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Stones, Kidney, Bladder, Gallbladder

Denice Moffat
kidney stone

Different breeds develop different types of stones.

Kidney, Bladder and Gallbladder Stones

Common Types of Stones:

What are Kidney Stones and how are they Formed? Kidney stones (also known as renal calculi, renal lithiasis, urinary calculi, urinary tract stone disease, nephrolithiasis, urolithiasis and ureterolithiasis) form from salts and minerals when the concentration of waste debris increase so much waste stagnates and sometimes surrounds a tiny nidus (nidus is Latin for “nest”) such as a bacteria or clump of minerals or amino acids. These tiny crystals in the urine clump around the nidus to form a solid mass or stone which just grows bigger and bigger if it is not discharged or flushed from the system. Stones are often formed in concentric circles or even in odd shapes as you will see in the pictures below.

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Picture reference: https://byhealth.com/urinary-system

Urine is formed in the kidneys which are two fist-sized organs shaped like kidney beans near the middle of the back. Blood travels through the kidneys, where tiny networks of filters called glomeruli remove waste products and extra water. Each day, the kidneys miraculously process about 200 quarts of blood filtering out toxins and waste water from the blood to make urine. The water and waste form urine, which flows from the kidneys, into small tubes called ureters and into a holding chamber (the bladder) for eventual elimination by the body through the urethra.

Some stones may be tinier than a grain of sand so that they easily pass into the bladder and out into the urine but others can even get to the size of the entire bladder. These really hurt and need to be surgically removed. If small stones get stuck in the ureter, this can cause excruciating pain and infection which can lead to permanent kidney damage.

Researchers say about 12 percent of American men and 5 percent of women develop a kidney stone in their lives. Some people have more than one episode. The reason why men develop more stones is because their urethra is smaller than a woman’s. Women produce stones and sand too, but they pass more easily through the plumbing system.

Male dogs, sheep and goats have a challenge because they have a bone within the penis (called the os penis) and stones get caught in this area.

If you do go to the Emergency Room to be diagnosed make sure you follow up with a specialist instead of ignoring the problem. Kidneys are vital organs and if you are experiencing pain in them you need to be seen and treated appropriately.

Symptoms of Kidney and Bladder Stones include:

These can also be symptoms of a urinary tract infection, or cystitis, which is much more common than kidney stones in young patients, especially women. If you have one or more of these symptoms you should seek medical advice so the proper tests can be performed to diagnose the problem. (See my handout on  Urinalysis Interpretation under Health Basics).

Kidney stones are usually passed out of the body within 48 hours, but attacks can sometimes last for over 30 days.

The types of kidney, gall or bladder crystals or stones that humans or animals produce depends on their diets, anatomy and predisposing factors which will be discussed below:

Predisposing factors for Stone Formation (Who gets kidney stones?)

Common bacteria associated with bladder stones include: Ureaplasma urealyticum, U urealyticum, Proteus mirabilis, Staphylococcus, Klebsiella, Providencia, Pseudomonas, and Staphylococci which are all urease-producing enzymes that result in the production of many struvite crystals.

Nanobacteria can also cause stones, but carbonate apatite ones. Nanobacteria is hard to diagnose as a core cause of kidney stone formation because they are about the size of a virus, don’t grow as quickly as the other bacteria listed above and don’t grow well on the media they normally use in the lab to culture out bacteria. Nanobacteria is best treated with Tetracycline at this point, but researchers are trying to find alternatives to this drug.

Kidney Stones: Depending on where they are located, kidney stones are also known as renal calculi, urinary calculi, urinary tract stone disease, nephrolithiasis, urolithiasis and ureterolithiasis.

How are kidney stones diagnosed?

Doctors can usually diagnose kidney stones by asking about your symptoms and examining you. Further tests may be done to confirm the diagnosis and to reveal the size, location and type of stone. These include:

Most Common Types of Stones:

Pictures from www.Herringlab.com (Here are just a few!)

Ammonium Acid Urate: These stones are common in the Dalmatian.Urate stones once present can cause “secondary” urinary infections where none existed before and the infection, in turn, can then complicate the diagnosis.

Brushite: Brushite stones (calcium hydrogen phosphate) develop in acid urine with pH values between 6.5 and 6.8 and in urine that has high concentrations of calcium and phosphate. When the pH value increases up to 6.8, Brushite converts into carbonate apatite. Brushite stones grow rapidly and return often if everything is not “just right.” Strong prophylactic treatment is very important in Brushite stone-formers. Brushite stones are very hard, therefore disintegration by lithotripsy is difficult to attain.

