Feline struvite urolithiasis: fasting reduced the effectiveness of a urinary acidifier (ammonium chloride) and increased the intake of a low magnesium diet

In three separate experiments nine male cats were fed either a canned complete diet or a commercially available dry pelleted diet or the same dry diet containing 1.6 per cent ammonium chloride for seven days and then fasted for 20 hours. Then ad libitum feeding was continued and urine samples were taken at four-hour intervals for 12 hours and a final sample 12 hours later. Urine pH and the presence of struvite crystals in urine sediment were evaluated. The food and water intake of four of the nine cats was measured at the time of urine collection. After the fast, urine pH was raised, even after feeding the dry diet supplemented with ammonium chloride. A post prandial rise in urine pH was also seen on all three diets. After feeding the dry diet the postprandial peak pH was 7.97 and struvite occurred spontaneously. Urine pH after feeding the dry diet supplemented with ammonium chloride peaked at 7.75 then fell to 6.1 12 hours after the start of feeding. Struvite occurred spontaneously at all times until the pH reached 6.1 but when the pH of urine was raised to 7.0 the struvite crystallised. Urine pH on the canned complete diet peaked at 6.8 then fell to 5.8; struvite did not occur spontaneously but when urine pH was raised to 7.0 struvite crystallised except at the eighth and 12th hour sampling. These data show that fasting initiates a post prandial rise in urine pH and struvite crystalluria even when a normally effective urinary acidifier is used.(ABSTRACT TRUNCATED AT 250 WORDS)     

Medical dissolution of struvite nephrolithiasis using amino acid preparation in dogs

A new chemolytic therapy with amino acid preparation was tried for use on struvite renal stones in two dogs, which were admitted to Azabu University Veterinary Teaching Hospital. No other special diet, for the purpose of dissolving the stones, was fed during the treatment. Dissolution of the stones began at week 1, and no stone was detected on radiography at week 4 in both cases. The amino acid preparation thereafter has been administered every 2-3 days to prevent formation of the stones. After 6 months from treatment, complete dissolution was confirmed, and no relapse has been observed. Therefore, it is concluded that chemolytic therapy with amino acid preparation might be useful for the treatment of nephrolithiasis with struvite renal stones in dogs.     

Feline struvite crystalluria: a comparison of some commercially available dry cat diets in New Zealand

Thirteen adult cats were each fed consecutively five test diets: firstly a complete canned diet, and then four commercially available dry cat diets (New Formula Biscats, Cat Chow, Go-Cat and Whiskettes) for 7,13, 5, 4 and 4 weeks respectively. Urine samples were tested for pH and presence of struvite crystals. Body weight was recorded weekly. Urine pH was ranked from acid to alkaline as follows: Whiskettes (pH 5.8), canned diet (pH 5.9), Biscats (pH 6.1), Cat Chow (pH 6.45) and Go-Cat (pH 6.5). The pH of urine when cats were fed Whiskettes, Biscats and canned diet was not significantly different. Biscats produced a urine pH significantly higher than Whiskettes but, in each case, these three diets produced a significantly lower urine pH than Cat Chow and Go-Cat. Struvite crystals occurred spontaneously in 9% of urine samples from cats when fed Whiskettes and Biscats, 71% when fed Cat Chow and 38% when fed Go-Cat: spontaneous struvite was not seen in any cat fed CX9. Haematuria was seen in 2.9% (2/69) urine samples from cats fed Cat Chow. One tom cat had a blocked urethra after 24 days on Go-Cat. No abnormalities were observed in any cat when fed canned diet, Biscats or Whiskettes. It was concluded that of the four dry cat diets tested only Biscats and Whiskettes produce urine with an acceptably low rate of spontaneous struvite crystalluria.     

Feline struvite urolithiasis: factors affecting urine pH may be more important than magnesium levels in food

Eighteen male cats were fed either a canned complete diet or a commercially available dry pelleted diet or the same dry diet containing 1.6 per cent ammonium chloride. The daily food and water intake of four of these cats was measured. Urine samples were taken at random and the pH and the presence of struvite crystals in their sediment estimated. In some samples in which the pH was less than 7.0, and struvite crystals were absent, the pH was increased to 7.0 and any sediment was examined for struvite. No spontaneous struvite was seen in urine samples (pH 5.8) from cats fed the canned complete diet but when its pH was raised to 7.0, 46 per cent of these samples showed struvite. Cats fed the dry pelleted diet had urine of higher pH (7.55) and 78 per cent of the samples contained struvite crystals. Cats fed this diet supplemented with ammonium chloride had a urine pH of 5.97 and only 9 per cent contained struvite crystals but when the pH was adjusted to 7.0 all the samples showed struvite crystals. Energy intake was similar on all three diets but the intake of dry matter was greater on the dry diets. Liquid water intake was greater on the dry diets but total water intake was greatest on the canned complete diet. The intake of magnesium, calcium and phosphate was greater on the dry diets. It is concluded that urine pH is a more important controller of struvite precipitation than mineral intake.     

