Feline Lower Urinary Tract Disease

Question 1

Clinical signs of FLUTD

Answer 1

• Multiple trips to the litter box
• Vocalizing/crying
• Straining with nothing coming out
• Hematuria
• Pollakiuria
• Agitation
• Pain
• Collaps, bradycardia, coma

Question 2

FLUTD Incidence/Signalment

Answer 2

• Males = females
• Males much more likely to come to the DVM because they obstruct much more easily
• 1st onset: 1-5 years of age
• Any breed

Question 3

Causes of FLUTD (syndrome)

Answer 3

• ~50% - no cause identified
• Other 50% - calculi, urethral plug (debris and crystals from bladder), bladder anomaly (diverticulum)
• Stress contributes
• <2% = bacterial infection
• Virus = never shown to cause problems

Question 4

FLUTD Predisposing diets

Answer 4

• High magnesium diets predispose
• Urine pH > 7 predisposes

Question 5

FLUTD Diagnostics: not blocked

Answer 5

• U/A - make sure urine specific gravity is concentrated
• +/- serum biochemical profile
• Symptomatic treatment

Question 6

FLUTD Diagnostics: Blocked

Answer 6

• Unblock (emergency - must resolve as quickly as possible)
• U/A - to check urine SG
• Chem - wait 18-24 hours to resolve post-renal azotemia
• Radiographs or ultrasound- definitely if more than 1st presentation

Question 7

FLUTD Treatment

Answer 7

• Manage hyperkalemia (know drug options - insulin + dextrose, sodium bicarbonate, calcium gluconate)
• IV catheter and fluids
• Unblock

Question 8

What is “post-obstructive diuresis”?

Answer 8

Following moderate to severe urinary obstruction, there is a 2-5 day period during which massive polyuria can occur, causing dehydration and electrolyte wasting. Happens due to renal tubular damage caused by back-pressure. Important to monitor urine output and make sure replacement fluids are adequate.

Question 9

Other in-hospital management

Answer 9

• Analgesics
• Potassium supplementation
• Fluid therapy
• Some use an alpha-blocker like prazosin to relax internal urethral sphincter (not sure if it helps)
• Antibiotics - AVOID while urianry catheter is in place
• Urinary catheters can block!

Question 10

Complications of FLUTD

Answer 10

• Bladder rupture
• Urethral rupture
• Repeat obstruction

Question 11

FLUTD prevention strategies

Answer 11

• Diet - acidifying, low magnesium, encourage water intake
• Anti-inflammatories?
• Amitryptilline (human anti-depressant - increases substance P in mucosa)
• Glycosaminoglycans (restore GAG layer in mucosa)
• Surgery - perineal urethrostomy?