Early Stage Kidney Failure in Cat

[growler~GateKeeper]

Thanks LP

Jim yeah it sounds like there are alot of pets who can't tolerate Duck

I've got Duffy scheduled for a check up & a recheck of her bloodwork for Wed

[growler~GateKeeper]

Back from the checkup w/Homeopath & Homeopath Vet. No blood work ran today we will wait a week to let her de-stress & see what her levels are at next wed.

So the homeopath has put together the cause of all these symptoms that prompted the ER visit etc. The food that Duffy was eating when the tainted recall came out was Rice & Duck........she's had Duck 2 times since then & both times she's had a reaction to it. The 1st time she was just really constipated & I thought there was too much psyillum husk in the food. This time a far more serious reaction than the last time. Basically her body reacted to the duck in the tainted food and so now views any duck as an allergen so that prompted the severe gastro intestinal reaction that the conventional vets could not figure out what was linking all symptoms. Duffy is now severely allergic to duck! because the food which was tainted also contained duck.

So my theory was half right & the actual cause is better than what I was thinking - far easier to treat an allergy to duck - never feed it again!, than it would be if it were an ongoing case of low potassium combined w/metabolic acidosis.

No Duck

[hazelrunpack]

How did the rest of the checkup go? Does the vet think she's recovering reasonably well?

Allergies are nothing to sneeze at (no pun intended ) but if it just means you can't feed her duck, that's an easy fix!

for next week's bloodwork!

[growler~GateKeeper]

Thanks Hazel

The vet was so very happy to see how well she has recovered from this, I told them I think she is not quite but almost back to 100%

[growler~GateKeeper]

So the bloodwork is in and everything looks good Duffy's liver values are normal, her Potassium is normal, glucose & CK are also normal. Her anion gap is normal & showing no signs of metabolic acidosis. Though she is still swallowing a bit more than normal but that could be due to the change in diet - temporarily back on canned & not eating as well as she did on raw. BUN is back to 14.7 and Creatinine is back to 240 both of which are lower than the regular tests run end of May USG is also slightly better than May's test right now it's 1.021 concentrating 0.001 higher than May This is the 2nd test where her urine is concentrating better than the previous, I hope this trend continues

The sharp drop of BUN & Creatinine into normal prior to any treatment during the crisis was attributed to not eating, vomiting etc and after IV treatment the numbers dropping farther into normal are because of the fluids directly into the veins, flushing out the toxins.

Duffy's hemoglobin & lymphocytes are still lower than normal but about twice the number they were from the ER test which is great The lab attributes it to stress.

Interestingly though her T4 is back way down below 6 (normal is 19-50) some of you may know she had HyperT several years back, was cured w/ 131 Iodine and has had numbers in normal with a couple dips into low in the years since, something that may continue to happen occasionally .

Something I didn't mention here before - the ER vet also found Duffy now has a heart murmur. Heart murmurs are graded from 1-6 with 1 being the least severe and 6 the most severe, often times audible even without a stethoscope. At the time she was 1st admitted (on a Thurs nite) it was graded at a 3 or 4 and when she was re-evaluated (a couple of days later on Sat morn) it was down graded to a 2. It is possible the murmur was brought on by the mild anemia and the allergy crisis that lead to the hospitalization, and it's also possible it is just normal aging. When the homeopath vet examined Duffy she had it as a 1 or 2.

Duffy is back on her homeopathic remedies and will start her supplements again with the 1st one tomorrow and adding the rest in one each week to be sure there are no reactions. She can then start back on raw the week after the last supplement is added back, so for the next 3 weeks she's still eating Wellness canned. Once back on raw there should be an improvement in the amount she's eating, she's not nearly so picky when eating raw.

[chico2]

Growler that's great news,you and little Duffy have been fighting these problems so hard,some good news are very encouraging
Not only have you been fighting for Duffy,but helped so many others as well

[hazelrunpack]

for even more improvement once she gets back to her normal raw diet and supplements!

[growler~GateKeeper]

Thanks Chico & Hazel

The restarting of one of the remedies on Sunday has shown it's working already - Duffy has definately been eating much better today

[TeriM]

Originally Posted by growler

The restarting of one of the remedies on Sunday has shown it's working already - Duffy has definately been eating much better today

Woohoo .

