Homemade diet for dogs with calcium oxalate bladder stones

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A description of homemade dog food used to prevent recurrence of calcium oxalate bladder stones.

Brenda Lorencovic

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How to Prevent Bladder Stone Recurrence

While nothing specific can be done at present regarding the genetic mutation, treatment is instead targeted at trying to control the other risk factors:

1. Testing

2. Medical treatment

3. Diet change

Testing

It is important to understand the reasons why the stones formed in each individual dog as fully as possible.

This means ruling out the presence of Hereditary Calcium Oxalate Urolithiasis with a blood test that can pick up this genetic mutation.

Next comes ruling out the presence of high blood calcium levels. If blood calcium is elevated then the cause needs to be further investigated, with there being many possibilities including: certain cancers, high vitamin D levels, kidney failure, and Addison’s disease.

Medical treatment

The most basic treatment of all is to increase the amount of water your dog is drinking. Here are some ideas to get your dog to drink more water.

If this increased water intake and diet change (which I discuss next) does not improve the acidity of the urine, then potassium citrate can be given to make the urine more alkaline.

If despite all this the calcium oxalate bladder stones keep recurring, and blood calcium levels are not elevated, then a drug called hydrochlorothiazide can be administered.

Diet

The challenge with choosing the best diet is that really high quality, long term studies have not been carried out and as such there is not currently a “best” diet option.

Canned foods can play a role by increasing a dog’s water intake, diluting the urine and so preventing high concentrations of calcium and oxalate from forming. Extra water can also be added to any wet or dry food that is fed.

Some of the desirable characteristics of a diet to prevent calcium oxalate stones in dogs include:

• Lower levels of animal protein to reduce urine acidity and also reduce urine concentration.

• Low sodium diets help to reduce excessive urine calcium levels compared to high sodium diets.

• Unless there is a known deficiency, avoid giving any vitamin or mineral supplements which may result in an unwanted increase in urine mineral content.

• Low-oxalate foods include cheese, vegetable oil, avocados, beef, fish, lamb, poultry, eggs, barley, corn or rice cereal, pasta, white rice and wild rice

• Ingredients to avoid, that contain moderate to high levels of calcium or oxalates, include: nuts, soy, wheat, bran, beans, beets, spinach, buckwheat, carrots, kale, flax seed, sunflower seed, apples, liver, sardines, brown rice, corn starch, oatmeal and cornmeal

Of the diets marketed to prevent CaOx, Hills C/D Multicare results in the greatest reduction in CaOx formation. Hills I/D Low Fat is another choice for dogs that also have high blood fat levels.

When it comes to formulating a home-cooked diet that is not only complete and balanced, but that also will help to prevent stone recurrence, I would always recommend consulting with a certified veterinary nutritionist.

Related Episodes

• Home-cooked diets for disease management

The focus then becomes preventing the calculi from recurring and become a problem all over again

How to Prevent bladder Stone Recurrence

While nothing specific can be done at present regarding the genetic mutation, treatment is instead targeted at trying to control the other risk factors:

1. Testing

2. Medical treatment

3. Diet change

Testing

It is important to understand the reasons why the stones formed in each individual dog as fully as possible.

This means ruling out the presence of Hereditary Calcium Oxalate Urolithiasis with a blood test that can pick up this genetic mutation.

Next comes ruling out the presence of high blood calcium levels. If blood calcium is elevated then the cause needs to be further investigated, with there being many possibilities including: certain cancers, high vitamin D levels, kidney failure, and Addison’s disease.

Medical treatment

The most basic treatment of all is to increase the amount of water your dog is drinking. Here are some ideas to get your dog to drink more water.

If this increased water intake and diet change (which I discuss next) does not improve the acidity of the urine, then potassium citrate can be given to make the urine more alkaline.

If despite all this the calcium oxalate bladder stones keep recurring, and blood calcium levels are not elevated, then a drug called hydrochlorothiazide can be administered.

Diet

The challenge with choosing the best diet is that really high quality, long term studies have not been carried out and as such there is not currently a “best” diet option.

Canned foods can play a role by increasing a dog’s water intake, diluting the urine and so preventing high concentrations of calcium and oxalate from forming. Extra water can also be added to any wet or dry food that is fed.

Some of the desirable characteristics of a diet to prevent calcium oxalate stones in dogs include:

• Lower levels of animal protein to reduce urine acidity and also reduce urine concentration.

• Low sodium diets help to reduce excessive urine calcium levels compared to high sodium diets.

• Unless there is a known deficiency, avoid giving any vitamin or mineral supplements which may result in an unwanted increase in urine mineral content.

