Nutritional support for feline lower urinary tract disease patients

Question 1

Clinical relevance of FLUTD

Answer 1

• feline lower urinary tract disease (FLUTD) is not a specific disease, but rather a term that encompasses disorders that affect the urinary bladder and/or urethra
• thought to affect around 1-3% of cats each year, so is among the more common diseases seen
• because of the diverse nature of the underlying causes, cats of any age, breed and gender can be affected

Question 2

Underlying causes of FLUTD

Answer 2

• (feline) idiopathic cystitis (FIC)
• bacterial infections
• urethral plugs
• anatomical defects
• urolithiasis
• neoplasia

stress & behavioural issues are thought to be contributing factors also

Question 3

Why do males tend to be more affected by obstructive FLUTD?

Answer 3

• narrow size and longer length o fate urethra
• this makes them more susceptible to blockages from calculi, crystals, mucus and smooth muscle spasm

Question 4

Dysuria definition

Answer 4

• difficult or painful urination, often associated with vocalisation

Question 5

Pollakiuria defintion

Answer 5

• increased frequency of urination

Question 6

Haematuria defintion

Answer 6

• blood in urine

Question 7

Periuria definition

Answer 7

• urinating outside the litter-box and in unusual or inappropriate places, often due to pain, inflammation and irritation causing urgency to pass urine

Question 8

FLUTD risk factors

Answer 8

• young to middle aged cats
• neutered cats
• cats with little or no access to outside space
• cats that solely eat dry food
• over-weight and inactive cats
• multi-cat households

Question 9

Use of stress management

Answer 9

• reducing stress will increase the benefits of a modified nutritional plan
• stress often exacerbate symptoms and undesirable behaviours such as inappropriate urination

Question 10

Stress management techniques

Answer 10

• multiple areas to rest
• vertical spaces
• multiple areas for litterboxes
• multiple areas for food and water
• variety of scratching posts and toys

Question 11

Examples of thing that can exacerbate stress

Answer 11

• lack of safe environment
• diet change
• transportation
• novel objects
• noises
• strangers
• new animals
• stressors often more impactful in multi-cat households

Question 12

Aims/characteristics of therapeutic urinary diets

Answer 12

• increase solubility of crystalloids within urine
• decrease the retention of urinary crystals
• limit pro-inflammatory mediators
• increase anti-inflammatory mediators
• increase intake of L-tryptophan
• increase intake of alpha-casozepine
• modify urine pH
• increase urine volume (diluting urine)
• maintain healthy body weight & BCS

Question 13

Diets containing what ingredients are good as they specifically target stress?

Answer 13

• L-tryptophan
• alpha-casozepine

Question 14

Nutrition hx q’s to aid management of FLUTD

Answer 14

1. Have you noticed any recent changes in [cat’s name]’s weight?
2. What do you currently feed [cat’s name]?
   *Have you changed his/her diet recently?
   *Is this a wet or dry preparation?
3. How much food do you give [cat’s name], and how often do you feed him/her?
   *Have you changed the amount or frequency recently?
4. What is [cat’s name] appetite like?
   * Has this changed recently?
   *Do you “top” his/her food with anything to entice eating?
5. Where are [cat’s name]’s food and water bowls?
6. How many bowls are there for fresh water?
7. If there are other cats in the household:
   *Do they share bowls?
   *Is there competition for food?
8. Do you give [cat’s name] treats?
   *If so, what brand/type/flavour? How many per day?
9. If [cat’s name] goes outside, does he/she have access to other food?
10. Do you give [cat’s name] any dietary supplements? If so, which ones?
11. How do you give [cat’s name] medications (if any)? Do you use food?

Question 15

Why should we increase water intake?

