SDMA indicates CKD. What do you wish you knew when your cat was diagnosed?

Discussion in 'Feline Health - (The Main Forum)' started by C&J, Feb 12, 2018.

  1. C&J

    C&J Member

    Feb 20, 2016
    Hi all,

    It has been a while! My new job has been keeping me extremely busy, so I haven't been able to say hello as much as I would've liked.

    Lily had a dental today, and her bloodwork turned up bad news. The SDMA test has her at 40 ug/dL. Her creatinine is "normal" at 2.1 mg/dL. Everything else is in "normal" range, except her blood glucose. She gets crazy stressed in the car, and while she's always between 40 and 50 at home, she was 161 at the vet. Her dentist is a specialist and did not want to get into any diagnoses (beyond saying I need to make a vet appointment, but that he was still comfortable putting her under anesthesia), but he said it suggested CKD.

    I've made an appointment with her regular vet and read up on Tanya's site. (Including the "Final Hours" page, which was a huge mistake for my goal of staying calm about this.) I've already ordered lower phosphorous food (Tiki Cat chicken) and have a water fountain to encourage more drinking in my Chewy cart, but the really hard part is sifting through all of these options--subq fluids, phosphorous binders, etc. It's like when I started researching diabetes before I adopted Winnie all over again, except this time I don't have 3 months and tons of free time to digest it.

    What do you wish you knew when your diabetic cat received a CKD diagnosis? What should I ask the vet for? What should I push back on if the vet suggests it? (My vet is great, but otherwise great vets are ignorant about diabetes, too. Plus I don't want to sound all "mom who read a thing on the internet and now thinks she has an MD" if I push back on high-carb renal food. Please make me sound smart.) What should I start doing now even if it's not recommended by the vet?

    I know I should probably post on a CKD-specific forum, but I trust you guys to help with the intersection between CKD and diabetes in remission. Thank you in advance for any suggestions (and thank you for letting me get all my concerns out--Lily is the crowd favorite and all my friends and family are just as upset as me by the prospect that she could be sick, so I feel bad reaching out to them...). It seems like her SDMA values are very high but I'm trying to stay optimistic that we caught this early since the other indicators are "normal." On the bright side, her dental went great, and it could be the meds, but she's in the snuggliest mood ever. Any happy stories of diabetic CKD kitties living long happy lives would be much appreciated...
  2. Sean & Rufus

    Sean & Rufus Well-Known Member

    Jan 10, 2018
    I'm no expert, so I'm confused. Why do they think CKD just because BG is high? 2.1 creatine isn't that bad.
  3. Sean & Rufus

    Sean & Rufus Well-Known Member

    Jan 10, 2018
    And btw, my vet told me the numbers can constantly change, I honestly would be a "little" concerned, but those numbers aren't bad.
  4. Tracey&Jones

    Tracey&Jones Well-Known Member

    Dec 12, 2016
    On Tanya's site it will give you the different stages based upon creatinine and phosphorus. The SDMA is supposed to be the early warning sign that there is an issue with the kidney's and will rise before the other marker's do.

    Diabetes can be hard on the kidney's. I think you did the right first steps of the low phosphorus food, encouraging more fluids by drinking or by putting a tsp in the food and mixing it in. A little bit of tuna water can go a long way with encouraging drinking.

    You will see quote's on Tanya's site about food. She has it all documented for reference to any vet about low protein, high protein, phosphorus levels.

    Do you happen to have all the lab results?
  5. C&J

    C&J Member

    Feb 20, 2016
    Great idea on the tuna water! The chart on Tanya's site suggests she's already in Stage 2 based on the SDMA levels. I do have the lab results right next to me, if any more figures would be helpful. I will take a closer look at the food page, thank you. Just grasping at straws here trying to figure out what to prioritize.

    The SDMA figure is very high according to the vet--normal is 14, and she's at 40. Like Tracey said, it's a newer test designed to catch CKD earlier.
  6. Sean & Rufus

    Sean & Rufus Well-Known Member

    Jan 10, 2018
  7. Tracey&Jones

    Tracey&Jones Well-Known Member

    Dec 12, 2016
    If you want to upload them or put them in Winnie's SS, Marje and Gracie is good at interpreting results and give you a good picture of what is going on. We tag her and see if she can help out.

    There is are CKD kitties here. I wonder if you would like to post into the Lantus forum...way more eyes there and you will get lot's of input for questions you may have.

    Another thought of the food - they need to eat, and even if not the best food, it is good food if they will eat it. I have had to make some compromises with my civvie who is CKD.

    You can also give little chunks of canned ham. That sodium will get them drinking and help flush the system.
  8. C&J

    C&J Member

    Feb 20, 2016
    Thank you both so much! I assumed Lantus was dedicated to dosing, so I didn't post there, but I will do so tomorrow if you think it would help. Thankfully, appetite is not a problem with my two...