• Low-oxalate foods include cheese, vegetable oil, avocados, beef, fish, lamb, poultry, eggs, barley, corn or rice cereal, pasta, white rice and wild rice

• Ingredients to avoid, that contain moderate to high levels of calcium or oxalates, include: nuts, soy, wheat, bran, beans, beets, spinach, buckwheat, carrots, kale, flax seed, sunflower seed, apples, liver, sardines, brown rice, corn starch, oatmeal and cornmeal

Of the diets marketed to prevent CaOx, Hills C/D Multicare results in the greatest reduction in CaOx formation. Hills I/D Low Fat is another choice for dogs that also have high blood fat levels.

When it comes to formulating a home-cooked diet that is not only complete and balanced, but that also will help to prevent stone recurrence, I would always recommend consulting with a certified veterinary nutritionist.

Related Episodes

• Home-cooked diets for disease management

• Different types of bladder stones in dogs
  

Full Transcript

Has your dog got bladder stones? It could be that your dog has just been diagnosed with bladder stones. You don't actually know what type they are. Calcium oxalates are, unfortunately, becoming more common as we are better able to tackle and prevent the most common type, struvite. If they are the calcium oxalate variety, they can be really challenging to treat and even harder to prevent, but it is possible.

Hello, hello, hello, and welcome to episode number 85 of the Call The Vet show! I'm veterinarian Dr. Alex, and this is the podcast for any dog and cat owner who really wants to optimize their pets health so that they can live the full and happy life that they deserve.

So, if that sounds like you, welcome along! Really happy that you're listening and make sure you hit that subscribe button on whichever podcasting app you're listening to.

And you can also get your question asked by simply heading over to callthevet.org. And that's exactly what Nicole did with today's questions. So, without further ado, let's jump straight in to it.

There are two main risk factors for calcium oxalate stones. So, the first one is urine super saturation. This means that it's really concentrated with specific minerals and the environment of the urine means that these stones are likely to form.

And this super saturation means that it's high in calcium and oxalate unsurprisingly given the name, but also acidic urine and concentrated urine and a low urine citrate level.

Now, those are not things that you're going to know that your dog has specifically before these events occur. But they're really important when it comes to thinking about how we can treat and more importantly, prevent calcium oxalate stones from being a really frequent recurrence in your dog.

And then the next big risk factor is a genetic mutation. So, this is strongly associated with the risk of calcium oxalate stones. And the mutation was actually first identified in English Bulldogs, but it's also present in other related breeds. So, our bully breeds. Ones like the Boston Terrier, Bull Mastiff, Havanese, Rottweiler, an American Staffordshire Bull Terrier or an American Staffy.

So, the condition that's associated with this mutation is actually now being referred to as Hereditary Calcium Oxalate Urolithiasis. So, urolithiasis simply means bladder stones and it's type one or CaOX1, and a genetic test is actually available for this.

So, if your dog is one of those breeds, and you're wondering if they might be affected, especially if they do seem to have bladder stones or are having problems with their waterworks, then it's a genetic test that may very well be worth requesting from your vet.

So, if those risk factors are present and calcium oxalate stones are formed in your dog, how can we go about treating them? Well, unfortunately, the news here isn't as good as the struvite stones, which I've already mentioned and are the most common .

So, struvite stones, we can dissolve with an appropriate diet as long as we keep the infection that's also going to be present in your dog's bladder under control. Now, I do have more information about struvite stones that I'll leave links in the show notes.

But, unfortunately, these calcium oxalate stones, they cannot be dissolved medically and they do require surgery to remove them unless they're very, very small. And if they are very small, we may actually be able to flush them out of your dog's bladder rather than needing to go in surgically.

And what's involved here is it still involves an anesthetic your dog will be catheterized. Their bladder will be filled up with sterile saline, and then it will be expressed while your dog is being held vertically so that those stones are falling to the neck of the bladder by gravity under then flushed out.

Now, clearly any stone that's too big to fit through that tube is not going to come out. And the only way then is to open up your dog surgically, obviously under anesthetic, and remove those stones. Unfortunately, it's not as straightforward as it sounds, although that clearly doesn't sound super straightforward, because unfortunately, some studies have shown that actually even experienced surgeons fail to remove all bladder stones in about 15 to 20% of dogs.

And you might be thinking, well, how can that be? But these stones can sometimes be very, very small. Now, clearly those very small ones may well then be flushed out, but they often also fall to that neck of the bladder and it can be really challenging to remove every single last one in some cases.

It's maybe going to depend on the size of your dog, their weight, how overweight they are, the shape of them, and if they've had any previous bladder surgery as well, and there's any scarring which may complicate matters,

But then once those stones are removed, however it is that that is managed, the focus then becomes on preventing them from being a problem in the first place. Because as I've discussed with those causes, the precipitating factors that may mean that your dog does form these calcium oxalate stones. We really need to focus on reducing those being a problem.

Clearly, we can't change genetics, but there are other factors we can change with that urine supersaturation of minerals.

