PAWS and CLAWS Pet Pantry

A common question on the K9Nutrition list is about urinary tract infections. People often ask about special diets for urinary tract infections or struvite crystals, about reoccurring infections, and also about the difficulty in treating them. I hope to address some of these concerns in this article and also to offer some solutions to this problem.

Common symptoms of a urinary tract infection include:

frequent urination
dribbling urine
blood in the urine
squatting frequently to urinate
straining to urine
strong odor to the urine
inappropriate urination (such as in the house) incontinence an increase in thirst and drinking.

Dogs may have all of these symptoms or perhaps just one or two of these and a few dogs simply won't show any symptoms at all. Urinary tract infections can be more common in female dogs and are often seen in young female puppies.

*Please note, if any of these symptoms are seen in your dog, have a veterinarian check up immediately*

These symptoms can also indicate other diagnoses, such as bladder stones, kidney problems, diabetes and Cushing's disease.

Generally, if a urinary tract infection is suspected, your veterinarian will do a urinalysis and a blood panel. A urinalysis is done to determine the specific gravity of the urine (to see how well your dog is concentrating the urine), to see if protein and/or blood is evident in the urine and to look for the presence of bacteria. However, seeing no sign of bacteria will not rule out urinary tract infection:

http://www.antechdiagnostics.com/clients/antechNews/2002/may02_01.htm

In a recent study of 101 dogs with hyperadrenocorticism, diabetes mellitus, or both disorders, 42% had UTI diagnosed by urine culture. UTI was present in 46% of dogs with hyperadrenocorticism, 37% of dogs with diabetes mellitus, and 50% of dogs with both disorders. E. coli was the most common bacterium isolated, present in 69% of dogs. Clinical signs of dysuria or pollakiuria were present in <5% of the dogs with UTI, and 19% of dogs with positive cultures had neither pyuria nor bacteriuria on urinalysis.

Instead of just a urinalysis, you should request that a urine culture and sensitivity be done in order to determine for sure whether or not your dog has a urinary tract infection and if so, the proper antibiotics to use for treatment. Usually, a culture is done on urine that is collected dog through cystocentesis, using a needle and syringe to collect the urine directly from the bladder. This will help to insure a sterile sample and reliable results. This sample can then be sent off to a laboratory to see if bacteria are present and also to identify the type of bacteria. The second part of this test is to find what drugs the bacterium is sensitive to in order to select the correct antibiotic to treat the UTI.

The three biggest mistakes seen in UTI treatment are:

Incorrect diagnosis (not finding any bacteria through urinalysis and thus believing no infection is present)
Using the wrong antibiotic (different bacteria need very specific antibiotics to be effective)
Not using antibiotics long enough (generally UTIs can be very persistent and difficult to treat)

http://courses.vetmed.wsu.edu/vm552/urogenital/uti2.htm

Bacterial relapse can be due to the administration of the wrong antibiotic, too low of a dose or given for too short a duration.

http://www.vetinfo4dogs.com/dogurinary.html

In dogs, persistent urinary tract infections sometimes occur when a difficult bacterial infection is not treated long enough with antibiotics or the bacteria have found a protected spot in the urinary tract where it is hard for antibiotics to reach it. In this case, there really isn't a time when the dog is free from infection, so the urinary tract infection is persistent, not recurrent. In this situation, identifying the bacteria through culturing the urine and then testing to see which antibiotic will work against it and using it long enough should work to stop the problem. It may take two or three months of antibiotics in some cases.

To best treat a dog that has, or is suspected of having, a urinary tract infection, always have your veterinarian do a urine culture and sensitivity test.

Give the appropriate antibiotics for a long enough course (four to six weeks) and then retest a week to ten days after finishing treatment to make sure the infection is gone.

The following may help prevent recurrent urinary tract infections:

Encourage your dog to drink more water, by ensuring that fresh water is always available and feeding meals high in moisture content (home cooked, raw or canned).

Also offer other high moisture foods, such as chicken broth, yogurt, soup and cottage cheese.

Let the dog have access to frequent urination. This helps to flush struvite crystals (if present, and often are there when bacteria is present) and to help flush the bladder.

