Journal of Feline Medicine and Surgery (2010) 12, 606e608

doi:10.1016/j.jfms.2010.03.004

Retrospective study to characterize post-obstructive

diuresis in cats with urethral obstruction
Brenda J Francis DVM, Raegan J Wells DVM, MS, DACVECC, Sangeeta Rao BVSc, MVSc, PhD,
Timothy B Hackett DVM, MS, DACVECC*

Department of Clinical Sciences,
Colorado State University, #1678,
300 West Drake Road, Fort Collins,
CO 80523, United States
Date accepted: 8 March 2010
Urethral obstruction is a common medical emergency in cats. Frequency of
post-obstruction diuresis in cats following resolution of urethral obstruction is
unknown. The objective of this study was to document frequency and associated
clinical features of post-obstruction diuresis in cats. The records of 32 cats
undergoing 33 admissions to the Colorado State University Veterinary Hospital
for urethral obstruction were reviewed. Signalment, admission blood values,
fluid therapy, and urine output were recorded. Diuresis was defined as
urine output greater than 2 ml/kg/h. Post-obstructive diuresis occurred in 46%
(13/28) of cats within the first 6 h of treatment. Occurrence of post-obstructive
diuresis was statistically more likely in cats with venous pH < 7.35 on
admission. Urine production following resolution of urethral obstruction should
be monitored so that fluid therapy can be adjusted to the individual patient, as
many cats will have a higher fluid requirement secondary to post-obstruction
diuresis.
Ó 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

U
rethral obstruction is a medical emergency,
often accompanied by post-renal azotemia
and uremia.1 Cats may also have cardiovas-
cular signs resulting from fluid and electrolyte distur-
bances.2 In a recent study of cats with urethral
obstruction, 97% of cats underwent urethral catheter-
ization for at least 24 h following unblocking.2 Al-
though temporary catheterization is not a benign
therapy (it carries risks of infection and further
trauma), careful maintenance of a urinary catheter
may be required in some cats for 1e7 days following
resolution of urethral obstruction. Subsequent urine
output measurements may assist in the management
of these cases where an indwelling urinary catheter
is maintained, especially in those cats undergoing
post-obstructive diuresis.
The hallmark sign of post-obstructive diuresis is in-
creased urine production. Post-obstruction diuresis
probably results from a combination of physiologic
factors.3 Following resolution of urinary obstruction,
glomerular filtration rate and renal blood flow are re-
duced.3,4 Therefore, diuresis in the post-obstruction
period is secondary to impaired tubular reabsorption
of glomerular filtrate.3 Impaired tubular absorption
*Corresponding author. Tel: þ1-970-297-500; Fax: þ1-970-297-
1275. E-mail: tim.hackett@colostate.edu
may result from urea osmotic diuresis, expansion of
extracellular fluid volume, altered intrarenal physical
factors secondary to elevated intrarenal pressure, va-
sopressin insensitivity, and alterations in other natri-
uretic factors yet to be defined.3e6
While there are many theories as to the etiology of
post-obstructive diuresis, the prevalence and contrib-
uting risk factors have not been reported. The objec-
tives of this study were to describe the frequency of
post-obstructive diuresis following urethral obstruc-
tion in cats and to identify factors associated with its
occurrence. We hypothesized that onset of diuresis
in the post-obstruction period might be associated
with the magnitude of acidebase disturbance, hyper-
glycemia, calculated plasma osmolality, and/or azote-
mia on admission.
Materials and methods
Records were identified by computerized medical re-
cord search from 12/01/2002 to 12/01/2007 and cats
were included if they were admitted for hospitalization
due to urethral obstruction and underwent laboratory
blood analysis, urinary catheterization, and urine out-
put monitoring. Cats were excluded from analysis if
urinary obstruction was secondary to trauma.
Medical records were reviewed for cat signalment,
body weight, presenting clinical signs, and vital

1098-612X/10/080606+03 $36.00/0 Ó 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.
 Post-obstructive diuresis in cats 607