So, step number one when it comes to preventing calcium oxalate stones rearing their head in your dog again comes down to testing. So, we need to rule out that hereditary calcium oxalate urolithiasis mutation. So, that genetic mutation that means they're more likely to form these stones.

And we should also be ruling out the presence of high blood calcium levels. They can be caused by very many different factors, including some cancers, high vitamin D levels, , kidney failure and Addison's disease, which is a hormonal abnormality.

If your dog does have high calcium levels, then the cause of that really needs to be investigated so that again, specific treatment can be targeted towards that underlying cause.

Now, next comes medical treatment. So we need to give additional water to reduce that urine concentration. If we can reduce the concentration of the urine, make your dog produce more urine, more dilute urine, then the saturation of all of those extra minerals is going to be reduced. The concentration of them in the urine is going to be reduced.

We can also give potassium citrate if the urine acid heat remains too high. And our very often, if we're giving a lots of extra water and we're diluting the urine, the acidity also falls. But if the acidity is too high, then we can add that potassium citrate.

Now, if stones keep recurring despite these factors and your dog's calcium levels are not elevated, we can give a compound called hydroclorothiazide.

And then, a diet change is clearly really important here as well and can factor into those other preventive aspects. Now, the challenge here is choosing the best diet because really high quality and long-term studies, they've simply not been carried out. And so really there isn't a current best or a gold standard diet yet.

Now, that clearly may change in the future. And hopefully it does as we learned to understand all of these factors and precipitating causes more fully now, canned foods are clearly going to increase your dog's water intake. We've already discussed how important that is to dilute the urine and so prevent those high concentrations of calcium and oxalate.

Now, extra water. You can also add that to your dogs, dry food if they are fed a dry food. And you could also encourage them to drink more water by adding ice cubes to their bowl, maybe boiling up some chicken or vegetables and using that broth in your dog's water bowl just to encourage them to really maximize their water intake.

Diets focused on preventing calcium oxalate stone should also have lower levels of animal protein because that's going to reduce the urine acidity and also reduce that year in concentration. Low sodium diets are also going to help to reduce excess to urine calcium levels compared to high sodium diets

And it's also really important that unless there are known deficiencies in your dog. So, unless you know that they struggle to maintain certain levels of vitamins or minerals, you shouldn't add extra vitamins and minerals to their diet because that's going to increase the risk of those minerals becoming saturated in your dog's urine.

And so, while there are many diets that are focused and formulated and advertised as being options for prevention of calcium oxalate, it really does seem that Hill's c/d Multicare does have the greatest reduction in calcium oxalate formation.

And for those dogs that are struggling with high blood fat levels, Hills i/d Low Fat is another option there. So, those are certainly things to consider trying.

Now, if your dog doesn't get home with the Hill's Diet as Nicole's dog Gizmo didn't, there are various other options that you can explore in the commercial pet food world.

But if you're wanting to home cook your dog's diet who's had calcium oxalate stones, then we need to be thinking about providing low oxalate foods and these include cheese, vegetable oils, avocado, beef, fish, lamb, poultry, eggs, barley, corn or rice cereal, pasta, white rice and wild rice.

And then combined with that, we want to be avoiding ingredients that contain moderate to high levels of calcium or oxalates. And that includes ingredients like nuts, soy wheat, bran, beans, beets, spinach, buckwheat, carrots, kale, flax seed, sunflower seeds, apples, liver, sardines, brown rice, corn starch, oatmeal, and cornmeal.

Now, clearly that's a lot of different ingredients to think about and the links will all be in the show notes for those if you haven't caught them at the first time of listening,

But all that being said, formulating a complete and balanced diet and an appropriate diet when you're trying to achieve a specific aim with a problem health condition, and regardless of what that health condition is, it is really, really hard.

So, I would always suggest and recommend consulting with a properly qualified veterinary nutrition specialist before you embark on home cooking. Because the last thing you want to do is completely be ineffective in your diet choice, or even actually make the situation worse.

So, I hope all that information helps answer your question, Nicole, and I hope Gizmo is really successful with preventing the formation of any more stones.

Now, I discuss home cooked diets for disease management in much more detail in Call The Vet episode 21, so head back into the archive to check that out.

And I also talk about the other types of bladder stones all the way back in episode number three. So again, dive back into the archive to hear about that, and I'll leave links to all of those episodes in the show notes as well.

And so, that's it for me for another episode of the Call The Vet show, please share it with your friends and family if you found it interesting, or if you know anybody else who is struggling with these difficult bladder stones. It really helps grow the podcast. And it helps me interact and help more people and benefit more pets, which is really what my mission is here at Our Pet's Health and on the Call The Vet show.

But until next time, I'm veterinarian Dr. Alex. This is the Call The Vet podcast. And until next time, take care.

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