Kidney Disease in cat or something else?

[MnM]

I'm hoping for some help here! I'm currently living in Bangkok with my two 12.5 year old cats. The vets here are ok...hard to understand and I'm just wanting to be sure that I'm not missing something. Recently my boy, Mikey, had a urinary tract obstruction and then infection. The doc used the catheter to push back the plug, took blood, gave sub-Q fluids, and meds. This was Monday night. The blood tests came back with BUN at 26 and Creatinine at 2.14-doc said renal failure. Continued sub-Q fluids, pill for bladder lining, pill for anti-inflammatory and an antibiotic. Since then started him on phosphorus meds and had to get an injection for stomach acid reduction. Doc had him eating Hill's C/D then switched Saturday morning to K/D (though that was when he was vomiting and we brought him in for the stomach acid, so didn't really get much of it in). Took blood again and BUN is up to 31 and Creatinine up to 2.41. Back in June of 2008 his BUN was at 26 and his Creatinine was at 1.0.
Does Mikey have renal failure and kidney disease? Is there any chance, any at all, that he could come back from this and live to the ripe old age of 20something? Is there something more I can do? I feel like my heart is breaking...any ideas or info would be appreciated.

[sugarcatmom]

Do you have a value for his Urine Specific Gravity?

Another member here, growler, has lots of experience and excellent advice regarding CRF in cats. I'm sure she'll chime in shortly, but in the meantime, here is her thread that is worth reading: http://www.pets.ca/forum/showthread....kidney+disease

[growler~GateKeeper]

Do you have the reference ranges for the lab that was used for the bloodwork? The creatinine @ over 2 is definately high, though most but not all labs put the BUN as normal when under 35.

Was there anything else out of normal on the blood test? I see Mikey's on phos meds - what is the phos level?

Do you have the names of the meds Mikey's on?

Did they do a urine test? Do you have a value for the urine specific gravity (USG), and what was the amount of crystals?

Urinary crystals & stones can also raise the BUN & creatinine values.

Renal failure and kidney disease are two terms for the same condition. Many cats do really well for years with renal failure, my own grrl, who's 18yrs, has been dealing well with renal failure for 2 years now.

This is a wonderful, informative site by a woman in the UK who has had a couple of cats with renal failure - http://www.felinecrf.org/index.htm - it is not meant to replace veterinary advice but written from an owners perspective.

[rainbow]

Welcome to pets/ca MnM but sorry to hear about Mikey.

I don't have any advice but just wanted to say that growler and sugarcatmom are the two best members on the forum to give you information about feline kidney disease.

[MnM]

Thanks so much for writing back...I'm feeling helpless being in Thailand. I read through Duffy's entire story-Mikey's sis (McKinley) is a tortie and her face looks so much like Duffy's! We love the 'tortitude', that is SO McKinley.

The 'normal' range for the lab here is BUN (7-26 mg/dl) and Creatinine (0.4-1.8 mg/dl). Mikey's Monday/Saturday were 26/31 BUN and 2.14/2.41 Creatinine. I don't have a copy of the urine tests, but will get those at our appt tomorrow-they're going to do it again tomorrow too. I'm worried about him having had blood drawn so close together (Monday and Saturday). If they want to do it again tomorrow that will be three times in a week. How long should I wait to test his blood again?

His glucose was high, which is high every time I've had his blood tested-in the past we fast him then retest it comes back normal (glucose 267 [normal 79-126]). His protein was at 8.0 (normal 5.8-7.9). The phosphorus was not high, but because of hind end weakness and wobbly balance on Thursday night, that vet trip resulted in Alumilk 1.5ml 3x/day.

There is another thing called "ALK.P" and it was VERY high at 147 (3-60 U/L is normal range), but we don't know what this is and couldn't understand the vet-I'll ask again tomorrow.

He is also on:Cystaid, Mabocyl, and Tofidine and between 250-300ml of subQ fluid a day.

