Page 923 - Small Animal Clinical Nutrition 5th Edition

Feline Lower Urinary Tract Diseases 955

Table 46-21. Summary of evidence for treatments used to Table 46-22. Comparison of key nutritional factors in selected
VetBooks.ir plugs and calcium oxalate uroliths.* commercial veterinary therapeutic foods for reducing the
manage cats with idiopathic cystitis, struvite uroliths or urethral
recurrence of feline idiopathic cystitis.*
Feline idiopathic cystitis
Grade III Moist foods** Omega 3 (%)
• Environmental enrichment/stress reduction Recommended levels 0.35-1.00
• Feeding moist food Hill’s Prescription Diet c/d Multicare with
• Long-term treatment with amitriptyline (6 to 9 months) for Chicken Feline 0.96
severe cases Hill’s Prescription Diet c/d Multicare with
Grade IV Seafood Feline 0.62
• Increased salt intake to stimulate urine dilution Iams Veterinary Formula Urinary S Low pH/S Feline na
• Additional methods to stimulate water intake Medi-Cal Veterinary Diet Urinary SO na
• Analgesics and nonsteroidal antiinflammatory drugs during Purina Veterinary Diets UR Urinary St/Ox
acute episodes Feline Formula na
• Feline facial pheromone Royal Canin Veterinary Diet Feline Urinary SO in Gel na
• Glycosaminoglycans (pentosan polysulfate, Dry foods Omega 3 (%)
glucosamine/chondroitin sulfate) Recommended levels 0.35-1.00
• Propantheline during acute episodes Hill’s Prescription Diet c/d Multicare Feline 0.65
Hill’s Prescription Diet c/d Multicare with
Chicken Feline 0.64
Dissolution of struvite uroliths
Grade III Medi-Cal Veterinary Diet Urinary SO na
• Hill’s Prescription Diet s/d Feline Purina Veterinary Diets UR Urinary St/Ox
• Medi-Cal Dissolution Formula Feline Formula na
Grade IV
• Other therapeutic foods formulated to dissolve uroliths Key: Omega 3 = total omega-3 fatty acids, na = not available
from manufacturer.
*Nutrients expressed on a dry matter basis.
Prevention of struvite urolith or urethral plug recurrence
Grade III **Moist foods are best because increased water intake is con-
• Hill’s Prescription Diet s/d (for urethral plug prevention) sidered important in the management of feline idiopathic cystitis.
Grade IV
• Other therapeutic foods formulated to prevent struvite dis-
ease
other treatments that may improve outcome and enhance qual-
Decreasing risk of calcium oxalate recurrence** ity of life for cats and their owners. In addition to considering
Grade III
• Feeding moist food key nutritional factors, the quality of evidence supporting dif-
• Hill’s Prescription Diet x/d Feline (currently available as c/d ferent treatments and foods should be evaluated (Roudebush et
Multicare Feline) al, 2004; Forrester and Roudebush, 2007). Tables 46-20 and
Grade IV
Other therapeutic foods formulated to prevent calcium oxalate 46-21 provide more information about evidence for treatments
• Potassium citrate of cats with FLUTD.
• Thiazide diuretics
• Vitamin B 6 Feline Idiopathic Cystitis
• Using other methods (in addition to moist food) to increase
water intake FIC is characterized by recurrent episodes of lower urinary tract
*Adapted from Forrester SD, Roudebush P. Evidence-based signs that usually resolve within three to five days. Because of
management of feline lower urinary tract disease. Veterinary
Clinics of North America: Small Animal Practice 2007; 37: 533- the nature of this disorder, complete elimination of episodes is
558. unlikely.Therefore, goals of treatment are to improve quality of
**Based on decreased urine calcium oxalate saturation or life by decreasing frequency of episodes and their severity.
decreased risk in epidemiologic studies.
Environmental enrichment (e.g., stress reduction, litter box
management) should also be implemented in patients with
FIC. In cats with persistent clinical signs, especially periuria,
necessary. Four feeding plans are reviewed below, including behavioral modification may be needed in addition to correct-
treatment and prevention of FIC, dissolution of struvite uro- ing the underlying medical disorder. Other treatments such as
liths, prevention of struvite urolithiasis and urethral plugs and pain management may be needed for some cats, especially dur-
managing cats with calcium oxalate urolithiasis. ing acute episodes. Boxes 46-5, 46-6, and 46-7 include infor-
Regarding the food assessment/selection step: more recently, mation about environmental enrichment, behavioral modifica-
several foods have been developed that are intended to simul- tion and pain management.
taneously manage the combination of risk factors associated
with FIC-,struvite- and calcium oxalate-based FLUTD.These Assess and Select the Food
foods are listed in Table 46-19 and are compared to the com- Moist foods are recommended for patients with FIC. Feeding
posite key nutritional factors for these three forms of lower uri- moist food has been associated with increased daily water
nary tract disease. The use of this type of food is intended to intake and urine volume in cats compared with feeding dry
simplify and improve the effectiveness of FLUTD prevention food (Table 46-14) (Burger and Smith, 1987; Gaskell, 1989).
strategies. The following sections provide guidelines for suc- Beneficial effects have been observed in patients with FIC
cessful implementation of feeding plan recommendations and when urine specific gravity decreased from values around 1.050