VNA Level II
Module 8: Therapeutic
Nutrition Lower
Learning Objectives
Urinary Tract Disease
Learning Objectives
After completing this module, your basic understanding should include:
• What the lower urinary tract does and how disease affects its function.
• Ways dietary mineral intake and other factors may predispose pets to urine crystals
and urinary stones.
• How intervention with nutritional aids such as Hill’s® Prescription Diet® s/d® Canine,
c/d® Canine, u/d® Canine, s/d® Feline and c/d® Multicare Feline may help manage
crystals and stones in the urinary tract.
• The features and benefits of Hill’s Prescription Diet brand products for lower urinary
tract disorders.
• Your vital role in promoting proper pet nutrition, as a way to help enrich and lengthen
the special relationship between people and their pets.
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Introduction
VNA Level II Module 8:
Therapeutic Nutrition
Lower Urinary Tract Disease
Introduction
Lower urinary tract diseases, (LUTD) are commonly seen in pets brought into
veterinary practices, and as such, are of concern to dog and cat owners, as well as
the veterinary health care team. Painful urination, blood in the urine, frequent
attempts to urinate, vocalization while urinating, and urinating in inappropriate
locations are common reasons why affected pets are presented. There are many
causes of LUTD, ranging from bacterial infections, urolithiasis (formation of stones
in the urinary tract), urethral obstruction (partial to complete blockage of the outflow
tract from the bladder), anatomic defects, prostate disease, cancer, trauma, etc.
Our focus here though, will be mainly on urinary tract stones (also called uroliths or
calculi) and urethral plugs, two categories that may often respond well to nutritional
therapy.
Signs of LUTD include painful urination,
blood in the urine, frequent attempts to
urinate, vocalization while urinating, and
urinating in inappropriate locations.
Because certain types of LUTD tend to recur, proper nutrition is a critical element
for managing these conditions in dogs and cats. Furthermore, nutrient
requirements may differ from one pet to another depending on the mineral
composition of crystals or stones in the urinary tract. This module will help you
communicate effectively with clients whose pets have LUTD, with an emphasis on
proper use of Hill’s® Prescription Diet® products.
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VNA Level II Module 8:
The Lower Urinary Tract
Therapeutic Nutrition
Lower Urinary Tract Disease
The Lower Urinary Tract
A pet’s urinary tract consists of two kidneys, two ureters that connect the kidneys to
the bladder, the bladder, and the urethra, the tube through which urine leaves the
body. The kidneys and ureters comprise the upper urinary tract. The bladder and
urethra comprise the lower urinary tract.
Figure 1. The dog and cat urinary tract
consists of two kidneys, two ureters, a
urinary bladder and a urethra.
The lower urinary tract functions to store and periodically release urine. The urinary
tract functions so that urine generally only flows one-way, from the kidneys, down
the ureters, into the bladder, and out the body through the urethra.
The urinary bladder and the urethra
comprise the “lower urinary tract”.
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VNA Level II Module 8:
The Lower Urinary Tract
Therapeutic Nutrition
Lower Urinary Tract Disease
The Lower Urinary Tract
The urinary system is designed to produce, store and periodically release urine,
(body wastes in a soluble, [liquid] form). Urine typically contains a number of
substances that are removed from the blood by the kidneys to try and maintain
body health. Among these substances are the breakdown products of protein
metabolism and excess minerals such as sodium, chloride, phosphorus (also
called phosphate), potassium, and others. Urine also contains substances that
usually inhibit minerals from forming crystals and crystals from adhering to one
another to form stones.
Urine is usually composed of about 95% water. However, the water content of urine
varies depending on how much water is in the body. Dehydrated pets and pets with
reduced water intake produce more concentrated urine. In general, cats produce
more concentrated urine than dogs. Urine concentration of soluble components is
important. For example, minerals that form crystals are more dispersed in dilute
urine; thus are less likely to form crystals and stones.
Urine is mostly composed of water, but
also contains breakdown products of
protein metabolism and excess minerals,
(which are excreted in the urine to
maintain body health).
It is important to make sure that all pets
have access to fresh, clean water, and that
they are consuming appropriate amounts
each day, (through the food, usually
canned), and from drinking water.
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VNA Level II Module 8:
Urine Crystals and Stones
Therapeutic Nutrition
Lower Urinary Tract Disease
Urine Crystals and Stones
The formation of stones in the urinary tract is called “urolithiasis”.
