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Old April 17th, 2013, 02:35 PM
Daveacksh Daveacksh is offline
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Kidney Disease in my 2-year old cat

Hello,

I introduced myself a couple of weeks ago in the "introduce yourself" section (http://www.pets.ca/forum/showthread.php?t=83735). You can see a picture of my cat Lily there . I'll post another at the bottom of this message.

She was diagnosed with 'kidney disease' or as I understand it, reduced kidney function. (She's only 2 yrs old)

She has always been a sensitive cat, vomiting once every 2-3 weeks but never acting like she was ill. She was always happy and energetic, eating and drinking normally. She does drink more often than my other cat though...

She has always been picky with her food. She doesn't like canned food and her favorite dry food is Royal Canin Indoor adult 27 which is what she is eating now. (Same as our other cat)

In mid February she vomited for 24hr (roughly once an hour) and was obviously ill. The vomit started out as undigested food, to bile, to small amounts of white foam.

I took her to the vet, who suspected pancreatitis or that she had swallowed something. X-rays and blood work were all negative (the x-ray revealed no foreign object, and the blood work showed no sign of infection and no elevated levels of anything that would indicate a problem with her pancreas/liver, or that she was diabetic)

She rested the next day and that evening she was eating/drinking and back to normal.

Over the next 2 weeks she vomited every few days, but otherwise seemed fine (she was acting normal, happy etc..). I switched her food to Hill's Gastro-intestinal Health i/d which she seemed to love. She was more energetic than ever.

2 Weeks later after switching her food (1month since the first episode) she had another episode where she vomited for 24hr straight. I waited a little longer before taking her to the vet this time because she recovered quickly last time.

After not eating or drinking much for a couple of days I took her to the emergency vet (it was Sunday evening). They gave her medication (antacid, anti-nasea) and re-hydration fluids. Once again, she got better relatively quickly. After this episode, she rejected the Hills food and only wanted to eat the Royal Canin.

I made an appointment with a specialist to determine the cause of these episodes (I have no plants, I don't feed her from the table, I clean her dish each day, there are no toxins she can get into etc..)

So after an ultrasound, blood work, urine test/cultures, it was determined that she had reduced kidney function based on elevated creatinine levels in her blood (She was at Stage 2 level kidney function, or disfunction?). Her kidney profile (blood work) was checked again 2 weeks later and had improved slightly, but her creatinine levels were still in what the vet called "early stage 2 kidney disease"

She had no protein in her urine and did not have hypertension which are apparently symptoms of more advanced kidney malfunction. The vet did say her urine was dilute.

He recommended famotidine (2.5 mg/day) which is an antacid as well as Hills Renal Diet.

She was on famotidine for 2 weeks before I started her on the Hills food. Once I started her on the Hills food (Slowly mixing with her regular food) she vomited a few times during the week, so I took her off the food and just kept giving her famotidine.

The vet wants her on the food, but she doesn't really like it and it seems to be upsetting her stomach so I am keeping her on her regular diet which has the same protein % as Hills renal.

She seems fine now and hopefully she won't have another episode for a while.

Does anyone have any similar stories to share? I've read alot about CRF on the web (Tanya's site) and others.

I'm not so interested in hearing about how dry foods are bad etc... it's the only food she will eat.

I'm more interested in hearing about similar situations and any advice people may have.

Thanks for reading!

p.s. I don't have copies of her lab results yet. The vet seems to keep forgetting to get them to me.
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Dave
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Old April 22nd, 2013, 11:31 AM
Daveacksh Daveacksh is offline
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The final lab results showed the only abnormality was in her creatinine blood levels:

216umol/L - 4 days after vomiting
182umol/L - 2 weeks after vomiting

Everything else was 'normal'
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Old April 22nd, 2013, 11:36 AM
Daveacksh Daveacksh is offline
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A friend of mine who is a medical resident (human medicine, not animal) had the following analysis:

Nobody has replied to my original thread but there's alot of analysis below which may be useful to others...

Here is my interpretation of the medical issues:

1) Vomiting

The famotidine and the diet change are reasonable measures to take. She could have just had a gastroenteritis which aggravated her stomach and caused the vomiting.

If the vomiting persists, it's a whole other story; it could still be infectious, but there's a whole list of other things which would require more tests to assess.

If she is no longer vomiting though I really wouldn't worry about it. If she continues to vomit, there are other things you can check (liver function, etc.) but I don't think that is necessary at this point.

2) The kidneys

I'm not sure if she has chronic kidney disease. Usually you need to have renal impairment for ~3 months before declaring that.

It seems her creatinine has gone from 216 to 182 over a short time, indicating some degree of renal recovery. I wouldn't be surprised if you rechecked it in a while and it normalizes.

It's possible that the excessive vomiting caused her to be dehydrated which led to the renal impairment. Now that she's not vomiting and that she's drinking well, she isn't dehydrated and her kidneys are perfused better, which is why the creatinine is coming down.

If that's the case, I would expect her kidneys to recover fully.

