Help with bloodwork results

Discussion in 'Feline Health - (The Main Forum)' started by JennC, Jan 11, 2019.

  1. JennC

    JennC Member

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    Feb 16, 2018
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    I recently switched all three cats in my house to Dr. Elsey's Clean Protein chicken dry and cut out Fancy Feast Chicken Pate all together. After doing so, I noticed one of my civvies (14 years old) drinking a lot more water and urinating more. After ruling out diabetes due to checking BGs, I took her urine into the vet (very dilute - almost clear) and the vet advised the specific gravity was low and we needed to do bloodwork. After I asked a few folks online, I added back the Fancy Feast Chicken Pate 1/3 can each cat twice daily with added water of course. After doing so, I noticed the civvie wasn't hanging around the water foundtain as much.

    Fast forward 5 days, we went to the vet, pulled blood and had the attached results. The vet says we have a kidney "deficiency" and recommends we start her on a kidney diet to lower the BUN. I understand that a high protein diet can raise the BUN as well as dehydration. Curious what everyone's thoughts are. Should we change foods? I'm going to try and catch her urine again to see if there is more of a yellow tint to it this time since the urine output seems less after adding the FF Chicken.

    I have one diabetic boy (14 years), one Civvie girl (14), and another Civvie girl (4)

    @Marje and Gracie - Chris Ronkoski advised you are the expert. :) Love to hear your feedback.
     

    Attached Files:

  2. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    Hi, I couldn't really see very well the actual BUN number, I can see is a bit elevated on the graph, but yes BUN can be elevated because other issues besides kidney problems like dehydration, gastrointestinal bleeding or congestive heart failure. which your girl fortunately does not have.

    When you mention she has a low specific gravity how low was it?

    Looking at her Creatinine and Phosphorus levels I think she does not have a kidney deficiency yet but given her age and the slightly low specific gravity I would think she is at risk so I do think she would benefit from a diet that would help protect her kidneys but not a prescription kidney diet because those have very low protein and are usually very high in carbs so those are usually recommended for late stages of CKD ( chronic kidney disease) , to help protect her kidneys and of your diabetic boy that would also benefit from a little care for his kidneys I would look for a low carb and low phosphorus food and you could also supplement their diet with omega 3 ( your 4 year old civie can also eat this type of low carb, low phosphorus diet )

    There's a test that you could ask for that will give you a more specific diagnose SDMA you could ask your vet for it

    Here's a link to Tanya's web page where you will find tons of very good information about CKD
    http://www.felinecrf.org/how_bad_is_it.htm
     
  3. JennC

    JennC Member

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    Feb 16, 2018
    Hi Veronica, thanks so much for taking a look. The BUN has a 54+ next to it but then when you look at the chart it shows 10 and 30 on the outside of the brackets and the marker isn't all the way against the 30 so I'm not sure if the 54+ means that her BUN was 54 or if it's really between 20 and 30. The vet didn't give me a copy of the UA since it was done a different day. I completely forgot to ask for it. :( I've been trying to filter the food list to find a low phosphorus and low carb and Dr. Lisa's food list doesn't align with Tanya's which leaves me even more confused. I really want to get everyone on the same food, but I'm struggling with understanding the food values to know which to choose.
     
  4. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    If you are using Dr Lisa's list look for food under 10% carbs (for diabetes ) and under 250 in phosphorus (if you can get one under 200 even better) to help the kidneys, the tables in Tanya's web site are calculated on dry basis and Dr. Lisa's uses as fed values that's why they do not exactly match.

    Also I forgot to mention that BUN can be a bit elevated on cats that are getting high protein diets
     
  5. JennC

    JennC Member

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    Feb 16, 2018
    Thank you!!! That helped tremendously!
     
  6. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    There is not much to go on there and I don’t understand how your vet could make that diagnosis just based on those labs and a lower USG. I’m not saying she might not have a kidney deficiency but there’s not enough info and a kidney diet will not lower the BUN.

    Here’s the thing about USG.....as the day progresses and the cat drinks water, the urine becomes more dilute. Just as it does with humans. To find out if she is capable of concentrating her urine.....which is really the question....you need to catch her first pee of the day and run it over to the vet. The vet should have a refractometer (I actually have one myself) that they can check her USG and see if she is capable of concentrating her urine. If the USG is below 1.040 on that sample, then I’d start to think about other possibilities. USG is going to be low in a cat that drinks a lot of water or gets fluids. So why is kitty drinking all the water? Could it be her thyroid?

    Personally, if I’m going to have labs done, I have a senior panel done (even on my 2 year old) because I get the most bang for the buck. Limited labs tell you limited info and you can’t track any trends. Her creatinine is totally normal and, yes, a decreased USG can be an early indicator of CKD but I wouldn’t go just based on that and a higher BUN. I’d do more investigative work. You could even ask your vet to send the labs to IDEXX where you will get an SDMA which is more accurate indicator of CKD.

