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Bengal brothers with elevated creatinine - need input!

Bengalgirl3
August 31st, 2010, 11:01 AM
Hello. First post here. I brought my 2 bengal boys (brothers from same litter...will be 6 on October 2) for dentals on August 13. The vet ran a mini-profile, prior to anasthetic. She called me back to say the dentals were off since both had elevated creatinine! She further stated that since 2 brothers were presenting with similar blood work, she suspected a genetic disease such as Polycystic Kidney Disease (PKD).

3 days later a complete urinalysis and UPC were done. I also sent off cheek swabs to UC Davis for genetic testing to rule out PKD1. Last Thursday, blood pressures were done. Here are all the results (numbers in parentheses represent reference values from the lab).

I should note that the boys came to me at 3 months of age, fed Iams dry. Zoomer vomited daily. I then did my research and switched to better dry, then ok wet, and now premium grain-free wet. Since cutting out Innova Evo canned last year, Zoomer has not vomited once. They each eat 5.5-6oz/day and a scant 1/8 cup premium grain-free dry at night (mix of Taste of the Wild and Acana Grasslands).

Both are enthusiastic drinkers/peers, and have always been. Tigger is 19 pounds and the vet estimates he should be 17, Zoomer is 18 pounds and the estimated healthy weight is 16.5 lb. They are extremely muscular boys, typical of the Bengal breed (mix of African Leopard cat and other breeds).

Ok, here are the test results:

Zoomer:
HCT = 41.4% (24-45)
HGB = 13.5 g/dL (8-15)
MCHC = 32.6 g/dL (30-36.9)
WBC = 10.30 K/uL (5-18.9)
GRANS = 5.40 K/uL (2.5-12.5)
%GRANS = 52.4%
L/M = 4.9x10^9/L (1.5-7.8)
%L/M = 48%
PLT > 205 K/uL (175-500)
ALKP = 39 U/L (14-111)
ALT = 39 U/L (12-130)
BUN/UREA = 28 mg/dL (16-36)
CREATININE = 2.9 mg/dL (0.8-2.4) HIGH
GLUCOSE = 131 mg/dL (74-159)
Total Protein = 8.2 g/dL (5.7-8.9)
Chloride = 128 mmol/L (112-129)
Potassium = 5.0 mmol/L (3.5-5.8)
Sodium = 166 mmol/L (150-165) HIGH

Urinalysis:
USG = 1.043
Glucose = negative g/dl
Bilirubin = negative
Ketone = negative mg/dl
Blood = negative
pH = 7.0
Protein = 100 mg/dl
Urobilinogen = normal units/dl
Sediment = squamous ephithelia cells: 0 to 5/40 pf, WBC 0 to 1/40 ph,
renal tubular cells occasional/40 pf
Comments = good urine concentration
Urine protein/creatinine ratio = 0.017

DNA testing: PKD1 = negative

Blood pressure = 149/67


Tigger:
HCT = 42.4% (24-45)
HGB = 14 g/dL (8-15)
MCHC = 33 g/dL (30-36.9)
WBC = 7.6 K/uL (5-18.9)
GRANS = 4.9 K/uL (2.5-12.5)
%GRANS = 64.5%
L/M = 2.7x10^9/L (1.5-7.8)
%L/M = 36%
PLT = 427 K/uL (175-500)
ALKP = 46 U/L (14-111)
ALT = 24 U/L (12-130)
BUN/UREA = 28 mg/dL (16-36)
CREATININE = 2.7 mg/dL (0.8-2.4) HIGH
GLUCOSE = 166 mg/dL (74-159) HIGH but very stressed at vet
Total Protein = 7.8 g/dL (5.7-8.9)
Chloride = 127 mmol/L (112-129)
Potassium = 4.3 mmol/L (3.5-5.8)
Sodium = 163 mmol/L (150-165)

Urinalysis:
USG = 1.050
Glucose = negative g/dl
Bilirubin = negative
Ketone = negative mg/dl
Blood = negative
pH = 6.5
Protein = 100 mg/dl
Urobilinogen = normal units/dl
Sediment = squamous ephithelia cells: 0 to 3/40 pf, RBC occasional. WBC
occasional/40 pf
Comments = well concentrated urine
Urine protein/creatinine ratio = 0.014

DNA testing: PKD1 = negative

Blood pressure = 133/71

The vet recently confered with an internist in Toronto. His opinion is that due to their high protein diet and more muscular nature, slighly elevated creatinine is normal for Tigger and Zoomer.

Any thoughts/opinions? I am getting a full blood panel done prior to the dentals to get phosphorus and calcium values, and double check the creatinine. If anything else is off, I do plan on getting ultrasounds done....

Love4himies
August 31st, 2010, 11:59 AM
Normally with kidney disease, you will get increased BUN and phosporus (I don't see a phosphorus level, but the BUN looks great) and your cat's urine specific gravity looks good, meaning the kidneys are doing their job.

High Creatine without the high BUN can also be signs of Diabetes and Hyperthyroidism.


Why would your vet think PKD???

Bengalgirl3
August 31st, 2010, 01:11 PM
No phosphorus yet, but we'll get that when a full panel is run before the dentals. The vet thought PKD since 2 brothers are presenting with similar trends. She thought it might be a genetic disease, hence PKD1. Fortunately, they were both negative for this gene!

How are diabetes and hyperthyroid diagnosed? Are those just standard blood tests? Since I'm having a full panel done, if any additional tests need to be done now would be the time for me to write up a "list" to discuss with their vet...

