Blood in Urine

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nepenthe

nepenthe

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My 10 year old male is back on Lantus again for the past week. I took him to the vet yesterday and all his BW came back normal, except the fact that there was blood in his urine (free-catch urine sample) .

She said that she will do a culture next week of another urine sample to look for bacteria. The odd thing is that his white count is normal and there are no outward signs of anything wrong. She said that it could be "related to his diabetes somehow" or some sort of bacteria. She did also say that there were no crystals in his urine.

Do you think blood in the urine is common with diabetic cats - or is it something more serious, like cancer?
 
You said that your cat "is back on Lantus again" -- does that mean he was off it for a while? If so, my suspicion would be a urinary tract infection. UTIs are a common side effect of uncontrolled / under-controlled diabetes due to the excess sugar that gets spilled over into the urine. Symptoms of UTIs include (but are not limited to) blood in urine, pink-tinged urine, straining to urinate, frequent attempts to urinate, attempting to urinate in inappropriate places. Since it's an infection, UTIs can also increase BG levels.

To test for a UTI, the vet collects a urine sample (preferably a sterile sample collected through a needle into the bladder) and sends it out for testing. The lab takes the sample and puts it in different petrie dishes to see if anything grows (they grow a culture). If something does grow, they then expose the culture to different types of antibiotics to see which ones the infection responds best to (which antibiotics the infection is sensitive to). The test takes about 5-7 days and is called a culture and sensitivity test (C&S).

Keep an eye on your cat for additional symptoms of UTIs and report them to the vet if needed. You should also know that UTIs can be very painful, so you may want to talk with your vet about painkillers. Finally, you'll want to keep an eye on your cat's urination in case of urinary blockage. That's a potential side-effect of UTIs; they're not common, but they occur much more frequently in male cats than female cats. The blood in the urine (or a crystal in the urine, if they're present) may block the opening of the bladder, making it impossible for the cat to urinate. If this occurs, it *IS* an emergency condition and your cat needs to go to the vet *NOW*. If it's the middle of the night, bring him to the emergency vet -- do *not* wait until morning.

You can read more about UTIs here and more about urinary blockages here.
 
Our civvie Furball, had blood in his urine. The vet said it was due to stress, although nothing in his life had changed. The vet tried many things over the course of a month or so. Poor little guy was stressed because he had lung cancer.
Prayers.
Dana
 
JJ & Gwyn: he has been back on Lantus for one week. He was diagnosed in March 09 and was on for only just over one month when the insulin and change to canned-only food seemed to reverse it. He was OTJ for 8 months, and I thought "he is over it". I stopped testing him, naively thinking it was done. Then last week I tested him and his numbers were 234-150, so he went back on. There was no visible blood in the urine and his white count is ok. I am going to take him in for culture testing. I am thinking that maybe a UTI has also raised his BG, making me think that he just became diabetic again, or that they both happened at the same time. I am noticing that he isnt responding to the same dose as before and seems to need more insulin.

So you are saying that when excess sugar gets spilled over into the urine, some blood can spill along with it?

Dana & Thomas: were there any outward signs of his cancer? Was his blood work normal? My cat seems otherwise normal and doesn't act any differently.
 
> he has been back on Lantus for one week. He was diagnosed in March 09 and was on for only just
> over one month when the insulin and change to canned-only food seemed to reverse it.

Cats and humans can be borderline diabetics and then, when something happens that causes pain, infection or inflammation, they can tip over into full-blown diabetes. If you can 'fix' whatever it was that caused the problem, you can increase their chances of getting back into remission (where their diabetes is controlled solely by diet). Remission is the best possible state for your cat's health (and your pocketbook).

So, if your cat has any other health problems at the moment -- anything that can causes pain, infection or inflammation -- you might consider treating that to increase the chances of remission. That potentially includes even minor things like tartar build-up on the teeth (which can cause inflammation).


> He was OTJ for 8 months, and I thought "he is over it". I stopped testing him, naively thinking it
> was done.

If you get into remission again, you should check BG levels at least once a month, or any time your cat is acting 'off'. You should also continue to keep him on a low-carb diet, and to promptly address health issues that may arise. Those three things will increase your chances of keeping your cat in remission.


> Then last week I tested him and his numbers were 234-150, so he went back on. There was no visible blood
> in the urine and his white count is ok. I am going to take him in for culture testing. I am thinking that maybe
> a UTI has also raised his BG, making me think that he just became diabetic again, or that they both happened
> at the same time.

