Evaluation of two diets in the nutritional management of cats with naturally occurring chronic diarrhea

Feeding either a highly digestible, moderate-carbohydrate diet or a highly digestible, high-protein, low-carbohydrate diet resulted in significant (P < .05) improvements in fecal scores in 71% of cats with chronic, nonspecific diarrhea. Approximately 58% of the cats improved on either diet, with no significant differences between the two diets regarding the percentage of cats responding or the degree of response. These results suggest that dietary management may be helpful in cats with chronic diarrhea. If cats do not respond within 1 month, an alternative diet should be considered.     

Survival of cats with naturally occurring chronic renal failure: effect of dietary management

Fifty cats with naturally occurring stable chronic renal failure (CRF) were entered into a prospective study on the effect of feeding a veterinary diet restricted in phosphorus and protein with or without an intestinal phosphate binding agent on their survival from initial diagnosis. Twenty-nine cats accepted the veterinary diet, whereas compliance (due to limited intake by the cats or owner resistance to diet change) was not achieved in the remaining 21. At diagnosis, both groups of cats were matched in terms of age, bodyweight, plasma creatinine, phosphate, potassium and parathyroid hormone (PTH) concentrations, packed cell volume and urine specific gravity. Feeding the veterinary diet was associated with a reduction in plasma phosphate and urea concentrations and prevented the increase in plasma PTH concentrations seen in cats not receiving the diet. Cats fed the veterinary diet survived for longer when compared with those that were not (median survival times of 633 versus 264 days). These data suggest that feeding a diet specifically formulated to meet the needs of cats with CRF, together with phosphate binding drugs if required, controls hyperphosphataemia and secondary renal hyperparathyroidism, and is associated with an increased survival time.     

Assessment of acid-base status of cats with naturally occurring chronic renal failure

Metabolic acidosis is reported to be a common complication of feline chronic renal failure (CRF) but acid-base status of feline patients with this disease is rarely assessed by general practitioners. A cross-sectional study involving 59 cases of naturally occurring feline CRF was conducted to determine the prevalence of acid-base disturbances. Cases were categorised on the basis of their plasma creatinine concentrations as mild, moderate or severe. A group of 27 clinically healthy, age-matched cats was assessed for comparison. A low venous blood pH (<7.270) was found in 10 of the 19 severe cases (52.6 per cent), three of the 20 moderate cases (15 per cent) and none of the 20 mild cases. Acidaemia was associated with an increased anion gap contributed to by both low plasma bicarbonate and low chloride ion concentrations. Biochemical analysis of urine samples showed urine pH to decrease with increasing severity of renal failure. Urinary loss of bicarbonate was not associated with the occurrence of acidaemia and there was a tendency for urinary ammonium ion excretion to decrease as the severity of renal failure increased. Cats with naturally occurring CRF do not show plasma biochemical evidence of acid-base disturbances until the disease is advanced.     

Blood oxygen binding in calves with naturally occurring diarrhea

OBJECTIVE: To assess blood oxygen binding in calves with diarrhea. ANIMALS: 22 dairy and 26 double-muscled calves with diarrhea, 31 healthy dairy calves and 37 healthy double-muscled calves. PROCEDURE: Severity of disease, including the ability of affected calves to stand, was evaluated. Hydration and signs of depression were scored. Venous and arterial blood samples were collected, and 2,3-diphosphoglycerate, ATP, chloride, inorganic phosphate, lactate, pyruvate, total protein, albumin, and hemoglobin concentrations, and Hct, pH, Pco2, and PO2 were determined. Oxygen equilibrium curves (OEC) were constructed under standard conditions, and oxygen extraction ratios were calculated. RESULTS: Recumbent calves of both breed-types were more dehydrated and had more severe signs of depression than ambulatory affected calves. In both breed-types, hemoglobin oxygen affinity was increased in calves with diarrhea, compared with healthy calves, as indicated by a decrease in standard partial oxygen pressure (P50). Diarrhea induced hypocapnia and hypothermia in the most severely affected calves, which counteracted the acidosis-induced right shift in arterial and venous OEC. Arterial and venous P50 were significantly less in double-muscled calves with diarrhea than healthy calves, whereas P50 for affected dairy calves were similar to those of healthy calves. Except in the most severely affected dairy calves, oxygen extraction ratio was significantly less in calves with diarrhea, compared with healthy calves. CONCLUSIONS AND CLINICAL RELEVANCE: Release of oxygen from blood may be impaired in calves with diarrhea, depending on the effect of the disease on certain blood biochemical variables.     

