VETgirl Q2 2021 Beat e-Magazine

QUARTERLY BEAT / JULY 2021 ///

SPONSORED ARTICLE

CAMILLE TORRES-HENDERSON , DVM, DABVP (Canine and Feline) Dilution May Be the Optimal Solution for Cats With Lower Urinary Tract Disease

Managing cats with lower urinary tract disease (LUTD) can be one of the more vexing problems you encounter as a veterinarian. But here’s the good news: We’re learning more about some of the potential causes of LUTD and, in some cases, are able to employ less-invasive ways to manage cats with this issue.

WHAT CATS ARE MOST AT RISK? Factors as diverse as neuter status, stress and weight can figure prominently into whether or not a cat develops LUTD. A study examined the risk factors for LUTD in cats and found that the proportional morbidity rates of cats developing LUTD, irrespective of cause, was 8 in 100 cats. 1 Here’s what this and other studies have revealed: • It’s a weighty matter. Cats with feline idiopathic cystitis (FIC)—inflammation of the urinary bladder with no identifiable cause—were significantly more likely to be overweight compared to both healthy cats in the same household and a control population of clinically healthy cats. 2 • Neutering is associated with the development of LUTD. Castrated males are at increased risk for each cause of LUTD except urinary tract infection (UTI) and incontinence, while spayed females had increased risk for urocystolithiasis, UTI and neoplasia. 1 • Lack of exercise and low moisture intake are also culprits. Inactivity and foods with low moisture content may also increase the risk of urolith development. 3 Urolith formation may be the end result of several combined disorders, not all of which can be corrected even if they are identified. 4 Here’s an example: A cat has an elevated level of calcium in his or her urine. Add a stress factor such as environmental stress or lack of enrichment, then add obesity. Taken alone, these individual factors might not be directly linked to urolith formation. Combined, they could result in a stone forming. However, it’s often difficult to make connections between those contributing factors.

TYPES OF LUTD AND MANAGEMENT Two of the most common forms of LUTD are urolithiasis and FIC. While both can be managed, they have different causes and can require different courses of action. Urolithiasis The overarching goal in managing cats with urolithiasis is to use the least-invasive strategy possible. Therapeutic dissolution diets are formulated to dissolve struvite uroliths. Veterinarians are often concerned about taking time to dissolve stones through diet because of the risk of obstruction. I used to feel that way myself. However, the 2016 ACVIM consensus statement on the treatment and prevention of uroliths in both dogs and cats supports adopting a more conservative approach to determine if stones can be dissolved through diet as opposed to surgical removal. 5 Postponing surgery for several weeks to first try a diet formulated to dissolve struvite uroliths (in conjunction with pain management and antibiotic therapy, if appropriate) can potentially lead to a more positive outcome. We may be able to avoid unnecessarily anesthetizing the patient or traumatizing the bladder through surgery. Calcium oxalate stones cannot be dissolved, regardless of diet. Regardless of stone type, one of the most beneficial approaches practitioners can take in managing cats with a history of urolithiasis is to increase urine volume. Increasing the volume of urine in the bladder decreases the concentration of calculogenic (stone-forming) minerals and increases voiding frequency. Increasing urine volume is usually accomplished by boosting moisture intake.

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