Civie question...vet visit

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Shiloh & Rhonda (GA)

Shiloh & Rhonda (GA)

Member Since 2015
Spuds had a vet appointment today. Appears that my 15 year old civie has kidney disease. I don't have the full test results but here is what I have:

BUN: 3.9
Creatinine: 2.5
Phosphorus: 5
Slightly anemic.

What is my next step? He has lost weight but still eating and still actively seeking my attention.
 
Hi Rhonda,

I'm very sorry to hear about Spuds' Dx. :( :bighug:

As Anita has recommended, you need to head over to Tanya's Site (TS). There is a mountain of information over there, and it does take time to get through it. To give you a bit of a leg up, here are things you can do quickly or read up on first:

1. Hydration - add some water to Spuds' food but not too much (so as not to put extra strain on the kidneys and also with an eye to fluid retention issues if present). Average cats need about 300ml a day between food and drinking but he may need a bit more if he's peeing a good bit. Get vet to check heart function and seek input on water intake, too.

2. Food - low phosphorus - ideally about 0.7% DMB or lower but nigh on impossible to find. Read all you can about phosphorus binders. Saoirse can't take Ipakitine (contains soy - she's allergic) or ProNefra (inflames her pancreas) so I use aluminium hydroxide in her food (read up caveats on TS about aluminium toxicity).

3. Food - bit of a debate over whether lower protein formulas are good for early stage renal insufficiency but it may be better for early stage cats to eat a diabetic-friendly diet to prevent loss of muscle mass.

4. Omega 3 for anti-inflammatory effects. Search for info on Astro's CRF Oil (web and TS). It's very, very fishy smelling and some cats (Saoirse included) won't eat it. An alternative is Moxxor omega 3 mini capsules (source is green-lipped mussel oil - capsules contain vitamin E). Saoirse gets 2 of these a day and she can swallow the small capsules OK. (Order online from their website.) Note that Astro's CRF Oil is a blend of omegas 3 and 6 plus ubiquinone (CoQ10) and IIRC I think it contains vitamin E as well.

5. Vitamin B Supplementation - start giving a B Complex supplement to replenish vitamins lost through excess urination (e.g. Jarrow B Right - 1/10 capsule per day). B12 supplementation can help with anaemia but TS advises to be cautious about dose because a human study has provided evidence that high level B12 supplementation can speed progression of CKD. Suggestion for dose from TS is c.1mg/day. (Saoirse gets 1-1.5mg/day at the moment - half a Zobaline tablet.)

6. If you do need to feed lower protein food, Astro's also do a protein hydrolysate powder that can be added to lower protein foods to increase supply of amino acids without as much strain on the kidneys. It's not advertised on the Astro's website but TS has some info on it. They also do a nitrogen scrub which claims to trap some nitrogenous waste products in the gut, thus lowering the strain on the kidneys.

7. Monitor urine for pH, proteins and infection (dilute urine can lead to greater vulnerability to UTIs).

8. Regular bloodwork to monitor effects of diet change/phosphorus binders/supplements unti Spuds' values are stable.

9. Ask vet about potassium levels - may get low due to excessive urination.

10. Keep an eye on sodium content of food (again, from a fluid retention viewpoint).

11. Watch for signs of nausea and check out the TS nausea, vomiting, and stomach acid page for tips on how to treat.

There's a very good thread on homemade food in Thinktank if you're interested in this option.

:bighug::bighug::bighug:



Mogs
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As you said the HCT of 24.4% indicates anemia which ispretty bad but not real bad. The BUM and Creatitine are not that bad.
A high TP indicates dehydration and when corrected HCT will decrease.
The phosphorous of 5 is not bad at all.
Was a urine specific gravity reading taken? That provides a good indication of kidney function when the blood values are not that bad.
 
Looks like his kidney values, although elevated aren't too bad just yet which is good - it looks like you've caught this early. The information you've already been given should pretty much cover what you need to do to keep those under control. I'm not a fan of reducing protein until it becomes unavoidable, although for me it's not much of an option because of course Rosa is diabetic as well as CKD. Both my vet and the IM specialist we saw are undecided about that as reduced protein diets are debatable in their effectiveness, but have been happy to follow my lead on it all apart from one vet at our practice who tried to push the prescription food and said I should just accept that she goes back on insulin...we don't see that vet any more because there were other things we weren't happy with either.

