Low carb & low protein food - kidney disease

Discussion in 'Feline Health - (The Main Forum)' started by Tilou, Jan 17, 2019.

  1. Tilou

    Tilou Member

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    Jan 20, 2018
    Bonjour everyone
    I have not been on the forum for some time and hope everyone and their fur babies are doing well.
    Bobby is continuing with his 3ui Prozinc, am and pm, except when his numbers fall low, which is not very often unfortunately! He is though maintaining his correct weight and been relatively healthy with minimal visits to the vet.
    I've kept him on a mainly wet food diet, of low carb - having found local supermarkets here in France are now producing wet food suitable for diabetic cats. I discovered that Aldi senior, for example, only has 0.5% carbohydrate. There are also bio wet food varieties available in Carrefour these days (although ironically Bobby doesn't like that particular brand!).
    From early advice on the forum, I have also maintained his diet with a variety of full nutritional and complementary food from ZooPlus - he adores their Cosma range, especially the tuna and crab, which is 0% and Animonda Vom Feinstein at 2.6% is a favourite treat.
    Today, however, he went to the vet for his annual boosters and while there she carried out a blood test, which revealed that Bobby is suffering from insufficient renal functioning. In true veterinary fashion, she wanted to put him on a diet of Royal Canin Renal biscuits, but I told her Bobby doesn't like kibbles (he does, and he does get a treat once a week, but I'm not having him on a dry food diet!). So she gave me some free samples of RC Renal sachets, which I checked the carb content of and am mortified to see values of 23 to 26%!
    She dismissed the Aldi senior and Cosma complementary foods, citing that the protein values were too high and I should aim for something under 20%. I knew the protein values weren't that high and said as such, but she said there is a difference between "good" and "bad" proteins and that the RC protein was low and good :blackeye:
    As it happens, on checking back home, Aldi senior has a protein value of 11% and the Cosma ranges between 11 and 20% (the ones Bob eats are in the 11-13% range), so I am now a tad confused.
    Having to make a new food order up anyway, I have checked ZooPlus for anything that is reasonably low(ish) carb and low (good?!) protein.
    I have found and ordered a German renal control brand, Beaphar - 15% carb, 7.2% protein. I have also ordered a selection of flavours from the Animonda Insufficient Renal wet food packets, ranging from 10.9-11.7% carbs with 7.8% protein values. Additionally I chucked in a box of Specific Cat FKW (expensive!!) at 5.2% carb and 9.9% protein.
    I have since read that the protein value issue is more related to the phosphorus levels in the food and am now wondering if the values for the above ordered, given as 0.08% (Beaphar) 0.16% (Animonda) and 0.15% (Specific Cat) is the key to what the vet meant by "good" and "bad" protein, as the RC sachets have a phosphorus value of 0.08%. Unfortunately there are no phosphorus values given for the Aldi or Cosma food on the packets/tins.
    Is there a top value for phosphorus that is not suitable for cats with insufficient renal functioning?
    Have I screwed up with what I have ordered (not that it matters because our 20 year old cat, Joey, will eat anything put in front of him)?
    How can you balance the diet of a cat with diabetes and renal failure - it seems at odds with everything I've been doing so far.
    I've updated Bob's spreadsheet to show the latest Lab results. There is a fructo test result to come tomorrow.
    Thanks for any advice :)
     
  2. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi,

    Sorry to hear about Bobby's diagnosis.
    What stage of kidney disease does he have? Is it still in the early stages?

    These days quite a few of us with CKD/CRF kitties (in the early stages) feed normal foods with just as low a phosphorous content as possible. And if the blood phosphorous is higher than normal (or at high end of normal range) it's possible to add 'phosphorous binders' to the food to reduce phosphorous absorption.
    Protein is actually important for CKD/CRF kitties as the disease can cause muscle wasting, and good quality protein helps them to maintain muscle mass. My understanding is that it is only in the later stages of the disease that protein needs to be restricted.

    I feed my old boy raw food as he needs this for his IBS. But I add a bit of phosphorous binder to it. It's not a 'perfect' solution. But he manages to maintain body weight and he (mostly) does nice poo too, haha! And his kidney values seem to be holding steady.

