Cystitis Or Kidney Disease? Confused And Worried About My 2-year Old Ragdoll

RagdollsApArt

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Hello everyone!

I’ve been lurking here since I got my two ragdoll kitties almost 2 years ago. The abundance of information shared here has been incredible support but today I need to share my specific story, as I feel completely lost.

So I have two ragdoll cats that turned 2 on Valentine’s Day just passed.
Today I’ll be talking to you about my boy Apollo. I got him when he was 10 weeks old, along with his sister Artemis. Apollo has been a healthy kitten, gaining weight steadily. Early on we noticed some odd behaviours, such as he was suckling on his paw before his nap and at one point, when he was about 6 months old, we noticed he had chewed off the end of the fur on his tail. He was investigated for skin conditions but nothing came up. The vet at the time said he is a “stressy cat”. We started using Feliway pheromone diffusers and has since stopped chewing his fur. Suckling persists to this day.

When he turned 1 year old, we moved to a different part of the country and I went from being a student to having a full-time job. He adjusted as well as can be expected during those huge changes, seemingly at least.

End of August last year, I started noticing dark brown-ish spots on the kitchen floor, near where the litter box is. I thought they were food stains or something. Neither of my cats seemed unwell at all. Neither was going to the litter box more often than usual, no urine puddles anywhere in the house. But one evening, he went to the litter box and when he came out, I could see a slightly pink-tinted urine on his white fur. Rushed to the vets. He was examined and found that his bladder was empty, he didn’t seem uncomfortable even though his abdominal area was squeezed extensively. The vet says he ticks all the boxes for idiopathic cystitis, aka he is male, neutered, pedigree, indoor, multi-cat household and overweight. Plus, prone to stress. Sent home with Metacam. Metacam made him worse. He was nauseous and had diarrhoea. I stopped it and the visible blood in his urine stopped after 5 days.

2 months later, he was in the litter box and as if something startled him, he jumped out and left a trail of pink urine on the floor. Vets again, Metacam and so on. I kept telling the vet that he is not in any pain but she didn’t believe me. We followed her advice, used more Feliway diffusers, switched him to urinary food, wet only, got 2 more litter boxes (both cats still use the same one), started him on Cystease capsules.

3 months later, tinted urine again. Phoned the vets and said I don’t want Metacam again, I want investigations. So I took him in and they did an x-ray, an ultrasound and a full urinalysis of sterile urine (from cystocentesis). When I went to pick him up, the vet said there was nothing out of the ordinary that came up in any of the examinations, except his urine was dilute. Being completely ignorant at that point, I said “Isn’t that a good thing?” and the vet said yes, it might be because he’s on wet food and because urinary food aims to make the urine more dilute to help with bladder issues. 2 days later when the laboratory analysis results came back, the vet phoned me and said again no concerning findings, no protein in his urine, no bacteria, no crystals. But the urine was found to be dilute so she suggested to bring him back in for a blood test. She said because he gets so stressed, it’s perfectly fine to give him time to recover from last vet visit and bring him in some time in the next couple of months. She reassured me that it’s unlikely to be kidney disease because he’d have other symptoms. She didn’t give me any specific numbers for his results and I beat myself up for not asking.

(If you’re still reading, you’re a hero and thank you from the bottom of my heart)

Of course I committed the cardinal sin and Googled “cat dilute urine” and now I’m paralysed with fear. First of all, apart from bloody urine, he has no other symptoms of cystitis. No pain, no frequent urination, no straining to urinate (as far as I can see at least). And wouldn’t the ultrasound show thickened bladder wall if this was cystitis? Especially since the tests were done while he was presenting with blood in his urine? On the other hand, if he had lost his ability to concentrate urine, wouldn’t he be dehydrated and drinking and peeing more? I have noticed neither of these signs. If anything, since switching him to wet food exclusively, I have never seen him drinking and the water bowls barely have any water missing at the end of each day. And while I’m at work 9 hours a day, I spend a couple of hours at home before work and 6 hours after I come back and before I go to bed, and during these times he consistently visits his box twice: one in the morning for number 1 and one in the evening for a 2 and presumably an 1. I know that the blood tests will give us a better idea, but I read that they are not accurate until most of the kidney function is lost. So I fear I’m looking at months and months of uncertainty without a definitive diagnosis.

Being fully aware that without specific numbers, you can’t give me any valuable insight, I would appreciate any opinions on this. Even if just to prepare me for what might be coming. Or inform me on what to ask for/talk about during the next vet visit.

Thank you so much and obligatory sorry for the long post.

Apollo says hi too! :)
 

Jem

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Apollo is very handsome!!!!

I've dealt with CKD as well as cystitis, and although I'm not a vet and this is solely based on my personal experience, I do think you're dealing with cystitis more so than CKD. Obviously it can happen, but you're kitty seems a little young for CKD.
When it comes to his "dilute urine" You have him on prescription urinary wet food right? (which one is it specifically?) That food purposefully dilutes the urine. So if there are no other signs, I would assume that is the reason. He will also not drink as much if he is eating wet. But if you are concerned, you can add a bit of water to his wet food to be safe, as well as getting a water fountain. Cats do tend to drink more from moving water over just a bowl.
I also have to side (a bit) with the vet about his pain. Cats hide their pain VERY WELL, and usually if you see signs of pain, that's when it's REALLY bad. The time he jumped out of the box like he was startled and left a trail of urine behind him is a sign that he was in pain. So although it may not be constant pain, you can be sure that anytime you see blood or he seems startled or jumpy using his box, he's at the very least, uncomfortable while peeing.

