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Risk factors associated with feline urolithiasis

Article  in  Veterinary Research Communications · March 2018

DOI: 10.1007/s11259-018-9710-8

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Veterinary Research Communications (2018) 42:87–94
https://doi.org/10.1007/s11259-018-9710-8

REVIEW ARTICLE

Risk factors associated with feline urolithiasis

Veridiane da Rosa Gomes1 · Paula Costa Ariza1 · Naida Cristina Borges1 · Francisco Jorge Schulz Jr.2 ·
Maria Clorinda Soares Fioravanti1

Received: 3 September 2017 / Accepted: 9 January 2018 / Published online: 16 January 2018
© Springer Science+Business Media B.V., part of Springer Nature 2018

Abstract
Urinary tract diseases are among the main reasons for consultation in veterinary clinics and hospitals. It affects animals of
any age, breed and gender. Among the diseases that affect this system, urolithiasis is the second largest cause of clinical
signs compatible with feline urinary tract disease. The term urolithiasis refers to the presence of uroliths in any region of the
urinary tract, but it is more commonly seen in the bladder and urethra. Uroliths are classified based on the type of mineral
present in their composition, therefore, quantitative and qualitative analyzes are important for a better therapeutic approach.
The animals may suffer from the disease and be asymptomatic, or show nonspecific clinical signs, making the diagnosis dif‑
ficult. The disease should not be seen as a single problem, but as a consequence of various disorders. As dietary, metabolic,
genetic and infectious causes, as well as factors that potentiate the chance of development of uroliths such as breed, age,
sex, age range, obesity, sedentary lifestyle, geographic region and climate. Thus, the knowledge of the factors that influence
the formation of uroliths, as well as the understanding of the pathophysiology, are key elements for better alternatives of
therapy and prevention. The recognition of these factors helps to identify susceptible populations, minimizing exposure and
increasing the protection factors, which facilitates the diagnosis and treatment of patients with urolithiasis. The objective of
this paper is to present the main risk factors involved in the formation of urinary lithiasis in felines.

Keywords  Calcium oxalate · Epidemiology · Small animals · Struvite · Uroliths

Introduction The occurrence of the disease is estimated between

Urolithiasis has been reported since antiquity, and calculus
have been found in egyptian mummies dated 8000 BC. The
first treatments for the disease were described between 3200
and 1200 BC (Domingos and Serra 2004). There are reports
of urinary lithiasis in humans, dogs, cats, horses, pigs, goats,
birds, reptiles, cattle, cervids, cetaceans and goats. This
change, however, is most commonly observed in humans,
canines and felines (Robinson et al. 2008).
* Veridiane da Rosa Gomes
veridiane.rgomes@yahoo.com.br
1
Department of Veterinary Medicine, School of Veterinary
Medicine and Animal Science, Federal Univesity of Goiás
– UFG, Campus Samambaia, Avenida Esperança, s/n, Conj.
Itatiaia, Goiânia, GO 74690‑900, Brazil
2
Department of Veterinary Medicine, College of Agronomy
and Veterinary Medicine, University of Passo Fundo – UPF,
Campus I, BR 285, São José, Passo Fundo, RS 99052‑900,
Brazil
15–23% in felines (Lekcharoensuk et  al. 2001a; Gerber
et al. 2005; Rodriguez and Bachs 2012) and around 33% of
canines (Rey and Pernas et al. 2012). In humans it affects
about 5% of the population in Asia, 9% in Europe and 13%
in North America (Ramello et al. 2000).
The calculus are named according to their position in the
urinary tract: nephroliths (kidneys), ureteroliths (ureters),
urocistoliths (bladder) and uretroliths (urethra). In company
animals 90% of the analyzed uroliths are from the lower uri‑
nary tract, mainly in the bladder (Grauer 2015). In cases of
ureteroliths and uretroliths, it is believed that their formation
occurs in the kidneys and bladder, respectively, and through
the urinary flow, they reach ureters and urethra (Osborne
et al. 2004; Grauer 2015).
The urinary lithiasis manifests quickly or insidiously,
and the affected patient may remain asymptomatic, which is
observed mainly in cases of renal and ureteral calculus (Ross
et al. 1999; Osborne et al. 2004; Palm and Westropp 2011;
Grauer 2015). The clinical manifestation varies according to
the size, quantity and location of the concretions. Thus, the

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Vol.:(0123456789)

