Congress on Demand 2021: Internal Medicine

Identifying kidney stones – incidental finding or the key to the patient’s problem? Nephrolithiasis can be an incidental finding or one that requires urgent action. In this session, the problem of kidney stones in dogs and cats is discussed. This will include an overview of the types of kidney stones that occur in dogs and cats, and the underlying medical conditions that can cause these. There is also a discussion about the imaging modalities used to confirm nephrolithiasis, as well as other diagnostics (e.g. laboratory testing) that help identify their composition.

Approach to calcium oxalate nephroliths: surgery, medicine or wait and see? Nephrolithiasis is becoming more frequently diagnosed but remains an uncommon condition. Historically, nephroliths have not been associated with increased rates of progression of chronic kidney disease (CKD) but newer evidence has suggested a relationship between the presence of nephrolithiasis and a more rapid progression of CKD. Although the nature of this relationship remains unclear, it has prompted reassessment of how we treat nephrolithiasis. Many cases of nephrolithiasis are discovered incidentally and it is clear that they do not all require treatment. It is now accepted, however, that intervention should be sought for “complicated” nephroliths such as: stones associated with partial or complete obstruction of the uretopelvic junction and progressive hydronephrosis; stones associated with renal parenchymal loss, and stones associated with persistent pyelonephritis despite appropriate medical management. All surgical interventions are associated with renal damage and subsequent loss of function. This has led to recent recommendations to be as minimally-invasive and minimally-destructive as possible. The risks and subsequent potential loss of GFR caused by any intervention need to be justified by the anticipated clinical benefit to the patient. Techniques employed to remove complicated nephroliths range from nephrotomy, pyelotomy to endoscopic nephrolithotomy and these are discussed.