1000 mg of Vitamin C for puppies 12 wks - adults.
FELINE LOWER URINARY TRACT DISEASE -
(FLUTD) HISTORY:
by Dr. Al Townshend DVM - March 20,2001
FLUTD has been described as far back as 1925.There have been many
names give to this condition over the years, most notable Cystitis,
Feline Urologic Syndrome (FUS), Feline Interstitial Cystitis FIC)
and Feline Lower Urinary Tract Disease (FLUTD). All of which only
describe where and what the condition is but give no clue as to
the cause.
INCIDENCE:
The incidence is defined as the annual rate of appearance of new
cases of the disease among the entire population of individuals
at risk for the disease. For FLUTD the incidence has been reported
to be approximately 0.5 to 1.0% per year.The above figure should
not be confused with the proportional morbidity ratio of cats
with FLUTD. This figure is the frequency with which these cats
are seen in veterinary hospitals.For FLUTD the incidence has been
reported to be as high as 10%, but the most common reports are
between 1% and 6%.
These figures would indicate that although the incidence in all
susceptible cats is only approx. 1%, up to 10% of them are seen
by veterinarians and that seems to be a significant number.
These figures further translates to between 250,000 and 500,000
of the 57 million cats in the United States are afflicted with
this disease annually.The condition most commonly affects mature
cats and infrequently immature animals (when it does the cause
is most likely to be associated with bacterial infections).Of
the 24,000 cat diagnosed with FLUTD in 24 veterinary schools 7%
were nonspayed females, 25% were neutered females, 16% were noncastrated
males and 52% were castrated males.
RISK FACTORS:
- Age: Uncommon in cats younger than 1 year of age. Most commonly
occurs in cats between 1 and 10 years of age with peak between
2 and 6 years of age.
- Sex: Urethral obstruction occurs most commonly in males.
Nonobstructive forms of the disease occur equally in males and
females.
- Neutering: There is an increased risk in neutered males and
females regardless of the age when neutered
- Diet: Consumption of an increased proportion of dry food in
the daily ration is
associated with an increased incidence.
- Water Consumption: Decreased daily water intake is associated
with an increased risk of the disease.
- Sedentary Life Style: Lazy cats are at increased risk.
- Spring and Winter Season: Some have indicated that there is
a seasonal increase in risk.
- Indoor Lifestyle: Cats using indoor litter boxes for urination
and defecation are at increased risk.
SYMPTOMS:
Symptoms very generally begin with frequent urination (pollakiuria)
eventually with blood (hematuria). Animal may also display inappropriate
urination (urinating in unusual places). Eventually the cat will
typically become obstructed and unable to urinate (dysuria). The
latter almost exclusively occurs in male cats and is a true emergency.
Symptoms vary greatly as there are so many causes that have been
identified and so many cases that have unknown causes.
CAUSES:
The following is a list of known causes of FLUTD taken from "Canine
and Feline nephrology and Urology" by Osborne and Finco 1995.
Metabolic Disorders (including nutritional)
Uroliths
Urethral Plugs
Inflammatory Disorders
Infectious agents
Viruses (feline Calicivirus sp. and more)
Bacteria (many species)
Mycoplasmas
Fungi (Candida sp. and more)
Parasites (Capillaria feliscati)
Others?
Noninfectious
Immune mediated?
Others?
Trauma
Neurogenic disorders
Reflex dyssynergia
Uretheral spasms
Hypotonic or atonic bladder
Others
Iatrogenic disorders
Reverse flushing solutions
Uretheral catheters (reverse flushing)
Indwelling urethral catheters
Postsurgical urethral catheters
Urethrostomy complications
Anatomic abnormalities
Congenital
Urachal abnormalities
Persistent uterus masculinus
Urethrorectal fistulas
Phimosis
Others
Acquired
Urethral strictures
Others
Neoplastic
Benign
Cystadenoma (bladder)
Fibroma (bladder)
Leiomyoma (bladder)
Papilloma (bladder)
Hemangioma (bladder)
Malignant
Transitional cell carcinoma (bladder and urethra)
Squamous cell carcinoma (bladder)
Adenocarcinoma (bladder)
Unclassified carcinomas (bladder)
Hemangiocarcinomas (bladder)
Lymphosarcoma (primary and metastatic in the bladder)
Myxosarcoma (bladder)
Prostatic adenocarcinoma (urethra)
Rhabdomyosarcoma (bladder)
Endometrial adenocarcinoma (extraurinary invading and compressing
the urethra.