Urinary stones, (uroliths) may form in any part of the urinary tract. Most
of these, however, develop in the urinary bladder, since the bladder serves as a
reservoir for urine accumulation.
Uroliths form when urine is oversaturated with waste products,
(minerals) that are able to crystallize into stones and/or when the
substances that naturally inhibit stone formation are deficient
or ineffective. Urinary stone formation is complex and involves many factors, many
of which are not yet completely understood. Some factors thought to be involved
include increased urinary levels of minerals (stone components), metabolic
influences (some uroliths occur because
of metabolic problems), ingestion and intestinal absorption of minerals, urine pH,
and presence of urinary tract infections. Microscopic, (can’t be seen without the aid
of a microscope) precipitates in urine are called crystals. Stones are macroscopic
precipitates; that is, they can be seen without the aid of a microscope.
Figure 2. Photomicrographs of
common crystals found in urine
sediment. Source: Small Animal
Clinical Nutrition, 4th Edition.
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VNA Level II Module 8:
Urine Crystals and Stones
Therapeutic Nutrition
Lower Urinary Tract Disease
Urine Crystals and Stones
Uroliths may pass through various parts of the urinary tract, dissolve, enlarge, or become inactive (no additional
formation occurs). Small uroliths may enter from the urinary bladder into the urethra of male and female dogs when they
urinate. Female dogs, because of their relatively shorter and wider urethra, are often able to pass these stones without
difficulty. Uroliths may obstruct the urethra of male dogs partially or completely, thereby compromising or preventing
urine flow. Urethral plugs may similarly obstruct urine flow in male cats. Urethral plugs are usually composed of urine
crystals and a substance called matrix. Complete obstruction of the urethra is always considered a medical
emergency.
Figure 3. Different mineral types of
canine uroliths illustrating common
sizes, shapes and surface
characteristics. Source: Small Animal
Clinical Nutrition, 4th Edition.
Figure 4. A cross-section of a
matrix-crystalline urethral plug.
This phenomenon is analogous
to a gelatin salad that contains
various fruits or vegetables (i.e.,
crystals, cells, cellular material)
embedded in a gelatin matrix.
Source: Small Animal Clinical
Nutrition, 4th Edition.
Figure 5. Complete obstruction of
the urethra is considered a
medical emergency. Source: Small
Animal Clinical Nutrition, 4th
Edition.
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VNA Level II Module 8:
Urine Crystals and Stones
Therapeutic Nutrition
Lower Urinary Tract Disease
Urine Crystals and Stones
Many pets with risk factors such as metabolic defects or uncontrolled urinary tract
infections have recurrent episodes of urolithiasis.
The mineral composition of uroliths is especially important and is the basis for most
medical management. A brief description of the most common types of uroliths
follows.
Calcium oxalate is the most common
urolith in older cats. Struvite is the most
common urolith in dogs and younger cats.
Struvite, (magnesium-ammonium-phosphate) is the most common urolith in
dogs and younger cats. Struvite uroliths occur in dogs often in conjunction with
urinary tract infections. More alkaline or less acidic urine and high magnesium
levels in the food are risk factors (see below).
Calcium oxalate is the most common urolith of older cats, and the second most
common urolith in dogs. More acidic urine favors the precipitation of calcium
oxalate.
Figure 6. Struvite uroliths are the
most common stone seen in dogs
and younger cats. Source: Hill’s®
Atlas of Veterinary Clinical Anatomy.
Figure 7. Calcium oxalate uroliths are
the most common type seen in older
cats. Source: Hill’s® Atlas of Veterinary
Clinical Anatomy.
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VNA Level II Module 8:
Urine Crystals and Stones
Therapeutic Nutrition
Lower Urinary Tract Disease
Urine Crystals and Stones
Ammonium urate is a less common urolith in cats and dogs. Dalmatian and
English bulldogs have significantly higher incidence of these uroliths, as do cats
and dogs with certain blood vessel abnormalities in the liver.
Cystine uroliths are a less common urolith type that most commonly affects male
English bulldogs and dachshunds. A metabolic error that causes increased
amounts
of the amino acid cystine in urine is responsible for most cystine uroliths.
Other stones you may occasionally see in practice include:
• Calcium phosphate
• Silica
• Compound uroliths, (center is composed of one mineral type, whereas the outer
layers are composed of another).
