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  #1  
Old February 17th, 2011, 03:21 AM
katts katts is offline
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*Extremely* high bloodwork levels (vets stumped)

Hi
New member, past lurker, long time cat owner.
I'm so desperate to find any answers I can on this issue, because the vets are puzzled. I've done a lot of my own research but I can't find anything on sudden levels this high.

Backstory: My 12(?) year old rescue cat has been healthy, aside from a basal tumor on his neck that was completely removed several years ago.
Late last week I'd noticed he'd lost a bit of weight, but nothing serious, and no behavior changes. This week, I saw that he lost a bit more weight and was unusually lazy, so I immediately took him into the vet to get bloodwork.
Got a shock today:

His urea level is 50 (normally supposed to be 5-12)
Creatinine level is 877 (normally supposed to be 71-203). How is he alive with these levels??

Additional abnormal levels/remarks:
Anion gap is 30 (normally 12-26),
Phosphorus is 2.55 (normally 1.00 to 2.40),
Calc osmality is 346 (normally 285-314)
Mean corp vol is low at 38.8.
Platelet adequate.
3+ Poikilocytosis is present
Marked echinocytosis present.
Marked azotemia
It says there is decreased GFR and t4 ok

Apparently there is no anemia (according to the vet)
The bloodwork also said there might be a possible urinary blockage but the vet seemed to dismiss this possibility.

I know a fair bit about CRF, as I had a senior CRF cat a long time ago, but her levels were nothing like this. The vet mentioned there could have been exposure to a toxic substance, but I have been so careful in never bringing any plants into the house, not using toxic cleaners, etc. Is there something I am missing?

He's currently at the vets overnight, but they're only giving him IV fluids at this point (and additional tests, they got a urine sample). I feel time is quickly running out and I don't want to lose my boy in the process.
Are there any other tests I can do, or something I can mention to the vet to check for?
Any help, anything at all would be so appreciated…
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  #2  
Old February 17th, 2011, 04:14 AM
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Hi katts

I'm glad to hear your cat (name?) is currently receiving IV fluids, and he should continue on them for 2-3 days min, one day is not enough.

As high/shocking as those numbers are I do know a cat diagnosed last summer with Acute Renal Failure whose initial numbers were much higher (BUN70 Cre1500), he is doing good today with numbers significantly lower and only needs subq fluids 1/week. This cat was found munching on a plant that unbeknownst to his owner was a lily, lilies are one of the most highly toxic flowers to cats.

I know you mentioned you have no plants, but what about cut flowers? A bouquet from a special occasion?

Has he eaten any grapes/raisins? (weird for a cat yes, but stranger things have been eaten)

What about suppliments, medications, asprin/tylenol, hormone replacement therapy drugs etc - including creams moisturizers etc? Any contact with any of those? A pill dropped, bottle knocked off the counter, lid not replaced, does he lick your arm after you've applied moisturizer?

Any flea/tick treatments used? Any ant bait or rat poison around?

Does your cat go outside? Antifreeze - even just the tiniest amount, windshield wiperfluid, road/sidewalk rock salt etc can all cause damage.

What food are you currently feeding?

Has your cat been on any medications/supplements lately specifically Metacam/Meloxicam or Baytril?

Does your cat have a history of kidney/bladder stones/crystals?

I see slight metabolic acidosis in the Anion gap, the body's pH level becomes too low & muscle wasting can occur - this may be part of the reason for the lazyness along with the high toxin levels.

The MCV is a little low but not so much that it would flag as anaemia yet, and it is true that most ARF cats aren't anaemic at least in the beginning.

When was the last time he had blood work done prior to this?

Let us know what the urinalysis says & for the IV treatments

More info on ARF here: http://www.felinecrf.org/acute_renal_failure.htm
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Old February 17th, 2011, 03:38 PM
katts katts is offline
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Hi growler
I cannot thank you enough for your support and providing such a thoughtful reply. Everything was very helpful – your comments, your support, the link you posted.

