Message Number: FHL5777 | New FHL Archives Search

From: Sukie Crandall
Date: 2008-08-17 19:56:22 UTC
Subject: [ferrethealth] Re: Suiki's urine problems
To: ytonytcla <Tonytclarke@aol.com>, fhl <ferrethealth@yahoogroups.com>

Tony, Calcium Oxalate uroliths call for reducing oxalate in the diet
from what i have been told, but I don't know how to go about that.
I'll see if I can find more info for you with a search now.

This is from a veterinary site:
http://www.2ndchance.info/homemadediets.htm
includes:
> In cats with oxalate bladder crystals, the addition of potassium
> citrate (300-500mg/day) will sometimes prevent ... in dogs to
> encourage oxalate crystals to dissolve, the dose is 300mg/10 pounds
> body weight to a maximum of 1,800mg/day...
>
> Oxalate stones form in an acid urine. They tend to reoccur and often
> have to be removed surgically. Although I have no experience
> formulating diets to prevent oxalate stone formation, farmer's
> cheeze, yogurt and other dairy products seem to be quite low in
> oxalates as are rice and green peas and mung beans. Coconut oil is a
> good source of low-oxalate fat and ground beef, chick and turkey all
> are low in oxalates. Liver, kidney and other organ meats are high in
> oxalates as are many vegetables, fruit berries and nuts. Cheeze is a
> good source of calcium. To this diet one might add potassium citrate
> at the previously doses give. This added potassium citrate would
> work its way into the urine where it would bind with the calium
> present forming soluable calcium citrate instead of insoluable
> calcium oxalate. Potassium citrate also helps create a basic or
> alkaline urine (pH over 7.0) in which calcium oxalate stones have
> difficulty forming. Multivitamins must also be provided. Protein
> content of the diet should be lower than normal. The more dilute the
> urine the better. Urine should be almost clear and odorless if
> sufficient water is consumed.
>
> Diets prepared to minimize oxalate stone formation in humans suggest
> an added calcium... I would be cautious in doing this since it might
> increase the calcium content of the urine.
>
> Unfortunately, much of the oxalate that contributes to stone
> formation is produced by metabolic processes in your pet itself.
>
> Commercial diets that have been recommended to prevent oxalate
> stones include Hills x/d diet designed especially to prevent oxalate
> crystals s/d, k/d, u/d, CNM's NF, and Waltham's SO or their Low
> Protein Diet. Sodium-potassium citrate supplementation of food shows
> potential in preventing oxalate reoccurence.
>
> Success is measured by an increased urine pH and the lack of
> microscopic calcium oxalate crystals in the urine. When all else
> fails to prevent formation of microscopic calcium oxalate crystals
> in your pet's urine, a thiazied diuretic can be give to reduce the
> calcium content of the urine. These medications are typically given
> twice a day. Blood calcium level can be measured through a blood
> test taken after two weeks of treatment.
>

and in
http://en.allexperts.com/q/Ask-Veterinarian-700/calcium-oxalate-bladder-stones.htm
another vet writes:
> I would try Science Diet C/D food. I have seen this work better
> than the U/D. Calcium Oxalate Crystals are in your dog's urine,
> which these then stick together, forming stones. Hill's Science
> Diet C/D food breaks down these crystals, which will result in the
> inability for them to create stones.
and more

Thanks for this info which is new to me:
> Calcium Oxalate (primary or secondary hyperoxaluria) Oxalbacter
> formigene deficiency, poor fat absorbtion, excessive uric acid, low
> urine citrate

Not ferret, but may be helpful:
http://www.healthgoods.com/education/health_information/General_Health/update_kidney_stones.htm
> Only eight foods definitely raise urinary oxalate values: spinach,
> tea, nuts including peanuts, chocolate, beets (the leaves and
> roots), rhubarb, strawberries and wheat bran.