parameters (temperature, pulse and respiration). Ad-
mission venous blood pH, glucose, bicarbonate, and
creatinine concentrations were recorded. Blood pH
was defined as acidotic if <7.35 [reference interval (RI)
7.33e7.44], hyperglycemia was defined at >168 mg/dl
(9.32 mmol/l; RI 3.82e7.55 mmol/l), and bicarbonate
concentration was defined as low if <14 mEq/l
(<14 mmol/l; RI 13e22 mmol/l). Plasma osmolality
was calculated by the following equation where BUN
is blood urea nitrogen: 1.86(Na þ K) þ BUN/
2.8 þ glucose/18 and considered elevated if
>316 mOsm/kg. Decreased renal function was de-
scribed as serum creatinine concentration >2.0 mg/dl
(177 mmol/l; RI 88.4e203 mmol/l). An indwelling uri-
nary catheter was maintained in all cats. The urinary
catheter was connected to a sterile closed collection sys-
tem to keep the bladder empty and to quantify urine
production. Urine was measured every 6 h following re-
lief of urinary obstruction. The urinary bladder was
emptied at time 0 immediately after urethral flushing
and prior to the start of monitored collection. If a techni-
cal issue was encountered with the urinary catheter dur-
ing a time interval, such as dislodging of the catheter or
disconnection of the closed collection system, it was cor-
rected and that time point was excluded from analysis.
Diuresis was defined as a urine output of >2 ml/kg/h.
Cats were concurrently treated with intravenous fluid
therapy at rates higher than maintenance to match rate
of output following initiation of treatment. Rate and
type of fluid therapy were recorded.
Continuous data were tested for normality using
the ShapiroeWilk W test and reported as mean and
95% confidence interval (CI) or median and interquar-
tile range (IQR) as dictated by distribution. Bivariable
regression analysis using a generalized estimating
equation method was used to investigate if there
was an association between time interval and diuresis.
Repeated measurements performed on the same cat
were taken into account for the bivariable and multi-
variable regression analysis. Multivariable regression
analysis using a generalized estimating equation
method with binary distribution and logit link was
used to evaluate the association between baseline
acidebase derangement parameters and diuresis and
between baseline azotemia, elevated osmolality and
diuresis. The crystalloid fluid rate was included in
the model to account for the impact of fluid rate on di-
uresis. Statistical analysis was performed with com-
mercial software (SAS version 9.1, SAS Incorporated,
Cary, NC). Statistical analyses were considered signif-
icant at a P value of <0.05.
Results
The records of 32 cats undergoing 33 admissions for
urethral obstruction were identified. All cats were cas-
trated males and were classified as domestic shorthair
or domestic longhair breeds. Mean body weight of
cats (n ¼ 33) was 6.0 kg (95%CI: 5.4e6.6 kg). Median
admission temperature (n ¼ 31) was 99.8F (IQR:
98.9e101.0F). One cat’s temperature was too low to re-
cord. Mean admission heart rate (n ¼ 33) was 183 bpm
(95%CI: 163e198 bpm). Median admission respiratory
rate (n ¼ 30) was 38 bpm (IQR: 30e60 bpm).
Forty-six percent (13/28) of cats admitted for ure-
thral obstruction developed post-obstruction diuresis
during the first 6 h of urine collection and the percent
of cats affected by diuresis continued to increase
throughout the measurement period (see Table 1).
The likelihood of developing diuresis was significantly
higher during the time periods of 18e24 h (P ¼ 0.0006),
30e36 h (P ¼ 0.0044), 42e48 h (P ¼ 0.012), and >48 h
(P ¼ 0.0023) post-obstruction when compared to the
time period of 6e12 h post-obstruction. Median serum
potassium concentration on admission (n ¼ 33) was
4.2 mEq/l (IQR: 3.8e7.6 mEq/l; RI 3.5e5.2 mEq/l).
Mean ionized calcium concentration on admission
(n ¼ 22) was 1.19 mmol/l (95%CI: 1.03e1.25 mmol/l;
RI 1.3e1.4 mmol/l). Median venous pH on admission
(n ¼ 20) was 7.32 (IQR: 7.26e7.37; RI 7.33e7.44). Base-
line acidemia as defined by an admission blood
pH < 7.35 was significantly associated with diuresis
(P ¼ 0.0084). Cats with urethral obstruction were five
times more likely to be diuretic when they had concur-
rent acidemia. Median glucose concentration on admis-
sion (n ¼ 25) was 152 g/dl (IQR: 115e195 g/dl; RI
69e136 g/dl) [in SI units: 8.44 mmol/l (IQR:
6.38e10.82 mmol/l; RI 3.83e7.55 mmol/l)]. Mean

