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    Digestive and Urinary Disorders and Diseases

    Digestive and Urinary Disorders and Diseases

    By Arnold Plotnick, DVM

    All cat owners know firsthand that cats pee and poop. Occasionally, they also puke and have the runs. Most cat owners try not to think about these ghastly things. However, when faced with a malodorous mound of diarrhea in the litter box, stepping into a pile of cat vomit upon coming home from work, or discovering that Tigger has urinated on your computer keyboard, thinking about such delightful topics becomes unavoidable. Read ahead, for a candid description of the disorders of these two prominent body systems: digestive and urinary.

    Digestive System Disorders and Diseases

    Digestive System Disorders and Diseases

    An occasional bout of digestive system disorders such as colitis, constipation, diarrhea, and vomiting may not be anything to worry about, but persistent occurrences can be symptoms of something serious, which is why it's important to understand both common and uncommon causes behind these problems. It can be even more crucial to recognize the symptoms of critical diseases ranging from inflammatory bowel diseases to gastrointestinal (GI) cancer.

    Colitis

    Colitis

    Colitis is defined as an inflammation of the colon. An occasional episode of colitis is not uncommon in cats; recurrent episodes, however, may signal a more serious problem and should be addressed by your veterinarian.

    All cats will experience an occasional digestive upset. Don't be overly concerned unless the episodes become frequent.

    Causes and symptoms

    There are several possible causes for colitis, including a sudden change in diet, eating something unusual, overeating, inflammatory bowel disease, food allergy, colon cancer, bacterial infection, parasites such as Giardia, and stress. Cats are very sensitive to changes in their environment and may experience a bout of colitis in response to a disruption in their routine (for example, relatives visiting for the holidays, a move to a new home, a drastic change to the owner's work schedule, a new cat in the household). Cats with colitis usually have diarrhea, often with blood or mucus in the feces. They may strain while defecating and may visit the litter box more frequently than normal. There may be vomiting, too, often at the same time the cat is straining to defecate or soon afterward. There is usually a sense of urgency associated with defecation, and some cats cannot make it to their litter box in time and will defecate on the floor.

    Diagnosis and treatment

    To diagnose the cause of colitis, your veterinarian may need to run several tests, including a complete blood count, chemistry panel, urinalysis, fecal examination, and fecal culture. x-rays or abdominal ultrasound may be warranted, and in some cases colonoscopy may be necessary to obtain a diagnosis. This requires general anesthesia. Treatment of colitis depends on the cause. Treatment may include changing the diet to a high-fiber or hypoallergenic one or administering probiotics, dewormers, antibiotics, or anti-inflammatory drugs. In many cases, a cause cannot be identified and cats are treated symptomatically. Typically, this involves withholding food for twelve to twenty-four hours and then gradually introducing a bland, nonirritating diet followed by gradual reintroduction of the cat's normal diet. Sudden changes to the diet should be avoided, and stressful events (any abrupt change in environment) should be kept to a minimum to avoid recurrences.

    A cat with colitis may run to her box but not quite make it in time.

    Constipation

    Constipation

    Constipation is defined as infrequent or difficult defecation with passage of hard, dry feces. All cats experience a bout of two of constipation over their lifetimes. Recurrent constipation, however, is not normal, and you should consult your veterinarian about it.

    Causes and symptoms

    There are many causes of constipation, the most common being dietary. Diets low in fiber may predispose cats to constipation. Cats with limited access to water may develop very firm stool. Cats who swallow a lot of hair when grooming may also develop constipation. Cats may retain feces and become constipated if their litter box is dirty. Some drugs can cause constipation. Constipation can occur if the passage of feces is blocked, perhaps by a tumor or other stricture. Cats may avoid defecation and become constipated if defecation is painful, for example, if cats have an anal sac abscess or a pelvic fracture. Certain metabolic, endocrine, and neurologic disorders can also result in constipation.Constipation should be suspected if very little or no feces are seen in the litter box, or if the cat is observed to be straining to defecate yet produces little or no feces. On occasion, a small amount of liquid feces will be produced after prolonged straining; this can be mistaken for diarrhea, when it is actually just some excess mucus produced by the irritated colon. Some constipated cats will show decreased appetite or occasional vomiting.

    Diagnosis and treatment

    A diagnosis of constipation is made based on a description of the cat's defecation behavior along with physical exam findings. On examination, most constipated cats have a large amount of feces that can be felt by the veterinarian. x-rays of the abdomen can confirm this and give information regarding the extent of the constipation. Blood, urine, and fecal tests may be warranted to provide further information as to the possible cause of the constipation. If an underlying cause for the constipation can be identified, it should be corrected if possible. A change in diet may be advisable. Laxatives or stool softeners may be prescribed. Cats with significant impaction of feces may require brief hospitalization and one or more enemas.

    Swallowing a lot of hair during grooming puts a cat at risk of hairballs and constipation.

    Diarrhea

    Diarrhea

    Like vomiting, an occasional bout of diarrhea in cats is not uncommon and is usually no cause for concern. Persistent diarrhea, however, is not a normal and requires veterinary attention. Left untreated, diarrhea can result in dehydration and electrolyte imbalances.

    Causes and symptoms

    There are many possible causes of diarrhea in cats. Some common causes include a sudden change in diet, eating inappropriate items, GI infections (bacterial, viral, protozoal), parasites, food allergy, pancreatitis, and inflammatory bowel disease. The presence of blood and/or mucus in the diarrhea indicates that the large intestine is involved and that the cat may have colitis. Depending on the cause, cats with diarrhea may have no other signs of illness other than loose stool, or they may be systemically ill and show signs such as fever, poor appetite, weight loss, and vomiting.

