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Old October 13th, 2009, 11:07 AM
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Dr Lee Dr Lee is offline
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Originally Posted by Onemeower View Post
Here are her numbers from last saturday

Bun 53 (ideal per the vet is below 34)
Creatinin 3.1 (ideal per the vet is below 2.3)
Thyroid 5.6 (don't remember what he said ideal was there maybe below 3)
Her last weight was 8.50

I am worried about what the vet recommended for her Subq's. 150 to 200 mls ever other day in one sessions seems a bit too much for her...
I am sorry to hear about Bandit. These problems can be no fun. Regardless of the heart condition, if the kidney enzymes sharply rise when you start methimazole, then Bandit was not a candidate for I131 anyways. The thyroid medication does not damage the kidney's - the thyroid disease artificially raises filtration which brings the kidney values lower than what they are. Thus sometimes it is striking a balance between the kidney values and signs with the thyroid values and signs. The blood pressure may be secondary to either the thyroid disease or the renal disease or both. Keeping her numbers down not only will save her eyesight but also her kidneys. When her sytemic blood pressure is up, her glomerular (inside the kidneys) goes up and you spill protein into the urine. If you are spilling protein into the urine with kidney failure, the prognosis becomes worse. Amlodipine will help address this. This is a good medication and well tolerated by most cats.

Topical methimazole can work but the absorption is different for each cat. Montoring the values, like your vet is doing, is the best method with methimazole.

As far as values.

Creatinine - a 'ideal' kidney should be at or less than 1.1. According to IRIS (International Renal Interest Society) anything above 1.6 places a cat into Stage 2/4 Renal Disease.

Thyroid T4 should be between 1 and 2. Below 1 is too low. However, in Bandit's case, an 'ideal' thyroid level may not be possible. So I agree with your vet, around or below 3 might be a good place for Bandit.

Phosphorus. This is a value that sometimes gets overlooked. Regardless of the lab's reference range, a cat with kidney disease should not have a phosphorus above 4.5 . As the kidneys start to fail, the phosphorus cannot be excreted and begins to rise. This leads to a variety of serious side effects including hyperparathyroidism (which is directly toxic to the kidney and the cat and can lead the cat to weight loss, loss of appetite, lethargy, etc...) and deadly crystalization of the kidneys and body.

How do we deal with phosphorus rise? 1) a renal diet. These prescription diets are not only neutral balanced, reduced in sodium, balanced in protein, fortified with potassium but they are also reduced in phosphorus. Wet is always better than dry! 2) phosphorus binder. The common one is Aluminum Hydroxide which is inexpensive and effective. However there is recent evidence that aluminum exposure in the face of kidney disease may have some toxicity issues and the medication tastes poorly. Epakitin is my choice as it is a nutraceudical made from shrimp and crab shells. Because of this it is fairly tasty and safe. Here is a link for more information: Epakitin There is a new one called lanthanum which is available. There is a cat form in Europe or a human one in the US but it is expensive.

As far as the SQ fluids. As a general rule I do not recommend more than 100mls at a time. The idea that 200mls once is the same as 100mls twice is not accurate. And in the face of the cardiac and blood pressure issues, I agree with you and I would use less at a time. I would talk to your vet about daily goals of fluid and how to divide them up.

Some additional nutriceudicals.

1) Rubenal. It comes from a medicinal form of rhubarb and has been shown to reduce interstitial nephritis a common type of inflammation and scarring that occurs during chronic renal disease. It has been shown to reduce the inflammation and prolong kidney health. In a taste test most cats will eat it well when mixed with food. No side effects have been seen so far.

2) Azodyl. It is combination of three specific strains of bacteria which will metabolize creatinine, BUN and other nitrogenous wastes. It has been shown to improve patient's appetite and quality of life. It has also been shown to reduce BUN and creatinine levels. There is a wild tiger and lion sanctuary that started using it on their kidney failure rescues. The one was given less than 6 months to live and is 3 years later still active and doing well. Here is a link to my website on Azodyl ( I will have some information on Rubenal coming soon): Azodyl.

When to use these? If your cat has any renal disease, I recommend Rubenal. If the phosphorus is above 4.5 then start Epakitin and if your cat has elevations of BUN and creatinine, then add Azodyl. Ask your vet.

I typically have a rule of 3. Try not to have any more than 3 medications going to a cat at any given time. I do not include the nutraceudicals with this. As we are looking at rhubarb extract, shrimp and crab shell component and harmless bacterial strains (similar to but not a true probiotic) they do not have the variety of issues as other medications.

So if I was to add a third medication to the amlodipine and methimazole regimen I would consider adding pepcid. Renal disease impairs the filtration of gastrin which in turn raises stomach acidity which leads to feelings of nausea. Nausea in a cat is seen as decreased appetite. Pepcid can help. I would ask your veterinarian.

So ask your vet about these. I would follow his or her recommendations on follow up blood and urine testing. I know it gets frustrating to have Bandit poked so much (not to mention the cost) but the follow values help us titrate the medication levels before they lead to more serious consequences.

Here is the website to IRIS: International Renal Interest Society

I hope this helps.
Christopher A. Lee, D.V.M., C.V.L.S.
Promoting surgical options and pet comfort through the use of lasers.
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