Next step????

RE: Next step????

Claire Godfrey — Wed, 02 Dec 2015 16:17:34 GMT

Thanks all,

I will try spinning down the urine next time and see if it makes a difference. To be honest I am not overly convinced by the polydipsia as not polydipsic in here BUT should not have blood in urine.

I was concerned if it was coming from the kidneys and not the bladder. There is no pollakiuria or dysuria.

RE: Next step????

Anthony Todd — Wed, 02 Dec 2015 15:01:14 GMT

I thought SG was only influenced by solutes??

If you put some washed sand into a jar of distilled water the SG will still be the same won't it?

RE: Next step????

Glen McIntosh — Wed, 02 Dec 2015 09:48:44 GMT

[quote user="Gillian Mostyn"](Might be a daft question, but wouldn't the s.g. be artificially high if the sample is full of blood???)[/quote]

Not a daft question.

I don't actually know the answer, but I always understood that you should spin down the u sample first and use the supernatant to check SG. By doing this you will remove any influence of rbc's on the SG reading.

I would imagine, though, that haemoglobinuria, like glycosuria and proteinuria, will also artefactually increase SG, even if you use the supernatant.

RE: Next step????

Robin Grimmer — Wed, 02 Dec 2015 07:15:17 GMT

Is there any dysuria or pollakiuria, or is it just haematuria? If so could be upper urinary tract in origin eg idiopathic renal haemorrhage.

RE: Next step????

Kara Gibson — Wed, 02 Dec 2015 02:48:46 GMT

Also worth checking about litter trays at home, if she has 4 other cats there should technically be 6 litter trays at home. A couple of water fountains would be helpful also. Competition for resources may be an issue here.

RE: Next step????

Rob Loxley — Tue, 01 Dec 2015 23:00:24 GMT

[quote user="Sammy82"]@Michael Convenia, although a 3rd generation Cephalosporin can be used as first line treatment[/quote]

Well anything can be used first line; however I quote from the datasheet "It is prudent to reserve third generation cephalosporins for the treatment of clinical conditions, which have responded poorly, or are expected to respond poorly, to other classes of antimicrobials or first generation cephalosporins. Use of the product should be based on susceptibility testing"

[quote user="Kate Richardson"] I personally don't find convenia particularly effective v UTIs anyway, and don't use it unless there really is no choice[/quote]

Neither do I, even when they've been cultured and should be susceptible

RE: Next step????

Emily Rainbow — Tue, 01 Dec 2015 22:50:32 GMT

Have had a few similar adult cats recently. Often I've picked them up at this stage too (often post multiple antimicrobials!!!) as I do all the scanning etc. i think all have responded to FLUTD management with metacam initially too. A couple I was worried about TCC on scan but no abnormal cells in urine so cysto-ed and culture/sediment NAD. The ones that have come back for re-scan/dipstick have improved.

RE: Next step????

Kate Richardson — Tue, 01 Dec 2015 22:46:57 GMT

[quote user="Gillian Mostyn"]

I would also want to take a cysto' sample for full analysis - wouldn't want to be relying on a free catch sample from the litter tray.

(Might be a daft question, but wouldn't the s.g. be artificially high if the sample is full of blood???)

[/quote]

No I don't think blood affects the SG.

Brain still ticking, could the kitten be subclinically dehydrated, and is thus drinking more or little and often to keep on top of hydration? Worth sub cut fluids or even 24hrs iv to flush through?

I agree cysto has advantages but potential for iatrogenic haematuria- so I would prob check a free catch first (for dipstick) and then cysto for culture if nec. I think if a free catch sample is negative on culture then you can be fairly certain no UTI, becomes more difficult to interpret if positive, but can help to assess sediment concurrently.

Also what were electrolytes?

RE: Next step????

nikki — Tue, 01 Dec 2015 22:43:07 GMT

[quote user="Gillian Mostyn"]

(Might be a daft question, but wouldn't the s.g. be artificially high if the sample is full of blood???)

[/quote]

Article I read recently in VetCPD said that USG can be artificially raised by glucosuria and heavy proteinuria but didn't mention haematuria as a cause.

RE: Next step????

Gillian Mostyn — Tue, 01 Dec 2015 22:35:56 GMT

I would also want to take a cysto' sample for full analysis - wouldn't want to be relying on a free catch sample from the litter tray. Also, as regarding the samples brought in from home- if the owner is unable to separate the cats for measuring water intake, is she absolutely sure the urine sample is from only that cat???