[growler~GateKeeper]

Thanks Teri it is great she's still being picky though must be cold straight from the fridge or right out of a freshly opened can

[sugarcatmom]

Originally Posted by growler

must be cold straight from the fridge or right out of a freshly opened can

Hilarious! Aztec is the exact same way. He rolls his eyes at me and walks away if I offer him refrigerated canned food that I've lovingly warmed up to mouse temperature, but if I just put it cold in his dish, he gobbles it up.

Glad to hear Miss Duffy is on the comeback trail.

[growler~GateKeeper]

Since last report Duffy has been fully back on raw & all her usual supplements. She had a physio appt for IMS in mid July - looking much better there as well her back far less reactive than the previous appt

Near the end of Aug was her 3 month check up she was doing good, Dr listened to her heart as well & could not hear the murmur, eating, drinking, peeing & getting fluids well, but still an issue w/dry poop & vomiting stomach acid while attempting to go, so her homeopath recommended increasing the muscle meat amount to 75% of her diet and the rest as meat/bone/organ mix, and her Vet suggested we increase the volume of fluids from 150cc every other day up to 100cc everyday. The extra meat went over great with Duffy loving the extra chicken breast, however a few days later, when I added a very small amount of bone-in premade raw chicken mix to that again came the straining, diarreah, hard poop, drooling, vomiting, slight panting - thankfully not anywhere near as bad as the "duck allergy episode" (which prompted a weekend in ER). She was doing okay w/the premade turkey mix just reacted to the chicken mix. I had her dropped off at the Homeopath Vet for the day for monitoring, they checked her over, gave her some fluids & a remedy, kept an eye on her, tempted her w/some food which she refused don't blame her it was a/d thinking that would be easiest to digest. The dr on staff (not Duffy's primary vet) said she felt a "doughy" feeling in Duffy's abdomen, this could be fat cuz she is a bit chubby, it could also be the pancreas or kidneys reacting to infection etc or possibly IBD. Duffy was not blocked w/poop, none to be felt in her colon. She recommended an ultrasound to see what is what. I brought her home where she attempted a poop got a wee bit out & went to bed. Repeated a couple of remedies & she was looking far better around 11 pm that night. The next day looking so much better she stayed @ my mum's so she could check on her during the day. The recommendation now from her homeopath is no bone at all for Duffy - she just can process it anymore. The monday after she had a semi hard slightly dry poop & later in the week a good soft/normal poop w/having had no bone all week. Currently she is eating raw chicken breast, I'm considering sourcing chicken liver to add in (trying to find small package size like 1-2 or a butcher here open on sundays) though understandably hesitant to change anything in her diet right now and every 4th day premade raw no-bone Bison mix which she prefers seared

Got her blood results in from the Aug 3 month check the vet is using a different lab so some of the reference ranges are slightly different
Out of range values:

BUN (5-12) 16 H.........last test in June was 14.7
Cre (83-181) 270.3 H.........last test in June was 240
Lipase (0-205) 323 H normal every previous test

In Duffy's situtation, as mentioned by my vet, the increase in Lipase could be due to the kidney issues as lipase is excreted by the kidneys, so here it is not necessarily pointing at anything else, though pancreatitis or IBD haven't been ruled out.

Platelet & lymphocyte counts are also low - this is nothing new for Duffy, both have been low in the past The platelet count a bit lower than previous test but the lymphocytes climbing higher towards normal. Lymphocytes are white blood cells important in production of antibodies and immunity.

Her USG came in lower this time (as the last couple of tests it was climbing) it's at 1.015 the bottom end of "normal", urine pH is up at 7 again and the Urobil came out at 17 where it should read "normal". Everything else is neg or normal.

Urobilinogen is an intestinal bacterial breakdown product of bilirubin. Some of it is absorbed from the intestine into the blood stream and them small amounts are excreted from the kidney into the urine. Urobilinogen in the urine infers the bile ducts is at least partially open which of course is good, (no urobilinogen does not mean the duct is blocked). The amount excreted in the urine also depends on the amount excreted in the feces, the activity of the gi microflora and intestinal transit time. Severe haemolysis, constipaiton & gi haemorrahage all may increase the amount of urobilinogen present. Constipation issues she has had.

The lab Dr who performed the tests remarked at the bottom the high lipase could be due to pancreatitis/pancreas injury or it could be due to the kidneys.

