Medical management of urolithiasis

image of Medical management of urolithiasis
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Urolithiasis is a general term referring to the causes and effects of stones anywhere in the urinary tract. Urolithiasis should not be viewed conceptually as a single disease with a single cause but rather as a sequela of multiple interacting underlying abnormalities. This chapter examines Diagnostic imaging for cystoliths; Diagnostic imaging for nephrolithiasis and ureterolithiasis; Dissolution protocol for struvite urolithiasis; Calcium oxalate urolithiasis; Medical management of ureterolithiasis; Urate urolithiasis; and Cystine urolithiasis.

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26.1 Ultrasonographic sagittal view of the left kidney of a 3-year-old neutered male Domestic Shorthaired Cat. The left kidney has moderate hydronephrosis and diverticular distension. There is a small focus of mineralization within each renal papilla and moderate dilatation of the left ureter was also present. This cat was treated conservatively with medical management due to the absence of azotaemia.
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26.2 Ultrasonographic sagittal view of the left kidney of a 10-year-old neutered female Pomeranian presented for anorexia, fever and lethargy. (a) Marked hydronephrosis of the left kidney was noted, with only a thin (2.3 mm) mantel of parenchymal tissue remaining. The renal pelvis contained urine with suspended particulate material; pyelonephritis was suspected. (b) The kidney was subsequently removed because of suspected sepsis and a 5 mm urolith was confirmed in the left ureter approximately 2.6 cm distal to the pelvis. It was composed of 100% calcium oxalate. The dog recovered with appropriate antimicrobial therapy and supportive care.
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26.3 Survey radiograph of a 7-year-old Domestic Longhaired Cat illustrating a solitary radiodense stone. The stone dissolved completely in 4 weeks with a struvitolytic therapeutic food.
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26.4 Stone removed from an 8-year-old European Shorthaired Cat and submitted for quantitative mineral analysis. The stone was composed of 100% magnesium ammonium phosphate. (Scale divisions shown on the ruler are millimeters.)
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26.6 Algorithm for the prevention of recurrence of calcium oxalate (CaOx) uroliths. USG = urine specific gravity; UTI = urinary tract infection.
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26.7 Algorithm for the prevention of recurrence of urate uroliths. PSS = portosystemic shunt; USG = urine specific gravity; UTI = urinary tract infection.
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