Urinary tract infections in cats with hyperthyroidism, diabetes mellitus and chronic kidney disease - SonoPath
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Journal of Feline Medicine and Surgery (2007) 9, 124e132
doi:10.1016/j.jfms.2006.09.004
Urinary tract infections in cats with hyperthyroidism,
diabetes mellitus and chronic kidney disease
1 2
Bettina Mayer-Roenne DVM , Richard E Goldstein DVM, DACVIM, DECVIM-CA *,
Hollis N Erb DVM, PhD3
1
Cornell University Hospital for The prevalence of urinary tract infections (UTIs) in cats with hyperthyroidism
Animals, College of Veterinary (n ¼ 90), diabetes mellitus (DM) (n ¼ 57) and chronic kidney disease (CKD)
Medicine, Cornell University, (n ¼ 77) was evaluated retrospectively. It was found to be 12% in cats with
Ithaca 14853, New York hyperthyroidism and DM, respectively, and 22% in cats with CKD. Associations
2
Department of Clinical Sciences, between UTIs and clinical signs, biochemical markers in serum and urinalyses
College of Veterinary Medicine, were investigated. Many of the cats with UTIs had no clinical signs of lower
Cornell University, Ithaca 14853, urinary tract disease or changes in their laboratory values indicative of infection.
New York Therefore, a urinalysis alone should not be used to exclude UTIs in these cats.
3
Department of Population UTIs are relatively common in cats with hyperthyroidism, DM and CKD, and
Medicine and Diagnostic Sciences, urine cultures are recommended as part of the basic diagnostic plan for cats
College of Veterinary Medicine, suspected of suffering from these conditions.
Cornell University, Ithaca 14853,
New York
Date accepted: 20 September 2006 ! 2006 ESFM and AAFP. Published by Elsevier Ltd. All rights reserved.
H
yperthyroidism is a very common en- and 9.9% in cats, and females were found to
docrine disease in older cats, affecting have a higher prevalence of UTIs when com-
approximately 1/300 cats, and has pared to males (Kirsch 1998). In another study
been diagnosed with increasing incidence since the incidence of UTIs was reported to be 24%
the 1980s (Gerber et al 1994; Edinboro et al in diabetic dogs, with the infected dogs having
2004). Common thyrotoxic complications are an increased incidence of bacteria in their urine
hypertension, heart failure and chronic kidney sediment, and a greater percentage of females
disease (CKD) (Gunn-Moore 2005). To the au- being present in the positive culture group
thors’ knowledge urinary tract infections (UTIs) (McGuire et al 2002). A retrospective study
have not been reported to be common in cats describing the clinico-pathological findings asso-
or humans with hyperthyroidism. ciated with CKD in cats showed a prevalence of
Multiple studies have been published on hu- bacterial UTI of 16.7% (DiBartola et al 1987).
mans with diabetes mellitus (DM) reporting Recently, Bailiff presented the preliminary
a high prevalence of bacteriuria and an increased results of a study assessing the prevalence of
risk for pyelonephritis (Geerlings et al 2000, 2001; UTIs in 879 cats seen at a university teaching
Ronald and Ludwig 2001; Stapleton 2002). Vari- hospital. The overall prevalence of UTIs was
ous publications also showed a high prevalence 15%; cats with DM had a prevalence of 13%,
of UTIs in humans with CKD, with asymptom- cats with CKD 18%, and cats with miscellaneous
atic bacteriuria being a common finding in these diseases had a 16% prevalence of UTIs. Of the
patients (Saitoh et al 1985; Rai et al 2002). In one miscellaneous group a small subdivision of cats
study the incidence of bacterial cystitis in 158 with hyperthyroidism had a prevalence of UTIs
dogs and 71 cats with DM was 12.7% in dogs of 24% (Bailiff et al 2004). However, many of
the cats were suffering from multiple conditions
*Corresponding author. Tel: þ1-607-253-4370; Fax: þ1-607-253- making conclusions about specific diseases and
3534. E-mail: rg225@cornell.edu their association with UTIs difficult. There was
1098-612X/07/020124+09 $32.00/0 ! 2006 ESFM and AAFP. Published by Elsevier Ltd. All rights reserved.Urinary tract infections in cats 125
also no attempt to correlate clinico-pathological were treated with radioactive iodine. Post iodine
data with the occurrence of UTIs in these cats. treatment blood work included CBC, serum
The goals of this study were to evaluate the chemistry panel and total T4. Concurrent renal
prevalence of UTIs in cats with three common failure was ruled out to the best of the authors’
diseases: hyperthyroidism, CKD and DM, and ability and cats were included only if the serum
to identify associations between the clinical pre- chemistry obtained following radioactive iodine
sentation, biochemical data, urinalyses and urine therapy demonstrated blood urea nitrogen and
culture results in those cats. serum creatinine concentrations within the refer-
ence range.
