# Kidney Stones in Cats: Diagnosing Nephroliths and Ureteroliths


## Key Takeaways

- Nephroliths are stones within the kidney, while ureteroliths are stones lodged in the ureter, posing an acute risk of kidney failure due to urine flow obstruction.
- Diagnosis is a multi-step process involving serum biochemistry (with SDMA being a more sensitive early marker than creatinine for kidney damage), urinalysis (assessing pH, specific gravity, and presence of hematuria/crystalluria), and advanced imaging (radiographs, ultrasound, or CT scans).
- Calcium oxalate stones are overwhelmingly the most common type in cats (up to 98%), with genetic predisposition (e.g., *AGXT2* gene variants) and diet playing significant roles in their formation.
- Management strategies range from medical management (increased fluid intake, dietary modification) for non-obstructive nephroliths to interventional procedures like Subcutaneous Ureteral Bypass (SUB) or Endoscopic Nephrolithotomy (ENL) for obstructive or symptomatic ureteroliths.
- Unproven home remedies are dangerous; only veterinary-supervised treatment is safe and effective, with prevention focusing on high-moisture diets and regular monitoring via bloodwork and imaging.

---

If your [cat](/knowledge/veterinary-medicine/clinical-methods/cat) has been diagnosed with a kidney stone, you are likely facing a complex and often confusing condition. The direct answer is that kidney stones, known medically as nephroliths when in the kidney and ureteroliths when in the ureter, are solid mineral formations that can cause significant damage to your cat's urinary tract. Diagnosis is not a single test but a multi-step process involving bloodwork, urinalysis, and advanced imaging. This article provides a definitive, source-grounded guide to understanding how veterinarians diagnose these conditions, what the findings mean, and what you should discuss with your veterinary team.

**Owner Triage Summary:** If your cat is showing any signs of painful urination, straining, blood in the urine, or a sudden decrease in appetite and energy, this is an emergency. A blocked ureter or a kidney stone causing severe pain can lead to acute kidney failure quickly. Do not wait to see if symptoms resolve. Contact your veterinarian or an emergency veterinary hospital immediately.

### At a Glance: Nephroliths vs. Ureteroliths

| Feature | Nephrolith (Kidney Stone) | Ureterolith (Ureteral Stone) |
| :--- | :--- | :--- |
| **Location** | Within the renal pelvis or kidney parenchyma. | Within the ureter, the tube connecting the kidney to the bladder. |
| **Primary Risk** | Chronic kidney disease (CKD), local inflammation, and potential to move into the ureter. | Acute, severe obstruction of urine flow, leading to rapid kidney failure (post-renal azotemia). |
| **Common Clinical Signs** | Often silent; may be incidental finding. Can cause hematuria or flank pain. | Acute onset of vomiting, anorexia, lethargy, and severe pain. Often a surgical emergency. |
| **Diagnostic Imaging** | Ultrasound, radiographs (X-rays), CT scan. | Ultrasound, radiographs, CT scan. May be difficult to see on X-rays if small or non-mineralized. |
| **Typical Composition** | Calcium oxalate (most common). | Calcium oxalate (most common). |
| **Prognosis** | Variable; depends on size, location, and effect on kidney function. | Guarded to good with prompt intervention; depends on the degree and duration of obstruction. |

## Understanding Feline Kidney Stones

Upper urinary tract urolithiasis, or the formation of stones in the kidneys and ureters, is an emerging and serious disease in cats [<a href="#ref-1">1</a>]. The vast majority of these stones, up to 98%, are composed of calcium oxalate [<a href="#ref-1">1</a>]. This is a significant shift from historical patterns where struvite stones were more common, and it presents unique challenges for diagnosis and management.