    Incidentally, there is a UK food list in my signature which also has a lot of Zooplus foods on it, and some of those have the phosphorous content listed as well as the percentage of calories from carbs.

    ...Oh, just a thought, but if you edit your thread title to include 'kidney disease' you may get more responses from others with CKD/CRF kitties.

    Eliz
     
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  3. Tilou

    Tilou Member

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    Jan 20, 2018
    Hi Eliz

    Many thanks for the informative reply, it is much appreciated.

    I'm presuming Bob is only in the early stages (I don't understand the blood readings) as the vet has asked me to change his diet for one month and then she'll do another test.

    I'll take a look at your list - very helpful to have one with UK/Zooplus values, as so many of the brands mentioned on the forum and other lists are only available in the US.

    I'll edit the thread title as suggested to include kidney disease.

    Thanks again :bighug:

    Edit: I've looked at phosphorus binders and have found it a veritable minefield! I don't have a phosphorus result for Bob's blood test, just urea and creatinine, 1.2 g/l and 29.3 mg/l respectively (last year 0.5 & 6), which has alerted the vet to the problem.
     
    Last edited: Jan 17, 2019
    Reason for edit: Addition
  4. Tilou

    Tilou Member

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    Jan 20, 2018
    Yikes! Fed Bob sachet of RC Renal and small amount of kibbles... BG of 527 (29.3)!

    Can't sustain that. Going to have to rethink this problem :banghead:
     
  5. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    Hi sorry to hear about Bob's diagnose, It would help to know what his creatinine, BUN and phosphorus levels are, also the rest of his labs but these 3 are the most important ones to get an idea of what stage of CKD (chronic kidney desease) he is.

    Vets usually go for the option of giving them renal food, and if you mention the fact that those are high carb they usually answer too bad raise the insulin dose but actually having an uncontrolled diabetes will harm his kidneys more than the food, so you need to give him low carb ( to help his diabetes ) and low phosphorus food ( to help his kidneys) in Dr. Lisa's list that would be less than 10% carbs and 200 or less phosphorus (the lower the better) but as they mention if you can not find a low phosphorus diet you can always add a phosphorus binder to his food ( not ideal but ok)

    The amount of protein is usually related to the phosphorus content that's why they say you need a low protein food but that is not always exact, a high quality protein (good) would be one that has high protein content also low phosphorus, egg whites for example are a very good high quality protein with high protein content and very very low phosphorus so very good :)

    Renal diets are sometimes necessary but that is usually only in the late stages of CKD, otherwise you want to have as high protein content as posible to avoid him getting to week and because the protein content also goes hand in hand with the taurine content of the food and high taurine content also helps the kidneys.

    Hope all of these makes sense

    Something else you can do is supplement him with omega 3 that also helps the kidneys

    Tanya's site has tons of very good information about CKD http://www.felinecrf.org/how_bad_is_it.htm#bloodwork
     
    Last edited: Jan 17, 2019
  6. Tilou

    Tilou Member

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    Jan 20, 2018
    Hi Veronica

    Thanks for the advice. I don't have a phosphorus result on the test results, but I do have urea (BUN?) and creatinine, 1.2 g/l and 29.3 mg/l respectively.

    I did make it known that I wasn't happy about the high carb renal option and my vet said she'd be happy for me to find food suitable rather than impose a regime she knows I won't stick to. She gave me sample packs of Royal Canin Renal sachets (wet) and I took a small bag of their dry biscuits, as Bob had been taking Metabolic for weight loss and he does like kibbles as a treat... ie when his blood glucose is very low!

    I've ordered an Omega 3 supplement (Easy Cat Renal Protect) to try before committing to phosphorus binders and sent an email to one of the food companies (Cosma) that don't provide full nutritional values on their tins, as Bob really likes their products.

    I've taken a look at Tanya's site and had used Dr Lisa's food charts when I first set out on this adventure - so helpful when you haven't a clue!

    My vet said the protein value shouldn't be over 20%, but didn't give any phosphorus maximum value, so I found that confusing as all the food I give Bob is less than 20% protein on the labelling.