Figure 8. Ammonium urate
uroliths. Source: Hill’s®
Atlas of Veterinary Clinical
Anatomy.
Figure 9. Cystine
uroliths. Source: Hill’s®
Atlas of Veterinary
Clinical Anatomy.
Figure 10. Silica uroliths.
Source: Hill’s® Atlas of
Veterinary Clinical
Anatomy.
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Risk Factors for LUTDVNA Level II Module 8:
Therapeutic Nutrition
Lower Urinary Tract Disease
Risk Factors for LUTD
The risk of stones forming in the urinary tract is greatest when there is a high
concentration of dissolved minerals in the urine. Foods high in certain minerals can
predispose to uroliths (more below) and inadequate water intake increases the risk
of uroliths. When a pet is dehydrated or does not consume adequate amounts of
water, its kidneys conserve water by producing concentrated urine. Bladder stones
may result from a longstanding bacterial urinary tract infection. Urinary tract
infections are common in dogs with urolithiasis, especially struvite stones. Urine
pH, (how acidic or alkaline the urine is) can affect the development of certain types
of bladder stones. Highly acidic urine favors calcium oxalate crystal formation. Less
acidic or alkaline urine favors struvite precipitation.
Age is also a factor, as depicted in Figure 11.
Bacterial urinary tract infections commonly
occur in dogs with urolithiasis, thus
appropriate diagnosis and treatment of the
infection (and stone type) is a critical part
of therapy.
Figure 11. The relationship
between urolith type and
age in cats. Note that the
struvite urolithiasis occurs
more frequently in young
cats, whereas calcium
oxalate urolithiasis occurs
more frequently in older
cats. Source: Small Animal
Clinical Nutrition, 4th
Edition.
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VNA Level II Module 8:
Important Nutritional Factors
Therapeutic Nutrition
Lower Urinary Tract Disease
Important Nutritional Factors
Water: Increasing water intake, (and thus urine formation) reduces the time crystal
components are in the urine and dilutes urine components that may crystallize.
Low urine volume increases the concentrations of all minerals that form uroliths,
and thus increases the risk of crystalluria. Many times, this can be mitigated by
feeding the appropriate Hills® canned pet food. Cats in particular, when fed canned
foods may drink little water, because they consume water in their food. Because of
the higher water content, canned foods have lower energy content by weight than
dry foods. Since, for the most part, cats eat to satisfy their energy requirement,
cats eating canned foods will often ingest more total water than when fed dry food.
This is probably also true of dogs.
Urine pH: Highly acidic urine favors calcium oxalate crystal formation. Less acidic
or alkaline urine favors struvite precipitation.
Figure 12. Supersaturation of urine with urolithforming constituents (e.g., calcium, oxalate)
results in crystal growth, aggregation and
ultimately urolith formation, if the components
are retained in the urinary tract. Source: Small
Animal Clinical Nutrition, 4th Edition.
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VNA Level II Module 8:
Important Nutritional Factors
Therapeutic Nutrition
Lower Urinary Tract Disease
Important Nutritional Factors
Salt (sodium chloride): While supplementing a pet’s regular food with salt can
increased water consumption and urine dilution, there are risks to random salt
supplementation. For example, excess salt may be associated with calcium oxalate
urolithiasis, high blood pressure, decline in kidney function and heart disease.
Figure 13. Schematic depicting
how increasing amounts of table
salt dissolved in water result in
under-saturated, metastable and
supersaturated solutions. Similar
phenomena occur with mineral
salts in urine. Source: Small
Animal Clinical Nutrition, 4th
Edition.
Magnesium: High dietary magnesium levels contribute to struvite formation.
Calcium and oxalate: Levels should be adjusted in relationship to calcium.
Protein: Moderate levels help limit the amount of phosphorus and ammonium
available for struvite uroliths.
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Diagnosis of LUTD
VNA Level II Module 8:
Therapeutic Nutrition
Lower Urinary Tract Disease
Diagnosis of LUTD
LUTD is usually diagnosed by the veterinarian based on the pet’s history, clinical
signs, veterinary physical examination, and results of diagnostic tests. Sometimes,
bladder stones can be felt during the physical exam on abdominal palpation.
Diagnostic tests frequently performed include urinalysis, urine culture for bacteria,
complete blood count, biochemistry tests (primarily for minerals such as calcium),
radiographs, and ultrasound. Quantitative analysis (determining the exact mineral
composition), of the urolith provides the most diagnostic, prognostic, and
therapeutic information. Uroliths should be sent to a qualified diagnostic laboratory
for quantitative analysis.