Idiopathic: Up to 53% in some studies are as a result of unknown
causes.
DIAGNOSIS:
Diagnosis is based on history given by the owner, a complete physical
examination by a veterinarian, laboratory tests and radiographs.
Some or all of the above may be necessary in order to make a diagnosis,
keeping in mind that a
cause may never be determined. Also one must remember that the
cause is usually
multiple in nature. All available information must be obtained
in order to initiate the best protocol for a successful treatment
and prevention program.
TREATMENT:
Within the scope of this article we will limit the discussion
of treatment too the three most common forms of FLUTD. Nonobstructive
hematuria and dysuria, Urolithiasis, and Obstruction with matrix-crystalline
urethral plugs.
Nonobstuctive hematuria and dysuria: If a cause can be
determined, the appropriate therapy should be instituted, however,
as in most cases, the cause will be undetermined. In such a case
a veterinarian would initiate a broad spectrum of therapy. It
could include all of some of the following: antibiotics, corticosteroids,
antispasmodics, analgesics, and intravenous fluids
Urolithiasis: If stones are found in the bladder, they
should be removed. That can be achieved by surgery, or if possible,
by using a special diet designed to dissolve stones made up of
magnesium ammonium phosphate (struvite). Again, if a cause can
be determined the proper therapy should also be initiated so as
to prevent reoccurrence.
Obstruction with matrix-crystalline plugs: The obstruction
should be eliminated as soon as possible. This is best accomplished
while the cat is under anesthesia. If the obstruction has been
for a considerable amount of time there may be significant damage
to the kidneys and so blood should be drawn and the status of
the kidneys evaluated. Later additional blood should be tested
to further study the kidneys. An intravenous catheter would be
instilled and the cat sedated. At the same time as eliminating
the obstruction intravenous fluids are given as well as some additional
medications. If a cause can be determined appropriate medication
would be given.
In all cases canned food, fresh water,
clean litter boxes and the reduction or elimination of stress
are essential.
DIET CONSIDERATIONS:
It is thought that one of the most significant problems associated
with this disease is the adequate consumption of water, both in
treating and preventing this condition. Canned food is 70+ % water
and should be fed. Fresh water should always be available and
encouraged.
Infection is a part of the problem and it is the nonobstructive
hematuria and
dysuria form a diet change may not be necessary. Eliminating the
infection and
canned food for a short period of time may be all that is needed.
The majority of uroliths are either magnesium ammonium phosphate
(struvite) or calcium oxalate in composition.
Struvite: Fresh water and
canned food are essential so as to get as much liquid into the
animal, at least initially. Hill's Feline S/D Diet is designed
to dissolve struvite uroliths. The difficulty is that they may
take a very long time to do that and in the mean time the cat
is uncomfortable and may continue to exhibit symptoms such as
inappropriate urination etc. A canned diet that makes the urine
acid (pH around 6.3) is recommended as well as a diet low in magnesium
(less than 0.1% Dry Matter). To convert the as fed nutrient content
of a food to a dry matter basis divide the percentage of the nutrient
on an as fed basis by the percentage dry matter.
Calcium Oxalate: Since the
introduction of cat diets that are low in magnesium and make the
urine acid we have seen a reduction in the incidence of struvite
crystals as well as uroliths. However, there has been an increased
incidence of oxalate crystals and uroliths. The ideal diet for
a cat with the above problem is a canned diet that maintains a
more alkaline urine pH (6.6 to 6.8), is not as low in magnesium.
Potassium citrate is also useful as it has the ability to form
soluble salts with calcium.
PREVENTION:
Prevention is of utmost importance. Once a cat has had a problem
there is an increased chance that it will reoccur. This is thought
to be as a result of the many predisposing factors mentioned above
and the difficulty in controlling many of then.
DIET CONSIDERATIONS:
In order to prevent the reoccurrence of any of the above conditions
it may be necessary to maintain the animal on a diet specifically
designed to help control the condition. In many instances this
is the case, however, a dry diet may be substituted for the canned
totally or partially. Water consumption, urine pH and stress are
the most important factors.