    Diagnosis and treatment

    Cats who are systemically ill should be checked by a veterinarian. Acute cases may respond to symptomatic therapy such as withholding food for twelve to twenty-four hours and then feeding a highly digestible prescription diet. Simple cases of intestinal parasites may only require routine deworming. Some cats cannot tolerate a particular brand of food or a particular form of the diet (dry vs. canned); in these cases, switching to a more appropriate diet resolves the problem. Cats with diarrhea for several days may require subcutaneous fluids and antidiarrheal medications. Over-thecounter antidiarrheal drugs intended for humans should not be given to cats with diarrhea because many of these medications contain substances that may be dangerous or toxic to your cat. Always consult your veterinarian.

    Depending on the severity and duration of the diarrhea, your veterinarian may want to perform some tests such as a complete blood count, chemistry panel, urinalysis, fecal exam, fecal culture, abdominal x-rays, ultrasound, and perhaps endoscopy, colonoscopy, or exploratory abdominal surgery to obtain a diagnosis. Treatment of diarrhea will vary depending on the cause. Infectious causes may require antibiotics or other antimicrobial drugs. Food allergy often responds to a hypoallergenic diet. More serious conditions such as GI cancer may require surgery and/or chemotherapy. As with chronic vomiting, the prognosis for chronic diarrhea depends on the cause.

    Vomiting

    Vomiting

    Every cat vomits occasionally. Most of the time, there is a harmless explanation for it, such as a sudden change in diet, eating too fast, or hairballs. In some instances, however, vomiting can be a serious sign of illness; consult with your veterinarian.

    Causes and symptoms

    Cats can vomit from a GI disorder such as food allergy or inflammatory bowel disease. They can also vomit from systemic disorders that have nothing to do with the GI system, such as kidney disease; if the kidneys can't remove toxins from the bloodstream, the toxins accumulate, leading to nausea and vomiting. Other potential causes of vomiting include intestinal parasites, diabetes, motion sickness, pancreatitis, heartworm disease, ingestion of foreign bodies, liver failure, and constipation. An acute bout of vomiting in a cat who seems normal otherwise is seldom a cause for concern and can be treated symptomatically at home by withholding food for a few hours and then gradually reintroducing the diet. Cats who have vomited multiple times in one day or several days in a row may need to be examined by your veterinarian.

    Diagnosis and treatment

    Because vomiting has so many potential causes, diagnosing the reason for the vomiting can be challenging. Your veterinarian will likely want to run a number of tests, such as a complete blood count, chemistry panel, urinalysis, fecal exam, x-rays, and perhaps ultrasound or endoscopy. In some cases, abdominal surgery is necessary to make a definitive diagnosis. Treatment of vomiting depends on the underlying cause. Some cases, such as food allergy, can be treated with a simple diet change. Mild cases may require subcutaneous (injected under the skin) fluids, antivomiting drugs, and a prescription diet designed for cats with GI problems. More severe cases, such as GI cancer, may require surgery and chemotherapy. The prognosis will vary depending on the cause.

    Cats who eat strange or new foods often develop upset stomachs.

    Inflammatory Bowel Disease

    Inflammatory Bowel Disease

    Inflammatory bowel disease (IBD) is an uncontrolled or excessive inflammatory response resulting in the infiltration of inflammatory cells into various segments of the GI tract. Most affected cats tend to be middle-aged or older, although any age cat can be affected. Inflammatory bowel disease is often mistakenly called irritable bowel syndrome.

    Causes and symptoms

    The most common symptom of feline IBD is weight loss. This may be accompanied by a decreased appetite, vomiting, or diarrhea. In most cats, physical examination tends to be normal. Occasionally, thickened or fluid-filled intestines are evident when the abdomen is examined. Routine laboratory tests tend to be normal. Increased liver enzymes are occasionally reported in cases of feline IBD and may indicate that the cat has concurrent inflammation of the liver and bile ducts (cholangiohepatitis) and/or pancreatitis. There are many disorders that can cause or mimic GI inflammation, including intestinal parasites, viral infections such as feline leukemia (FeLV) or feline immunodeficiency virus (FIV), food intolerance, food allergy, GI cancer, and metabolic disorders such as hyperthyroidism. These must be ruled out before a diagnosis of IBD can be considered.

    Diagnosis and treatment

    x-rays and ultrasound may be necessary to rule out a GI obstruction or an abdominal mass. x-rays alone, however, are ineffective for diagnosing IBD. Increased intestinal wall thickness and enlarged intestinal lymph nodes may be visible on ultrasound in suspected cases of IBD. These findings, however, are suggestive, not diagnostic, of IBD. Ultimately, a definitive diagnosis requires obtaining biopsy specimens from the GI tract. Biopsies can be obtained either via endoscopy or exploratory surgery. Endoscopy is a procedure in which a long, flexible snakelike tube (the endoscope) enters the GI tract through the cat's mouth (upper GI endoscopy) or anus (lower GI endoscopy) to visualize the internal lining of the tract and obtain biopsy specimens. Endoscopy is less invasive than surgery and allows for direct examination of the mucosal surfaces (innermost lining) of the GI tract. The limitations of endoscopy are that the biopsy specimens obtained by this method consist only of the mucosal lining rather than a full-thickness biopsy of the intestinal tract, occasionally resulting in a misdiagnosis if the disease process primarily involves a deeper layer of the intestinal wall. Another potential disadvantage of endoscopy is that the endoscope can only reach the stomach and the duodenum (the first part of the small intestine). The jejunum (the next part) and the ileum (the final part) cannot be reached with an endoscope. In most cases of IBD, however, the GI tract is diffusely affected, and samples from the stomach and duodenum are sufficient to achieve a diagnosis.

