Category: cat

Feline lymphoma

A diagnosis of cancer is always frightening. One of the most common forms of this disease in cats is lymphoma. This is a cancer of the lymph nodes and can arise almost anywhere in the body. However modern treatment protocols can be highly effective in providing some control of the disease and it is possible for affected cats to have several years of normal life following treatment.

Lymphoma is a cancer of the white blood cells. In cats the disease can take many forms and these are typically distinguished by the area of the body that is affected. Lymphoma affecting some sites such as nasal lymphoma and lymphoma of the cranial mediastinum (tumour in the chest, in front of the heart and between the lungs) is associated with a better outcome. Historically, infection with FeLV has often been associated with an increased risk of lymphoma and leukaemia but this association seems to be declining.

Currently, the most common form of feline lymphoma is the intestinal form. Cats with this type of lymphoma often present with a history of reduced appetite, intermittent vomiting and sometimes a mass can be felt in the abdomen.

Another frequent presentation is cranial mediastinal lymphoma. For an unknown reason cranial mediastinal lymphoma is seen more frequently in young cats, often as young as one year old. The first sign of illness in cats with this form of disease is often severe breathing difficulty.

Kidney lymphoma appears to be a disease of the older cat. The first signs are usually reduced appetite and weight loss. Often an owner identifies a large mass in the abdomen that is actually the enlarged left kidney. These cases invariably have a degree of renal failure and may show excessive drinking and urination.

Cats with nasal lymphoma usually present with sneezing or a discharge from the nose.

Your vet will first want to examine your cat. They may be able to feel a mass in your cat’s abdomen or a thickening of the intestines.

Chest X-rays or ultrasound may be needed to identify the presence of a tumour in the chest or abdomen.

Diagnosis is made by taking a sample of the tumour tissue for examination. This can be done using a fine needle aspirate, core biopsy or surgical biopsy. A sample of the fluid in the chest or some cells from an enlarged kidney can be examined under a microscope.

Multiple treatment options have been described. Currently there appears to be some uncertainty about which is the best type of treatment protocol to use. Two basic protocols are used by most vets, the three drug COP protocols which use the drugs vincristine, cyclophosphamide and prednisolone, and the four drug CHOP protocols which also use the drug doxorubicin. When doxorubicin is used as part of the treatment plan there appears to be a significantly increased risk of gastrointestinal side effects, mostly anorexia. It is unclear whether the addition of doxorubicin adds a real benefit in terms of overall survival.

Your vet will advise you on the best treatment for your cat.

Sadly, there is no cure for lymphoma. Chemotherapy in cats is aimed at providing prolonged high quality life.

There appear to be 3 groups of feline lymphoma patients. Some cases fail to show a good response to any chemotherapy offered. For these patients, their lymphoma is unfortunately fairly rapidly progressive over a few weeks.

Patients in the middle group tend to show a degree of response to the treatment but never achieve complete normality and for these patients there is an average life expectancy of approximately 4 months.

A third group of cats achieve complete remission from their lymphoma and their life expectancy can be measured in years. Cats with fluid in their chest due to a mediastinal lymphoma may appear to be very sick but can be extraordinarily responsive to chemotherapy provided that the initial respiratory complaint can be stabilised.

Whilst cats with kidney lymphoma can respond well to chemotherapy, the significant kidney damage that has inevitably arisen prior to diagnosis persists. This has consequences both in the short and the long term. In the short term, it may be harder for these cats to handle the chemotherapy. In the long term, renal damage is likely to be progressive and therefore, even if the lymphoma enters complete remission, life expectancy can be reduced.

Feline injection site sarcoma

Feline ‘Injection Site Sarcoma’ or ‘Vaccine Associated Fibrosarcoma’ is a rapidly progressive and aggressive cancer affecting cats. The true cause of the disease is not yet understood but it is definitely associated with the administration of long-acting injections like vaccinations. Vaccine technology has advanced since the condition was first reported in October 1991 and effective vaccinations now exist that have not yet been associated with this condition. Rapid appropriate action is required to give patients with this condition the best chance of a lengthy remission or cure.

Feline ‘Injection Site Sarcoma’ or ‘Vaccine Associated Fibrosarcoma’ is a rapidly progressive and aggressive cancer affecting cats. The true cause of the disease is not yet understood but it is definitely associated with the administration of long-acting injections like vaccinations.

Injection site sarcomas can develop in cats of almost any age – usually months or years after vaccination. They typically occur at the base of the neck between the shoulder blades as this is the site most commonly used for injection in cats. However, they may develop at any site where an injection has been given.

Usually the mass if the first sign noticed before the animal becomes ill in any other way.