I don't know if the foods you are giving have any of these in them. I
do know that some foods use beets, and I think I have heard of some
with spinach or with wheat bran.

and
Hypothesis based on a recent large human study:
> A recent study of male health professionals found that individuals
> with the highest intakes of dietary calcium actually had the lowest
> incidence of kidney stones. Researchers believe calcium in the
> intestine combines with oxalate in the diet and prevents it from
> being absorbed. Then both calcium and oxalate are excreted in the
> feces instead of in the urine.
> In this study, calcium supplements did not seem to have a protective
> effect and even slightly increased the risk for kidney stones.
> Researchers believe that supplements do not help because they are
> usually taken only once a day, either between meals or at breakfast,
> when few foods containing oxalate are consumed. Calcium helps
> prevent kidney stones the most when it is consumed at least in small
> amounts at every meal.
>
> Reserch shows that higher urinary oxalate levels increase risk for
> kidney stones more than higher levels of urinary calcium.
>


Struvite uroliths usually call for reducing vegetable matter in the
diet, but I think that infections can cause them to be created. A
urine acidifier sometimes help ferrets who get those.

Wondering if she may be helped -- if you can get it into her -- by
cranberry or blueberry juice both for the acidity and for the tannin
type found to prevent bacteria from sticking to bladder walls. I have
a vague recollection that yet another infection fighting compound was
found in them this year, but can't recall details so it might be a
false recollection. (Ah, the answer is probably "No" because of the
oxalate aspect. See the NY Times article cited.)

The site above contains:
> Some concern has also been voiced about the effects of high intakes
> of ascorbic acid or vitamin C on oxalate levels. Since ascorbic acid
> can be converted to oxalate, some urologists warn against taking
> large doses of vitamin C. However, a recent study published in the
> Journal of Urology showed that drinking a quart of orange juice each
> day reduced the incidence of kidney stones in individuals
> susceptible to them. The citrate contained in the juice lowered the
> risk for stone formation. This is good news because the medication,
> potassium citrate, often prescribed to help prevent stone
> recurrence, frequently causes stomach upsets. Other juices like
> cranberry juice, grape juice, and other citrus juices may also have
> the same positive effect.

It also calls for lots of water (extremely important for any type of
urolith), having foods with calcium through the day but no calcium
supplements and no one-time a day calcium splurge, limiting fat intake
(meshes with your note on her possible inability to absorb fats
well.), having moderate intake of at least some animal protein sources
(specifically listed: chicken, fish, meat), and limiting high oxalate
foods "like spinach, tea, nuts, peanuts, chocolate, beets, beet
greens, rhubards, strawberries and wheat bran".

(The third type of common urolith found in ferrets is cystine and
those ferrets need their protein intake reduced and there is info in
the separate FHL Archives on medication the ones from whom this isn't
sufficient.)

Other sources of info:
http://www.kidney.org/kidneydisease/fs/showFS.cfm?id=41
includes:
> If you have had a kidney stone that contains oxalate, some evidence
> (research) suggests that limiting high oxalate foods may help reduce
> your chance of forming another oxalate stone. Foods that are high in
> oxalate include: peanuts, tea, instant coffee (more than 8 ounces a
> day), rhubarb, beets, beans, beets, berries (blackberries,
> raspberries, strawberries, gooseberries, etc. ), chocolate, Concord
> grapes, dark leafy greens, oranges, tofu, sweet potatoes and draft
> beer. Because the stone contains calcium and oxalate, you may also
> need to follow the calcium recommendations from the last question.
and
> If you have had a calcium stone, your doctor may ask you to cut back
> on the salt and sodium in your diet. Extra sodium causes you to lose
> more calcium in your urine, putting you at risk for developing
> another stone. Your doctor will probably advise you to limit your
> sodium to 2,000 to 3,000 milligrams a day. Your dietitian can help
> you make sodium changes in your diet.
> You may not need to avoid excessive (too much) calcium in your diet.
> It is important that you learn from your doctor and dietitian the
> right balance of calcium you should eat. Following a diet low in
> calcium for a long period of time can lead to a loss of bone mass,
> or osteoporosis.
and
> The B vitamins (which include thiamine, riboflavin, niacin, B6 and
> B12) have not been shown to be harmful to people with kidney stones.
> However, check with your doctor or dietitian for advice on the use
> of vitamin C, vitamin D, fish liver oils or mineral supplements
> containing calcium since some supplements can increase the chances
> of stone formation in some people.