14+kitties
August 31st, 2010, 01:18 PM
This sounds like a good thread for Dr Lee. I will PM him. :thumbs up

Bengalgirl3
August 31st, 2010, 01:29 PM
Here are the canned foods the boys currently eat in a week (each eats 5.5-6oz/day): 3 cans Wellness Chicken, 3 cans Wellness Turkey, 1 can Natural Balance Duck & Green Pea, 1 can Natural Balance Venison & Green Pea, 1 can Natural Balance Chicken & Green Pea, 1 can California Natural Salmon & Sweet Potato, 1 can either Evangers Organic Turkey & Butternut Squash OR By Nature Organics (chicken, turkey, or a combination), 1 can Nature's Variety Instinct Rabbit, 1 can Nature's Variety Instinct Lamb, and finally 1 can Nature's Variety Instinct Venison OR Duck.

For dry they each get a scant 1/8 cup dry before bed. I mix Taste of the Wild and Acana (Grasslands variety).

Lastly, all foods are 100% grain-free and by-products free....

The internist my vet spoke to thought that the elevated creatinine could be due to high muscle mass and/or high protein diet....

Love4himies
August 31st, 2010, 01:54 PM
Nomally a high protein diet will affect BUN, but not so much creatinine. However, as your boys are large they may have higher cre naturally.

Hyperthyrodism is normally done on separate blood work and sent out to a lab.


Have you ever had blood work done on them in the past to compare?

Bengalgirl3
August 31st, 2010, 02:16 PM
No, the boys are only 5 years old and otherwise super healthy so no testing has ever been done on them before....

Dr Lee
August 31st, 2010, 07:06 PM
1) ...the BUN looks great and your cat's urine specific gravity looks good, meaning the kidneys are doing their job.

High Creatine without the high BUN can also be 2) signs of Diabetes and 3) Hyperthyroidism.

These are common ideas. However let me clarify a bit and the interaction of BUN, Creatinine, Urine Specific gravity, Diabetes, Hyperthyroidism can be super confusing sometimes! I agree with you Love4himes but need to clarify some of these points:

1) While dogs will lose their concentrating ability early in renal (kidney) disease, most cats do NOT lose their concentrating ability until late in the stage of renal disease. In light of the creatinine, Zoomer's concentration is not actually that high - for a cat. BUN is a function of protein metabolism and renal filtration. So I agree, most of the time, renal disease will have a rise of both creatinine and BUN, BUN can vary a lot upon protein intake (diet).

2) If you have DKA (diabetic ketoacidosis), then the ketones can falsely elevate creatinine. Dehydration that arises from some diabetics can also raise creatinine. However with negative glucose and ketones on the urinalysis combined with no real (Tigger's 167 is from stress, not DM) elevation in blood glucose; creatinine cannot be caused from diabetes in this case.

3) You are correct, uncontrolled hyperthyroidism can alter creatinine levels but it will LOWER creatinine, not raise it. When cats are on active treatment for hyperthyroidism, then creatinine can rise if there is existing renal disease. So there is not a direct relation here.

The concern with Zoomer and Tigger is two fold: elevated creatinine (2.9, 2.7 respectively) and proteinuria (100mg/dl in both). For these reasons I think that your vet was very wise to consult an internist. The fact that your vet performed very thorough blood, urine testing and blood pressure, was worried about PKD due to the familial link and contacted an internist is indeed a wonderful thing. I would give this vet a lot of kudos!!! As proverbs says, ”it is the wise that seek counsel”. :highfive:

What is creatinine? :shrug:
“Creatinine is a breakdown product of muscle exertion. You may have heard of ATP (Adenosine TriPhosphate). ATP is the basic unit of energy in the body and the ‘fuel’ that drives most cells. When ATP is used, it turns into ADP (Adenosine DiPhosphate). Like a dead battery, ADP can be ‘recharged’ into ATP. Muscles (and the brain too) use phosphocreatine (sometimes called creatine phosphate) to regenerate ATP after muscular (and neuronal) exertion. This regeneration creates creatine which passively turns into creatinine. Thus creatinine is produced at a consistent rate in relation to the muscle mass of the body and eliminated at a consistent rate by the kidneys. Thus blood creatinine is based upon a direct relationship between kidney filtration (also known as Glomerular Filtration Rate GFR) and total body muscle mass. Assuming that the body muscle mass stays the same, if the creatinine rises, then a drop in the GFR has occurred.” – Silent Spiral: Kidney Disease in Cats – an Owner’s Guide. Author: me (Dr Lee).



Since creatinine is a function of both muscle mass and kidney function – muscular animals with normal kidneys can have slightly elevated creatinines and animals in renal failure who have lost muscle mass – can have a reduction in their overall creatinine.

Furthermore, in cats, an ideal creatinine is 1.1 and definitely less than 1.6. Many specialists disagree with the reference range of cats being up to 2.6. According to IRIS, cats are in stage II/IV renal disease from 1.6 – 2.8. So 2.6 is actually closing in on Stage III/IV!! For more information, please see: IRIS – International Renal Interest Society. (http://www.iris-kidney.com/index.shtml)

With that said, we cannot put on blinders and look at creatinine. We must also look at BUN, Phosphorus, physical condition, urine specific gravity, urine protein, UPC ratio, and oh, yeah, the cat too! :crazy:

The second concern for me is the urine protein. Your vet did a great job by running a urine protein creatinine UPC ratio. Normal dogs and cats should have a UPC ratio < 0.4. Zoomer and Tigger are 0.017 and 0.014.