Materials and methods Cats with DM
Case selection The diagnosis of DM was also based on history,
clinical findings and laboratory data including
Medical records of cats with a diagnosis of hyper- a CBC, serum chemistry panel, and urinalysis.
thyroidism, DM and CKD presenting to Cornell Hyperglycemia (>140 mg/dl, 7.8 mmol/l) and
University Hospital for Animals (CUHA) from glucosuria, increased fructosamine concentration
January 1996 through December 2003 were (>325 mmol/l) and/or treatment with insulin
reviewed. Cats were enrolled if their medical had to be documented in the record for inclusion.
record documented a urine culture with urine
collected by cystocentesis or catheterization, Cats with CKD
a urinalysis and non-equivocal evidence of the
primary diagnosis. At CUHA a urine culture The diagnosis of CKD was based on history, clin-
was considered part of the basic diagnostic ical signs and laboratory data (CBC, serum
work-up in cats presenting with these diseases chemistry panel, and urinalysis). All cats in-
during the years of the study. Cats were excluded cluded in the study had to have increased blood
if there was evidence in the record of urethral urea nitrogen (>35 mg/dl, 12.5 mmol/l) and cre-
catheterization or treatment with antibiotics in atinine concentrations (>2.1 mg/dl, 186 mmol/l)
the month before presentation. Cats with concur- and a low urine specific gravity (USG) (126 B Mayer-Roenne et al
acid, ceftiofur, cephalexin, enrofloxacin, tetracy- urine sediment (P < 0.0001). These two variables
cline and trimethoprim/sulfonamide (TMS). were interrelated (P < 0.0001). No associations
Microscopic evidence of bacteria on evaluation were found with variables of the CBC and other
of the urine sediment was considered bacteriuria variables of the urinalysis. No additional associ-
and a positive urine culture was considered ations were found when including only cats with
a UTI. a markedly increased total serum T4 concentra-
tion (tT4 > 7.0 mg/dl) or only cats without prior
Statistical analysis methimazole therapy.
The prevalence of UTIs in each group and the
confidence interval (CI 95%) was calculated. Diabetes mellitus
The c2 test was used to look for an association
In the cats with DM concurrent disorders inclu-
between clinical signs of lower urinary tract dis-
ded feline asthma (n ¼ 4), hypertrophic cardio-
ease (LUTD) and positive cultures. Fisher’s exact
myopathy (n ¼ 3), corneal ulcer (n ¼ 2), hepatic
test was used to find associations between clini-
lipidosis (n ¼ 3), pancreatitis (n ¼ 5), cholangio-
cal signs and biochemical markers in blood tests
hepatitis (n ¼ 4), gastroenteritis or inflammatory
and urinalysis and UTIs in each group sepa-
bowel disease (n ¼ 6). These cats had also been
rately. Fisher’s exact test was also used to look
treated historically or concurrently with glucoco-
for interrelations when associated factors were
rticoids, or for eosinophilic granuloma (n ¼ 1),
found. A one-sided approach was chosen for
seizures (n ¼ 2), chronic respiratory infections
all questions. All data were divided into two
(n ¼ 1), stomatitis (n ¼ 1) and abscess (n ¼ 1).