Uroliths should always be sent to a
qualified laboratory for quantitative
analysis.
The link below will take you to a pdf file for urolith analysis. The Minnesota Urolith
Center at the University of Minnesota College of Veterinary Medicine conducts, at
no charge, quantitative urolith analysis, supported in part by an educational grant
from Hill’s®.
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Level II Module 8:
Treatment and Prevention ofVNA
LUTD
Therapeutic Nutrition
Lower Urinary Tract Disease
Treatment and Prevention of LUTD
Depending on their type, uroliths may either be removed physically, (mechanically
or surgically) or dissolved. Keep in mind that many urolith types tend to recur after
they are removed surgically or dissolved, especially if no other therapy is instituted.
Therefore, urolith removal is often only the beginning of therapy; many dogs and
cats require preventive measures and follow-up diagnostic tests, (see below).
Formulating effective medical therapy for urolith dissolution, (dissolving the urolith
in the bladder through use of therapeutic foods and sometimes other therapy)
depends on the mineral composition of the urolith. Failure to analyze uroliths
quantitatively or otherwise determine the urolith’s mineral composition may lead to
incorrect and possibly harmful therapy.
Many urolith types tend to recur after they
are removed surgically or dissolved.
Therefore, urolith removal is often only the
beginning of therapy; many dogs and cats
require preventive measures and follow-up
diagnostic tests. Proper pet nutrition is a
prudent key component.
Figure 14. Series of radiographs of a 12-year-old spayed female German shepherd
crossbred dog, illustrating struvite urolith, (multiple) dissolution with Prescription
Diet® s/d® Canine. Sequential radiographs at diagnosis, 58, 97 and 127 days post
nutritional therapy respectively. As part of therapy, the antibiotic, ampicillin was
also administered. Source: Small Animal Clinical Nutrition, 4th Edition.
Your progress is saved. Slide 13 of 24
Level II Module 8:
Treatment and Prevention ofVNA
LUTD
Therapeutic Nutrition
Lower Urinary Tract Disease
Treatment and Prevention of LUTD
As mentioned above, water is a important nutritional factor for urolithiasis.
Generally, dogs and cats with uroliths should be encouraged to drink more water
during and after treatment for urolithiasis. Feeding the appropriate canned Hills®
pet food and placing multiple water bowls throughout the home encourage water
consumption, which helps dilute minerals in the urine. Advise owners to always
provide fresh, clean water for their pet.
Increasing water intake benefits pets with
urolithiasis. Feeding the appropriate canned
Hill’s® pet food is one approach.
Some uroliths are caused by bacterial urinary tract infections or are complicated by
infections that develop as a result of the urolith. Urinalysis and urine culture testing
are necessary to determine the bacteria involved and which appropriate
antimicrobial agents to utilize.
Specific nutritional aids and preventive measures for specific urolith types follow.
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Hill’s® Products Available as Nutritional
VNA Level II Module 8:
Aids in Treating LUTD:Therapeutic Nutrition
Lower Urinary Tract Disease
®
Hill’s Products Available as Nutritional
Aids in Treating LUTD:
CANINE
Click here to visit
Hill’s Key to Clinical Nutrition
Prescription Diet® s/d® Canine
Struvite Crystals and Stone Dissolution
Prescription Diet® s/d® Canine contains low levels of protein, magnesium and
phosphorus, and promotes the formation of a more acidic urine. The nutritional
characteristics, (features) have been shown to aid dissolution of struvite crystals
and uroliths, (benefit) without the need for surgical intervention.
Very low dietary intake of magnesium and phosphorus results in decreased urinary
concentrations of struvite building blocks. Very low protein intake and high sodium
intake increase urine volume, diluting the concentration of struvite forming
constituents in the urine. A more acidic urine pH increases the solubility of struvite
crystals aiding in the dissolution of struvite uroliths. Eradicating bacterial urinary
tract infections, (continuous antibiotic therapy is recommended during the entire
course of dissolution). Monitoring urine pH and urinalysis helps ensure
continuously acidic urine for successful treatment. The target urine pH- more acid,
(5.9-6.1).
Feeding other foods besides and/or in
addition to s/d® Canine during the struvite
dissolution period may delay or prevent
stone dissolution!