    Thanks again for the info :)
     
  7. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    Think more about reducing phosphorus rather than reducing protein, specially with comercial food some may have low protein content (and actually you don't want it very low) but still be high in phosphorus if they are adding a lot of bone for example
     
    Last edited: Jan 17, 2019
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  8. Tilou

    Tilou Member

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    Jan 20, 2018
    I have just received the following phosphorus information from complementary food company, Cosma - as Bob loves their range. It may be helpful to others:

    Cosma Thai - tuna and crab – 0,17%
    Cosma Original - tuna, chicken - Tuna: 0,16 % - chicken - 0,07 %
    Cosma Glory - chicken & quail egg - 0,14 % , chicken & prawn - 0,11 % , chicken & tuna caviar - 0,10 %
    Cosma Nature – tuna , chicken filet 0,2%

    I see that the phosphorus in Cosma Original chicken at 0.07% is on a par with the vet's recommendation of the Royal Canin sachets at 0.08%. Although the carb for Cosma chicken is 4.6% as opposed to RC's 23%, so the latter is totally unsuitable.

    Seeing that the Cosma range is primarily in the 0.10-0.17% range, I presume these are ok too, as Animonda's Insufficient Renal, low phosphorus, product is given at 0.15-0.16% (carb at 10.9-11.7%) as is Specific Cat FKW at 0.15% (carb at 5.2%)

    Beaphar's Renal gives phosphorus level the same as RC Renal, 0.08%, but with carbs lower at 15% (tad high for diabetes, but I'd use them sparsely when Bob's BG was low).

    I'm a tad wary of continuing to give Bob the Cosma Nature chicken filet and tuna with the 0.2% phosphorus value, as these products also carry the highest protein value of 20% that the vet warned me was the upper limit (the rest of the Cosma range that I buy is 11-13% protein).

    Is there a maximum % phosphorus level to watch out for on the food labelling?

    Btw, forgot to mention, my vet is French speaking only, so things do sometimes get lost in translation as my French is not up to veterinary medical jargon level and her English is minimal. Hence my waffling on about this subject on this thread!
     
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  9. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    Don't worry keep asking as much as you want, actually you want the phosphorus to be as low as possible as a reference Hill's renal diet would be around 89-129 mg/100 kcal (47-50% in Tanya's list) of phosphorus and those would be one of the lowest so as close as you can to that would be ok, It is suggested that you do not go over 250 in Dr. Lisa's list and as mentioned if you can go under 200 is even better, regarding the protein the low protein suggestions are usually realted to the fact that with a lot of protein sources the higher the protein the higher the phosphorus, but that is not always the case, you can actually have a fairly high protein low phosphorus food depending on the protein they are using. In my case I add egg whites to the food and that allows me to keep the phosphorus low and the protein high
     
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  10. Tilou

    Tilou Member

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    Thank you. I think the different scales are causing me the confusion. The percentages I've got from the labelling and the company don't relate to the numbers given on Tanya and Dr Lisa's list.
     
  11. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Yes is complicated you would need to know if the values the company gave are guaranteed analysis or as fed, and if they are on dry or wet basis to be able to know how to compare them
     
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  12. Tilou

    Tilou Member

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    Jan 20, 2018
    Indeed. I'm working on the basis that the numbers they gave me are correct and I'm putting an upper limit of 0.2% phosphorus on the 100g packets of wet food and hoping for the best.
     
  13. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    They are probably correct is just that it would be good how are they calculating it so that you can really compare with other foods
     
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  14. Tilou

    Tilou Member

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    Jan 20, 2018
    I checked against another Animonda variety, for sterilized cats, that Bob had been having as it's low in carbs. It's phosphorus level is given as 7.5% (again a 100g sachet), so considerably higher and not one that I will feed him in future.

    I think my main aim is to balance low carb varieties with renal low phosphorus marketed brands for the next four weeks and see how the follow up blood test shapes up.

    I will keep you posted.
     
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  15. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Phosphorous needs to be calculated on a dry matter basis for comparison. And even then there are two ways of expressing the value... :confused:
    To get the same type of calculations that the Tanya CRF/CKD list uses you need both the moisture % and the phos %. Then you can use this very nifty online calculator to do the rest for you. :)
    http://fnae.org/dmb.html?inputboxm=77&inputboxi=1.7&button.x=75&button.y=21&button=Click
    .
     