    Abdominal exploratory surgery may be more appropriate, however, if concurrent abnormalities are detected, such as increased liver enzymes, enlarged lymph nodes, or an abnormal liver or pancreas is seen on ultrasound, because biopsy specimens of these organs can be obtained at surgery. Both procedures-endoscopy and abdominal exploratory surgery-require general anesthesia.The typical finding on biopsy specimens in cases of IBD is an increased number of inflammatory cells infiltrating the walls of the GI tract. Inflammatory cells may be detected in the stomach, the small intestine, or the colon. The degree of severity is often graded mild, moderate, or severe by the pathologist.

    Treatment of feline IBD can be challenging. The goal of treatment is to identify and remove the cause of the inflammation and to suppress the immune response. This is usually accomplished through the use of immunosuppressive drugs and prescription diets. No single diet is suitable for all cats with IBD. For some cats, a highly digestible diet may be most beneficial. For others, a hypoallergenic diet may be the most effective. A hypoallergenic diet is a diet that contains a protein source to which the cat has not previously been exposed. Hypoallergenic diets alone, however, are usually inadequate at inducing long-lasting remission in cats with IBD, and immunosuppressive drugs are required.Corticosteroids are the most commonly prescribed immunosuppressive drugs for the treatment of IBD. Typically, oral prednisolone is given for at least two to four weeks. If clinical signs resolve, the dosage of prednisolone is slowly tapered until the lowest effective dose is reached. In cases of severe inflammation in which a dietary change and prednisolone are ineffective, other immunosuppressive drugs can be added. Although IBD isn't curable, the prognosis is good for adequate control of the disease.

    Endoscopy or colonoscopy may be necessary for an accurate diagnosis of several digestive disorders.

    Ingested Foreign Bodies

    A foreign body is a nonfood object that results in a GI problem when eaten. Dogs are much less discreet than cats about what they put in their mouths and will often be found to have ingested rubber balls, toys, clothing, corn cobs, coins, and so on. Cats tend to avoid solid objects. The majority of foreign bodies cats ingest are strings, ribbons, thread, and rubber bands. These are often referred to as "linear" foreign bodies. Gastrointestinal foreign bodies can become lodged in the GI tract and cause a life-threatening GI obstruction. Cats of any age are susceptible, but young cats (less than two years old) are particularly vulnerable. Although strings and ribbons can sometimes pass through the GI tract intact, in most cases they get lodged, resulting in serious digestive problems. The reason why linear foreign bodies can cause so much damage is the manner in which they cause an intestinal obstruction. Usually, one end of the string becomes anchored, either by wrapping around the base of the tongue or by getting lodged in the pylorus (the part of the stomach that leads to the small intestine). The peristaltic waves generated by the intestines try to propel the free end of the string along the intestinal tract. Because the leading end of the string is lodged, it cannot be pulled along. What happens instead is that the intestines "climb" up the string, causing them to become pleated. Food cannot pass through the pleated intestines, resulting in an obstruction. Initially, the cat tries to eat, but vomits when the food encounters the obstruction. Eventually, the cat stops trying to eat. Cats may stop drinking as well. Most affected cats are extremely lethargic and may show signs of abdominal pain. The fluid loss from vomiting and not drinking can lead to severe dehydration.

    A linear foreign body can sometimes be diagnosed during the physical exam because the string or thread may be visible lodged under the tongue. Abdominal x-rays may reveal a linear foreign body, although in many cases the foreign material is radiolucent and not visible on the x-ray. Pleating of the intestines is sometimes visible, suggesting the presence of a linear foreign body. A barium x-ray may be necessary to make the diagnosis. In this type of x-ray, the cat is given liquid barium, which appears bright white on the x-ray film. This type of x-ray will reveal if the intestines are pleated or bunched up and may reveal the foreign material itself. Some foreign objects can be retrieved from the stomach using an endoscope. Grasping forceps can be inserted through the endoscope, and the foreign object can be grabbed. Linear foreign bodies, however, cannot be grabbed this way. They must be removed surgically. Most cats recover well after surgery. However, if the obstruction has been present for several days, the intestines can become inflamed, and toxins from the intestinal contents can seep through the intestinal wall, causing peritonitis. This is a serious complication that can lead to septic shock and death. Some cats who swallow thread will also swallow the sewing needle that is attached to it. If the needle perforates the intestine, this, too, can lead to peritonitis and septic shock. Foreign body ingestion can be prevented by not allowing your cat access to objects that can be easily swallowed. If you suspect your cat has swallowed a string or other object, visit your veterinarian immediately. The sooner a diagnosis is made, the better the prognosis.

    Megacolon

    Megacolon

    Megacolon is a condition involving extreme, irreversible dilation of the colon. The colon loses its ability to propel the feces, causing the feces to accumulate.

    Causes and symptoms

    Although chronic, recurrent bouts of constipation can eventually lead to megacolon, megacolon can also develop on its own, in cats with no history of previous constipation problems. In fact, this is the most common scenario. Megacolon is seen most often in middle-aged cats; the average age is six years. It is more common in males. The clinical signs of megacolon are the same as those in cats with simple constipation: straining to defecate and passage of small amounts of hard, dry feces. As a result of a prolonged inability to defecate, cats may show systemic signs of illness such as poor appetite, lethargy, weight loss, abdominal discomfort, and vomiting.