There is up to date info in today's New York Times (a must-read
although it does not differentiate among the types of uroliths well
enough and different types need different approaches except for a few
things like more water for all):
http://health.nytimes.com/health/guides/disease/kidney-stones/prevention.html
Some of the things that differ from the others quoted:
> The most important dietary recommendations for reducing the risk for
> calcium stones are increasing fluid intake, restricting sodium, and
> reducing protein intake.
> A lower risk for calcium stones is also associated with higher
> potassium intake.
> A high calcium diet does not appear to increase the risk for kidney
> stones as long as it also contains plenty of fluids and dietary
> potassium and phosphate. (Increasing calcium alone may pose a modest
> risk for stones.)
> Patients should try to correct any dietary habits that cause acidic
> or alkaline imbalances in the urine, which promote stone formation.
...
> In all cases, patients need more fluid after exertion and during
> times of stress. If they drink enough, the urine should be pale and
> almost watery, not dark and yellow.
...
> One study reported that drinking hard tap water increased urinary
> calcium concentration by 50% compared to soft bottled water. On the
> other hand, mineral water containing both calcium and magnesium may
> reduce several risk factors for both calcium and uric acid stone
> formation.

There is a LOT of DETAILED DIET INFO in there including (but far from
limited to):
> Cranberry and Apple Juice: Apple and cranberry juice contain
> oxalates, and both have been associated with a higher risk for
> calcium oxalate stones. Cranberry juice has properties that may
> increase the risk for both calcium oxalate and uric acid stones. On
> the other hand, cranberry juice helps prevent urinary tract
> infections and so may be helpful for reducing the risk for struvite
> and brushite stones.
and
> Salt Restriction. Because salt intake increases the amount of
> calcium in urine, patients with calcium stones should limit their
> sodium intake. Sodium may also increase levels of urate, the
> crystalline substance that can trigger formation of recurrent
> calcium oxalate stones. ...
> Protein Restriction. Protein increases uric acid, calcium, and
> oxalate levels in the urine, and reduces citrate levels. Diets high
> in protein, particularly meat protein, have been consistently
> connected with kidney stones. (Meat protein has a higher sulfur
> content and produces more acid... 2002 study of those following a
> high-protein, low-carbohydrate diet ... found dramatically increased
> levels of urinary uric acid and calcium after just several weeks.
> These effects put patients at higher risk for not just kidney
> stones, but possibly osteoporosis as well. ... about a third of
> people at risk for calcium stones may have a sensitivity to meat
> proteins that causes mild hyperoxaluria.
> Whether restricting meat protein alone has any protective value
> without restricting sodium as well is unknown...

There is loads more but the info doesn't differentiate between urolith
types and very different diets have to be used for different types of
uroliths.

I will try to see if I can find a comparative reference on oxalate
levels in various sources of animal protein (beyond the lamb warning
and higher up there is the organ meats warning) later if I get the
time. If I don't but someone else does, please, share the info. The
sulphur level comment makes me think that eggs might have a chance of
posing a problem with some types of uroliths but I do not know.

This differs from how struvite uroliths are historically well handled
for ferrets:
> Although the precise role of dietary protein in kidney stones needs
> further clarification, it is reasonable for everyone to consume meat
> protein in moderation. People with struvite stones, who need to
> reduce phosphates in their diets, should also cut down on proteins.
For ferrets usually increasing the meat protein while reducing the
plant protein helps reduce the levels of struvite uroliths.

