Feline Lower Urinary Tract Disease (FLUTD)

What it is

• Common veterinary condition affecting cats' urinary system

• Impacts bladder or urethra functionality

• Affects cats of all ages

• Is an umbrella-like term and encompasses other diseases like FIC (feline idiopathic cystitis) and urolithiasis

• Requires comprehensive diagnostic approach as it can progress to emergency situations like partial or complete obstruction

Clinical Signs of FLUTD

• Dysuria (painful urination)

• Pollakiuria (frequent urination)

• Stranguria (straining to urinate)

• Hematuria (blood in urine)

• Periuria (urination in inappropriate places)

Urolith Composition Evolution

• 1981: 78% struvite, 2% calcium oxalate

• Mid-1980s: Calcium oxalate increase begins

• 1994–2002: 55% calcium oxalate, 33% struvite

• 2022: 50% struvite, 37% calcium oxalate

  • 96% of urethral plugs were struvite

Understanding Urine Crystals

• Most common crystals: struvite and calcium oxalate

• Crystal presence doesn't guarantee urolith formation

• Indicates urine supersaturation; patient is at greater risk for developing stones

• Requires careful interpretation

Pathogenesis of Feline Idiopathic Cystitis (FIC)

1. Stress response system activation when cat perceives stress in the environment

2. Sympathetic nervous system heightened and increases the outflow from the spinal cord to the bladder

3. Neurogenic inflammation occurs from increased sympathetic input

   • a. Increases the permeability of the bladder mucosa

   • b. Greater access of substances in the urine to sensory neurons in the bladder wall

   • c. Increased pain receptors in the bladder

   • d. Releases inflammatory cytokines from cells in the bladder wall and increases sensitivity of afferent nerves

4. Creates cyclical stress-bladder interaction because of recognition of pain from the bladder to the brain. Treatment should be aimed at managing both.

Stress Factors in FIC Development

• Psychogenic factors: anxiety, fearfulness, nervousness

• Physiologic factors: sedentary lifestyle, decreased water intake, increased BCS

• Environmental factors: indoor living vs outdoor, less hunting activities, using a litter box

Nutritional Management Strategies

• Goals:

  • Reduce stress

  • Provide pain relief

  • Decrease the severity of clinical signs

  • Increase the intervals between episodes

• Moist food (>60% moisture) recommended to decrease urine specific gravity (dilute the urine)

• Increase water intake methods → broth, ice cubes in water, water fountains

• Omega-3 fatty acids for inflammation

• L-tryptophan for stress reduction

  • Essential amino acid used to create serotonin

• Increase sodium intake → mixed research; cats can't also be experiencing any kidney disease for this

Nutritional Stress Reduction Approach

• Serotonin regulation through tryptophan

  • Improves mood and provides sense of calmness

  • Counteracts the inflammatory cytokines

• Alpha-S1 casein for anxiety management

  • A milk protein

  • Calcium-binding protein that lowers cortisol levels

  • Research done on human babies with cow's milk and cats showing a decrease in fearfulness and improving cats' contact with people

Environmental Enrichment Principles

• Minimize stressful situations, which is important for all aspects of FLUTD

• Provide play and resting opportunities

• Enrichment!

  • Create vertical and horizontal spaces for scratching, hiding, and climbing

• Gradual environmental changes

• Conflict avoidance between cats

Litter Box Management

• Goals:

  • Decrease vulnerability while toileting (causes stress)

  • Discourage unwanted habits

• Prefer clumping, unscented litter; cats may have other preferences so trying multiple litter types may be necessary

• Uncovered boxes recommended

• Boxes with lower sides for older cats

• Daily scooping essential and washing the box every few weeks

• Multiple box locations

• Follow 1+1 box rule

Struvite Urolith Management

• Struvites are also known as "MAP" crystals

  • Composed of magnesium, ammonium, & phosphate

• Physical removal or nutritional dissolution

  • Approximately 1 month dissolution time

• Transition to a canned calculolytic food over a 7-day period

  • Restricts precursors (Mg, Amm, Ph)

  • Increased sodium (to keep urine more dilute)

  • Creates an acidic environment to dilute the minerals

    • Urine pH should remain less than 6.1

• Continue feeding dissolution diet for 1 month beyond radiographic resolution of the urolith

• Feed preventative diet afterwards

Calcium Oxalate Urolith Treatment

• Surgical urolith removal only; dissolution is not an option

• Tend to form in acidic environments; need to create a stable pH

• Moist therapeutic food

  • Increased water intake

• Limit calcium oxalate-rich foods

• Quarterly urinalysis, bi-annual diagnostic imaging

• Urohydropropulsion is an option for medical management when uroliths are detected at a smaller size

Client Education Importance

• Explain FLUTD complexities

• Discuss treatment rationale

• Emphasize nutritional management

• Highlight stress reduction techniques

• Encourage proactive healthcare