Nephroliths and ureteroliths pose unique challenges to the clinician compared to lower tract uroliths. Complications of nephroliths include obstruction of the renal pelvis or ureter, pyelonephritis, and compressive injury of the renal parenchyma leading to chronic kidney disease (CKD). Nephroliths may be considered incidental if they are small and are not causing any of these complications. An additional consideration of determining if the nephrolith is incidental or may cause obstruction is the location within the renal pelvis. Nephroliths located at the ureteral pelvic junction (UPJ) that are small enough to move into the proximal ureter pose a greater risk of causing ureteral obstruction than nephroliths located at the collecting recesses of thediverticula of the renal pelvis. Incidental nephroliths do not require removal, but they should be monitored periodically by serum biochemistry profile, urinalysis, urine culture, and radiography and ultrasonography. Indications for intervention for nephroliths and ureteroliths in dogs include obstruction of the UPJ or ureter, relapsing UTI from infected uroliths, progressive nephrolith enlargement, and nephroliths located near the UPJ of a solitary functional kidney.13 The major indication for removalof upper tract uroliths in cats is obstructive ureteroliths.35 Removal of incidental nephroliths is not recommended in cats.
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