So when we add up the wonderful work up by your vet, I would agree the lab data other than the creatinine looks good. I would have also wanted an internist’s opinion before I placed a cat with 2.9 and 2.7 creatinines as “normal”. I would also agree with your vet’s caution even with such evaluation. I think that the checking of phosphorus, calcium and repeating creatinine is a very good idea. I think keeping close contact with the internist is also a good idea. If money is not an issue, I think that an ultrasound is good idea perhaps along with rechecking the creatinine in a few months. (I would get your vet’s recommendation on this since she seems to be doing a great job!).

Hope that helps. :pawprint:

Bengalgirl3
September 1st, 2010, 09:19 AM
Hello and thank you so much for your input, Dr. Lee! Your thorough explanations are very appreciated given that I'm new to all this and still educating myself.

My vet also consulted with experts at Hills (pet food) and yet another internist. The concensus now amongst all is that we go into this assuming the beginnings of renal failure, but hoping of course for nothing!

I'm bringing both brothers in for full abdominal ultrasounds ASAP. Also, the vet(s) suggested very slowly transitioning to lower protein/phosphorus foods (not "kidney" diets per say, but lower such as Hills G/D and Hills T/D (also have bad tartar issues). We will retest via a full bood panel in 1 month. I'm to closely watch for any symptoms and report anything to my vet immediately.

At this point, given the above current test values, what further testing would you recommend? I've heard of a "E.R.D. (early renal damage) healthscreen urine test" that can detect renal failure much earlier than other testing. Is there any value to having this done for Tigger and Zoomer?

Again, many thanks for your expertise! :thumbs up It's a huge relief given how much conflicting information I've received over the past few weeks....

Dr Lee
September 1st, 2010, 08:12 PM
The concensus now amongst all is that we go into this assuming the beginnings of renal failure, but hoping of course for nothing!

I'm bringing both brothers in for full abdominal ultrasounds ASAP. Also, the vet(s) suggested very slowly transitioning to lower protein/phosphorus foods (not "kidney" diets per say, but lower such as Hills G/D and Hills T/D (also have bad tartar issues).

At this point, given the above current test values, what further testing would you recommend? I've heard of a "E.R.D. (early renal damage) healthscreen urine test" that can detect renal failure much earlier than other testing. Is there any value to having this done for Tigger and Zoomer?.

I think this is a good plan. Creatinines at this level are disconcerting but again, much of the other values are looking good.

Hill's G/D is a very good food. Think of it as a transition between regular and kidney diets. It has more protein than k/d but is moderate in its levels. G/D has restricted phosphorus, restricted sodium, some pH balance, supplemental omega 3 to help improve kidney blood flow and supplemental potassium. The food is also all natural - no artificial preservatives. I wrote an article that may be helpful, "Is There Science in Science Diet?". It goes over some common misconceptions of the diet. The key to switching to this diet is to go very, very slowly. It is generally recommended to slow transition over a month or more.

The ERD Test is a great screen and it looks for microalbuminuria. In English, this means we are looking for presence of a blood protein called albumin being found abnormally in the urine. When present it is often representative of kidney damage. This test would be a good idea. Even when the UPC is normal (<0.5), and a ERD is positive (even low positive), it is still supportive of abnormal presence of blood albumin in the urine (microalbuminuria) and suggests that monitoring for renal and/or systemic diseases is indicated.

Typically this test must be done a couple of times to make sure that we are seeing a consistent elevation. The exact significance of microalbuminuria however is not completely clear as many cases that are positive do not necessarily progress to end stage renal failure. There are other causes of a positive microalbuminuria other than renal disease so sometimes additional tests may be needed. When positive, it is more evidence that there may be a problem and that nutritional changes should be made.

I hope this helps and I am glad that my earlier post was clear. :pawprint:

growler~GateKeeper
September 2nd, 2010, 03:56 AM
The abdominal ultrasounds are a great diagnostic tool, see if you can get them to take a quick peek at their hearts at the same time (just for normal reference & not to have to do it again separately if needed). Hopefully your clinic allows you to be present at the ultrasound, I found that a great experience especially since you can ask questions & get instant feedback. It is also wonderful to have the vet explain any abnormal findings along the way.

Here's a little reading for you on glomerulonephritis:
http://www.felinecrf.org/causes_of_crf.htm#glomerulonephritis
http://www.marvistavet.com/html/body_glomerulonephritis.html

and proteinuria:

http://www.felinecrf.org/diagnosis.htm#proteinuria
http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2010&Category=&PID=56122&O=Generic

As for diet here's my :2cents: I would stick with the Wellness Chicken & Wellness Turkey as they both already have low phosphorus levels :thumbs up

drop the Natural Balance the phos levels are far too high for kidney related issues
drop the California Natural Salmon & Sweet Potato the phos levels are too high for kidney related issues

Unfortunately Evangers, By Nature & Nature's Variety don't post their nutrient analysis :frustrated: so I can't check the phos levels in their foods and unless there has been a formula change since I fed NV Instinct a couple of years ago the Rabbit & Beef are too high in phos, likely the Venison, Lamb & Duck are as well.


To stay within your grain/by products free wish other foods with good low phos numbers: EVO 95% Chicken & Turkey, Felidae Grain Free Salmon, Felidae Grain Free Cat & Kitten, Wellness Kitten, Wellness Beef & Chicken, Wellness Core Chicken, Turkey & Chicken Liver.