groups, male and female, treatment and no treat-
Blood work was performed at the time of the
ment, physiological and pathological, values in
urine culture in 53 cats. The remaining four
reference range or above. Intact and neutered
had blood work performed at CUHA at other
cats were not separated for the purpose of anal-
presentations within the same year. Three cats
ysis. The cut off for defining low USG was cho-
had a blood glucose concentration within the ref-
sen by the authors at 1.020, and for high urine
erence range and five had no glucosuria. All had
pH at 7.5, because low USG and alkaline pH
been treated with insulin.
have been associated with a higher risk for bacte-
The prevalence of UTIs in cats with DM was
rial growth (Lees et al 1979). A P-value of less
12% (7/57; CI 3e22%). One cat was reported to
than 0.05 was considered significant. All statisti-
show dysuria and stranguria. No associations
cal analyses were performed using commercially
were identified between UTIs and female gender
available software (Statistix 8; Analytical Soft-
or UTIs and age >10 years. An association was
ware, Tallahassee, FL 32317-2185).
found between UTIs and bacteriuria (P < 0.0001)
and increased WBC (P < 0.0001). These two vari-
ables were interrelated (P ¼ 0.05). Associations
Results were also found between UTIs and low USG
Two hundred and twenty-four cats were (USG < 1.020) and glucosuria (P ¼ 0.01). No asso-
included in the study: 90 with hyperthyroidism, ciations were found with variables of the CBC and
57 with DM, and 77 with CKD (Table 1, Figs 1e5). other variables of the urinalysis.
Hyperthyroidism Chronic kidney disease
In the group of cats with hyperthyroidism two Concurrent diseases identified in cats with CKD
were reported as having signs of LUTD; one were heart disease (n ¼ 3), inflammatory bowel
with pollakiuria, one with hematuria. Twelve disease (n ¼ 3), fever (n ¼ 2) and seizures (n ¼ 1).
percent of cats had a positive urine culture (11/ Fifty-six cats had ultrasonographic findings con-
90: CI 5e20%). None had clinical signs of sistent with CKD; reduction in size and abnormal-
LUTD reported in their record, or abnormalities ities in shape and architecture of the kidneys were
in the CBCs or serum chemistry panels. An asso- reported. The rest of the cats did not have abdom-
ciation between UTIs and female gender inal ultrasound performed at CUHA. Serum
(P ¼ 0.006) was identified. No association was creatinine concentrations were measured at the
found with age greater than 10 years. An associ- same time as urinalysis and urine culture in 76
ation was found between UTIs and bacteriuria cats, the remaining cat had blood work performed
(P < 0.0001), as well as increased WBC in the at another visit within the same year. The meanUrinary tract infections in cats 127
Table 1. Signalment, history and clinico-pathological data from 224 cats
Hyperthyroidism Diabetes mellitus Chronic kidney disease
All With UTI All With UTI All With UTI
Total number 90 11 57 7 77 17
Female 52 10 21 3 39 14
Male 38 1 36 4 38 3
Age range (in years) 4e18 9e18 1e18 9e18 2e19 2e18
Age median (in years) 13.0 14.0 12.0 12.5 13.0 13.5
History
Polyuria/polydipsia 11 2 30 1 29 5
Signs of LUTD 2 0 3 2 6 4
Other health problems 0 0 23 0 11 4
Treated with methimazole 42 6 0 0 0 0
Treatment with steroids 0 0 6 0 0 0
