? Asia 5/29 AMPS 75, +2 79 Blood in urine (test) questions

http://www.felinediabetes.com/FDMB/threads/5-24-asia-amps-103.196032/

I’ve been away from the board a couple days, everyone in my house has a horrible head cold (including me) and it’s been miserable over here. Getting a little better, but still feeling pretty awful.

Asia had a weird spike the other night, nothing to bounce from that I could discern and I hadn’t given her any sugar or high carb for a low number, she went right to reds and probably black too, randomly. Whenever that happens, I test for ketones more often than usual, but I also use Vet-9 strips instead that test for a host of other things as well, including protein and blood in the urine. Some of the parameters are unreliable on the strips (like USG) and others don’t really apply so much to cats, so what it tests for that is reliable and does apply to cats are: glucose, bilirubin, ketones, blood, pH and protein.

Asia has never had anything unexpected show up on these test strips outside of occasional trace amounts of protein, which isn’t a big deal from what I’ve read. Yesterday she had a result that was positive for trace amounts of non-hemolyzed blood. It’s not a result that is easy to misread as this one is orange with green specks rather than a solid color (negative). It was so unusual and surprising that I tested it again to be sure, same result. I took another sample several hours later and it read Small (+) 25 ca CELLS/μL. Tested that twice as well, same results. Tested once more a few hours later and it came up negative. Results: trace @ 1900 (very hyperglycemic), Small @ 2300 (very but less hyperglycemic than the trace reading), negative @ 0200 (BG 170ish).

I plan to get more tests today, but I have to wait for pee. My understanding is blood in the urine is never “no big deal” outside of from a cystocentesis sample that could introduce the blood from the stick. Visually, I cannot see blood in her urine, it’s straw colored and not cloudy. She has had visual blood in her urine only once when she had a really bad UTI. I don’t really know what this means other than what Dr Google has turned up: UTI, kidney stones, bladder stones, cancer and some very nondescript CKD cats and diabetic cats can have blood in their urine (why? Because of a UTI or just because? I have no idea, couldn’t find additional info on that).

I emailed my vet of the findings last night asking what do we do with this information. She said bladder cancer is rare in cats, she had an X-ray on 5/10 and no stones were present (guess they take a long time to develop or couldn’t have developed since? I really don’t know). She said to keep testing and see how repeatable it is and we will try to address it further if it is. She said we could repeat u/s but may not be worth the stress to her. I completely agree that I don’t want to stress her unnecessarily, but we still don’t have a good answer for some recent goings on with her and if something is treatable, I’m not happy to wait until it gets so bad that becomes difficult/impossible to treat, and I feel like that is exactly the game we have been playing recently.

I wish I could say her response eased my mind, but it didn’t. The reason I got these strips in the first place was because she is so prone to UTIs, I thought it could give me some early warning signs as to things awry perhaps before any obvious symptoms present. She is currently being treated for UTI/kidney infection with Zeniquin and has been on this round of abs since 4/14. I’m adding water to her food as usual and I’ve since been adding even more as of the trace reading last night. I’m also giving her d mannose BID (no confirmed bacteria this go round, but she has had a confirmed E. coli UTI infection in the past and it was susceptible to Zeniquin). I don’t know if these antibiotics are wrong for this infection as no bacteria were present in the sample and vet did not culture it (but likely nothing would have grown in the culture regardless, her urine is very dilute and nothing grew when she had a kidney infection which this “UTI” may be a continuation of).

No additional symptoms, other than the weird spike, it’s been status quo. I gave her R after the spike seemed not interested on settling and now she’s back in good, euglycemic numbers again. There is blood in her raw food, obviously, but I wouldn’t think that could relate to blood showing up in her urine and besides, it has never happened before if that is even possible which I highly doubt. I’m meticulous with testing and use a pipette to put urine on the testing strips and make sure hands and tools are free of detergents and debris, tap the strips sideways so no reagents can mix to other test areas, etc. Any thoughts on these results? Anything I can do about blood in the urine besides d mannose and increasing her water intake?

 

It could be a UTI.

 

No answer on the blood in the urine.

Hope you and your family feel better soon.

 

I don't have any suggestions. Sending prayers.

 

I don’t know either but I am sending

 

As in the one she is being treated for right now isn’t properly managed with these antibiotics? I’m afraid of the wrong antibiotics or a resistant strain, particularly because we didn’t seem to knock out the first one/kidney infection (I think the course was too short) and it came back with gusto.

 

Bronx has same thing going on (blood in urine) and getting him in for an U/S since culture came back negative for a UTI, @Amy&TrixieCat also told me: "sterile cystitis - basically symptoms of a UTI without an actual bacterial infection - can cause blood in the urine, so that could be something to investigate. I also believe it is diagnosed by ruling everything else out, which would also point to doing a U/S to make sure something else isn't causing it."

