? Internal Medicine Visit Today - Kidney Disease??

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babyg

babyg

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We go for a specialist visit today for an overall checkup and to specifically make sure her kidneys and heart are okay (higher kidney values, high blood pressure, and a gallop sound heard during last visit). I thought I'd make a thread now so if I run into any issues or questions during the visit, I have a place to ask. Hoping for a good report!
 
Suzanne & Darcy said:
I hope all is going /went well.
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Thank you. We are still here. So far they are not hearing any abnormal heart sounds so will likely not be pursuing anything cardiovascular, which is good. Blood pressure was normal and her rear end is healing nicely from the anal gland rupture.
But we are going to run bloodwork and do a urinalysis to check kidneys. They said when she peed there out of fright, that her pee was clear, which can be concerning if kidneys are able to concentrate or not. I know the last couple times bloodwork was run, her kidney values came back slightly elevated but were attributed to dehydration at the time, so not sure what kind of results we will get now that she is eating and drinking well. I really hope she does not have kidney disease.
Also, almost forgot...They kind of wonder if her previous diagnosis of chronic pancreatitis is correct or not, or if it is IBD instead, so they may run a GI panel. In the past, the GI panel showed pancreatitis, but ultrasounds showed slightly thickened walls, so who knows.
 
Still awaiting results from the GI panel, but so far, based on the urinalysis and bloodwork, they are thinking she has elements of kidney disease (I asked for copies of the labwork to be emailed; once I receive those, I will post here...if anyone can please take a look!).
Here are some stats they gave me thus far: Creatine was 2.2, BUN was 62; no high Phosporous; not leaking proteins; there was glucose in her urine but we are still trying to regain control over her BGs; blood pressure was good; and she's still holding on to her electrolytes. They cannot stage her quite yet without doing a Urine Protein Creatine Ratio urine test and an SDMA test (they said local vet can run those if I want), but they are guessing she is borderline between stage 1 or 2, or tentatively early/non definite stage 2. They said her bun and creatine levels are what they would call mild Azotemia. I know last year when the primary vet checked her, they said her kidney levels were mildly elevated but at that time they didn't seem all that concerned and said maybe we may have to change her diet but that was about it.
As far as getting her rechecked and properly staged, they want to wait until the GI panel results are back, which could be by Friday or Monday at the latest. Bad thing is I start a new job in a couple weeks so I am hoping she doesn't need to see Internal Medicine any time soon again and that anything we need can be done locally, at least for a little while until I settle into the new job.
In the meanwhile, they recommended trying (again) to get her converted to eating wet food, but they do not recommend a renal diet as of yet since she is still holding onto her protein. They wonder too how her values will look once her anal gland rupture is fully healed and we have a better grip on the diabetes again (they recommend raising her to 5 units; I just recently upped her to 4.25 and think that is too big a jump just now...I can ask in the Lantus forum but I believe they will agree the same, based on SLGS).
If anyone can please provide insight into kidney disease and how all of this sounds, I would greatly appreciate it. I will be doing more research on kidney disease and trying to learn more about it. From what I understand thus far, it's pretty common in cats, but I'm hoping it can be managed and she can still have a good long life.
 
Thanks for the update when you get all the labs back you can go to your SS and there is a tab called Labs you can post them all there . I found your Lab tab all the way at the bottom of your SS
 
babyg said:
Still awaiting results from the GI panel, but so far, based on the urinalysis and bloodwork, they are thinking she has elements of kidney disease (I asked for copies of the labwork to be emailed; once I receive those, I will post here...if anyone can please take a look!).
Here are some stats they gave me thus far: Creatine was 2.2, BUN was 62; no high Phosporous; not leaking proteins; there was glucose in her urine but we are still trying to regain control over her BGs; blood pressure was good; and she's still holding on to her electrolytes. They cannot stage her quite yet without doing a Urine Protein Creatine Ratio urine test and an SDMA test (they said local vet can run those if I want), but they are guessing she is borderline between stage 1 or 2, or tentatively early/non definite stage 2. They said her bun and creatine levels are what they would call mild Azotemia. I know last year when the primary vet checked her, they said her kidney levels were mildly elevated but at that time they didn't seem all that concerned and said maybe we may have to change her diet but that was about it.
As far as getting her rechecked and properly staged, they want to wait until the GI panel results are back, which could be by Friday or Monday at the latest. Bad thing is I start a new job in a couple weeks so I am hoping she doesn't need to see Internal Medicine any time soon again and that anything we need can be done locally, at least for a little while until I settle into the new job.
In the meanwhile, they recommended trying (again) to get her converted to eating wet food, but they do not recommend a renal diet as of yet since she is still holding onto her protein. They wonder too how her values will look once her anal gland rupture is fully healed and we have a better grip on the diabetes again (they recommend raising her to 5 units; I just recently upped her to 4.25 and think that is too big a jump just now...I can ask in the Lantus forum but I believe they will agree the same, based on SLGS).
If anyone can please provide insight into kidney disease and how all of this sounds, I would greatly appreciate it. I will be doing more research on kidney disease and trying to learn more about it. From what I understand thus far, it's pretty common in cats, but I'm hoping it can be managed and she can still have a good long life.
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@Suzanne & Darcy
@Wendy&Neko
 
