Case of the Month: Clark

Clark is a 3-year-old male neutered domestic shorthair cat who presented to the Pekin Veterinary Clinic because he was straining to urinate and the owner was seeing blood in his urine (hematuria). He was also acting like he was in pain and was not eating or drinking at home. On physical examination, Clark's heart rate was greatly increased (tachycardia) and he had a large hard bladder on abdominal palpation. When Clark's abdomen was manipulated, he was extremely painful.

At this time, Clark was taken to our ultrasonography room to assess his bladder on the ultrasound and collect a urine sample by cystocentesis. The ultrasound showed that the bladder was very large, distended and contained a lot of foreign material. The urine sample that was collected revealed that the urine was very bloody and contained an abundance of what appeared to be crystalline material. The urine sample was sent into the laboratory for urinalysis. The urinalysis revealed that the bladder contained crystals (struvite) and blood from the inflammation of the inside of the bladder wall from the crystals.

Clark was in very critical condition, so it was decided between Clark's mom and the veterinarian that he needed to be treated as soon as possible for this condition. We started by collecting Clark's blood and assessing his kidney function and electrolytes. His blood work showed that both of his kidney values were highly elevated. His blood urea nitrogen (BUN) was 119 (normal range 10-30) and his creatinine was 9.8 (normal range 0.3-2.1). The electroyte that was dangerously high was potassium (this is a common bloodwork finding in cats who cannot urinate due to having stones lodged in their urethra).

Clark was immediately anesthetized to relieve his pain and so that we could unblock him by passing a sterile urinary catheter. We needed to unblock Clark as soon as possible to decrease his chance of complications from his condition. These potential complications included: bladder rupture from overextension of the bladder wall, irreversible kidney damage and/or adverse effects on the heart from the high potassium. Once anesthetized, we unblocked Clark's urethra which was blocked with multiple small crystals. After the urinary catheter was placed, we flushed that bladder with a mixture of sterile saline and lubricant to try to remove as many of the crystals from the bladder and urethra as possible.

A sterile urine collection system was placed on the end of Clark's urinary catheter so that his urine output and quality could be assessed. An intravenous catheter was placed in Clark's cephalic vein so that he could receive fluids to correct his electrolyte disorders and flush the kidneys to bring down the elevated kidney values. Clark was given oral pain medications to help keep him comfortable. He was also given an antibiotic to decrease his chances of getting a urinary tract infection as a result of the urinary catheter being placed. Clark rested for the remainder of the afternoon and evening without complication.