Effects of a high-protein diet versus dietary supplementation with ammonium chloride on struvite crystal formation in urine of clinically normal cats

OBJECTIVE: To evaluate the effects of a high-protein diet versus dietary supplementation with ammonium chloride (NH4Cl) on struvite crystal formation in the urine of clinically normal cats by measuring the urine concentration of hydrochloric acid (HCl)-insoluble sediment, urine pH, struvite activity product (SAP), number of struvite crystals in urine, and urine volume. ANIMALS: 23 healthy adult cats. PROCEDURE: Urine was fractionated by centrifugation with subsequent extraction of the sediment with 1 N HCl (study 1). Diets containing either 29% crude protein or 55% crude protein were fed to cats in a crossover trial of 3 weeks/period (study 2). Diets supplemented with either sodium chloride (NaCl) or NH4Cl were fed, by use of a 3 x 3 Latin-square design with 3 wk/period (study 3). In studies 2 and 3, urine samples were collected for the last 7 days of each period. RESULTS: The HCl-insoluble sediment contained Tamm-Horsfall glycoprotein (THP; study 1). The high-protein diet (study 2) and dietary supplementation with NH4Cl (study 3) resulted in a decrease in urine pH, SAP, and the number of struvite crystals in urine. However, the high-protein diet decreased urine concentrations of HCl-insoluble sediment containing THP (study 2), in contrast to the NH4Cl supplementation that increased urine volume without a significant effect on the urine concentration of the HCl-insoluble sediment (study 3). CONCLUSIONS AND CLINICAL RELEVANCE: Our results indicate that compared with dietary supplementation with NH4Cl, the high-protein diet is preferable as a urine acidifier for the prevention of struvite crystal formation in clinically normal cats.     

Phenothiazine toxicity

Thirteen adult cats were each fed consecutively five test diets: firstly a complete canned diet, and then four commercially available dry cat diets (New Formula Biscats, Cat Chow, Go-Cat and Whiskettes) for 7,13, 5, 4 and 4 weeks respectively. Urine samples were tested for pH and presence of struvite crystals. Body weight was recorded weekly.

Urine pH was ranked from acid to alkaline as follows: Whiskettes (pH 5.8), canned diet (pH 5.9), Biscats (pH 6.1), Cat Chow (pH 6.45) and Go-Cat (pH 6.5). The pH of urine when cats were fed Whiskettes, Biscats and canned diet was not significantly different. Biscats produced a urine pH significantly higher than Whiskettes but, in each case, these three diets produced a significantly lower urine pH than Cat Chow and Go-Cat. Struvite crystals occurred spontaneously in 9% of urine samples from cats when fed Whiskettes and Biscats, 71% when fed Cat Chow and 38% when fed Go-Cat: spontaneous struvite was not seen in any cat fed CX9. Haematuria was seen in 2.9% (2/69) urine samples from cats fed Cat Chow. One tom cat had a blocked urethra after 24 days on Go-Cat. No abnormalities were observed in any cat when fed canned diet, Biscats or Whiskettes.

It was concluded that of the four dry cat diets tested only Biscats and Whiskettes produce urine with an acceptably low rate of spontaneous struvite crystalluria.     

Evaluation of trends in urolith composition in cats: 5,230 cases (1985-2004)

OBJECTIVE: To determine trends in urolith composition in cats. DESIGN: Retrospective case series. SAMPLE POPULATION: 5,230 uroliths. PROCEDURES: The laboratory database for the Gerald V. Ling Urinary Stone Analysis Laboratory was searched for all urolith submissions from cats from 1985 through 2004. Submission forms were reviewed, and each cat's age, sex, breed, and stone location were recorded. RESULTS: Minerals identified included struvite, calcium oxalate, urates, dried solidified blood, apatite, brushite, cystine, silica, potassium magnesium pyrophosphate, xanthine, and newberyite. During the past 20 years, the ratio of calcium oxalate stones to struvite stones increased significantly. When only the last 3 years of the study period were included, the percentage of struvite stones (44%) was higher than the percentage of calcium oxa-late stones (40%). The most common location for both types of uroliths was the bladder. The number of calcium oxalate-containing calculi in the upper portion of the urinary tract increased significantly during the study period. The number of apatite uroliths declined significantly and that of dried solidified blood stones increased significantly, compared with all other stone types. No significant difference in the number of urate stones was detected. CONCLUSIONS AND CLINICAL RELEVANCE: The increasing proportion of calcium oxalate uroliths was in accordance with findings from other studies and could be a result of alterations in cats' diets. However, the decreased percentage of calcium oxalate calculi and increased percentage of struvite calculi observed in the last 3 years may portend a change in the frequency of this type of urolith.     