If this is a UTI, then he probably had a relapse of his diabetes, which then caused the UTI.


> I am noticing that he isnt responding to the same dose as before and seems to need more insulin.

I can think of a few possibilities here.

First, are you using the same Lantus as you were using last spring, or did you open a new vial? Because insulins don't last forever; once they're opened, they usually have some form of limited shelf-life. So if you're still using your old Lantus, even if it's still within the expiration date, it may no longer be any good.

The second possibility is that the storage shed is still filling up. If it is, then hopefully you'll see some movement in the numbers soon. For info on the storage shed, read this here.

Finally, a UTI is a source of infection and potentially a source of pain, both of which can increase BG numbers. So, yes, the UTI can definitely be skewing the numbers here, but it's important to be aware of and make allowances for the other possibilities as well.


> So you are saying that when excess sugar gets spilled over into the urine, some blood can spill
> along with it?

No, the excess sugar gets spilled over into the urine, and the extra-sweet urine is a good breeding ground for various types of bacteria. Once the infection is present, it can irritate the lining of the bladder and cause blood clots to form.
 
Furball'swhite blood count was high, and he just seemed tired. It all happened fairly suddenly.
Praying that it is something that can be treated.
Dana
 
JJ & Gwyn: I was using the same Lantus I opened in March 09. The expiry date on it says May 2011, but I think its misleading. I am going to get a new vial tmrrw. That will give me a more realistic picture of how well the shed is filling up too. His numbers around 225-255 aren't too-too bad. I have had him on a canned only diet since he was diagnosed, but, the stupid thing I did was somewhere a few months back started giving him 15 or so pieces of kibble before bed as a treat. I think that even a as little amount as this over a few months caused him to become diabetic again. He hasn't had any of that stuff for over a week now. Will never make that mistake again.

I am anxious to get him in for the culture testing tmrw. Is it still likely it is a UTI even if his WBC is normal?
 
> I was using the same Lantus I opened in March 09. The expiry date on it says May 2011, but I think
> its misleading.

Depending on how it's handled, Lantus can 'poop out' in as little as 28 days, though some folks have used it for 6-7 months. I'm not a Lantus user, but I'm not sure anyone's had it last for over a year -- once the vial is opened, you risk the insulin losing it's effectiveness, regardless of what the expiration date on the vial says. I'm not sure whether you've been to the Lantus forum yet, but I'd suggest reading this sticky here. That gives information on how to best store and handle Lantus to make it last as long as possible.

Also, if you're picking up new insulin, you may want to consider getting pens or cartridges instead of a vial; that's what most folks here do. It's a little bit more initially, but it's usually more cost-effective in the end. You can read a bit ore about vials, pens and cartridges in the sticky I just linked to.


> a few months back started giving him 15 or so pieces of kibble before bed as a treat. I think that even
> a as little amount as this over a few months caused him to become diabetic again.

Kibble is generally a high-carb food. If you go to the Health Links forum, there's a post there on treats that are diabetic-friendly.


> I am anxious to get him in for the culture testing tmrw. Is it still likely it is a UTI even if his WBC
> is normal?

Honestly, I don't know. While Gwyn had a *lot* of UTIs, I don't recall ever checking her WBC at those times. From what I know of medical issues in general, infection *should* drive up WBC, but I don't know how far it would rise on a UTI, nor how quickly.

When you have him tomorrow to get the urine sample, ask the vet that. You might also ask for some painkillers. Also, if you don't already know your local emergency vet, ask your regular vet who they'd recommend for after-hours care. Some vets even have little flyers they can give with hours and directions and such. It's unlikely that your cat will have a urinary blockage but, if he does, you don't want to waste time.

(BTW, what *is* the name of your cat? It's annoying to keep referring to him as 'he'.)
 
JJ & Gwyn: My cat's name is Chingis. I wonder why my vet didnt think of that - his WBC was normal, but she still wants to look for bacteria. Maybe he could have bacteria without any infection?
 
> From what I know of medical issues in general, infection *should* drive up WBC, but I don't know
> how far it would rise on a UTI, nor how quickly.

What I was trying to say is that I don't know how a UTI would affect WBC numbers. It's possible that a UTI could drive up WBC numbers, but they might still be within the normal range; or it's possible that it takes a comparatively long time for a UTI to drive up WBC numbers. I simply don't know. It's something to ask your vet tomorrow.


*waves 'hi' to Chingis*!!
 
Dana & Thomas: thanks for the support!