Dogs not allowed to urinate frequently (every four hours) are more prone to UTIs. Give your dog a vitamin B complex (full dose for large dogs, half dose for medium sized dogs and < dose for small dogs). B vitamins help in fighting urinary infection and maintain kidney health.

Once the infection is gone (as shown in a second, clear urine culture and sensitivity), give cranberry juice capsules daily. These help to prevent new bacteria from adhering to the bladder wall. Cranberry juice capsules will *not* help if bacteria is already present, so make sure your dog has a clean urine culture first.

Bolster the dog's immune system with antioxidants and supplements, including vitamin E and vitamin C. A good combination we offer is the Bertes Immune Blend. EPA fish oil or salmon oil capsules also help with the immune system; give 1,000 mg per 10-20 lbs of the dog's body weight daily.

Lastly, COQ10 is helpful, especially for dogs with renal problems.

Lastly, let's address the question of diet changes. Evidence shows that diet does not cause urinary tract infections. Prescription diets do not to help in treating urinary tract infections. I always encourage dog owners to feed the best diet they can, as this helps with the overall system of the dog.

These diets would include raw diets, home cooked diets or premium dog foods with fresh food added (animal proteins, such as meat, dairy products and eggs). Please do not be led to believe that a different brand of kibble or a prescription diet will help in the case of a UTI or struvite crystals.

The number one cause of struvite crystals is a bacteria infection. Treatment of the bacteria infection with use of the correct antibiotic (found in a urine culture and sensitivity test), given at the correct dosage and length should properly treat both of these problems.

http://www.vetinfo4dogs.com/dogurinary.html

"Are the commercial diets like c/d (tm) optimal? That is much harder to figure out, especially for diets that are made to manipulate normal physiologic processes, like serum and urine pH maintenance. There are patients that do better on diets that acidify urine. There is very little concrete evidence to show that keeping urine pH low actually decreases the risk of urinary tract infection, though. There is pretty good evidence that doing this reduces the incidence of struvite bladder stone formation but it increases the likelihood of formation of other bladder stones. We almost never use or recommend use of c/d (tm) diet in our practice, for dogs, and we have managed to control most cases of recurrent urinary tract infections without long term use of c/d. We do not routinely use urinary acidifiers in pill or powder form, in dogs, either. The only exceptions in our practice are patients who we have obtained a bladder stone from, had it analyzed and it was determined to be struvite."

Also note that many vets want to use prescription diets if struvite crystals are found in the urine. This, too, is unnecessary and ineffective.

Struvite crystals are common in dogs; one study found that 44% of urine samples from normal, healthy dogs contained struvite crystals. Urinary tract infections cause urine to be alkaline (high pH) and form struvite crystals. In that case, it is important to treat the cause (the infection) rather than trying to change the diet or acidify the urine.

Incontinence is another issue. Some dogs will dribble urine, and this symptom is similar to urinary tract infections. Again, always do a urine culture and sensitivity test. If this test comes up clear, you may be dealing with the problem of incontinence (dribbling of urine, or inability to hold urine). This happens more frequently with our senior dogs, and spayed females. Diet can make a difference in this problem, and often feeding diets with no, or low amounts of grains and starches can help. Giving the herbal tincture, Kidni Kare can also help with this problem. Kidni Kare is given at one drop per five pounds of body weight, in between meals with a small amount of favorite food or apple juice. Give once or twice daily, depending on the severity of the problem.

SPECIAL ANNOUNCEMENT

Most people have seen this warning on the internet and the news, but I am including it here as it has an impact on our dog community:

The FDA has removed ProHeart 6 Injectable Heartworm medication from the market until health concerns can be addressed.

http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01312.html

"Fort Dodge Animal Health, of Overland Park, Kansas, at FDA's request, has agreed to immediately cease production and recall its heartworm medication ProHeart.6 from the market until the FDA's concerns about adverse reaction reports associated with the product can be resolved. FDA is requesting that the firm continue to conduct research to determine the cause of related adverse reactions and develop a strategy to help prevent such problems in the future before the product is marketed again. The FDA will convene an independent scientific advisory committee to thoroughly evaluate all available data."

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