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Feline lower urinary tract disease (FLUTD)

ffelis

Synonym(s): FUS; Feline urologic syndrome; Idiopathic cystitis


Introduction

  • Describes a collection of conditions that can affect the bladder and/or urethra of cats.
  • The urinary tract can respond to insult in only a limited number of ways, so the clinical signs are not indicative of a particular disease.
  • Most common diagnoses in cats with signs of FLUTD, presented according to age (data from USA) see figure FLUTD graph 1 (Bartges J W, 2002).
  • Cause: majority of cases are idiopathic (iFLUTD), but specific causes include:
  • Causes of iFLUTD may include:
    • Neurogenic mediators.
    • Stress.
    • Viral infections.
    • Altered GAG function/quantities.
  • Signs: dysuria, hematuria, inappropriate urination.
  • Diagnosis: history, urinalysis, radiography/ultrasound, biochemistry.
  • Treatment: no specific therapy.
  • Prognosis: good-most cases resolve with or without treatment, however up to 50% of cats may have recurrent episodes which may be of different etiology. 
    Print off the owner factsheet Problems passing urine - the blocked cat  Problems passing urine - the ‘blocked cat’  to give to your client.

Pathogenesis

Etiology

  • Cause of non-obstructive FLUTD:
    • Non-obstructive idiopathic FLUTD 65%.
    • Urolithiasis 15%.
    • Anatomical defects/neoplasia/other 10%.
    • Behavioral problems <10%.
    • Bacterial infection <2%.
  • Cause of obstructive FLUTD
    • Obstructive idiopathic FLUTD 29%.
    • Urethral plug 59%.
    • Uroliths 10%.
    • Uroliths + bacterial infection 2%.
    • Urethral stricture/rupture Urethra: rupture.
    • Urethral neoplasia Urethra: neoplasia (rare).
  • Cause of iFLUTD:
    • Idiopathic so no causes have been proven. Possible factors include:
      • Neurogenic mediators.
      • Stress.
      • Diets: lack of moisture.
      • Obesity Obesity.
      • Viral infections.
      • Altered GAG function.

Unifying hypothesis

  • Different causes of FLUTD may occur individually, or in various interacting combinations.
  • Cats may present with recurrent episodes of different etiology, eg idiopathic cystitis Idiopathic cystitis followed by urolithiasis. 

Predisposing factors

General

  • Idiopathic FLUTD is more common in cats that:
    • Eat a predominantly dry diet.
    • Are overweight.
    • Have restricted access to the outdoors.
    • Are of nervous disposition and very dependent on their owners.  

