Strange (conflicting?) urinary test results and symptoms

With apologies for the length of this, here is the situation:
 

About 6 months ago my kitty suffered from a complete urinary blockage (which I fortunately caught right away), and he ended up having a PU surgery when the doctors discovered that he had abnormal anatomy that made conventional urinary blockage treatments not a viable option.  The surgery went well, although the recovery process was a nightmare, and everything seemed to be going great, until...

...3 days ago, when I found him laying on the floor, shaking, and not responding to food/toys/etc.  I rushed him in to the emergency vet, and the found he had a fever of 104.6.  The vets immediately suspected a UTI, which I was warned would be much more likely after his surgery.  The initial urinalysis results came back and he had a very high pH (8.5) and protein in the sample (both strong signs of a UTI), but he also had a high USG (1.046), which is supposed to be a hostile environment for the development of bacteria, and the UA found no sediment in his urine, including bacteria.  He was kept overnight and given fluids and IV antibiotics, and within 24 hours his temperature returned to normal, he started eating again, and they sent him home with a prescription for antibiotics although they still thought that it was very unlikely he had a UTI given that they didn't find any bacteria during the UA (confirmatory culture still pending).

So, with all that background, I'm left with a million questions.  I don't understand how his urine pH could be so high if he doesn't have UTI, especially since post-surgery he has been exclusively eating Weruva canned food (Paw Lickin' Chicken and Mideast Feast varieties), both of which are grain free, very low carb, and very low phosphorus.  And if he doesn't have a UTI, where did this fever come from?  And why did it seem to respond so well to antibiotics?  He didn't have any injuries or wounds that could have been infected, and he's strictly an indoor kitty.  I know that high urine pH is not good for a cat's' urinary health, but short of feeding him the prescription diets, which he hates and which have a bunch of ingredients I don't like either, I don't know how to bring it down.  Maybe that isn't even necessary since the UA showed no crystals in his urine?  I'm really at a loss about what to do going forward. I have read everything I can find on the subject (including reading catinfo.org cover to cover, so to speak) and I just don't see anything that would explain what is going on with him or what I should do about it.

Any ideas or suggestions are most welcome!

Edit: Just after I posted this I heard from the vet that the culture confirmed that there was no bacteria in the urine.

That is a mystery. It may be that he had an infection elsewhere? I don't know why that would cause the high urine pH though...

I guess what I would in your situation is wait for him to recover fully from this incident and then run the urinalysis again to check urine pH and USG. If they are both normal then, I would attribute it to this illness, whatever it is. If the results are the same, then you know you have a potential issue to deal with.

Thanks for the response. I definitely will get him back to the vet for another urinalysis once the antibiotics are done. Part of what is frustrating me is that even if the results came back the same, none of the vets seem to have any reasonable explanation for what could be causing it, so I wouldn't even begin to know what to do next. The few explanations I've heard are completely unsupported by the facts. One vet suggested that maybe he naturally has a high urine pH, but his urine has been tested several times in the past year, and the only other time it tested in that range was when he definitely did have a UTI, caused by the attempts to insert the catheter before the PU surgery.  That time it was 8.0.  Both other times it was tested following the PU, including just a month ago in early March, the pH was 6.0.  Other explanations like "maybe he just had eaten a big meal" also don't fit, because one of the reasons I knew he was sick was that he hadn't eaten much since the previous morning, and nothing at all for the 12 hours before I brought him in.  

It's just so scary and frustrating not to have a single explanation that even remotely matches all the test results and facts.

When all else fails, some have had success using at-home urine test strips and Methionine, a urine acidifier. Obviously, it's important that you talk to your vet about this.

These two threads discuss using urine test strips and Methionine:

http://www.thecatsite.com/t/252702/angel-has-cystitis-again-3rd-time-in-5-mo-s (starting at post # 22 by @LDG)

http://www.thecatsite.com/t/254174/help-cat-with-flutd-and-nothing-is-working

This thread discusses other tactics:

http://www.thecatsite.com/t/270377/for-all-of-you-struggling-with-flutd-in-cats

I agree with vball91 that there could have been an infection elsewhere that caused the fever. Perhaps a complication from the surgery that still lingers? Its strange that the antibiotics were able to correct the situation so quickly however. As has been suggested, I too would wait and re-test the urine once your kitty is fully recovered from this current situation.

