Page 336 - Problem-Based Feline Medicine

328 PART 6 CAT WITH WEIGHT LOSS OR CHRONIC ILLNESS

losing enteropathy or severe liver failure should be Very careful use of diuretics can help to reduce fluid
considered. retention and improve the patient’s well-being (e.g.
frusemide 1–2 mg/kg q 8–12 hours PO, reducing to as
low dose as possible and monitoring closely for side-
Treatment
effects).
Treatment for nephrotic syndrome is controversial
Thromboembolic disorder is rare in cats, but if present
and usually empirical.
consider giving low doses of aspirin (10–25 mg/kg
Monitor response to treatment by assessing changes every 3 days PO).
in body weight, serum and urinary protein levels.
Where an underlying cause can be found it should be Prognosis
treated.
Very variable and often unpredictable. Some
Alter the level of dietary protein: undergo spontaneous complete or partial remissions
● High protein diets may help to correct hypoalbu- (~30%), others need temporary or continuous therapy,
minemia and reduce protein malnutrition. while others progress relatively rapidly to require
● However, they may exacerbate proteinuria, glomeru- euthanasia.
lar hypertension and glomerular damage.
● High-protein diets should not be fed if serum urea Approximately 50% survive for 2.5–6 years.
is elevated. Cats with nephrotic syndrome that do not originally
● Some cats benefit from mild protein addition while have renal insufficiency, may or may not progress to
others benefit from mild protein restriction. Feed develop renal insufficiency.
the chosen diet for ~ 2 weeks then reassess.
Prognosis is poor with worsening clinical signs or pro-
Angiotensin-converting enzyme (ACE) inhibitors gression to renal failure.
help to reduce proteinuria and any associated systemic
hypertension (e.g. benazepril 0.25–0.5 mg/kg/day PO).
Prevention
If systemic hypertension is significant, the calcium
channel antagonist amlodipine (0.625 mg/cat/day
Prompt recognition and treatment of underlying dis-
PO) should be given.
ease may prevent the development of secondary
Use of corticosteroids and immunosuppressive drugs glomerulonephritis. However, since it is not usually
is controversial. They may or may not help to reduce possible to detect the underlying cause, it is not usu-
immune complex formation, will worsen any azotemia, ally possible to prevent the onset of glomeru-
and are contraindicated once renal failure is evident. lonephritis.

RECOMMENDED READING
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Fondacaro JV, Richter KP, Carpenter JL, et al. Feline gastrointestinal lymphoma: 67 cases (1988–1996). Eur J Comp
Gastroenterol 1999; 4: 5–11.
Foster DM, Gookin JL, Poore MF, Stebbins ME, Levy MG. Outcome of cats with diarrhea and Tritrichomonas foe-
tus infection. J Am Vet Med Assoc 2004; 225: 888–892.
Gookin JL, Breitschwerdt EB, Levy MG, Gager RB, Benrud JG. Diarrhea associated with tritrichomonas in cats.
J Am Vet Med Assoc 1999; 215: 1450–1454.
Gookin J, Copple C, Papich M, Poore M, Levy M. Efficacy of ronidazole in vitro and in vivo for treatment of feline
Tritrichomonas foetus infection. Proceedings of the ACVIM, 2005, Abstract 131.