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Feline lower urinary tract disease: what's new?

01 August 2014, at 1:00am

Dr Sarah Caney summarises recent key advances in our understanding of feline lower urinary tract disease and hence our ability to manage this condition.

FELINE lower urinary tract disease (FLUTD) is a common and important cause of distressing clinical signs. It can be caused by a number of conditions including urolithiasis, urinary tract infections and idiopathic disease.

What “causes” feline idiopathic cystitis? 

Feline idiopathic cystitis (FIC) remains the most common cause of FLUTD and accounts for approximately 50-70% of all FLUTD cases. Recent research has highlighted the role that stress plays in triggering and exacerbating FIC.

Researchers now hypothesise that many cats with FIC are suffering from a systemic disorder: “Pandora syndrome” (Buffington, 2011; Stella et al, 2011). Cats suffering from Pandora syndrome have a defective stress response system resulting in clinical signs when the cat is stressed.

It is thought that the stress response system may be abnormal in these cats as a result of genetic factors and/or adverse experiences during development in utero and early life. The end result is that stressful events in these “susceptible” individuals may result in clinical signs – what the authors call “sickness behaviours”.

Organ systems including the gastrointestinal tract, skin, respiratory tract, central nervous system, cardiovascular and immune systems may be involved in addition to the lower urinary tract. The sickness behaviours include non-specific clinical signs such as vomiting, decreased food intake, changed grooming behaviour and decreased social interactions (Stella et al, 2011). 

For cats suffering from Pandora syndrome, it is suggested that lower urinary tract signs (FIC) are the bladder’s manifestation of a systemic disorder (Buffington, 2011).

The most important stressors for cats with Pandora syndrome are suggested to be those that are unpredictable and inescapable such as introduction of a new baby/pet into the household. Whilst healthy cats may also show sickness behaviours (including lower urinary tract signs) when stressed, cats with Pandora syndrome are especially vulnerable.

Current criteria for diagnosis of Pandora syndrome include: 

  • evidence of chronicity;
  • co-morbidity – presence of clinical signs referable to other organ systems;
  • waxing and waning severity associated with stressful events;
  • resolution of signs with effective environmental enrichment;
  • history of early adverse experience (e.g. bottle fed kitten); 
  • evidence of familial involvement (e.g. sibling or parent also affected).

Alleviating stress in affected cats 

Diagnosis and management of FIC must include a behavioural history and behavioural modi cation/stress reduction as key components. For example, in cats that are stressed by conflict with other cats in the household, carers need to ensure that all cats have easy access to key resources such as food, water, litter boxes, resting areas and points of exit and entry to the territory.

This is covered in more detail in Dr Tony Buffington’s paper on multimodal environmental enrichment (Buffington et al, 2006) and on the Indoor Pet Initiative website which he developed: 

Nutraceuticals can be employed as an adjunctive management option to help alleviate stress. There are no current data specifically regarding use of these products in cats with FIC.

Alpha-casozepine is a milk protein hydrolysate which is thought to interact with the GABA-A receptor and result in anxiolytic effects. A small double- blinded, placebo-controlled study using this product in cats identified to be suffering from anxiety showed beneficial effects in many of the cats receiving this dietary supplement (Beata et al, 2007).

Tryptophan, another nutraceutical, is an essential amino acid and precursor for serotonin synthesis. Serotonin is an important neurotransmitter involved in mood control and believed to contribute to feelings of well-being. A placebo-controlled study showed that supplementation of L-Tryptophan resulted in a reduction in stress- associated behaviours such as house soiling (Da Graca Pereira et al, 2010). Nutraceuticals can be supplied as supplements but are also contained in some therapeutic foods (e.g. Hill’s Prescription Diet c/d Feline Urinary Stress; Royal Canin Calm).

Dietary management

A recent study reported a signi cant reduction in recurrence of clinical signs in cats diagnosed with acute FIC on a dietary study (Kruger et al, 2013). In this prospective, randomised, double-blinded study the owners were able to choose whether to feed wet or dry food.

The test food comprised Hill’s Prescription Diet c/d Multicare Feline and the control food was a custom- formulated food designed to mimic typical supermarket brands. In this study, both dry and wet formulations of the test diet reduced the rate of recurrent episodes of FIC signs by 89% although a previous study indicated that feeding a wet food was more successful for management of FIC (Markwell et al, 1999).

Dietary management of struvite urolithiasis 

Nutritional dissolution is well established as a treatment for struvite urolithiasis. A recent randomised, controlled, double-blinded clinical trial has advanced our knowledge by evaluating the efficacy of two commercially available dry foods for struvite stone dissolution (Lulich et al, 2013).

The test diets were a dissolution formula (Hill’s Prescription Diet s/d Feline Dissolution) and a preventive/ maintenance food for cats with FLUTD (Hill’s Prescription Diet c/d Multicare Feline).

The cats were monitored via weekly abdominal radiography. Both diets were 100% effective in dissolving struvite stones although the rate of dissolution differed. The mean time to dissolution was 27 days for cats receiving c/d versus 13 days for cats receiving s/d.

The authors reported that calculation of percentage dissolution at two weeks was helpful since all struvite stones had decreased in size by 35-100% at this time point for both diets. Minimal or no stone reduction at two weeks would be consistent with a different form of urolith such as calcium oxalate.

Although dissolution is slower with the maintenance food, it has the advantage of being a suitable long-term food which can be fed to all healthy cats in the household. Compliance to the foods was high with all of the cats reportedly accepting a sudden change in their diet. 

  • References are available on request.