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  16. Tilou

    Tilou Member

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    That's great! Thank you very much!

    :bighug:
     
  17. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  18. Tilou

    Tilou Member

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    I would love to do that, unfortunately my husband is in the last stages of chronic heart failure and most of my time is spent looking after his needs and I barely have time to open a tin of cat food these days :(
     
  19. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I am so sorry. I do understand.
    Sending you and your husband best wishes
     
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  20. Tilou

    Tilou Member

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    Thank you, it's much appreciated x
     
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  21. JanetNJ

    JanetNJ Well-Known Member

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    You want under 250 (under 200 is best)... That would translate to under 1%
     
  22. JanetNJ

    JanetNJ Well-Known Member

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    Some good choices are Tiki cat (I like the after dark line) and weruva bff.
     
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  23. Tilou

    Tilou Member

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    Jan 20, 2018
    Hi Janet

    Many thanks. Unfortunately I cannot get the must suitable food listed on Dr Lisa's or Tanya's CKD lists here in France.

    I have found that the German Animonda range, which is Bob's favourite, has a renal brand that is low phosphorus, although the carbs are really on the limit at 10 & 11%, so can only be fed sparingly.

    I'm coupling that up with Specific Cat Kidney care that is both low carb (5%) and low phosphorous.

    The vet wants me to feed him Royal Canin Renal - no way! Not at 23 - 26% carb.

    I have also ordered a complementary omega 3 based kidney health product to try.

    Onward and upward!
     
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  24. JanetNJ

    JanetNJ Well-Known Member

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    You can always supplement the food with low carb fresh chicken as well.... Mixing the foods together... To bring down the overall carbs.

    Another option is to feed a low carb food but add a phosphorous binder to it such as aluminum hydroxide.
     
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  25. Tilou

    Tilou Member

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    Jan 20, 2018
    That will work perfectly as Bob adores fresh chicken. I have bookmarked phosphorus binder on Vetostore, where I get his needles from, so will as that to the next online shop.

    I was very down after the analysis but, as always, the forum members have boosted me with the lovely advice and information.

    Hugs to all...

    :bighug:
     
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  26. JanetNJ

    JanetNJ Well-Known Member

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    Ckd and diabetes are both treatable... With early intervention kidney cats can usually do well for some time. You will down the road want to also do sub q's at home.... It makes a world of difference. What stage ckd is your cat?
     
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  27. Tilou

    Tilou Member

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    I don't know what stage as the French vet didn't say. She just wanted me to feed him "low protein" (I found out on here she actually meant phosphorous - translation difficulties), for one month, then retest.

    I put the results on his spreadsheet.
     
  28. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Sheba was diagnosed with early stage CRD and I was very down about it too, but I soon realised it can be managed alongside the diabetes. Sheba’s CRD numbers remained stable for more than 2 years and she died from an unrelated illness.:bighug:
     
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  29. Tilou

    Tilou Member

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    Thank you. Sorry for your loss :bighug:
     
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  30. JanetNJ

    JanetNJ Well-Known Member

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    Some vets put ckd cats on low protien diets too early. That should be reserved for cats in stage 4 kidney failure... Starting low protien before that can lead to muscle wasting. Really you just need low phosphorus right now to slow the progression and keep them feeling good and keep their appetite normal.
     
  31. JanetNJ

    JanetNJ Well-Known Member

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    @Marje and Gracie can you please look at the lab numbers?
     
  32. Tilou

    Tilou Member

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    Yes I was confused about putting Bob onto low protein especially when the vet said there was "good" & "bad" protein. That's why I headed onto the forum and realised the vet was taking about lowering his phosphorous intake (language difficulties can be a problem).

    I'd shown her my food list, which included a couple of supermarket brands that are low carb but - on closer examination - are high phosphorus and she put a big cross next to them. She knows I won't use the high carb Royal Canin vet diet, even though she gave me some free samples. I realised when looking at the percentages on it's labelling that it's the phosphorous she's wanting me to lower.