I am dearly hoping Boi (his name) can make it through this. Even when I took him into the vet initially, he didn't seem “sick”. He last had bloodwork 2 years ago, which came back fine.

I'm trying very hard to think of the reason, because we have two other cats, one of which (Tuddy) was "not acting himself" for a couple of days in late December - but he returned to 100% normal before the vet appointment, so we chalked it up to the food change (the cats were briefly switched from a mature blend we get from the vets, to Wellness brand- but their stomachs objected so they were switched back). I'll be getting Tuddy tested ASAP as well. This is terrible.

Absolutely no plants come in the house (even if they are gifts). We don't use flea treatments, ant/rat poison, or toxic cleaners. Our own OTC medicines are kept in a drawer. We don't leave any food out uncovered. Our cats are 100% indoors. Boi has never bothered to groom himself (or anyone else), so accidental ingestion from licking isn't under question.
However, grapes were indeed brought in the house, and even though they were never left out, this is the only thing I can think of. Perhaps one fell and went completely undetected? Similarly, a pill might have fallen and went completely undetected, but we are all so careful...

The urinanalysis just came back and results were faxed to me (the vet was in with a patient and I haven't heard back from him for hours). The comments do not look good. Can I still have hope to buy him a little more time?


UA
Specific Gravity: 1.013
pH: 5.5
Urobillogen: 3.2
Blood: Positive 2+
Urine Bilrubin: Negative
Glucose: Negative
Ketones: Negative
Protein: Negative

Sediment:
Amorphous debris: Moderate
Bacteria: None seen
RBC: 0-3/HPF
Squamous epithelial: 1-5/HPF
WBC: 0-3/HPF

Comments:
Iatrogenic hematuria
Prior azotemia noted, this usg supports renal insufficiency and borderline failure


I know this isn't good - in CRF cats, failure is 90%+ loss of kidney function, right? If there's anything else you can think of, let me know. Just hoping to get a little more time with him.

If nothing else, thank you so much for your previous support and insight - the response I already received was so incredibly helpful to me, and made me feel less like I'm "navigating blind".
Thank you for everything.

EDIT:
Vet now says it is NOT poisoning because the USG is high, and that it is CRF(?!). I'm not sure about this. He is presenting with no anemia, extremely high creatinine/urea, metabolic acidosis... no problems with anything before recently... this isn't making sense to me.
I'll ask for an ultrasound to check for enlarged kidneys (CRF = shrunken kidneys, ARF = enlarged?) - is there anything else I can do?

Last edited by katts; February 17th, 2011 at 05:53 PM.
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Old February 18th, 2011, 02:46 AM
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Quote:
Originally Posted by katts View Post
Even when I took him into the vet initially, he didn't seem “sick”.
Yup the darn buggers are so good at hiding illness/pain.

Quote:
Originally Posted by katts View Post
I'll be getting Tuddy tested ASAP as well.
for Tuddy's tests

Quote:
Originally Posted by katts View Post
UA
Specific Gravity: 1.013
pH: 5.5
Urobillogen: 3.2
Blood: Positive 2+
Urine Bilrubin: Negative
Glucose: Negative
Ketones: Negative
Protein: Negative

Sediment:
Amorphous debris: Moderate
Bacteria: None seen
RBC: 0-3/HPF
Squamous epithelial: 1-5/HPF
WBC: 0-3/HPF

Comments:
Iatrogenic hematuria
Prior azotemia noted, this usg supports renal insufficiency and borderline failure
Urinalysis tests look pretty good, as noted in the comments the blood in the urine was as a result of the process of urine collection, not a medical reason.

Ideally the USG in a completely healthy cat should be between 1.035-1.060, but normal is quite wide ranging 1.015-1.060. The 1.013 is reflective in part due to dehydration as Boi was likely drinking/peeing more trying to flush the toxins out. The USG may drop even lower after the IV treatment but that is to be expected, it may also stay around the same once he's stabilized & off IV for a bit.

Quote:
Originally Posted by katts View Post
I know this isn't good - in CRF cats, failure is 90%+ loss of kidney function, right? If there's anything else you can think of, let me know. Just hoping to get a little more time with him.
Failure is about 66-75%+, but as it is a chronic condition it is not immediate.

