Risk factor analysis and relative supersaturation as tools for identifying calcium oxalate stone-forming dogs

A urinary proteomic study in hypercalciuric dogs with and without calcium oxalate urolithiasis

Background and Aims

Hypercalciuria is an important predisposing factor commonly found in humans and dogs with calcium oxalate (CaOx) urolithiasis. Calcium oxalate crystals can induce an inflammatory reaction that subsequently produces several proteins that have an inhibitory or stimulatory effect on stone formation. This study aimed to evaluate the differences in urinary proteomic profiles between hypercalciuric CaOx stone dogs and hypercalciuric stone-free dogs (CaOx stone and control groups, respectively).

Materials and Methods

Seven dogs with hypercalciuric CaOx urolithiasis and breed-, sex-, and aged-matched controls with hypercalciuria were included in the study. Serum and urine samples were obtained from all dogs to analyze electrolytes. Urinary proteomic profiles were analyzed using liquid chromatography-mass spectrometry. Student's t-test was used to compare the differences between groups.

Results

Forty-nine urinary proteins were identified in the stone-free and CaOx stone groups, whereas 19 and 6 proteins were unique in the CaOx stone and stone-free groups, respectively. The urinary thrombomodulin level was significantly higher in the CaOx stone group (relative ratio = 1.8, p < 0.01) than in the stone-free group.

Conclusion

This study demonstrated that urinary proteomic profiles may be used as a candidate biomarker for urinary tract injury in CaOx urolithiasis in dogs.

NO PROGRESSION OF UROLITHS IN ASIAN SMALL-CLAWED OTTERS (AONYX CINEREUS) FED A NATURALISTIC CRUSTACEAN-BASED DIET FOR 2 YEARS

Asian small-clawed otters (ASCO; Aonyx cinereus) are a popular species of otter housed in zoological institutions. A common health challenge in this species is the development of uroliths, which may have a dietary origin. Feeding recommendations for ASCO are largely based on the nutrient requirements of domestic carnivore models. Using otter-specific feeding ecology may allow for further refinement of these nutrient recommendations. This study aimed to assess if a naturalistic diet of crustaceans, mollusks, and fish could control the development of uroliths in ASCO. Baseline data were collected on 10 ASCO (five males and five females) of different ages and repeated 2 years after the treatment diet was introduced. Blood and urine parameters, as well as the size of nephroliths based on radiographic images, were recorded. The treatment diet was higher in protein and lower in calcium than the nontreatment diet and did not contain any kibble. During the 2-year treatment trial, blood globulin, glucose, and sodium increased and albumin decreased. Glucosuria and leukocyturia significantly decreased. There were no significant changes in urolith size over the 2 years, and animals without nephroliths at the beginning of the study remained urolith free. The development of nephroliths was significantly reduced during the treatment compared with the year prior. Although interpretation is limited by the methods used, a naturalist diet may have a beneficial impact in the development of uroliths in ASCO.

The association between single nucleotide polymorphism in vitamin D receptor and calcium oxalate urolithiasis in dogs

Background

Polymorphisms of the vitamin D receptor (VDR) are associated with calcium oxalate (CaOx) nephrolithiasis in humans.

Objectives

To investigate the association between VDR polymorphisms and susceptibility to CaOx urolithiasis in dogs.

Animals

Thirty‐five dogs with CaOx urolithiasis were compared with 40 stone‐free dogs.

Methods

This was a case‐control study. Two VDR gene polymorphisms (rs851998024 and rs852900542) were detected by specific TaqMan real‐time polymerase chain reaction assay, and their relationship with serum 1,25‐dihydroxyvitamin D, serum and urinary electrolyte concentrations was evaluated.

