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Agnieszka Kurosad, Pawe! Jonkisz, Agnieszka Sikorska ©
Department of Internal and Parasitic Diseases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life
Sciences, Poland
FELINE LOWER URINARY TRACT DISEASE (FLUTD) - CASE
PRESENTATION
Abstract. FLUTD is a very common cat diseases, which affected almost 5% of feline population. It characterized by dysuria, urethral obstruction, urolithiasis and hematuria. The etiologies include infection (i.e. viral, bacterial, fungal and parasitic), urolithiasis, neoplasia, neurological disorders, inflammatory condition or anatomic abnormalities (2, 5, 6). The article described the history, clinical and laboratory examination of urine and therapy of obstructive form of FLUTD in 7 year old neutered cat.
Key words: FLUTD, struvite uroliths, cat
Introduction
FLUTD is a very common cat diseases, which is characterized by dysuria, urethral obstruction, urolithiasis and hematuria. The etiologies include infection, urolithiasis, neoplasia, neurological disorders, inflammatory condition or anatomic abnormalities (2, 5, 6). It is very difficult to define strictly the one cause of FLUTD, because they may act in combination. There are two main forms of FLUTD: unobstructive, observed in males and females with hematuria and dysuria or both and obstructive diagnosed in males. In 69% of the non-obstructed cats, when we can not define the cause of disease, we classified it as Idiopathic Feline Lower Urinary Tract Disease (IFLUTD) (2, 5).
Burmese, Persian and Himalayan breeds are in "the risk group" of calcium oxalate urolithiasis, although there are at reduced risk for developing struvite uroliths (2). There is no sex predilection, but because of anatomy of urethra in males the obstructive form of FLUTD is much more often observed in males than females. FLUTD is uncommon for cats younger than one year old. It is usually observed in animals between two to six-ten years. Neutering, regardless of age at sterilization, increase the risk of FLUTD. Obesity, sedentary lifestyle, indoor litter boxes for more than one cat are defined as the risk factors of FLUTD (2, 5, 6). Water deprivation or reduce fluids intake predispose to supersaturation of urine and subsequently forming the specific uroliths. Some pharmaceutical agents e.g.: corticosteroids and furosemide can predispose cats to hypercalcemia and hypercalciuria. Urinary acidifiers can cause metabolic acidosis and subsequent hypercalciuria, which may predispose to calcium oxalate uroliths. Composition of diet can be reported as the risk factor for a specific kind of uroliths, i.e.: high protein food, additionally rich in magnesium and phosphorus increase the risk for struvite urolithiasis and high calcium, high protein diet is a risk factor for oxalate urolithiasis (2, 5, 6).
© Agnieszka Kurosad, Pawel Jonkisz, Agnieszka Sikorska, 2008
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Task, the aim of the article
The main aim of that article is to present the readers the case of 7 years old neutered cats with obstructive form of struvite urolithiasis.
Material and methods
In December 2007, 7 years old neutered Siberian cat came to our clinic with suspicious of obstructive form of FLUTD. The owner reported: hematuria, pollakiuria, stranguria and dysuria.
Cat spent ineffectively much more time then earlier in a litter box, he was apathic, but very interested in licking his uro-genital areas. The owner could smelt a characteristic odour of urine and saw a blood drops in a litter-box. The owners reported that the cats had earlier the episode of calcium oxalates urolithiasis and was operated on it and from those time fed an appropriate prophylactic diet according to calcium oxalate uroliths. On physical examination the cats bladder was well palpated, because of its large shape and painfulness. The cats was catheterized and urine was taken for further laboratory examination.
The pH of urine was above 8 and many struvite crystals and a lot of bacteria, red and white cells were observed in urine sediment. Struvite crystals consist of magnesium and ammonium phosphate and form in high pH of urine. They may be either rough or smooth, round and faceted or sometimes disk-shapes.
The therapy of struvite urolithiasis consist of introduction an appropriate diet, which can dissolve the struvite crystals and pharmacological treatment of bacterial inflammatory disease of lower urinary tract. The cat was rehydratated by NaCl and glucosum fluid and amoxycyline was give according to antybiogram. For a few days after catheterization the urethra, the cat obtained a spasmolytic agent, like NO-SPA. A low protein, low-magnesium diet was introduced into cat's feeding. Those veterinary therapeutic diet lowering the pH of the urine below 6,2 in which condition the struvite dissolved. Cat was fed a moist form of diet, because of higher amount of water (above 80%). After one month of those therapy the sample of urine was taken to check the urine sediment and because of lowering pH of urine and absence of crystals and bacteria the dry form of veterinary diet was introduced for next month. After two months of such a treatment the urine analysis was checked and because of its good result the prophylaxis veterinary diet according to struvite crystals was introduced into the cat's feeding. Up till now the cat's urine is checked monthly and there are neither struvite crystals nor bacteria, pH of urine is around 6,2-6,4 and the cat condition is good.