On Saturday morning we rushed him because of vomiting (saliva and then the k/d food) and straining in the litter box with multiple trips and even though he pooed, still coming back and straining-then vomiting. He was given an injection for stomach acid reduction and an anti-nausea injection.

Yesterday afternoon was the first I felt hopeful that he may 'recover'. Then the vet called with the new lab results of the elevated BUN and Creatinine. Back into depression I sank.

Last night/wee hours of this morning, Mikey was very much his usual obnoxious self (kneading and drooling in my hair at 3am-though instead of the usual toss off the bed, I let him knead and drool away!). Today he actually PLAYED with a piece of paper and a shoe lace-not for long, but still...I cried (again). He's eating about a can+ of K/D a day-seems to actually like it, though we can't feed his sister something else when he's around or he'll refuse to eat his. He's not drinking ANY water, but the poor guy walks around like a slushy most of the day with that much fluid being poured into him, so I can't blame him.

I can not get ANY of the good canned foods here, I'm lucky to be able to get the prescription ones. I was all of last year (Sept-June) feeding him a homemade cooked diet-duck, sweet potatoes, mung beans with calcium citrate, probiotic, flaxseed oil, taurine added in. He liked it. I also bring back as much as I can carry from the states of canned foods like wellness, weruva, etc, but can't bring enough to last long. Starting this Sept though, I forced him on to a dry diet with a can once or twice a week. He started losing weight (which was what prompted my original move to the homemade/canned food diet, a vet suggested grain allergy after $3K in tests revealed no other cause-ugh; part of this testing did show he had some scarring on the kidneys and two small kidney stones, but everything else checked out). He gained some weight back and had regular bowel movements, he maintained this for a year. Then about three weeks ago I noticed he was dropping weight again and having trouble pooing and was frustrated (as even the dry kibble was grain free). So started throwing whatever canned food he wanted at him-which unfortunately was mostly Thai canned cat foods which I have no idea what was in them, LOTS of fish though.

I noticed him acting 'funny' a week ago Friday. Left for the weekend, came home on Sunday and still had that funny feeling. He didn't cry, or stop eating, or anything that you can describe to a vet-but we knew something wasn't right. Monday night took him in and found the urinary tract obstruction. And then I've told you most of the rest...

He's only 12 1/2...I was banking on another 8 or so years of having to toss the 3am drooler off the bed...with moving around as much as we do, he IS my family, he is home.

Thanks for listening, sharing and giving hope. It's rare to find people that understand that he's not 'just a pet'...thank you.

[rainbow]

I'm not the person to give you advice but Growler is logged on and I'm sure she will help you.

I do know that a mainly fish diet is not good for cats ....especially ones with urinary problems so hopefully you can get Mikey to eat some other flavours.

[growler~GateKeeper]

Originally Posted by MnM

The 'normal' range for the lab here is BUN (7-26 mg/dl) and Creatinine (0.4-1.8 mg/dl). Mikey's Monday/Saturday were 26/31 BUN and 2.14/2.41 Creatinine. I don't have a copy of the urine tests, but will get those at our appt tomorrow-they're going to do it again tomorrow too. I'm worried about him having had blood drawn so close together (Monday and Saturday). If they want to do it again tomorrow that will be three times in a week. How long should I wait to test his blood again?

The BUN is not too bad, the creatinine rising but still in low 2's is not alarming (Mikey's BUN & cre are both lower than Duffy's right now but she is good-stable with little to no symptoms right now)

Given the severity of symptoms vs the relatively low numbers I would say there is something else more pressing right now than the kidney numbers, likely either the crystals/stones, a liver issue or a possible diabetes issue

I would say blood drawn no more than 3 times a week once a month in emergency type situations.

Having blood drawn too often on a sick animal can push them into anaemia especially with cats (due to size) & smaller sized dogs.

In a stable cat the blood values are not going to fluctuate enough for a significant change 1 week to the next. However when formulating a treatment plan for a sick cat (as Mikey would be classed now) one may need more frequent testing.