Quote:
Originally Posted by katts View Post
Vet now says it is NOT poisoning because the USG is high, and that it is CRF(?!). I'm not sure about this. He is presenting with no anemia, extremely high creatinine/urea, metabolic acidosis... no problems with anything before recently... this isn't making sense to me.
I'll ask for an ultrasound to check for enlarged kidneys (CRF = shrunken kidneys, ARF = enlarged?) - is there anything else I can do?
Not all CRF cats will be anaemic, mine never was, and though she did have a short term issue with metabolic acidosis it was from a protein allergy reaction, once that was treated, she didn't have any more issues with ma.

Though most of the time the sudden high values are Acute RF related, sometimes CRF will present this way as the cat is able to manage & seem fine for some time with high numbers and when they do show it's more of a shock. This is what's called a Crashing cat. At this point the dehydration has really made things look worse at the initial diagnosis, quite possibly those really high numbers are not going to be too bad once the dehydration is taken care of through the IV fluids Boi is already receiving.

An ultrasound is a great (but expensive usually runs about $400+) tool to visually check the form/function as well as progression of disease, if you are just looking as a "back-up" to the diagnosis your vet should be able to physically palpate the kidneys & tell if they are abnormal in size.

My girl had a few ultrasounds done in the later stages of her fight w/CRF, they were done to check the kidneys but we also had other concerns we were looking into at the same time. While they are cool to watch/participate in (if given the chance) and do give good indications of size, scar tissue etc you might choose to save yourself the cost now unless the vet feels something really abnormal when he palpates Boi's abdomen.

How is Boi doing during his "Vet-cation"? Has he been eating well for them?

Loads of awesome info here: http://www.felinecrf.org/index.htm
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  #5  
Old February 19th, 2011, 04:46 PM
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Welcome Katts for finally posting. As Growler said CRF is not necessarily a death sentence and Bol's response to the IV fluids will probably alter the blood work significantly, lowering many of the high levels.

I have a male cat who has been living with CRF for over 5 years after having several bouts of urinary crystals that blocked his urethra. He is now 13 1/2 years and at the beginning of all this totally refused any prescription food so for at least a year he was untreated other than several visits to the vet for rehydration with IV fluids and removal of the blockage and regular medication with a drug that relaxes the bladder and urethra walls so that he could pass the crystals more easily. He also had frank blood in his urine for months and months showing that the crystals were continuing to pass frequently.

He developed CRF during that period with one episode of ARF that had him living at the vets for a week. He finally started eating the prescription food and to this day will now pass up the other 3 cat's food to eat his prescription diet. He has had no acute episodes of ARF for almost 2 years now and is 13 1/2 years old and healthy. We still have occasional periods about every 6 months when he strains and passes blood in his urine. He always lets me know when he is having these problems by peeing outside the box, often right in front of me. At those times I give him the medication to relax his bladder and urethral walls and the problem passes in a few days without a visit to the vet.

Good luck with Bol, I hope the IV fluids work and you have many years of her company like I have. Sending good vibes for you and Bol
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Old February 20th, 2011, 05:47 PM
katts katts is offline
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Hello again

Thank you all for posting, your information is what is getting me through this difficult situation.

Boi is still on IV fluids, but his recent blood tests have me very alarmed: White cell count has skyrocketed, while RBC, Hemoglobin, and Hematocrit have plumetted.

White cell count = 17.5 (up from 12.1 when we took him in; norm is 4.0-16.0)
RBC = 6.1 (down from 8.6; norm is 6.3-10.8)
Hemoglobin = 86 (down from 116; norm is 104-160)
Hematocrit = 0.27 (down from 0.33; norm is 0.32 - 0.49)
Platelets = 201 (down from 320; norm is 300-800)

His Urea is now 41.5 and his Creatinine is 570.
His ALT is up to 95 (and was 36 before norm is 28-76).
ALP is up to 59 (was 36 before - norm is 0-62)

They put him on ampicillin because of the white blood cell count, even though they do not know the cause (and are not trying to diagnose the cause in any manner). This makes me extremely nervous. He seems to be going into some sort of liver failure.
Should I switch vets?