Medical dissolution of feline struvite urocystoliths

The efficacy of a diet designed to facilitate dissolution of feline magnesium ammonium phosphate (struvite) uroliths was evaluated in 30 cases of urolithiasis, sterile struvite uroliths dissolved in a mean of 36 days after initiation of dietary treatment. In 5 cases of urolithiasis, struvite urocystoliths associated with urease-negative bacterial urinary tract infection dissolved in a mean of 23 days after initiation of dietary and antimicrobial treatment. In 3 cases of urolithiasis, struvite urocystoliths associated with urease-positive staphylococcal urinary tract infection dissolved in a mean of 79 days after initiation of dietary and antimicrobial treatment. Dissolution of uroliths in cats fed the treatment diet was associated with concomitant remission of dysuria, hematuria, and pyuria, and reduction in urine pH and struvite crystalluria. In one case, a urocystolith composed of 100% ammonium urate, and in another case, a urolith composed of 60% calcium phosphate, 20% calcium oxalate, and 20% magnesium ammonium phosphate did not dissolve.     

Comparison of corn gluten meal and meat meal as a protein source in dry foods formulated for cats

OBJECTIVE: To compare the nutritional value of corn gluten meal (CGM) and meat meal (MM) as a dietary source of protein in dry food formulated for adult cats. ANIMALS: 8 healthy adult cats (4 males and 4 females). PROCEDURE: Diets containing CGM or MM as the main protein source were each fed for a 3-week period in a crossover study. Digestibility and nutritional balance experiments were conducted during the last 7 days of each period. Furthermore, freshly voided urine was obtained to measure urinary pH, struvite crystals, and sediment concentrations. RESULTS: Daily food intake and dry-matter digestibility were significantly higher for the MM diet. Fecal moisture content also was higher for the MM diet. Apparent nitrogen (N) absorption and N retention were higher for the MM diet, even when values were expressed as a percentage to account for differences in N intake. Urinary pH, struvite activity product, number of struvite crystals in urine, and urinary sediment concentrations were not different between diets. Retention of calcium, phosphorus, and magnesium was lower for the CGM diet, and cats lost body calcium and magnesium when fed the CGM diet. CONCLUSIONS AND CLINICAL RELEVANCE: Meat meal was superior to CGM as a protein source in dry foods formulated for cats, because dry-matter digestibility and N utilization were higher for the MM diet. In addition, net loss of body calcium and magnesium for the CGM diet suggests that mineral requirements increase when CGM is used as a protein source.     

Evaluation of effects of dietary carbohydrate on formation of struvite crystals in urine and macromineral balance in clinically normal cats

OBJECTIVE: To evaluate effects of dietary carbohydrate on urine volume; struvite crystal formation; and calcium, phosphorus, and magnesium balance in clinically normal cats. ANIMALS: 21 healthy adult cats (15 sexually intact males and 6 sexually intact females). PROCEDURE: Diets containing no carbohydrate source (control diet), control plus starch, or control plus fiber were given in a 3 X 3 Latin-square design. The diets were available ad libitum in study 1 (n = 12) and given under restrictions in study 2 (9) to equalize daily intakes of crude protein among the 3 groups. Formation of struvite crystals and balance of calcium, phosphorus, and magnesium were measured. RESULTS: Urine volume was lower in the starch group and fiber group in study 1, whereas no differences were detected among the groups in study 2. Urinary pH and struvite activity product were higher in the starch group in both studies, and the fiber group also had higher struvite activity product in study 2. In both studies, urinary concentrations of HCl-insoluble sediment were higher in the starch group and fiber group. In the fiber group, a net loss of body calcium, phosphorus, and magnesium was detected in study 2. CONCLUSIONS AND CLINICAL RELEVANCE: Starch and fiber in diets potentially stimulate formation of struvite crystals. Hence, reducing dietary carbohydrate is desirable to prevent struvite urolith formation. In addition, a net loss of body calcium, phosphorus, and magnesium during feeding of the fiber diet suggests that dietary inclusion of insoluble fiber could increase macromineral requirements of cats.     