Calcium containing stones are the most common type of kidney stone. They are either spiky or large and smooth, and are made up of calcium oxalate or calcium phosphate. Calcium stones are more common in people who have excess levels of vitamin D or who have an overactive parathyroid gland.

Note: Uh, please note this because recently there has been a rash of advertising that everyone is low in Vitamin D and Vitamin D supplements are being prescribed like crazy. If you need it, you need it, but if you don’t then your body has to get rid of the excess. People who have medical conditions such as cancer, some kidney diseases, or a disease called sarcoidosis are also more likely to develop calcium stones.

Calcium Carbonate (Crystal in urine sediment) Also called calcite, is in limestone, dolomite and marble. Some calcium supplements contain this type of calcium. It’s best to take calcium supplements that are suited for your particular body type. Calcium carbonate stones are exceptionally rare. A previous analysis of a small number of pediatric gallstones from the north of England showed a remarkably high prevalence of calcium carbonate stones. Calcium carbonate stones were more common in boys, and almost half had undergone neonatal abdominal surgery and/or required neonatal intensive care. (Reference: https://www.ncbi.nlm.nih.gov/pubmed/17923195)

One source I read suggested a core cause of liver disease. Calcium Carbonate stones are common in guinea pigs and rabbits. I suspect it may be from feeding too much alfalfa to these critters.

Calcium Oxalate Stones (Note how they look different—this is why we need to have the lab test them to see what kind they are.) See Also: Urinalysis on Calcium Oxalate (Hippurate).

Some conditions predisposing to Calcium Oxalate Crystals include:

Calcium oxalate crystals form in acid to neutral urine and are the most common stones in male dogs. These crystals can be smooth, rough, speculated or jackstone in shape. The jack shape is really weird and must hurt like a son-of-a-gun!

If you see calcium oxalate crystals in the urine, be sure to run additional tests to check for the diseases listed above. These crystals don’t dissolve and must be surgically removed and are very visible with radiography.

They can be prevented with low protein and low oxalate diets (See High Oxalate Food List Link below) and diets with higher amounts of magnesium, phosphorus (which prevents the calcium from dumping into the urine). Also,  more dietary calcium helps reduce the absorption of calcium oxalate from the intestine. Complicated stuff. The addition of potassium citrate and thiazide diuretics have also been shown to help with oxalate uptake.  (See Medical Treatments for Stones Handout—link below.)

Calcium oxalate – the most common type of stone. Can be due to excess amounts of calcium or oxalate in the urine. These stones come in two different types –calcium dehydrate and calcium monohydrate:

Calcium Oxalate Dihydrate (Also called Weddellite) breaks easily with lithotripsy.

Calcium Oxalate Monohydrate (also called Whewellite) these are really tough stones and do not break up with lithotripsy.

These type of stones are often in people and animals that have a diet high in oxalates (See list of High Oxalate foods.) They cannot be dissolved. Calcium oxalate crystals are more common in Europe than in the United States.

Treatment and Prevention of Calcium oxalate stones:

Calcium Pyrophosphate: Calcium pyrophosphate deposition disease (CPDD) is a metabolic disease which affects the joints resulting from the deposition of calcium pyrophosphate dihydrate (CPPD) in and around joints, especially in articular and fibrocartilage.

Although CPDD often is asymptomatic with only radiographic changes (ie, chondrocalcinosis), various clinical manifestations may occur, including acute pseudogout and chronic arthritis. Although almost any joint may be involved, the knees, wrists, and hips are most commonly affected. This condition is the most common cause of secondary metabolic osteoarthritis.

Canine Gout is a rare form of Gout and it is often diagnosed as calcium circumscripta
(Calcium Gout) or calcium pyrophosphate-dehydrate disease, which is a chalky liquid that can ooze from a dogs paws or from surgical interference. It can also appear as lesions on the paws of larger dogs.

Treatments and Prevention for Calcium pyrophosphate stones:

Calcium phosphate (also known as Hydroxyapatite) stones are formed in neutral to alkaline urine and are usually smooth and round. This is rarely a pure stone and is often found combined with calcium oxalate and struvite. Dogs predisposed to this type are Yorkshire Terriers, Miniature Schnauzers and Cocker Spaniels. Core cause suspected includes metabolic disorders resulting in too much calcium being excreted into the urine. These must be surgically removed. You can prevent more from forming by acidifying the urine, feeding a calculolytic diet and preventing too much calcium from being excreted into the urine.

Carbonate Apatite: Two different kinds of calcium phosphate stones occur depending on the urinary pH value. Carbonate apatite stones develop in alkaline urine (pH > 6.8) with high calcium and low citric acid concentrations.