Survival in cats with naturally occurring chronic kidney disease (2000-2002)

Background: Duration of survival of cats with naturally occurring chronic kidney disease (CKD) is poorly characterized.
Hypothesis: Stage of kidney disease based on serum creatinine concentration (SCr) at the time of diagnosis and after correction of prerenal azotemia is strongly associated with duration of survival in cats.
Animals: Two hundred and eleven client-owned cats with naturally occurring CKD evaluated between April 2000 and January 2002.
Methods: Retrospective case review of 733 cats with SCr > 2.3 mg/dL. Examination of the medical records identified 211 cats that met all other inclusion and exclusion criteria for this study. Clinical characteristics, clinicopathologic data, and survival times were extracted from the medical record. Owners and referring veterinarians were contacted by phone to obtain follow-up if it was not documented in the record. Kaplan-Meier survival curves were performed to determine survival times for International Renal Interest Society (IRIS) stage both at diagnosis and at baseline (ie, after correction of prerenal azotemia).
Results: Median survival for cats in IRIS stage IIb at the time of diagnosis was 1,151 days (range 2–3,107), and was longer than survival in stage III (median 778, range 22–2,100) or stage IV (median 103, range 1–1,920) ( P -value < .0001). P -value for effect of stage at diagnosis was <.0001.
Conclusions and Clinical Importance: IRIS stage of CKD based on serum creatinine at the time of diagnosis is strongly predictive of survival in cats with naturally occurring CKD.     

Effect of diets differing in fat content on chronic diarrhea in cats

Background: Fat‐restricted diets have been advocated for dogs with diarrhea for many years. Recommendations for cats with diarrhea have varied between low‐fat and high‐fat diets, but there have been no published studies to support either recommendation. Objectives: The objective of this study was to compare the clinical responses of cats with chronic diarrhea to dietary management using either a high fat or a low fat, highly digestible diet. Animals: Sixty pet cats with chronic diarrhea were recruited; 55 cats completed the study. Methods: Randomized, double‐blinded, controlled clinical trial. Upon completion of baseline measures, cats were fed 1 of 2 diets for 6 weeks, during which the owners recorded fecal scores daily using an illustrated fecal score chart ranging from 0 (very watery) to 100 (firm and dry). After 6 weeks, cats were reevaluated by the attending veterinarians. Results: Fecal scores improved significantly, with 78.2% of cats improving by at least 25 points on the 100‐point scale or having a final fecal score of at least 66. Over one third of the cats developed normal stools. There were no differences in clinical responses between the diets. Clinical improvement was noted within the 1st week, and maximized within 3 weeks. Conclusions and Clinical Importance: These results show that dietary management can be helpful in cats with chronic diarrhea, but dietary fat content does not appear to affect the outcome. Cats that do not respond within 3 weeks should be evaluated further.     

Haemostatic abnormalities in cats with naturally occurring liver diseases

Alterations in the haemostatic system were characterized in cats with different naturally occurring liver diseases. The study looked at 44 healthy cats and 45 cats with different liver diseases confirmed histologically or cytologically (neoplasia, n=9; inflammation, n=12; hepatic lipidosis, n=13; other degenerative liver diseases, n=11). The following parameters were evaluated: platelet count; prothrombin time; activated partial thromboplastin time; thrombin time; factor (F) II, FV, FVII, FX, and FXIII activities; fibrinogen concentration; activities of antithrombin, protein C, plasminogen, and α(2)-plasmin inhibitor, and D-dimer concentration. In cats with liver diseases, 44/45 (98%) had one or more abnormalities of the coagulation parameters measured. In cats with inflammatory liver diseases, increased D-dimer concentrations and decreased FXIII activity were the most consistent abnormalities and were found in 83% and 75% of cats, respectively. The most common abnormality in cats with neoplastic liver disease was FXIII deficiency (78%). The most consistent abnormalities in cats with hepatic lipidosis were increased FV activity and D-dimer concentration with 54% of cats having values above the reference range for both parameters. Cats with miscellaneous degenerative liver disease most frequently showed FXIII deficiency (64%). The results of this study show that alterations of single haemostatic components are a frequent finding in cats with liver disease. Activation of haemostasis with subsequent consumptive coagulopathy (rather than decreased synthesis) seems to be responsible for these alterations. Increased blood levels of different haemostatic components in cats with inflammatory lesions may be related to an acute phase reaction.     

Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria

BACKGROUND: Tubulointerstitial kidney disease is a common cause of illness and death in pet cats and is typically not associated with overt proteinuria. HYPOTHESIS: Proteinuria would be independently related to survival in cats with renal failure, with or without hypertension. ANIMALS: The study included 136 client-owned cats; 28 apparently normal, 14 hypertensive but not azotemic, 66 azotemic but not hypertensive, and 28 both hypertensive and azotemic. METHODS: Cox's proportional hazards model was used to determine the influence of initial plasma creatinine concentration, proteinuria (urine protein-to-creatinine ratio or albumin-to-creatinine ratio), age, and systemic hypertension on the risk of death or euthanasia during the follow-up period. Multivariable linear regression was used to determine the relation between severity of proteinuria and predictive variables, including age, plasma creatinine concentration, systolic blood pressure, sex, and urine specific gravity. RESULTS: Plasma creatinine concentration and proteinuria were very highly related to survival. The hazard ratio (95% confidence intervals) for death or euthanasia was 2.9 (1.4-6.3) and 4.0 (2.0-8.0) for urine protein-to-creatinine ratio 0.2-0.4 and >0.4, respectively, compared with the baseline group with a urine protein-to-creatinine ratio of <0.2 and were 2.4 (1.2-4.8) and 4.9 (2.3-10.2) for an albumin-to-creatinine ratio of 30-82 mg/g and <82 mg/g, respectively, compared with a baseline group with albumin-to-creatinine ratio of <30 mg/g. Treated hypertensive cats did not have reduced survival, although systolic blood pressure, together with plasma creatinine concentration was positively related to the magnitude of proteinuria. CONCLUSIONS AND CLINICAL IMPORTANCE: Despite the relatively low concentrations of proteinuria typical of chronic renal disease in cats, this measurement is of prognostic significance.     

Liver glutathione concentrations in dogs and cats with naturally occurring liver disease

OBJECTIVE: To determine total glutathione (GSH) and glutathione disulfide (GSSG) concentrations in liver tissues from dogs and cats with spontaneous liver disease. SAMPLE POPULATION: Liver biopsy specimens from 63 dogs and 20 cats with liver disease and 12 healthy dogs and 15 healthy cats. PROCEDURE: GSH was measured by use of an enzymatic method; GSSG was measured after 2-vinylpyridine extraction of reduced GSH. Concentrations were expressed by use of wet liver weight and concentration of tissue protein and DNA. RESULTS: Disorders included necroinflammatory liver diseases (24 dogs, 10 cats), extrahepatic bile duct obstruction (8 dogs, 3 cats), vacuolar hepatopathy (16 dogs), hepatic lipidosis (4 cats), portosystemic vascular anomalies (15 dogs), and hepatic lymphosarcoma (3 cats). Significantly higher liver GSH and protein concentrations and a lower tissue DNA concentration and ratio of reduced GSH-to-GSSG were found in healthy cats, compared with healthy dogs. Of 63 dogs and 20 cats with liver disease, 22 and 14 had low liver concentrations of GSH (micromol) per gram of tissue; 10 and 10 had low liver concentrations of GSH (nmol) per milligram of tissue protein; and 26 and 18 had low liver concentrations of GSH (nmol) per microgram of tissue DNA, respectively. Low liver tissue concentrations of GSH were found in cats with necroinflammatory liver disease and hepatic lipidosis. Low liver concentrations of GSH per microgram of tissue DNA were found in dogs with necroinflammatory liver disease and cats with necroinflammatory liver disease, extrahepatic bile duct occlusion, and hepatic lipidosis. CONCLUSIONS AND CLINICAL RELEVANCE: Low GSH values are common in necroinflammatory liver disorders, extrahepatic bile duct occlusion, and feline hepatic lipidosis. Cats may have higher risk than dogs for low liver GSH concentrations.     

Open-label trial of a multi-strain synbiotic in cats with chronic diarrhea

This study was designed to test the hypothesis that in cats with chronic diarrhea the daily administration of a proprietary synbiotic (Proviable-DC) would result in an improvement in stool character, as assessed by the owner. Adult cats with chronic diarrhea were recruited for the study and screened for systemic diseases. Fecal flotation, wet mount, immunofluorescence assay (IFA) for Giardia and Cryptosporidium species, and Tritrichomonas species polymerase chain reactions (PCRs) were used to screen for intestinal parasitism. The synbiotic was administered for 21 days; otherwise, no changes were made to ongoing treatment(s) or diet. The severity of the diarrhea was assessed using a standardized fecal scoring system and the owner's subjective perception before, and after, supplementation. The mean fecal score for the 53 cats completing the study decreased from 6.0 to 4.4, representing a significantly (P <0.001) firmer stool character. Seventy-two percent of owners perceived an improvement in their cat's diarrhea following a 21-day course of synbiotic supplementation.