JJ & Gwyn: I got an appointment for him tmmrw for a culture and sensitivity test. Today his BG is back down to 144, 6 days after going back on Lantus, and three days after dosing every 12 hrs.

My big fear now is that the culture tests come back negative, since there are only a few potential causes of blood in a cat's urine: stones/crystals, infection/bacteria, parasites, trauma, and cancer. I can almost certainly rule out parasites, as he is 100% indoor and can rule out trauma. My fear, as with any pet owner, is some sort of tumour, esp because of the insidious nature of cancer. Our pets can present no symptoms, have perfect blood work and pass a work-up and still may have it.
 
> I got an appointment for him tmmrw for a culture and sensitivity test.

Okay, good.


> Today his BG is back down to 144, 6 days after going back on Lantus, and three days after
> dosing every 12 hrs.

That's probably the storage shed filling up, which is good news. Did you switch over to a new vial / pen /cartridge, or are you still using the one you opened in spring of '09?


> My big fear now is that the culture tests come back negative, since there are only a few potential causes
> of blood in a cat's urine: stones/crystals, infection/bacteria, parasites, trauma, and cancer. I can almost
> certainly rule out parasites, as he is 100% indoor and can rule out trauma. My fear, as with any pet owner,
> is some sort of tumour, esp because of the insidious nature of cancer. Our pets can present no symptoms,
> have perfect blood work and pass a work-up and still may have it.

True. If the C&S comes back negative, you might check with your vet. I would think that stones would show up on an x-ray or an ultrasound.

My primary guess for blood in the urine of a diabetic cat would be a UTI. After that (for all cats), you've already (mostly) ruled out parasites and trauma, so my next thought would be feline idiopathic cystitis, and then stones. I wouldn't necessarily jump immediately to cancer.

FWIW: my Gwyn had a *long* history of intestinal problems, and she was checked several times over the years for various stomach cancers; those checks were all done by abdominal ultrasounds. I've no idea whether all abdominal cancers show up in ultrasounds, and I doubt cancer that's still in the early stages might show up, but if blood-in-the-urine problem is still an issue later on, you may want to check with your vet about getting an ultrasound.
 
hi there,
i just wanted to throw in there that i have a civie that presented a couple years ago with inappropriate urination (on my sleeping fiance) and blood in the urine....i could actually see the blood in the litterbox. obviously we took him to the vet where she ruled out infection, crystals, etc....and he ended up with an official diagnosis of idiopathic cystitis and became known as our stress kitty. seriously. that day he didn't want to come out of the cage at the vet's when i went to pick him up. they asked me if i wanted to go in the back and give it a try as that may be easier on him. when i opened the cage door, he wet himself. so ever since, he's our stress kitty. :)

a proper maintenance dose of Prozac and he hasn't had a problem since (except that one time when we tried to wean him off the prozac and he took to pee'ing on fiance again)

so i know it's hard not to panic but that is what i'm gonna tell you to do :) don't panic yet. it may not be anything too bad.
 
Oh -- Cindy's post just reminded me! I understand that diet can help a lot in idiopathic cystitis so, if you do end up with that as your diagnosis, you may want to explore dietary options to reduce the chances of a recurrence. (No, I've no idea what the best dietary options for FIC are, I just remember hearing that sometimes food helps keep things stable.)
 
JJ & Gwyn: I am still using the vial from 09. It seems to be working, with dosing him every 12 hrs, he got down to a 145.

Today they took urine and the vet did say that bladder/urinary cancers are rare and she doesn't suspect it. What she did narrow it down to is:

  • infection is unlikely b/c his WBC is normal
    crystals are unlikely, b/c there are none in his urine
    there could be stones somewhere, maybe bladder
    "idiopathic cystitis" is what she would suspect if there is no bacteria from the C&S test (will know on Monday/Tuesday) and there are no stones in x-rays

She said if the C&S test rules out bacteria, the next step is an x-ray (to look for stones) She said that stones would definitely show up on x-ray if they existed. I doubt that idiopathic cystitis would be caused by stress him him, as he is very laid back and seldom stressed. Unless there is some unknown correlation between his diabetes and idiopathic cystitis.
 
> I am still using the vial from 09. It seems to be working, with dosing him every 12 hrs,
> he got down to a 145.
Okay, good. (I don't usually check spreadsheets unless it's an insulin I'm familiar with, so I never looked at yours.)

