The University of Tennessee College of Veterinary Medicine


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Kidney Stones

Dalmatian Owner's Survey

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This study is supported by a grant from the Dalmatian Club of America Foundation (http://www.dcaf.org/).

 

  

VETERINARIAN QUESTIONNAIRE
Questionnaire to be filled out by veterinarian

 
Department of Small Animal Clinical Sciences 
College of Veterinary Medicine  
Knoxville, TN 37996-4544 
E-mail: jbartges@utk.edu 

C247 Veterinary Teaching Hospital
The University of Tennessee
Tele: (865) 974 - 8387

 

DALMATIAN URINARY STONE DISEASE 

The purpose of this study is to determine if urate kidney stone formation is common in Dalmatians that have formed urate stones elsewhere in the past. When performing the necropsy, please: incise both kidneys longitudinally and examine the renal pelves, palpate and then open both ureters from renal pelvis to trigone, and completely open the urinary bladder. If you find any stones, sand, sludge, or solid matter in any part of the urinary tract please note the location, place them in small plastic bottles (material found in different sites separated and labeled accordingly), fill out the questionnaire, and mail the samples and completed questionnaire to us. Do not put any solid material found in the urinary tract in formalin; please send it dry. Please fill out the questionnaire and mail the completed questionnaire to us even if no material is found in the urinary tract and send by standard mail. You will be paid $50 for your time by the study to supply stones or solid material if present and/or the completed questionnaire, and to cover costs of mailing the sample(s) and/or information to us. 

Please provide the following information

 

  Veterinarian Information Owner Information
     
  Vet's First Name:
 Owner First Name:
  Vet's Last Name:
 Owner's Last Name:
  Clinic:
 Owner's Address 1:
  Address 1: Owner's Address 21:
  City: Owner's City:
  State:   
Owner's State:   
  Zip Code: Owner's Zip Code:
  Phone:
 Owners Phone:
 PART A
   
 

Dog's Name:   
Gender:      

 Age (yrs.) of date of birth: (MM/DD/YYYY)
Color:
  Does the dog have a history of stone disease?
 
Date of FIRST episode: (mm/dd/yyyy) Type of stone:

Location of stone(s) -- (mark al that apply)
  Kidney
  Ureter
  Bladder
  Urethra

 

How was it managed: 

If medically managed, please describe:

  Diet:
  Drug:
     
  Date of SECOND episode:  (mm/dd/yyyy)
  Type and location:
  Describe management:
  Describe prevention:
 
If there have been additional episodes, please list:
     
 PART B
     
  Date of Death: (mm/dd/yyyy)    Cause of Death:
  Were urinary stones found on post mortem examination? 
  If YES, check all that apply:
Right Kidney
Left Kidney
Right Ureter
Left Ureter
Urinary Bladder
Urethra
   
  Was he/she medicated? 
  What diet was the dog eating at the time of death?
...........
     
  If on medication, please list:
...........