Got a call from my vet as he saw the referral request for diagnostics, he agreed it would be a good idea to get a clear picture of what is going on in her abdomen as we may still be looking at a pancreas issue even though her fPLI test from the ER came back normal, or there could be IBD - though at this point I'm thinking it's just gonna show the kidney disease as she has had no issues this last week & a half. My vet said he was marking me down for a referral for an abdominal ultrasound, but also told me to ask if they can take a quick peek at her heart while we're there to check out the murmur.

Duffy was playing w/her feather toy for a wee bit this weekend. Just waiting on a call from the specialist to book the ultrasound.

[chico2]

WOW Growler,I just read this whole post and I think by now you have gone through the the whole gamit with Duffy,you are probably just about qualified to be a vet
I hope Duffy will get through this with no serious issues and the Ultra Sound will give you some treatable answers

[hazelrunpack]

that the ultrasound rules out pancreas problems and IBD! Glad she's doing so much better on the modified diet. When you see her playing, it must just warm your heart!

[PMFan]

where do you buy the SP products?
thanks

Originally Posted by growler

Breakfast (usually btwn 4:30-6am)

3 supplements are pilled right before she eats:
1 Standard Process Feline Renal Support tablet as per her Homeopath Vets' directions
1 Standard Process Feline Whole Body Support tablet as per her Homeopath Vets' directions

[growler~GateKeeper]

PMFan I get the Standard Process from my Homeopath Vets, it is a regularly ordered item.

If there is a holistic or homeopath vet in your area, call & ask if they carry it & if they can order in for you, prescription not required.

If you are in the US you can click on the "how to order" at the top right of the page & enter your zip code it will show who carries the human products or for US or Canada the "contact us" to ask for someone in your area that carries the vet formulas.

[PMFan]

great, thanks much!

i'm thinking of starting her on the SP, probiotic and maybe the oil.

she's recently started howling more and i'm not quite sure how to pinpoint the cause. she recently had blood in urine so given a course of antibiotic (hence the need for probiotic).

BUN and CREA went down a few points from May 09.
Only changes I made was
-higher quality protein canned w/ near 1.0% phos (wellness, merrick, felidae)
-SD K/D and Purina NF infrequently - she actually likes these
-wellness salmon dry
-freeze-dried raw treats
-slippery elm bark as needed for upset stomach

2009 BLOOD WORK = US values
FEB / MAY 3 / MAY 26 / AUG 29 (ref range)
*=outside reference range
*BUN: 38 / 47 / 56 / 52 (15-34)
*CREA: 2.8 / 2.7 / 2.7 / 2.4 (.8-2.3)
PHOS: 4.2 / 3.9 / 3.5 / 4.8 (3.0-7.0) - increasing
CALC: 9.9 / 9.7 / 9.7 / 9.5 (8.2-11.8)
POTASSIUM: 5.8* / 5.0 / 5.1 / 4.8 (3.9-5.3) - decreasing
TCO2: 19 / 21 / 19 (13-25)
Thyroid: 0.4* / 0.7 / 0.4* (0.5-4.7)
HCT: 38.8 / n/a / 37.6 / 35.2 (29.45%) - decreasing
LYMPHOCYTES: 25 / n/a / 18* / 12* (20-55%) = dramatic fall - 1/2 it's value from 6 mos ago?
EOSINOPHIL: 17 / n/a / 18* / 17* (2-12%) - not sure what causes this
*absolute LYMPHOCYTE: 1425 / n/a /1080 / 636 (1500-7000) = dramatic fall ?


URINE USG
MAY 09 / AUG 09
1.022 / 1023

Originally Posted by growler

PMFan I get the Standard Process from my Homeopath Vets, it is a regularly ordered item.

If there is a holistic or homeopath vet in your area, call & ask if they carry it & if they can order in for you, prescription not required.

If you are in the US you can click on the "how to order" at the top right of the page & enter your zip code it will show who carries the human products or for US or Canada the "contact us" to ask for someone in your area that carries the vet formulas.

[Love4himies]

I missed this update, growler. Wow you have fantastic vets and of course you are the best cat mom .

Sending to Duffy.

[growler~GateKeeper]

Originally Posted by PMFan

great, thanks much!

i'm thinking of starting her on the SP, probiotic and maybe the oil.

she's recently started howling more and i'm not quite sure how to pinpoint the cause. she recently had blood in urine so given a course of antibiotic (hence the need for probiotic).