Bronx is also on 50% raw food, that would be interesting to find out if that could be the culprit?

 

I'm no help! But sending lots of and vines for everyone!

 

As with pancreatitis, we treat supportively and “as if” with FIC, she’s on pain meds, immaculate box, lots of water, guess blood could just be part of that equation. Raw food is really reaching for me, there is no logical reason it should have anything to do with it. Asia has been eating raw for about a decade anyway. U/S seems a logical step, but vet doesn’t seem worried or interested to jump on that. I would like to just breathe a sigh of relief and say that sounds right, but I can’t. I’m worrying.

 

Hey, check out my update from the IM visit in Gizmo's condo today. I swear these two cats are related .

 

If the blood was caused by FIC I would expect to be seeing symptoms of cystitis such more frequent visits to the box, straining, etc.

Hypertension can cause hematuria, but IIRC, she had normal BP last vet visit, yes?

Blood in the urine can come from anywhere in the urinary tract - kidneys, ureters, bladder, etc. So further testing (US, cystoscopy, etc) would be needed to pinpoint the exact origin.

CKD cats and cats with previous pyelonephritis can have persistent, occult hematuria simply due to renal damage. We don't know why, but some believe it is vascular. If she is not anemic due to the blood loss, then there is no treatment in that case.

 

They could be, we will never know for sure! I’m glad your IM day finally came.

 

Thanks for more ideas.

No straining or difficultly urinating and she goes quite a bit, but it’s not any more frequent for her than is typical since CKD and FD came on the scene together. She does strain to poo, but I don’t think it’s a constipation thing as much as an arthritis/not fun to get in position strain. I don’t know if that could do it.

BP was very decidedly normal on last visit.

The last one, as alarming as it sounds, would be the most relief to me, I guess. At least it would just be a known thing and would fit with her history as opposed to something new and very not normal that we are ignoring until it progresses further.

Everything I’ve read said false positive/negative with the strip tests is related to detergents, bleach, cleaners etc. contaminating the testing area and it isn’t the case. I rinse the pipettes only with water and throw them away after a few uses. Using these tests once on several different cats would be one thing, but I have used them on just Asia and these results are not typical for her, I guess that’s why I’m alarmed. I’m pretty meticulous about testing carefully and do my very best not to contaminate anything as much as I can using a paper Dixie cup to grab a sample and then test right away on a clean paper towel, not touching the urine or strip test areas with my hands.

 

One way to rule out a false positive would be to save the sample (If you can get enough) that tests positive on your strips and take it in for your vet to do a full urinalysis including microscopic sediment exam. If their strips and exam match your results, you'd at least have more confidence that your test is accurate.

 

I will definitely do that if I get another positive sample and it’s during their office hours. I know things go wonky the longer you keep the sample so it wouldn’t assuage my concerns much if it sat in the fridge overnight. They said I could bring her in just for a cysto and I replied if I could instead just bring in a sample from home, it’s not ideal because it’s not sterile, but if a cysto can put a bit of blood in the urine, how helpful would that be? Plus, it would leave Asia going to the vet out of the equation and I can get pee samples all day long (bonus of having a deaf cat, very easy to sneak up and grab pee samples so long as she doesn’t see me coming).

 

Yes, a free catch sample is not always ideal, because you can't culture it, but you can still get a lot of info. You can still see if there are RBCs, WBCs, etc. If you're mainly concerned about RBCs at this point, a free catch IS ideal, because like you said, a few RBCs on a cysto can't be confirmed to NOT be because of the stick. If the free catch was at all off (more bacteria than would be consistent with contamination, WBCs), a follow-up cysto could be done. That way, you'd know there's actually a reason to take her in and go through the stress.

 

Vines and vines and vines, Stacy

 

Treating the cat and not her labs wise, Asia is doing well all things considered. BG has settled down, she’s being very Asia like, no symptoms at all from this blood in the urine business so far, I just prefer to be proactive instead of reactive, given all that she has going on. It’s hard not to worry, but thankful she’s eating well and doing all the cat things she likes to do. The two tests since the small reading last night have been negative for blood, so hopefully it’s just a fluke/kidney related thing as opposed to continued bleeding. Paws crossed for that!

 

Did he run a culture and sensitivity? Yes, the antibiotic might not be working or not long enough. Sure hope you get this figured out pronto.

 

Not this time, but did for the kidney infection and it came back nada. Between diabetes and CKD, very dilute urine over here. I don’t think it was long enough last time, but I had to beg for every week I got and I got more than the 2 weeks she wanted to give at first.