Treatment with insulin 0 0 34 5 0 0
Complete blood count
Hematocrit decreased 3 1 2 0 25 6
Hematocrit increased 3 1 1 0 0 0
WBC increased 10 2 29 1 19 4
Left shift 1 0 14 3 10 2
Serum chemistry
Glucose1 >140 mg/dl (7.8 mmol/l) 10 1 50 3 16 5
Glucose1 >250 mg/dl (13.9 mmol/l) 0 0 42 2 0 0
Urea nitrogen2 increased 6 0 15 4 77 16
Creatinine3 increased 0 0 2 1 77 17
tT4*4 measured 83 9 31 2 31 6
tT4*4 increased 78 9 0 0 0 0
tT4*4 decreased 0 0 23 2 18 3
Mean tT4*4 in mg/dl (mmol/l) 11.6 (150) 13.4 (173) 1.1 (14) 0.6 (8) 1.4 (18) 1.4 (18)
Urinalysis
Gross appearance abnormal5 27 5 7 1 3 1
Urine specific gravity >1.020 82 11 47 2 5 2
Urine specific gravity mean 1.029 1.036 1.034 1.019 1.013 1.012
Urine dipstick
Glucosuria 6 (mild) 1 52 3 4 (mild) 2
Ketonuria 3 (trace) 1 10 1 0 1
Bilirubinuria 0 0 5 1 0 0
pH #7.5 10 2 3 1 5 0
Proteinuria #1þ 29 4 16 2 24 9
Urine sediment
WBC >5/HPF 4 2 4 2 13 11
Bacteria seen 14 8 6 5 14 14
Casts seen 6 0 5 2 6 1
Crystals seen 15 0 10 2 7 2
Urine collection
Cystocentesis 90 11 54 5 77 17
Catheterization 0 0 3 2 0 0
* ¼ Total T4, UTI ¼ urinary tract infection, LUTD ¼ lower urinary tract disease, WBC ¼ white blood cell,
HPF ¼ high-power field. Reference ranges: 1serum glucose 63e140 mg/dl (3.5e7.8 mmol/l); 2serum urea nitrogen
17e35 mg/dl (6.1e12.5 mmol/l); 3serum creatinine 0.7e2.1 mg/dl (62e186 mmol/l); 4total T4 1.5e4.0 mg/dl
(19.4e51.6 nmol/l); 5abnormal urine color and turbidity: orange, brown or red and cloudy or opaque.128 B Mayer-Roenne et al
100%
80%
60%
Negative culture
Positive culture
40%
20%
0%
e*
e*
e
e
e
e
al
al
al
al
al
al
em
-M
em
-M
-M
em
-F
-F
-F
T
KD
M
H
D
KD
M
C
T
D
H
C
Fig 1. Gender. HT ¼ hyperthyroidism, DM ¼ diabetes mellitus, CKD ¼ chronic kidney disease.
serum creatinine concentration was 4.3 mg/dl hematuria reported, six of these had UTIs. An
(range 2.2e19.2 mg/dl). association between UTIs and clinical signs of
Positive urine cultures were found in 22% of LUTD was identified (P ¼ 0.005).
cats with CKD (17/77; CI 12e32%). Four cats
were found to have signs of LUTD. An asso- Urine cultures and susceptibility
ciation between UTIs and female gender
The results of the 35 positive urine cultures are
(P ¼ 0.002) was identified. No association was
presented in Table 2. Thirty-two bacterial isolates
found between UTIs and age >10 years. An asso-
(89%) were sensitive to amoxycillin/clavulanic
ciation was present between UTIs and bacteriuria
acid with only two cases of Streptoccocus species
(P < 0.0001) and increased WBC seen in the urine
group D and two of Pseudomonas aeroginosa being
sediment (P < 0.0001). These two variables were
resistant at tested urine MIC. The only resistance
interrelated (P < 0.0001). An association was
to enrofloxacin was reported in one case of Strep-
also present between UTIs and glucosuria
tococcus species group D. Resistance was frequent
(P < 0.0001). No associations were found with
to ceftiofur and cephalexin, especially with the
variables of the CBC and other variables of the
genus Enterobacter faecalis. This genus also
urinalysis. Furthermore, no association was
showed in vitro intermediate sensitivities to enro-
found between UTIs and markedly increased
floxacin in five cases. Pseudomonas aeroginosa were
serum creatinine concentrations (>5.0 mg/dl).
highly resistant in both cases with reported sensi-
tivities to enrofloxacin.
