Question Details
Ammonium Acid Urate Stones
by kderfuss - January 15, 2022
Hello Steve,
A 6 year old, 15#. small mixed breed dog recently had a urinary obstruction and went to emergency. Liver small on u/s, the stone was ammonium acid urate, liver values normal but resing bile acids was 24.8 (<13 wnl) , post prandial normal.
I'm thinking microvascular shunt. He has a great appetite so not SP deficient. I'm finding that the herbals suggested for urolithiasis or microvascular shunt in your big red book don't seem to fit for him and ammonium stones not noted at all that I could find (I checked your book with Susan Wynn also)
I have not seen him to do a tongue and pulse yet.
I appreciate your recommendations.
Karin
Replies
by naturevet
January 15, 2022
Hi there,

A small liver means reduced liver circulation. This can be associated with reduced functioning of the liver urea cycle, through which ammonia liberated from protein metabolism is converted into urea. If that doesn't happen, ammonium is excreted directly and can combine with urates to produce stones. All this is to say, increasing liver blood flow and metabolism is critically important to resolving ammonium biurate crystalluria in the carnivore.

Switching to Chinese medicine, given the propensity for stones, we know the dog is Damp, and therefore that the Spleen is compromised at least a little. Combining the two requirements - improving liver blood flow and metabolism while draining Damp - my first suggestion is probably Dang Gui Shao Yao San. Herbs that can be added and that help increase urate solubilization and excretion include Atractylodes (Bai Zhu, Cang Zhu), Coix (Yi Yi Ren) and Plantago (Che Qian Zi). These can be added to DGSYS (esp. Atractylodes and Plantago), although Atractylodes is already in there.

That's how I'd start, anyway. If the dog is on a very high protein diet, it should be reduced to a normal protein diet. Hopefully this all helps!

Steve
by kderfuss
January 15, 2022
Thank you!
Dang Gui was top on my list but I was also considering Yi Guan Jian. Of course the emergency hospital put the dog on u/d (yuk!) and he is starving and losing weight. I added egg to help increase the calories and was always taught albumin is the best protein for liver or kidney problems. Will work on his diet. Hope you agree.
Karin
by naturevet
January 16, 2022
Sounds good! Protein restriction will only perpetuate the Liver Blood deficiency. If you have another marker you can monitor for reduction of crystal tendencies, then as soon as you see improvements there, you can gradually start normalizing protein levels and have the diet be part of the solution instead of risking perpetuating the problem

Good luck!

Steve
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