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Hill’s® Products Available as Nutritional
VNA Level II Module 8:
Aids in Treating LUTD:Therapeutic Nutrition
Lower Urinary Tract Disease
®
Hill’s Products Available as Nutritional
Aids in Treating LUTD:
Prescription Diet® c/d® Canine and w/d® Canine
Urinary pH of individual dogs may vary
due to several complicating factors
including time of feeding before urine
collection, type of urine collection and skill
of urine collector, individual pet variation
and test methodology.
A Nutritional Aid for Struvite Crystalluria and Urolithiasis:
Prescription Diet® c/d® Canine has low levels of struvite building blocks and
produces an acidic urine pH. These nutritional characteristics, (features) help to
prevent recurrence, (benefit) of struvite crystalluria, (crystal formation in the urine)
and urolithiasis. For obese-prone dogs with struvite crystalluria and urolithiasis,
w/d® Canine brand dietary food is a low calorie food with similar nutritional
characteristics. Target urine pH for both c/d® Canine and w/d® Canine- 6.2- 6.4.
Prescription Diet® Canine Treats are an excellent nutritional complement to c/d®
Canine and w/d® Canine.
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Hill’s® Products Available as Nutritional
VNA Level II Module 8:
Aids in Treating LUTD:Therapeutic Nutrition
Lower Urinary Tract Disease
®
Hill’s Products Available as Nutritional
Aids in Treating LUTD:
Prescription Diet® u/d® Canine
Urinary pH of individual dogs may vary
due to several complicating factors
including time of feeding before urine
collection, type of urine collection and skill
of urine collector, individual pet variation
and test methodology.
Urolithiasis- Calcium Oxalate, Urate and Cystine.
Prescription Diet® u/d® Canine contains very low levels of calcium, protein and
nucleic acids, and promotes the formation of an alkaline urine pH. These nutritional
characteristics aid in the management of non-struvite uroliths and crystals.
Your progress is saved. Slide 17 of 24
Hill’s® Products Available as Nutritional
VNA Level II Module 8:
Aids in Treating LUTD:Therapeutic Nutrition
Lower Urinary Tract Disease
®
Hill’s Products Available as Nutritional
Aids in Treating LUTD:
FELINE
For Struvite Stone and Crystal Dissolution: Prescription Diet® s/d® Feline helps
eliminate struvite crystals and uroliths from the urinary tract by reducing urinary
concentrations of struvite components and allowing maintenance of a more acidic
urine pH. After the initial feeding period, (usually two to three months) c/d® Feline
or w/d® Feline veterinary exclusive pet food may be used to help avoid recurrence
of Feline LUTD, (FLUTD).
Prescription Diet® s/d® Feline
For Initial Management of Struvite LUTD: Prescription Diet® s/d® Feline helps
eliminate struvite crystals and uroliths from the urinary tract by reducing urinary
concentrations of struvite components and allowing maintenance of a more acidic
urine pH.
Your progress is saved. Slide 18 of 24
Hill’s® Products Available as Nutritional
VNA Level II Module 8:
Aids in Treating LUTD:Therapeutic Nutrition
Lower Urinary Tract Disease
®
Hill’s Products Available as Nutritional
Aids in Treating LUTD:
After the initial feeding period, (usually two to three months) c/d® Feline or
w/d® Feline veterinary exclusive pet food may be used to help avoid recurrence of
Feline LUTD, (FLUTD).
If FLUTD should recur when only c/d® Feline or w/d® Feline is being fed, change to
s/d® Feline and monitor appropriately. Because of the increased acidifying effect of
s/d® Feline, it is not recommended for long-term maintenance of routine cases of
FLUTD where c/d® Feline is adequate to avoid recurrence.
Urinary pH of individual dogs may vary
due to several complicating factors
including time of feeding before urine
collection, type of urine collection and skill
of urine collector, individual pet variation
and test methodology.
Your progress is saved. Slide 19 of 24
Hill’s® Products Available as Nutritional
VNA Level II Module 8:
Aids in Treating LUTD:Therapeutic Nutrition
Lower Urinary Tract Disease
®
Hill’s Products Available as Nutritional
Aids in Treating LUTD:
Prescription Diet® c/d® Multicare Feline and w/d® Feline
Urinary pH of individual cats may vary due
to several complicating factors including
time of feeding before urine collection,
type of urine collection and skill of urine
collector, individual pet variation and test
methodology.