Results

The distribution of the rs852900542 polymorphism was significantly different between the case and the control dogs (x² = 6.369, P = .04). Dogs with a CC or CT genotype had an increased risk of CaOx stones than those with the TT genotype (odds ratio = 3.82, 95% confidence interval 1.04‐13.98). The CaOx dogs with the TT genotype had a significantly lower urinary calcium‐to‐creatinine ratio than the CT+CC genotypes. 1,25‐(OH)2D concentrations did not differ between the cases and the controls (308.7 ± 217.4 vs 286.7 ± 185.1 pg/mL, P = .45).

Conclusions and Clinical Importance

This finding suggests that vitamin D metabolism might play a role in CaOx stone formation in dogs.

Increasing Dietary Potassium Chloride Promotes Urine Dilution and Decreases Calcium Oxalate Relative Supersaturation in Healthy Dogs and Cats

Urine dilution is a strategy used to decrease the risk of crystallization in cats and dogs at risk of urolithiasis. Sodium chloride has been used in prescription diets to effectively promote urine dilution, but the effect of the salt-substitute potassium chloride (KCl) on urine parameters has not been extensively investigated. Two diets differing only in KCl (Diet A; K 0.44 g/MJ, Diet B; K 1.03 g/MJ) were fed to 17 cats and 22 dogs for seven days, followed by three days of urine collection. Urinary ion concentrations were determined by ionic chromatography, and SUPERSAT software was used to calculate the relative supersaturation (RSS) value for struvite and calcium oxalate. Water intake and urine volume increased, and USG decreased on diet B (p < 0.001). Urine concentration of potassium increased on diet B, but concentrations of all other ions did not change or decrease in line with urine dilution. Calcium oxalate RSS decreased on diet B (p < 0.05). This short-term study showed that increased dietary KCl in a dry extruded diet effectively dilutes the urine of cats and dogs and therefore offers a novel nutritional strategy for the prevention of urolithiasis. This finding is of interest for patients that would benefit from dietary sodium restriction.

Urolithiasis in dogs: Evaluation of trends in urolith composition and risk factors (2006-2018)

BACKGROUND

Urolithiasis is a common and often recurrent problem in dogs.

OBJECTIVE

To evaluate trends in urolith composition in dogs and to assess risk factors for urolithiasis, including age, breed, sex, neuter status, urolith location, and bacterial urolith cultures.

SAMPLE POPULATION

A total of 10 444 uroliths and the dogs from which they were obtained.

METHODS

The laboratory database at the UC Davis Gerald V. Ling Urinary Stone Analysis Laboratory was searched for all urolith submissions from dogs between January 2006 and December 2018. Mineral type, age, breed, sex, neuter status, urolith location, and urolith culture were recorded. Trends were evaluated and variables compared to evaluate risk factors.

RESULTS

Calcium oxalate (CaOx) and struvite-containing uroliths comprised the majority of all submissions from dogs, representing 47.0% and 43.6%, respectively. The proportion of CaOx-containing uroliths significantly decreased from 49.5% in 2006 to 41.8% in 2018 (P = .006), with no change in the proportion of struvite-containing urolith submissions. Cystine-containing uroliths comprised 2.7% of all submissions between 2006 and 2018 and a significant nonlinear increase in this mineral type occurred over time (1.4% of all submissions in 2006 to 8.7% in 2018; P < .001). Of all cystine-containing uroliths, 70.3% were from intact male dogs. Age, breed, and sex predispositions for uroliths were similar to those previously identified.

CONCLUSIONS AND CLINICAL IMPORTANCE

Although calcium oxalate- and struvite-containing uroliths continue to be the most common uroliths submitted from dogs, a decrease in the proportion of CaOx-containing uroliths and an increase in the proportion of cystine-containing uroliths occurred during the time period evaluated.

