1. Screening the Ageing Cat
Gary Coxon BVetMed MRCVS
Veterinary advisor
Vetoquinol UK and Ireland

2. Agenda Who/what are we looking for? History and physical exam
Urinalysis
USG
UP:C and proteinuria
Bloods and blood pressure
What to include/is it worth it?

3. Source – FAB expert panel- Well cat for life initiative
Senior/Geriatric?
Life Stage
Age
Kitten
0 - 6 months
Junior
7m – 2 years
Prime
3 – 6 years
Mature
7 – 10 years
Senior
11 – 14 years
Geriatric
15y +
Source – FAB expert panel- Well cat for life initiative

4. What Are We Looking For? ‘Old age’ CRF Hypertension Hyperthyroid
Osteoarthritis
Dental Disease
Senility
Reduced appetite
Reduced activity
Stiffness
Reduced interaction
Poor coat
Halitosis
Inappropriate toileting
‘Old age’

5. What Are We Looking For? ‘Sammy’ a 14yo FN DSH Sleeps a lot
Doesn’t jump
Lost weight
Eats really well
Can’t see
Smelly breath
‘But he’s getting on a bit now you know’

6. What Are We Looking For? ‘Sammy’ a 14yo FN DSH Arthritis
Hyperthyroidism
Hypertension
Dental disease

7. What Will it Cost? CRF History Hypertension Physical examination
Hyperthyroid
Osteoarthritis
Dental Disease
Senility
History
Physical examination
Weight
Urine specific gravity and dipstick
Blood pressure

8. History Thirst, halitosis, weight, V/D+ Wellness Questionnaire
under ‘Toolbox’
Activity, sociability
Mobility
Cat flap, stairs
Behavioural changes
Grooming, toileting, vocalisation
Appetite
Increased, decreased, more fussy
Thirst, halitosis, weight, V/D+

9. Physical Examination Coat condition Shine, scurf, matted Heart
Rate, murmur, gallop rhythm
Palpable goitre?
Eyes- retinal exam
Abdomen, thorax ...
Joints
Subtle changes in cats
Swelling, thickening, reduced ROM – usually absent

10. Body Weight Weigh every cat, every time it comes into the surgery
Cat scales in the consulting room
Record the weight!
Discuss changes in terms of % body weight
Convert to human terms if necessary

11. Urinalysis Cystocentesis Quick Easy Inexpensive Ideal for analysis
Fresh
Uncontaminated
Needs to have urine in bladder
Need two people
Owner collection
May be possible eg Katkor
Sample is adequate for
USG
Glucose
Blood
Protein?

12. Cystocentesis With/without US guidance
Cat immobilised by nurse in dorsal or lateral recumbency
Check bladder size
Shave and scrub skin over bladder region
Immobilize bladder with one hand
With the other hand, a fine needle (23 gauge, 5/8" long for cats) is introduced at an angle of 45° from the front to the back towards the neck of the bladder

13. Urine Specific Gravity
Normal cats urine is highly concentrated
Cats with CRF often maintain concentrating ability but it is reduced
USG< 1.030
Investigate for cause eg CRF, DM, hyperT
USG
Check on a second occasion
Can use as justification for recommending blood sample if not already included in senior check

14. Urine Dipstick Glucosuria Bilirubinuria Blood sample
Haematuria - Sediment
Proteinuria - Sediment, UP:C
LEUKOCYTES- DO NOT USE

15. Significance of Proteinuria
Always check urine sediment before interpreting proteinuria
UTIs common in female cats with low USG
Sterile cystitis common in cats with high USG
Proteinuria with inactive sediment
Only significant if persistent (2 samples 1w apart)

16. Urine Protein : Creatinine (UP:C)
Test run on urine to measure protein loss from the kidney
Can be done at external lab or on VetTest
Helps to determine if protein in urine is significant
Can detect smaller amounts of protein in urine than a dipstick
Must rule out other possible sources of protein loss eg bladder – do sediment exam ast
Can be used to
Detect early renal disease
Prognostic indicator
Guide treatment esp ACEi
Monitor response to treatment
Goes beyond the remit of senior check but it interesting for those that are keen to go further with tests

17. UP:C Values UP:C Value Substage Dogs Cats <0.2 Non-proteinuric
0.2 – 0.5
0.2 – 0.4
Borderline
>0.5
>0.4
Proteinuric

18. Persistent Proteinuria in CRF Cats
Negative prognostic indicator
50% survival time
UP:C >1 – 130 days
UP:C 0.2–1 – 300 days
UP:C< >1000 days
UP:C> Start ACEi
King et al, JVIM :906

19. Persistent Proteinuria
For all cats may be a warning sign of impending azotaemia?
95 non azotaemic ‘healthy’ cats >13y
30% developed azotaemia within 1 year
Proteinuria at presentation was significantly associated with the development of azotaemia
Jepson et al, JVIM :806-13

20. Proteinuria Summary Measuring proteinuria on dipstick has its pitfalls
Negative is probably non-proteinuric unless very dilute sample (but may miss early/mild proteinuria)
Positive needs confirmatory test eg UP:C

21. Blood Pressure Healthy Renal compromise Get nurses involved
mmHg
Renal compromise
<170 mmHg
Get nurses involved

22. Blood Tests Full blood count – or PCV Biochemistry
TP, Alb, Glob, U/C, ALT, ALKP
Glucose – if glucosuria
Phosphate, K+ - if evidence of CRF
T Bil – if yellow serum or bilirubinuria
FBA or BAST - if high liver enzymes
Total T4
Including blood panel-cost issue if in all or can offer discount as part of scheme following exam, urinalysis

23. Cost Vs Benefit What to include in senior check promotion?
Free/discounted consultation
Free urinalysis +/- katkor/cystocentesis
Free/discounted BP
Free/discounted bloods
E.g.
Free consultation and urinalysis (USG and dipstick)
Discounted BP
Discounted bloods – in house or external (lab support)
Because of work you should uncover- worth offering free consult

24. Benefit of Senior Promotion
40 ‘healthy’ cats >12y
6 has CRF
6 needed dental treatment
4 had UTIs
4 had low USG but normal creatinine
3 needed tx for OA
2 had liver dz
1 diabetic
1 hyperthyroid
Why not just at booster – not all vaccinated when over 12, not concentrating as much on issues