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D I A G N O S I S O F F E L I N E L O W E R
U R I N A R Y T R A C T D I S E A S E ( F L U T D )
DIAGNOSTICS:
■ Obtain history■ Perform physical exam, complete urinalysis1 and serum chemistry panel■ If UTI, obtain urine culture and sensitivity (MIC if possible)■ Perform radiography2 and contrast studies Urolith(s)/crystalluria detected?
Unknown or mixed
composition
Calcium Oxalate
Struvite or
Ammonium Urate
Struvite Urethral Plugs
Consult Struvite Flowchart
■ Surgically remove uroliths or obtain by ■ Confirmed or suspected UTI; treat with If no UTI, idiopathic cystitis is likely.
(Depending on patient’s age and history, ■ Contact Hill’s Veterinary Consultation Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U L T
F E L I N E A M M O N I U M U R A T E U R O L I T H I A S I S
Urolith(s)/crystalluria identified as
possible ammonium urate
Diagnostics
■ Radiography (double contrast2) or ultrasound ■ Fasting chemistry panel including liver enzymes and paired bile acids Are bile acids and/or liver enzymes elevated?
■ Perform appropriate follow-up diagnostics for suspected portosystemic shunt or other liver disease ■ If patient can withstand surgery, remove uroliths; post-op radiography3; perform quantitative analysis4 ■ Feed Prescription Diet® Feline l/d®■ Encourage water consumption5 ■ If urine pH consistently <6.5, verify cat is eating Prescription Diet® Feline l/d®; add potassiumcitrate8 to maintain urine pH 6.5-7.0 ■ Re-evaluate every 3-6 months■ Follow-up diagnostics for liver disease as needed■ Perform complete UA1■ Double contrast radiography2 Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U L T
F E L I N E S T R U V I T E U R O L I T H I A S I S
Urolith(s)/crystalluria or urethral plug
detected; identified as possible struvite
Cats that have:
Cats that do not have:
Struvite Crystalluria
Struvite Urolith
or Urethral Plug
Feed Prescription Diet® Feline s/d®
food exclusively. Discontinue all
treats and supplements.
Signalment will dictate the proper Prescription Diet®
brand cat food to feed.
Please contact Hill’s Veterinary Consultation Service
for additional information.7

■ Treat UTI if present■ Encourage water consumption5■ Monitor UA1 Continued
Hill’s Veterinary Consultation Service 1-800-548-8387
Continued
M E D I C A L M A N A G E M E N T O F A D U L T
previous
F E L I N E S T R U V I T E U R O L I T H I A S I S
Urine pH 5.9-7
Urine pH>7
Urine pH< 5.9
If average urine pH 5.9-7,
If average urine pH>7, or if
If average urine pH<5.9:
no crystalluria and
struvite crystalluria and/or
asymptomatic cat
clinical signs are present:
Struvite Crystalluria
Struvite Urolith
■ Continue Prescription Diet® Feline s/d® for two months ■ Monitor dissolution with monthly radiographs3 No change in stone(s)
Stone(s) dissolving
Probably NOT pure struvite;
surgically remove and:
Feline s/d® food one monthbeyond apparent dissolution of NOTE: Do not feed Prescription Diet®
complete UA,1 bloodchemistry and contrast studies Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U L T F E L I N E
C A L C I U M O X A L A T E U R O L I T H I A S I S
Urolith(s) detected; identified as
possible calcium oxalate
Concurrent renal disease
■ Treat secondary UTI if present■ Encourage water consumption5 ■ Check serum calcium■ Obtain stone(s) by urohydropropulsion if patientis female; surgically removeurolith(s) if patient is male or unable to void; perform No other disease problems
reduced in protein, oxalatesand sodium. Feed canned foodif possible to increase waterconsumption and form a moredilute urine5 Concurrent fiber-responsive disease
■ Treat secondary UTI if present■ Encourage water consumption5 Continued
Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U L T F E L I N E
C A L C I U M O X A L A T E U R O L I T H I A S I S
Continued
previous
Recheck urinalysis after 2 weeks1
Urine pH< 6.5
Urine pH 6.5-7.5
Urine pH >7.5
Continue therapeutic
food and monitoring
Continue to monitor
Continue to monitor
Every 3-6 months:
■ Verify dietary compliance■ Perform complete UA1 Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U LT C A N I N E
S T R U V I T E U R O L I T H I A S I S
Probable diagnosis of urolith(s)/crystalluria as struvite (MAP)
■ Perform complete urinalysis1■ Urine culture (MIC if possible)■ Obtain 12-hour fasting chemistry panel■ Perform radiography2 Does the dog have any of these conditions?
■ Cardiac, liver, renal disease or other sodium retention problems■ Pancreatitis, history of pancreatitis or other abnormalities of fat metabolism■ Obesity, diabetes or other fiber-responsive condition■ Heart failure or hypertension■ Hyperlipidemia■ For additional contraindications, contact Hill’s Veterinary Consultation Service7 Surgically Remove Stones:
■ Feed Prescription Diet® Canine w/d®5;6■ Obtain quantitative analysis4■ Culture stones or bladder wall DETERMINE BEST OPTION:
■ Treat with antibiotics for at least one month following surgery SURGERY OR DISSOLUTION
For Long-Term Care:
■ Monitor urine pH weekly at home10; ideal pH is 6.0-6.5 ■ Perform urinalysis monthly1; check for crystalluria and Continued
Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U LT C A N I N E
S T R U V I T E U R O L I T H I A S I S
Continued
previous
DISSOLUTION PROTOCOL
SURGICALLY
REMOVE STONES
If no
change in
stone size
For long-term care:
or density
after eight
weeks,
surgically
Is sand, gravel or
remove
sludge present (with
or without stones)?
Are stones dissolving?
Monitor progress while on
Prescription Diet® Canine s/d®*