88
clinical signs are non-specific (Grauer 2015), usually with
hematuria, dysuria, strangury and periury (Lekcharoensuk
et al. 2001a; Gerber et al. 2005; Rodríguez and Bachs 2012).
Partial or total obstruction of the urethra is observed
in some cases, especially in felines (Rodríguez and Bachs
2012), although it is more frequent in patients with ure‑
thral caps (Osborne et al. 2004, 2009c; Palm and Westropp
2011). For nephroliths, symptoms such as vomit, anorexia
and apathy are also reported (Lekcharoensuk et al. 2001a;
Gerber et al. 2005; Rey and Pernas 2012; Rodríguez and
Bachs 2012).
Factors such as breed, gender, age, diet, lifestyle, and even
climate, are considered risk, since they interfere in the elimi‑
nation of metabolites, predisposing a greater occurrence in
certain individuals (Cannon et al. 2007; Houston and Moore
2009; Palm and Westropp 2011). It should be noted that the
existence of one or more factors is not determinant for the
development of uroliths and each factor alone plays a limited
role in the disease (Osborne et al. 2009c).
The classification of the type of the calculus is based on
the mineral present in its composition. The struvite, also
known as magnesium ammonium phosphate (MgNH4PO4.
H2O) and the calcium oxalate (CaOx) monohydrate and
dihydrate, are the most observed in canines and felines,
although they present variations in the last decades as its
occurrence (Cannon et al. 2007:; Houston and Moore 2009;
Osborne et al. 2009c). Urate uroliths, constituted of uric
acid, ammonium urate, or urate salts, are the third most
commonly encountered mineral type, other less common
are xanthine, cystine, calcium phosphate, silica, and solidi‑
fied dry blood calculus (Fig. 1) (Ling et al. 1998; Westropp
Fig. 1  Images of feline bladder
uroliths. A- struvite urolith. B-
calcium oxalate urolith. C- urate
ammonium urolith. D- cystine
urolith
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Veterinary Research Communications (2018) 42:87–94
et al. 2006; Cannon et al. 2007; Houston and Moore 2009;
Osborne et al. 2009c).
According to the analyzes performed, the CaOx com‑
pound was present in 55% and 46% of the samples recovered
from the lower urinary tract of felines and canines, respec‑
tively. Whereas, in the upper urinary tract, this index was
90% for felines (Robinson et al. 2008). In another study, it
was identified that the increase of CaOx lithiasis coincided
with the increase of nephroliths (Osborne et al. 2009c).
It is important to emphasize that the identification of the
mineral present, is not the final diagnosis, it is necessary to
investigate the causes of occurrence of lithogenesis in the
patient, considering the mineral in question (Lekcharoensuk
et al. 2001a; Gerber et al. 2005; Rey and Pernas 2012).
Risk factors
General risk factors
In general, risk factors for urolithiasis can be divided into
three groups: etiological factors, such as infectious, toxic
and teratogenic agents; demographic factors, that is, spe‑
cies, breed, age, gender, genetic predisposition, and envi‑
ronmental factors that include living conditions, water and
food source, and socioeconomic status (Osborne and Lulich
1999).
Considering the close relationship between animals and
humans, it is important to consider that factors that increase
the incidence of urinary lithiasis in people, interfere in the
disease in dogs and cats (Osborne et al. 2009c).
Veterinary Research Communications (2018) 42:87–94 89
The climate is a widespread factor in studies (Lopez et al.
2010; Palm and Westropp 2011; Houston et al. 2016), as
already demonstrated in humans, being the people who live
in countries or regions with a hot climate more likely to
develop urolithiasis, due the larger liquid losses, not com‑
pensated by water ingestion, associated with low urine debit.
It has also been demonstrated, a greater relapse of urolithi‑
asis in summer and fall, than in spring and winter (Lopez
et al. 2010; Lieske et al. 2014).
Obesity is considered another risk factor (Palm and Wes‑
tropp 2011), since it is associated with higher food consump‑
tion, storing larger amounts of fat and consequent bigger
excretion of minerals in the urine (Osborne et al. 1996,
2004). In humans, it is also observed a relation between
obese and overweight patients, and a higher occurrence of
the disease (Taylor et al. 2005; Scales et al. 2012).