If you detect a swelling under the skin in your cat at a site where they have previously had an injection seek veterinary attention straight away (within the following two days). Your vet will evaluate and measure the lump.

Lump larger than 1cm

If the lump is larger than 1cm across or appears to be rapidly growing ask your vet to contact a veterinary oncologist to get up-to-date advice on treatment. For rapidly growing or larger lesions it is recommended that an incisional biopsy is taken in all cases. Attempted removal without knowing the true nature of the lump can foil all chances of a long term remission.

Lump smaller than 1cm

If the lump is less than 1cm or appears not to be rapidly growing it may be assessed again 1 month later. If at follow up examination it is apparent that the lump is not growing, continue monthly checks for 3 months in total. After this time decisions can be made between you and your vet about the most appropriate way to proceed, this may involve biopsy or removal of the lump.

It is generally well recognised by veterinary oncologists that surgery offers the best chance of long term control. However, this surgery must be performed by an appropriately trained soft tissue surgeon and it is likely that your cat would need to be referred to a specialist centre to get the most effective treatment.

Specialist oncologists may offer a combination therapy approach which harnesses the benefits of both chemotherapy and surgery to provide a dramatically improved outcome for the patients concerned. Unfortunately, this treatment strategy is not appropriate for all patients. It is important that patients are fully evaluated first to ensure that treatment is not prescribed to patients that would not ultimately benefit from the treatment plan offered. As always, the goal of therapy is first and foremost to extend a good quality of life, not to attempt to extend life at all costs.

Chemotherapy: safe handling

Chemotherapy is now a commonplace treatment for cancer in pets. In many people’s mind the term ‘chemotherapy’ conjures up frightening images of people suffering with cancer (and the effects of treatment) – however chemotherapy in pets is usually very different.

Chemotherapy is a highly toxic drug given alone, or in combination with other drugs, to damage and destroy cancer cells. Chemotherapy drugs can kill all cells (healthy ones as well as cancer cells) and great care is necessary when using them. Many vets in practice will refer patients to specialist veterinary oncologists when chemotherapy is being considered.

All chemotherapy drugs are toxic and should not be taken unnecessarily. However, it is important to get the risks into proportion and not to be afraid of managing your pet at home. Whilst the drugs can cause many side effects these are usually seen with large doses or long term use.

If your pet is taking a tablet and you touch that tablet the amount on your hands is unlikely to cause you any side effects even if you put your fingers in your mouth. However, many of the cancer treating drugs can cause cells to mutate. It is essential that pregnant women do not come into contact with these drugs as damage can be done to the foetus. Drugs causing DNA mutations can also cause normal cells to become cancerous.

Some chemotherapy drugs are irritant and can cause reactions or allergies in the skin if touched.

Often you will be asked to give tablets to your pet at home. It is important the drugs are given at regular intervals according to set treatment plans (protocols). Before your pet starts on treatment your vet will need to be sure that you are able to give the drugs regularly and to follow instructions regarding their use.

If you are really concerned about giving treatment at home, share your concerns with your vet. It may be that there is an alternative treatment that your vet can administer for you. These will have to be given in the veterinary hospital and you will need to take your pet for regular treatment appointments.

Many of the drugs can be given with food. Your vet will advise you on the best time and method of giving the drugs. If you give the drug with food always handle them with gloves and put in a small amount of tasty food (that you can be sure your dog will want to eat) in a small dish.

Watch your cat to make sure they eat the food and all of the tablets and then make sure that they do not spit the tablet out again afterwards. The bowl can then be washed up separately before giving your cat the rest of his food.

If you are doubtful whether your pet can be relied on to eat the tablets with food it may be safer to put the tablets straight down the throat. If you do this it is even more important to wear gloves as the protective coating put on some tablets can be dissolved by saliva in your cat’s mouth. If you have not given tablets to your pet before ask your vet to show you how to do this safely and effectively.

Your vet will not allow your pet to go home with you if there are any risks to you from your cat. It is perfectly safe to continue to treat your pet as part of the family and hugging and petting are all permitted. The risks to you come from exposure to the drug itself. Remember also that the drugs are removed from the body in urine and faeces so there is a potential second risk of exposure.

There is some debate over how long pets can excrete chemotherapy drugs and metabolites in their urine and faeces. Therefore it is sensible to avoid direct contact with waste from your pet while they are receiving chemotherapy.

Once a treatment course has finished, you should maintain the same strict measures that you followed during treatment for a further three weeks. If your cat is having tablets or capsules there may be a risk of exposure to the drugs in these if your cat vomits after treatment. Ensure that you wear protective gloves to clear up any vomit and place all the cloths used for cleaning and gloves in a tied plastic bag with the vomit and place straight in an outside dustbin.