When my little one had cystitis, my vet specifically told me that there were inflammatory cells in his urine. Did your vet say this at all at the time the urinalysis was done while he also presented with blood? Maybe that could be a question to ask him. Also the thickening of the bladder may not necessarily show (on ultrasound) or even be there at all if he simply has some mild inflammation in the lining of the bladder. And the fact that he has never blocked or even strained to pee also makes me think his bladder and urethra is not "too" thick or inflamed, so it would not necessarily be visible or palpable. Also, blood work did not show anything out of the ordinary with mine when he had it.

My other one who had CKD, although diagnosis was not until he was in stage three, showed several markers were off in his blood work, as well as the many physical signs that we noticed. Even before we knew he had any issues at all, he peed A LOT, and his pee clumps were pretty big also. That (I know now) is a sign of the first stages of CKD. So if Apollo, even with dilute urine, does not drink or pee a lot, I would lean towards the cystitis as the culprit.

I hope this is helpful, please feel free to ask me anything about my experience, I don't mind writing my own novels either (as you can see);), so I will stop writing for now, but as I said, just ask.
 
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RagdollsApArt

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Apollo is very handsome!!!!
He says thank you! :D He’s most gentle, loving and kind of dumb in an extremely cute way, I’ve loved him from the moment I first saw him. I love his sister just as much, but with him it just feels different; like I always knew I would have to protect him from everything -whereas Artemis is a more independent spirit.

I've dealt with CKD as well as cystitis, and although I'm not a vet and this is solely based on my personal experience, I do think you're dealing with cystitis more so than CKD. Obviously it can happen, but you're kitty seems a little young for CKD.
First of all, thank you so much for taking the time to read and reply. I am a new cat owner and while I do trust my vet, it’s always helpful to get advice and support from experienced cat people. I know the internet can be a filthy place and I have more than once been amazed at the kindness of strangers -and this one of those times. :)

When it comes to his "dilute urine" You have him on prescription urinary wet food right? (which one is it specifically?) That food purposefully dilutes the urine. So if there are no other signs, I would assume that is the reason. He will also not drink as much if he is eating wet. But if you are concerned, you can add a bit of water to his wet food to be safe, as well as getting a water fountain. Cats do tend to drink more from moving water over just a bowl.
We initially tried Hills Urinary Stress c/d wet food pouches. They gave him a really bad case of colitis -mucus, blood and all. Vet said it’s probably due to the milk protein in this food that’s meant to help with stress. He wouldn’t touch the Royal Canin equivalent when we tried. So I tried the RC Urinary Care pouches (Urinary Care in Gravy Cat Food - ROYAL CANIN®) which you can get off the shelf -it’s not prescription food per se but it supposedly supports mineral balance and appropriate pH. I also add a bit of water to the gravy on the bottom of the pouch and pour it over his bowl. Before all this adventure started he was eating mostly dry food (I know, this is bad) but since he is exclusively on wet. He gets biscuits once a week in a food maze to keep him occupied when I do housework, but that’s it.


I also have to side (a bit) with the vet about his pain. Cats hide their pain VERY WELL, and usually if you see signs of pain, that's when it's REALLY bad. The time he jumped out of the box like he was startled and left a trail of urine behind him is a sign that he was in pain. So although it may not be constant pain, you can be sure that anytime you see blood or he seems startled or jumpy using his box, he's at the very least, uncomfortable while peeing.
You are absolutely right and I should have known better. I’m not proud but at the time I thought I knew my cat better than the vet -and to think that I work in healthcare and get frustrated with patients who think they know better than me on a daily basis…! Insert facepalm here. Anyway, it’s not an excuse but I had googled Metacam and thought I was harming my cat for no good reason. I should’ve just listened to my vet!!

When my little one had cystitis, my vet specifically told me that there were inflammatory cells in his urine. Did your vet say this at all at the time the urinalysis was done while he also presented with blood? Maybe that could be a question to ask him. Also the thickening of the bladder may not necessarily show (on ultrasound) or even be there at all if he simply has some mild inflammation in the lining of the bladder. And the fact that he has never blocked or even strained to pee also makes me think his bladder and urethra is not "too" thick or inflamed, so it would not necessarily be visible or palpable. Also, blood work did not show anything out of the ordinary with mine when he had it.
She didn’t mention inflammatory cells but, knowing her style, she would probably focus on the things that we were concerned about (crystals, glucose, protein) and perhaps leave out findings that were expected from a cat that is suspected to have cystitis. But thanks for the pointer, I’ll make sure to ask in our next appointment.

My other one who had CKD, although diagnosis was not until he was in stage three, showed several markers were off in his blood work, as well as the many physical signs that we noticed. Even before we knew he had any issues at all, he peed A LOT, and his pee clumps were pretty big also. That (I know now) is a sign of the first stages of CKD. So if Apollo, even with dilute urine, does not drink or pee a lot, I would lean towards the cystitis as the culprit.
I’m sorry about your cat having CKD and thanks for sharing your experience. Apollo so far seems normal in his litter box habits. That’s a bit reassuring, but doesn’t stop my obsessive mind wandering and thinking of the worst. I stalk him every time he goes in there, I think he’s starting to think I’m a pervert! :D I’m using clay litter but I’m thinking if I switch to a clumping litter, I can keep a better eye on his output without annoying him.

I hope this is helpful, please feel free to ask me anything about my experience, I don't mind writing my own novels either (as you can see);), so I will stop writing for now, but as I said, just ask.
This is extremely helpful, thank you so much once again! :)
 
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RagdollsApArt

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Just posting to share an update on Apollo’s health. Today had a kidney panel done and all the values came back “absolutely normal”, vet says! :)
 
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RagdollsApArt

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That's great news!! How has he been feeling/doing otherwise?
Aw thanks for asking! :) He’s been fine, apart from the usual grumpiness after being at the vet! :D
Obligatory cat photo attached. :lol2:

 
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