The formation of these stones is a complex process. A leading theory involves the aggregation of proteins within the urine. Research comparing the protein matrix of cat and human calcium oxalate stones has found remarkable similarities. Both species show an enrichment of strongly anionic (negatively charged) and strongly cationic (positively charged) proteins within the stone matrix [<a href="#ref-2">2</a>]. This suggests that specific proteins bind to the surface of calcium oxalate crystals, and other proteins are then recruited through non-specific charge interactions, creating the stone's structure [<a href="#ref-2">2</a>][<a href="#ref-3">3</a>]. This process is similar to how crystals aggregate in human kidney stones, making the cat an excellent model for the human disease [<a href="#ref-2">2</a>].

While the exact cause of the initial crystal formation is still under investigation, it is clear that genetics and metabolism play a significant role. A study of a large cat colony found that cats with certain variants of the *AGXT2* gene, which is involved in glyoxylate metabolism, are more prone to forming stones [<a href="#ref-4">4</a>]. This genetic predisposition is a key area of research, as it may explain why some cats develop stones while others on similar diets do not.

## Causes and Differentials: What Can Mimic or Cause Kidney Stones?

When a veterinarian sees a cat with signs of kidney disease, they must consider several differential diagnoses. These are conditions that can present with similar symptoms or be found alongside kidney stones.

**Causes and Risk Factors for Stone Formation:**
- **Genetics:** As mentioned, specific gene variants like those in *AGXT2* are linked to stone formation [<a href="#ref-4">4</a>].
- **Diet:** While not a direct cause in every cat, diet plays a role. The type of food, its moisture content, and its effect on urine pH and mineral concentration are all factors. Studies have shown a link between commercial dry food and the presence of urinary tract abnormalities, although this is a complex relationship [<a href="#ref-5">5</a>].
- **Metabolic Imbalances:** Conditions like hypercalcemia (high blood calcium) can increase the risk of calcium oxalate stone formation.
- **Rare Metabolic Disorders:** A rare but important cause is hereditary xanthinuria, a genetic defect in purine metabolism that leads to the excretion of excessive xanthine, forming xanthine stones [<a href="#ref-6">6</a>][<a href="#ref-7">7</a>]. This should be a differential in young cats with urolithiasis [<a href="#ref-6">6</a>].
- **Microbiota:** Emerging research suggests that the gut and urinary microbiomes may play a role. Cats with kidney stones have been found to have a less diverse intestinal microbiota, and the absence of certain bacteria that degrade oxalate could contribute to stone formation [<a href="#ref-1">1</a>].

**Differential Diagnoses (Conditions with Similar Signs):**
- **Chronic Kidney Disease (CKD):** This is a common condition in older cats and can be a cause or a consequence of kidney stones. The diagnostic challenge is differentiating the two and determining which is the primary issue [<a href="#ref-8">8</a>][<a href="#ref-9">9</a>].
- **Feline Lower Urinary Tract Disease (FLUTD):** This encompasses conditions like cystitis (bladder inflammation) and urethral obstruction. While these affect the lower tract, they can cause similar signs like hematuria and straining.
- **Urinary Tract Infection (UTI):** While less common in cats than dogs, a bacterial infection can cause inflammation and hematuria.
- **Neoplasia (Cancer):** Tumors of the kidney or ureter are rare but can cause similar clinical signs and may be seen on imaging.
- **Polycystic Kidney Disease (PKD):** This inherited condition is characterized by fluid-filled cysts in the kidneys. It is common in Persian and related breeds and can be detected via ultrasound. In one study, the prevalence of PKD in Persian cats was 33.8% [<a href="#ref-5">5</a>]. While different from stones, both can lead to CKD.

## Risk Factors for Developing Kidney Stones

Identifying risk factors is crucial for both prevention and early diagnosis.