While not grain free but by product free and still with good low phos numbers: Felidae Platinum, Eagle Pack Holistic Select Turkey & Barley, Eagle Pack Holistic Select Duck & Chicken, Eagle Pack Holistic Select Chicken & Lamb, Felidae Chicken & Rice.

There are plenty of high quality holistic low phosphorus foods perfect for feeding kidney cats that one does not need to resort to the prescription diets.

Bengalgirl3
September 2nd, 2010, 08:18 AM
Thanks again Dr. Lee! I picked up some Hills T/D dry last night and added just 4 nuggets to their pre-bed snack (1/8 cup total). Both cats gobbled it up and no vomiting since (concern with Zoomer who has a delicate digestive system) so I'll tentatively call this one a success. Today I get some Hills G/D canned. I didn't realize that canned needed a slow introduction as well, so that's good to know.

I will push my vet for the ERD test, if possible. At this point I want to pursue any "early detection" testing that I can, within reason since this is stressful to the boys. I'm booking their ultrasounds today, hopefully for next week. So within 1 week I hope to get a much clearer picture of what is really going on!

Bengalgirl3
September 2nd, 2010, 08:28 AM
Thanks so much for chiming in, Growler! I've read your entire thread and have a great deal of respect for your experience with CRF, so I was really hoping to get your input.

I have been researching the issue of diet extensively and do plan to also include premium grain-free in their diet. It's just so hard to find the information on some of these brands! I'm a big fan of Nature's Variety Instinct and By Nature Organics, but no data....so frustrating. I guess to be on the safe side I should exclude any foods that I can't find phosphorus numbers on.

EDIT: did more digging and found out that Nature's Variety Instinct canned venison has 2.6% phosphorus and chicken is 1.2% phosphorus. By Nature Organics are in the "mid to high 300s mg/100kCal". I'm assuming Evangers is also elevated so all 3 of these brands are not "officially" out of rotation.

So far in premium grain-free canned in 5.5 oz sizes (no fish/seafood, no beef, brands I can find in Ontario Canada) I have also come across Merrick Turducken, Merrick Thanksgiving Day Dinner, and also the "Addiction" line (exotic meats such as buffalo).

On that note, has anyone ever heard of "Addiction"? See here: http://www.addictionfoods.com/usa/products.php
Apparently the entire canned cat food line has 45.45% protein, 1% phosphorus, and 27.27% fat. Hmmm....I think I can get this ordered in IF it really is as great a product as it seems. Just curious to get input....

growler~GateKeeper
September 3rd, 2010, 01:00 AM
I have been researching the issue of diet extensively and do plan to also include premium grain-free in their diet. It's just so hard to find the information on some of these brands! I'm a big fan of Nature's Variety Instinct and By Nature Organics, but no data....so frustrating. I guess to be on the safe side I should exclude any foods that I can't find phosphorus numbers on.

It is definately safer to stay away from the foods you can't find info on, however you can always email the companies to see if they will give it to you, always better to explain you have cats with potential kidney issues etc gives them a little more push to give up the goods. Some companies are better than others when it comes to customer service, Wellness & Eagle Pack for example have been outstanding with providing full nutritional data :thumbs up, whereas a few years ago when I contacted Nature's Variety for their actual numbers I was just directed to their website which only lists mins & maxs :shrug:

EDIT: did more digging and found out that Nature's Variety Instinct canned venison has 2.6% phosphorus and chicken is 1.2% phosphorus. By Nature Organics are in the "mid to high 300s mg/100kCal". I'm assuming Evangers is also elevated so all 3 of these brands are not "officially" out of rotation.

Depends on where you're getting the info from, the KatKarma food data pages and the Janet & Binky food data pages are about 3-5 years old, be sure to check the dates at the top/side of the data.

Some of the manufactures websites only lists min and max values which isn't accurate enough for the conversion.

This list is current but not complete yet, still in progress: http://www.felinecrf.org/canned_food_usa.htm#food_data_tables, the dates are all listed at the end of each food flavour row

What you are looking for is no higher than a maximum of 1.25% dry matter phosphorus, this works out to about 240-245mg/100kcal anything over 1.25% or 245mg/100kcal is too high.

If the Nature's Variety Instinct Venison has 2.6% phosphorus that is excessively high and should not be fed to any cat with any hint of renal issues. If their Chicken is current at 1.2% dry matter phos then it's good to feed.

By Nature Organics at "mid to high 300mgs/100kcal" is too high, you don't want anything higher than 245mgs/100kcal. The By Nature 95% Beef & Beef Liver is good @ 1.09% dm phos as per Tanya's list above, all the rest of their flavours are either not listed or too high.

Evangers is not yet reported on the list, nor do they have it on their site so their numbers are all unknown.

So far in premium grain-free canned in 5.5 oz sizes (no fish/seafood, no beef, brands I can find in Ontario Canada) I have also come across Merrick Turducken, Merrick Thanksgiving Day Dinner, and also the "Addiction" line (exotic meats such as buffalo).

Does one or both have issues with or dislikes beef?

Those two flavours of Merricks both have good phos levels.

On that note, has anyone ever heard of "Addiction"? See here: http://www.addictionfoods.com/usa/products.php
Apparently the entire canned cat food line has 45.45% protein, 1% phosphorus, and 27.27% fat. Hmmm....I think I can get this ordered in IF it really is as great a product as it seems. Just curious to get input....

Never heard of it before :shrug:, one thing I don't like about their ingredients is the amount of protein vs everything else, I would prefer to see more than 1 protein source listed. Also they don't mention what kind of "broth" and what animal the "liver" comes from.