Associations between urine cultures
and clinical signs
All cats with hyperthyroidism, DM and CKD Discussion
were combined to look for associations between A prevalence of bacterial UTI of 12% was identi-
UTIs and clinical signs of LUTD. Thirty-five of fied in hyperthyroid cats. However, urinalyses
224 cats had UTIs. Only 11 of the 224 cats had did not provide any common specific risk factors
signs of pollakiuria, stranguria, dysuria and/or for UTIs in this group. Glucosuria and low
100%
80%
60%
Negative culture
Positive culture
40%
20%
0%
*
*
*
PF
PF
PF
PF
PF
PF
H
H
H
/H
H
H
5/
5/
5/
5/
5/
>5
:>
:>
:
:
T:
T:
M
KD
M
KD
H
H
D
D
C
C
Fig 2. WBC seen in urine sediment. HPF ¼ high-power field.Urinary tract infections in cats 129
100%
80%
60%
Negative culture
Positive culture
40%
20%
0%
n
en
n
n*
n*
n*
e
e
ee
ee
e
se
se
se
se
:s
:s
ne
e
e
T:
on
on
M
KD
no
H
D
:n
:n
C
T:
KD
M
H
D
C
Fig 3. Bacteria seen in urine sediment. HT ¼ hyperthyroidism, DM ¼ diabetes mellitus, CKD ¼ chronic kidney disease.
specific gravity were a rare finding and when associated with immune compromise or in-
they occurred they did not appear to be associ- creased likelihood of infection in humans and
ated with a UTI. Mild proteinuria was found in rats (Botella-Carretero et al 2005; Johnson et al
one-third of the hyperthyroid cats. This may be 2005; Vinayagamoorthi et al 2005; Klecha et al
attributed to hypertension and increased glomer- 2006). Further studies are necessary to evaluate
ular filtration rate (GFR) or glomerular pressure. renal and immune system function of hyperthy-
Mild pre-glomerular proteinuria has been re- roid cats compared to healthy older cats to ex-
ported in the majority of thyrotoxic human and plain this apparent increased risk for UTIs.
feline patients because of increased GFR, espe- An increased prevalence of UTIs has previ-
cially if intrarenal or systemic hypertension is ously been suspected in cats with DM and
present (Ford et al 1989; Gunn-Moore 2005; CKD (Saitoh et al 1985; DiBartola et al 1987;
Langston and Reine 2006). Systemic blood pres- Kirsch 1998; Geerlings et al 2000; McGuire et al
sure and urine protein:creatinine ratios were 2002; Rai et al 2002). Low USG and glucosuria
not assessed in most cats in this study; therefore have been suggested to predispose diabetics to
further conclusions could not be drawn. No asso- bacterial UTIs (Lees et al 1979; Lees 1996). Our
ciation was found between proteinuria and pos- data showed significant associations between
itive urine cultures in this group of cats. As the UTIs and both factors in diabetic cats. Other fac-
mean USG was 1.029 in this group, compromised tors that have been suggested to play a role in the
renal function could not be completely ruled out pathogenesis of UTIs in humans and animals
as a factor in the pathogenesis of UTIs, though with DM are diabetic microangiopathy and im-
the mean USG of cats with UTIs was 1.036 and paired leukocyte function (Rayfield et al 1982;
no association was found between a low USG Forrester 1999; Stapleton 2002). Cats with CKD
and UTIs. Experimentally, thyroid hormones showed a positive association between UTIs
have been shown to modulate the immune re- and glucosuria. Increased blood glucose concen-
sponse, but hyperthyroidism has not been tration above the renal threshold for glucose
100%
80%
60%
Negative culture
Positive culture
40%
20%
0%
0*
0*
0
20
20
20
02
02
02
.0
0
.0
1.
1.
1.
1.
>1
>1
:>
T:
T:
F:
F:
:
M
M
H
H
R
R
D
D
C
C
Fig 4. Urine specific gravity (USG). HT ¼ hyperthyroidism, DM ¼ diabetes mellitus, CKD ¼ chronic kidney disease.130 B Mayer-Roenne et al
100%
80%
60%
Negative culture
Positive culture
40%
20%
0%
*
*
eg
g
s
eg
os
os
po
ne
:n
:n
:p
:p
T:
T:
KD
M
KD
M
H
H
D
D
C
C
Fig 5. Glucosuria (dipstick). *Significant association with positive urine culture. HT ¼ hyperthyroidism, DM ¼ diabetes
mellitus, CKD ¼ chronic kidney disease.