At Home: Check urine pH weekly10
At Clinic: Monthly urinalysis1; check
■ Urine Specific Gravity (USG) should be ≤1.020 while on Prescription Diet® Canine s/d® Monitor Progress
■ If UTI present, treat with antibiotics ■ Check urine pH, ideal average is 6.0-6.5 Monitor Progress
Urine pH>7.0
Urine pH>7.0
Urine pH 5.5-7.0
Urine pH<5.5
USG1.020
Struvite crystals:
*Total length of time fed should not exceed six months.
Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U L T C A N I N E
A M M O N I U M U R A T E U R O L I T H I A S I S
Probable diagnosis of urolith(s)/
crystalluria as ammonium urate
■ Feed Prescription Diet® Canine w/d® or For long-term care:
■ Monitor urine pH weekly at home; ideal ■ Radiography (double contrast)2 or ultrasound Urinalysis monthly1; check for crystalluria Is dog overweight,hyperlipidemic, history of Is dog a Dalmatian?
Consider additional tests
Is liver function normal?
■ Feed Prescription Diet® Canine l/d®5;7 Continued
Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U L T C A N I N E
Continued
A M M O N I U M U R A T E U R O L I T H I A S I S
previous
DETERMINE BEST OPTION:
SURGERY OR DISSOLUTION
DISSOLUTION IS BEST
CONTINUE
DISSOLUTION
PROTOCOL
SURGERY IS BEST OPTION:
Are stones dissolving?
Go To: Monitor Progress
If no change in stone size or
density after 8 weeks,
Go To: Monitor Progress
surgically remove
M O N I T O R P R O G R E S S
At home: Check urine
Check urine pH
Check USG
At clinic: Monthly urinalysis1:
(feed Prescription Diet®Canine u/d® exclusively) Check for ammonium
Check BUN
urate crystalluria
BUN should be ≤10mg/dl while onPrescription Diet®Canine u/d® MONITOR PROGRESS LONG-TERM:
■ Continue monthly UA;1 every 6 months, fasting (feed Prescription Diet® Canine u/d® exclusively) ■ Once past active phase of stone formation, change ■ Add low dose allopurinol13 if persistent food to Prescription Diet® Canine k/d® indefinitely Hill’s Veterinary Consultation Service 1-800-548-8387
M E D I C A L M A N A G E M E N T O F A D U L T
C A N I N E C A L C I U M O X A L A T E U R O L I T H I A S I S
Urolith(s) detected; identified as possible calcium oxalate
■ Perform quantitative stone analysis to ■ Obtain stones using urohydropropulsion in both males and females if possible; if not, High serum calcium levels
Normal serum calcium levels
Urolithiasis may be one consequence of
Urolithiasis may be the result of increased
hyperparathyroidism or other disease
levels of calcium or oxalate, or decreased
levels of citrate in the urine