 

My vet was generous with everything but antibiotics. I’ve read they need 4 weeks with a kidney infection unless it’s your vet or mine.

 

Tanya’s says 4-6 weeks minimum for kidney infections. Something about it taking longer to reach the kidneys in CKD cats. I wanted overkill because I suspected it was there for some time, likely stemmed from a UTI in September that was undertreated (two weeks, with convenia at that). It is tricky to get them on board in the absence of confirmed bacteria, but u/s confirmed the kidney disease and antibiotics brought her suddenly high kidney values back down again. It’s lowering them again this time. It’s a tricky thing with antibiotics, I see both sides of it, I do, but selfishly, I want my cat to feel better and if they work, I want them. If there’s a good hunch in the absence of bacteria in dilute urine, I still want them. Would be nice if they had a more sensitive or refined way to culture bacteria from tricky cases and dilute urine. The only thing they can really do is take a sample from the kidney which is invasive and dangerous.

 

Stacy, I hope you can get this all figured out. Sorry to be of no help. Sending a bunch of beautiful vines for Asia.
s for you. Hope you and the family are feeling better soon.

 

Just speculating here. In my experience cats often pee and poop consecutively. If Asia's having trouble pooping because the position is painful, she might wait a bit too long before pooping. Then the blood trace might come from a small abrasion in her anus. That would be temporary, because the abrasion would heal.

As to the raw food possibility? Not unless the food went straight from her mouth to the lower intestines, and that is impossible. unless everything in between had been surgically removed. I know you know this. I'm just supporting your knowledge and logic.

Hugs

 

That is good food for thought, thank you Kathy! Asia doesn't normally do both that I have seen recently as poop has become a production. She pees mid meal or right after because I add a good bit of water to her food. Her poops tend to take more time and the ones I've seen no pee with them. No blood on her stools either, I check those to make sure everything is coming out okay and since she's supposed to be constipated form bupe and AlOH, but thankfully it hasn't been more than infrequent. We got the litter robot a few years ago, she doesn't bother to cover her stuff anymore because it goes away magically...we got the litter robot in the first place because civvie Toki refuses to cover anything that comes out the back end since we got her and only will go through the motions to cover her food with pretend cat litter when it's not the right temperature. Asia probably does wait too long to poop, I've seen her try, give up, leave and come back a few minutes later, I've also seen her lay down in the box to catch a break which she hasn't done (touch wood) in a good while which I contribute to the adequan. Not a miracle at her age, but it does seem to help make the basics easier. It has been negative today for blood 3 times, I hope that's a good sign.

 

This was my only suggestion, but then I read your mention.. I am sure you know far more! I will say, I would not doubt any results on those strips (I know you are not ). I use the very same for Pig and with the exception of the few values you noted above, they are incredibly accurate. In fact, they are precisely how I determined he was Acro before we ran the blood draws for it, because that was the one "off" thing that could not be explained.. Proteinuria. My vet swears by them for home care and was the one that pointed me in that direction. She said that outside of clinical testing they were the most reliable that she had seen. So, if they read urine, they read urine.

 

Very cool! I didn’t know of anybody else on here that used them, but the price difference is pretty much no difference from me buying ketodiastix so why not have more tests, right?! It does seem like they are useful to detect some things early, it’s just having a vet on board/what to do with that information, but I’m still thankful to have it anyway.

 

Not starting a new condo today, I’m still sick and today in particular feel like I’ve been run over by a truck. This had better go away soon, my first experience of having a cold at the apex of allergy season so it’s a gross double whammy and I am quite miserable!

 

There is something wicked going around...my Mom and DH have both had it for over a week with very little sign of if letting up...and now my brother (who lives with my Mom) has it too. DH in particular usually doesn’t get this walloped. I hope you start feeling better soon!

 

Hope you are feeling better soon Stacy

 

Feel better

Just fyi.. Gizmo is anemic and we restarted the epogen tonight. It was the only BIG difference in the labs from a month ago (don't have copy of new labs yet, so just verbal from tech).

 

I hope you feel better soon. Sending prayers.

 

Glad Asia FEELS well, but shame about the blood in the urine. I think it's probably good that it's not visible blood. Our severe CKD kitty, Mamuka (GA) regularly had intermittent hematuria. She would have normal, straw-colored urine at times and visibly bloody urine other times. And there were times the urine appeared normal, but tripped for occult blood on a urine strip. I think you're right in that that might just be the best reason for hematuria with Asia. But I agree that bringing in a free catch urine to have a U/A performed at the vet would be a good idea if the blood persists! We would happily take a free catch sample at my clinic (unless it were for a culture) - and especially if it's blood we're worried about. They could run their stick and look for RBCs in the sediment.