Feline Urinary Tract Disease

By Dr. Barry Baker, ECC Staff Doctor

One of the more common ailments seen in felines is urinary tract disease. This can present in different ways depending on the gender and age of the cat. For example, urinary tract infections are more common in females. Urethral obstruction is more common in young male cats. Chronic kidney disease is typically seen in older cats. Some cats can be inherently predisposed to developing certain urinary tract ailments, but many environmental factors can also contribute to urinary tract health and disease. 

Recognition of urinary tract disease in cats can be aided and diagnosed by your veterinarian, but being able to detect the signs at home is generally going to be most important for catching signs early on before it progresses to the cat becoming very sick. 

Urinary tract disease may also be difficult to detect in multi-cat households, or in cats that go outside, where individual eliminations and habits cannot be observed or distinguished from one cat versus another.

Common signs of urinary tract disease include increased drinking, increased frequency of urination, straining to urinate, decreased urine production, inappropriate urination outside the litter box, bloody urine, lethargy/hiding, loss of appetite, vomiting, abdominal pain and labored breathing. Cats can have just one or multiple signs depending on the type and severity of their urinary tract ailment.

A clean and low stress environment is important to a cat’s overall health as well as their urinary tract health. Cats are pretty well adapted to litter box training at an early age. Litter box cleanliness and type of litter can contribute to the cat’s health and if not maintained appropriately, make them more prone towards certain urinary tract issues and other health ailments. The number of litter boxes available to a cat has been shown to affect their urinary tract health. The current recommendation is to have one litter box for every cat, plus one. So one cat should have at least two litter boxes, a house with two cats should have three litter boxes, and so on. Boxes should be cleaned on a regular basis, at least twice weekly, but sometimes daily changes are necessary. Unclean litter boxes can make cats more susceptible to developing urinary tract infections (UTIs). Certain types of litter like the clay litters and litter with fine dust can also contribute towards respiratory disease, and make cats with asthma have more frequent flare ups. Cats can also be very particular and sensitive to the types of litter used, and sometimes an abrupt change in the type of litter can be stressful and cause the cat to urinate outside the box if it doesn’t care for that particular type of litter. Litter changes should be done slowly, starting with only one litter box and mixing two litters together to ease the transition.

Diet can also have an indirect bearing on urinary tract health. Cats that are obese may develop urinary tract infections because of difficulty reaching their back end and cleaning themselves. Obese cats can also develop type II diabetes, which leads to glucose (blood sugar) leaking into the urine that creates a feeding ground for bacteria and can often lead to urinary tract infections. Eating certain food types can lead to urinary crystals or stones that can cause irritation, discomfort and blockage. Stones can also be a nidus for bacterial growth and infection. Prescription veterinary diets are available to reduce formation of crystals and stones in the urine, however larger stones typically will need to be surgically removed.

Crystals in the urine and bladder stones can lead to a urinary obstruction, which quickly becomes life threatening. Recognizing the signs of a cat struggling to urinate or not acting normally is very important and should be addressed by a veterinarian as soon as possible. Urinary obstruction most commonly presents in young male cats. They’re particularly predisposed for this because of their unfortunately very small and narrow anatomic design of their urethra and penis. Because of this, crystals and stones can easily become lodged and cause a urinary obstruction, but cats can also obstruct just from inflammation that can be brought on simply by a stressful event or other unknown causes (idiopathic). If a cat is blocked and cannot urinate over a 24 hour period, they are at risk of dying. Toxins normally eliminated by the kidneys build up in the blood stream, and electrolytes such as potassium build up to high levels that can lead to fatal arrhythmias and cardiac arrest.

Signs associated with urinary obstruction are similar to other urinary tract disease signs, including straining to urinate, producing little to no urine in a 12-24 hour period, having accidents outside the litter box, loss of appetite, vomiting, hiding and sometimes vocalizing in pain. Treatment for obstruction usually involves heavy sedation or general anesthesia in order to pass a urinary catheter to flush the obstruction back into the bladder and create a patent opening for urine to flow out. The current recommendation based on studies done in urinary obstruction cats is to leave an indwelling urinary catheter in for at least 36 hours. This has been shown to significantly reduce the recurrence of obstruction. Some cases will need the catheter left in longer, especially if they’re very sick with kidney damage and electrolyte abnormalities. Once a cat has had a urinary obstruction, they’re at risk for reblocking at any time for the rest of their lives. Cats that have recurrent obstructions are recommended to get a surgical procedure called a perineal urethrostomy (PU), which permanently widens the urethra. This can greatly reduce the chance for obstruction, but doesn’t completely eliminate it. Cats with a PU surgery are also at a higher risk for contracting UTIs. Treatment for urinary blockage including the catheterization, hospitalization for 36+ hours, medications, blood work, urinalysis and x-rays can be a significant financial investment and range from $1,500-$2,500 depending on the facility and severity of the case. If a PU surgery is needed, cost can increase to around $3,000 to $4,000.

Older and geriatric cats commonly present for chronic kidney disease. In general, kidney abnormalities on blood work don’t start to show up until about 75% of kidney function is already lost. Kidney cells do not regenerate like cells of other organs in the body, so any kidney damage is permanent. Chronic kidney disease occurs when enough kidney damage has occurred over a long period of time that results in greater than 75% loss of kidney function. Sometimes chronic kidney disease can be exacerbated by acute causes such as infection or toxins (lily plants are very toxic to kidneys in cats). With kidney dysfunction, the kidneys are no longer able to concentrate urine, and cats usually present for drinking a lot more water and/or urinating more frequently, sometimes in larger amounts, sometimes accidents outside the box. There is no cure for chronic kidney damage. Management generally consists of a low protein diet (available in prescription veterinarian diets) and adequate hydration. With more severe cases a veterinarian may recommend subcutaneous fluid administration at home. This can vary from once weekly to daily depending on the severity of the case. When chronic kidney disease progresses to end stage, cats usually have lost weight, have a poor appetite, may be vomiting, and can have an anemia. The kidneys are responsible for 80% of red blood cell production, due to secretion of a hormone called erythropoietin. This hormone can be medically supplemented for anemic cats with chronic kidney disease. When caught early, cats can be successfully managed for several years with chronic kidney disease. Cats that are caught closer to end stage have a more guarded long term prognosis.

In summary, kidney disease is a common finding among the feline population. There are multiple different types and causes that can occur at any age and for either gender. Clinical signs can be similar for different types of kidney disease. Regular veterinary visits are important for keeping a cat’s urinary tract health in check, but close monitoring at home is important for detecting early signs. This is especially important for young male cats that can develop a urinary obstruction that can quickly become life threatening. Keep cats in a clean and low stress environment, and check with your veterinarian about the best diet for them to be on.