    Diagnosis and treatment

    On physical examination, a very large colon full of hard feces is felt through the abdomen. x-rays of the abdomen can help determine the severity of the condition and whether there are predisposing factors such as a foreign body or a pelvic fracture. Treatment for a cat with megacolon may initially require the administration of one or more enemas at the veterinary hospital. If enemas do not effectively remove the impacted feces, anesthesia and manual removal of feces will be necessary. Once the colon is emptied, long-term home management can be instituted. Motivated clients with cooperative cats may be taught to give their cat an enema at home, if warranted. Enemas available for over-the-counter purchase at human pharmacies should never be used on a cat at home. Instead, enemas designed specifically for companion animals should be obtained from your veterinarian. Your veterinarian or one of his veterinary technicians will demonstrate the proper technique for administering an enema in the home setting, if such treatment is necessary.

    Long-term management of megacolon will likely involve a change in diet. Formerly, high-fiber diets were recommended; now, however, many veterinarians feel that a highly digestible diet may be equal or superior to high-fiber diets. Your veterinarian can make recommendations, and he or she will likely prescribe laxatives or stool softeners as well. Another treatment option is to give "prokinetic" drugs. These are drugs that help the colon to contract and propel the feces. Although most cases of megacolon respond to therapy initially, many cases become refractory to medical therapy. In these patients, surgical treatment in which most of the colon is removed may be the only remaining option. The prognosis for cats with megacolon is guarded.

    Food Allergy

    Although food allergy is not a very common problem in cats, it does occur. Most people assume that a sudden change in diet is necessary for a food allergy to develop, but, in fact, the opposite is true. In most cases, the allergy develops to ingredients that have been fed over a long period. The ingredients most commonly responsible for food allergies in cats are chicken, beef, and fish. Eggs and milk are also commonly implicated in food allergies in cats. The cause of food allergy is genetic. It is an immunological condition that is passed on from one or both parents. Most cases of food allergy manifest themselves as skin problems-scaling, redness, scabs, ear infections, hair loss, and itching, especially around the head and face. Less commonly, food allergy results in GI signs, mainly vomiting and/or diarrhea.

    Diagnosis of food allergy is achieved by performing what is called an "elimination food trial"; that is, feeding a hypoallergenic diet and seeing if the clinical signs resolve. A hypoallergenic diet is one that contains a protein source that the cat has never been exposed to, such as rabbit, venison, or duck. Absolutely no other food can be fed during this trial period or the results will be inconclusive. Gastrointestinal signs usually resolve in a few days. Dermatological signs may take several weeks (as long as eight to twelve weeks) before signs resolve. Once signs resolve, feeding the previous diet and seeing the clinical signs return is definitive proof of food allergy. Because there are so many other illnesses that can cause vomiting and/or diarrhea, your veterinarian may want to perform some diagnostic tests such as blood work and x-rays to rule out other reasons for vomiting and/or diarrhea. Treatment of food allergy involves continued feeding of the hypoallergenic diet and avoiding foods containing the protein (or carbohydrate) source known to trigger the reaction. A recently developed diet that contains hydrolyzed protein may be more effective for cats prone to developing food allergy. Hydrolyzed protein is protein that has been converted into molecules small enough to evade detection by the immune system so that they cannot trigger an allergic reaction.

    Gastrointestinal Cancer

    Gastrointestinal Cancer

    Gastrointestinal cancer can strike cats of any age, although it is mostly seen in older cats. Although the GI tract is susceptible to several types of cancer, lymphoma is the most common.

    Causes and symptoms

    Exactly why lymphoma develops in some cats is not clear, but viruses may play a role. The feline immunodeficiency virus is associated with an increased risk of lymphoma. Cats infected with FIV are 5.6 times more likely to develop lymphoma than are FIV-negative cats. Infection with FeLV dramatically increases the risk of developing lymphoma; FeLV-positive cats are 62 times more likely to develop lymphoma than their negative counterparts. Most cats who develop GI lymphoma, however, are negative for these two viruses.Gastrointestinal lymphoma usually involves the small intestine. The stomach and colon are less likely to be affected. The average age of cats with GI lymphoma is nine to thirteen years. The most common clinical signs of GI lymphoma are decreased appetite and weight loss. Vomiting occurs in about 50 percent of cases and diarrhea in about 30 percent.

    Diagnosis and treatment

    To obtain a definitive diagnosis of GI lymphoma, biopsies must be performed. Biopsy specimens can be obtained to two ways. One is endoscopy, in which a long snakelike tube with a camera on the end is inserted into the cat's mouth and then advanced into the stomach and small intestine. Biopsies are then obtained using special forceps that are inserted through the endoscope. The other way to obtain biopsy specimens is via abdominal surgery. Both procedures require general anesthesia. Once a diagnosis is achieved, the lymphoma is categorized into one of two general types: low grade (also called small cell or lymphocytic) or high grade (also called large cell or lymphoblastic). The type of lymphoma is significant in terms of prognosis. Lowgrade lymphoma has a significantly better prognosis than does high-grade lymphoma.

    Chemotherapy is the treatment of choice because lymphoma is the considered the most chemotherapy-responsive cancer. Combination chemotherapy, in which several drugs are administered sequentially, is the primary method of treatment. In cases in which the lymphoma is causing a complete or partial intestinal obstruction or an intestinal perforation, immediate surgery may be necessary, followed by chemotherapy. The prognosis for GI lymphoma varies, depending on type. The median survival time with chemotherapy for high-grade lymphoma is only 2.7 months. Cats with low-grade lymphoma fare much better. Median survival of 18–24 months has been reported, and it is not uncommon for cats to survive even longer.