(Might be a daft question, but wouldn't the s.g. be artificially high if the sample is full of blood???)

RE: Next step????

Sammy82 — Tue, 01 Dec 2015 22:28:51 GMT

We do have "veterinary specific" dip sticks at work (will look at the name of them tomorrow). The main difference seems to be the higher price, otherwise I think they have exactly the same fields in a different order on them.

RE: Next step????

Kate Richardson — Tue, 01 Dec 2015 22:22:12 GMT

[quote user="nikki"]She can't be truly polydipsic with an SG off the scale.[/quote]

That's very true. It maybe that she is drinking little and often and owners often interpret this as drinking more (same with eating, sometimes owners think they are eating more but are eating little and often, often secondary to dental pain but that's an aside)

So thinking outside the box, could it be pain related? Nausea? Check mouth carefully, ask re any GI signs/licking lips etc. If its pain related, then could be stress related cystitis.

RE: Next step????

nikki — Tue, 01 Dec 2015 21:57:01 GMT

I'm going to design a veterinary dipstick for urine. It should be pretty easy - I'm just going to chop off the leucocytes/nitrates section of a human one! These two things are completely and utterly useless when analysing dog/cat urine and should definitely not prompt the use of antibiotics. Will get down from soapbox now!

Cystitis would be my top differential and cystaid and increased water in the diet would be my treatment and then repeat culture once Convenia out of system. She can't be truly polydipsic with an SG off the scale.

RE: Next step????

Kate Richardson — Tue, 01 Dec 2015 21:47:32 GMT

[quote user="claire godfrey"]Owner brought in urine same which was concentrated off the scale and had a large amount of blood and protein ++ with leukocytes also.[/quote]

Was that leucocytes on the dipstick? If so, means nothing. Any cells seen on the sediment? Negative culture when on antibiotics not always that helpful as will suppress growth, but getting a positive culture result can be difficult anyway- when you sent the sample to the lab did you just send the urine or did you send a swab from the urine? I personally don't find convenia particularly effective v UTIs anyway, and don't use it unless there really is no choice.

If cat is asymptomatic, I would probably leave off all treatment and make sure at least 2 weeks after convenia out of system and repeat urinalysis, and send for culture/sediment again if still has haematuria. If you or the owner want to do something in the mean time, Cystaid or something similar will do no harm.

What is the kitten's diet? Any other cat's in the house?

RE: Next step????

grumpyoldman — Tue, 01 Dec 2015 21:40:35 GMT

If its fine and growing well leave the antibiotics off ,get a cystocentesis sample for culture and sediment analysis.

RE: Next step????

Claire Godfrey — Tue, 01 Dec 2015 21:10:07 GMT

I'm not really convinced it is cystitis and she is not showing any other symptoms. Would definitely have added NSAIDs if thought this was the case.

RE: Next step????

Claire Godfrey — Tue, 01 Dec 2015 21:07:38 GMT

Sorry have done a sediment on the urine no crystals seen.

Owner has 4 other cats and struggles to measure water intake just aware keeps going to the bowl and when she does seems to spend a long time there. I am probably more concerned there seems to be a lot of blood in the urine.

RE: Next step????

Sammy82 — Tue, 01 Dec 2015 20:56:43 GMT

@Michael Convenia, although a 3rd generation Cephalosporin can be used as first line treatment.Although discovered more recently, it is grouped with most 2nd generation cephalosporins based on bacterial resistance. It is ineffective against Pseudomonas unlike most other 3rd generations Cs.

I would also use NSAIDs and/or Nutracys in the managment of cystitis in cats. With the urine being so concentrated I would doubt any significant polydipsia. Can the owner measure water intake at home?

RE: Next step????

Glenn Hodgson — Tue, 01 Dec 2015 19:48:58 GMT

Urine sediment would be top of my to do list. Crystals? And then a double check of vulva.

Anyone seen a kitten with vaginitis like puppies get? I haven't.

RE: Next step????

Michael Woodhouse — Tue, 01 Dec 2015 18:41:49 GMT

[quote user="claire godfrey"]any extra precautions you would take?[/quote]

I'd be less keen to throw about 3rd generation cephalosporins........

I suspect that is not the help you are seeking.