Feline lower urinary tract disease: what's new? - Veterinary Practice
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Feline lower urinary tract disease: what’s new?

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

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
, 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,

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.

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