    Anal Gland Problems

    Just inside the cat's anus are two small glands: the anal glands. These glands produce a foul-smelling secretion that is normally released in small amounts when the cat defecates. Occasionally, when cats get excited or frightened, they may express the contents of these glands, resulting in a very foul musky odor. Diseases of the anal glands include impaction, abscess formation, and tumors (common in dogs, uncommon in cats). Sometimes, the duct leading from the gland to the anus becomes clogged with dried secretions. The gland becomes distended, which causes discomfort to the cat. Cats may show signs of discomfort by "scooting" or dragging their anus on the floor or the carpet, or they may spend an inordinate amount of time licking or cleaning the anal area.

    In cases like this, your veterinarian can express the anal glands manually, relieving the pressure within the gland. This is usually sufficient to solve the problem. Occasionally, the entrapped anal gland secretion will become infected and pus will begin to accumulate within the gland, forming an abscess. If the pus cannot exit the gland through the duct, it will burrow through the skin and eventually drain out. If it does not drain on its own, it may need to be lanced while the cat is sedated or under anesthesia. After lancing, oral antibiotics are prescribed. Warm compresses to the area are also beneficial after lancing. High-fiber diets have been recommended for cats with recurrent anal gland problems. The fiber causes a bulkier stool, which puts more pressure on the anal glands during defecation, allowing them to express more efficiently. Cats who suffer repeated impactions or abscesses may require surgical removal of the anal glands.

    Successful treatment of your cat's IBD requires that you identify and eliminate the ingredient in her diet causing the inflammation.

    Urinary System Disorders and Diseases

    Urinary System Disorders and Diseases

    Disorders of the urinary system are common in cats. In fact, kidney failure is one of the most common disorders of geriatric cats. Cats who urinate in places other than their litter box should be evaluated for a medical problem before being accused of a behavioral problem because inflammatory and infectious disorders are a frequent cause of inappropriate urination.

    Kidney Infection

    Kidney Infection

    A bacterial infection of the kidney is called pyelonephritis.

    Causes and symptoms

    Infection of the kidneys can occur if bacteria from a bladder infection travel up the ureters toward the kidneys. Disorders that suppress the immune system, such as FIV or diabetes, put cats at increased risk. Signs of pyelonephritis may include increased frequency of urination, straining to urinate, and bloody urine. Cats with pyelonephritis are often systemically ill and may show fever, decreased appetite, lethargy, Biblevomiting, excessive thirst and urination, and pain in the area of the kidneys.

    Diagnosis and treatment

    Diagnosis of pyelonephritis requires, at minimum, a urinalysis and urine culture and may require additional tests such as a complete blood count, serum chemistry panel, abdominal x-rays, or abdominal ultrasound. Unlike cats with simple urinary tract infections (UTIs), cats with kidney infections may require hospitalization, intravenous fluid therapy, and intravenous antibiotics for several days. Mild cases may be treated with antibiotics on an outpatient basis.

    Chronic Kidney Disease

    Chronic Kidney Disease

    Chronic kidney disease (CKD)-the slow progressive loss of kidney function-is a common cause of illness in cats, especially in older cats. While the condition is often still referred to as chronic renal failure (CRF), the term is falling out of favor, and the condition is now more commonly referred to as chronic kidney disease (CKD).

    Causes and symptoms

    Although kidney infections, ingestion of toxins, and other diseases of the kidney can lead to a decline in kidney function, in most cases a cause is never identified. Signs of kidney disease include increased thirst, excessive urination, decreased appetite, weight loss, and vomiting.

    Diagnosis and treatment

    Diagnosis of CKD is usually made through blood and urine tests. The kidneys filter toxins out of the bloodstream and put them in the urine. When the kidneys fail, the toxin level rises, and the urine becomes dilute. Cats with CKD may also have elevated levels of phosphorus, have low levels of potassium, be anemic (have a low red blood cell count), and have high blood pressure. For many cats, a diagnosis is made after the veterinarian runs routine blood and urine tests during a wellness exam. These cats do not require hospitalization and can be treated on an outpatient basis. Cats who are acutely ill with CKD require hospitalization, intravenous fluids, and other supportive measures. Unless the underlying cause of the initial renal injury can be discovered and treated, CKD invariably progresses. With the exception of a kidney transplant, it is difficult or impossible to improve kidney function in cats with CKD.

    It is possible, however, to delay the progression of renal failure, improve the cat's quality of life, and extend a cat's survival time through a variety of diet and drug interventions. If a cat is not acutely ill or her condition improves and she is sent home, she should be fed a prescription diet designed for cats with CKD. It has been proved that cats with CKD who eat these diets do better and live longer. Nausea is a common occurrence in cats with CKD, contributing to the poor appetite and vomiting. Antacids such as famotidine (found in the brand name Pepcid) have proven beneficial in some cats with CKD. Some cats with CKD will develop low levels of potassium in their blood. This can accelerate the progression of the CKD. Potassium supplements can correct this problem. Twenty percent of cats with CKD have high blood pressure. This, too, can accelerate the CKD as well as damage the eyes, heart, and nervous system. Cats with CKD and high blood pressure should be given medication to control the latter. Some cats with CKD are found to have excessive levels of protein in their urine. These cats tend to have shorter survival times. Fortunately, this can also be corrected with proper medication. Cats with CKD tend to develop anemia over time. Severe anemia can be treated with injections of a hormone that causes the bone marrow to release more red blood cells.

    As the kidneys continue to fail, the blood phosphorus level may begin to rise. Elevated phosphorus levels can be detrimental to the kidneys. For cats with high phosphorus levels, a phosphate binder can be mixed into the food. These supplements bind the phosphorus in the food so that it is not absorbed by the cat. Cats with CKD should be encouraged to drink as much water as possible. This can be done by feeding canned food, adding water or broth to the food, and using fountain-type water bowls. Cats with an inadequate water intake can be given fluids subcutaneously (under the skin) at home. Although this sounds daunting, cat owners can quickly master this skill, once shown the proper technique. Many advances have been achieved regarding the treatment of CKD. Although CKD is not curable, cats can live for many years after diagnosis if treated appropriately.

