"Have you heard of FLUTD?" I asked the young couple who showed me a large pool of blood-tinged urine on the wooden floor of the room in which the 7-year-old female spayed gentle cat was locked in. The cat peed on the floor as she did not have access to the litter box.  There were two other cats in the house.

"No," the wife said. "We were informed that our cat had a urinary tract infection."

Their vet was fully booked on the 4th of August and so they consulted me. Their vet had diagnosed polycystic kidneys based on ultrasound and had been consulted 7 times for haematuria in the past 2 years. The couple had the medical records from the vet and showed them to me. A blood test showed high creatinine levels. A urine test showed struvites. The owners had been advised to go on feline C/D but did not comply.

So what is the solution to resolve the problem of the cat passing blood in the urine needing 7 consultations and no cure?

BLOOD TEST on August 5, 2013.  WhatsApp to the owner the blood and urine test report.

Glucose 7.6  (3.9 - 6.0).  I asked the owner to monitor the 24-hour water intake. Follow up on Aug 12, 2013  - no measurement but the wife said no particular increase in drinking as the amount was perceived to be similar to the other 2 cats

The creatinine level was 105 (71-160) and so the kidneys were OK.

The serum urea was 11.2 (7.2 -10.8) which was slightly high but acceptable. I would say the kidneys are normal.

URINE TEST on August 5, 2013
Red turbid urine.  pH 7, SG 1.015, Protein 3+, Blood 4+, WBC 135, RBC >2250, Bacteria 3+, Crystals Nil. (No crystals do not mean no urinary stones).

HISTOLOGY on August 5, 2013 of gingival lump
I opened the cat's mouth to check for ulcers. No ulcers. However the lower jaw right side had a fleshy mass of 0.7 cm x 0.4 cm x 0.3 cm. Was this squamous cell carcinoma?  It would be painful for the cat to eat, leading to stress. So was this the cause of the FLUTD?  FLUTD (Feline Lower Urinary Tract Disease) is due to multiple causes and so could this growth and pain be a stressful cause? The other cat likes to pounce on this gentle cat and there could be kidney trauma causing blood in the urine. However this gentle cat would miss the rough cat which I advised to be separated. So the trauma would continue.

The owner agreed to the surgical excision. The lab report was a non-malignant squamous mucosa with surface ulceration. The lump was an inflamed granulation tissue. So, it was good news. The lump was electro-excised by Dr Daniel and the hole stitched.

I had examined the vulval area during the first consultation. A reddish blood clot was present there.

"Has the cat been making lots of noises like caterwauling on heat although she is spayed?" I asked.

"No," said the wife.

"Yes, sometimes," said the husband.

"There could be remnants of ovarian tissue if the cat had been spayed with some little ovarian tissue left. Therefore the cat caterwauls."  This issue is a mystery as the couple did not give one answer.

UPDATE ON AUG 12, 2013
The wife said the cat was normal when I phoned. No more blood in the urine. She is mixing the prescription C/D I prescribed with the cat food to get her to eat.  It is too early to celebrate. It is extremely difficult to educate the ordinary Singaporean pet owner to comply with prescription diets and do regular urine and blood tests. New diets should be fed at 5% initially, gradually increasing to 100% after 2 weeks. Otherwise the cat will not accept the food.  Follow ups are necessary but all vets do not have the time to persevere in following up many times.  

This appears to be a FLUTD case. No crystals in the urine test do not mean no stones. X-rays of the bladder were not done this time.  So far, so good. It is always the same for this cat. After treatment and antibiotics, no haematuria. Then it comes. We have to wait and see whether the C/D diet would resolve the problem permanently. 

I had an older dog with similar problem of haematuria recurring after antibiotics were completed and the vet was consulted many times. This case was recorded as it was interesting. It was diagnosed as possible bladder tumour and struvites. I got an ultrasound of the bladder which showed no tumours.

After some weeks of the prescription S/D diet, the lady owner was satisfied. I have not heard from her for the past year and presumed all are well.

6322. Blood in urine seen on apartment floor. Handphone image	6323. Gingival mass seen in lower jaw. Electro-excision	6324. Blood & urine tests. No urinary crystals	6325. Gingival mass for histology. Non-malignant

Updates will be on this webpage:
www.sinpets.com/F6/20130813haematuria_8th_time_cat.htm

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