Cholesterol (Biliary): The incidence of gallstones is one million new cases per year and includes 20 million cases among Americans.  Mexican Americans and several American Indian tribes, particularly the Pima Indians in the Southwest, have very high prevalence rates of cholesterol gallstones. Decreased bile acid secretion is believed to be the common denominator in these ethnic groups. The formation of gallstones usually starts after the age of 40.

(Reference: https://www.emedicine.com/MED/topic225.htm )

Cystine (Crystals in urine sediment and stones which may or may not show up in an X-ray.)

Cystine stones are yellow and crystalline and form in acidic to neutral urine and are usually round and smooth. Only one in a hundred kidney stones in the human are caused by this condition. Cystine stones tend to develop earlier in life than other kidney stones, usually between the ages of 10 and 30 years. This type of stone cannot be dissolved and needs to be surgically removed.

They are caused by an increased urine excretion of cystine and are a result of renal tubule reabsorption of cystine (inherited renal tubular transport defect of cystine).

Treatment and prevention includes surgery, decreasing dietary protein and alkalizing the urine. The pH of the urine should be kept above 7.5. Medications used to help dissolve these crystals by alkalizing the urine include potassium citrate, D-penicillamine, and 2-PMG.

Cystinuria is inherited and is a recessive trait in Newfoundlands. In other breeds it is sex linked and found primarily in male dogs. Dog breeds predisposed are Bulldogs, Dachshunds, Basset Hounds, Chihuahuas, Yorkshire Terriers, Irish Terriers and Newfoundlands.

Magnesium Ammonium Phosphate (See Struvite below)

Octacalcium Phosphate Pentahydrate: I’d never heard about this one in vet school, but it is a combination stone containing calcium and phosphate. I thought the picture was kind of cool so included it. There are really all types of different stones with combinations of minerals. Each stone needs to be sent to the lab where it is crushed and the components identified so that a treatment protocol can be formulated.  It kind of looks like a fossil, doesn’t it? Infections may be part of the cause of this particular stone type.

Oxalate Stones:

Males produce 73% of the calcium oxalate stones. This stone type is unusual in females. Breeds at especially high risk include: miniature Schnauzer, Lhasa Apso, Yorkshire terrier, Miniature Poodle, Shih Tzu, and Bichon Fries’. Most cases occur in dogs between ages 5 and 12 years of age. Studies have shown that 50% of dogs that have undergone such surgery will develop new calcium oxalate stones within three years.

Calcium oxalate stones do not dissolve over time by changing to a special diet (as can be done with struvite or uric acid bladder stones). After the stones are removed, judicious therapy is adhered to for the prevention of future stones.

Core Causes of Oxalate Stones: Some people and animals have a genetic predisposition that prevents the production of enough substance called nephrocalcin in the urine. Nephrocalcin helps to naturally inhibit the production of calcium oxalate stones.

Some foods in the human diet exacerbate this genetic predisposition. These foods include: peanuts, spinach, Vitamin C supplements, chocolate, dairy products, calcium supplements and tea. These foods would also cause problems in predisposed breeds but these foods are not commonly incorporated into pet commercial diets.

Medications which can increase the risk of calcium oxalate stone development:

Note these supplements and medications should be discontinued for people and animals predisposed to this type of stone.

Treatment and Prevention of Oxalate Stones:

While special diets cannot dissolve existing stones, they do help prevent the development of new stones. The goal is to create a urinary environment with minimal calcium and oxalates in a urine pH that is not conducive to stone growth.

Commercial diets for the dog that achieve this goal include:

Canned forms are preferable to dry because they have more water in them and you really need to keep the person or pet hydrated and the urine dilute to keep the components of the stones flushed out of the system. It’s really difficult to convince pet owners that they shouldn’t give (unbalanced) treats to their pets. So:

Acceptable treats for oxalate stone forming dogs:

Note: Many pet owners ask if any non-prescription diets are appropriate for this condition. None are.

So, what does one do after having the stones surgically removed? The specific step-by-step protocol is presented in the link below, but here is a summary of the general steps:

Two to four weeks after surgery, check the urine. If the urine is not adequately dilute, water consumption will have to be increased (either by adding water to the food or increasing the amount of canned food).

If urinary pH is less than 6.5 or if oxalate crystals are seen, add in potassium citrate. By taking potassium citrate orally, citrate levels increase in the urine.  Calcium binds to citrate instead of to oxalate which is a desirable event since calcium citrate tends to stay dissolved whereas calcium oxalate tends to precipitate out as mineral deposit. Potassium citrate also helps create an alkaline urine (in which calcium oxalate stones have difficulty forming). Potassium citrate supplements are typically given twice a day.