Since T4 has ruled out HyperT at this point, other causes of howling could be: urinary infection, bladder kidney stones, hypertension or by the toxins in the blood (BUN & Cre)

Originally Posted by PMFan

BUN and CREA went down a few points from May 00.
2009 BLOOD WORK = US values
FEB / MAY 3 / MAY 26 / AUG 29 (ref range)
*=outside reference range
*BUN: 38 / 47 / 56 / 52 (15-34)
*CREA: 2.8 / 2.7 / 2.7 / 2.4 (.8-2.3)
PHOS: 4.2 / 3.9 / 3.5 / 4.8 (3.0-7.0) - increasing
CALC: 9.9 / 9.7 / 9.7 / 9.5 (8.2-11.8)
POTASSIUM: 5.8* / 5.0 / 5.1 / 4.8 (3.9-5.3) - decreasing
TCO2: 19 / 21 / 19 (13-25)
Thyroid: 0.4* / 0.7 / 0.4* (0.5-4.7)

The BUN & Cre dropping is good, the potassium dropping is good it is falling back towards middle of normal which is where you want it. The phosphorus at a 4.8 it not that alarming, yes it has increased but still mid normal and the ratio of phos to calcium is good. The value you want is around 4 http://www.felinecrf.org/diagnosis.htm#phosphorus but still needs to be in a 2:1 ratio calc : phos.

The thyroid being a bit low doesn't normally happen in cats - more in dogs, shows the immature red blood cells are abnormal in size/shape. Have it rechecked with the next blood test.

Originally Posted by PMFan

HCT: 38.8 / n/a / 37.6 / 35.2 (29.45%) - decreasing
LYMPHOCYTES: 25 / n/a / 18* / 12* (20-55%) = dramatic fall - 1/2 it's value from 6 mos ago?
EOSINOPHIL: 17 / n/a / 18* / 17* (2-12%) - not sure what causes this
*absolute LYMPHOCYTE: 1425 / n/a /1080 / 636 (1500-7000) = dramatic fall ?


URINE USG
MAY 09 / AUG 09
1.022 / 1023

HCT is red blood cells left after the blood is spun down in relation to blood volume, it is a measure of anaemia but it's still in normal range. The lymphocytes, eosinophil and absolute lymphocyte all point towards infection as they function in detoxifying foreign substances (eosinophils) and destroying bad cells and in antibody formation (lymphocytes).

Antibiotics should be helping with the infection & that will raise those values back into normal.

USG not moving much is good.

One thing to remember is all values fluctuate constantly so sometimes it might be up other times down. The most important thing, even more than the numbers, is how your cat is feeling.

[growler~GateKeeper]

Originally Posted by Love4himies

I missed this update, growler. Wow you have fantastic vets and of course you are the best cat mom .

Sending to Duffy.

Thanks L4H

Duffy had her ultrasound done today at the specialists everything went great Everything other than the kidneys are normal, no cancer, virtually no scarring on the kidneys - Radiologist said they look like 10 yr olds kidneys not 18yr olds Pancreas, Liver are normal, 3 very small areas in the intestines that look like they might have a bit if IBD but he said it wasn't anything to be worried about - I'm thinking this was being irritated by the bone, which she apparently can't handle.

Dr also checked her heart, again everything looks great very minor weakening of the valve on the right side which is what was causing the murmur (the sound of the blood seeping backwards out of the ventricle). So still rated between 0-1 The left ventricle is perfect - the left side is more serious/important if/when there is an issue.

Interesting little tidbit the radiologist who did Duffy's ultrasound also did a cardiac ultrasound on my Calvin back in 2001 also for a murmur

[Love4himies]

I am glad to hear that her heart is in good shape!


Is it normal for cats who are going into kidney failure to have issues with bone, or is it that some cats just can't handle too much bone?

[growler~GateKeeper]

L4H to my knowledge there is no connection between crf & issues with bone. Some cats and dogs don't do so well on certain meats and some need lower bone amounts. Older cats also don't need as much bone as younger ones, of course gaugeing by the condition of their poop is an easy way to spot any issues.

In Duffy's case it is likely the very small spots the radiologist noted on her intestines that is being irritated by the bone, like a very mild case of IBD - he wasn't told she is rawfed, but this was a possible cause of the recent issues she was having pooping, that was suggested by my vet. He should call me in the next few days to go over the radiologists findings.