As far as the high urine PH, there are different causes for this besides diet such as stress! Your kitty has very likely been under an enormous amount of stress due to the attempts to catheterize him and on account of the surgery, which could explain the high urine PH at different times. Ultimately, its important to determine WHY your kitty's PH is rising, before starting any supplements or alternative treatments, and always in consultation with your vet.

As your kitty has been on antibiotics, it might be a good time to also give him some probiotics which will work to replenish the good bacteria that gets killed off by the antibiotics.

Hope he can make a full recovery! ...

GoHolistic said:

 
When all else fails, some have had success using at-home urine test strips and Methionine, a urine acidifier. Obviously, it's important that you talk to your vet about this.

These two threads discuss using urine test strips and Methionine:

http://www.thecatsite.com/t/252702/angel-has-cystitis-again-3rd-time-in-5-mo-s (starting at post # 22 by @LDG)

http://www.thecatsite.com/t/254174/help-cat-with-flutd-and-nothing-is-working

This thread discusses other tactics:

http://www.thecatsite.com/t/270377/for-all-of-you-struggling-with-flutd-in-cats

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If I understand correctly (the PU surgery was due to stones), then I absolutely agree with the above advice.

oneandahalfcats said:

 
I agree with vball91 that there could have been an infection elsewhere that caused the fever. Perhaps a complication from the surgery that still lingers? Its strange that the antibiotics were able to correct the situation so quickly however. As has been suggested, I too would wait and re-test the urine once your kitty is fully recovered from this current situation.

As far as the high urine PH, there are different causes for this besides diet such as stress! Your kitty has very likely been under an enormous amount of stress due to the attempts to catheterize him and on account of the surgery, which could explain the high urine PH at different times. Ultimately, its important to determine WHY your kitty's PH is rising, before starting any supplements or alternative treatments, and always in consultation with your vet.

As your kitty has been on antibiotics, it might be a good time to also give him some probiotics which will work to replenish the good bacteria that gets killed off by the antibiotics.

Hope he can make a full recovery! ...

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Catheterization alone can sure increase the risk for UTI's.  I've had human patients not have much of anything show up in UA's or C/S, yet they had UTI's.  Considering this kitty's stones history, I'd be concerned about whatever processes are going on that cause these stones (and thus high pH) as well.

You can test pH of urine now, and I'd be doing that now since this kitty has history of stones.  He has a shorter urethra now, but he still has a urethra that can get blocked again.

peaches08 said:

 You can test pH of urine now, and I'd be doing that now since this kitty has history of stones.  He has a shorter urethra now, but he still has a urethra that can get blocked again.

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Yes, testing urine with PH strips can be helpful to monitor levels, but as cats PH can change through the day, I don't find this to always be a very reliable source. Urinalysis is much more definitive in that it not only determines the presence of crystals and what concentration, but will also confirm USG, protein and leucocyte levels and whether there is any WBC in the urine.

@emuhawk : Somehow I missed this in your initial post : "The initial urinalysis results came back and he had a very high pH (8.5) and protein in the sample (both strong signs of a UTI), but he also had a high USG (1.046), which is supposed to be a hostile environment for the development of bacteria, and the UA found no sediment in his urine, including bacteria".

While the PH value above is definitely high, the USG is in the normal range which is between 1.015 and 1.060. Concentrations above 1.030 usually confirm normal kidney function. Its when the USG dips below say 1.012 on a regular basis that this can indicate a problem with concentration or the ability of the kidneys to produce a dilute urine. So the above value is normal, not abnormal.

I was looking at L-Methionine at one point for Thomas as we believe he may be predisposed to crystals, but I have since changed my mind about this in lieu of using Vit C which I think is safer. Vit C provides other benefits and any excess gets flushed out in the urine. But as Thomas is back to peeing up a storm, no need at this time for any further intervention, fingers crossed, beyond keeping an eye on the PH and getting routine urinalysis done.

@emuhawk, how is your kitty?

oneandahalfcats said:

 
Yes, testing urine with PH strips can be helpful to monitor levels, but as cats PH can change through the day, I don't find this to always be a very reliable source. Urinalysis is much more definitive in that it not only determines the presence of crystals and what concentration, but will also confirm USG, protein and leucocyte levels and whether there is any WBC in the urine.

