Crystals in urine

Hi all, I am fostering a young (10-12mo) cat named Fiona.  The rescue I work with pulled her from the death row list at a local animal shelter on April 26, and she has since been spayed, tested for FeLV, and vaccinated.

About 2 weeks ago, Fiona was diagnosed with urinary crystals after peeing outside the litterbox.  The urine had a lot of blood in it in addition to what the vet called 'crystal fragments.'  She sent us home with an antibiotic and Science Diet c/d.

A week later, I was still scooping lots of tiny urine clumps, which made me think she was still peeing too frequently.  Took her back to the vet--the blood was greatly reduced, but the crystals were still present.  This was last Wednesday.

I am still seeing these tiny clumps in her litterbox, and when I am in the room for long periods, I see her frequently going to the bathroom.  The vet said stress can be a factor, so I separated her from the other cats (she doesn't get along with them) and just try to spend lots of alone time with her.  I have also been feeding her the c/d (wet and dry) exclusively.

I guess I am just concerned since the crystals were still present, and she is still showing symptoms.  The vet made it seem like she would be good to go after that first visit--did not even recommend a follow-up, and when I took Fiona in a week ago, almost didn't check her urine because she thought the little clumps were nothing to worry about   At the end of that visit, she again said a follow-up was not necessary and to just 'see how it goes,' and that the only thing to do from there was an x-ray for bladder stones.  I am also a bit concerned about the food--I keep reading dry food of any kind is not recommended for cats with crystals, but this vet advised me to feed the dry c/d.  This is the vet associated with the rescue, not my personal vet, and I am contemplating taking her elsewhere.

I spoke to our organization's director about this, and she agreed that Fiona should have her urine checked again to follow up.  She wanted to wait 2 weeks, which would put us at midweek next week, but I want to be well informed before this next appointment.  I'm sure there are many of you here who have experienced crystals with your cats--do you have any advice for me?  If the crystals persist, does that necessarily mean bladder stones, or is there some other reason why they might not be going away?  Am I jumping the gun in thinking the crystals should have cleared up already?

If the crystals persist, it could mean the Science Diet c/d isn't working. 

WHY did the vet suggest a DRY food, when all studies point to water being really important in a cat who has crystals.

I understand this is the rescue organization's vet (who presumably is paid [not much] for by the rescue org), but I'd do some more research about the importance of a wet food diet for a cat this young to already be having crystals.  I kind of think the rescue org's vet dismissed you a bit too fast.

Ritz' peeing/no peeing/peeing pea size amounts cleared up within a few days of starting antibiotics.  I did not change her diet at all; I was feeding wet at the time (now I feed Raw).

And, yes, stress certainly can contribute to the problem:  do you have Feliway installed?

I wouldn't expect struvite crystals to be dissolved completely in one week, so their presence in urine is not unexpected. However, the blood in urine usually indicates bladder inflammation, so there's still some concern here. The c/d may not be strong enough. You may need s/d temporarily which has a higher level of methionine which is the active ingredient urine acidifier that keeps urine at the proper pH to dissolve and prevent struvites.

As Ritz said though, she needs lots of water to help flush out the sludge as struvites dissolve. Dry food of any kind is not going to help.

The alternative is to add l-methionine to the canned food of your choice and monitor urine pH at home.

First, you should definitely keep getting her urine checked until she is peeing normally. The vet should have had you bring her back for a recheck after about a week. She should not just have assumed the c/d would dissolve the crystals and all would be fine.

When my Jeta had struvite crystals I could tell within a day or two after starting the rx food (dry) that she was peeing more comfortably. After about 5 days she appeared to be fine. A recheck after a week showed the crystals were gone. I don't remember anymore which foods she was on but the first week it was a food that that would quickly dissolve the crystals but could not be fed long term. She was then switched to the "for life" food.

The reason Fiona is peeing a little bit at a time is because peeing is painful for her. Those crystals are like tiny little razor blades. Based on what you have said about the shelter vet I would seriously consider taking Fiona to a different vet, one that shows more concern about her condition.  

When a cat is prone to struvite crystals, increasing her water intake can help to prevent them. That is why wet food is considered better for them than dry food. But the rx foods, including the dry ones, are formulated to lower urine pH and that will dissolve the crystals. The wet form of the rx foods are better because of the hydration issue but some cats won't eat the wet. You can ask the vet for a can or two of the wet to see if Fiona likes it.

When you took Fiona to the vet  the second time you said she "almost didn't check her urine". So I assume she did check it?? Were there still crystals?

Thanks everyone for the input!

Ritz said:

If the crystals persist, it could mean the Science Diet c/d isn't working. 

WHY did the vet suggest a DRY food, when all studies point to water being really important in a cat who has crystals.

I understand this is the rescue organization's vet (who presumably is paid [not much] for by the rescue org), but I'd do some more research about the importance of a wet food diet for a cat this young to already be having crystals.  I kind of think the rescue org's vet dismissed you a bit too fast.

Ritz' peeing/no peeing/peeing pea size amounts cleared up within a few days of starting antibiotics.  I did not change her diet at all; I was feeding wet at the time (now I feed Raw).

And, yes, stress certainly can contribute to the problem:  do you have Feliway installed?

