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-   -   Kidney failure diagnosis - possible misdiagnosis? (http://www.pets.ca/forum/showthread.php?t=80281)

tiff123 February 21st, 2012 11:56 PM

Kidney failure diagnosis - possible misdiagnosis?
 
My 15 year old cat, Fred, was just diagnosed with CRF based on the following:

BUN of 56
weight loss
muscle wasting

His creat and phosphorus levels were not elevated, in fact, his phosphorus was below normal levels. I thought elevated creat and phosphorus were something that went hand in hand with CRF. Couldn't elevated BUN be due to other problems?

Anyhow, Fred is on the following regimen:

10 cc(mL) fluid subq
k/d canned cat food
Rubenal 75

I tried the subq tonight for the first time. Unfortunately the needles the vet gave me were 22 gauge (extremely small) and it appeared not to be working well. Also, I'm not quite sure how to gauge 10 mL off the bag since it is divided into 100mL sections - a little difficult to eyeball.

Fred is tolerating the k/d cat food well. I bought an electric, filtered, running water tray, but he doesn't seem to want to drink much.

The Rubenal pills are big. I am worried about giving them because they contain Phosphorus, even though his levels are low... I'm not sure what to think about that.

Finally, poor Fred is bleeding when he goes potty. I can smell the blood in his feces and there is blood on his anus. I wonder if this could have caused a high BUN reading, perhaps he does not have CRF after all? I am thinking about getting a second opinion.

I know this is a lot to throw out there, I am still trying to digest everything myself. Any nugget of info would be highly appreciated. I can't imagine a day without my Fred, so any that I can save is all that I hope for. :pray:

Thanks!

sugarcatmom February 22nd, 2012 09:09 AM

Can you get a copy of the rest of Fred's blood work and post the results, with the lab range in brackets next to it? Also, was a urinalysis done? That's a vital piece of the puzzle (urine specific gravity in particular). If there was no urinalysis, I would make an appointment for one, and add a urine protein creatinine ratio test as well.

I would cease and desist with the K/D. Absolutely atrocious ingredients and there is no valid reason to feed such a protein depleted diet to an obligate carnivore, who actually needs MORE protein as he ages. Instead, find a few different brands/flavours of a good quality MEAT-based wet food with little to no grains and reasonable amounts of phosphorus. There are a couple charts on the net that can help you with that:
[url]http://binkyspage.tripod.com/canfood.html[/url]
[url]http://www.felinecrf.org/canned_food_usa.htm[/url]

growler~GateKeeper February 23rd, 2012 02:19 AM

[QUOTE=tiff123;1035093]My 15 year old cat, Fred, was just diagnosed with CRF based on the following:

BUN of 56
weight loss
muscle wasting

His creat and phosphorus levels were not elevated, in fact, his phosphorus was below normal levels. I thought elevated creat and phosphorus were something that went hand in hand with CRF. Couldn't elevated BUN be due to other problems?[/quote]

A BUN of 56 is high, and yes could be due to other issues. Nearly all (but there will always be exceptions) with CRF will have elevated Cre but not necessarily phosphorus as well ~ my late CRF girl never had high phos not even at her worst numbers.

[QUOTE=tiff123;1035093]Anyhow, Fred is on the following regimen:

10 cc(mL) fluid subq
k/d canned cat food
Rubenal 75

I tried the subq tonight for the first time. Unfortunately the needles the vet gave me were 22 gauge (extremely small) and it appeared not to be working well. Also, I'm not quite sure how to gauge 10 mL off the bag since it is divided into 100mL sections - a little difficult to eyeball.[/quote]

22g Monoject-type needle is better than having the vet give you 18g Monoject those are like harpoons.

The fluid will run slowly in a regular 22g but since you're not giving much you don't want the flow to be very fast & end up giving far more.

Some pointers on how to give sub-q fluids easily including the direction the slanted needle tip should be facing: [url]http://www.weirdstuffwemake.com/weird/stuff/pets/cats/sophia/catjuice.html[/url]

Take the bag hang it up & using a ruler mark off sections divided evenly into 10mL - can either use a thin strip of black duc/electrical tape or a sharpie.

[QUOTE=tiff123;1035093]Fred is tolerating the k/d cat food well. I bought an electric, filtered, running water tray, but he doesn't seem to want to drink much.

The Rubenal pills are big. I am worried about giving them because they contain Phosphorus, even though his levels are low... I'm not sure what to think about that.

Finally, poor Fred is bleeding when he goes potty. I can smell the blood in his feces and there is blood on his anus. I wonder if this could have caused a high BUN reading, perhaps he does not have CRF after all? I am thinking about getting a second opinion.[/QUOTE]

Fred may just need a little time to get used to the new water dish, and if he's exclusively eating wet food he may not need to drink a lot during the day. Some cats tend to drink mostly at night as they are usually more active then.

The phos content of Rubenal is likely not going to cause an increase in blood phos levels - it would have to be much higher amounts.

Is the vet aware of the blood in the feces?

What colour is the blood - bright red & liquid like a fresh cut or dark red/black & tarry? If dark & tarry is may be a symptom of gastro-intestinal bleeding which can cause high BUN reading, in that case a trip to the vet is needed to determine the cause.

A second opinion is always an option :)

:goodvibes:

tiff123 February 23rd, 2012 10:53 PM

Thank you for the advice on the bag of solution and the angle of the needle. Fred doesn't have a lot of extra skin and he tenses up so it feels like the needle will go right into his body.

Fred's blood is bright red on the anus and feces, which would seem to indicate hemorrhoids or other lower system bleeding. But it had the distinct smell of bloody feces (I used to draw blood from patients at hospitals and nursing homes, and the smell is so distinct....).

