�ݺ�ߣ

Feline Lower Urinary Tract Disease

 5 kg, 8 year old, mc DSH
 Recently rehomed
 Previous history of Urinary Tract Disease
 Free fed veterinary therapeutic food to
manage struvite urolithiasis
 Indoor/Outdoor
 Recently urinated blood

 WNL
 BCS 4/5
 Bladder not palpable
 U/A- blood 3+, protein 2+, pH 7.0

 Urolithiasis
 Urinary Tract infection
 Idiopathic
 Atypical UTI
 Trauma to bladder or urethra
 Urethral Stricture
 Inflammation
 Neoplasia
 Iatrogenic
 Neurogenic

 Type of Crystals
◦ Struvite - Magnesium Ammonium Phosphate
 Forms in Alkaline Urine
◦ Calcium Oxalate
 Forms in Acidic to neutral urine, dependent on the
presence of Oxalate
 Others
◦ Amonium Urate, Calcium Phosphate, Uric Acid,
Cystine, Xanthine and Matrix

 More common in Geriatric cats (12 yr +)
 Causes
◦ Bacterial
 E.coli, Staph/Strep, Proteus/Klebsiella, etc…
◦ Viral
 Can predisposes animals to crystal formation
◦ Not common in cats (70% sterile)

 Most common in neutered, sedentary,
overweight, castrated male cats
 Consuming dry foods
 Young adult (1-10 years)
 Likely stress related
 Frequency of feeding???

 Urinalysis
 Urine culture and sensitivity
 Biochem
◦ Increased Ca2+, Renal Values (Urea, Creatinine, K)
 CBC
◦ Inflammatory leukogram
 Radiographs, Ultrasound

 Depending on the findings, urinary tract
disorders can be treated by:
◦ Nutritional
◦ Medication
 Anti-inflammatory
 Antibiotics – Useful in UTIs only!!!
◦ Decrease Stress
◦ Surgery
◦ Benign Neglect – Useful in idiopathic only!!!!

 The most important therapeutic is Antibiotics.
 Anti-inflammatories are also helpful.
Idiopathic Cystitis Treatment
• The best treatment is to prevent it
– concentrate on decreasing stress
– increase their water consumption.

 Urinalysis showed struvite crystals, ph>6.5:
◦ Infection present?
 Treat with antibiotics
◦ Do radiographs to look for uroliths,
 if present begin calculolytic diet (ex: s/d).
◦ Recheck at 2 weeks
◦ Recheck rads to evaluate for resolution of uroliths
 If present, continue feeding food for 1-2 month

◦ If resolution is obtained
 continue dissolution for 2-3 months with monthly
monitoring
 Then, switch to a preventative diet because the
calculolytic diet has too much NaCl and too acidifying
for long term use
◦ if there is no change in size after 2 months.
 Surgery should be considered
 Switch to preventative diet (ex: c/d)
◦ Monitor every 6 months with a U/A.

 Urinalysis revealed calcium oxalate crystals,
acidic pH
◦ Culture urine and treat infection if needed.
◦ Radiograph to look for uroliths,
 Make sure to check kidneys and bladder
◦ If present, the only option is surgical removal.
 Do post-op radiograph and submit uroliths for
quantitative analysis.
◦ Treat hypercalcemia, if present

◦ Start a diet which prevents calcium oxalate urinary
precipitates (ex: UR St/Ox Urinary by purina).
◦ Avoid vitamin and mineral supplements, urinary
acidifiers, high salt treats and hair ball pastes.
◦ Encourage water consumption.
◦ Recheck urinalysis at 2 weeks and then at monthly
intervals.

◦ If urinary pH is < or equal to 6.5,
 add potassium citrate.
◦ If between 6.5-7.5, and no crystals are present,
 continue with the therapeutic food and monitor.
◦ If average pH is >7.5,
 look for a bacterial urinary tract infection.
◦ If crystals recur, consider vitamin B6
supplementation, restart treatment and continue to
monitor.

 Water
◦ To flush the bladder of crystals
◦ To prevent supersaturation and crystal
aggregation/formation
 Sodium Chloride
◦ Restricted for Calcium oxalate and other crystals
◦ Increased for Struvite, to increase thirst and water
consumption

 Acidifying agent
◦ To lower the pH to 6.1 for dissolution, and 6.2-6.4
for maintainance
◦ for example Phosphoric Acid
 Mineral restrictions
◦ Mg, P, Ca and Oxalate are restricted in the diet to
lower the urine concentration and potential for
supersaturation and formation of crystals

 Protein - Restricted to 30-45% dry matter
◦ Struvite: prevents the urine pH from being too
acidic, restrict the ammonia in the urine,
preventing struvite synthesis
◦ Calcium Oxalate: minimizes the excretion of
Calcium , Uric Acid and Oxalate
 Vitamin D
◦ Restricted to 5,000 IU (max) to lower the
production of Calcium Oxalate

 Potassium
◦ Increase in K+ affects ammonium synthesis
◦ The acidifying diets increase the excretion of K+
 Fat
◦ Moderate levels reduces the overall mineral intake
 Fiber
◦ Higher level reduces the amount of Calcium
absorbed

 NSAIDs
◦ To decrease the inflammation in the bladder that
facilitates the formation of crystals
 Environmental enrichment
◦ Reduce stress
 Fluids
◦ To correct any dehydrations, only used in server
cases

 Monthly Urinalysis until resolution of the
urolithiasis
 Have the owner monitor for signs of Blocking
◦ Straining to urinate
◦ Painful urination
◦ Persistent or increased blood in the urine
◦ Listlessness, depression, anorexia
 Monitor for any weight gain or loss

 Increase water consumption
 Strictly follow the proposed diet plan
◦ Only offer the therapeutic food
◦ Eliminate treats, unless they are safe for urinary
tract health
 Decrease the BCS to a normal weight
 Decrease the amount of stress

�ݺ�ߣ

Feline Lower Urinary Tract Disease

More Related Content

Feline Lower Urinary Tract Disease