It includes:
> Foods high in oxalic acid include beets, soy, beet tops, black tea,
> chenopodium, chocolate, cocoa, dried figs, ground pepper, lamb, lime
> peel, nuts, parsley, poppy seeds, purslane, rhubarb, sorrel,
> spinach, and Swiss chard.
> Foods containing moderate amounts of oxalates include beans (green
> and wax), blackberries, blueberries, carrots, celery, coffee
> (roasted), concord grapes, currants, dandelion greens, endive,
> gooseberries, lemon peel, okra, green onions, oranges, green
> peppers, black raspberries, strawberries, and sweet potatoes.


Does she have trouble digesting fats? Has she had other signs of that
like "bird seed" stools?

In the NY Time article:
> eat too much fat, calcium may bind to unabsorbed fat instead of to
> oxalates. This increased oxalate levels, resulting in increased risk
> of stone formation.


Sukie (not a vet)

Recommended ferret health links:
http://pets.groups.yahoo.com/group/ferrethealth/
http://ferrethealth.org/archive/
http://www.afip.org/ferrets/index.html
http://www.miamiferret.org/fhc/
http://www.ferretcongress.org/
http://www.trifl.org/index.shtml
http://homepage.mac.com/sukie/sukiesferretlinks.html


You wrote:
http://pets.groups.yahoo.com/group/ferrethealth/message/7259
> --- In ferrethealth@yahoogroups.com, "Tony Clarke" <Tonytclarke@...>
> wrote:
> > Suki has had an apparent urine infection almost continously since
> > 11/05/2007.
> >
> This has become a long drawn out problem and has now taken a new
> twist.
> During numerous urine tests over several months blood,hemaglobin,
> various bacteria species and until now unidentified (needle like
> shape could not be identified by morphology) crystals have
> been seen (not always together in the same test). Ph has always been
> 5.5-6.0, SG always 1.05. needle like cystals always present.
> After 2 courses of Synolux (Amoxycillin with Clavulanic Acid) 1 of 10
> days and 1 of 23 days we seem to have got rid of the enterococcus and
> blood.
> The latest sample was sent to a specialist lab to get a better
> analysis of the crystals.
>
> Lab Results below.
> RBC's_____ none
> WBC's_____ <5
> Epithelial none
> Crystals___Scanty calcium oxalate crystals and occasional struvite
> ___________crystals
> Casts______none
> Aerobic culture >100,000 colonies of non hemolytic steptococcus /ml.
>
> Cytology - Cytospin concentrated peparations of the submitted plain
> boric acid,EDTA and fixed urine sample examined.
>
> Description - The appearance of the four peparations was similiar
> revealing no intact nucleated cells and moderate numbers of single
> anucleate epithelial cells identified on a finely granular pale
> background containing large amounts of amorphous cantaminent debris.
> Fungal hyphae,small bacterial coccobacilli and larger bacterial
> bacilli were seen on all samples. Moderate sized spherical
> buddingbasophilic organisms (consistent in appearance with yeasts}
> were seen on all, (apart from the fixed), samples. Struvite crystals
> were detected on one of the plain samples.
>
> Comments - This sample seems to be a collection from a tray (well
> spotted, but it was a clean, sterilised tray, but unavoidable fecal
> contamination.-Tony).
> There is no evidence of leuconuria or neoplasia.
> Lab Results end.
>
> Both of my ferrets are fed the same, a 50/50 mix of two good quality
> kibbles(James Wellbeloved and Vitalin) and one egg with a small
> amount of milk each per 6 days (in two sessions 3 days apart).
>
> Any comments appreciated re the 2 kinds of crystals in the urine.
>
> Struvite (bacterial UTI ??) but always has been the wrong species of
> bacteria).
> Calcium Oxalate (primary or secondary hyperoxaluria) Oxalbacter
> formigene deficiency, poor fat absorbtion, excessive uric acid, low
> urine citrate
>
> > Tony (not a vet), Sugar and Suki.
> > In memory of Sally and Sue.
> >





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