The lyfestyle also influences, since, animals kept inside
the house, develop more predisposition, being associated
with less physical activity, reduced water consumption and
low urine debit (Osborne et al. 1996; Houston et al. 2003).
Castration is a predisposing factor, with a description of
85% of analyzed uroliths coming from castrated cats, which
means a risk of 8.3 times greater than non castrated animals
(Picavet et al. 2007; Lulich and Osborne 2009). Another
study indicated 81.8% of occurrence in castrated cats, which
may be associated with sedentary lifestyle and obesity
(Lulich and Osborne 2009; Hesse et al. 2012).
The use of drugs such as sulfonamides, ciprofloxacin,
tetracyclines and antacids interfere in the nucleation pro‑
cess, inducing the lithogenesis. Although most commonly
observed in canines and humans (Osborne et al. 2009a; Rey
and Pernas 2012). In a study developed with feline uroliths,
the presence of sulfadiazine was identified in samples from
eight animals, and of these, six patients had received treat‑
ment with the drug (Osborne et al. 2009a).
Risk factors associated with the type
of the urolith
Urolithiasis by struvite
Struvite was the main mineral found in the analysis of feline
uroliths in the 1980s (Cannon et al. 2007; Houston et al.
2009; Osborne et al. 2009c). Although it has undergone
changes in the last three decades as to its occurrence, it is
still one of the main mineral types observed (Osborne et al.
2009c). Struvite uroliths usually have a tetrahedral, ellip‑
soidal or spherical shape (Osborne et al. 1995), being most
commonly seen in the bladder and urethra (Osborne et al.
1996; Ross et al. 1999; Houston et al. 2003).
According to pathophysiology, struvite lithiasis occurs
as a consequence of the presence or absence of urinary tract
infection (UTI) (Osborne et al. 2009b; Bahador et al. 2014).
The mechanism of UTI in the formation of struvite uroliths
occurs from the action of urease positive bacteria, such as
Sthapilococcus spp and Proteus spp (Rey and Pernas 2012;
Grauer 2015). The urease present in the bacteria, hydrolyzes
the urea in ammonia and bicarbonate, in this way, the bicar‑
bonate, raises the urinary pH, decreasing the solubility of
the minerals (Rey and Pernas 2012).
The ammonium is released to bind with phosphorus and
magnesium, causing urinary precipitation. It also exerts a
local irritant effect, facilitating the formation of an organic
matrix, which acts as a nidus of crystallization (Rey and
Pernas 2012). However, in cats, unlike dogs, the disease is
associated with UTI in only 5% of the patients (Osborne
et al. 1996, 2004; Rey and Pernas 2012), with the majority of
these animals being less than one year old or over 10 years
old (Osborne et al. 1996; Houston et al. 2003; Lulich and
Osborne 2009). Struvite uroliths are formed within eight
weeks after infection, although in the species, this type of
urolithiasis occurs in sterile urine (Osborne et al. 1995).
For the felines, it is generally believed that the disease
is related to dietary and metabolic factors (Osborne et al.
1996; Grauer 2015). In relation to the alimentation, diets
rich in magnesium, phosphorus, calcium, chlorine and fiber,
as well as moderate amounts of protein, are suggested to
be major risk factors (Lekcharoensuk et al. 2001b; Grauer
2015), since their use may lead to hypermagnesuria, hyper‑
ammonuria and hyperphosphaturia, in this way, the chance
of precipitation and aggregation of crystals in the urine is
bigger (Osborne et al. 1996; Lekcharoensuk et al. 2001b).
The diet also causes an increase in pH, which is kept
constantly high (6.5 to 7.0) (Table 1), favoring crystalliza‑
tion (Lekcharoensuk et al. 2001b; Lulich and Osborne 2009;
Grauer 2015). Other changes related to the feline patient are
increased urinary concentration, low water intake, associ‑
ated with decreased frequency of urination and excessive
Table 1  Influence of urinary pH for the formation of different types
of uroliths in felines species. Source: Osborne et  al. 1996; Lekchar‑
oensuk et al. 2001b; Osborne et al. 2004; Lulich and Osborne 2009;
Albasan et al. 2012; Rey and Pernas 2012Bartges and Callens 2015;
Grauer 2015
Urolithiasis Type Urinary pH
Struvite Alkaline
Calcium oxalate Acid
Urate Acid
Xanthine Acid
Cystine Acid
Silica Not influenced
Calcium phosphate Alkaline
Solidified dried blood uroliths Not influenced
13