- **Age:** Calcium oxalate uroliths tend to develop in mid-to-older aged cats [<a href="#ref-8">8</a>]. This is in contrast to some other types of stones that may occur in younger animals.
- **Breed:** While any cat can develop stones, certain breeds may be predisposed. Persian cats, for example, have a high prevalence of polycystic kidney disease, which can complicate kidney health [<a href="#ref-5">5</a>]. Hereditary xanthinuria, a cause of stones, has been identified in domestic shorthair cats [<a href="#ref-6">6</a>].
- **Sex:** Some studies suggest a difference in stone location between sexes. For example, ureteral stones located at the ureterovesicular junction (where the ureter enters the bladder) were found to be more common in male cats than in female cats [<a href="#ref-10">10</a>].
- **Pre-existing Kidney Disease:** Cats with chronic kidney disease are at a higher risk of developing kidney stones, and the relationship is bidirectional. The presence of a stone can worsen CKD, and the altered urinary environment in CKD can promote stone formation [<a href="#ref-8">8</a>][<a href="#ref-4">4</a>].
- **Diet and Environment:** Cats fed commercial dry food in one study showed a higher incidence of urinary tract abnormalities, including renal calculi, compared to those on homemade diets [<a href="#ref-5">5</a>]. This does not mean dry food causes stones, but it highlights the importance of nutrition and hydration in urinary health.

## The Veterinary Diagnostic Approach

Diagnosing kidney stones is a systematic process that combines a thorough history, physical examination, and a suite of diagnostic tests. The goal is not just to find the stone, but to assess its impact on kidney function and overall health.

### History and Physical Examination

The veterinarian will start by taking a detailed history. You will be asked about your cat's appetite, water intake, urination habits (frequency, volume, straining), and any changes in behaviour. Many cats with kidney stones are asymptomatic, and the stones are found incidentally during an examination for another issue [<a href="#ref-8">8</a>]. However, if a stone is causing an obstruction, the signs can be acute and severe.

The physical examination may reveal:
- **Pain on Palpation:** The veterinarian may feel pain when palpating the kidneys (located in the mid-back area).
- **Enlarged or Irregular Kidneys:** A stone can cause the kidney to become enlarged or feel irregular in shape.
- **Dehydration:** This is common if the cat is not eating or drinking well due to nausea.
- **Oral Ulcers:** In advanced kidney failure, ulcers can develop in the mouth.
- **Pale Mucous Membranes:** This can be a sign of anemia, which is a complication of chronic kidney disease.

### Key Diagnostic Tests: Bloodwork and Urinalysis

These are the foundational tests for assessing kidney health.

**Bloodwork (Serum Biochemistry):**
- **Serum Creatinine (sCr):** This is a standard marker for kidney function. However, it is not very sensitive. It only increases after a significant loss of kidney function (approximately 75%). In cats with kidney stones, sCr may be normal even when there is substantial damage [<a href="#ref-8">8</a>].
- **Symmetric Dimethylarginine (SDMA):** This is a more reliable and earlier marker for chronic kidney disease compared to serum creatinine [<a href="#ref-8">8</a>][<a href="#ref-9">9</a>]. SDMA has been shown to increase earlier than creatinine, often by many months. In one study, the mean time that SDMA was increased before creatinine was 26.9 months [<a href="#ref-8">8</a>]. This makes SDMA a critical tool for detecting early kidney damage caused by stones. In a study of cats with kidney stones, SDMA was found to be increased in 39 of 43 cats, while creatinine was only increased in 18 of 43 [<a href="#ref-8">8</a>]. This demonstrates that SDMA is far more sensitive for detecting the renal compromise caused by nephroliths.

**Urinalysis:**
- **Urine Specific Gravity (USG):** This measures the concentration of the urine. Cats with kidney disease often have dilute urine (low USG) because their kidneys cannot concentrate it properly.
- **Urine pH:** The pH of the urine can influence the type of crystals that form.
- **Hematuria (Blood in Urine):** This is a common finding and can be microscopic (only seen under a microscope) or macroscopic (visible to the naked eye).
- **Crystalluria (Crystals in Urine):** The presence of crystals in the urine can be a clue, but it is not a definitive diagnosis of stones. Some healthy cats can have crystals in their urine.
- **Urine Culture:** This is important to rule out a urinary tract infection, which can be a complicating factor.

### Advanced Imaging: Seeing the Stones

Imaging is the primary way to confirm the presence, size, and location of kidney stones.