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I agree that a urinalysis from the vet is the best diagnostic tool for evaluating urine. There is, however, the stress of the vet visits. And, as we all know, stress can be a major contributing factor to urinary issues. Also, the composition of the urine is what it is at the time of the urinalysis draw, as well, so I would actually think that twice-weekly testing of the urine with pH strips and logging it into a journal could actually give a better sense of the cat's pH and how it may fluctuate, while continuing with routine urinalysis (whatever time frame is best determined by the OP and his/her vet). The suggestion of using pH strips is not meant to replace veterinary diagnostics.

Thanks to all who have commented here.  Sorry I haven't replied earlier -- for some reason I wasn't getting notifications about responses until this evening.  

The fever seems to have stayed away since I brought him home from the hospital, at least according to the pediatric thermometer I purchased so I could monitor more closely at home.  I'm pretty sure my kitty now feels I have violated the fundamental trust between us by taking his temperature back there, but that's a whole other issue.

Unfortunately, even though the fever is gone, everything isn't back to normal.  He still isn't eating with what I would call his usual appetite and is sleeping more than usual.  And starting the day he came home from the hospital, I noticed he was itching his ears to the point he started creating bald spots.  The next day he started sneezing and gagging every so often.  And the day after that, he started having clear discharge out of one eye.  My vet now thinks he's having a herpes flareup due to the stress of being in the hospital, but this is the first time I've ever seen him have these symptoms.  Seems more like some sort of allergic reaction to me (but I'm certainly not the expert). 

My plan is to take him in to have another UA done next week once the antibiotics are finished and cleared out of his system.  If the pH comes back high again we'll have to do more investigating, but as long as no crystals are forming (which has been the result of the past 3 UAs he's had), I'm pretty happy as far as that is concerned.  I would sleep much better at night knowing what could have possibly caused the fever/pH elevation/high WBC in the first place, if not a UTI, and if he would stop itching and licking so much, but I suppose we have to take it one step at a time.  For now the plan is to finish the course of antibiotics, start giving him some lysine with his food in case it is herpes, and see how he does over the next few days.

On a potentially related note...has anyone ever had a cat with a potato allergy?  I realized when I was trying to figure out what could be causing an allergic reaction that both flavors of food I have been feeding him since his PU surgery are in a potato broth.  I know it's a common ingredient in elimination diets so it doesn't seem likely, but at this point I don't think there are any particularly likely explanations left for everything that is happening to him.  

I'm glad that the fever has not returned, but that you are still facing some challenges. What antibiotics is he on? Could he be having an allergic reaction to the antibiotics?

Cats can have an allergic reaction to almost anything, unfortunately. I'm pretty sure that my Sebastian is allergic to guar gum, and boy, what a trial-and-error that was. Typically, the top major food allergens are chicken, fish, grains and beef because they are used the most in cat food, but I've heard of cats being allergic to the carbohydrate source (i.e., peas) as well as additives.

Yikes guar gum - I can only imagine how tough that was to figure out and eliminate!  My boy is a pretty picky eater when it comes to wet food (he's a total dry food addict, even though he has no teeth), so the trial and error method is extra tough.  

The antibiotic he's on is marbofloxacin.  Tomorrow should be the last dose.  In the hospital they had him on IV ampicillin, but I would think any side effects from that should have worn off by now.  It certainly could be the marbofloxacin that is causing the problems, although that wouldn't explain all the licking and chewing at the PU site for the past couple of months.  One of the many frustrating things about this is that it's really hard to say how many separate-but-interacting issues we're dealing with here.

 I would sleep much better at night knowing what could have possibly caused the fever/pH elevation/high WBC in the first place, if not a UTI, and if he would stop itching and licking so much, but I suppose we have to take it one step at a time.

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Silent pyelonephritis turning into acute pyelonephtritis. The urine C&S will sometimes come back normal when you test for it. Which is when I curse my C&S results.

k

Dr Kris said:

 
Silent pyelonephritis turning into acute pyelonephtritis. The urine C&S will sometimes come back normal when you test for it. Which is when I curse my C&S results.

k

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Curious to know which antiobiotic you would use to treat the pyelonephritis?

emuhawk said:

 
Thanks to all who have commented here.  Sorry I haven't replied earlier -- for some reason I wasn't getting notifications about responses until this evening.  

The fever seems to have stayed away since I brought him home from the hospital, at least according to the pediatric thermometer I purchased so I could monitor more closely at home.  I'm pretty sure my kitty now feels I have violated the fundamental trust between us by taking his temperature back there, but that's a whole other issue.