I know it's not looking good now.

Last edited by katts; February 20th, 2011 at 06:00 PM.
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Old February 20th, 2011, 09:05 PM
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Has he ever gotten into ticks, katts? Some of the tick-borne diseases can mess up WBC and platelet counts and they can be really hard on the organs...especially if the disease becomes chronic. At least that happens in dogs--not sure what the symptoms might be in cats.

Hope you can find some answers soon!
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Old February 21st, 2011, 01:55 AM
katts katts is offline
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hi hazelrunpack, thanks so much for responding.

He's an indoor cat, so recent tick exposure is not a possibility. But he was a stray cat before, so who knows what he was exposed to... but that's actually a good point.
When I first brought him in, I had him tested for FeLV and FIV, but his test came back negative. I heard it can lie dormant for years though (another rescue from my area apparently had dormant FeLV, neg results initially) - maybe I should get another FeLV test.
At this point, I just want to know why this is happening and how I can stop the progression... I'm really hoping he will come home.

Once again, to everyone who has commented thus far - thank you so much for your support and insight. I cannot tell you how much I appreciate it.
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Old February 21st, 2011, 03:12 AM
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Quote:
Originally Posted by katts View Post
Boi is still on IV fluids, but his recent blood tests have me very alarmed: White cell count has skyrocketed, while RBC, Hemoglobin, and Hematocrit have plumetted.

White cell count = 17.5 (up from 12.1 when we took him in; norm is 4.0-16.0)
RBC = 6.1 (down from 8.6; norm is 6.3-10.8)
Hemoglobin = 86 (down from 116; norm is 104-160)
Hematocrit = 0.27 (down from 0.33; norm is 0.32 - 0.49)
Platelets = 201 (down from 320; norm is 300-800)
The increase in WBC is not unusual, once the body is more able to manage the issue at hand (increase in kidney levels) the immune system can restart it's job of fighting off foreign susbstances, infection, etc. It still hasn't been definatively determined why there was such high numbers in the first place.

The drop in RBC, Hemoglobin, Hematocrit & Platelets can partially be explained by the IV Fluids - you're adding excess fluid into the blood stream which ineffect thins the blood a bit so the values may be off a bit in the sample taken.

When my CRF girl was in the ER Clinic on IV for a weekend (protein allergic reaction) she had a similar result in her CBC results: WBC & Platelet increase; RBC, HG & Hct decrease.

Quote:
Originally Posted by katts View Post
His Urea is now 41.5 and his Creatinine is 570.
His ALT is up to 95 (and was 36 before norm is 28-76).
ALP is up to 59 (was 36 before - norm is 0-62)

They put him on ampicillin because of the white blood cell count, even though they do not know the cause (and are not trying to diagnose the cause in any manner). This makes me extremely nervous. He seems to be going into some sort of liver failure.
Should I switch vets?

I know it's not looking good now.
Good drop in BUN & Cre results so far

ALT & AST - These enzymes elevate relatively easily and are not as important in liver evaluation as ALP elevations but a substantial increase may also warrant follow up liver testing. In the event of hepatic lipidosis or fatty liver, the elevation in ALP is often dramatic

http://ahdc.vet.cornell.edu/sects/cl...em/leakage.htm

ALT is a liver specific enzyme but can also increase in severe myopathies (release of muscle enzyme) and hemolysis

Quote:
ALT is found in the liver, muscle (cardiac and skeletal), brain, kidneys, and erythocytes.
ALP has increased but is still within normal. It is also a liver & bone tissue specific enzyme but can also increase due to other factors including hyperthyroidism, pancreatitis, bile duct obstruction etc.