> Today they took urine and the vet did say that bladder/urinary cancers are rare and
> she doesn't suspect it. What she did narrow it down to is:
> infection is unlikely b/c his WBC is normal
> crystals are unlikely, b/c there are none in his urine
Okay, good.

> there could be stones somewhere, maybe bladder [...]
> She said that stones would definitely show up on x-ray if they existed.
I thought they 'should' but wasn't positive; thanks, I'll this to my bank o' miscellaneous facts.

> "idiopathic cystitis" is what she would suspect if there is no bacteria from the C&S test
> (will know on Monday/Tuesday) and there are no stones in x-rays [....]
> I doubt that idiopathic cystitis would be caused by stress him him, as he is very laid back
> and seldom stressed. Unless there is some unknown correlation between his diabetes and
> idiopathic cystitis.
No correlation that I'm aware of.

Re: stress causing this problem. 'Cystitis' means inflammation of the urinary bladder; 'idiopathic' means 'of unknown origin'. Basically, it means there's some sort of inflammation going on in the bladder, but they don't know what's causing it, making it difficult to treat the root cause of the problem. This MaristaVet article has some info in it.

If it is FIC, is Chingis on anything for arthritis ATM? If so (and depending on what it is), you might consider switching medications. Dasuquin has anti-inflammatory properties, which may help the bladder lining; and I recall hearing the Adequan may also help.


> She said if the C&S test rules out bacteria, the next step is an x-ray (to look for stones)
Sounds like a good plan!
 
The crazy thing is that my main vet mentioned something called "interstitial cystitis", but said it was unlikely, b/c that accd'ng to her only happens to younger cats around age 4. (Chingis is 10)
She thinks bacteria, "diabetes related" or stones.

The other vet (her partner) thinks that it is either stones or "idiopathic cystitis". Unlike my vet, she doubts that he has an infection.

Then I get to reading that "idiopathic cystitis" and "interstitial cystitis" are the same thing, and its also the same thing as "FLUTD", which also used be be called "FUS". Sounds confusing, but that's the sense I can make of it all - these things are all the same thing, by different names.

The odd thing is that I have a cat with only one symptom aside from the diabetes/insulin changes: he has otherwise normal looking urine, with red blood cells in it. But he has none of the other symptoms associated with all UT/bladder problems: no changes in urination frequency, no inappropriate urination, no licking/scooting, no visible pain or tenderness, no lack of energy/appetite, no lethargy, etc..

he isn't on any thing ATM for arthritis, but I read that glucosamime is apparently very good at somehow rebuilding the lining of the bladder when its been impaired by infections.

I would be curious to know how many other, older cats have idiopathic cystitis.
 
My understanding of naming (which may be wrong):

FLUTD (previously FUS) is kind of a cover-all name for a set of symptoms: blood in urine, difficulty urinating, sometimes grooming the opening, etc. Some of the causes for the symptoms can be a UTI, stones, cystitis, etc. Idiopathic cystitis is inflammation of the bladder from an unknown cause. If the inflammation persists, the structure of the bladder may change; this is interstitial cystitis.

There's definitely cross-over in the terminology, and some folks may use the terms interchangably. Also, AFAIK, a formal diagnosis of interstitial cystitis requires an examination of the bladder wall via a cystoscopy (they stick a scope into the bladder and have a look around). I suspect the procedure isn't done solely to confirm interstitial cystitis, so that may cause some folks to refer to a long-term case of idiopathic cystitis as interstitial, even though the physiological changes may not have occured.


> he isn't on any thing ATM for arthritis, but I read that glucosamime is apparently very good at
> somehow rebuilding the lining of the bladder when its been impaired by infections.

Glucosamine can help; if you go that route, I still think you might be better off with Dasuquin, which contains glucosamine and anti-inflammatories (drugs that help reduce inflammation; remember that cystitis is an inflammation).


> I would be curious to know how many other, older cats have idiopathic cystitis.

Gwyn had quite frequent UTIs, so irritation to the lining of her bladder wasn't uncommon. She only had idiopathic cystitis once, though; it showed up a few weeks after her hind legs were paralysed by a stroke. I originally assumed it was a UTI, but the C&S came back clean and it cleared right up once she started walking again.

Oddly enough, another, later stroke also impaired her ability to walk for a much longer period of time, but this time she *didn't* get idiopathic cystitis. But the first (paralysis) stroke actually affected the blood flow to her lower body and could well have had some sort of direct or indirect effect on the bladder. The other stroke I referred to was neurological; it went to her brain. *shrugs*
 
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