Nutrition and lower urinary tract disease in cats

Prevalence, Risk Factors, Pathophysiology, Potential Biomarkers and Management of Feline Idiopathic Cystitis: An Update Review

Feline idiopathic cystitis is a widespread disease in small animal clinics, which mainly presents with urinary signs like dysuria, stranguria, hematuria, pollakiuria, and periuria. The etiopathogenesis of the disease may involve interactions between the environmental stressors, neuroendocrine system and bladder of affected cats. Diagnostic biomarkers have not been tested in clinical studies though they are theoretically feasible, and since the clinical signs of the disease assemble those of other feline lower urinary diseases, its diagnosis is a procedure of exclusion. The primary treatment of the disease is long-term multimodal environmental modification (or enrichment) while anti-anxiety drugs and nutritional supplements are recommended for chronic recurrent cases. Still, many medicines need to be evaluated for their efficacy and safety. This review aims to provide readers with a comprehensive understanding of feline idiopathic cystitis by summarizing and updating studies concerning the prevalence, risk factors, etiological hypotheses, diagnostic procedures, possible treatments, and prognosis of the disease.

[Feline uroliths: Analysis of frequency and epidemiology in Germany (2016-2020)]

OBJECTIVES

This study was aimed to assess the distribution and frequency of uroliths in cats as well as to evaluate gender-, age-, and breed-specific differences.

MATERIAL AND METHODS

3629 uroliths from cats in Germany were analyzed by infrared-spectroscopy during the period 2016-2020. The majority (3300) of the uroliths originated from purebred cats of 22 breeds.

RESULTS

Uroliths were prevalent in the order of male neutered (45.3 %), female spayed (35.3 %), male intact (7.4 %), and female intact cats (6.3 %). Median age of the cats with uroliths was 7 years, although it varied slightly depending on types of the urolith. The most frequent uroliths were calcium oxalate (59.5 %), followed by struvite (33.7 %), ammonium urate (2 %), calcium phosphate (1.7 %), cystine (0.7 %) and xanthine (0.4 %). Males (59.4 %) and females (59.2 %) showed nearly identical prevalence of calcium oxalates, whereas it significantly diverged in castrated (60.2 %) versus intact animals (54.4 %; p = 0.01). With regard to struvites, male cats (32.6 %) were less prone than females (35.4 %; p = 0.08) while intact cats (38.2 %) significantly outnumbered the castrated cohorts (33.1 %; p = 0.02). The prevalence for calcium oxalate uroliths increased by 6.6 % during the study period, contrasting a decrease of 5.5 % for struvites. Some breeds (> 10 individuals) showed significantly higher propensities than others for urolith formation. Calcium oxalates were significantly more frequent in British shorthair cats (85.2 %), Ragdoll (75 %), Scottish fold (74.1 %) and Persians (72.4 %). Struvites were prevailing in Norwegian forest cats (48.5 %), British longhair (41.7 %), European shorthair (41.7 %) and Siberian forest cats (36.8 %). Siamese cats had the significantly highest percentage of cystine uroliths (16 %).

CONCLUSIONS AND CLINICAL RELEVANCE

The occurrence of urine calculi in cats from Germany was found to be most frequent for calcium oxalate and struvite types. We also found breed-, age-, gender- specific differences in addition to variations depending on the neutering status of the animals.

Urinary incontinence secondary to a suspected congenital urethral deformity in a kitten

Case summary

A 5-month-old entire male domestic shorthair kitten was referred for investigation of a month-long history of urinary incontinence. Clinical examination, baseline blood work and imaging (plain radiography and ultrasonography) were unremarkable. Urinalysis documented a urinary tract infection and a retrograde urethrocystogram revealed an outpouching of the pelvic urethra. Surgical exploration revealed the absence of the dorsal portion of the urethral wall in this section of pelvic urethra, replaced by an epithelial lined expanded ‘pouch’. The ventral aspect of the urethra appeared grossly normal. A modified perineal urethrostomy was performed to create an anastomosis of the urethral pouch to the skin of the perineum alongside conventional castration. The kitten made a full recovery and the incontinence resolved within 48 h. A congenital urethral diverticulum and secondary urinary tract infection were deemed the most likely aetiology in this case.