■ Identify and treat underlying disease Does the dog have any of these conditions?
Feed Prescription Diet® Canine w/d®6 or other therapeutic food, and add potassium citrate8 ■ Urinalysis monthly at clinic;1 USG should be <1.020 on Prescription Diet® Canine u/d® ■ If average urine pH < 7, add or adjust dose of USG<1.020
USG1.020
Every 3-6 months:
Verify dietary compliance (BUN <10 mg/dl; USG <1.020 when on Prescription Diet® If CaOx crystalluria persist or stones recur, contact Hill’s Veterinary ConsultationService7; as last resort considerhydrochlorothiazide15 Hill’s Veterinary Consultation Service 1-800-548-8387
R E F E R E N C E N O T E S
to avoid pH drift and artifactual crystal 12. Lithostat® (acetohydroxamic acid) is a cially if CaOx stones are suspected.
antibiotics. Re-evaluate in 2-3 weeks.
creatitis, or at risk of pancreatitis, and Hill’s Key to Clinical Nutrition for addi- dose: 50-100 mg/kg BID-TID. Taurinedose: 500 mg BID.
Hill’s Veterinary Consultation Service 1-800-548-8387
L U T D F O R M U L A R Y
Give potassium citrate to alkalinize urine.
Dose for dogs and cats: 50-75 mg/kg BID with food.

Urocit®-K‚ available in 540 mg or 1080 mg wax matrix tablets.
For more information, contact Mission Pharmacal at 1-800-531-3333;
www.missionpharmacal.com.
Polycitra®-K‚ 220 mg/ml liquid, may be more convenient for cats and small dogs. For
more information, contact Alza Corp. at 650-564-5000; www.alza.com
NOTE: The above products are intended for use in humans; not approved for use in dogs
or cats. Monitor serum potassium and renal function.
Lithostat® (acetohydroxamic acid) is a urease inhibitor and may help decrease urine pH in
patients with UTI caused by a urease-producing organism.
Dose for dogs: 12.5 mg/kg BID, used in conjunction with appropriate antibiotics.
Re-evaluate in 2-3 weeks. For more information, contact Mission Pharmacal at
1-800-531-3333; www.missionpharmacal.com.
NOTE: Lithostat® is intended for use in humans; not approved for use in dogs.
Allopurinol: Dose for dogs: 10-15 mg/kg BID for dissolution of ammonium urate uroliths.
Beware of use in hepatic or primary renal failure, as allopurinol is metabolized to its
active form in the liver and excreted via the kidney. Do not feed foods high in purines to
patients on allopurinol as xanthine uroliths could result. Maintenance dose of allopurinol
if indicated, 10 mg/kg once a day.
NOTE: This drug is intended for use in humans; not approved for use in dogs.
Hydrochlorothiazide: Dose for dogs: 2 mg/kg every 12 hours to inhibit calcium excretion
in urine.
NOTE: Side effects of this diuretic are many and significant. Use only as a last resort.
Monitor for hypokalemia and hypercalcemia (found in patients with absorptive
[intestinal] hypercalciuria) every 3-6 months. This drug is intended for use in humans;
not approved for use in dogs.
Hill’s Veterinary Consultation Service 1-800-548-8387
F E L I N E T A R G E T U R I N A R Y p H C O M P A R I S O N
U R I N A R Y p H R A N G E S F O R T H E R A P E U T I C P R O D U C T S
5.8 5.9 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7
Feline c/d®-s
Feline c/d®-oxl
Feline g/d®
Feline d/d®
Feline h/d®
Feline i/d®
Feline l/d®
Feline k/d®
Feline p/d®
Prescription Diet
Feline r/d®
Feline s/d®
Feline t/d®
Feline w/d®
Feline z/d™
Eukanuba Low pH/S™ 1
Eukanuba Moderate pH/O™ 2
IVD™ Select Care™ Control Formula, Canned
IVD™ Select Care™ Modified Formula, Canned
CNM UR-Formula®
CNM NF-Formula®
Waltham® Veterinary Diet S/O Control pHormula Diet™ Canned
9 Lives Plus Care, Canned (no min.)
Friskies® Special Diet, Dry
Purina® Special Care™ (no min.)
5.8 5.9 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7
1 Eukanuba Veterinary Diets® Nutritional Urinary Formula™ Low pH/S™ 2 Eukanuba Veterinary Diets® Nutritional Urinary Formula™ Moderate pH/O™ Source: Hill’s® TechSource, 2001Eukanuba® Product Reference Guide, TIS Index No. 9,487. IVD™ Product Reference Guide, TIS Index No.13,205.
Purina® Product Guide, 02/2001, TIS Index No. 10,530Waltham® S/O Product Sheet, TIS Index No. 9,246. 9 Lives® Plus Care: mfg contact, TIS Index No. 13,614 Hill’s Veterinary Consultation Service 1-800-548-8387

Source: http://www.sbc.co.kr/data/file/vet_03/8ae61e20_Uro-Flow-Charts-Complete.pdf

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