Chemotherapy for your cat

Although it can be frightening to learn that your pet has cancer there have been big advances in the treatment of cancer in animals. Chemotherapy is now a commonplace treatment for cancer in pets. If your cat is diagnosed with cancer it is possible that you will be offered some form of chemotherapy (perhaps alongside surgery or radiation therapy).

Chemotherapy is the use of drugs to damage and destroy cancer cells. Chemotherapy drugs can kill all cells (healthy ones as well as cancer cells) and great care is necessary when using them. There are many types of chemotherapy and depending on the drug they can be given by mouth, directly onto the lesion or given by injection into a body space or directly into the blood stream.

Different chemotherapy drugs are more effective against specific types of cancer and it is essential to get an accurate diagnosis of the type of cancer before the appropriate drug can be selected for treatment. Many vets in practice will refer patients to specialist veterinary oncologists when chemotherapy is being considered.

Chemotherapy is just a highly toxic drug given alone or in combination with other drugs. Your vet will try to find a treatment that is particularly toxic to a given type of cancer cell but less so to normal healthy body tissue.

Chemotherapy is given at a dose that will kill as many cancer cells as possible without doing too much damage to normal tissue. Doses are given at intervals (which may be days, weeks or months apart) and during the interval healthy tissue is able to recover and regenerate. Unfortunately in most cases the cancer cells also start to recover and over time the cancer cells often develop a resistance to the drug that is being used for treatment.

Often more than one type of chemotherapy is given at the same time – the aim of this is to attack the cancer cells from two or more sides whilst minimising the amount of damage to normal tissue by using lower doses of each drug.

Cancers can be treated using a variety of therapies (surgery, radiation or chemotherapy) and often a combination of treatments is given. If your vet has recommended chemotherapy it will be because it is the most effective treatment for your pet. You may need to travel to a specialist oncology centre for treatment and some forms of chemotherapy are expensive, therefore it is important that you discuss all your concerns with your vet before treatment starts.

It is very important that if you begin a course of treatment that you are able to see it through to the end. Treatments must be given regularly so before agreeing to start treatment make sure you are able to give regular medication or can take your pet to hospital for regular treatment sessions as necessary.

In some cases you may be given tablets to give your pet at home. Remember that these drugs are potentially toxic and must be handled according to the instructions given by your vet. Drugs should always be handled with gloves and must be given according to the schedule prescribed by your vet. Obviously it is particularly important that these drugs are kept out of the reach of children and pregnant women should not be exposed to them. Other drugs have to be given by your vet in the veterinary hospital and you will need to take your pet for regular treatment appointments.

Chemotherapy protocols are carefully designed to maximise the beneficial effect and minimise side effects of the drugs. The drugs are given regularly with an interval that allows healthy tissue to recover between doses. It is therefore important that doses are not given too close together or too much damage can be done to healthy tissues. If you accidently give too many tablets in one dose or give the doses too close together you must contact your vet or veterinary oncologist immediately.

Everyone has heard stories of how unwell some people are whilst receiving chemotherapy and no-one wants this for their pet. However, there is a difference between human and veterinary medicine. In human medicine doctors are aiming to prolong life for as long as possible – this means that treatment in people is often very aggressive (high doses of drugs are used to kill the maximum numbers of cancer cells). The high dose of drugs used makes the side effects much worse. In veterinary medicine vets are trying to prolong only high quality life. In general doses of treatment are calculated to minimise any ill effects experienced by your pet.

All chemotherapy drugs can cause side effects but these vary depending on the type of drug and the way it works. Hair loss, a well-recognised (and much feared) problem in people, is rare in animals receiving chemotherapy. However, clipped hair may take longer to regrow and the texture of the hair coat may change. Many cats receiving chemotherapy will be given steroids as well; these typically have side effects of increased drinking and urinating.

Commonly, chemotherapy can cause damage to the bone marrow which may make animals anaemic or suppress their immune response. For this reason pets receiving chemotherapy are usually closely monitored with regular blood tests to monitor levels of blood cells.

Digestive system upsets (nausea with or without vomiting and diarrhoea) are caused by damage to cells lining the intestine. Effects can range from extremely mild diarrhoea to severe vomiting and bloody diarrhoea. In most cases these complications are short lived and can be managed quite simply with the use of drugs to control sickness. However it is very important to report such complications to your vet so that they can provide you with additional treatment and it may be necessary to reduce the dose of the chemotherapy to prevent these complications occurring after the next dose.

If you are concerned in any way about your cat’s health you should contact your vet immediately.