    Kidney disease is one of the most common disorders of senior cats.

    Excessive thirst is one sign of kidney disease, but that symptom also has other, less severe causes.

    Acute Renal Failure

    Acute Renal Failure

    As mentioned in the previous section, the kidneys filter toxins from the bloodstream and put them in the urine. The kidneys also regulate the amount and composition of the fluid in the bloodstream. Acute renal failure (ARF) is a sudden decrease in kidney function. This is a serious condition that, if not recognized and addressed quickly, can lead to rapid decline and possible death.

    Causes and symptoms

    Cats with ARF are usually very sick. Loss of appetite, vomiting, extreme lethargy, weakness, and decreased urine production are common signs of ARF. Unfortunately, most of the signs of ARF are nonspecific and may result in delayed recognition that the cat is ill. The most common causes of ARF in pet cats are ingestion of ethylene glycol (antifreeze) and ingestion of lilies. Other possible causes include Biblekidney infection, misguided administration of toxic drugs (for example, ibuprofen), and any situation that results in decreased blood flow to the kidneys (for example, anesthesia).

    Diagnosis and treatment

    Diagnosis is based on results of various tests, which may include a complete blood count, chemistry panel, urinalysis, x-rays, ultrasound, ethylene glycol test, and perhaps a kidney biopsy. A thorough medical history is very important as well. For example, cats who reside totally indoors are unlikely to encounter antifreeze. The presence of a lily plant in the house raises the possibility of lily toxicity. Aggressive treatment is the key to survival for cats with ARF. Cats must be hospitalized and given intravenous fluids as well as drugs that increase the blood flow to the kidneys and promote urine production. Electrolyte abnormalities are common and must be monitored and corrected. The most problematic electrolyte disturbance is an elevated blood potassium level. Potassium, if not excreted in the urine, accumulates in the bloodstream and can lead to serious heart disturbances if not corrected promptly. Induction of vomiting may be beneficial if recent toxin ingestion is suspected as a cause of the ARF. Treatment is more likely to be successful if the underlying cause of the ARF can be identified and corrected. If affected cats do not begin to produce urine despite medical treatment, dialysis may be the only remaining option to save the cat's life. There are two types of dialysis-peritoneal dialysis and hemodialysis. These are advanced procedures that can only be performed at specialty practices and are very costly. The prognosis for cats with ARF is guarded and is dependent on the cause of the damage, the severity of the damage, and the response to therapy.

    Urinary Tract Infections

    Urinary Tract Infections

    Bacterial UTIs are less common in cats than they are in dogs. This is because feline urine is typically very concentrated and is an unfriendly environment for bacteria to grow in.

    Causes and symptoms

    It is easier for bacteria to live in dilute urine. Disorders that cause dilute urine, such as kidney failure, increase the risk of UTIs. Diabetes is a risk factor because the urine is dilute, and the sugar in the urine is a nutrient source for the bacteria. Grooming problems can also cause UTIs. Longhaired cats may not groom their anal area very effectively, which may result in feces stuck to the fur being pressed up against the opening of the urinary tract when the cat sits, increasing the risk of fecal bacteria migrating into the urinary tract. This is especially true for female cats because females have a shorter urethra, and their urinary tract is located closer to the anus than that of males. Older cats may have trouble grooming their anal/genital area because arthritis has reduced their flexibility to groom. Overweight cats are less efficient at grooming their anal/genital area, putting them at risk for UTIs.

    Diagnosis and treatment

    Cats with UTIs often show signs such as frequent trips to the litter box, straining to urinate, urinating in inappropriate places, and possibly having blood in the urine. To diagnose a UTI, a urine sample needs to be analyzed and cultured. Typically, there will be an increased number of white blood cells in the urine, and the culture will grow the specific organism(s) responsible for the infection. Diagnostic laboratories test a variety of antibiotics against the organism they isolate to see which antibiotics are most effective. While waiting for culture results, your veterinarian will likely place your cat on a broad-spectrum antibiotic. If the culture results show that the organism is sensitive to the chosen antibiotic, that therapy is continued, usually for fourteen to twenty-one days. If the organism is revealed to be resistant to the chosen antibiotic, your veterinarian will switch your cat to an antibiotic that has been shown to be effective. Urinary tract infections are not only uncomfortable for your cat but also can worsen if left untreated. Bacteria can migrate from the bladder to the kidneys, leading to a kidney infection. This is a more serious condition. Cats with untreated UTIs may develop inappropriate urinary elimination behavior. The incidence of UTIs can be reduced if the predisposing factors can be controlled. Overweight cats should be put on a diet. Longhaired cats who cannot keep their anal area properly cleaned should have the hair in that area trimmed or shaved. Arthritic cats who cannot groom properly may require arthritis medication. Most cats with UTIs respond rapidly to antibiotic therapy, although recurrences are possible if underlying conditions, such as renal failure or diabetes is present.

    If your cat stops using her litter pan, a urinary tract infection may be the cause.

    Urinary Stones

    Urinary Stones

    Calculi (stones) can be found anywhere in the urinary tract. When found in the kidneys, they are called renal calculi. When found in the bladder, they are called cystic calculi. The bladder is the most common place in the urinary tract for calculi to form. The more familiar term is bladder stones.

    Causes and symptoms

    Why stones occur in some cats and not in others is something of a mystery. Genetic and dietary factors are suspected of playing a role, as are other potential factors, such as metabolic disorders, congenital problems, and bacterial infections of the urinary tract. In most cases, a cause is never identified. Cats with bladder stones may have signs similar to those seen in cats with UTIs: straining to urinate, urinating in inappropriate places, frequent trips to the litter box, and sometimes having blood in the urine.