Answer 15

• [] of minerals in dilute urine is decreased; great for stopping uroliths
• increasing water intake is beneficial as it will decrease USG and increase urination; more dilute urine is produced
• increase urine production = more frequent urination = less urine retention; esp useful for cystitis
• less time in the bladder = less time for crystals to form

Question 16

Dietary management & modifications - water

Answer 16

• hydration supplements
• water fountains
• wet food (higher moisture content cf dry food)
• appropriate water dish: low edges with wide opening, can be easily cleaned
• appropriate location of water dish: quiet place with low foot traffic, away from litter trays and food bowls
• provide fresh, clean water
• leave water at the bottom of a sink or bath
• splitting meals so they’re more frequent = steady water intake

Question 17

Therapeutic urinary diet examples

Answer 17

• Hills c/d + metabolic urinary + weight management diet
• Hills urinary care s/d diet
• Hills urinary care c/d diet (weight management)
• Hills urinary care c/d diet
• Hills urinary care c/d diet multicare
• Royal Canin S/O-Kcal Control
• Royal Canin Urinary S/O moderate calorie
• Royal Canin Urinary S/O
• Royal Canin S/O-Biopeptide

Question 18

Benefit of using Hills c/d + metabolic urinary + weight management diet

Answer 18

• L-tryptophan & milk protein hydrolysate to control stress
• Reduce weight
• Controlled levels of magnesium, calcium, and phosphorus to reduce the building blocks of crystals and stones
• Promotes optimal urinary pH to help dissolve stones and prevent recurrence
• High levels of omega-3 fatty acids to help break the cycle of inflammation

Question 19

Benefit of using Hills urinary care s/d diet

Answer 19

• food for dissolution of struvite stones in adult cats
• urine acidifying properties and contains a low level of magnesium

Question 20

Benefit of using Hills urinary care c/d diet (weight management)

Answer 20

• dissolves struvite stones and to reduce the recurrence of FLUTD including FIC
• Contains L- tryptophan and milk protein hydrolysate to help control stress
• Reduced calorie intake through controlled fat

Question 21

Benefit of using Hills urinary care c/d diet

Answer 21

• dissolve struvite stones
• Contains L-tryptophan and milk protein hydrolysate to help control stress

Question 22

Benefit of using Hills urinary care c/d diet multicare

Answer 22

• dissolution of struvite stones and for reduction of oxalate stones formation in adult cats
• This food has urine undersaturating properties for struvite, urine alkalising properties and contains low levels of magnesium, calcium and vitamin D

Question 23

Benefit of using Royal Canin S/O-Kcal Control

Answer 23

• High fibre to increase satiety and high protein to support muscle mass
• Urine dilution makes the urine less liable to form struvite and calcium oxalate stones
• lowers the concentration of ions contributing to struvite and calcium oxalate crystal formation

Question 24

Benefit of using Royal Canin Urinary S/O moderate calorie

Answer 24

• Urine dilution makes the urine less liable to form struvite and calcium oxalate stones
• Helps dissolve all types of struvite stones
• Moderate calorie content to help maintain ideal weight
• Helps lower the concentration of ions contributing to crystal formation

Question 25

Benefit of using Royal Canin Urinary S/O

Answer 25

• High moisture content increases urine dilution – useful for cystitis and reduction in struvite and oxalate stones
• Helps lower the concentration of ions contributing to crystal formation
• Helps dissolve all types of struvite stones.

Question 26

Benefit of using Royal Canin S/O-Biopeptide

Answer 26

• Urine dilution makes the urine less liable to form struvite and calcium oxalate stones
• Helps dissolve struvite stones
• Contains hydrolysed casein (milk protein) and L- tryptophan to help manage stress
• Maintenance of ideal weight

Question 27

Benefit of adding L-tryptophan to diet

Answer 27

• an essential amino acid that is a precursor for synthesis of serotonin, an inhibitory neurotransmitter
• It may have an anxiolytic effect in cats

Question 28

Benefit of adding alpha-casozepine to diet

Answer 28

• anxiolytic properties
• derived from bovine milk

Question 29

Benefit of adding EPA and DHA to diet

Answer 29

• Long-chain omega-3 fatty acids which reduce bladder inflammation
• Especially useful for FIC as this is an inflammatory condition

Question 30

Benefit of adding vitamin E & beta-carotene to diet

Answer 30

• Antioxidants
  – have the potential to protect against free radicals release from inflammation

Question 31

Benefit of adding calcium, phosphorus and magnesium to diet

Answer 31

• Urinary diets often contain a restricted amount as high levels are associated with stone formation
• Assists with dissolution also

Question 32

Benefit of an acidifying diet

Answer 32

• Harder for struvite crystals to grow in an acidic environment
• An elevated pH is ideal for dissolving struvite crystals and preventing the formation of oxalate crystals.