Many of the chemotherapy drugs have cumulative toxic effects (that means that the effect of each dose builds up in the body). Many of the drugs are processed or removed from the body by the liver or kidneys. Your vet may need to check liver and kidney function with regular blood tests, particularly if your pet is receiving drugs which can cause damage to these organs. One commonly used chemotherapy drug can cause damage to the heart muscles and if your pet is receiving this you may be asked to take them for regular ultrasound scans of the heart.

Cancer in your cat – possible options

Cancer is the uncontrolled growth of abnormal cells. The speed with which a cancer spreads and the severity of the disease it causes depends on the type of tissue cell affected. As many as one in five cats are likely to develop one of the many different forms of cancer at some stage of their lives. The risk of developing cancer increases with age. This means that, as cats now enjoy a longer life expectancy through improved veterinary care, the number of animals with cancer has been increasing in recent years.

As with human cancers, the causes of cancer in cats are still not well understood. Possible causes include:

  • Toxic chemicals or exposure to harmful radiation.
  • Feline leukaemia virus (a very common cause in cats).
  • Abnormalities in the immune system that usually protects against infectious diseases.
  • Abnormal genes.

The signs of cancer are very variable and depend on the type of tissue cells involved, the site of the cancer and the stage of the disease. Animals with advanced cancer often show weight loss and loss of appetite. Your cat may be depressed, vomit, have diarrhoea or constipation, or fever. Your cat may also get tired easily because of anaemia. You might also find an unusual lump or swelling on your pet, if so, you should make an appointment for your vet to check it out. Although most lumps are harmless, some can be very dangerous if left untreated.

Cancer can occur in any animal at any age but certain types of cat are more susceptible to particular forms of cancer. Cats with white fur and skin that like to sunbathe are vulnerable to skin cancers especially on the ears, nose, lips and any other areas where the skin is exposed to direct sunlight. The risk of cancer developing may be reduced by applying sunscreen to areas of exposed white skin/hair on sunny days.

Feline leukaemia virus is the most common cause of cancer in the cat, although not all cats exposed to the virus will develop the disease. Most cats are able to resist the virus but those that cannot, will develop permanent infection and 3 out of 10 of these will get some form of cancer.

Yes, most forms of cancer can be treated, but this depends on the type of cancer involved and whether the disease has spread. The outcome of treatment can be very variable. In some cases treatment can produce a complete cure, or at least significantly increase the length or improve the quality of your cat’s life. Sometimes euthanasia is the only humane alternative to a slow and painful death.

There are three basic options for treating cancers; not all are appropriate for every case and sometimes a combination of treatments has the best chance of success. The treatment options are:

Surgical removal

Usually the best choice for most cancers of solid tissue. If the cancer is relatively benign, or if a more malignant cancer has not yet spread to other parts of the body, surgical removal often produces very good results.

Chemotherapy (drug treatment)

Chemotherapy is the best option for cancers affecting the blood or multiple areas of the body. Drug treatment may also prevent or delay the appearance of secondary tumours in other organs after surgical removal of the original lump. Chemotherapy is used to improve quality of life in pets and the side-effects of chemotherapy seen in people are usually not seen in cats.

Radiotherapy (x-rays)

Radiotherapy is often effective when tests have clearly shown the extent and size of the tumour. The radiation is usually delivered by a special machine in a radiotherapy unit. A beam of radiation is most effective on cancers of the extremities (such as the limbs and head) where it is less likely to damage normal tissue before reaching the tumour.

Radiotherapy units are only located in a few specialised centres and your vet would need to refer you to a cancer specialist for this form of treatment. In some cases it may be possible to treat the cancer by injecting radioactive material into the body.

Discomfort can be severe when the cancer is advanced, but most cancer-related pain can be controlled. Your vet will probably try a gentle painkiller at first and move on to more powerful drugs if these are required. Your vet will try to improve your cat’s quality of life rather than prolonging the life of your cat if it is suffering.

Careful attention to your cat’s diet may improve its quality of life. Cats need extra food to cope with the effects of a fast growing tumour but many cancer patients have a poor appetite and so lose weight. Warming the food or feeding by hand may help stimulate your cat to eat. There are also special diets designed for animals with cancer which provide good nutrition even if your cat’s appetite is poor.

This is the question that every owner wants answered but as with human cancer it is impossible for your vet to give you an answer with any confidence. The survival chances will depend not only on the type and stage of the disease but also on your cat’s general state of health. You should discuss this issue with your own vet so that you can agree between you an appropriate treatment plan for your cat.

It is understandable that, faced with a diagnosis of cancer, you will feel frightened about the future for your pet – discussing your fears with your vet is the very best way to obtain reassurance and an independent assessment that you are doing what is right for your pet.