    Diagnosis and treatment

    Diagnosis of bladder stones is usually made by taking x-rays. The two most common types of stones-struvite stones and calcium oxalate stones-are usually visible on x-rays. Other types of stones, such as cystine and silica, are quite rare. In some cases, stones may not be dense enough to be seen on an x-ray but may show up on an abdominal ultrasound. There are two possible treatments for bladder stones: surgical removal or dietary intervention. Of the two most common types of stones found in cats, one type-struvite stones-may be treated by feeding the cat a special diet designed to dissolve the stone. Calcium oxalate stones cannot be dissolved using diets. Your veterinarian cannot tell which type of stone is in your cat's bladder based on x-rays or ultrasound. If a urine specimen from the cat contains crystals, it is reasonable to assume that the type of crystal seen in the urine is a reflection of the type of stone in the bladder. If no crystals are seen, your veterinarian can make a guess based on the pH of the urine (calcium oxalate tends to form in acid urine; struvite tends to form in alkaline urine), although urine pH measurements aren't very precise and there is a lot of overlap.

    If the stone is presumed to be struvite but is actually calcium oxalate, it will not dissolve on the diet and the cat's clinical signs will remain. Surgery is a faster and more effective way to remove the stones; of course, it is also more invasive. Once the stones are removed, they can be analyzed to determine their mineral composition. Cats with bladder stones should be fed a prescription diet designed to prevent their recurrence. Several companies manufacture these diets, and most veterinary offices sell them. Cats at risk for developing bladder stones should be encouraged to drink more water.

    The symptoms of a urinary tract infection and urinary stones are very similar; see your vet for an accurate diagnosis.

    Feline Lower Urinary Tract Disease

    Feline Lower Urinary Tract Disease

    As mentioned in the previous sections, it is fairly common for cat owners to observe their cat showing a number of clinical signs associated with a urinary tract problem. The combination of some or all of these clinical signs is a condition or syndrome that has been given several names over the years. The term feline urologic syndrome (FUS) was coined in 1970 to describe cats with these types of symptoms; however, the term currently favored in veterinary medicine is feline lower urinary tract disease (FLUTD).

    Causes and symptoms

    Symptoms include straining to urinate, urinating more frequently, urinating very small amounts, and doing it in inappropriate places, that is, places other than the litter box. Occasionally, blood may be seen in the urine. Although there are many possible causes of FLUTD, most cases of FLUTD occur for no known reason. These cases are termed idiopathic, a technical way of saying that we don’t really know why it happens.

    Diagnosis and treatment

    Before a cat can be said to have idiopathic disease, recognized causes of urinary tract disease must be eliminated, such as UTIs, bladder stones, anatomical defects involving the bladder or urethra, and neoplasia (cancer). Blood work is usually normal in cats with signs of FLUTD. Urinalysis results, however, can be variable. Sometimes, crystals are present in the urine. Crystals can irritate the bladder lining, causing capillaries (tiny blood vessels) in the bladder wall to bleed. Occasionally, bacteria are present, indicating that a UTI is the cause of FLUTD. Blood is a common finding, either grossly (the urine appears pink or red) or microscopically (red blood cells detected only when the urine is viewed under the microscope). x-rays are usually normal, although special studies in which a dye is injected into the bladder may reveal a thickened, irregular bladder wall. This occurs as a result of chronic irritation. Occasionally, a bladder stone or an anatomic defect is identified on x-rays.

    Treatment of FLUTD can be very frustrating for the veterinarian and the owner. If the urinalysis reveals the presence of bacteria, the urine should be cultured and antibiotics should be prescribed (see the section on UTIs). If crystals are present, an appropriate diet should be prescribed. Struvite crystals (the most common type) form in alkaline urine, so in these cases a diet that acidifies the urine should be prescribed. Calcium oxalate crystals form in acid urine; in these cases, an alkalinizing diet should be prescribed. Several companies make prescription diets designed to alter the pH of the urine, so that new crystals do not form. More recently, prescription food manufacturers have marketed new diets that prevent formation of both types of crystals. These diets work by making the urine very dilute and preventing crystals from forming. For finicky cats who won't eat these prescription diets, it is possible to obtain urinary acidifiers or alkalinizers from your veterinarian and mix them into the cat's regular diet. If x-rays reveal a bladder stone, surgery and medical dissolution are the current treatment options.

    The most difficult cases are those in which there is no obvious cause for the urinary tract disease. In these cases, urinalysis typically reveals adequately concentrated urine. Blood is often the only abnormality detected in the urine. x-rays are normal-no bladder stones or anatomical defects are visible. Ultrasound reveals no tumors. Urinalysis reveals no crystals. Urine culture reveals no infection. A variety of terms have been used to describe this condition, including idiopathic FLUTD, idiopathic cystitis, and feline interstitial cystitis (FIC). Currently, there is still no universally accepted treatment for the idiopathic form of FLUTD. In most cases, the condition resolves on its own after a few days, regardless of the treatment prescribed. Feeding a diet designed to prevent crystal formation may be helpful, even if crystals do not seem to be the cause of the problem. Although clinical proof is lacking, anecdotally, supplements containing glucosamine and chondroitin sulfate, which are typically given to cats with arthritis or other joint problems, may help decrease the frequency and severity of recurrences in some cats.