Relevance and novel information

Urethral diverticuli are a rare condition in veterinary medicine. To our knowledge, it has only been reported in two dogs and presumptively in one cat, all of which made a complete recovery after surgical intervention. The present case reports an unusual urethral deformity as a potential differential diagnosis for lower urinary tract signs in a young cat.

Effects of crude protein and sodium intake on water turnover in cats fed extruded diets

The comprehension of strategies to increase urine production may be important, especially in kibble diets to prevent urolithiasis in cats. The effects of increasing amounts of crude protein (CP) and sodium on the water turnover of cats were evaluated using the water balance (WB) method and the deuterium dilution technique. The study followed a randomized block design, with three blocks of eight cats, two cats per food type in each block, and six cats per food. Four extruded diets with different amounts of CP and sodium were evaluated (on DM basis): 28% CP and 0.58% sodium; 39% CP and 0.64% sodium; 52% CP and 0.76% sodium; and 64% CP and 0.87% sodium. Cats were individually housed in cages for 8 days to measure WB, urea excretion, and faecal and urine characteristics. Deuterium oxide was used to evaluate water turnover, and during the period cats were housed in a collective cattery. The data were analysed by an F test, and the means were compared by polynomial contrasts. The ɑ level of significance was set at 0.05. The methods were compared by Pearson correlation, and Bland and Altman analysis. The increase in the CP content elevated linearly the renal excretion of urea (p < .001), and, together with the higher sodium intake, elevated the renal solute load, which resulted in a linear increase in urine production and water intake (p < .01). The urine density, metabolic water, and faecal and insensible water losses did not differ (p > .05). The water flux increased linearly when using the deuterium method (p < .001), but the obtained values were 20.85 ± 11.11 ml/cat/day higher than those verified using the WB method (p = .001). Higher CP and sodium amounts in dry diets increased the urine production and water consumption of cats, and this can be explored as a possible option to increase urination.

Evaluation of three herbal compounds used for the management of lower urinary tract disease in healthy cats: a pilot study

OBJECTIVES

Lower urinary tract disease (LUTD) occurs commonly in cats, and idiopathic cystitis (FIC) and urolithiasis account for >80% of cases in cats <10 years of age. Although several strategies have been recommended, a common recommendation is to induce dilute urine resulting in more frequent urination and to dilute calculogenic constituents. In addition to conventional therapy using modified diets, traditional Chinese and Western herbs have been recommended, although only one - choreito - has published data available. We evaluated three commonly used herbal treatments recommended for use in cats with LUTD: San Ren Tang, Wei Ling Tang and Alisma. We hypothesized that these three Chinese herbal preparations would induce increased urine volume, decreased urine saturation for calcium oxalate and struvite, and differences in mineral and electrolyte excretions in healthy cats.

METHODS

Six healthy spayed female adult cats were evaluated in a placebo-controlled, randomized, crossover design study. Cats were randomized to one of four treatments, including placebo, San Ren Tang, Wei Ling Tang or Alisma. Treatment was for 2 weeks each with a 1 week washout period between treatments. At the end of each treatment period, a 24 h urine sample was collected using modified litter boxes.

RESULTS

Body weights were not different between treatments. No differences were found in 24 h urinary analyte excretions, urine volume, urine pH or urinary saturation for calcium oxalate or struvite between treatments.

CONCLUSIONS AND RELEVANCE

The results of this study do not support the hypothesis; however, evaluation of longer-term and different dosage studies in cats with LUTD is warranted.

Macronutrients in feline health

Dietary macronutrients include protein, fat, and carbohydrates. Current nutritional recommendations establish minimums but not maximums for protein and fat but not for carbohydrates; thus, commercial feline maintenance diets have a wide range of macronutrient distribution depending on manufacturer, ingredients, and processing. There is growing interest and discussion, however, in defining the ideal macronutrient composition of feline diets to maximize longevity and health. Current recommendations should be tailored to each patient based on age, body condition, presence of muscle mass atrophy, and the presence of disease.