[growler~GateKeeper]

Since the last update Duffy was on butternut squash for the soft slightly squishy (but not liquidy) poops resulting from lack of bone (I can not just add in bone to her diet since that is one trigger of her mild IBD), we were upto 1tsp per day with not enough difference seen and she was still occasionally vomiting stomach acid (just when pooping0 as a result of the pushing. So I switched her to Slippery Elm Bark Powder she's at 1/2 tsp per day and I am seeing much improvement in the poop department not perfect just yet but definately easier for Duffy to go, so to speak, and no vomiting. Yay!

Another vet visit update, from Sunday 15 Nov, the visit went good silly grrl refused to pee for me in the morning before the appt so I could bring a urine sample in, therefore she had to hold it for a cysto. After the urine & blood samples were taken, she was offered a litterbox & she still refused to go in it so after the appt on the way out to my mum's truck I leash walked her out to the parking lot & she peed beside a tree out in the pouring rain

Treatment plan is same as before, wiith Azodyl in place of a regular probiotic, Duffy's homeopath has heard great results from some of the ultrasound techs so we started that on 1 Dec. Duffy's appetite has been awesome since on the Azodyl not sure if it's a result of that or just because I bought some of her favorite food topping treats in the same week Amazing thing too is that MC is going to cover the cost of the Azodyl which is fabulous considering it's expensive & I'll be going through 3 bottles every two months.

Blood results came back good, stable numbers a 1 point increase in her BUN currently at 17 and nearly a 27 point drop in her Creatinine currently at 243.4.

I have samples of Feline Future TC Inctincts and TC Instincts Plus pre-mix for rawfood so I'll see how Duffy likes that over the next couple of weeks, I mentioned this to Duffy's homeopath to let her know I was going to try her on it & she definately recommends the products as she was the homeopath for the company when they started - small world

So her blood results are looking good & she's feeling great

[TeriM]

I have used the instincts stuff in the past when I first introduced Bud to raw food (there wasn't the selection available like now) and I think it is very good stuff. I also recommended it to someone a while back whose cat wouldn't try raw and it really helped the cat to convert .

[luckypenny]

What a wonderful update, Growler .

Anyone take any pics of Duffy on leash peeing next to the tree by any chance? The dogs think she's the coolest kitty around .

Have you considered bone meal to replace the raw bone content in her food?

[growler~GateKeeper]

Originally Posted by luckypenny

Anyone take any pics of Duffy on leash peeing next to the tree by any chance? The dogs think she's the coolest kitty around .

Have you considered bone meal to replace the raw bone content in her food?

nope no one was taking pics, but when I mentioned it to Duffy's homeopath she thought it was pretty funny especially given the rain & her refusing to use their litterbox

I mentioned bone meal to my homeopath she said that it would likely cause the same IBD reaction as the ground bone. There is one local rawfood company I know of that uses bone meal instead of ground bones but Duffy refuses to eat anything from them My homeopath vet & homeopath are the ones who said to put her on a muscle meat only diet and that in Duffy's case she is fine on just meat right now as there is calcium etc in it plus she is taking NuCat Vitamins and her blood results for calcuim, phos, potassium etc were nearly identical to the previous tests where she was also eating bone & organs. I'll see how it goes with the TC Instincts.

[growler~GateKeeper]

Originally Posted by TeriM

I have used the instincts stuff in the past when I first introduced Bud to raw food (there wasn't the selection available like now) and I think it is very good stuff. I also recommended it to someone a while back whose cat wouldn't try raw and it really helped the cat to convert .

Good to hear. Duffy's loved raw right from the moment I put her on it , and she's doing great on the recommended meat only so right now I'm just wanting to see if I can make her diet a little more complete without aggrevating the IBD by adding bone.

[rainbow]

YAY for Duffy doing so well.

You are doing an amazing job, growler.

[hazelrunpack]

Oh, wow! I should have stayed up a bit longer last night! What a great update

You really are doing an amazing job!!!!

[luckypenny]

Originally Posted by growler

nope no one was taking pics, but when I mentioned it to Duffy's homeopath she thought it was pretty funny especially given the rain & her refusing to use their litterbox

I don't blame her. Who likes using public toilets ?