Table 1. Frequency of post-obstruction diuresis by urine collection time period among cats admitted for
urethral obstruction.
Cats post-obstruction Urine collection time (h)
6 12 18 24 30 36 42 48 54 60 66 72 78 84
Urine production # 15 8 3 1 0 2 1 0 1 0 1 0 1 0
<2 ml/kg/h % 54 36 13 5 0 12 9 0 13 0 20 0 25 0
Urine production # 13 14 20 19 13 15 10 9 7 6 4 3 3 3
>2 ml/kg/h % 46 64 87 95 100 88 91 100 88 100 80 100 75 100
Total 28 22 23 20 13 17 11 9 8 6 5 3 4 3
# ¼ Number of cats where data were available at this time point.
608 BJ Francis et al
bicarbonate concentration on admission (n ¼ 30)
was 15.7 mEq/l (95%CI: 14.5e17.0 mEq/l; RI
13e22 mEq/l) [in SI units: 15.7 mmol/l (95%CI:
14.5e17.0 mmol/l; RI 13e22 mmol/l)]. Presence of
hyperglycemia (P ¼ 0.29) and hypobicarbonatemia
(P ¼ 0.53) were not associated with diuresis. Median
serum creatinine concentration on admission (n ¼ 18)
was 4.1 mg/dl (IQR: 1.6e11.9 mg/dl; RI 1.0e2.0 mg/
dl) [in SI units: 360 mmol/l (IQR: 140e1050 mmol/l; RI
88e180 mmol/l)]. Baseline azotemia as defined by
serum creatinine > 2.0 mg/dl was not associated with
diuresis (P ¼ 0.78). Mean plasma osmolality at admis-
sion (n ¼ 13) was 333 mOsm/kg (95%CI:
316e351 mOsm/kg). Elevated calculated osmolality
defined as >316 mOsm/kg was also not associated
with diuresis (P ¼ 0.76).
Discussion
This study is the first to document the frequency of
post-obstruction diuresis in cats with naturally occur-
ring urethral obstruction. Most cats developed diuresis
following non-surgical resolution of obstruction, with
nearly half of cats displaying signs of diuresis within
6 h. Specific clinical variables associated with post-ob-
struction diuresis evaluated in this study were magni-
tude of acidebase disturbance, hyperglycemia,
calculated plasma osmolality, and azotemia on admis-
sion. The admission variables evaluated were chosen
as they clinically mirror disease severity. While serious
electrolyte abnormalities like hypocalcemia and hyper-
kalemia are known to occur with urethral obstruction,2
only acidemia was significantly associated with onset
of diuresis in this population. Acidemia has long
been recognized as the primary acidebase disturbance
associated with urethral obstruction in cats and as
a marker for the severity of disease.7
Though this study contains relatively small num-
bers of cats, several of them displayed signs of diure-
sis for up to 84 h following resolution of urethral
obstruction. Similarly, in an experimental model of
urethral obstruction in the cat, urine output more
than doubled following relief of obstruction and
neared pre-obstruction amounts after 4 days regard-
less of the presence or absence of crystalloid
Available online at www.sciencedirect.com
treatment.1 These two studies support the conclusion
that feline urethral obstruction may result in a signifi-
cant period of post-obstruction diuresis. The length of
diuresis may be more prolonged in cats undergoing
naturally occurring urethral obstruction that have ex-
perienced preceding episodes of partial obstruction or
have been obstructed for a longer time course, there-
fore, these cats should have urine output and fluid
balance monitored closely. Intravenous fluid replace-
ment at rates higher than normal maintenance may
be necessary in these cats to prevent a negative fluid
balance. Close attention to these parameters is espe-
cially important in cats with acidemia as low blood
pH was significantly associated with diuresis. Other
studies have documented variable times to resolution
of azotemia following fluid replacement which they
attributed to variable degrees of post-obstruction
diuresis.7 Inherent variability in the physiologic
responses of cats with naturally occurring urethral
obstruction underscores the need to monitor urine
production, hydration, and body weight in order to
individualize replacement fluid therapy to account
for increased urinary losses.
References
1. Finco DR, Cornelius LM. Characterization and treatment
of water, electrolyte, and acidebase imbalances of in-
duced urethral obstruction in the cat. Am J Vet Res 1977;
38: 823e30.
2. Lee JA, Drobatz KJ. Characterization of the clinical char-
acteristics, electrolytes, acidebase, and renal parameters
in male cats with urethral obstruction. J Vet Emerg Crit
Care 2003; 13: 227e33.
3. Kauker ML, Zawada ET. Post-obstruction diuresis: influ-
ence of renal prostaglandins. Nephron 1992; 60: 281e5.
4. Harris RH, Yarger WE. The pathogenesis of post-obstruc-
tive diuresis. The role of circulating natriuretic and di-
uretic factors, including urea. J Clin Invest 1975; 56: 880e7.
5. Narins RG. Post-obstructive diuresis: a review. J Am
Geriatr Soc 1970; 18: 925e36.
6. Klahr S, Harris K, Purkerson ML. Effects of obstruction on
renal functions. Pediatr Nephrol 1988; 2: 34e42.
7. Burrows CF, Bovee KC. Characterization and treatment of
acidebase and renal defects due to urethral obstruction in
cats. J Am Vet Med Assoc 1978; 172: 801e5.