- **Radiography (X-rays):** Many calcium oxalate stones are radiopaque, meaning they appear white on an X-ray. This makes radiographs a useful first-line imaging test. However, small stones or those in certain locations can be missed. Radiographs are particularly useful for identifying the distribution of ureteral stones. A study of 78 cats found that ureteral stones were more commonly located in the proximal (near the kidney) and mid-ureter than at the junction with the bladder [<a href="#ref-10">10</a>]. The study also found that larger stones were associated with a more proximal location [<a href="#ref-10">10</a>].
- **Ultrasonography (Ultrasound):** This is an excellent tool for visualizing the internal structure of the kidney, including the renal pelvis and the presence of stones. It is more sensitive than radiography for detecting small stones and those that are not mineralized. Ultrasound is also essential for assessing the overall health of the kidney, looking for signs of chronic kidney disease, such as increased echogenicity (brightness) of the kidney tissue, loss of corticomedullary distinction, and the presence of cysts [<a href="#ref-11">11</a>][<a href="#ref-5">5</a>]. In one study, a higher ultrasound-based chronic kidney disease (US-CKD) score of the contralateral kidney was associated with a worse long-term outcome in cats treated for a unilateral ureteral obstruction [<a href="#ref-11">11</a>]. This highlights the importance of evaluating both kidneys, not just the one with the stone.
- **Computed Tomography (CT):** CT scans provide the most detailed images of the urinary tract. They are highly sensitive for detecting small stones and can precisely map the anatomy, which is especially helpful for surgical planning. CT is often the preferred imaging modality for complex cases.

## Evidence-Based Management of Nephroliths and Ureteroliths

The management of kidney stones in cats depends heavily on the location, size, and clinical impact of the stone. A "one-size-fits-all" approach does not exist.

### Medical Management

For small, non-obstructive nephroliths that are not causing clinical signs, a "watch and wait" approach with medical management may be appropriate. This involves:
- **Increased Fluid Intake:** Encouraging water consumption is crucial. This can be done by offering canned food, water fountains, or flavored water.
- **Dietary Modification:** A therapeutic diet designed to manage calcium oxalate stones may be recommended. These diets aim to create a urinary environment that is less conducive to stone formation. However, it is important to note that these diets are not effective for dissolving calcium oxalate stones, unlike struvite stones.
- **Monitoring:** Regular monitoring with bloodwork (especially SDMA) and imaging is essential to track the progression of the disease [<a href="#ref-8">8</a>].

### Interventional and Surgical Management

When a stone is causing an obstruction, severe pain, or a decline in kidney function, more aggressive intervention is needed.

- **Subcutaneous Ureteral Bypass (SUB):** This is a surgical procedure where a device is placed to bypass the obstructed ureter, allowing urine to flow directly from the kidney to the bladder. It is a common and effective treatment for ureteral obstructions. A study evaluating cats after SUB placement found that preoperative ultrasound parameters of the contralateral kidney were associated with long-term kidney function, highlighting the importance of assessing the health of the "good" kidney before surgery [<a href="#ref-11">11</a>].
- **Endoscopic Nephrolithotomy (ENL):** This is a minimally invasive procedure used to remove complicated nephroliths from the kidney. It can be performed through a surgically assisted approach or a percutaneous (through the skin) approach. In a study of dogs and cats, ENL was successful in completely removing stones in 15 of 16 renal units, even for large and complex stones [<a href="#ref-12">12</a>]. The median stone diameter in this study was 2.5 cm, with a range up to 5.7 cm [<a href="#ref-12">12</a>].
- **Burst Wave Lithotripsy (BWL):** This is an emerging, non-invasive technology that uses focused ultrasound waves to fragment stones. It is currently being studied for use in cats. In vitro testing on natural calcium oxalate stones from cats showed that BWL could fragment stones to less than 1 mm in size [<a href="#ref-13">13</a>]. This technology holds promise as a future treatment option that avoids surgery.