Feline Infectious Anaemia (FIA)

Feline infectious anaemia, also known as FIA, is an anaemia in cats that is caused by a parasite that lives in the blood. If your cat is unwell and pale, it may be that it is anaemic, but there are many different causes of anaemia in cats and FIA is just one of these. Early recognition and treatment of FIA is important to maximise the chances of full recovery.

There are a number of infections (e.g. Babesia felis in South Africa) that can result in anaemia in the cat, but FIA typically refers to anaemia caused by parasites called ‘haemoplasmas’.

Haemoplasmas are bacteria that live on the surface of red blood cells. Several different haemoplasma species infect cats. Mycoplasma haemofelis (also called the large strain) is the most important haemoplasma as it causes the most severe anaemia in cats. Other haemoplasma species tend to cause less disease in cats: ‘Candidatus Mycoplasma haemominutum’ (also called the small strain) and ‘Candidatus Mycoplasma turicensis’.

When the red blood cell is infected with the haemoplasma parasite it does not survive long in the circulation. The parasite can cause damage to the membrane surrounding the red cell, causing the cell to rupture. Affected blood cells may also be destroyed by the body and, as numbers of circulating red blood cells drop, anaemia develops.

The natural method of haemoplasma transmission has not yet been proven. Fleas are thought to be able to spread infection, so flea bites may transmit infection to your cat. Infected blood transfusions have also been found to spread infection.

It may be that aggressive cat bites transmit infection since haemoplasmas are found in the saliva, but transmission this way isn’t always thought to be very effective. It is known that male cats are more likely to be affected than females which may be the result of their lifestyle and increased risk of fighting. Very young kittens can be infected from contact with their infected mother.

Cats may be more at risk of getting anaemia due to haemoplasma infection if their immune response is reduced. This can occur in cats that are ill with other diseases or cancer. Some drugs (e.g. treatments for cancer) and infections like FeLV and FIV also suppress the immune response and can put cats more at risk from infectious anaemia.

Cats are very good at hiding signs of illness, especially anaemia, so it is possible that you won’t recognise signs of anaemia in your cat until the anaemia is very severe.

Cats with anaemia are generally depressed, lethargic and their appetite may be reduced. The membranes inside their mouth and eyes may appear paler than normal, or sometimes these membranes and the eyes take on a yellowish tinge due to jaundice (as a result of excessive red cell breakdown).

Severely affected cats may have breathing problems and become breathless even after minimal exercise. Cats with infectious anaemia often have a high temperature too, and they often become quite markedly dehydrated as they stop eating and drinking.

Your vet will examine your cat and may be suspicious that it is anaemic from the examination. It will be necessary to take blood samples to confirm the anaemia. If anaemia is found then further tests, such as X-rays and ultrasound, may be required to look for possible causes of anaemia.

Further samples of blood may need to be sent away to get final confirmation of the presence of haemoplasma parasites in the blood. Because of the association between infectious anaemia and other disease such as cancer and FeLV/FIV your vet will probably also want to do other tests to find out if any of these conditions is present in your cat.

The parasites can be killed with antibiotics. Cats usually show quite a rapid response to treatment in terms of improvement in clinical signs, but a longer course (up to 8 weeks) of antibiotics may be required to try and maximise the chances of your cat getting rid of the infection completely.

Additionally, if your cat is very severely affected with profound anaemia, they may need to be hospitalised for emergency treatment such as a blood transfusion, intravenous fluids and/or nutritional support.

Unfortunately infection persists in some cats despite long courses of antibiotics, but they usually don’t show any signs of disease; these cats are called carrier cats. Longer antibiotic treatment courses try to eliminate this carrier status, but it is not always possible.

Following treatment your cat may appear to be quite well again but there is always the potential for a stressful trigger to result in the disease returning in carrier cats, although this is probably not that common.

It is important to control fleas in all cats as fleas are thought to be involved in transmission. Generally the outlook for your cat is good if they do not have any underlying diseases.

Urine samples: how to collect

Tests are used by vets to help them diagnose disease in animals that are ill, which means your vet may ask you to bring in a urine sample (water sample) from your pet to help find out what’s wrong with your cat. Urine samples are usually taken to check for diseases such as diabetes or cystitis. Urine samples are also often used as part of a routine health check to detect hidden disease before the development of obvious symptoms; this allows your pet to be treated earlier and more effectively.

The best sample is a mid-stream sample (a urine sample) collected by placing a suitable container (a small bowl or dish) under the stream of urine whilst your pet wees. However this is almost always extremely difficult to do in cats. You may be able to catch your cat out by using a long handled collecting pot. Attach a pot, for example a clean yoghurt carton, to a stick or broom handle using sticky tape. Once your cat starts to wee, move the carton under the stream of urine to collect the sample.