    More confusingly she said nothing higher than 20% protein, which meant nothing to me then - or now - as the protein values on my listed food were all around 11%! Again, I think something got lost in translation.

    I've used the Dry Matter calculator to check the Cosma complementary food Bob likes, having got them to send me their phosphorous data for the individual products he likes. I've had to remove some of them, including his favourite tuna and crab, but there are some that fall into the lower range, which I will use as a treat.

    Main problem is Bob gets used to eating one particular product and its difficult to move him onto something new - he suffers from tummy upsets too if I transition too quickly, so I'm mixing in with some of his Cosma and using freshly cooked chicken.
     
  33. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    You can also add egg whites to his food that will give him a lot of good protein and nutrients, being low carb and low phosphorus, buy some of those that come in a jar
     
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  34. Tilou

    Tilou Member

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    You must be a mind reader. I cooked up some eggs and gave him some egg white mixed in with his chicken last night. He loves eggs, so it worked a treat :)
     
  35. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I used to give Sheba a cooked egg white every day mashed in her food.
     
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  36. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Not exactly. These are two different measurements. The “200” refers to mgP/100 kcal and the 1.00% is the percentage on a dry matter basis. One does not equal the other. Those are just the limits for either as fed or DMB, respectively.

    @Tilou The creatinine of 29.3 mg/l converts to 2.93 mg/dL which is how we read it in the US; it’s odd it was reported in mg/l as usually in Europe, you see it in mmol/L. At any rate, that would indicate very, very early Stage 3.

    Are you sure the 1.2 g/l on the BUN is correct because that would convert to 120 mg/dL which is a pretty high BUN.

    Regarding his labs, I really can’t give you much info because there’s just not enough there to go on. Is that all the vet did? You really need a full panel to see how his CKD is...there’s really not enough info to tell you anything. Any chance of getting more comprehensive labs any time soon? And can you please recheck the BUN because, as I said, that’s pretty high especially for his creatinine to not be so elevated. Normally, at that stage, we’d expect the BUN to be about 45 in US numbers which would be 16 mmol/L which is the usual index reported in outside of the US.
     
  37. JanetNJ

    JanetNJ Well-Known Member

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    See I knew you could help
     
  38. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Thank you!!!! :bighug::bighug::bighug:
     
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  39. Tilou

    Tilou Member

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    Apologies for the delay in replying. I was hoping to get the full results for Bob's blood test back in January through the post, but it seems that the vet is waiting until we go back this Thursday - when she is also going to do a follow up test.

    Bob has been on a low phosphorous diet for the month - quite difficult as the commercial foods are so high in carbs. But he's taken to the Animonda Renal (he's always liked their diabetes range), which is manageable in small amounts as it's just over the 10% limit.

    He's also always been a fan of cooked chicken and I've added turkey to his menu. As he was a stray when we got him he's not afraid of the odd bite of raw meat - particularly beef - so he has that as a special treat, although I tend to cook some up for him as well to try and vary the diet away from solely commercial foods. He's also taken to the Applaws tuna that I saw on Tanya's list and is really available here.

    I'm keeping my fingers crossed for a good result on Thursday, but have sourced some phosphorous binder just in case!

    I'm update the spreadsheet with the blood results when I get them.
     
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  40. Tilou

    Tilou Member

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    Btw, here are the results from January as a picture file... the handwritten numbers are the results from last year, which the vet wrote on there for comparison.
     

    Attached Files:

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  41. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Do you know the urine specific gravity (USG)? That is a very good indicator of kidney function
     
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  42. Tilou

    Tilou Member

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    I don't, unfortunately. I'm hoping to get a full set of results on Thursday.
     
  43. Tilou

    Tilou Member

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    Update: been to vet for follow up blood tests. She only carried out urea, creatinine and phosphorus. Results attached. Much improved, which she puts down to the change to a low phosphorous diet.
     

    Attached Files:

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  44. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    What a nice improvement but I don't think is just because the low phosphorus diet it seems more like there was something else in play like an infection or something and it clear up but still I think that keeping him on a low phosphorus diet is a good idea
     
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