C09984120 / invoice 10000

Reason: Check Up & Cysto Urine If RequiredAppointment Notes: Overdue reminders  ------- Sms reply: YHistory: On CD multistress....Patient Information: - Date of examination: 04/03/2026 Subjective: - Presenting for discussion of recurrent urinary signs, including haematuria. - History of three bacterial urinary tract infections (UTIs) since April last year, treated with antibiotics. Episodes were approximately ten weeks apart. The second UTI was asymptomatic and diagnosed on a screening urine test. A recent episode of haematuria on Sunday prompted this visit. - Past medical history includes mild kidney disease. Previous investigations included multiple cystocenteses and urine tests. An in-house ultrasound in December was inconclusive for the kidneys. History of over-grooming of ears, possibly stress-related, which resolved after stopping antibiotics. - Current medications include Gabapentin as needed. - Diet is c/d Multistress dry food pellets and Fortiflora probiotic. Does not eat wet food. Appetite and drinking are normal. - Lives in a quiet environment with another cat, Bonzi, who also has a history of haematuria. Four litter trays are available, one of which is an ensuite. Uses a tray on the patio occasionally. No inappropriate urination reported. Objective: - Weight: 3.92 kg. - Urinalysis (recent): No bacteria detected. Blood present. Protein present (attributed to blood). Dilute concentration, consistent with kidney disease. Sediment is otherwise clean. Findings are similar to the December sample. - Bloods (12/12/2025): Creatinine 210 (high normal, consistent with early kidney disease). Phosphorus is within normal limits. Previous bloods from April showed creatinine of 180. Assessment & Plan:1. Recurrent Haematuria / Lower Urinary Tract Signs - Assessment: The clinical picture is complex. Haematuria is a consistent finding. The primary differential is sterile interstitial cystitis, which is common in cats. A low-grade, persistent bacterial infection (e.g., E. coli from a previous culture) is a possibility, though less likely. The mild kidney disease is a complicating factor, as it can predispose to UTIs and increases the risk if a bladder infection ascends. - Differential diagnoses: Interstitial cystitis, recurrent/chronic bacterial cystitis, urolithiasis (less likely). - Recommended diagnostics: This will help rule in or out an active bacterial infection. A repeat urinalysis will be performed at the same time. - Follow-up recommendations: Recheck in two weeks for cystocentesis and urine culture. The owner will monitor for any changes in urinary behaviour, such as straining, vocalising, or increased frequency in the litter tray. 2. Mild Chronic Kidney Disease (CKD) - Assessment: Stable early-stage kidney disease, as indicated by mildly elevated creatinine and dilute urine. Currently clinically well. - Treatment plan: No change in management at this stage. Continue current diet. A transition to a kidney-specific diet may be considered in the future if phosphorus levels increase or CKD progresses. - Follow-up recommendations: Continue monitoring clinical signs, particularly appetite and water intake. Additional Notes: - Owner education provided regarding the complexities of haematuria in cats, discussing the likely role of interstitial cystitis versus a potential underlying bacterial component. The rationale for performing another urine culture before considering further antibiotic therapy was discussed, including the risk of antibiotic resistance and the stress of medication. The current status of the mild kidney disease was explained, noting it is early-stage and the cat is currently stable. The limitations of a UPC test in the presence of haematuria were also explained. Use of Feliway was discussed as a potential adjunctive therapy for stress.    Vital Signs    Weight: 3.92;