reabsorption could theoretically be the cause for No associations were found between increased
the glucosuria in these cats. However, none of blood leukocyte counts and UTIs. This is consis-
the cats in this group had an increase in blood tent with the notion that lower UTIs typically do
glucose of greater than 250 mg/dl (13.75 mmol/ not influence the results of routine blood tests
l), the value that is thought to be consistent (Osborne and Lees, 1995; Bartges 2004).
with the renal threshold in cats (Kruth and Cowgill Urinalyses were shown to be a useful predictor
1982). Therefore, renal tubular damage may be the for UTIs; there were associations between posi-
cause of glucosuria in these cats. It is unclear tive urine cultures and bacteriuria and increased
whether the association between glucosuria and WBCs in the urine sediment in all three groups.
increased risk for UTI is a result of the cats having Nevertheless, eight cats with UTIs had no bacte-
a potential proximal tubular disorder or the possi- riuria and six of these had no abnormal findings
bility that glucose, a good substrate for bacterial in their urine sediment. Therefore, urine cultures
growth in the urinary bladder, predisposes to were often necessary to diagnose UTIs in cats
UTI in cats with CKD regardless of the type of with these diseases, reinforcing the claim that
renal injury. quantitative urine culture is the gold standard
The DM group included cats with concurrent for identifying bacterial UTIs (Bartges 2004).
diseases including six with historical administra- The data in this study documented an associa-
tion of glucocorticoid therapy. Excluding them tion between UTIs and signs of LUTD in cats
would have severely limited our ability to assess with hyperthyroidism, DM and CKD. In older
UTIs in cats with DM. Their inclusion could have cats these signs are more likely to be associated
affected the prevalence of UTIs in this group but with bacterial infection compared to young cats
appeared not to, as none of these cats had UTIs at with the same presentation. It remains unclear
the time of urine culture. whether this is due to age, underlying disease
Table 2. Results of 35 positive urine cultures
Total number Hyperthyroidism Diabetes mellitus CKD
35 11 7 17
Genera of bacteria 37 12 8 17
Escherichia coli 17 (46.0%) 4 3 10
Enterococcus faecalis 10 (27.0%) 4 4 2
Staphylococcus species 2 (5.4%) 2
Streptococcus species 2 (5.4%) 1 1
Pseudomonas aeroginosa 2 (5.4%) 2
Enterobacter species 1 (2.7%) 1
Pasteurella multocida 1 (2.7%) 1
Proteus mirabilis 1 (2.7%) 1
Citrobacter freundii 1 (2.7%) 1
CKD ¼ chronic kidney disease.Urinary tract infections in cats 131
or a combination of the two (Bartges 2003). changes in blood work, or urinalysis indicating in-
However, of the 35 cats with UTI only six showed fection. Therefore, a urinalysis alone should not be
clinical signs of LUTD. More research in geriatric used to exclude UTIs in these cats and urine
cats without evidence of underlying disease is cultures are recommended. Antibacterial suscepti-
necessary to come to clear conclusions in this bility testing should follow every positive urine
matter. In the mean time it is reasonable to recom- culture. Of the antibiotics tested, amoxycillin/
mend searching for underlying endocrine or clavulanic acid seemed to be a good initial choice
metabolic diseases in older cats presenting with for the treatment of most Gram-negative and
lower urinary signs and/or UTIs. Gram-positive bacteria.
Significant associations between the female
gender and UTIs in cats with hyperthyroidism
and CKD were found. It is unclear why this could References
not be shown for cats with DM. Other studies in Bailiff N, Nelson R, Jang S, Westropp J (2004) Prevalence or
humans and in animals have shown a greater urinary tract infections in diabetic cats. In: Congress
prevalence of UTIs in females with DM (Patterson Proceedings 22nd ACVIM Forum, Minneapolis, MN,
and Andriole 1995; Kirsch 1998; Forrester 1999; Abstract 218. p. 863.
