats. A total of twenty-one cats were used, of which seventeen completed the study. Of the seventeen cats, eight were fed the wet test diet and nine the dry test diet. Uroliths dissolved in a median of 18 (10-55) d. In the remaining four cats, uroliths failed to dissolve and were removed surgically. Quantitative analysis showed that these uroliths contained either calcium oxalate or calcium phosphate. The present study demonstrates that diets that induce a struvite RSS < 1 result in struvite stone dissolution in vivo.

Evaluation of the efficacy of a commercial diet in the dissolution of feline struvite bladder uroliths.

Clinical signs of struvite urolithiasis resolved in an average of 19 days in cats fed either a canned or dry urine-acidifying, magnesium-restricted diet, and stones completely dissolved in 31 of 39 cats in an average of 30 days. Stones were surgically removed from five cats, and analysis revealed that these stones were not composed of struvite. The results of this study strongly suggest that the diet will dissolve naturally occurring feline struvite bladder uroliths.

A influência de diferentes dietas na excreçäo urinária de cálcio, sódio, ácido úrico e uréia / Influence of different diets on urinary excretion of calcium, sodium, uric acid and urea

Litíase do trato urinário apresenta nítida associaçäo com hábitos alimentares. Procuramos analisar a influência de diferentes dietas: vegetariana, hiperprotéica e hipercálcica na excreçäo de vários constituintes urinários responsáveis pela formaçäo de cálculos renais em nove indivíduos normais. Observamos que a dieta vegetariana diminuiu, de forma significativa, a excreçäo urinária de cálcio, sódios, ácido úrico, uréia e creatinina. Desta forma, este tipo de dieta pode ser útil no tratamento de pacientes portadores de cálculos renais no sentido de diminuir a recorrência de litíase

Dietary management in urolithiasis in the dog.

Struvite uroliths are found more frequently than other types of uroliths in the urinary tracts of dogs. Medical dissolution of struvite uroliths with a Swedish calculolythic diet has been evaluated. The palatability of the diet was good and only two out of a total of 69 dogs in the study could not be maintained on the diet because of diarrhea. In 19 of 33 dogs medically treated, the uroliths were dissolved over a period of one to 6 months (mean time 2.5 months). In the remaining dogs uroliths were surgically removed, and calculolytic diet was postoperatively given. Consumption of the calculolytic diet was in most cases associated with a lowered specific gravity and pH of the urine. A representative case report of medical dissolution of struvite uroliths located in the urinary bladder of a 9 year-old female cocker spaniel with a history of recurrent urolithiasis is described. It is concluded that the Swedish calculolytic diet can be used successfully to dissolve struvite in adults dogs.

Evaluation of a calculolytic diet in female dogs with induced struvite urolithiasis.

The calculolytic effect of a diet designed to reduce the urine concentration of urea, P, and Mg was evaluated in female Beagles with induced urease-positive urinary tract infections and struvite urolithiasis and in female Beagles with induced sterile struvite urolithiasis. The reduced-protein calculolytic diet induced urolith dissolution in 5 of 6 infected dogs with struvite urolithiasis in 2 to 5 months (means = 14.4 weeks). At the end of 6 months, uroliths in comparable control dogs fed a maintenance diet were 5 times larger and 14 times heavier than at the beginning of the study. The calculolytic diet induced urolith dissolution in 6 of 6 noninfected dogs with struvite uroliths in 2 to 4 weeks (means = 3.3 weeks). Four uroliths in noninfected dogs fed the maintenance diet dissolved over a period of 2 to 5 months (means = 14 weeks). Urolith dissolution in dogs fed the calculolytic diet was associated with diet-induced diuresis, reduction in urine pH, reduction in urine concentration of urea ammonia, P, and Mg, and increase in urine titratable acidity. Consumption of the calculolytic diet was also associated with significant (P = less than 0.01) reduction in the serum concentration of urea and albumin and a significant (P = less than 0.01) increase in serum hepatic alkaline phosphatase activity. Concomitant occurrence of hydropic degeneration of hepatocytes indicated that these biochemical and morphologic changes were associated with dietary protein restriction.