Animal models of naturally occurring stone disease

The prevalence of urolithiasis in humans is increasing worldwide; however, non-surgical treatment and prevention options remain limited despite decades of investigation. Most existing laboratory animal models for urolithiasis rely on highly artificial methods of stone induction and, as a result, might not be fully applicable to the study of natural stone initiation and growth. Animal models that naturally and spontaneously form uroliths are an underused resource in the study of human stone disease and offer many potential opportunities for improving insight into stone pathogenesis. These models include domestic dogs and cats, as well as a variety of other captive and wild species, such as otters, dolphins and ferrets, that form calcium oxalate, struvite, uric acid, cystine and other stone types. Improved collaboration between urologists, basic scientists and veterinarians is warranted to further our understanding of how stones form and to consider possible new preventive and therapeutic treatment options.

Measurement of preprandial and postprandial urine calcium to creatinine ratios in male Miniature Schnauzers with and without urolithiasis

Background

We aimed to identify a simple test for excessive calciuresis and predict calcium oxalate (CaOx) disease in Miniature Schnauzers. We investigated the impact of postprandial time on the urine calcium to creatinine ratio (UCa/Cr) in male dogs of this breed, with the goal of improving the utility of the UCa/Cr.

Hypotheses

(1) Significant differences will exist in preprandial and postprandial UCa/Cr between CaOx urolith‐forming and control Schnauzers. (2) The UCa/Cr will increase significantly from the first morning baseline at ≥1 postprandial time point(s) in both control and CaOx urolith‐forming dogs. (3) Biochemical abnormalities and other variables may be associated with urolith status.

Animals

Twenty‐four male Miniature Schnauzer dogs, consisting of 9 with (urolith formers) and 15 without (controls) CaOx uroliths.

Methods

Urine was collected before and 1, 2, 4, and 8 hours after feeding a standardized diet. Receiver operator characteristic curve analysis was performed to identify the UCa/Cr cutoff that most accurately differentiates dogs based on urolith status.

Results

Urolith formers had significantly higher mean UCa/Cr over the course of 8 hours. The postprandial change in UCa/Cr was not significant at any time point between or within groups. The cutoff UCa/Cr value of 0.06 had a specificity of 93% (95% confidence interval [CI], 80%‐100%) and a sensitivity of 56% (95% CI, 21%‐86%) for identifying CaOx urolithiasis.

Conclusions and Clinical Importance

Urolith‐forming male Miniature Schnauzers have excessive calciuresis, and the postprandial sampling time up to 8 hours is not critical. This simple urine measurement has potential as a marker of CaOx disease.

SaRNA-mediated activation of TRPV5 reduces renal calcium oxalate deposition in rat via decreasing urinary calcium excretion

Hypercalciuria is a main risk factor for kidney stone  formation. TRPV5 is the gatekeeper protein for mediating calcium transport and reabsorption in the kidney. In the present study, we tested the effect of TRPV5 activation with small activating RNA (saRNA), which could induce gene expression by targeting the promoter of the gene, on ethylene glycol (EG)-induced calcium oxalate (CaOx) crystals formation in rat kidney. Five pairs of RNA activation sequences targeting the promoter of rat TRPV5 were designed and synthesized. The synthesized saRNA with the strongest activating effect was selected, and transcellular calcium transportation was tested by Fura-2 analysis. Subsequently, Sprague-Dawley rats were equally divided into three groups and fed with water, 1% EG for 28 days after injecting the negative control saRNA, 1% EG for 28 days after injecting the selected TRPV5-saRNA, respectively. The CaOx crystal formation and the 24-h urine components were assessed. In vitro study, saRNA ds-320 could significantly activate the expression of TRPV5 and transcellular calcium transportation. In vivo study, after 28 days treatment of EG, rats pre-infected with saRNA ds-320 had lower urinary calcium excretion and renal CaOx crystals formation as compared to that pre-infected with negative control saRNA. Activation of TRVP5 with saRNA ds-320 could inhibit EG-induced calcium oxalate crystals formation via promoting urine calcium reabsorption and decreasing urine calcium excretion in rats.