Unfortunately, even though the fever is gone, everything isn't back to normal.  He still isn't eating with what I would call his usual appetite and is sleeping more than usual.  And starting the day he came home from the hospital, I noticed he was itching his ears to the point he started creating bald spots.  The next day he started sneezing and gagging every so often.  And the day after that, he started having clear discharge out of one eye.  My vet now thinks he's having a herpes flareup due to the stress of being in the hospital, but this is the first time I've ever seen him have these symptoms.  Seems more like some sort of allergic reaction to me (but I'm certainly not the expert). 

My plan is to take him in to have another UA done next week once the antibiotics are finished and cleared out of his system.  If the pH comes back high again we'll have to do more investigating, but as long as no crystals are forming (which has been the result of the past 3 UAs he's had), I'm pretty happy as far as that is concerned.  I would sleep much better at night knowing what could have possibly caused the fever/pH elevation/high WBC in the first place, if not a UTI, and if he would stop itching and licking so much, but I suppose we have to take it one step at a time.  For now the plan is to finish the course of antibiotics, start giving him some lysine with his food in case it is herpes, and see how he does over the next few days.

On a potentially related note...has anyone ever had a cat with a potato allergy?  I realized when I was trying to figure out what could be causing an allergic reaction that both flavors of food I have been feeding him since his PU surgery are in a potato broth.  I know it's a common ingredient in elimination diets so it doesn't seem likely, but at this point I don't think there are any particularly likely explanations left for everything that is happening to him.  

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Glad to read that he is doing much better .. My little female is currently on a course of clavamox/amoxicillin to correct a bladder infection due to, I am pretty certain, a stress reaction. I have a young tuxedo male who is always pestering Maggie. Her urinalysis did not feature crystals but there was some WBC in her urine. Her PH was 6.0. Her appetite is okay but her pee situation is slow in getting back to normal. It could be that the antibiotics that your kitty is on, is causing him to sleep more?

Dr Kris said:

 
Silent pyelonephritis turning into acute pyelonephtritis. The urine C&S will sometimes come back normal when you test for it. Which is when I curse my C&S results.

k

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Very interesting.  I wasn't familiar with the term, but I just did some reading, and while my boy certainly has some of those symptoms, wouldn't you expect his bloodwork to show abnormal kidney function if this was the case?  His BUN tested at 2.0 when he was in the hospital, not sure about other kidney-related results besides those I've already mentioned.

emuhawk said:

 
Yikes guar gum - I can only imagine how tough that was to figure out and eliminate!  My boy is a pretty picky eater when it comes to wet food (he's a total dry food addict, even though he has no teeth), so the trial and error method is extra tough.  

The antibiotic he's on is marbofloxacin.  Tomorrow should be the last dose.  In the hospital they had him on IV ampicillin, but I would think any side effects from that should have worn off by now.  It certainly could be the marbofloxacin that is causing the problems, although that wouldn't explain all the licking and chewing at the PU site for the past couple of months.  One of the many frustrating things about this is that it's really hard to say how many separate-but-interacting issues we're dealing with here.

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Here in a link to a factsheet on marbofloxacin (also know as zenoquin) : http://www.petmd.com/pet-medication/marbofloxacin-zeniquin, with information on side effects associated with this antibiotic.

@oneandahalfcats  Thanks for the info!  It does look like the decreased activity and nausea I'm seeing could be due to the antibiotic.  I'm hoping I'll see an improvement in at least those symptoms over the next few days.  If it is pyelonephritis like @Dr Kris  suggests, though, it sounds like he will have to be on antibiotics for quite a bit longer.

emuhawk said:

 
Very interesting.  I wasn't familiar with the term, but I just did some reading, and while my boy certainly has some of those symptoms, wouldn't you expect his bloodwork to show abnormal kidney function if this was the case?  His BUN tested at 2.0 when he was in the hospital, not sure about other kidney-related results besides those I've already mentioned.

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Yes, absolutely you would expect those bloodwork changes to show up. But alas - alot of these guys can go through this with the bloodwork and urine cultures coming back "silent". Very difficult and fustrating to diagnose. I can just imagine how scary it must have been finding him on the ground like that. If i suspect this as going on, Im often treating these guys for atleast one month. Your care for this guy is really amazing!

Good luck

k