Dietary treatment of progressive feline struvite crystalluria

Eight cats were fed a dry commercial cat food and after six months developed urinary struvite crystalluria with alkaline urine. The animals were subsequently divided into two groups and fed either a dry or a canned struvite calculolytic diet. The crystalluria was reduced after five to six weeks with both treatment diets. Decreased crystalluria coincided with a reduction in urinary pH and an increased titratable acidity. The highest food acid load, determined by the lowest undetermined anion, was found with the dry diet and resulted in the highest renal hydrogen excretion, measured as net acid excretion.     

The effect of urine acidification on calcium oxalate relative supersaturation in cats

There is an apparent reciprocal relationship between magnesium ammonium phosphate (MAP, struvite) and calcium oxalate (CaOx) urolithiasis incidence rate in cats. The number of struvite uroliths submitted for analysis over the past 35 years has been decreasing, with an increase in CaOx urolith submissions. Commercial diets aimed to dissolve struvite uroliths are typically acidified, and it has been suggested that dietary acidification increases urinary calcium excretion and the risk of CaOx crystallization. The objective of this study was to assess the effect of urine acidification on the relative supersaturation (RSS) of CaOx in cats, as a representation of crystallization risk. Four diets were extruded to contain identical nutrient contents, but with gradual acidification (0, 0.6, 1.3 and 1.9% sodium bisulphate substituted sodium chloride in diets A, B, C and D respectively). Thirteen adult cats were fed each diet sequentially for a minimum of 10 days. Average urine pH was 6.4, 6.2, 6.0 and 5.9 on diets A, B, C and D respectively (p < 0.0001). Struvite RSS decreased on diets inducing more acidic urine pH (p < 0.0001). Urinary calcium excretion and concentration increased with diets inducing lower urine pH (p < 0.0001), but oxalate excretion and concentration decreased (p < 0.001). CaOx RSS was not different between diets (p = 0.63). These results suggest that a lower diet base excess and resulting urine pH to support struvite dissolution do not increase the risk for CaOx crystallization in the range of urine pH representative of most commercial feline diets. Long-term studies are needed to confirm this.     

Effect of food intake on urine pH in cats

Ninety adult cats were fed an experimental canned meat-based cat food at levels necessary to maintain weight for 11 days. On the 12th day the cats were split into six groups of 15 cats each and fed 0, 20, 40, 60, 80 or 100 per cent of their previous food allotment. Four hours after the food was offered a urine sample was obtained via cysto-centesis. The pH of the urine sample was determined and the sample microscopically evaluated for the presence of struvite crystals. Post prandial urine pH was found to be a linear function of the amount of food consumed: (urine pH = 6–15 + [food intake (g) × 0–015]; P = 0-000). The presence of struvite crystals was dependent on urine pH while amorphous crystals were not. These data suggest that ad libitum feeding (nibble eating) may be beneficial in the management of feline struvite urolithiasis by reducing the magnitude of the post prandial alkaline tide. It also supports the suggestion that struvite crystal formation is largely a function of urinary pH.     

Treatment and prevention of feline struvite urolithiasis

A diet providing less than 20 mg of magnesium per 100 kcal that maintains urine pH near 6.0 3 to 5 hours after eating, or a diet providing this amount fo magnesium (see Table 2) with 1 gm of ammonium chloride or 1.5 gm of dl-methionine added daily, should be fed for 1 to 3 months to dissolve struvite uroliths (see Fig. 1). The low-magnesium diet should be fed indefinitely to prevent recurrence, because struvite urolithiasis and all of its effects (hematuria, pollakiuria, and/or complete to partial obstruction to urinary excretion) recurs repeatedly in cats that have previously experienced the condition if they are returned to regular cat food. In contrast, if a diet low in magnesium is fed, recurrence is uncommon. For cats that have never been affected, feeding a low-magnesium ration is unnecessary. For all cats, the following measures are recommended: encourage exercise, allow frequent urination, prevent obesity, decrease confinement, keep the litter box clean, and always have palatable water readily available.     