It is important not to use jars that have previously contained jam or honey as these can affect the test results.

In most cases your vet will only need a few teaspoons of urine to perform all the tests. If a larger sample is needed your vet will tell you.

Often the only way to collect a sample from a cat is to allow it to wee in peace in a tray and then collect the sample from the tray. Place some non-absorbent cat litter (glass beads or fish tank gravel) in the clean and dry litter tray and confine your cat in a room with the tray. Once your cat has used the tray suck up some urine from the tray with a pipette or a syringe and squirt it into a pot for storage. When you take the sample to the vet always tell them how you collected the sample as this may affect the tests your vet can do.

Some cats are extremely unwilling to wee anywhere except outside. If you really cannot get a urine sample your vet will probably suggest that they take your pet into the hospital and collect the sample for you. Samples can be collected directly from the bladder using a catheter passed up the urethra or via a needle placed into the bladder through the stomach wall. Both these procedures are simple and carry few risks for your pet.

Pour the sample into a clean, screw-topped container; write your cat’s name, your name and address and the date the sample was taken on the jar. If you can’t take the sample to the vets immediately, it is best to store it in the fridge for a maximum of 12 hours.

Kidney disease in your cat

Kidney failure is a common health problem in middle-aged and elderly cats. A gradual reduction in the ability of the kidneys to do their job is an inevitable part of the ageing process and occurs at varying rates in different animals. The damage is irreversible and will eventually be fatal. Your cat may still have many months of good quality life after diagnosis of kidney disease if it receives effective treatment and if you co-operate with your vet.

Damage to the cells which filter natural poisons (the normal waste produced by the body’s internal processes) out of the blood for removal in the cat’s urine is a normal ageing process. In time, so much kidney tissue is affected that these waste products can no longer be eliminated and build up inside the blood stream. This condition – which vets call chronic renal failure – is very common in cats over seven years old.

Inherited defects (particularly in long-haired breeds), bacterial infections, viral diseases like Feline Leukaemia or Feline Infectious Peritonitis, poisoning and the growth of cancers can make the damage worse.

Sudden or acute kidney failure can also occur as a result of poisoning, bacterial and viral infections, blockage of the tubes leading from the kidneys to the bladder or heart disease. These cases need emergency care and, even if successfully treated by your vet, your cat may still suffer long term kidney damage.

The kidneys have a lot of spare capacity for filtering blood, so symptoms only appear when about three-quarters of the kidney cells have stopped working.

One of the first indications of disease is the loss of ability to produce concentrated (dark) urine. So to get rid of the same quantity of waste material your cat has to produce larger quantities of more diluted urine. Your cat will be thirstier than usual and have to pass urine more often.

As the disease gets worse other symptoms may appear. Your cat may seem depressed and lose interest in food, vomit regularly, lose weight and its coat becomes dull. You may also notice bad breath and ulcers in its mouth. In the very final stages of the disease your cat may go into a coma.

Many of these symptoms also occur in other diseases such as diabetes. Your vet will want to test samples of blood or urine or perform X-rays or ultrasound examination of your cat to show that the kidneys are not working properly.

Although damaged kidneys cannot be repaired there is much that can be done to make your cat feel better. Many cats that are producing abnormally large amounts of urine become severely dehydrated. Your vet will want to give extra fluids to counter this and give medication to treat the secondary effects of the disease, such as mouth and stomach ulcers.

Damaged kidneys may be unable to get rid of waste products from the body and this may cause kidney or bladder stones. Anaemia is a common problem in cats with advanced disease and in some cats this may be treated.

The most important thing in helping your cat is to reduce the work load on the remaining healthy kidney tissue. This can be done by altering your cat’s diet. There are special diets available from your vet which reduce the waste products in the blood. They also have extra amounts of some vitamins and minerals.

Avoid giving your cat leftovers or treats which may interfere with the new diet. Affected cats often feel sick and lose interest in their food. It may help if you warm up the food to stimulate your cat’s sense of smell or hand feed it while it is getting used to the new food. Feed it ‘little and often’ and throw away uneaten food.

Always make sure your cat has plenty of fresh, clean water at all times, allowing your cat to go thirsty will make the problem rapidly worse.

If the damage to the kidneys is related to ageing, your cat may live for several years after diagnosis. As with other diseases, if you can keep your cat comfortable there is a good chance that it will survive for many months.