Ronald and Ludwig 2001; Stapleton 2002). A Bartges, JW (2003) Feline lower urinary tract cases. In:
Congress Proceedings 21st ACVIM Forum, Charlotte, NC.
shorter and wider urethra has been proposed to pp. 579e581.
be the reason for a higher risk of UTIs in females Bartges JW (2004) Diagnosis of urinary tract infections.
(Osborne et al 1979; Kirsch 1998). Veterinary Clinics of North America: Small Animal Practice
Urine culture results in this study are compa- 34, 923e933.
rable to previous studies. Infections caused by Botella-Carretero JI, Prados A, Manzano L, Montero MT,
Sancho J, Escobar-Morreale HF (2005) The effects of
Escherichia coli have been reported to account thyroid hormones on circulating markers of cell-mediated
for one-third to one-half of all organisms isolated immune response, as studied in patients with differenti-
from the urine of infected cats (Lees 1996). An ated thyroid carcinoma before and during thyroxin with-
additional study reported that bacteria belonging drawal. European Journal of Endocrinology 153, 223e230.
to nine different genera cause nearly 99% of UTI Davidson AP, Ling GV, Stevens F, Franti CE, Johnson DL,
Lang SS (1992) Urinary tract infections in cats: a retro-
in cats; Escherichia coli accounted for 52% of the spective study, 1977e1989. California Veterinarian 46 (5),
infections (Davidson et al 1992). In our study 32e34.
there were no major differences in the pattern DiBartola SP, Rutgers HC, Zack PM, Tarr MJ (1987) Clinico-
of distribution of the different genera of bacteria pathologic findings associated with chronic renal disease
in cats with hyperthyroidism, DM and CKD. in cats: 74 cases (1973e1984). Journal of the American Veter-
inary Medical Association 190, 1196e1202.
Of cultured bacteria 89% of the isolates were Edinboro CH, Scott-Moncrieff JC, Janovitz E, Thacker L,
sensitive to amoxycillin/clavulanic acid and 83% Glickman LT (2004) Epidemiologic study of the relation-
to enrofloxacin. Considering these results amoxy- ships between consumption of commercial canned food
cillin/clavulanic acid seemed to be a good first and risk of hyperthyroidism in cats. Journal of the American
choice antibiotic. Nevertheless a few very resistant Veterinary Medical Association 224, 879e886.
Ford HC, Lim WC, Chisnall WN, Pearce JM (1989) Renal
genera of bacteria were also found. Both the function and electrolyte levels in hyperthyroidism: uri-
human and veterinary literature recommend nary protein excretion and the plasma concentrations of
antibacterial susceptibility testing to choose an urea, creatinine, uric acid, hydrogen ion and electrolytes.
appropriate antibiotic therapy (Bartges 2004; Clinical Endocrinology 30, 293e301.
Wilson and Gaido 2004). This seemed especially Forrester SD, Troy GC, Dalton MN, Huffman JW, Holtzman
G (1999) Retrospective evaluation of urinary tract infec-
important in patients with underlying metabolic tions in 42 dogs with hyperadrenocorticism or diabetes
diseases, immune compromise, changes in urine mellitus or both. Journal of Veterinary Internal Medicine 13,
consistencies and therefore greater risk for persis- 557e560.
tent bacterial UTIs or pyelonephritis (Stamm and Geerlings SE, Stolk RP, Camps MJ, Netten PM, Hoekstra JBL,
Hooton 1993; Senior 2000). Bouter PK, Bravenboer B, Collet TJ, Jansz AR, Hoepelman
AIM (2000) Asymptomatic bacteriuria may be considered
In summary, this study showed a high preva- a complication in women with diabetes. Diabetes Care 23,
lence of bacterial UTI in cats with hyperthyroidism 744e749.
(12%), DM (12%) and CKD (22%). Associations Geerlings SE, Stolk RP, Camps MJ, Netten PM, Collet TJ,
were found between positive urine cultures and Schneeberger PM, Hoepelman AIM (2001) Consequences
clinical signs of LUTD, and between positive urine of asymptomatic bacteriuria in women with diabetes
mellitus. Archives of Internal Medicine 61, 1421e1427.
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