For Struvite Management: c/d® Multicare Feline contains reduced building blocks
of struvite and produces a normal acidic urine pH. These nutritional characteristics,
(features) help to prevent, (benefit) recurrence of struvite crystalluria and
urolithiasis, an important contributor to FLUTD. For obese-prone cats with struvite
crystalluria and urolithiasis, w/d® Feline brand dietary food is a low calorie food with
similar nutritional characteristics. Target urine pH for both c/d® Feline and w/d®
Feline- 6.2-6.4.
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Urethral Plugs
VNA Level II Module 8:
Therapeutic Nutrition
Lower Urinary Tract Disease
Urethral Plugs
Restoring urine flow and stabilizing obstructed male cats is paramount. Because
struvite is the most common mineral type in urethral plugs, feeding affected cats,
(especially younger cats) for prevention of struvite crystals as mentioned above
may help prevent recurrences. As always, results of a urinalysis should dictate
therapy. Increasing water consumption and treating bacterial urinary tract infections
are important aspects of prevention. Review Figure 5.
For more information about LUTD, see Chapters 20 and 21 in Small Animal Clinical
Nutrition, 4th ed., the Hill’s Key to Clinical Nutrition, and www.HillsVet.com.
Your progress is saved. Slide 21 of 24
VNA Level II Module 8:
Monitoring patients with LUTD
Therapeutic Nutrition
Lower Urinary Tract Disease
Monitoring patients with LUTD
Monitoring is a critical aspect of treatment and prevention. Generally, radiographs
should be taken every two to four weeks to monitor dissolution of bladder uroliths.
Uroliths should become progressively smaller with successful therapy. Foods used
for dissolution of uroliths are commonly fed for one month after no evidence of
bladder stones can be seen on a radiograph. Review Figure 14.
Other tests are also useful for monitoring dissolution of uroliths. On urinalysis, urine
pH should change to reflect the food being fed. Urine crystals, red and white blood
cells, bacteria, and other abnormal urine constituents should decrease
progressively. Urine should become less concentrated when canned foods are fed,
or if the pet owner is successful in encouraging increased water intake. Recall from
Level I, Module 1 (Nutrients) that foods with increased amounts of protein produce
more waste products for the kidneys to excrete. Nutritional aids for dissolving and
preventing recurrences of uroliths often have reduced amounts of protein to
increase urine volume and reduced precursors of certain uroliths. As a
consequence, pets exclusively eating such foods may have decreased protein
breakdown products in their blood and urine. Blood urea nitrogen (BUN) levels may
decrease from what is normal for the pet. All of these tests can be used to help
determine whether a client is complying with your practice’s feeding
recommendations. Ideally, through effective communications, they should be.
Foods used for dissolution of uroliths are
commonly fed for one month after no
evidence of bladder stones can be seen
on a radiograph.
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VNA Level II Module 8:
Monitoring patients with LUTD
Therapeutic Nutrition
Lower Urinary Tract Disease
Monitoring patients with LUTD
Because uroliths may recur without consistent health care team follow-up, (proper
long-term therapy and pet owner adherence to recommendations) periodic
diagnostic studies are important. Radiographs and urinalyses may be necessary
every one to three months to monitor the effectiveness of prevention. Remember,
surgically removing or dissolving uroliths is not the endpoint of treatment.
Prevention and monitoring are equally important.
Results of diagnostic studies can help
determine whether clients are complying
with your practice’s communications for
prevention of LUTD. Surgically removing
or dissolving uroliths is not the endpoint of
treatment! Prevention and monitoring are
equally important.
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VNA Level II Module 8:
Therapeutic Nutrition
Lower Urinary Tract Disease
Summary / Are you ready?
Summary
Pet owners bringing dog and cats into a veterinary practice because of urinary
tract problems are relatively common occurrences. Your understanding of lower
urinary tract problems and your ability to effectively communicate can help clients
appreciate their pet’s situation, reinforcing the veterinarian’s recommendations for
diagnosis, therapy and long-term care. Hill’s® has a variety of Prescription Diet®
products that are extremely efficacious in helping manage LUTD, assisting you in
your efforts in being an advocate for the pet’s best interest!
Are you ready?
To continue, you will need to complete the quiz for this module. When you are
ready, click on the forward arrow below to take you to the quiz.
Your progress is saved. Slide 24 of 24
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