If all is well, a urinalysis should be performed every two months or so for the rest of the dog’s life (University of Minnesota’s current recommendation). If you are unable to stabilize the urinary pH, then a thiazide diuretic is added to keep the urine dilute. This medication is typically given twice a day and electrolytes are generally measured via blood test within the first two weeks of this treatment.

Radiographs are taken every 3-6 months to identify any new stones. It is assumed that by taking an X-ray within this time span one will identify the stones as small enough to be retrieved from the bladder by flushing. If one skips this monitoring, stones present may develop to a large size which means another surgery to remove them.

Reference: https://www.marvistavet.com/html/body_canine_oxalate_bladder_stones.html

Silica and Silicate

Silicate stones form in acid to neutral urine. They usually have a jackstone shape. Diets high in corn gluten or soybean hulls predispose the German Shepherd, Golden Retriever, Labrador Retriever and Miniature Schnauzer to this type of stone. Of course this type of diet is not good for the skin either! These stones cannot be dissolved.

Treatment and Prevention include:

Urine alkalinization and diets with low amounts of silicates.

Note: Foods high in silica include: Beer, beets, bell peppers, brown rice, leafy green vegetables , root vegetables, seafood, soybeans and whole grains.

Struvite Stones and Crystals:

100% magnesium ammonium phosphate hexahydrate (stone) This stone measures 35mm long (1.5 inches).

Struvite stones (Also known as infection stones, Magnesium Ammonium Phosphate)

Struvite crystals form in neutral to alkaline urinary pH and are often the result of bacterial urease-producing bacteria in dogs and humans. This bacteria is not usually present in cats.

Stones vary in size and shape and can assume the shape of the bladder or urethra and become quite large.

They develop when there is too much ammonia in the urine and can be seen upon routine urinalysis. This can happen if you have a urinary tract infection (UTI), because the urease enzyme producing bacteria generate ammonia. This kind of kidney stone is most often found in women.

Treatment and Prevention of Struvite Stones: To dissolve the crystals an acidified, low-protein diet is needed. We usually use Science Diet S/D (Struvite Diet) at first for about 6 weeks then change to a bit less acid diet like Science Diet C/D (Calculi diet) because the body can’t handle acid diets for long periods of time. There are now other prescription diets that accomplish the same goal.

These special diets have less protein, phosphorus and magnesium and more salt in them to stimulate thirst. These are not good diets to use in animals and people who suffer from heart failure, liver failure, kidney failure, pancreatitis (they are a bit high in fat), high blood pressure and those who have lower serum albumin in their blood.

Struvite Notes:  The core cause of these stones are thought to be from the bacteria Staphylococcus aureus and possibly genetic core cause. You can see the stones with X-ray and the crystals with a urinalysis; they can be dissolved or surgically removed. These are the most common crystals and stones found in the dog and cat.

Tricalcium Phosphate with Apatite (Stones can be a mixture of two types of substances and are then called mixed composition stones. But stones formed in acid urine can’t mix with stones formed in alkaline urine.)

Uric Acid and Urates: Uric acid stones are smooth, brown and soft. Urate crystals which include ammonium urate or sodium urate monohydrate form in acidic to neutral urine. They are caused by in increased excretion of uric acid. There is genetic predisposition to having these types of crystals. Uric Acid stones cannot be dissolved. Excess amounts of uric acid can be caused by:

Treatment and Prevention of Uric Acid Stones:

Uric Acid stone and crystals in urine sediment seen under special lighting

This image provides a good example of uric acid. These crystals can take multiple forms: “A” is one of the rhombic plate (diamond-shaped) and is very common. “B” is the uric acid crystal in the shape of a barrel. They are often yellow to orange-brown in color. Under polarized microscopy they exhibit birefringence and many colors.

Uric Acid Dehydrate (Crystals in urine sediment)

Xanthene or Xanthine stones are very rare and are caused by an inborn defect of xanthine oxidase (something involving nitrate degradation). Drug therapy to dissolve xanthine stones is not available.

Treatment and Prevention of Xanthene stones includes:

Referred pain from Kidney Stones: Referred pain is defined as pain that originates in one part of the body, but is felt in another part of the body. Pain in the shaded areas may be caused by a kidney stone. Referred pain is kind of a tricky area because the practitioner and patient both are looking for something specifically wrong in that area and they can’t find anything. I’m including this diagram because often you’ll have to determine on your own that it is a referred pain from another cause and not a primary pain caused by injury.

Links and Resources:

Related Stone Pages/Links on this site:

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