    Recent studies suggest that stress may play a role in the development of idiopathic FLUTD. Single cats who live indoors may experience stress in the form of boredom or monotony. Cats in multiple-cat homes may suffer from the stress of constantly engaging in territorial battles or of being the most subordinate cat on the totem pole. Treatment of idiopathic FLUTD and prevention of future episodes should include actively making the indoor environment more stimulating for cats. Cats enjoy surveying their environment from high places, so providing them with cat trees or a wall-mounted shelf is helpful. Appropriate scratching surfaces (both horizontal and vertical) should be provided, so cats can stretch their muscles and engage in natural scratching behavior. Owners should engage in interactive play with their cats at least twice daily. Toys on a wand or "fishing pole" are especially appealing. When cats are home alone, toys that encourage solo play should always be available. Toys should be rotated often, so that cats don't get bored. Toys that mimic prey and allow cats to engage their natural hunting instincts, such as stalking, pouncing and capturing, are ideal. Videos designed for cats, featuring bugs, birds, small mammals, fish, and natural sounds, are available commercially and are mesmerizing to many cats. By incorporating some of these suggestions and reducing environmental stress, you can actively minimize the risk of future bouts of idiopathic FLUTD.

    Encouraging Your Cat to Drink More

    Cats with kidney disease, constipation problems, and urinary issues should be encouraged to drink more water because this has been shown to have therapeutic benefit. There are several ways to accomplish this. Feeding canned food instead of dry food is an important first step. Adding a few spoonfuls of water to the food creates a broth that cats will often consume with the food. Cats are often attracted to water in a novel location. It is not unusual to find a cat drinking from a glass of water left unguarded on a coffee table. This interest can be exploited by placing additional water bowls in atypical areas, such as the corner of a bedroom or an office. Many cats are attracted to flowing water and will often drink from a leaking kitchen or bathroom tap. Fountain-type water bowls are ideal for cats fascinated with running water. Like humans, cats prefer their water fresh and cool. Rather than adding more water to a bowl that is half empty, discard the entire contents of the water bowl and replaced it with cool, fresh water.

    Urinary illnesses can be life-threatening; take your cat to the vet if you suspect she has one.

    Feline urethral obstruction is seen almost exclusively in male cats.

    Urethral Obstruction

    Urethral Obstruction

    Feline urethral obstruction (UO) is a lifethreatening urinary disorder seen almost exclusively in male cats. Obstruction occurs when crystals in the urine come together and form sand; the sand combines with mucus and other inflammatory debris to form a plug in the urethra that obstructs the flow of urine. Less commonly, the flow of urine may be obstructed by a tiny bladder stone that gets lodged in the urethra during urination.

    Causes and symptoms

    Exactly why some cats develop UO while others do not has not been determined, although genetic and dietary factors are suspected. Indoor, overweight cats with a sedentary lifestyle are at increased risk of developing UO. Cats with UO may go in and out of the litter box, repeatedly squatting and straining to produce urine. The amount of urine passed may be small (just a few drops), or there may be no urine produced at all. Some cats cry or yowl during these attempts. Cats may groom their genital area excessively. Some cats will urinate in inappropriate locations. Clearly, these cats are uncomfortable. Cat owners sometimes mistakenly interpret the unsuccessful attempts to urinate as a sign of constipation rather than a urinary obstruction. As time goes on, if the obstruction is not relieved, cats will become lethargic, will stop eating, and may begin to vomit. Some cats resent being picked up because their bladder is distended and tender, and they will cry when lifted.

    Diagnosis and treatment

    UO is a serious veterinary emergency. Male cats with these clinical signs need to be evaluated by a veterinarian immediately. If your regular veterinary hospital is closed, the cat should be taken to a twentyfour- hour veterinary emergency center. Diagnosis is usually made on physical examination; most cats with UO have a large, rock-hard distended bladder that can be readily felt in the abdomen. In overweight cats, an abdominal x-ray or ultrasound may be necessary for the diagnosis. Treatment consists of sedating the cat and relieving the obstruction by placing a urinary catheter into the urethra and flushing the bladder with sterile fluid. Once the obstruction is relieved, a sample of the urine can be analyzed to obtain more information as to the possible cause of the obstruction. Blood can be collected while the cat is sedated to evaluate kidney function and electrolyte levels. An intravenous catheter is also necessary to correct the serious electrolyte and acid–base derangements that may occur during UO. Pain medication may be prescribed to help with urinary discomfort. Cats with long-standing obstructions (greater than forty-eight hours) may develop cardiac problems due to elevated levels of potassium in the bloodstream. An electrocardiogram (EKG) may be necessary to monitor the cat's heart rate and rhythm. Cats with very high potassium levels may need to be given medications immediately to help quickly lower the potassium level and prevent adverse effects on the heart.

    After a day or two, the urinary catheter can be removed. The cat will remain in the hospital and be monitored very closely to ensure that he is able to urinate normally. Re-obstruction is a common occurrence during the first twenty-four to fortyeight hours after the urinary catheter is removed, so this close monitoring is necessary. Once the cat is urinating normally, he can be sent home. Cats who have experienced a urethral obstruction should be encouraged to drink water. Obesity should be corrected or prevented. Prescription diets designed to prevent formation of urinary crystals must be fed to minimize future incidents of UO. Ideally, only the canned version of these diets should be fed due to their higher water content. Although most cats never experience a second episode once preventive measures are taken, a few cats will suffer a recurrence. In these cats, a surgical procedure called a perineal urethrostomy (often referred to as a "PU") may be recommended to prevent future episodes. This surgery results in a shortening and widening of the male cat's urethra. This may increase the incidence of future UTIs, but it greatly reduces the chances of another life-threatening UO.

    From The Cat Bible, Copyright by Sandy Robins, licensed through ContentOro, Inc and used by arrangement with I-5 Press

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