Angel's kidneys are getting worse - need advice

Angel had a checkup yesterday, and it showed that her kidneys are getting worse, despite the increased sub-Q fluids. I really need an idea from others as to how bad this is - my sense is that it's really bad. :cry:

In December, she seemed to be doing pretty well for her, with BUN 54 and creatinine 3. Then she had to take antibiotics for a couple of weeks, which apparently was very hard on her kidneys, and she went up to BUN 72 and creatinine 5. We added more sub-Q fluids (from 150 to 200 mL per day), and that brought her back to BUN 52, creatinine 3.3. Now, a month later, she's back up to BUN 89 and creatinine 4.5. She's also more anemic now than she has been, but the vet said it's regenerative anemia.

She's also not eating much at all, so I've been having to assist-feed her for the past couple of weeks. Even so, she sometimes just doesn't want to go through it, and I've had trouble getting enough food into her. She's still lost a bit more weight, and her liver values are slightly elevated now, which could be from any number of things, but in any case it's worse than it was a couple of months ago.

The vet mentioned possibly putting a feeding tube in through her neck, but I feel terrible about doing that. Partly I don't know what the real prognosis is, etc. I know that her CRF is terminal, but I don't have a sense for how quickly she's declining, or how much time she could have left, and whether getting more nutrients into her would help her actually get better (help her kidneys regenerate and help with her anemia) or just prolong the time until the end, with her suffering more and more every week until then.

Can anyone help give me some perspective on this? I asked the vet, but she didn't really answer the questions.

 

I have two kids with CRF (which i really hate the term, by the way), a brother and sister, and am struggling to keep my girl in the healthy range of BUN. She's been to the vet twice (once at diagnosis and once since when I wasn't giving enough lactated ringers) where they kept her for a few days on "dialysis." Although she wasn't happy at all about the ordeal the constant drip of ringers really seemed to help her levels get down. I don't know where she's at currently but she came home with numbers higher than Angel's. Perhaps this might be an option.

And it's a personal opinion only but I wouldn't opt for the feeding tube.

Best wishes.

 

Have you read the CRF posts that are done periodically on the Health board here? She may need phosphorus binders at this point.

Here is a good "basic" article, http://www.veterinarypartner.com/Conten ... &A=572&S=2 but it includes links to several more articles on the right side of page which may provide some more info for you as to treatment options. If fluids are all your vet is offering, there are things such as the phosphorus binders which will help as well. Her CREA of 4.5 is approaching 5 which is the severe failure point.

Hope this gives you some options.

 

Vicky,

Angel has been on aluminum hydroxide as a phosphorous binder for over a year. I do think I need to increase the amount I'm using, though, because her phosporous level has also risen since last month.

 

You said the vet says it is regenerative anemia. So, what is the vet doing to find the cause of the anemia? During the final stages of CRF, the kidneys do not send sufficient harmon to the bone marrow to produce red blood cells but that is non- regenerative anemia. One can use human drugs such as Epogen to get the bone marrow to produce more red blood cells.

What is the phosphorous level in relation to the normal range. The dosing of the binder is based on the phosphorous level.

 

Hi Larry,

The vet hasn't said anything about treating the anemia with Epogen or any other med. Maybe she's hesitant to try that because of one of Angel's other problems, but I don't know what that is (or I've forgotten, if it ever came up in the past). Do you know if there are side effects of Epogen that might be a concern? She also said that Angel has elevated Heinz antibodies now, while she hasn't in the past. She said that can just be from the uncontrolled diabetes. But since she's always been an uncontrolled diabetic, I don't know why that would have changed, except that maybe her body is just losing its ability to compensate now.

Her phosphorous was 7.3 this week, and the lab gave the reference range as 3.0-7.0. Others with CRF kitties have said that the phosphorous level needs to be below 4 for them to feel like eating. Because of Angel's megacolon and IBD, constipation is a continual problem. Since the aluminum hydroxide can increase constipation, I've always been careful not to overdo it, even though she also gets miralax for that. I've seen other web sites that give a dose based on the P level, but that seems to only cover half the story in my opinion. Since the binder works by reacting with P in the stomach, the dose should depend not just on the current blood levels, but also on the P content of the food. I've been trying to give Angel the lower P foods, but that means generally around 200 on Janet and Binky's charts. If she eats something higher in P, like her favorite Fancy Feast flavors, I'll add more binder. However, it looks like I need to increase the amount I'm mixing in a bit, because her P is a bit high now.

 

The only adverse effect of Epogen is that the cat by develop antibodies against it. However, that would not prevent me from using it if the result of not using it was fatal anemia. Yahoo's CRF group has details on phosphorous binder dosing. The group is:
http://pets.groups.yahoo.com/group/Feline-CRF-Support/