Effects of oral administration of N-acetyl-d-glucosamine on plasma and urine concentrations of glycosaminoglycans in cats with idiopathic cystitis

OBJECTIVE

To determine the effects of once-daily oral administration of N-acetyl-d-glucosamine (NAG) on plasma and urine glycosaminoglycan (GAG) concentrations in cats with idiopathic cystitis (IC).

ANIMALS

19 cats with IC and 10 clinically normal cats.

PROCEDURES

Cats with IC were randomly assigned to receive 250 mg of NAG in capsule form orally once daily for 28 days (n = 12) or a placebo (capsule containing cellulose) orally once daily for the same period (7). In cats with IC, plasma and urine GAG concentrations and urine creatinine concentration were measured on days 0 (immediately before first dose), 7, 14, 21, 28, and 56. For purposes of comparison, those variables were measured in 10 clinically normal cats on day 0.

RESULTS

Mean ± SEM urine GAG-to-creatinine concentration ratios (day 0 data) for cats with IC and clinically normal cats differed significantly (3.11 ± 0.62 μg/mL and 14.23 ± 3.47 μg/mL, respectively). For cats with IC, mean plasma GAG concentration in NAG-treated cats (39.96 ± 5.34 μg/mL) was higher than that in placebo-treated cats (24.20 ± 3.35 μg/mL) on day 21. In the NAG-treated cats, plasma GAG concentration on days 21 (39.96 ± 5.34 μg/mL) and 28 (39.91 ± 6.74 μg/mL) differed significantly from the day 0 concentration (27.46 ± 3.90μg/mL).

CONCLUSIONS AND CLINICAL RELEVANCE

Cats with IC have lower urinary GAG-to-creatinine concentration ratios than did clinically normal cats. Administration of NAG (250 mg, PO, q 24 h) significantly increased plasma GAG concentrations in cats with IC after 21 days of treatment.

Influence of nutrition on feline calcium oxalate urolithiasis with emphasis on endogenous oxalate synthesis

The prevalence of calcium oxalate (CaOx) uroliths detected in cats with lower urinary tract disease has shown a sharp increase over the last decades with a concomitant reciprocal decrease in the occurrence of struvite (magnesium ammonium phosphate) uroliths. CaOx stone-preventative diets are available nowadays, but seem to be marginally effective, as CaOx urolith recurrence occurs in patients fed these diets. In order to improve the preventative measures against CaOx urolithiasis, it is important to understand its aetiopathogenesis. The main research focus in CaOx formation in cats has been on the role of Ca, whereas little research effort has been directed towards the role and origin of urinary oxalates. As in man, the exogenous origin of urinary oxalates in cats is thought to be of minor importance, although the precise contribution of dietary oxalates remains unclear. The generally accepted dietary risk factors for CaOx urolithiasis in cats are discussed and a model for the biosynthetic pathways of oxalate in feline liver is provided. Alanine:glyoxylate aminotransferase 1 (AGT1) in endogenous oxalate metabolism is a liver-specific enzyme targeted in the mitochondria in cats, and allows for efficient conversion of glyoxylate to glycine when fed a carnivorous diet. The low peroxisomal activity of AGT1 in cat liver is compatible with the view that felids utilised a low-carbohydrate diet throughout evolution. Future research should focus on understanding de novo biosynthesis of oxalate in cats and their adaptation(s) in oxalate metabolism, and on dietary oxalate intake and absorption by cats.