I would be a little concerned about the anemia. Comparing it to Rosa's last numbers a couple of weeks ago, when we were told the anemia was actually quite bad, she had a hematocrit of 22% and RBCs at 4.56 so although lower than Spuds numbers, not by a huge amount. Spuds does look as though he's still regenerating RBCs although possibly a reduced response from where it should be. He's definitely regenerating better than Rosa who has a noticeably reduced response to the anemia. But that makes me think there may be something causing it. B12 may help as Mogs said. It may or may not be risky for CKD kitties, but there comes a point with the anemia where all the treatments carry a risk - my vet told me that the other option (and the one they wanted to take) we have is to wait for the hematocrit to drop further (to about 18) and then start Aranesp which carries a risk of an antibody reaction. At the moment, I'm giving an iron and B complex supplement and Carafate to Rosa as well as B12 to hopefully stop any GI bleeding from an ulcer or similar - it may or may not help and my vet thinks not, but is prepared to try it to see if we can get her levels back up. I had to fight to get the Carafate prescribed, but if you can get it it's worth a try for 2-3 weeks to see if things improve. Pepcid AC at 1/4 of a pill once a day may also help if he has excess acid causing GI ulcers.

His total protein is a little raised, and his globulin is also high. According to my vet that can be a sign of inflammation somewhere although the difficulty can be with identifying where if it isn't something obvious like needing a dental.

I would ask for a urinalysis to be done. You'll want to check his urine specific gravity, but it's also worth having them check for proteinuria...Rosa had this on diagnosis but there are meds that can help to bring it under control.
 
Hi Rhonda,

Shiloh & Rhonda said:
No, @Larry and Kitties, a urine specific gravity wasn't done, as far as I know. This was all they sent when I asked for the test results. Should I take him back and ask for that?
Click to expand...
You can monitor USG through home urine testing. Granted, it won't be as accurate as a lab but it'll give you a baseline and allow you to monitor trends. I use Multistix 10SG urinalysis strips and our vet has been satisfied with the results I get.

I came across this article from the Merck Veterinary Manual which might be helpful to you:

Urinalysis



Mogs
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Hi Rhonda, sorry to hear about Spuds' kidneys. Did the vet say what stage he's in? If his numbers aren't that bad, he might not need fluids at home yet. If he needs a phosphorous binder, Epakitin works well, just sprinkle it on the food.

I don't have as much experience as the others do with CRF but I wanted to bring up one point: if he's having nausea or stomach acid raise his bowl a few inches. It sounds like a small thing to do but Mogs told me to do it when Marshmallow was sick and it helped a lot. I just put a couple of paperbacks under her bowl and it made eating a lot easier when she was feeling queasy.

Hang in there, and scritches to both Shiloh and Spuds.
 
He looks like a stage 2 as his creatinine is still under 2.8. Unless he's already dehydrated, a lot of people don't start fluids until that gets to the mid 3s. His Ca is in the higher end of normal, so he might do better with phos-bind than with Epakitin as that can raise calcium levels further, though his phosphorus level certainly isn't too bad at this point.

Raising the bowl a few inches might help - I can't do it with Rosa even though she has stomach acid because her usually excellent appetite turns into a refusal to so much as touch the food if I raise the bowl so much as an inch. But if you can get it to work, it's definitely worth trying.
 
Thanks everyone for the suggestions. His appetite is still great, and the vet suggested that the weight loss may not be from the kidneys, but that I am not feeding him enough. He is always ravenous at feeding time, so I have gone back to the autofeeder that my laziness stopped me from using after Shiloh was in remission. He has been his normally loving self, so hopefully I caught it in time to prevent or postpone the horrible experience Franki had with the kidney disease.
 
Glad to hear that Spuds is well in himself - that is the only thing which counts! :)

Another suggestion: digital baby scales and a food diary to record approximately how much you're feeding.

:bighug: for being such a good cat mom.


Mogs
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