MS 파워포인트 
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임상세미나임상세미나1.Patient - Gogo McNeely McNeelyWeight -11.4kgSpecies -CanineBreed -Miniature SchnauzerAge -7 yrs oldSex CMChief complaint -HematuriaCase history - Pollakisuria over the last weekPhysical examination and Lab findings1.Unremarkable physical and rectal examination2.During Cystocentesis, three 2-3cm hyperechoic densities were found and cystic calculi are strongly suspected. 3.Urinalysis ; moderate calcium oxalate crystalluriaPH 6.0USG 1.045 (high margin)4.Blood work ; serum calcium was unremarkable5.Surgery went well,Stones were made of “100% calcium oxalate “Recommend Nutritional Therapeutic Diet Q1. Which therapeutic diet would you recommend for Gogo and Why?Based on a surrogate end-pointsChanges in urine concentration of calciumoxalate excretionCalcium oxalate RSS relative supersaturation (RSS)Rather thanthe reduction of recurrence ratesSo, Therapeutic diet should be.Wet diet ; for diuresis- water intake has to be increased- How? hydratin dry food before servingUntil…USG is less than 1.020 (Urinalysis check-up needed)Sodium chloride ; for diuresischloride-added diet is expected to make water consumption increased with urine volume and urine calcium목차
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Proper Calcium & Phosphorus content included- If dietary calcium eliminated only without oxalate reduction
-> aborption from intestine and excretion from kidney are
increased
-> so, the risk of calcium oxalate urolithiasis recurrence
could be elevated
Included higher level of Protein
- Higher level of protein content included
mechanism is not clear
but lower protein diet → Ca excretion ↑ Citrate ↓
( chlelates Ca → soluble salt )
and higher protein diet → diuresis ↑
Traditional Nutritional Recommendations
Increasing water intake to dilute urine calcium and oxalate
Sodium chloride restriction has been recommended which is based on the hypothesis that minimizing natriuresis would minimize hypercalciuria
Calcium & Phosphorus restricted because when dietary Ca is restricted, It was considered that urinary Ca will also be decreased
Reduced dietary level of Protein content for relieving kidney’s burden
Reduced oxalate precursors such as spinarochi
Q2, Traditional nutritional recommendations were made to decrease the risk of calcium oxalate urolithiasis recurrence, what are four of them and what are their proposed mechanisms.