### The Role of Microbiota Modulation

Current research is exploring the role of the gut and urinary microbiome in stone formation. Studies have shown that cats with kidney stones have a distinct urobiome with greater richness and diversity compared to healthy cats, and a less diverse gut microbiome [<a href="#ref-1">1</a>]. This has led to the hypothesis that modulating the microbiota, for example, with probiotics or specific dietary ingredients, could be a strategy to prevent renal lithiasis [<a href="#ref-1">1</a>]. This is an exciting area of research, but it is not yet a standard clinical recommendation.

## Unsafe and Unproven Home Remedies

It is critical to understand that there are no safe or effective home remedies for dissolving calcium oxalate kidney stones in cats. You should never attempt to treat your cat for kidney stones without veterinary supervision.

- **Do Not Give Human Medications:** Human pain relievers like ibuprofen or acetaminophen are extremely toxic to cats and can be fatal.
- **Do Not Use Apple Cider Vinegar or Other "Detox" Remedies:** These are unproven and can be harmful, potentially causing metabolic imbalances.
- **Do Not Change Diets Abruptly:** While dietary changes are part of a treatment plan, they must be made under the guidance of a veterinarian, especially for a cat that is already ill.
- **Do Not Withhold Food or Water:** This can worsen dehydration and kidney damage.

The only safe approach is to work with a veterinarian to develop a comprehensive treatment plan.

## Prevention and Long-Term Monitoring

Preventing the formation of new stones or the recurrence of existing ones is the ultimate goal. This requires a long-term commitment to management.

- **Diet and Hydration:** A high-moisture diet is one of the most important preventive measures. Canned food has a much higher water content than dry kibble, which helps dilute the urine and reduce the concentration of stone-forming minerals. Your veterinarian may recommend a specific prescription diet.
- **Regular Veterinary Check-ups:** For cats with a history of stones, regular check-ups are essential. This should include bloodwork (especially SDMA) and urinalysis every 3 to 6 months. Imaging (ultrasound or X-rays) may be recommended every 6 to 12 months to monitor for new stone formation.
- **Medication:** In some cases, your veterinarian may prescribe medications to help manage underlying conditions, such as hypercalcemia.

## Prognosis

The prognosis for a cat with kidney stones is highly variable and depends on several factors:
- **The Presence and Degree of Obstruction:** A complete ureteral obstruction is a life-threatening emergency with a guarded prognosis if not treated promptly.
- **The Health of the Contralateral Kidney:** The function of the unaffected kidney is a major determinant of long-term outcome [<a href="#ref-11">11</a>].
- **The Underlying Cause:** If the stones are due to a genetic condition like xanthinuria, the prognosis is more guarded due to the high risk of recurrence [<a href="#ref-6">6</a>][<a href="#ref-7">7</a>].
- **Response to Treatment:** How well the cat responds to surgical or medical management also influences the prognosis.

Cats with kidney stones have a shorter lifespan compared to those without, and chronic kidney disease is more common in stone formers [<a href="#ref-4">4</a>]. Early detection and aggressive management can significantly improve the quality and length of life.

## Limitations and When to Contact a Veterinarian

This article provides a general overview of the diagnosis of kidney stones in cats. It is essential to understand that this information cannot predict the specific outcome for an individual cat. Breed-level information, for instance, cannot tell you if *your* cat will develop a stone or how *your* cat will respond to a particular treatment. The clinical presentation, imaging findings, and response to therapy are unique to each patient.

**You should contact your veterinarian immediately if your cat exhibits any of the following emergency red flags:**
- **Straining to urinate with little or no urine production.**
- **Complete inability to urinate.**
- **Repeated vomiting or retching.**
- **Severe lethargy or collapse.**
- **Crying out in pain, especially when picked up or touched on the back.**
- **Blood in the urine that is visible to the naked eye.**

These signs can indicate a life-threatening ureteral obstruction or acute kidney failure. Do not delay seeking professional help.

## Frequently Asked Questions

### 1. What is the difference between a nephrolith and a ureterolith in a cat?
A nephrolith is a kidney stone located within the kidney itself. A ureterolith is a stone that has moved from the kidney and become lodged in the ureter, the tube that carries urine from the kidney to the bladder. Ureteroliths are more likely to cause an acute, life-threatening obstruction.