Timecourse

  • Idiopathic FLUTD:
    • Recurrent episodes, acute in onset, duration usually 3-5 days, sometimes up to 10 days.
    • Frequency and severity of episodes varies considerably from case to case.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Kaul E, Hartmann K et al (2020) Recurrence rate and long-term course of cats with feline lower urinary tract disease. J Feline Med Surg 22(6), 544-556 PubMed.
  • Lund H, Eggertsdottir A (2019) Recurrent episodes of feline lower urinary tract disease with different causes: possible clinical implications. J Feline Med Surg 21(6), 590-594 PubMed.
  • Palm C A & Westropp J L (2011) Cats and calcium oxalate: strategies for managing lower and upper urinary tract stone disease. J Feline Med Surg 13 (9), 651-660 PubMed.
  • Segev G, Livne H, Ranen E et al (2011) Urethral obstruction in cats: predisposing factors, clinical, clinicopathological characteristics and prognosis. J Feline Med Surg 13 (2), 101-108 PubMed.
  • Bartges J & Kirk C (2007) Nutrition and urinary tract disease - myths and legends. J Feline Med Surg 9 (6), 487-90 ResearchGate.
  • Gerber B, Boretti F S, Kley S et al (2005) Evaluation of clinical signs and causes of lower urinary tract disease in European cats. JSAP 46 (12), 571-577 PubMed.
  • Gunn-Moore D (2003) Feline lower urinary tract disease. J Feline Med Surg (2), 133-138 PubMed.
  • Gunn-Moore D A (2002) Investigation of feline lower urinary tract diseaseUK Vet Jan 02.
  • Gunn-Moore D A (2001) Treatment of feline lower urinary tract disease. UK Vet Sep 01. 27-32.
  • Gunn-Moore D A (2001) Pathophysiology of feline lower urinary tract disease. UK Vet Sep 01. 20-26.
  • Leckcharoensuk C, Osbourne C A & Lulich J P (2001) Epidemiologic study of risk factors for lower urinary tract diseases in cats. JAVMA 218 (9), 1429-1435 PubMed.
  • Kalkstein T S, Kruger J M & Osborne C A (1999) Feline idiopathic lower urinary tract disease; Part I Clinical manifestations. Comp Cont Ed Pract Vet 21 (1), 15-26 VetMedResource.
  • Kalkstein T S, Kruger J M & Osborne C A (1999) Feline idiopathic lower urinary tract disease; Part II Potential causes. Comp Cont Ed Pract Vet 21 (2), 148-152 VetMedResource.
  • Kalkstein T S, Kruger J M & Osborne C A (1999) Feline idiopathic lower urinary tract disease; Part III Diagnosis. Comp Cont Ed Pract Vet 21 (5), 387-94 VetMedResource.
  • Kalkstein T S, Kruger J M & Osborne C A (1999) Feline idiopathic lower urinary tract disease; Part IV Therapeutic options. Comp Cont Ed Pract Vet 21 (6), 497-509 VetMedResource.
  • Markwell P J, Buffington C A, Chew D J et al (1999) Clinical evaluation of commercially available urinary acidification diets in the management of idiopathic cystitis in cats. J Am Vet Med Assoc 214 (3), 361-365 PubMed.
  • Buffington C A, Chew D J & DiBartola S P (1994) Lower urinary tract disease in cats: is diet still a cause? J Am Vet Med Assoc 205 (11), 1524-1527 PubMed.
  • Osborne C A, Kruger J M, Lulich J P et al (1992) Feline matrix-crystalline urethral plugs: a unifying hypothesis of causes. JSAP 33 (4), 172-177 VetMedResource.
  • Kruger J M, Osborne C A, Goyal S M et al (1991) Clinical evaluation of cats with lower urinary tract disease. J Am Vet Med Assoc 199 (2), 211-216 PubMed.

Other sources of information

  • Bartges J W & Kirk C A (2010) Dietary therapy of diseases of the lower urinary tract. In: Consultations in Feline Internal Medicine 6. Ed August J R. pp 88-95.
  • Westropp J L & Buffington C A T (2010) Lower urinary tract disorders in cats. In: Textbook of Veterinary Internal Medicine. Eds Ettinger S J & Feldman E C. pp 2069-2086.
  • Bartges J W (2006) Revisiting bacterial urinary tract infection. In: Consultations in Feline Internal Medicine 5. Ed August J R. pp 441-444.
  • Fischer J R (2006) Acute uretal obstruction. In: Consultations in Feline Internal Medicine 5. Ed August J R. pp 379-386.
  • Kirk C A & Bartges J W (2006) Dietary considerations of Calcium Oxalate uroliths. In: Consulations in Feline Internal Medicine 5. Ed August J R. pp 423-432.
  • Buffington C A T & Chew D J (2001) New treatments in the medical management of feline interstitial cystitis. In: Consultations in Feline Internal Medicine 4. Ed August JR. pp 315-319.
  • Gunn-Moore D A (2000) Feline lower urinary tract diseaseIn Practice 22, 534-542.
  • Kruger J M, Osborne C A & Lulich J P (2000) Non-obstructive idiopathic feline lower urinary tract disease: therapeutic rights and wrongs. In: Kirk's Current Veterinary Therapy XIII Small Animal Practice. Ed. JD Bonagura. WB Saunders, Philadelphia. pp 888-893.

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