Your cat will need regular check ups by your vet and possibly changes to its medication. By weighing your cat often, watching its behaviour and checking how much food and water it consumes, you will be able to provide your vet with valuable information which helps to control the disease.

Feline lower urinary tract disease (FLUTD)

FLUTD is a catch-all term used by vets to describe a number of conditions which cause cats pain and discomfort when trying to pass urine. These include different types of bladder stones, blockages in the tubes running from the bladder to the outside and inflammation of the bladder itself (cystitis). About three in every 100 cats will be affected at some stage in their lives and some can suffer recurrent problems. In extreme cases your cat may be unable to empty its bladder and may die without emergency treatment.

Domestic cats are descended from cats which hunted in the arid regions of North Africa and the Middle East and so are adapted for acquiring most of their water from their diet without the need to drink. Commercially prepared diets often contain less water than natural ones but many cats do not drink enough water to make up for this.

In up to half of cats with FLUTD it is very difficult to be sure of the cause of the disease. However, a number of factors appear to increase the risk, such as:

  • Stressful experiences such as moving house may trigger problems in susceptible cats.
  • Diet – mineral balance, urine pH and water intake may all affect the risk of the disease.
  • Infection may produce swelling and the formation of pus which can block the cat’s urine tubes (ureter and urethra). Diabetes and some viral diseases may make cats more vulnerable to infection.
  • Obesity – problems are more common in overweight and inactive cats which are often too lazy to go outside to toilet frequently.
  • Urine retention – cats who, for some reason, hold their urine for long periods, i.e. do not go to the toilet frequently may be at greater risk of developing bladder stones.
  • Anatomical abnormalities or tumours may make it difficult for some cats to pass urine.

Neutered male cats are the most likely to develop blockages in the urethra, the tube which runs from the bladder to the penis. But the condition can also occur in un-neutered males and females.

The urethra is longer and narrower in males than females, which seems to increase the risk of it becoming blocked by inflammation or stones in the urine. The disease is more common in young cats and the risks decrease with age. Affected cats are often between two and six years old.

If your cat is suffering from FLUTD it will make regular visits to its litter tray or outside to its favourite toilet area but without much success. There may be small amounts of dark or red (blood-stained) urine. Your cat may look as if it is straining and may cry out in pain or lick around its bottom or penis area.

The discomfort may cause changes in its toilet habits and a normally reliable cat may try to go to the toilet in the wrong place. If there is a total blockage of its tubes, pressure can build up in the bladder causing it to burst. Alternatively there may be kidney failure and poisons normally filtered out by the kidneys will build up in the blood.

Often the discomfort of FLUTD is mistaken for constipation. If you are in any doubt, assume FLUTD and consult your vet as soon as possible.

Your vet may need to take a urine sample to show the difference. An affected cat will have abnormalities such as crystals in the urine (mineral salts which cause bladder stones) or unusually concentrated urine. Blood samples will also show evidence of kidney damage if this has already occurred. An x-ray may help your vet to find the source of the blockage.

A complete blockage is an emergency and your vet will have to act fast. At first your cat may only seem mildly depressed with occasional vomiting but within 48 hours it could have lapsed into a coma and died.

Your cat will be sedated (or anaesthetised) and a tube (‘catheter’) inserted into its bladder to drain the trapped urine and relieve the pressure. Occasionally stones may be surgically removed. Less serious cases will be given pain killers and drugs to reduce the inflammation. Antibiotics may help get rid of any infection. Remember, only use the medicines recommended by your vet – some human drugs are poisonous to cats.

Encouraging your cat to drink plenty of water and adjusting its diet are the best ways of treating and preventing FLUTD.

You must make sure there is always clean, fresh water available. Ideally you should feed your cat moist food only and make your cat drink extra water by mixing one third of a cup of water with every meal for the rest of its life. The water should be mixed thoroughly with the food and allowed to stand for 10 minutes before feeding so that it takes up the flavour of the food.

There are special diets available from your vet which can reduce the risks of stones developing. Some cats may need daily medication to help keep their urine acid.

Cats are very choosy about their toilet habits and a dirty litter tray may make them hold on to their urine and this may be a factor in the formation of stones. If there are several cats in your household the affected cat should be encouraged to use its own litter tray. This will allow you to check how much urine it produces and spot signs of further problems as soon as they develop.

Drinking: increased water intake in cats

Drinking more is a common medical problem in cats, particularly older cats. This factsheet discusses how to tell if your cat is really drinking excessively, the causes – common and rare – and how the issue may be managed. The medical term for an increased thirst is polydipsia and for an increase in the volume of urine being produced it is polyuria. Vets often refer to the joint syndrome as PU/PD.