Why is the k/d food bad for him? This is the only food available in my area for cats with kidney problems. What are the options for that? Fortunately he still has an appetite and manages to steal food from our plates when we are not looking or the kid's crumbs. :cat:

On the bright side, I heard Fred purr for the first time in a long time, and he is cuddling with me at night again after we started giving him Rubenal. :highfive:

growler~GateKeeper February 24th, 2012 02:30 AM

[QUOTE=tiff123;1035187]Thank you for the advice on the bag of solution and the angle of the needle. Fred doesn't have a lot of extra skin and he tenses up so it feels like the needle will go right into his body.[/quote]

Before giving fluids take a couple of deep breaths to calm yourself - Fred can sense the nervous energy. Stroke him a couple of times or if he'll permit a very light muscle massage before giving fluids to relax him a bit, randomly do this at other times when he is not getting fluids to get him used to being handled in this area in this way & to show it's not always going to result in a poke :).

Another good tip is don't poke the same spot every time, there's a pic on Sofia's site listed above that shows the "saddle" area, where anywhere in that area is okay to give fluids. Lessens the chance of continued soreness/scarring in one area.

[QUOTE=tiff123;1035187]Fred's blood is bright red on the anus and feces, which would seem to indicate hemorrhoids or other lower system bleeding. But it had the distinct smell of bloody feces (I used to draw blood from patients at hospitals and nursing homes, and the smell is so distinct....).[/quote]

If this is an ongoing issue I would still discuss this w/the vet, it may be anal fissures or could be indicative of something more serious.

What are Fred's poops like? Hard & dry, soft & mushy, normal?

[QUOTE=tiff123;1035187]Why is the k/d food bad for him? This is the only food available in my area for cats with kidney problems. What are the options for that? Fortunately he still has an appetite and manages to steal food from our plates when we are not looking or the kid's crumbs. :cat:[/quote]

If you were to read the ingredients of the k/d and compare them to the foods listed below, you can see a marked difference in the quality of protein and other nutrient sources. The k/d and other renal prescription foods are based on the theory that CRF cats should have low protein food because that means lower phos numbers. Problem with that is there isn't enough protein to maintain muscle mass, as well as protein fat is also greatly reduced both of those combine for a food that isn't very tasty to obligate carnivores. Cats eat based mostly on smell - if it smells really good they'll eat it, protein & fat is what gives a majority of aroma/flavour to food.

Some high quality low phosphorus foods to get you started:

[URL="http://www.bynaturepetfoods.com/productpages/organiccannedcat.php"]By Nature Organics[/URL] Turkey & Turkey Liver, Chicken & Chicken Liver, Turkey & Chicken, Chicken & Mackerel, Beef & Beef Liver

[URL="http://www.innovapet.com/products/default.asp?id=1693"]Innova Flex Beef & Barley Stew[/URL]
[URL="http://www.evopet.com/products/default.asp?id=1662"]Evo 95% Chicken & Turkey[/URL]

[URL="http://www.canidae.com/cats/platinum/canned.html"]Felidae Platinum[/URL]
[url=http://www.canidae.com/cats/cat_and_kitten/canned.html]Felidae Cat & Kitten[/url]
[URL="http://www.canidae.com/cats/grain-free-cat-food/canned.html"]Felidae Grain Free[/URL]

[URL="http://www.merrickpetcare.com/store/detail.php?c=114&s=20481"]Merricks Before Grain 96% Beef[/URL]
[URL="http://www.merrickpetcare.com/store/detail.php?c=114&s=20480"]Merricks Before Grain 96% Turkey[/URL]

[URL="http://www.merrickpetcare.com/store/detail.php?c=52&s=20246"]Merricks Cowboy Cookout[/URL]
[URL="http://www.merrickpetcare.com/store/detail.php?c=52&s=01803"]Merricks Thanksgiving Day Dinner[/URL]

[URL="http://shop.halopets.com/Canned-Cat-Food/Wholesome-Chicken-Recipe-3-5-oz"]Halo Spots Stew Wholesome Chicken[/URL]
[URL="http://shop.halopets.com/Canned-Cat-Food/Cat-Canned-Turkey-3-5oz"]Halo Spots Stew Wholesome Turkey[/URL]

[URL="http://www.wellnesspetfood.com/recipes.aspx?pet=cat&ft=2"]Wellness[/URL] Turkey, Chicken, Beef & Chicken, Beef & Salmon, Kitten, Wellness Core Chicken Turkey & Chicken Liver (other flavours are too high in phos)

[URL="http://www.holisticselect.com/product.aspx?pet=cat&cat=2&pid=33"]Holistic Select Turkey & Barley[/URL]
[URL="http://www.holisticselect.com/product.aspx?pet=cat&cat=2&pid=30"]Holistic Select Duck & Chicken[/URL]

Many more choices listed here [url]http://www.felinecrf.org/canned_food_usa.htm#food_data_tables[/url]

[QUOTE=tiff123;1035187]On the bright side, I heard Fred purr for the first time in a long time, and he is cuddling with me at night again after we started giving him Rubenal. :highfive:[/QUOTE]

Wonderful that means he's feeling a bit better already :highfive:

Diana US February 24th, 2012 03:23 PM

My Rainbow has very similar numbers like Fred if yours in US term as mine, but his T4 is in a grey zone for a 15 yrs old:

BUN 58
Cre 1.6
phos 3.7
T4 2.2

My vet said he is in an early stage. He drinks and peeps a lot :-(

I sure hope Fred and Rainbow has something curable other than CRF!!!


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