Urinary metals in a spontaneous canine model of calcium oxalate urolithiasis

Calcium oxalate urolithiasis is a common and painful condition in people. The pathogenesis of this disease is complex and poorly understood. Laboratory animal and in vitro studies have demonstrated an effect of multiple trace metals in the crystallization process, and studies in humans have reported relationships between urinary metal concentrations and stone risk. Dogs are a spontaneous model of calcium oxalate urolithiasis, and the metal content of canine calcium oxalate stones mirrors that of human stones. The aim of this study was to test for a relationship between urinary metals and calcium oxalate urolithiasis in dogs. We hypothesized that urinary metals would differ between dogs with and without calcium oxalate urolithiasis. Urine from 122 dogs (71 cases and 51 stone-free controls) was analyzed for calcium and 12 other metals. The cases had higher urinary calcium, copper, iron, and vanadium and lower urinary cobalt. Higher urinary vanadium in the cases was associated with being fed a therapeutic stone-prevention diet. Urinary calcium had a strong positive correlation with strontium and moderate positive correlations with chromium, nickel, and zinc. The results of this study complement the findings of similar human studies and suggest a potential role of trace metals in calcium oxalate urolithiasis. Further investigation into how trace metals may affect stone formation is warranted.

Pathogenesis of calcium oxalate urinary stone disease: species comparison of humans, dogs, and cats

Idiopathic calcium oxalate nephrolithiasis is a highly recurrent disease that is increasing in prevalence. Decades of research have not identified effective methods to consistently prevent the formation of nephroliths or induce medical dissolution. Idiopathic calcium oxalate nephroliths form in association with renal papillary subepithelial calcium phosphate deposits called Randall's plaques (RPs). Rodent models are commonly used to experimentally induce calcium oxalate crystal and stone formation, but a rodent model that conclusively forms RPs has not been identified. Both dogs and cats form calcium oxalate uroliths that can be recurrent, but the etiopathologic mechanisms of stone formation, especially renal pathologic findings, are a relatively unexploited area of study. A large animal model that shares a similar environment to humans, along with a shorter lifespan and thus shorter time to recurrence, might provide an excellent means to study preventative and therapeutic measures, along with enhancing the concepts of the one health initiative. This review article summarizes and compares important known features of idiopathic calcium oxalate stone disease in humans, dogs, and cats, and emphasizes important knowledge gaps and areas for future study in the quest to discover a naturally occurring animal model of idiopathic calcium oxalate stone disease.

[Effects of a supplementation on sodium chloride or ammonium chloride on urolithic potential in the rabbit]

AIM

Reduction of urolithic potential by means of increased water intake and urine dilution through supplementation of sodium chloride (NaCl) or decrease of urine pH by supplementation of ammonium chloride (NH4Cl) in rabbits.

MATERIALS AND METHODS

Sixteen female, 6-month-old dwarf rabbits received the following three feeding regimens in a random order: complete feed without supplements = control; complete feed + 10 g NaCl/kg feed = NaCl; complete feed + 2.5 g NH4Cl/kg feed = NH4Cl. The diets were fed ad libitum over a period of 27 days without roughage. Water was provided ad libitum by a drinker. A 14-day wash-out-period (hay feeding) was performed between the different diets. Blood, faeces, and urine were collected at the beginning of each feeding period, after 21-day adaptation to the respective diet, and after the 3-day collection period. The following parameters were analysed: water and food intake as well as acid-base balance and mineral content in blood, urine, and faeces.

RESULTS

NaCl supplementation numerically increased the daily water intake from 40.5 ± 14.4 ml/kg body weight (BW) (control) up to 49.5 ± 14.3 ml/kg BW and significantly increased the daily urine volume from 16.9 ± 7.8 ml/kg BW (control group) to 21.1 ± 7.4 ml/kg BW. The specific gravity of urine samples from NaCl supplementation decreased from 1.060 ± 0.008 to 1.044 ± 0.008. NH4Cl supplementation did not induce significant changes in urine pH, blood acid-base parameters, or calcium retention. Relative supersaturations (RSS) for calcium oxalate and calcium phosphate showed no significant changes after treatment. RSS for struvite increased from 360 ± 735 (after hay feeding) to 3312 ± 6188 on control feeding, 2910 ± 4913 with NaCl supplementation, and 3022 ± 6635 with NH4Cl supplementation (p < 0.05).