90
consumption or excretion of calculogenic minerals (Osborne
et al. 1995, 1996, 2009b).
Struvite lithiasis is observed in both, males and females,
although more recent studies have shown a higher incidence
in females (Houston et al. 2003; Cannon et al. 2007; Houston
and Moore 2009). The most likely justification is the shorter
length of the urethra associated with increased development
of UTI, although this hypothesis is more commonly applied
to canine females (Rey and Pernas 2012). Castrated animals
also have larger occurrences (Osborne et al. 1996).
Considering the age range, struvite urolithiasis is reported
at any age, although the occurrence decreases after 10 years
(Lekcharoensuk et al. 2000; Lulich and Osborne 2009),
as well as the highest percentage occurring between four
and seven years (Osborne et al. 1996; Cannon et al. 2007).
Young cats appear to be more predisposed to presenting this
type of calculus (Cannon et al. 2007).
Any breed develops the disease, although higher inci‑
dences have been described in the Himalayan, Persian, Sia‑
mese (Houston et al. 2009; Osborne et al. 2009c), still in the
Foreign Shorthair, Ragdoll, Chartreux, Oriental Shorthair
(Lulich and Osborne 2009; Osborne et al. 2009c; Houston
et al. 2016), domestic cats of short and long hair (Houston
et al. 2003) and Manx (Cannon et al. 2007).
Urolithiasis by calcium oxalate
The incidence of calcium oxalate uroliths in felines has
increased since the 1990s, becoming the most observed
mineral in the analyzes of calculus obtained in the species
(Houston and Moore 2009; Osborne et al. 2009c). Currently,
along with struvite, it is the main mineral found in lithiasis
of felines, canines and humans (Osborne et al. 2009c; Rey
and Pernas 2012; O’Kell et al. 2017).
Calcium oxalate calculus have white coloration and most
often have irregular borders (Osborne et al. 1995). They can
be observed in any part of the urinary tract, being the most
obsverved mineral in the analyzes of nephroliths and uret‑
eroliths (Osborne et al. 1996; Ling et al. 1998; Ross et al.
1999; Cannon et al. 2007). The upper urinary tract uroliths
were already very uncommon in felines, comprising only
about 4% of the total uroliths (Ling et al. 1998), which cur‑
rently show higher frequency (Osborne et al. 2009c).
One of the main factors involved is hypercalciuria (Ross
et al. 1999; Dijcker et al. 2012), considered a quite com‑
mon factor in humans (O’Kell et al. 2017), which results
from increased intestinal absorption of calcium (absorptive
hypercalciuria), excessive renal excretion due to tubular
reabsorption (by renal loss) and/or increased bone absorp‑
tion (resorptive) (Palm and Westropp 2011; Grauer 2015).
Diseases that cause hypercalcemia (primary hyperpar‑
athyroidism, idiopathic hypercalcemia and hyperparathy‑
roidism) are predisposing factors to urolithiasis by calcium
13
Veterinary Research Communications (2018) 42:87–94
oxalate because they lead to hypercalciuria (Lulich and
Osborne 2009). Hypercalcemia has been reported in 35%
of cats with this type of calculus and its cause has not been
identified (Houston et al. 2003; Lulich and Osborne 2009).
Another important risk factor involves hyperoxaluria
(Osborne et al. 1996; Grauer 2015). Oxalate comes from
endogenous and exogenous production, increased intake of
oxalate and vitamin C (Dijcker et al. 2011). Primary hyper‑
oxaluria was also associated as a cause of hyperoxaluria in
young cats, although the condition is not well understood,
requiring further research (De Lorenzi et al. 2005). The
absence of enteral colonization by the Oxalobacter formi-
genes bacteria, which is associated with a higher risk of
calcium oxalate calculus formation in humans (O’Kell et al.
2017), was described in dogs (Gnanandarajah et al. 2012).
