Doodle update and questions

I just got Doodle's latest labwork back and there's good news and bad news -- and of course more questions.
The good news is that his blood pressure is down to 155 and the spironolactone seems to be helping.
sodium = 153 (147 - 156)
potassium = 3.9 (3.9 - 5.3) (and he's only been getting 7mEq)

Bad news is that his kidney values have deteriorated a bit more.
BUN = 50 (15 - 34)
Creatinine = 3.7 (0.8 - 2.3)
Phos. = 4.8 (3.0 - 7.0) - up from 3.0 for the last couple of years
My vet thinks it's time to start a phos binder and says that these results confirm kidney "failure".
She said it also probably means that the hyperaldosteronism is secondary - but that it won't hurt to go ahead and test his level again (which of course I plan to do)

The other bad news (I think) is that my vet is moving out of the state. (her husband is military)
So now I have to find someone else to do a follow-up ultrasound on Doodles adrenal glands -- and apparently, on his liver. ??
(I guess no one else there is trained to do ultrasounds)
When he had his ultrasound done on June 7th my vet mentioned a "liver cyst" and noted an "area of grape-like echogenicity along the margin medial and ventral to the stomach" -- at the time she said it wasn't something to really worry about.
But just a few hours ago, on the phone, she said to make sure to follow up on the "concerning area of his liver"
SO now I'm a little freaked - I guess I had convinced myself it wasn't "concerning".


So my questions are
1.) do I actually need to start a binder yet?
2.) does anyone else have any experience or knowledge of a liver with "grape-like echogenicity" - like what could that mean?
And 3.) is this something that needs to be looked at this weekend? or can it wait?

 

oh Michelle, I sadly have no answers for you but know I think of you guys often and keeping you in my prayers. I would PM Jess if she does not see this

 

Thanks Dian - I may indeed PM Jess.
I was thinking, surely it's not something that needs to checked quickly or she wouldn't have let it go this long.
And now I can't reach her by phone to ease my worry.
sucky.

 

As I posted on FB, many peeps would kill for a phos of 4.8. I think most on the CRF group wouldn't start a binder yet at that level, but if I'm not mistaken, Latte's Dr Polzin tends to be more aggressive than other specialists on starting binders. You may want to check with Carolyn on what levels he would advocate starting, it may be in this range.

And we prefer to call it kidney disease. Failure sounds so .... bleak.

What was his USG?

I'd ask for a full abdominal u/s, look at adrenal glands, kidneys, liver, spleen, pancreas, etc.

I posted the ACVR link on your FB page. See if there are any close to you.

umm ... grape-like ... juicy? confused_cat

In our case, the first time she had her u/s and they found the cysts, they weren't alarmed, but wanted to follow up in 6 mths to a year to monitor to see that it stayed stable or if it grew larger or more complex. I don't know if this is what vettybean means, in Doodle's case.

 

why would he need a binder if he's in normal range?
yea for the potassium, tho. he was low before, right?

 

Well I'm glad to hear that sodium is down. That was rather terrifying.

The picture you posted is classic for a liver cyst (hepatic cystadenoma). Fluid looks black on ultrasound. There is always the potential for it to be something worse (a cancerous type cyst), so the recommendation is usually to look at it periodically to make sure it hasn't grown exponentially. If a cat with a cyst stops eating or becomes lethargic, it should be looked at if nothing else is apparently wrong because sometimes even benign cysts get so large that they cause discomfort. I think the recheck recommendation is probably just to be thorough. Can you have the u/s repeated before she leaves?