These are listed as 1% phos which is good, the other flavours are too high
Addiction Safari Buffalo Meatloaf
Addiction Herbed Duck Confit & Sweet Potatoes
Addiction Black Forest Rabbit & Blueberries
Addiction Turkey with Cranberries & Apples
Addiction Hunters Venison Stew

I do however have to wonder about the rabbit - usually rabbit is very high in phosphorus.

Bengalgirl3
September 5th, 2010, 04:04 PM
Thanks Growler! Yes, if I add beef flavors and allow some grains, the list grows quite a bit. I was looking at some flavors of Weruva which have phosphorus under 1.25% (i.e. Polynesian BBQ, Mack and Jack, Mideast Feast, Mediterranean Harvest, Meow Luau) BUT they are also extremely high protein (75%). What do you think about feeding these to potentially early CRF kitties?

growler~GateKeeper
September 6th, 2010, 04:49 AM
I think I might be okay with that high level of protein as a once a month kinda thing except for the fact they're mostly all tuna based. http://www.felinecrf.org/which_foods.htm#fish

Bengalgirl3
September 7th, 2010, 08:17 AM
Oh. So out goes Weruva. Well, I cut the list down to ones with no by-products, protein under 50%, sodium under 0.5%, phosphorus under 1.25% so it narrowed things down quite a bit! I'm assuming there's no physical reason that CRF cats can't eat seafood/fish, other than the potential for addiction. If I hear otherwise, well down goes the list of canned cat food yet again. Still, I'm impressed that there are so many options. :thumbs up

On a positive note, By Nature Organics had their numbers reported just last Friday! Phosphorus = 0.68%, Protein = 45.45%, Sodium = 0.23% for all 4 flavors. Ironic since I was sending a bunch of brands back with my sister (I bought them where she lives, 400 km away!) when I just happened to check Tanya's list and there it was! I quickly hauled the cans back into the house so that was a close call....

growler~GateKeeper
September 9th, 2010, 03:17 AM
Regarding the fish, aside from the addictivie potential, any cat that eats am exclusive/near exclusive fish diet is at higher risk of developing steatitis (yellow fat disease), which is caused by a Vitamin E deficiency, there is also the risk of vit b1 deficiency. Fish is also lacking taurine an esseitial amino acid that helps maintain proper fat digestion, eye sight, heart health, & good nervous system.

Fish as a treat is okay I :2cents: would feed no more than once every one-two weeks, even better if there is another non-fish protein source ie Turkey & Salmon etc

Great numbers for the By Natures Organics :thumbs up & nice timing too :highfive:

Bengalgirl3
September 9th, 2010, 08:53 AM
Yeah, I was ecstatic on the By Nature since my boys' old rotation is down to just Wellness turkey and chicken! Not much variety so knowing that By Nature is ok is a big bonus.

I'll keep the fish to just 2 out of 14 meals/week. The ones I hope to be able to locate are: Wellness Beef & Samon, By Nature Organics Chicken & Mackerel, Solid Gold Chicken, Whitefish, etc., Organix Organic Turkey & Salmon or Turkey & Seafood, Newman's Own Organics Chicken & salmon, Felidae no grain Salmon, and Holistic Select Ocean Fish & tuna. Most of those are in combination with another meat source, so I think this is ok.

Another hitch in my "list" was finding out calorie levels should be kept at 180 and up! 220 is optimal but very few on my list have that amount. Solid Gold just reported back to me that their canned food has 291 calories/5.5oz. By Nature Organics is 138! Holy moly. Merrick Turducken is 163, Felidae no grain salmon is 149. Kind of low but again, since I'm trying to incorporate as much variety as I can, those won't make up more than 1-2 cans out of 14/week so I think this is ok.

Boy, my head is reeling from all this research into proper nutrition! Now if I can only get the boys to actually eat the foods on this list! Minor details....:pray:

Well, I dropped off Tigger and Zoomer at 8h30 AM today for their full abdominal ultrasounds. I did ask and couldn't stay for the belly clipping and actual procedure. Since this is a new vet, I'm sure their stress level is through the roof! Poor muffins. At least they'll be kept together so that should help. Hoping for positive vibes that all goes well and nothing non-manageable shows up!:pray::pray::pray:

Bengalgirl3
September 10th, 2010, 02:40 PM
To review, so far in the past 4 weeks Tigger and Zoomer have had: mini profile with CBC & electrolytes, complete urinalysis with UPC, PKD1 DNA test, blood pressures taken, and now full abdominal ultrasounds. What is "off": Tigger creatinine 2.7, Zoomer's is 2.9. The ultrasounds showed "shiny" kidneys which MAY be typical in neutered overweight males or something else. A radiologist and yet another internist will be consulted for their input on the ultrasounds.

My vet has also talked to 2 other internists and the specialists at Hills prescription food. All agree that this is either within the norm for 2 such muscular and large male Bengals OR it is kidney disease. Quite the spread between those 2 answers!

In 3 weeks we go in for full blood profiles/CBC/electrolytes and at last their dentals. Only obvious malady in my boys is that both have tartar build-up and require professional cleanings. Other than that and the creatinine oh and now the "shiny" kidneys (gave it a medical term which I can't recall), all else a-ok....

Mystery continues! Just thought I'd update you all and again thank everyone who took the time to provide me with valuable input and advice....

chico2
September 10th, 2010, 04:06 PM
I hope everything works out and nothing serious is wrong:fingerscr
I would love to see some more pics of your Bengals they are such beautiful cats.;)

growler~GateKeeper
September 11th, 2010, 01:48 AM
The ultrasounds showed "shiny" kidneys which MAY be typical in neutered overweight males or something else. A radiologist and yet another internist will be consulted for their input on the ultrasounds.