In felines, its relation with the development of this type of
calculu is unknown.
Exclusive diets for treatment and prevention of struvite
uroliths, are acidifying and restricted in magnesium, mak‑
ing an acidic urinary pH and causing hypomagnesemia
(Lekcharoensuk et al. 2001b; Grauer 2015). Magnesium acts
by forming a complex with oxalate, inhibiting its aggrega‑
tion with calcium, so its absence and/or decrease contributes
to the formation of crystalluria by calcium oxalate (Osborne
et al. 1995).
Lithiasis by calcium oxalate is associated with middle
age cats to the elderly (five to 12 years) (Lulich and Osborne
2009; Grauer 2015), and the highest rate of involvement is
at 7.3 years (Osborne et al. 1996). The highest frequency
of development was reported for the breeds: Persian, Rag‑
doll and Himalayan (Ling et al. 1998; Houston et al. 2003;
Houston and Moore 2009; Lulich and Osborne 2009). Some
studies have shown occurrence in Havana Brown, British
Shorthair, Foreign Shorthair, Scottish Fold and Exotic Short‑
hair (Houston et al. 2003; Cannon et al. 2007; Hesse et al.
2012).
Males have a higher risk of urolithiasis by calcium oxa‑
late, especially castrated animals (Lulich and Osborne 2009;
Palm and Westropp 2011). In an accomplished study, cas‑
trated males were 25 times more affected than non castrated
(Osborne et al. 1996; Cannon et al. 2007; Houston et al.
2016). Cats kept indoors are also considered potencies in
the development of the disease, by the decrease in water
consumption and urination, in addition to obesity (Cannon
et al. 2007; Lulich and Osborne 2009).
Urolithiasis by urate
Urate uroliths represent about 5% of the analysis of calculus
in felines, being the third most frequently identified type of
mineral in the species (Houston and Moore 2009; Mccue
et al. 2009; Appel et al. 2010; Houston et al. 2016). The site
of greatest occurrence is the bladder (Osborne et al. 1996).
Veterinary Research Communications (2018) 42:87–94 91
They have a light yellow or brown color and are usually
small and spherical (Lulich and Osborne 2009; Mccue et al.
2009). The main risk factors for its occurrence are hyperu‑
ricosuria, hyperamonuria, aciduria and decreased urinary
volume (Osborne et al. 1996).
In normal physiological situations, the excretion of uric
acid in the urine normally occurs only in humans, rodents
and primates, so urate calculus are associated with meta‑
bolic changes in the other species (Ángel-Caraza et  al.
2012). Lithiasis by urate is commonly observed in dogs of
the Dalmatian breed, whose appearance is associated with
a defect in the metabolism of purines, leading to hyperico‑
suria (Rey and Pernas 2012). In this breed, the conversion
rate of uric acid to allantoin is lower than the others. First, it
was believed to be due to the absence of the urease enzyme,
however, it is now suggested that purine metabolism is infe‑
rior because of a defect in the transport of uric acid through
hepatocytes, not by the enzyme (Rey and Pernas 2012).
The formation of this type of urolith may be related to
severe liver diseases and portosystemic shunting, leading to
increased excretion of ammonia and uric acid in the urine, as
a result of the lower capacity to convert ammonia into urea
and uric acid into allantoin (Rey and Pernas 2012). Although
less frequent than in dogs, urate uroliths were observed in
felines with portosystemic shunt (Albasan et  al. 2012).
Another cause described for cats is the increase in consump‑
tion of diet rich in proteins, or the lithiasis of unknown ori‑
gin (Lulich and Osborne 2009; Mccue et al. 2009).
The higher concentrations of protein in the diet lead to a
greater renal excretion of urate salts with consequent acidi‑
fication of the urinary pH, promoting a lower solubility of
the crystals (Albasan et al. 2012).
It usually affects young felines, and those who have por‑
