Screening the Ageing Cat Gary Coxon BVet Med

Screening the Ageing Cat Gary Coxon BVet. Med MRCVS Veterinary 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 7 m – 2 years Prime 3 – 6 years Mature 7 – 10 years Senior Geriatric 11 – 14 years 15 y + 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 14 yo 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 14 yo 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

History Wellness 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

Urinalysis Cystocentesis • 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, hyper. T • 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 1 w 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 Vet. Test 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 Values UP: C Value Substage Dogs Cats <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 >13 y • 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 mm. Hg • Renal compromise • <170 mm. Hg • 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 T 4

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 >12 y • 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