Sunday, March 29, 2015

1157. STORY. The meowing cat. Kidney disease FLUTD cat passes blood in the urine - follow up

A challenging medical case. On March 17, 2015, the cat came to me for a 2nd opinion. He had bladder obstruction and had been treated by the other vet for around 4 days before discharge. But the cat was not eating and had blood in the urine. I got X-rays done after palpating much enlarged painful kidneys of 3-6X normal and seeing the inflamed red prepuce of this 1-year-old male, not neutered cat much loved by the family for his vocalisation.




He would meow to greet people unlike the dumb sterilised cats in the apartment.  He meowed as if saying "good morning" when he recovered after 2 days of in-patient. So I could understand how much he was loved. He looked good and I sent him home.

However, the owner could not feed him or syringe him. He came back with ulcers in his tongue, right lip commissure and right upper gum. I suspected he was forced fed and suffered traumatic ulcerations. So he would rather die than be forced fed by the owner. Severe dehydration and recumbent. Low body temperature or hypothermia. Poor pulse volume.

I thought he would die soon on this date of admission - Mar 24, 2015. I gave him 250 ml of SC fluids with all the multivitamins and amino acids and antibiotics per day for 2 days and did not expect him to revive.

But he bounced back to life after 2 days of in-patient treatment when he meowed again on the 3rd day. The owner did not want him home and wanted another 2 days for him in Toa Payoh Vets. He recuperated and meowed whenever he saw the staff. Such a lovely behaviour. Much as if he appreciated being visited. So he went home on Mar 26, 2015.




No bad news till Mar 29, 2015 when the owner said he had passed blood in the urine.  


Mar 30, 2015

"My cat is eating and drinking a lot, but he passes blood in the urine!"   the owner phoned today.

Advised:
1. Stop medication
2. Urine test
3. Switch to dry Renal within 3 days.

The cat has not fully recovered from kidney disease. He went home 2 days ago, meowing and eating a bit of his canned food. Alert. But the owner phoned to say he is passing blood in the urine. A urine test was done on
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Mar 30, 2015
pH 6.5, SG 1.025, Protein 2+, Blood 4+, White blood cells >2250, Red blood cells >2250. Bacteria Nil. Casts and crystals Nil.


Compare to the previous 2 urine tests.

Mar 24, 2015
pH 6.5, SG 1.019, Protein 3+, Blood 4+, White blood cells >2250, Red blood cells >2250. Bacteria 2+. Casts and crystals Nil.

Mar 17, 2015 (first consult at Toa Payoh Vets)
pH 6.5, SG 1.025, Protein 3+, Blood 4+, White blood cells 1791, Red blood cells >2250. Bacteria 2+, Casts and crystals Nil. Spermatozoa +, Ketones Trace.

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Mar 17, 2015 URINE CULTURE
Amoxycillin+Clavulanic Acid, Cefuroxime, Nitrofurantoin, Ampicillin+Sulbactam, Ampicilin --- Resistant

Cipofloxacin, Gentamicin, Cotrimoxazole, Fosfomycin  --- Susceptible. 
The first vet had prescribed amoxycillin + clavulanic which is commonly given to cats in Singapore.

CONCLUSION
The cat is eating and drinking, but the kidneys have not recovered fully. There is no bacteria in the urine in the 3rd test on Mar 30, 2015.  He was not "passing blood in the urine" from March 19 to Mar 29 after a change of antibiotics and 2 days of inpatient treatment.

But on Mar 29, the owner phoned me to say he was passing blood in the urine. Will the cat get kidney failure again?

This FLUTD plus kidney infection is a complex case to resolve.


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