Discussion
FLUTD is a very common cat diseases, which is characterized by dysuria, urethral obstruction, urolithiasis and hematuria. The etiologies include infection, urolithiasis, neoplasia, neurological disorders, inflammatory condition or anatomic abnormalities (2, 5, 6). There are two main cases of FLUTD: struvite and calcium oxalate urolithiasis. The management of FLUTD consist of antibiotic, spasmolytic and anti-inflammatory and rehydratation therapy connecting with an appropriate diet. Dietary manipulation is thought to alter the urinary pH and achieve the urine undersaturated with calculogenic crystalloids as well as increase the frequency of
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urination and volume of urine (2, 5). Diet can contribute to the aetiology, management or prevention of recurrence of some of the cases of FLUTD, because the dietary composition can influence on pH, volume and concentration of ions in urine. Home in 1977 presented the experiment in which cats were fed high magnesium and low moisture-containing diet and hematuria was observed very often in those group of animals (5). However, introducing the diet contained nearly 80% of water resolved those problem. Also the proportion of recurrence of FLUTD was greater in the group fed dry (39%) than moist commercial acidifying diet (5). The mechanism of that was not determined, but there is the tendency for cats to produce large amount of urine with a lessen concentration of ions, when they fed canned food than dry one. Cats also might not repair a water deficit as well as dogs and when they are fed dry food they drunk less water then dogs did (2, 5). However, both species drank more than human if dehyratation exceeded 5%. Many of those differences caused by changes of Potential Renal Solute Load (PRSL) of diet fed. PRSL is defined as the amount of minerals (sodium, chloride, phosphorus, potassium content) and nitrogen in diet that must be excreted in the urine (5). Gaskell in 1985 reported that in cat groups fed diets contained from 10 to 45% of water, total water intake, urine volume and specific gravity were not different among groups. However, when the water content exceed 75% of total amount, total water intake, urine volume increased significantly and specific urine gravity decreased (1). So changing the cat's diet from dry to a wet one is a very good reason in successfully treatment of FLUTD.
To decrease the saturation degree of urine, lowering the specific gravity, increase the volume of urine and water intake, sodium chloride or potassium chloride is added to the diet. Sodium chloride is well tolerated by healthy cats and influences a little the blood pressure in animals without heart, renal disease, hypertension and obesity. Dry diets with a high sodium content resulted in significant higher urine volume and lower saturation with stone-forming minerals than those with a lower sodium content (3, 4). Moderate level of sodium in cats diets can be used in prophylaxis of lower urinary tract disease.
The concentration of ions in an urine sample can be measured relatively easily by the adequate computer programs (e.g.: SUPERSAT) and RSS (the relative supersaturation) is a basis for formulating the most veterinary therapeutic diets, used in therapy of FLUTD (7). All diets, used in treatment of FLUTD, are low-protein, low-sulphur-containing aminoacids, high or moderate in sodium with a specific inhibitors of crystalloid formation and protector agents, as: e.g.: glycosaminoglycans, proteoglycans, glycoproteins ect., which restore the mucosa of bladder in case of chronic cystitis. But as important as the diet composition is to persuade the cats owners to use prescripted veterinary therapeutic food.
References
1. Gaskell C.J.: Feline urological syndrome: a United Kingdom perspective. Feline Medicine: Proc. Seminar Eastern States Veterinary Conference, Orlando; 27-32. Veterinary Learning Systems, NJ; 1985
2. Hand M.S., Thatcher C.D., Remillard R.L., Roudebush P.: Small Animal Clinical Nutrition, 4th ed. Mark Morris Institute. Topeka, Kansas, 2000
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3. Hawthorne A.J., Markwell P.J.: The effect of dietary sodium content on water intake and urine composition in cats. Waltham International Science Symposium: Pet Nutrition Coming of Age. August 7-8, 2001; Vancouver; Canada: A25
4. Luckschander N., Iben C., Hosgood G., Gabler C., Biourge V.: Dietary NaCl does not affected blood pressure in healthy dogs. J Vet Intern Med 2004,18, 463-467
5. Markwell P., J., Buffington T., Smith B., H.E.: The effect of diet on lower urinary tract disease in cats. J N; 1998, 2753S-2757S
6. Roberts W.G., Jones J.S., Heaton M.A., Stevenson A.E., Markwell P.J.: Predicting the crystallization potencial of urine in cats and dogs with respect to calcium oxalate and magnesium ammonium phosphate (struvite). J N; 2002, 1637S-1641S
7. Werness P.G., Brown CM., Smith L.H., Finlayson B.: EQUIL 2: a BASIC computer programm for the calculation of urinary saturation. J. Urol. 1985,134, 1242-1244
Summary
Kurosad A., Jonkisz P., Sikorska - Kopylowicz A, Department of Internal and Parasitic Diseases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and
Life Sciences, Poland
FELINE LOWER URINARY TRACT DISEASE (FLUTD) - CASE
PRESENTATION
The article describes the case of 7 years old Siberian neutered cat with FLUTD. It presents the history, clinical and laboratory examination and therapy of FLUTD caused by struvite urolithiasis.
Cmammx nadiumna do peda^ii 3.04.2008
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