Again when my CRF girl was in ER on IV for a protein allergic reaction the reg vets were orginally concerned about liver issues because her ALT & AST were elevated & ALP was low, but once she has been retested after 24+ hrs on IV and was also given ampillicin at that time - at that point we also hadn't realized it was a specific protein she was having a reaction against, the next test done showed a drop in both ALT & AST. She was later determined to have a very mild form of IBD & pancreatitis.

Obviously I'm not a vet but my the mild liver enzyme increases may be due to not eating as well as he should in clinic. Often cats that are hospitalized don't eat as much as they normally would, in part due to stress and also being kennelled they are not expending energy moving about therefore need less calorie intake, the restricted activity also promotes muscle wasting which as mentioned above can result in the release of the liver enzymes.

The vet will likely want to run the blood work again before releasing Boi from the hospital, so all these levels can be compared again. You can ask for a Bile Acids Test to determine if there is any liver damage, and/or a Spec fPli test can be done to check for pancreatitis.

Unless you are uncomfortable with the vet & staff or the services they are providing I would leave Boi there as the transfer to another vet would result in retesting & re-evaluating everything & may be more stressful to Boi than necessary.

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Old February 22nd, 2011, 04:35 PM
katts katts is offline
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It's not looking good.

Boi has gotten much worse and the vets are now telling me they cannot do anything to save him. They said he will pass on in a couple of days.

He now apparently has fluid in his lungs (“from the fluids”???). They are disconnecting him from IV and are sending him home later today.

I'm sick of the vets. Even though they are sending him home to die, they want me to buy forticor for his heart (he has never had myopathy). They dismissed pancreatitis because they said "it's always extremely painful", which I know is not true. I just.. dont know what to believe. I'm just tired.

Thank you for all of your responses.
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Old February 22nd, 2011, 07:51 PM
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katts, I'm so sorry for you and Boi. You will both be in my thoughts and 'ers tonight. Don't give up... he could turn out to be a miracle baby. I have one of those myself, he's a canine version
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Old February 23rd, 2011, 02:31 AM
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Sad to say, Boi came home in very poor shape, and passed away later in the evening from the fluid in the lungs. He was surrounded by family and will never be forgotten.
I extend my sincere gratitude to everybody who commented. It was your support that helped me through this extremely difficult time, and it made me feel less alone. It was really nice to know other people were rooting for him to pull through as well.

Thank you everybody, for all that you have done for Boi and I. I only hope I can someday do for another person what you have all done for me.

RIP Boi. (? – Feb 22, 2011)
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Old February 23rd, 2011, 07:23 AM
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I am so sorry, katts


Boi
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Old February 23rd, 2011, 09:09 AM
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I am very sorry for your loss as well. He knew he was loved and it sounds like you gave him a wonderful life. He was a beautiful "Boi".

sweet kitty

And many to you katts.
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Old February 23rd, 2011, 10:57 AM
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I've been following the threads and hoping for a miracle. So very sorry that your beautiful black Boi with the gorgeous gold eyes did not make it. But he knew he was well loved and cherished to the end. I honestly believe that no love is every lost and that some day we will be reunited with our pets.

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Old February 23rd, 2011, 10:58 AM
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I am so very sorry Katts
Boi,was a beautiful little black cat.
little Boi
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Old February 23rd, 2011, 03:37 PM
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I'm so sorry, katts

Boi was obviously much loved and you were both lucky to have found each other.



Boi
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Old February 23rd, 2011, 04:02 PM
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I am so sorry for your loss

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Old February 24th, 2011, 02:20 AM
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katts I'm so very sorry

sweet Boi He is playing at the Rainbow Bridge with those who've gone before
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Old February 25th, 2011, 10:13 AM
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I'm so sorry


I'm so sorry Boi didn't make it. You did more than your best to help him. I just lost my girl Luna to renal failure, she was my angel and Boi will be your guardian angel now.
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Old February 25th, 2011, 11:23 AM
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I am so sorry Bol wasn't able to be saved. It was his time, he knew love for all those years and is now playing at the Rainbow Bridge. I hope you find peace knowing he is

I am glad you found us even if it was at the end, I hope we were able to support you during this awful time and wish it had ended quite differently.
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