Chemical composition and microstructure of uroliths and urinary sediment crystals associated with the feeding of high-level cottonseed meal diet to water buffalo calves

The chemical composition and microstructure of seven uroliths and four urinary sediment samples associated with the feeding of high-level cottonseed meal diet to buffalo calves were examined by chemical qualitative analyses, scanning electron microscopy ( ), X-ray diffraction, and X-ray energy dispersive spectrometry ( ). Struvite was a major component of kidney stones and of some bladder stones. The kidney stone sample appeared cracked under low power under , aggregated into tiny balls under high power, and as a bladelike structure under even higher power. The bladder stone samples appeared finely granular or granular with various forms of prismatic crystals. The urinary sediments were prismatic crystals, with granules. The newly found prismatic crystals, which were rich in potassium and similar to struvite in crystal structure, were identified as potassium magnesium phosphate (KMgPO₄ · 6H₂O) in some bladder stones and urinary sediments. However, crystals which contained Mg and P only, which had been used for struvite identification, were not found by examination in urinary sediments from fresh urine samples of buffalo calves fed the high-level cottonseed meal diet.     

A survey of urolithiasis in cats

The incidence of urolithiasis in cats is 0.6 per cent. A total of 41 calculi were subjected to epidemiological and analytical investigation. Calculus formation is most frequent in male castrates and occurs exclusively in the bladder and urethra. Eighty per cent of the animals under investigation were overweight and the same percentage required surgical or instrumental treatment. Thirty-seven per cent of the calculi were recurrent, but only 22 per cent were accompanied by an infection. A predisposition due to diet (dry food/tinned food) was not established. Over 75 per cent of the calculi which were analysed consisted of struvite, the formation of which is promoted by an increased pH-value, as well as by a high level of magnesium and phosphate in the urine. The crystalline structure of the calculi indicates a slow growth rate not influenced by an acute infection. The genesis of struvite urolithiasis in cats, as well as measures to prevent its recurrence, are explained.     

Perineal urethrostomy versus dietary management in prevention of recurrent lower urinary tract disease

The frequency and cause of recurrent lower urinary tract disease was compared prospectively in three groups of 10 male cats during a one year period following correction of obstructive urethropathy caused by matrix-crystalline plugs. One group of cats was managed by perineal urethrostomy, one group with a calculolytic diet, and the third group by perineal urethrostomy and the calculolytic diet. Ten episodes of bacterial urinary tract infection developed in five of 10 cats with perineal urethrostomies; six episodes of bacterial urinary tract infection developed in four of 10 cats with perineal urethrostomies and consuming the calculolytic diet. Bacterial urinary tract infections were not observed in cats managed only with the calculolytic diet. Staphylococcal-induced struvite urocystoliths developed in two cats with perineal urethrostomies. Vesicourachal diverticula detected in nine cats at the time of diagnosis of urethral obstruction healed spontaneously following restoration of urethral patency and remission of clinical signs. Transient microscopic haematuria was observed in approximately 25 per cent of the cats in all three treatment groups during the one year study. Results of this study confirm the effectiveness of dietary management in prevention of recurrent urethral obstruction caused by struvite-containing urethral precipitates, and verify that recurrent signs of lower urinary tract disease in cats may be caused by agents that are different from those that initiate the problem. They also confirm that perineal urethrostomies predispose cats to recurrent ascending bacterial urinary tract infections.     

Evaluation of meat meal, chicken meal, and corn gluten meal as dietary sources of protein in dry cat food

The nutritional value of meat meal (MM), chicken meal (CM), and corn gluten meal (CGM) as dietary sources of protein in dry food formulated for adult cats was evaluated. Twelve healthy adult cats (11 males and 1 female) were used. Dry diets containing MM, CM, or CGM as the main protein source were given for a 3-week period in a 3 x 3 Latin-square design. Digestion and balance experiments were conducted during the last 7 d of each period. In addition, freshly voided urine was taken to determine urinary pH and number of struvite crystals. As compared with the CM diet, dry-matter digestibility was higher and lower for the MM and CGM groups, respectively. Percentages of nitrogen (N) absorption and N retention to N intake were higher in the MM group, and N utilization was not different between the CM group and the CGM group. All cats excreted alkaline urine (pH > 7). Urinary pH, struvite activity product, and number of struvite crystals in urine were lower for the CGM group. There was no difference in retention of calcium and magnesium among the groups. From the point of view of digestibility and N utilization, MM is superior to CGM, and CM is better than or equivalent to CGM as a protein source of dry foods for adult cats. However, when CM is used as a dietary protein source, some manipulation of dietary base excess may be needed to control urinary acid-base balance, because CM contains higher calcium and phosphorus.     

棉籽饼和棉籽壳对育肥羊尿结石发病率的影响

新疆某肉羊育肥场2007年春季因棉籽壳喂量过大,引起1岁龄育肥羊尿石病群发,经病原学与病理学诊断为因棉酚慢性中毒而导致尿路感染形成磷酸铵镁结石。经调整饲料配方后,病情得到控制。