tosystemic shunts may present the change with less than
one year of age (Lulich and Osborne 2009). In one study
the average age was 6.3 years. However, the Egyptian Mau
breed, averaged 4.8 years (Appel et al. 2010). Although there
is no predisposition regarding the breed, some studies cite
the highest occurrence in the Egyptian Mau (Houston and
Moore 2009; Appel et al. 2010; Albasan et al. 2012), Bir‑
man and Siamese (Houston et al. 2003; Cannon et al. 2007;
Albasan et al. 2012). With regard to gender, it affected more
females (Appel et al. 2010).
Urolithiasis by xanthine
Xanthine urolithiasis is uncommon in cats. The uroliths,
which are yellow or light brown in color, are small in size
and have a smooth surface (Lulich and Osborne 2009), and
are most observed in the lower urinary tract (Bartges and
Callens 2015). The pathophysiology of the disease involves
a defect in the activity of the xanthine oxidase enzyme in the
metabolism of purines (Lulich and Osborne 2009).
The enzyme in question has the function of converting
xanthine into uric acid. Thus, the conversion does not occur
with consequent accumulation in the urine (Osborne et al.
1995; Rey and Pernas 2012). Xanthine is also the least sol‑
uble metabolite in the metabolism of purines excreted in
urine, therefore, high concentrations of xanthine result in
formation of uroliths. This change is classified as primary
xanthinuria (Osborne et al. 1995; Ángel-Caraza et al. 2012).
The secondary form is related to the use of diets with
high concentrations of purines, as well as the treatment of
urate urolithiasis, through allopurinol (Lulich and Osborne
2009; Rey and Pernas 2012), although there are no reports
of felines affected by the use of the medication (Lulich and
Osborne 2009; Albasan et al. 2012; Bartges and Callens
2015).
Despite the low incidence, a study carried out shows
only 0.14% of the analyzes, the disease is more observed
in males (Lulich and Osborne 2009), mainly castrated ani‑
mals, however, some studies report that the frequency is the
same between the sexes (Bartges and Callens 2015). In one
study, xanthine calculus were observed in 55% and 33% of
castrated males and females, respectively, whereas non cas‑
trated animals corresponded to 10% and 1% for males and
females, respectively (Osborne et al. 2009a).
Xanthine lithiasis affects animals under five years of age,
with a average age of 2.8 years (Lulich and Osborne 2009;
Bartges and Callens 2015). It was more observed in domes‑
tic cats of short, long, medium hair, Siamese, British Short‑
hair and European Shorthair (Osborne et al. 1996). Acid
urinary pH, concentrated urine and incomplete urination are
also risk factors (Osborne et al. 2004; Bartges and Callens
2015).
Urolithiasis by cystine
Urolithiasis by cystine is uncommon in felines, account‑
ing less than 1% of the analyzed urolith samples (Lulich
and Osborne 2009; Houston et al. 2016). Cystine calculus
are yellow and brown, and are usually small and spherical
(Lulich and Osborne 2009). They are mainly located in the
bladder and urethra (Osborne et al. 2004).
Cystinuria is the main triggering factor and is associated
with a hereditary defect in the reabsorption of cystine and
others amino acids (ornithine, lysine and arginine) in the
proximal tubule, resulting in cystinuria and consequent for‑
mation of calculus (Osborne et al. 1995; Mizukami et al.
2015, 2016). However, not all animals that have this defect
have cystinuria or cystine uroliths (Osborne et al. 1995).
The disease has been reported in several species of
domestic and wild animals, although in humans and dogs it
is associated with a mutation in the amino acid transporter
genes, SLC3A1 and SLC7A9 (Mizukami et al. 2015). Cys‑
tine uroliths in cats represent 0.1% of all analyzes in the
13