CONCLUSIONS

NaCl supplementation significantly increased the urine volume and decreased its specific gravity. Therefore, NaCl supplementation might be an additional dietary treatment to increase the elimination of urine crystals in rabbits. NH4Cl supplementation did not induce acidification of the urine.

A Single Nucleotide Polymorphism (rs4236480) in TRPV5 Calcium Channel Gene Is Associated with Stone Multiplicity in Calcium Nephrolithiasis Patients

Nephrolithiasis is characterized by calcification of stones in the kidneys from an unknown cause. Animal models demonstrated the functional roles of the transient receptor potential vanilloid member 5 (TRPV5) gene in calcium renal reabsorption and hypercalciuria. Therefore, TRPV5 was suggested to be involved in calcium homeostasis. However, whether genetic polymorphisms of TRPV5 are associated with kidney stone multiplicity or recurrence is unclear. In this study, 365 Taiwanese kidney-stone patients were recruited. Both biochemical data and DNA samples were collected. Genotyping was performed by a TaqMan allelic discrimination assay. We found that a TRPV5 polymorphism (rs4236480) was observed to be associated with stone multiplicity of calcium nephrolithiasis, as the risk of stone multiplicity was higher in patients with the TT+CT genotype than in patients with the CC genotype (p = 0.0271). In summary, despite the complexity of nephrolithiasis and the potential association of numerous calcium homeostatic absorption/reabsorption factors, TRPV5 plays an important role in the pathogenesis of calcium nephrolithiasis.

Fasting urinary calcium-to-creatinine and oxalate-to-creatinine ratios in dogs with calcium oxalate urolithiasis and breed-matched controls

BACKGROUND

Hypercalciuria and hyperoxaluria are risk factors for calcium oxalate (CaOx) urolithiasis, but breed-specific reports of urinary metabolites and their relationship with stone status are lacking.

OBJECTIVE

To compare urinary metabolites (calcium and oxalate) and blood ionized calcium (iCa) concentrations between CaOx stone formers and breed-matched stone-free controls for the Miniature Schnauzer, Bichon Frise, and Shih Tzu breeds.

ANIMALS

Forty-seven Miniature Schnauzers (23 cases and 24 controls), 27 Bichons Frise (14 cases and 13 controls), and 15 Shih Tzus (7 cases and 8 controls).

METHODS

Prospective study. Fasting spot urinary calcium-to-creatinine and oxalate-to-creatinine ratios (UCa/Cr and UOx/Cr, respectively) and blood iCa concentrations were measured and compared between cases and controls within and across breeds. Regression models were used to test the effect of patient and environmental factors on these variables.

RESULTS

UCa/Cr was higher in cases than controls for each of the 3 breeds. In addition to stone status, being on a therapeutic food designed to prevent CaOx stone recurrence was associated with higher UCa/Cr. UOx/Cr did not differ between cases and controls for any of the breeds. Blood iCa was higher in cases than controls in the Miniature Schnauzer and Bichon Frise breeds and had a moderate correlation with UCa/Cr.

CONCLUSIONS AND CLINICAL IMPORTANCE

Hypercalciuria is associated with CaOx stone status in the Miniature Schnauzer, Bichon Frise, and Shih Tzu breeds. UOx/Cr did not correlate with stone status in these 3 breeds. These findings may influence breed-specific stone prevention recommendations.