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Yes, from what research I've done so far, I am highly concerned about the dry food.  The vet did give me a few cans of wet c/d, so I have been feeding both.  I have been adding water to the wet c/d, just to supplement her water intake.  I definitely felt like this vet had a kind of dismissive attitude--perhaps because they treat these cats at a discount, who knows.  I don't want to disrespect anyone, but I'm thinking of asking the org director if there is another doctor we could see.  I have never used Feliway--is that the plugin that is supposed to calm stress? 

vball91 said:

I wouldn't expect struvite crystals to be dissolved completely in one week, so their presence in urine is not unexpected. However, the blood in urine usually indicates bladder inflammation, so there's still some concern here. The c/d may not be strong enough. You may need s/d temporarily which has a higher level of methionine which is the active ingredient urine acidifier that keeps urine at the proper pH to dissolve and prevent struvites.

As Ritz said though, she needs lots of water to help flush out the sludge as struvites dissolve. Dry food of any kind is not going to help.

The alternative is to add l-methionine to the canned food of your choice and monitor urine pH at home.

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Your first paragraph has made me feel even stronger that we need to see a different vet!  I feel like the s/d you mentioned should have been suggested at our last visit--or at least mentioned as a possibility if the crystals don't clear up.  I will keep that in mind when I take her for another recheck.  One question though--what are struvite crystals?  Are all urinary crystals struvite, or are there other types?

mschauer said:

First, you should definitely keep getting her urine checked until she is peeing normally. The vet should have had you bring her back for a recheck after about a week. She should not just have assumed the c/d would dissolve the crystals and all would be fine.

When my Jeta had struvite crystals I could tell within a day or two after starting the rx food (dry) that she was peeing more comfortably. After about 5 days she appeared to be fine. A recheck after a week showed the crystals were gone. I don't remember anymore which foods she was on but the first week it was a food that that would quickly dissolve the crystals but could not be fed long term. She was then switched to the "for life" food.

The reason Fiona is peeing a little bit at a time is because peeing is painful for her. Those crystals are like tiny little razor blades. Based on what you have said about the shelter vet I would seriously consider taking Fiona to a different vet, one that shows more concern about her condition.  

When a cat is prone to struvite crystals, increasing her water intake can help to prevent them. That is why wet food is considered better for them than dry food. But the rx foods, including the dry ones, are formulated to lower urine pH and that will dissolve the crystals. The wet form of the rx foods are better because of the hydration issue but some cats won't eat the wet. You can ask the vet for a can or two of the wet to see if Fiona likes it.

When you took Fiona to the vet  the second time you said she "almost didn't check her urine". So I assume she did check it?? Were there still crystals?

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I totally agree with that first paragraph!  I was very uncomfortable with not knowing for certain that the crystals were gone.  I agree that a different vet would be a good idea.  That poor baby, that must be awful.  All the more reason I can't believe this vet wasn't more proactive about treating her and making sure she was well.

I am glad your Jeta recovered so well!   I wonder if the first food was the s/d vball91 mentioned.  I am truly surprised the vet didn't give us something similar at our first visit--Fiona was practically peeing blood at that time.

The vet did give me a few cans of the wet c/d, and Fiona eats it just fine.  I add water to it, so that it's like soup, LOL.  I've went back for more but they are funny about giving me much of it--a few cans at a time, even though our org's director has repeatedly OK'd it.  I will talk to her (our director) about the wet being better, and see if maybe she can instruct them how much to give me

Sorry, I did not describe that timeline very well.  The first visit was on 5/21, and the second was on 5/29.  That was when the vet (who had not requested a follow-up) didn't want to check the urine, but I asked her to anyway, and crystals were still present.  Fiona hasn't been back for a recheck since--I was planning to take her next week.

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Thanks again for all of the info, everyone.  It certainly pays to do your research before going to the vet!

The term bladder stones is sort of a catch-all phrase. There are different kinds of stones/crystals that can form. The most common is struvite which is what s/d, c/d, and some other rx foods are prescribed for. They generally form in urine that is too alkaline, hence the rx foods that have the urine acidifier called methionine that is added. S/D has a higher level of methionine added and should only be used temporarily. C/D has lower levels of methionine and is meant to be used long-term. Personally I would just add methionine on my own while checking urine pH at home because the ingredients in both are not great, but they are known to work, so that's a choice.

81lives said:

I am glad your Jeta recovered so well!   I wonder if the first food was the s/d vball91 mentioned.

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It think so. I'm pretty sure the 2 foods were c/d and s/d. I couldn't remember which was the one used for just a week and which was the other and the Hill's web site wasn't any help.

 Personally I would just add methionine on my own while checking urine pH at home because the ingredients in both are not great, but they are known to work, so that's a choice.

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Just know there is a risk to this. Giving too much methionine can cause the urine to be *too* acidic which increases the risk of oxalate crystals. That is why the s/d can't be used long term. And oxalate crystals can't be dissolved, they have to be surgically removed. So, using methhionine means keeping a very close eye on urine pH. All of my litter boxes are out of sight. It would be difficult for me to catch Jeta in the act to test her urine. Of course  that won't be the case for everyone.

I think TCS member LDG (Laurie) uses methionine. If anyone is interested in her experience with using it I know she wouldn't mind a PM.