They indicate that the specific gravity is normal which favours renal disease; I don't know if it's the same for cats but in people we don't really use that value at all.

The most common causes of chronic kidney disease are diabetes (which apparently she doesn't have) and hypertension (the BP was 140; in a human that's a little elevated, probably not high enough to give renal impairment, but maybe in a cat that value is normal)

She said maybe there was suggestion of a urine infection (WBCs in the urine) however the culture was negative. I don't think she has a pyelonephritis; the culture would have grown something and she would be much sicker. Her temperature was 38.2...in a human that is a fever, but I'm not sure of what to make of that in a cat.

The fact that there's no protein in the urine (UPCR was 0.1) is reassuring and suggests only very mild renal impairment.

I think the renal diet is reasonable (although in humans there is no evidence that that is even necessary).

The only curious thing on the ultrasound were those small calcification they noticed. In renal disease, the first metabolic signs are often hyperparathyroidism leading to calcium phosphate depositions in the kidney.

The only thing you could check are the calcium and phosphate levels in the blood if that wasn't already done. If the phosphate levels are high, there are medications for her which might be useful.

In summary, for her kidneys, I would recommend the following:

1) Don't worry about it; the creatinine is not that elevated and is coming down, theres is no proteinuria (all reassuring signs), etc.

2) Recheck the creatinine at the next visit.

If her creatinine is still high, in a human we would tend to look for causes of the renal failure (since there is no definite hypertension or diabetes). I don't know how much it would change the management in a cat, though, and it would be very expensive...

In any case, we would consider treatments aimed at preventing progression of the disease, such as an ACE inhibitor (to protect the kidneys), bisphosphonates (for skeletal protection), calcium/vitamin D supplementation, etc.

At the next visit, you can ask the vet about those things.

3) A small thing...lymphopenia

The vet says this is related to stress? That doesn't really make sense. How lymphopenic is she? I'm not sure what to make of this; you may want to get it repeated to make sure it has resolved.

I hope this is helpful and that she feels better.
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Old April 23rd, 2013, 01:55 PM
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RUSTYcat RUSTYcat is offline
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Hi Daveacksh and welcome to the forum!

'Just a couple of quick points for you.......
Quote:
I'm not so interested in hearing about how dry foods are bad etc... it's the only food she will eat.
Would you be interested in knowing that, in periodic surveys among members of the most populated online specialized group of guardians of cats with kidney disease, the #1 recommendation for the prevention of CKD is.........NO DRY FOOD? This is the group I'm referring to http://pets.groups.yahoo.com/group/tanyas-crf-support/ That group is owned by the woman who authors Tanya's CKD site. After 7 years and with 4000 members, those people know a thing-or-two about kidney disease.

When you say that dry food is the only food Lily will eat, most of us here really do understand that....it's extremely common among the cats we have adopted and know of.

Kittens learn about food from their mothers...and, when it's weaning time and there's no wet food on 'the table' and mother is eating dry kibble....well....

Our cats evolved as desert animals who derived their hydration from their prey...this is the 'design' in which they come to us today - unchanged over all that time (which also explains why their urine specific gravity IS IMPORTANT to them - but, not so much to humans...but, more about that later).

Given that evolutionary history, it is utterly counter-intuitive to feed dry food to an animal which is designed to take hydration from that food.

I said that all of us are familiar with dry food addiction. There's a very reputable Veterinarian who owns a website focusing on feline nutrition who has written on this subject. Many people have benefited from some of her suggestions (borne from her own experiences) for re-training cats toward wet food. If you're interested, that part's here: http://www.catinfo.org/#Transitionin...o_Canned_Food_ BEFORE you go there, do understand her main message: "The transition process often involves much more than just plunking down a new food item. Time, patience and tricks are often required." Those of us here who have had to re-train a cat (me included) will undoubtedly endorse those statements.

I'd encourage you to sniff around and then read through that entire site. The piece I referenced is one small part of one article and, that article (really a 'Feline Nutrition 101') is just one small part of the entire site - really a wealth of informative, sound and reliable "catinfo".

------------

Quote:
In mid February she vomited for 24hr...I took her to the vet, who suspected pancreatitis... X-rays and blood work were all negative...and the blood work showed no sign of infection and no elevated levels of anything that would indicate a problem with her pancreas...
"Blood work" is too general a term. There are specific tests for pancreatitis. Perhaps you might want to first read about them and then ask your Vet exactly which blood work tests were done in February. Here you go: http://www.felinecrf.org/pancreatitis.htm#bloodwork If only 'standard' blood chemistry was done, pancreatitis cannot be ruled out.

Quote:
I'm more interested in hearing about similar situations and any advice people may have.
What I can say is that, after years of hearing about cats vomiting (reading other peoples experiences posted here and elsewhere - TheCatSite/CatForum/Itchmoforums) - the single most common relief has been had when people changed from dry to wet foods - specifically, no-grain, low carbohydrate, high meat protein, moderate fat levels.
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