Recent shifts in the global proportions of canine uroliths

Epidemiological surveys are important tools to identify emerging trends in disease. The Minnesota Urolith Centre has been tracking the occurrence of uroliths for over 30 years. To evaluate global changes in the frequencies of canine uroliths, submissions to the Minnesota Urolith Centre in 1999 and 2000 (n = 39,965) were compared with submissions in 2009 and 2010 (n = 99,598). The proportion of calcium oxalate uroliths rose on every continent except in Europe. Seventy-five per cent of dogs with calcium oxalate uroliths were between 5 and 11 years old. The proportion of struvite uroliths decreased on every continent except in Australia-Oceania. Seventy-seven per cent of all struvite formers were between two and eight years old. The proportion of purine uroliths has declined slightly. Worldwide, uroliths composed of cystine, calcium phosphate, calcium phosphate carbonate and silica remain uncommon. Epidemiological studies of urolithiasis are essential for constructing effective experimental designs and selecting appropriate cases and controls to conduct clinical trials with meaningful results.

Metabolite fingerprinting of urine suggests breed-specific dietary metabolism differences in domestic dogs

Selective breeding of dogs has culminated in a large number of modern breeds distinctive in terms of size, shape and behaviour. Inadvertently, a range of breed-specific genetic disorders have become fixed in some pure-bred populations. Several inherited conditions confer chronic metabolic defects that are influenced strongly by diet, but it is likely that many less obvious breed-specific differences in physiology exist. Using Labrador retrievers and miniature Schnauzers maintained in a simulated domestic setting on a controlled diet, an experimental design was validated in relation to husbandry, sampling and sample processing for metabolomics. Metabolite fingerprints were generated from 'spot' urine samples using flow injection electrospray MS (FIE-MS). With class based on breed, urine chemical fingerprints were modelled using Random Forest (a supervised data classification technique), and metabolite features (m/z) explanatory of breed-specific differences were putatively annotated using the ARMeC database (http://www.armec.org). GC-MS profiling to confirm FIE-MS predictions indicated major breed-specific differences centred on the metabolism of diet-related polyphenols. Metabolism of further diet components, including potentially prebiotic oligosaccharides, animal-derived fats and glycerol, appeared significantly different between the two breeds. Analysis of the urinary metabolome of young male dogs representative of a wider range of breeds from animals maintained under domestic conditions on unknown diets provided preliminary evidence that many breeds may indeed have distinctive metabolic differences, with significant differences particularly apparent in comparisons between large and smaller breeds.

Effects of dietary supplementation with sodium chloride on urinary relative supersaturation with calcium oxalate in healthy dogs

OBJECTIVE

To evaluate the effect of dietary supplementation with sodium chloride (NaCl) on urinary calcium excretion, urine calcium concentration, and urinary relative supersaturation (RSS) with calcium oxalate (CaOx).

ANIMALS

6 adult female healthy Beagles.

PROCEDURE

By use of a crossover study design, a canned diet designed to decrease CaOx urolith recurrence with and without supplemental NaCl (i.e., 1.2% and 0.24% sodium on a dry-matter basis, respectively) was fed to dogs for 6 weeks. Every 14 days, 24-hour urine samples were collected. Concentrations of lithogenic substances and urine pH were used to calculate values of urinary RSS with CaOx.

RESULTS

When dogs consumed a diet supplemented with NaCl, 24-hour urine volume and 24-hour urine calcium excretion increased. Dietary supplementation with NaCl was not associated with a change in urine calcium concentration. However, urine oxalate acid concentrations and values of urinary RSS with CaOx were significantly lower after feeding the NaCI-supplemented diet for 28 days.

CONCLUSIONS AND CLINICAL RELEVANCE

Dietary supplementation with NaCl in a urolith-prevention diet decreased the propensity for CaOx crystallization in the urine of healthy adult Beagles. However, until long-term studies evaluating the efficacy and safety of dietary supplementation with NaCl in dogs with CaOx urolithiasis are preformed, we suggest that dietary supplementation with NaCl be used cautiously.