Renal lipidosis? The only thing I'm coming up with here is fat tissue shows up shiny on an ultrasound, ie with Hepatic lipidosis (fatty liver disease) the liver will show up as extremely shiny :shrug:


Is there any way you can contact the boys breeder & see if any of their cats or other offspring have had an ultrasound to see if there is something to be taken as a basis for normal for this breed/particular genetic line?

Bengalgirl3
September 13th, 2010, 09:40 AM
Yes, it was something along those lines since Tigger IS 2 pounds overweight and Zoomer about 1-1.5 lb. All else looked absolutely normal, hence the added mystery.

Within an hour of my vet calling to tell me about elevated creatinine and the possibility of PKD1 (genetic disease), I did call the breeder. I grilled her about the parents and other siblings to see if anything like this has come up before. She claims not so :shrug:

On September 30 we go in for the dentals, finally! Beforehand I'll get a full blood panel to retest the creatinine AND get values for phosphorus and calcium.

What exactly should I ask for in the new blood work? Just a complete blood panel???

Bengalgirl3
September 13th, 2010, 09:43 AM
I hope everything works out and nothing serious is wrong:fingerscr
I would love to see some more pics of your Bengals they are such beautiful cats.;)

Well they're normally quite spectacular with Tigger being marbled and Zoomer spotted. HOWEVER, with their bellies shaved and a large % of their sides, not so good looking now :cry: At least it will grow back (several months is what I'm thinking) and the ultrasounds proved 100% that no cysts are present. So, devastating as it was to have half my cats' gorgeous coats shaved off, the news was worth it...

Love4himies
September 13th, 2010, 12:14 PM
So does that mean the high creatinine is their "normal"? :pray:

We don't mind pics of shaved kitties :D, they are all beautiful :cloud9: hint hint.:pray:

Bengalgirl3
September 13th, 2010, 01:29 PM
Well, you asked for it....http://i8.photobucket.com/albums/a38/Bengalgirl/Tigger%20and%20Zoomer/Bengals%20year%205-6/Shavedboth.jpg

http://i8.photobucket.com/albums/a38/Bengalgirl/Tigger%20and%20Zoomer/Bengals%20year%205-6/ShavedTiggie.jpg

http://i8.photobucket.com/albums/a38/Bengalgirl/Tigger%20and%20Zoomer/Bengals%20year%205-6/Zoomershaved.jpg

Bengalgirl3
September 13th, 2010, 01:31 PM
Sorry, not the best image quality since I took those with my phone. Not sure if I want to have quality images of my boys looking, well, like they currently look! Tigger is the marbled Bengal, Zoomer is the spotted Bengal (brothers from the same litter).

Love4himies
September 13th, 2010, 02:27 PM
They are just beautiful :lovestruck:, love their markings. :cloud9::cloud9:

Bengalgirl3
September 13th, 2010, 02:37 PM
They are just beautiful :lovestruck:, love their markings. :cloud9::cloud9:

Hmmm....ok so here are pictures (in focus) of the boys REALLY in their full glory....

http://i8.photobucket.com/albums/a38/Bengalgirl/Tigger%20and%20Zoomer/Bengals%20year%205-6/October142009.jpg

http://i8.photobucket.com/albums/a38/Bengalgirl/Tigger%20and%20Zoomer/Bengals%20year%205-6/December2520093.jpg

http://i8.photobucket.com/albums/a38/Bengalgirl/Tigger%20and%20Zoomer/Bengals%20year%205-6/April92010-1.jpg

Love4himies
September 13th, 2010, 02:48 PM
Oh that last pic is so wonderful :cloud9::cloud9::cloud9::cloud9:. Who says animals don't feel love. :lovestruck:

chico2
September 13th, 2010, 03:27 PM
Awww Bengal-girl,they are just stunning,beautiful kitties,even with their sides shaved....the one where they cuddle is an amazing pic.
L4H,I am sure kitties feel love,I think probably even more so if they are siblings.

I am glad they had no ugly cysts,does that mean they are ok???

growler~GateKeeper
September 14th, 2010, 01:26 AM
Within an hour of my vet calling to tell me about elevated creatinine and the possibility of PKD1 (genetic disease), I did call the breeder. I grilled her about the parents and other siblings to see if anything like this has come up before. She claims not so :shrug:

If none of her cats have had any kidney issues before that's great :thumbs up

Has she had blood panels done on any of her healthy adult (not senior) males before? Just to give a baseline for the breed/genetic lines/size of the cats?

We already know that normal healthy muscular male cats may (but not always) have a normal increase in creatinine due to the muscle size/weight, what we're looking for here is if this is also true in the Bengal breed.

What exactly should I ask for in the new blood work? Just a complete blood panel???

Yup a "complete blood panel" is what most clinics call it - this will include a Complete Blood Count with differential (CBC w/diff - breaks down the count for all the blood cells) & Small Animal Chem screen which includes all electrolytes (SA Chem - shows all the blood values for the organ systems).

:goodvibes: :goodvibes: for the dentals

:lovestruck: :lovestruck: handsome boys you have there :cloud9: :cloud9:

Bengalgirl3
September 14th, 2010, 09:32 AM
Awww Bengal-girl,they are just stunning,beautiful kitties,even with their sides shaved....the one where they cuddle is an amazing pic.
L4H,I am sure kitties feel love,I think probably even more so if they are siblings.

