Screening the Ageing Cat

Gary Coxon BVetMed MRCVSVeterinary advisor

Vetoquinol UK and Ireland

Agenda• Who/what are we looking for?• History and physical exam• Urinalysis• USG• UP:C and proteinuria

• Bloods and blood pressure• What to include/is it worth it?

Senior/Geriatric?Life Stage Age

Kitten 0 - 6 months

Junior 7m – 2 years

Prime 3 – 6 years

Mature 7 – 10 years

Senior 11 – 14 yearsGeriatric 15y +

Source – FAB expert panel- Well cat for life initiative

What Are We Looking For?•CRF•Hypertension•Hyperthyroid•Osteoarthritis•Dental Disease•Senility

•Reduced appetite•Reduced activity•Stiffness•Reduced interaction•Poor coat•Halitosis•Inappropriate toileting

‘Old age’

What Are We Looking For?

‘Sammy’ a 14yo FN DSH•Sleeps a lot•Doesn’t jump•Lost weight•Eats really well•Can’t see•Smelly breath

‘But he’s getting on a bit now you know’

What Are We Looking For?

‘Sammy’ a 14yo FN DSH

•Arthritis•Hyperthyroidism•Hypertension•Dental disease

What Will it Cost?•CRF•Hypertension•Hyperthyroid•Osteoarthritis•Dental Disease•Senility

•History•Physical examination•Weight•Urine specific gravity and dipstick•Blood pressure

HistoryWellness Questionnaire

• www.isfm.net under ‘Toolbox’• Activity, sociability• Mobility

• Cat flap, stairs• Behavioural changes

• Grooming, toileting, vocalisation• Appetite

• Increased, decreased, more fussy

• Thirst, halitosis, weight, V/D+

Physical Examination• Coat condition• Shine, scurf, matted

• Heart• Rate, murmur, gallop rhythm

• Palpable goitre?• Eyes- retinal exam• Abdomen, thorax ...• Joints• Subtle changes in cats• Swelling, thickening, reduced ROM – usually absent

Body Weight• Weigh every cat, every time it comes into the surgery• Cat scales in the consulting room• Record the weight!

• Discuss changes in terms of % body weight• Convert to human terms if necessary

UrinalysisCystocentesis•Quick•Easy•Inexpensive •Ideal for analysis

• Fresh• Uncontaminated

•Needs to have urine in bladder•Need two people

Owner collection•May be possible eg Katkor•Sample is adequate for

• USG• Glucose• Blood• Protein?

Cystocentesis• With/without US guidance• Cat immobilised by nurse in dorsal or lateral recumbency• Check bladder size• Shave and scrub skin over bladder region• Immobilize bladder with one hand• With the other hand, a fine needle (23 gauge, 5/8" long for

cats) is introduced at an angle of 45° from the front to the back towards the neck of the bladder

• https://www.idexxlearningcenter.com/idexx/user_activity_info.aspx?id=443&SSOTOKEN=0

Urine Specific Gravity• Normal cats urine is highly concentrated• Cats with CRF often maintain concentrating ability but it is reduced

• USG< 1.030• Investigate for cause eg CRF, DM, hyperT

• USG 1.030-1.035• Check on a second occasion

• Can use as justification for recommending blood sample if not already included in senior check

Urine Dipstick•Glucosuria•Bilirubinuria Blood sample

•Haematuria - Sediment

•Proteinuria - Sediment, UP:C

•LEUKOCYTES- DO NOT USE

Significance of Proteinuria• Always check urine sediment before interpreting proteinuria• UTIs common in female cats with low USG• Sterile cystitis common in cats with high USG

• Proteinuria with inactive sediment• Only significant if persistent (2 samples 1w apart)

Urine Protein : Creatinine (UP:C)• Test run on urine to measure protein loss from the kidney• Can be done at external lab or on VetTest• Helps to determine if protein in urine is significant• Can detect smaller amounts of protein in urine than a dipstick• Must rule out other possible sources of protein loss eg bladder – do

sediment exam ast• Can be used to

• Detect early renal disease• Prognostic indicator• Guide treatment esp ACEi• Monitor response to treatment

UP:C ValuesUP:C Value Substage

Dogs Cats

<0.2 <0.2 Non-proteinuric

0.2 – 0.5 0.2 – 0.4 Borderline

>0.5 >0.4 Proteinuric

Persistent Proteinuria in CRF Cats

• Negative prognostic indicator• 50% survival time• UP:C >1 – 130 days• UP:C 0.2–1 – 300 days• UP:C< 0.2 - >1000 days

UP:C> 0.4 - Start ACEi

King et al, JVIM 2007 21:906

Persistent Proteinuria• For all cats may be a warning sign of impending azotaemia?• 95 non azotaemic ‘healthy’ cats >13y• 30% developed azotaemia within 1 year• Proteinuria at presentation was significantly associated

with the development of azotaemia

Jepson et al, JVIM 2009 23:806-13

Proteinuria Summary• Measuring proteinuria on dipstick has its pitfalls• Negative is probably non-proteinuric unless very dilute

sample (but may miss early/mild proteinuria)• Positive needs confirmatory test eg UP:C

Blood Pressure•Healthy• 120-180 mmHg

•Renal compromise• <170 mmHg

•Get nurses involved

Blood Tests• Full blood count – or PCV• Biochemistry• TP, Alb, Glob, U/C, ALT, ALKP• Glucose – if glucosuria• Phosphate, K+ - if evidence of CRF• T Bil – if yellow serum or bilirubinuria• FBA or BAST - if high liver enzymes

• Total T4

Cost Vs Benefit• What to include in senior check promotion?• Free/discounted consultation• Free urinalysis +/- katkor/cystocentesis• Free/discounted BP• Free/discounted bloods

• E.g. • Free consultation and urinalysis (USG and dipstick)• Discounted BP• Discounted bloods – in house or external (lab support)

Benefit of Senior Promotion• 40 ‘healthy’ cats >12y• 6 has CRF• 6 needed dental treatment• 4 had UTIs• 4 had low USG but normal creatinine• 3 needed tx for OA• 2 had liver dz• 1 diabetic• 1 hyperthyroid