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Alternative therapeutic options for management of chronic or recurring urinary tract disease in the dog and cat (Proceedings)

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Nov 01, 2010

Although standard, mainstream, accepted therapy should always play a prominent role in treating patient problems, alternative therapeutic approaches can be valuable as adjunctive treatment options. Chronic or recurring urinary tract disease may benefit from alternative treatment options as discussed below.

Probiotics and Prebiotics

Probiotics are live microorganisms, which when administered in adequate amounts, confer a health benefit on the host. Prebiotics are defined as non-living, nondigestible food ingredients such as oligosaccharides which beneficially affect the host by selectively stimulating the growth of and/or activating the metabolism of one or a limited number of health promoting bacteria in the intestinal tract. When a probiotic is combined with a prebiotic for the purpose of producing a synergistic effect, the mixture is referred to as a synbiotic. Probiotics with or without prebiotics appear to have the most potential for use in dogs and cats as nutritional aids in the treatment and prevention of diarrhea. However, other organ systems besides the gastrointestinal tract may also benefit from the use of such supplements.

As a general rule, in order to be effective probiotics must be stable in storage and provide large numbers of microorganisms after surviving gastric transit. In addition, the microorganisms involved must be nonpathogenic, nontoxic, non-resistant to antibiotics, and incapable of being absorbed into the bloodstream following consumption. Probiotics are frequently administered with food. The microorganisms administered are only transient residents of the GI tract. Consequently, when probiotics are indicated, they must be administered on a continuing basis to achieve the desired effect. If given concurrently with an antibiotic, the probiotic should be administered at a different time of day than the antibiotic.

One synbiotic product (Azodyl®, Vetoquinol) has been marketed as a preparation that will lower the concentration of nitrogenous waste products (especially, BUN and creatinine) in the blood of canine and feline patients with chronic kidney disese (CKD) through enteric metabolism of uremic solutes by the probiotic organisms. This action, according to the marketing company, helps prevent further kidney damage and minimizes the clinical and biochemical consequences of declining renal function. Azodyl® is administered to patients as an enteric-coated capsule which contains Enterococcus thermophilus, Lactobacillus acidophilus, and Bifidobacterium longum as probiotic organisms and oligosaccharides as prebiotic agents. Although anecdotal and/or uncontrolled reports exist of reduction in azotemia in dogs and cats, the studies on which the company's claims are primarily based are nephrectomized rat and minipig models. A clinical study of cats with a placebo-control group has been conducted, but the results, as-of-yet, have not been published. An additional concern raised about efficacy of Azodyl® lies in the fact that this product can be difficult to administer to cats in its capsule form. Consequently, the contents of the capsule are frequently sprinkled on the feline patient's food for administration, raising the question of whether the probiotic agent will be sufficiently active to be effective following GI transit.

As of this writing, although Azodyl® would not be considered harmful to canine and feline patients with CKD, its efficacy in regard to the manufacturer's claims is questionable.

It has also been suggested that probiotics may aid in the prevention of oxalate urolith formation. Studies in humans and rats have shown a decrease in urine oxalate concentration with colonization of the intestinal tract with Oxalobacter formigenes, a microorganism that facilitates degradation of oxalate in the gut and leads to decreased excretion of oxalate in the urine. The potential for use of this organism as a means of reducing oxalate urolith formation in dogs and cats has not been investigated. Furthermore, the microbe which most consistently degrades oxalate in the gut, Oxalobacter formigenes, is not contained in the common probiotic preparations used in the dog and cat.