Effects of dietary sodium chloride on health parameters in mature cats

High sodium diets have been shown to enhance water intake and urine output, a potential benefit in the management of lower urinary tract diseases. However, one study suggested that high salt (sodium chloride) diets might have adverse effects on the kidneys [Kirk CA, Jewell DE, Lowry SR. Effects of sodium chloride on selected parameters in cats. Vet Ther 2006; 7: 333–46]. Therefore, the objective of this controlled, prospective study was to evaluate the effects of diets with different salt content (1.11% sodium and 1.78% chloride versus 0.55% sodium and 1.02% chloride, dry matter (dm)) when fed to mature cats (mean age 7.0 years; 12 cats per group) over a 6-month period. Food intake, body weight, bone mineral content, total body hydration status, blood pressure, and markers of renal function were unaffected by salt intake, and no adverse effects were observed. When a subset of cats ( n=9) with an initial serum creatinine ≥1.6 mg/dl was evaluated separately, there remained no evidence of adverse effects associated with increased salt intake. These results are consistent with the majority of other studies evaluating sodium intake in cats, as well as with the National Research Council's assessment, all of which indicate that sodium at 1.5% of the diet dm is not harmful to healthy cats.

Demographics and husbandry of pet cats living in Sydney, Australia: results of cross-sectional survey of pet ownership

Our aim was to collect baseline data on the age, gender, breed, reproductive status and husbandry (housing, diet, vaccination, veterinary attention) of pet cats living in Sydney. Accordingly, a cross-sectional survey of 2768 households was conducted using a postal questionnaire. The 2006 Sydney residential phone book was used as the sampling frame. Non-responders were re-mailed the questionnaire on two further occasions, 2 and 4 weeks after the first posting. Completed questionnaires were received from 884 households. No pets were kept by 387 (43.8%) respondents. Dogs and cats were owned by 295 (33.4%) and 198 (22.5%) of households, respectively, with 7.8% of households having both cat(s) and dog(s). Fish and birds were the next most popular pets. Of the 198 cat-owning households, 54.0% kept only cat(s), while 46.5% kept cats with other pets. The distribution of cat ownership across Sydney was non-uniform. Each cat-owning household kept 1.3 cats on average, with the majority keeping one (75.8% households) or two (18.7%). For the 260 cats, the mean age was 7.1 years, the median 6 years, with a range of 3 months to 22 years. There were significantly more female (143; 55%) than male cats (117; 45%). Only seven cats (2.7%) were sexually entire, and these were all ≤6 years. Crossbred cats outnumbered pedigree cats by a ratio of 3.3:1. The Burmese was the most common breed, followed by the Persian. The median age of pedigree cats (5.5 years) was significantly lower than for domestic crossbred cats (7.0 years). Most cats were housed both indoors and outdoors (72.6%), with 19.7% being restricted to indoors and/or ‘pet park enclosures’. Pedigree cats were significantly more likely than crossbreds to be housed indoors. Most owners fed their cats a combination of commercial dry and canned food (38.1%), although fresh meat was popular also and either fed alone (1.6%) or in combination with dry food (14.4%), tinned food (1.6%) or canned and dry food (25.8%). A diet consisting of dry food alone was fed to cats in 13.4% of households. Ninety percent of cats had been vaccinated at least once, while 72.2% received a vaccination in the last 3 years. Older cats were less likely to have been vaccinated recently than younger cats. Only 5.8% of cats had never visited a veterinarian. For the 243 cats that had received veterinary attention, the average number of years since the last visit was 1.5.

Factors affecting struvite (MgNH4PO4.6H2O) crystallization in feline urine

Factors affecting struvite, a magnesium-ammonium-phosphate complex (MgNH(4)PO(4).6H(2)O), in feline urine were evaluated. Incubation of just "urine mineral (UM)" solution, in which mineral concentrations are compatible with those in feline urine, for 4 h at 37 degrees C did not induce the formation of crystals. Similarly, incubation of urine alone did not produce crystals. However, struvite crystals were formed by the addition of urine to UM solution. Mg, NH(3) and P were all required for urine-induced struvite crystallization. The lower molecular weight (LMW) fraction of urine was essential for struvite crystal formation, and the higher molecular weight (HMW) fraction enhanced formation of LMW-induced struvite crystals. The effects of urine proteins further fractionated by column chromatography were examined. A protein at >250 kDa and cauxin, a major urine protein recently identified as a regulator of felinine production, potentiated struvite crystal formation induced by the LMW fraction. In contrast, Tamm-Horsfall glycoprotein, a urine protein thought to promote struvite crystallization, did not have this activity. The present study reveals a novel mechanism of feline struvite crystallization.