    Feeding the diet you are feeding is not high protein and shouldn’t have affected the BUN. A high protein diet is usually a raw diet. But stress and dehydration can raise BUN. Look for trends.

    I hope this helps!!! And again...I’m not saying she doesn’t have early CKD; I’m saying you don’t really have enough info to make that unequivocal diagnosis.
     
  7. JennC

    JennC Member

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    Feb 16, 2018
    @Marje and Gracie, thank you for taking a look. They did double check her thyroid due to her heart rate. That's the Bloodwork1 file attached. Since I started this thread, I've been trying to catch her in the litter box so I can catch her urine. If I had to bet money, I'd bet her urine is more concentrate then when I took it in originally. The food values she has right now is below, which is DMB. I'm honestly unsure if she really has a kidney deficiency, I think only giving dry might have caused her to drink more. Since I've added back the fancy feast chicken pate, she has slowed down drinking quite a bit. The below food values is from the Dr. Elsey's Clean Protein Chicken. I'd really rather not switch foods since the high protein food actually helped her gain weight, she's almost 8 lbs and my diabetic is in remission.

    Protein % 62.60
    Fat % 19.46
    Fiber % 0.42
    Ash % 7.41
    Carbs % 4.69
    ME kcal/kg - 4008.73
    Calcium % 1.67
    Phosphorus % 1.08
    Magnesium % 0.08
    Sodium % 0.58
    Potassium % 0.72
     
  8. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    Ahhh...now I see her T4. It’s really faint and I didn’t see it before. When you have an older cat with a lower T4 like that, you could have what’s called euthyroid sick syndrome going on where the T4 is decreased due to some other health issue going on. Again, I’m not a vet and can’t diagnose that but I don’t put a lot of stock into just a tT4 alone.

    On a DMB, the % calories from protein is 54%. You might want to read my post on how to determine those what you really need to know when you are given DMB or as-fed values. I couldn’t quickly find those same values as DMB or as-fed so not sure where you got them but, again, I didn’t spend much time looking. I googled the website for Dr. Elsey’s Clean Protein Chicken and it didn’t pop right up (not a good sign in my opinion).

    IMHO, I do not believe it is possible to make a nutritional dry food. In fact, I’m not even a proponent of commercial canned foods but even less so dry foods. But, I also believe it is your decision what you wish to feed your kitties as long as you feel informed about the ingredients that are in them. While 54% calories from protein is higher than many foods, it’s not the same as what I’d consider high protein from feeding a raw diet. Those are where you’d see elevations in BUN if you were going to see them due to high protein.
     
  9. JennC

    JennC Member

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    Feb 16, 2018
    I'll take a look at your post, trying to understand what value to use has been challenging. I've tried to just stick with Dr. Lisa's list since that's what we started with. Here's the web link for the dry food we're feeding. https://www.drelseys.com/

    The values I received were directly from the manufacturer. As far as the elevated BUN, if our food wouldn't be considered to increase the BUN, what other items could cause it?
     
  10. JennC

    JennC Member

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    Feb 16, 2018
    I was able to catch urine on her and test it with urine strips. All values were normal except Leukocytes and Specific Gravity:

    Leukocytes - moderate
    Specific Gravity - 1.020

    Now, I have no idea what these mean if anything but just wanted to share.
     
  11. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    For cats the leukocyte pad will indicate a false + 99+% of the times so that pad is worthless for cats.
    The pad for urine specific gravity is also very inaccurate. I would not use the value indicated by that pad for anything. I use a refractometer
    https://www.amazon.com/V-Resourcing...t=101&pf_rd_i=393272011&pf_rd_m=ATVPDKIKX0DER
     
  12. JennC

    JennC Member

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    Feb 16, 2018
    Thank you so much!! I'm going to check out that refactor.
     
  13. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    if you are using human strips as Larry said I wouldn't take into consideration the leukocytes because it doesn't read ok on cats, and the specific gravity although in my experience is more o less approximate to what I get with a refractometer it does tend to have a bit of an error sometimes especially as the values get smaller, 1.020 would be a bit low though.

    So far as I mentioned earlier and Marge said, there's not enough information to consider that she has a chronic kidney desase (CKD) but given her age, and some of the results she may be at risk of developing it so considering a high protein, low phosphorus diet and maybe supplementing her with omega 3 could benefit her, I wouldn't change her to a prescription kidney diet because those ones have very little protein and can cause her to lose muscle for example and so far nothing in her results points to an stage of CKD that would need that kind of diet
     
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  14. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    It doesn't make any difference if human or pet strips. There is nothing different between pet and human strips except that some human strips have more/different pads than pet strips.
    When I was at vet tech school we did many UAs and the test trisp has USG but we also measured USG with a refractometer. As shown and discussed in class the USB pads are really not accurate.
     
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