For chronic conditions such as renal failure once every 3 months is standard, the exception being diabetes however the amount of blood taken for a glucose-only test is far lower than a lab work up.

Originally Posted by MnM

His glucose was high, which is high every time I've had his blood tested-in the past we fast him then retest it comes back normal (glucose 267 [normal 79-126]). His protein was at 8.0 (normal 5.8-7.9). The phosphorus was not high, but because of hind end weakness and wobbly balance on Thursday night, that vet trip resulted in Alumilk 1.5ml 3x/day.

Sugarcatmom is better able to guide you regarding the high glucose & possible diabetes. Glucose will rise with stress but shouldn't go 100+pts due to stress more like 20.

The wobbly back legs could be as a result of: low potassium, anaemia, high phos, metabolic acidosis (one symptom being excess stomach acid), diabetic neuropathy, arthritis, hypertension or constipation

Originally Posted by MnM

There is another thing called "ALK.P" and it was VERY high at 147 (3-60 U/L is normal range), but we don't know what this is and couldn't understand the vet-I'll ask again tomorrow.

Alkaline Phosphatase is an enzyme produced by the biliary tract (liver). High levels indicate bone disease, liver disease or bile flow blockage. Can also be indicated because of vomiting, several days of not eating enough proper balance nutrition.

Originally Posted by MnM

He is also on:Cystaid, Mabocyl, and Tofidine and between 250-300ml of subQ fluid a day.

Cystaid is for the bladder lining, Marbocyl treats tissue infections & URI and while I can't find a direct english explaination for Tofidine it appears to be an antibiotic

Are you dividing the amount into 2 subq session a day? Are the fluids fully absorbed by the next day?

Originally Posted by MnM

On Saturday morning we rushed him because of vomiting (saliva and then the k/d food) and straining in the litter box with multiple trips and even though he pooed, still coming back and straining-then vomiting. He was given an injection for stomach acid reduction and an anti-nausea injection.

Can you ask the vet about something more frequent acting for controlling stomach acid: http://www.felinecrf.org/treatments....g_stomach_acid Also if you raise the food dishes up about 3-5 inches off the ground it puts their head higher than the stomach when eating so it keeps the acid below & out of the throat. Small frequent meals also helps especially one right before bed.

The straining there was likely him trying to pee & being unable to pass urine due to the stone/crystals. Cats will sometimes vomit after straining w/multiple attempts in the litterbox, this then puts them at further risk if dehydration.

Originally Posted by MnM

I can not get ANY of the good canned foods here, I'm lucky to be able to get the prescription ones. I was all of last year (Sept-June) feeding him a homemade cooked diet-duck, sweet potatoes, mung beans with calcium citrate, probiotic, flaxseed oil, taurine added in. He liked it. I also bring back as much as I can carry from the states of canned foods like wellness, weruva, etc, but can't bring enough to last long. Starting this Sept though, I forced him on to a dry diet with a can once or twice a week. He started losing weight (which was what prompted my original move to the homemade/canned food diet, a vet suggested grain allergy after $3K in tests revealed no other cause-ugh; part of this testing did show he had some scarring on the kidneys and two small kidney stones, but everything else checked out). He gained some weight back and had regular bowel movements, he maintained this for a year. Then about three weeks ago I noticed he was dropping weight again and having trouble pooing and was frustrated (as even the dry kibble was grain free). So started throwing whatever canned food he wanted at him-which unfortunately was mostly Thai canned cat foods which I have no idea what was in them, LOTS of fish though.

Why did you take him off the homemade diet and put him on dry? I would suggest to put him back on the homemade diet with canned and most definately get rid of all dry food. It is entirely inappropriate for cats with crystals/stones and compromised kidneys. http://www.catinfo.org/#Common_Felin..._Ties_to_Diet_

You do also want to limit the amount fish in the diet (no more than 1 per week/two weeks) as too much may not only cause an imbalance in vit e but also lead to refusing to eat other varities