### 2. How are kidney stones diagnosed in cats?
Diagnosis is a multi-step process that includes a physical examination, bloodwork (especially SDMA and creatinine), a urinalysis, and advanced imaging such as ultrasound or X-rays. CT scans may be used for complex cases to get a detailed view of the urinary tract.

### 3. Is SDMA a better test for detecting kidney damage from stones than creatinine?
Yes, studies have shown that SDMA is a more reliable and earlier marker for chronic kidney disease compared to serum creatinine. SDMA can increase in the blood months or even years before creatinine levels become abnormal, allowing for earlier detection of kidney damage caused by stones [<a href="#ref-8">8</a>][<a href="#ref-9">9</a>].

### 4. What are the most common types of kidney stones in cats?
The most common type of kidney stone in cats is calcium oxalate, accounting for up to 98% of cases [<a href="#ref-1">1</a>]. Other less common types include xanthine stones, which are due to a rare genetic metabolic disorder [<a href="#ref-6">6</a>][<a href="#ref-7">7</a>].

### 5. Can kidney stones in cats be dissolved with a special diet?
No, calcium oxalate stones cannot be dissolved with a special diet. Dietary management is used to prevent the formation of new stones and to slow the progression of existing ones. In contrast, struvite stones (more common in the bladder) can often be dissolved with a therapeutic diet.

### 6. What is a subcutaneous ureteral bypass (SUB) device?
A SUB device is a surgically implanted system that creates a new pathway for urine to flow from the kidney directly to the bladder, completely bypassing a blocked ureter. It is a common and effective treatment for cats with ureteral obstructions [<a href="#ref-11">11</a>].

### 7. Are there any non-surgical treatments for ureteral stones?
Yes, there are emerging non-surgical options. Burst wave lithotripsy (BWL) is a non-invasive technology that uses focused ultrasound to fragment stones and is currently being tested for use in cats [<a href="#ref-13">13</a>]. Medical management with fluid diuresis and smooth muscle relaxants is sometimes attempted, but it is infrequently effective [<a href="#ref-13">13</a>].

### 8. What is the long-term outlook for a cat with kidney stones?
The prognosis is variable. It depends on whether the stone is causing an obstruction, the health of the other kidney, and the underlying cause. Cats with kidney stones are more likely to develop chronic kidney disease and have a shorter lifespan, but with early detection and aggressive management, many cats can have a good quality of life for a significant period [<a href="#ref-4">4</a>].

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**This article is educational and is not a substitute for veterinary diagnosis or treatment.**

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<a id="ref-16"></a>[<a href="#ref-16">16</a>] [Anti-inflammatory effects and mechanism of Plantago asiatica L. and Lonicera japonica Thunb. extracts based on canine and feline kidney cell models.](https://pubmed.ncbi.nlm.nih.gov/39528117/)

<a id="ref-17"></a>[<a href="#ref-17">17</a>] [Exploration of the Feasibility of Mini-Percutaneous Nephrolithotomy with Gravity-Assisted Low-Pressure Irrigation in the Treatment of Renal Stones with "Cat's Paw Sign" Pyonephrosis Instead of Multiple Percutaneous Drainage.](https://pubmed.ncbi.nlm.nih.gov/41671202/)

<a id="ref-18"></a>[<a href="#ref-18">18</a>] [Urine metabolomic changes in cats with renal disease or calcium oxalate uroliths.](https://pubmed.ncbi.nlm.nih.gov/40824970/)

<a id="ref-19"></a>[<a href="#ref-19">19</a>] [Nontraumatic Paraureteral Urinoma in a Cat with Urolithiasis.](https://pubmed.ncbi.nlm.nih.gov/36359058/)

<a id="ref-20"></a>[<a href="#ref-20">20</a>] [Metabolomic changes in cats with renal disease and calcium oxalate uroliths.](https://pubmed.ncbi.nlm.nih.gov/35962261/)

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