Clinical Suite: Idiopathic FLUTD
David F. Senior, BVSc, DACVIM (SAIM), DECVIM-CA, Louisiana State University School of Veterinary Medicine
Sandy Walsh, RVT, CVPM, PetOps, LLC, Wilton, California
Overview
David F. Senior, BVSc, DACVIM (SAIM), DECVIM-CA, Professor Emeritus, Louisiana State University
Idiopathic feline lower urinary tract disease (idiopathic FLUTD) is most commonly observed in young and middle-aged cats1,2 and is exhibited through repeated signs of lower urinary tract inflammation, including hematuria, pollakiuria, stranguria, dysuria, and periuria.
Current management strategies focus on stress reduction, dietary adjustment, and environmental enrichment.
The distinction between idiopathic FLUTD and urethral obstruction may be blurred because the former may predispose to the latter. Recent evidence suggests that some affected cats have an aberrant neuro-hormonal response to stress3,4; changes in local bladder eicosanoid metabolism have also been identified.2 Current management strategies focus on stress reduction, dietary adjustment, and environmental enrichment.5
Related Article: Feline Kidney Disease at a Glance
Diagnostic tests to rule out known causes of FLUTD include urinalysis, urine culture, survey and contrast radiography, abdominal ultrasound, and, in some cases, cystoscopy and bladder biopsy.2 The natural history of the disease includes clinical signs that wax and wane for 2 to 3 days; controlled studies to assess the efficacy of various treatments have been challenging. Clinical signs can vary from relatively mild, infrequent occurrences to severe, repeated episodes that cause the patient major discomfort.2
Treatment Plan
David F. Senior, BVSc, DACVIM (SAIM), DECVIM-CA, Professor Emeritus, Louisiana State University
The following represents a comprehensive treatment plan for patients with idiopathic FLUTD, including which team members play a role in each part of treatment.
Related Article: Idiopathic FLUTD: Overview
Environmental Review and Enrichment
Veterinarian and Veterinary Technician5-7:
Explain to the client the situations that could increase the patients stress (eg, conflict for space with other animals and children; safe feeding, watering, and absence of littering areas; absence of safe hiding or resting areas; introduction of a new pet; neighborhood dogs; severe weather; family relocation).
With the client, brainstorm changes that would provide a safe, predictable, enriched environment and make the patient feel in control (eg, separate food and litter box areas for each cat; safe hiding, perching, resting, and playing areas; routine, dedicated play and predatory behavior time). Also, discuss techniques that enhance the quality of play and provide positive and consistent humancat interaction time, and address environmental aspects that consider the importance of the cats sense of smell (eg, warming food to body temperature to increase olfactory stimulation).
The veterinary team should emphasize to clients that current dietary recommendations are supported by contradictory or minimal studies.
Diet
Veterinarian and Veterinary Technician:
Feed patients canned food. In 2 studies,3,5 recurrence of clinical signs was observed less often in cats that were fed canned food than in those fed an otherwise identical dry diet.<sup8 sup> However, another study comparing otherwise identical wet and dry food failed to reduce the recurrence of clinical signs of acute idiopathic FLUTD, so this recommendation may not always be beneficial.9 That said, feeding canned foods may provide behavioral benefits beyond producing more dilute urine.5
Feed patients diets that assist with formation of urine with low relative supersaturation with respect to struvite and calcium oxalate. Elimination of urolithiasis as a cause of the clinical signs is intrinsic to an idiopathic FLUTD diagnosis, and it is best to eliminate crystalluria, which often contributes to urethral obstruction.
Consider methods to increase water consumption (eg, add water to food; adjust water container size; offer bottled or distilled water; use a pet fountain; leave water in the sink, bathtub, or shower with a slow drip; flavor water with low-salt meat or fish broth).2,5
Feed diets with increased antioxidant and fatty acid levels. In one study, cats fed a diet with the higher levels of these nutrients suffered fewer days with clinical signs of idiopathic FLUTD.9
The veterinary team should emphasize to clients that current dietary recommendations are supported by contradictory or minimal studies.
Prescribed medication
Veterinarian:
If the patient exhibits severe clinical signs, prescribe buprenorphine 20 g/kg IM, then transmucosal buprenorphine 5-20 g/kg PO 2 to 4 times a day for 5 days to control pain.10
To tranquilize the patient, administer acepromazine 2.5 mg/cat PO as needed.11
For chronic cases, consider pheromone therapy12 and/or amitriptyline.13
Team Roles
The following guide outlines each team members role and responsibilities, from client education to diagnosis and treatment.
Team Training Plan
Sandy Walsh, RVT, CVPM, PetOps, Wilton, California
Training in all aspects of idiopathic FLUTD is critical. The practices established patient care models should be developed in advance and clearly documented, as they will set the standard of care. Team members should be fully knowledgeable about the disease signs, diagnostics, treatments, and prevention.
All team members must provide clients with consistent information; in-house team training will help ensure the highest level of consistency. The team must understand the importance of early disease detection and preventive measures (eg, environmental changes, diet changes, medication administration) so that they can communicate them to clients.
Related Article: Idiopathic FLUTD: Tailoring Treatment
Regular continuing education (CE) is important for all team members. Large conferences, local events, and online CE opportunities are some of the best venues to achieve continual team learning.
Communication Keys
Sandy Walsh, RVT, CVPM, PetOps, Wilton, California
Whether delivering or obtaining information or answering client questions, it is important that each team member possess the communication skills necessary to assist each other and clients. This is an important skill set that should be screened for during the hiring process.
Every team member will communicate with the client at some stage of diagnosis, treatment, and case management. Clients may not always understand the disease information, so avoid the vet speak whenever possible and communicate in terms they will understand. Share verbal and written information, and confirm client understanding by encouraging them to ask questions. Important discussion topics include:
Clients may not always understand the disease information, so avoid the vet speak whenever possible and communicate in terms they will understand.
Diet changes and restrictions
Suggestions to encourage litter box use
Medical progress examinations
Pain-control options
Stress-reduction techniques
Use and importance of medications.
The team must do everything possible to help the client manage the patients idiopathic FLUTD, including recognizing the signs, diagnostics, treatment, and prevention. Communication is key to successful case and client management.