I am glad they had no ugly cysts,does that mean they are ok???

They are cuddling even more now since the temp has fallen and, well, they're missing half their insulating coats! Poor muffins.

No cysts is fantastic news as these are "genetically programmed" so may grow fast or slow, drastically impacting quality/length of life. Nothing at all can be done to control these, so that would have been the worse diagnosis.

Once repeat blood testing is done and we know the phosphorus and calcium values, we'll have a clearer picture. I've removed all foods with dry matter phosphorus over 1.2% from their diet. By the time we go in for blood work and the dentals, it will be 1 month on diet modification. If only the creatinine remains high, it will lend further weight to this being "normal" for the boys since they are very large/muscular Bengal boys.

In any event, I do plan on maitaining the lower phosphorus diet as long as the boys actually eat it! So far so good....

Bengalgirl3
September 14th, 2010, 09:37 AM
Thanks Growler! I'll just ask for that complete panel. They run the tests in-house but are going to also send the samples out to an independent lab for testing. That way we can eliminate "lab" error from the equation.

Sigh...dentals. They really do need them but that will be trip to the vet #5 in just over 1 month! Neither travels well and there's ZERO cooperation at the vet. They had to sedate just to get blood last time. For the ultrasounds, it took THREE rounds of sedation to be able to handle the boys. Basically they were just short of general anasthetic. Trip home was nice and quiet though...:sleepy:

Bengalgirl3
October 1st, 2010, 08:13 AM
The boys went in yesterday for a full blood panel before finally getting their dental done. Here are the new results (numbers in parantheses are the reference values):

Zoomer:
HCT = 47.1% (24-45) HIGH
HGB = 15.0 g/dL (8-15)
MCHC = 31.8 g/dL (30-36.9)
WBC = 10.50 K/uL (5-18.9)
GRANS = 6.0 K/uL (2.5-12.5)
%GRANS = 57.1%
L/M = 4.5x10^9/L (1.5-7.8)
%L/M = 43%
PLT > 400 K/uL (175-500)

BUN/UREA = 23 mg/dL (16-36)
CREATININE = 2.7 mg/dL (0.8-2.4) HIGH (but down from 2.9)
Phophorus = 3.3 mg/dL (3.1-7.5)
Calcium = 10.0 mg/dL (7.8-11.3)
Total Protein = 8.1 g/dL (5.7-8.9)
ALB = 3.4 g/dL (2.2-4.0)
GLOB = 4.7 g/dL (2.8-5.1)
ALT = 32 U/L (12-130)
ALKP = 46 U/L (14-111)
TBIL = 0.4 mg/dL (0.0-0.9)
Cholesterol = 272 mg/dL (65-222) HIGH
AMYL = 832 U/L (500-1500_
GLUCOSE = 111 mg/dL (74-159)

Sodium = 166 mmol/L (150-165) HIGH
Potassium = 4.2 mmol/L (3.5-5.8)
Chloride = 126 mmol/L (112-129)


Tigger:
HCT = 39.6% (24-45)
HGB = 12.7 g/dL (8-15)
MCHC = 32.1 g/dL (30-36.9)
WBC = 6.3 K/uL (5-18.9)
GRANS = 3.7 K/uL (2.5-12.5)
%GRANS = 58.7%
L/M = 2.6x10^9/L (1.5-7.8)
%L/M = 41%
PLT > 366 K/uL (175-500)

BUN/UREA = 24 mg/dL (16-36)
CREATININE = 2.7 mg/dL (0.8-2.4) HIGH
Phophorus = 3.1 mg/dL (3.1-7.5)
Calcium = 9.4 mg/dL (7.8-11.3)
Total Protein = 7.0 g/dL (5.7-8.9)
ALB = 2.7 g/dL (2.2-4.0)
GLOB = 4.3 g/dL (2.8-5.1)
ALT = 23 U/L (12-130)
ALKP = 47 U/L (14-111)
TBIL = 0.3 mg/dL (0.0-0.9)
Cholesterol = 243 mg/dL (65-222) HIGH
AMYL = 669 U/L (500-1500_
GLUCOSE = 108 mg/dL (74-159)

Sodium = 160 mmol/L (150-165)
Potassium = 4.1 mmol/L (3.5-5.8)
Chloride = 127 mmol/L (112-129)

Could someone please "bump" this (or whatever it's called) to Dr. Lee to ensure he sees this? Thank you!

Oh, results of dentals. Tigger fine but did see grooves on 2 teeth. X-rays showed no damage. Zoomer had 1 resorbed lower pre-molar with affected roots. Crown amputation with flap closure so roots will resorb naturally. Another tooth showed on x-rays as beginning resorption but very early so no action taken. Sent home with clavaseptin (50 mg) as antibiotic/anti-inflammatory pills, 1.5 pills given 2X/day for 1 week. Also given tolfedine (20mg) as pain killer, 1.5 pills given every 24 hours for 2 days only - this one does affect the kidneys so the vet wants me to dose exactly every 24 hours, for only 2 days.

Last thing. The vet(s) now think it extremely likely that the boys fall into the 2.5% of all cats with naturally elevated creatinine. HOWEVER, they did the dentals on the premise of kidney failure so altered the anasthetic protocol accordingly (doubled IV fluids, etc.) I am worried about the tolfedine but the vet assured me that I'm only giving it for 2 days and with all the other blood tests results, long-term negative impacts on the kidneys are unlikely...