    Here are the lab results (faster to type than to guess my imgur password to upload photos):
    GLU 161
    SDMA 40
    CREA 2.1
    BUN 26
    BUN/CREA 12
    PHOS 4.5
    CA 8.9
    TP 7.8
    ALB 3.4
    GLOB 4.4
    ALB/GLOB .8
    ALT 77
    ALKP 30
    GGT 0
    TBIL .6
    CHOL 247
    AMYL 742
    LIPA 828
    Na 161
    K 4.4
    Na/K 37
    Cl 121
    OSM Calc 326
  9. AbyResq

    AbyResq Member

    Feb 28, 2016
    SDMA is an early marker for CKD. To give you some reassurance, I've had several cats with CKD. Never one with diabetes and CKD. My cats, who I caught early based on their creatinine and BUN, lived for many more happy years. You are doing the right things by lowering phosphorous intake and increasing water consumption. You do not need a phosphorous binder yet.

    Many people don't realize their cats are in CKD until the cat is in a fairly advanced stage. Based on the labs, it appears that your may be headed into CKD. How far in the future before that happens - I'm not sure anyone knows. My original understanding of SDMA was that it didn't fluctuate. Clearly my understanding was wrong because one of my cats just had a lower SDMA reading than his labs from 2 years ago.

    I hope some of that helped. It's not time to panic yet.
    Sean & Rufus likes this.
  10. Larry and Kitties

    Larry and Kitties Well-Known Member

    Dec 28, 2009
    Have you had a recent urinalysis performed? Urine specific gravity is a very good indicator of kidney function
    AbyResq likes this.
  11. Elizabeth B

    Elizabeth B Member

    Jul 30, 2017
    The diets for FD and CKD are difficult to accomodate. Tiki has no carbs and that can sometimes push BG higher depending on how your kitty uses carbs. Some other good options are weruva regular line, truluxe, or cats in the kitchen (easier on the budget); whole earth duck flavor; and I think soulistic has some good options. The lesson I learned was only buy a couple cans of something until I know what happens with the sugars.
    C&J and Critter Mom like this.
  12. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Aug 5, 2016
    Hi, I know what you are going through and there are quite a few kitties with both CKD and FD, and is manageable specially if like yours CKD is in a lower stage, one thing you do want to discuss with your vet is that at least for the time being is not a good idea to change him to any renal diet (that's all vets first indication ) since they are all very high carb and that would make his FD worse which will affect his kidneys more instead of helping (probably you'll never change but you don't want to sound too pushy right now), also most renal diets are low protein and that is also not good since they start losing muscle mass and you do not want that either.

    His phosphorus levels are ok so you do not need phosphorus binders at this point but is best if you look for a low phosphorus food (obviously low carb), take a look at Dr Lisa's list there are quite a few of those, also you could ask your vet about Azodil (only if your cat more o less accepts pills because they are quite big so not so easy to give ) because that can also help

    Getting an urianalisis so that you can see how is his density, creatinine in urine and if there aren't any proteins in urine will also help give you an idea of how everything is going.

    Babu was diagnosed with CKD nine months ago, later than your kitty since we do not have SMDA test down here so he is Stage II ( with higher creatinine, BUN, and phosphorus levels than your kitty ) and so far he's doing ok.
    C&J, Critter Mom and Kris & Teasel like this.
  13. PussCatPrince - GA

    PussCatPrince - GA Well-Known Member

    Nov 25, 2017
    Exactly. couldn't agree more. That is exactly what happened to Tyler. Blasted dry renal diet. May it all be smote into the dust that it is.

    That no matter what , steer clear of prescription renal diets.
    A low carb, low phos wet food will do far far better.
  14. Elizabeth B

    Elizabeth B Member

    Jul 30, 2017
    I cannot agree enough that Rx diets are not the answer. They are one sided and often void of elements that answer to complex situations.
    Veronica & Babu-chiri likes this.
  15. C&J

    C&J Member

    Feb 20, 2016
    This is super helpful, thank you <3 The variability of prognoses is part of what made that first day so overwhelming and scary.

    We are waiting on bloodwork to arrive at the regular vet before she can have a full workup done. I will try to keep my grumbling about why no one can send a ^&%$ing fax to a minimum in light of how great the vets otherwise are...
    (I've also decided to bring Winnie in for the same bloodwork because her dental isn't for several months and it'll help me sleep at night to know.)

    Thank you! This is exactly the information I needed. She wolfed down her Tiki Cat test run tonight, which has about half the phosphorous of Fancy Feast, so I'm sticking with that plan for now! Her numbers were awful when she was on high carb food and in the shelter. She was in remission 10 days after the switch to FF (and aside from the spike in the labs after a 30 minute car ride where she wailed the whole time). The last thing I want to do is reintroduce high carb foods.

    You guys are so great and such a huge comfort. Lily is making biscuits near the laptop and drooling on the keyboard to say thank you for everything.

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