92
USA and Canada, while representing 0.3 to 1% in dogs
(Houston and Moore 2009; Osborne et al. 2009c; Albasan
et al. 2012).
In a paper of 2015, was verified the first case of cystinuria
associated to the genetic mutation in felines, associated with
the SLC3A1 gene (Mizukami et al. 2015). The patient was
diagnosed with urolithiasis at two months of age and at four
months, the uroliths were removed, however the animal died
(Mizukami et al. 2015). Through blood, spleen and other
organs samples, it was possible to identify the genetic muta‑
tion as the cause of the lithiasis. Also, in a recent study, the
first report associated with the SLC7A9 gene was observed
(Mizukami et al. 2016).
Due to its low incidence, there are few studies involving
this type of compound, however, in analyzes verified in dif‑
ferent places, it was observed a higher occurrence in males
(Osborne et al. 1995), with an average of 4.1 years of age
(Lulich and Osborne 2009). Among the breeds affected are
evidenced the domestic cats of short and long hair, Siâmes
(Lulich and Osborne 2009) and Korat (Osborne et al. 1995).
Diets with high protein concentration and urinary acid pH,
also influence the occurrence (Bartges and Callens 2015).
Urolithiasis by silica
Silica uroliths are grayish-white in color, and are mostly
seen in the bladder and urethra. They have a format called
jackstones. The factors for its formation are still unknown
(Osborne et al. 1995, 2004).
It is known that the silicate is consumed in small quanti‑
ties in the diet and eliminated in the urine without com‑
plications (Rey and Pernas 2012). However, the increase
in dietary intake (vegetable source of protein, such as rice
husk), environmental (water) or pharmacological (antacids),
may predispose the formation of lithiasis by silica (Osborne
et al. 2004; Rey and Pernas 2012).
Silica uroliths are uncommon in felines, with no pre‑
disposing for gender or breed (Houston and Moore 2009;
Houston et al. 2016). The urinary pH does not appear to
influence its formation (Rey and Pernas 2012).
Urolithiasis by calcium phosphate
Calcium phosphate is most commonly found in association
with other mineral types, usually struvite and calcium oxa‑
late, presenting a small index in the composition of uro‑
liths (Osborne et al. 1995). Pure calculus of this mineral are
uncommon, with 0.3 to 0.6% for dogs and less than 1% for
cats (Houston and Moore 2009).
In humans and dogs it is associated with primary hyper‑
parathyroidism, but has not been reported in cats (Osborne
et al. 1996). Potential risk factors include hypercalciuria due
to hypercalcemia, excessive vitamin D and calcium in the
13
Veterinary Research Communications (2018) 42:87–94
diet (Osborne et al. 2004). Hyperphosphaturia, due to exces‑
sive phosphorus consumption, besides alkaline urinary pH
and decreased urine volume (Osborne et al. 1996).
In some cases, calcium phosphate calculus are the result
of mineralization of blood clots, which have formed and
become incarcerated in the urinary system, therefore, sig‑
nificant hematuria may predispose its appearance (Osborne
et al. 2004).
Females account for 57% of cases of calcium phos‑
phate uroliths, while males 43% (Osborne et al. 2004). It
affects animals of all ages with a large occurrence from
five months to 19 years of age, with the average age being
8 years ± 5 years (Osborne et al. 1996).
Urolithiasis by solidified dried blood uroliths
This type of pure calculus, so far, is reported only in cats. In
canines, it has been noted in conjunction with other calculus,
however the percentage is small (Osborne et al. 2009c). It
occurs in several places of the urinary tract and about 57%
comes from the lower urinary tract (Westropp et al. 2006).
Usually this calculus does not contain crystalline mineral
(Westropp et al. 2006; Cannon et al. 2007).
It began to be more observed from the 2000 year and its
incidence has been increasing (Westropp et al. 2006; Can‑
non et al. 2007), being its diagnosis challenging (Osborne
et al. 2009c). The solidified dry blood uroliths do not appear
on plain radiographs, since they are not radiopaque, only
are visualized when there is a portion of calcium oxalate,
calcium phosphate or other mineral type (Westropp et al.
2006; Osborne et al. 2009c), are also difficult to identify on
ultrasonography (Osborne et al. 2009c).
The incidence of this mineral type is still small, with a
higher occurrence in males, possibly due to anatomical dif‑
ferences of the urethra and potential obstruction (Cannon
et al. 2007). Most of the samples come from domestic cats
of short and long hair, although it was observed in cats of
breed Ragdoll, Balinese and Snowshoe, however, without
significant representation (Westropp et al. 2006; Cannon
et al. 2007).
There was no significance regarding age and location,
and the average age of affected cats was nine years (Cannon
et al. 2007). It was not possible to determine the cause of its
formation, but it is speculated that hematuria may contrib‑
ute, since most of the animals had this signal, although, not
all patients with hematuria developed this type of urolith
(Westropp et al. 2006).
The knowledge of the formation of the different types of
uroliths, as well as their predisposing factors is important,
so that the preventive and treatment measures can be traced,
so it is necessary to perform the analysis of the composition
of the calculus.
Veterinary Research Communications (2018) 42:87–94 93
Conclusion
Considering that urolithiasis is a disease with broad causes
and consequences and observed in the most varied animal
species, it is important to carry out studies in order to under‑
stand more its pathophysiology, since there are still unknown
issues, especially for cases of lithiasis of genetic origin.
To understand that the formation and development of
uroliths does not only depend on the existing theories, but
also on several factors related to the affected patient is the
fundamental step for further studies in the area. Understand
further that surgical removal of the calculus is not the end,
but the beginning of a series of investigations and is essential
for proper therapy and prevention.
Consider that the climate is also a factor that interferes in
the occurrence of the disease, pointing out the importance
of the need to obtain local epidemiological studies, due to
the regional variations observed in the disease, thus con‑
tributing to the prevention of urinary lithiasis. Only then it
will be possible to trace the disease profile and institute the
necessary therapeutic and prophylactic measures.
Compliance with ethical standards  Lekcharoensuk C, Osborne CA, Lulich JP, Pusoonthornthum R, Kirk
Conflict of interest  The authors declare no conflict of interest regard‑
ing the authorship of this article.
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