Bengalgirl3
October 1st, 2010, 04:28 PM
....another thing. The new tests show an ALB/GLOB ratio of 0.72 in Zoomer, 0.63 in Tigger. Optimal apparently is around 1.1. What does this mean since it is low in my boys?

Also, the Calcium/Phosphorus ratios are off for both Tigger and Zoomer. Optimal is 1.1-1.4 (???) but theirs are extremely high at 3.03. Is this cause for concern?

I've been researching like crazy but can't find anything at all on these ratio. All of the above individual values (i.e. ALB, GLOB, Ca, Ph) are within normal ranges, but the ratios are very off...

Love4himies
October 1st, 2010, 07:16 PM
Have you searched for Bengal specific sites (forums or on Facebook), that may help you with the bloodwork. If these results are common in the Bengal breed, it may set your mind at ease. :grouphug: If not, then perhaps your vet can consult with a blood specialist (if there is one):shrug:

Bengalgirl3
October 3rd, 2010, 12:39 PM
No, I haven't investigated on Bengal only forums. I was hoping to get some input from Dr. Lee since he was so informative before. Is there any way to PM him to ensure that he sees the new numbers?


Have you searched for Bengal specific sites (forums or on Facebook), that may help you with the bloodwork. If these results are common in the Bengal breed, it may set your mind at ease. :grouphug: If not, then perhaps your vet can consult with a blood specialist (if there is one):shrug:

Love4himies
October 3rd, 2010, 01:20 PM
I have PM'd him for you.

Bengalgirl3
October 3rd, 2010, 01:21 PM
:thumbs up Thank you! :highfive:

I have PM'd him for you.

Dr Lee
October 4th, 2010, 02:07 AM
Could someone please "bump" this (or whatever it's called) to Dr. Lee to ensure he sees this? Thank you!


Love4Himies was nice enough to PM (private message me). This or direct email or via my website are the all great ways to get my attention. With my job, my volunteer time comes in waves on pets.ca. However, if you direct email me I virtually always respond and try to respond within 24 hours if possible. :D

You stated that the specialist thinks that the kidney function is fine - will all other values than creatinine looking good - this appears to be good news.

I am glad that they handled the anesthesia fine. It sounds like everything looks appropriate.

My recommendation would be to keep up with whatever regular checkups your vet wants on the creatinine and stay on a kidney friendly diet. A kidney friendly diet would have controlled and balanced levels of protein, low phosphorus, low sodium and supplemented DHA (Omega 3).

Again, I am very glad that all appears to be well. Please keep us updated! :cat:

Bengalgirl3
October 4th, 2010, 07:47 AM
Thanks for your input Dr. Lee! There's just Zoomer's elevated HCT level but I'll ask the vet specifically about that this Thursday. Both cats' lungs sounded congested for a few days so I think they pushed too many fluids, too fast and pulmonary edema resulted! Zoomer in particular (had crown amputation so under anasthetic longer) sounded very "rally" for a couple of days so I kept a close watch on him. Both are much better today but still a bit of coughing. That is something else I'll bring up with their vet as I don't think this is within the norm of post-anasthesia reactions...

growler~GateKeeper
October 9th, 2010, 02:42 AM
Good to hear the dentals went well & to see the blood results looking good :thumbs up

I would also say considering the creatinine level on the brothers is exactly the same, it is likely caused by higher muscle density on the slightly larger than average cats.

The HCT measures the percent of blood volume occupied by red blood cells. Very basically it means Zoomer is producing slightly higher than normal amount of red blood cells in a certain volume of blood (as we know blood is made up of red and white blood cells, platelets etc). This is likely due to being slightly dehydrated, or the test could've just caught it during red cell production.

How did the vet visit go Thursday? :goodvibes:

Bengalgirl3
October 9th, 2010, 08:18 AM
Hello Growler and thank you, as always, for your valuable input! The vet follow-up visit went great except Zoomer was looking at the ceiling (last time he almost went through the floating ceiling!) and Tigger was on the chair next to the door, grabbing the knob with both paws and trying to turn it! The vet just looked at him for a while, saying "well I've never seen anything like that" then promptly locked the door. Sigh. Downside to having extremely observant and intelligent cats!

The vet did listen to Tigger's lungs, heart and throat then took his temp. She said his lungs were clear and no sign of infection. She figures since she put a larger tracheal tube than normal (big boy!), the coughing is due to irratation, not infection. Tigger is still coughing today, but the vet thought even another week could be expected. He isn't showing any signs of lack of oxygen (low energy, not eating, not peeing/pooping, gasping for air), just the 2-3 coughing fits per day.

Zoomer's crown amputation healed up beautifully! I couldn't believe how white his teeth are and how nice and pink the gums also are. I started giving them Orazn gel 1 time/day and was also given instructions to brush the teeth. I do have the CET brushes and toothpaste but never worked up the courage. The vet basically told me I HAVE to brush their teeth daily, so there you go :yell: She also wanted me to up their Hills t/d dry amount per day. I'm now giving them just a snack of 1/8 cup at night, then feeding a premium no-grain diet of canned food during the day. Um, I have NO plans to change this! Naughty me...:angel:

As for Zoomer's slightly elevated HCT, the vet also said this was likely due to slight dehydration. Since all other related parameters were ok, not a cause for concern. I should be bringing him back in for full dental x-rays in 6 months since 1 other mildly resorbing tooth was detected. It wasn't nearly bad enough to warrant removal now. Not sure about this since this necessitates full anasthesia. Although the elevated creatinine very likely IS due to their big size/muscle mass, I'm not sure that anasthesia 2 times/year is a good idea....