A healthy cat may take in between 20 and 90ml of water per kg of body weight per 24 hours. This figure includes the water in food, which obviously varies according to how much dry and how much canned/pouched food the cat has.

So it is not until your cat is drinking around 100ml of water per kg body weight (for an average cat this is around 300-400ml) per day that you can be sure this is excessive. However, most cats do not drink this much and for many a lesser intake may be significantly abnormal so if you notice any increase in the amount of water being drunk by your cat this may be the first indication of a problem and should not be ignored. Cats on dry diets will need to drink more than cats on moist food so if you have recently changed your cat’s diet this may be the reason for a change in drinking habits.

If you are worried about how much your cat is drinking you might want to try to measure their actual intake. The easiest way to do this is fill their bowl with a known volume of water using a jug and then at the end of the day measuring how much water is left. Of course, for many cats this is difficult as they drink outside, from sources other than their bowl and often share a water bowl with other animals. To measure the water intake in these cats you might have to isolate your cat and keep her indoors for three days.

If your cat is drinking more you may notice increased urination. Here we are most interested in an increase of the total volume of urine being produced. Again, this may not be noticed in cats that are outside for much of the day but, for other cats, owners may notice that the litter needs changing more often or that litter training is lost.

If your cat is visiting the litter tray more often this may not be due to an increase in urine volume. Often it will be due to increased urgency in urination caused by diseases of the bladder such as cystitis. These cats will usually pass only small volumes of urine, they may vocalise as they are irritated or in pain and there may be blood staining.

When cats are drinking more it is nearly always caused by a disease (either based in the kidneys or elsewhere in the body but affecting the kidneys secondarily) that is causing the kidneys to make dilute urine and the cat then has to drink to stop being thirsty. So it is actually usually the increased urine production that happens first and the increased drinking is to compensate.

In the vast majority of cats that are drinking excessively it is because they are genuinely thirsty as their kidneys are making more urine, their bodies are detecting the loss of fluid and stimulate the desire to drink. There are two main reasons for this: either there is a problem with a hormone that regulates the concentration of urine – this is best known as ADH (anti-diuretic hormone). It may be that there is not enough ADH being produced or it may be that the kidneys fail to react to the ADH. The second cause is that the urine contains large amounts of an abnormal substance that draws water out with it into the urine by a physical process called osmosis; an example is glucose (sugar) in the urine of a diabetic cat.

The commonest diseases that often show up as a cat drinking excessively are chronic kidney failure, diabetes mellitus and hyperthyroidism – but all these conditions may show in other ways, for example weight loss or changes in appetite and behaviour.

There are many other conditions that also have an increase in thirst and urination as part of their clinical signs:

  • high blood calcium levels (hypercalcaemia)
  • low blood potassium (hypokalaemia)
  • bacterial infection in the kidneys (pyelonephritis)
  • liver failure
  • acromegaly and hyperadrenocorticism (each of which show with signs of diabetes mellitus),
  • acute renal failure (especially in the recovery phase)
  • diabetes insipidus
  • renal glucosuria
  • pyometra (infection in the uterus)
  • hypoadrenocorticism and damage to the pituitary gland

Other possibilities that should be obvious but must be considered are certain drugs such as the diuretics often used to treat heart failure and some foods that are designed to promote water intake by being high in salt.

There are also important underlying diseases that must be considered. For example hypercalcaemia is often caused by cancers such as lymphoma and hypokalaemia might be caused by hyperaldosteronism (Conn’s syndrome).

Occasionally excessive thirst is the basic cause, and this is called primary polydipsia. It can be due to brain disease or a behavioural abnormality. In cats the commonest cause of primary polydipsia is probably as part of the common endocrine condition hyperthyroidism.

A veterinary surgeon will want to ask questions about your cat and examine her. Most of the causes of PU/PD will give other clues that they are present. If there is uncertainty about the extent of the problem then actually measuring the volume of water drunk (daily for about three days) and weighing your cat will allow your vet to assess if water consumption is excessive.

Most cats will require a combination of blood and urine tests as an initial investigation and the common causes of PU/PD are usually easily diagnosed or ruled out. Some cats will require a more in-depth investigation to uncover their problem, involving further blood tests, imaging with ultrasound or x-rays and the taking of biopsies.

One important point is that now many cats are living into old age it is quite common for them to have to cope with more than one condition and combinations such as chronic renal failure and hyperthyroidism need to be considered.

Finding out the cause of the excessive drinking is the priority so if you think your cat may be drinking more than usual an early visit to your vet is advisable. There will then be options for treatment. Not all options suit every cat and each owner but the conditions listed above can all be helped, to varying degrees. One thing that is common to all is that in no circumstances should water be withheld.