babyg said:
Here are some stats they gave me thus far: Creatine was 2.2, BUN was 62; no high Phosporous; not leaking proteins; there was glucose in her urine but we are still trying to regain control over her BGs; blood pressure was good; and she's still holding on to her electrolytes
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I certainly would like to see the labs when you get them. Her BUN is elevated, yes, but without further information I would not say she has kidney disease. BUN can definitely fluctuate up and down and is affected by things like hydration status. If she eats dry food, it really would be a good idea to switch her to a low phosphorus wet food diet for hydration and less work on her kidneys. I would like to see her USG as part of the urinalysis. A creatinine of 2.2 is still within normal limits for IDEXX labs anyway (U.S. numbers) and the SDMA (which I have seen fluctuate around in my own cats). Creatinine also can fluctuate up and down. Was this just a general checkup for her or did you take her in because she was acting off/ill? (Sorry, I don’t recall if you said before.)

You already know that getting her blood glucose down into at least blues and very low yellows will help her kidneys. You are right about just jacking her dose up to 5 units — too much too quickly for an SLGS kitty, but she does need an increase based on spreadsheet numbers and she needs have her insulin dose be very consistent even with the lower preshots since Lantus does allow you to shoot lower numbers. Then I really think she will be able to get down below the kidney threshold.
 
If it turns out in the future that she does have CKD, then she can still live a long time with quality of life. There are many things to be done for helping a CKD kitty. The best place to become educated on it is felinecrf.org. The support group associated with that website is also populated with truly knowledgeable and kind people! I have been a member over there for years, although I don’t have enough time to be over here and over there right now, so I am mostly here. It’s an extremely busy group, but you can start just by reading on the site.
 
Suzanne & Darcy said:
If it turns out in the future that she does have CKD, then she can still live a long time with quality of life. There are many things to be done for helping a CKD kitty. The best place to become educated on it is felinecrf.org. The support group associated with that website is also populated with truly knowledgeable and kind people! I have been a member over there for years, although I don’t have enough time to be over here and over there right now, so I am mostly here. It’s an extremely busy group, but you can start just by reading on the site.
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Thanks, I joined the group.
 
I haven't received the lab results yet so am going to call today and request them again.
I'm having her try Weruva now; we've tried Tiki Cat in the past and she didn't care for it, sadly. I think it will be an achievement in itself if I can get her fully on canned food in general lol. I'm making a log book of all the brands and flavors we are trying so I can see what she likes and dislikes and hopefully build an array of food to keep her happy.
 
They finally emailed me her labs so I will upload those here and on my spreadsheet as soon as I get home this evening.
 
Diagnostic Tests Performed:
Blood Pressure
133/82 MAP 95
CBC
A Eos. 1.17 HI 0.00 - 0.80 x10^3/ul
Chemistry
Creatinine 2.2 HI 0.4 - 1.6 mg/dL
BUN (Urea) 62 HI 18 - 38 mg/dL
Total Protein 8.5 HI 5.8 - 8.0 g/dL
Glucose 425 Hi 60 - 122 mg/dL
Cholesterol total 188 HI 66 - 160 mg/dL
Triglycerides 284 HI 21 - 166 mg/dL
Bicarbonate (TCO2) 23 HI 12 - 21 mmol/L
Urinalysis
Source Cystocentesis
Color Yellow
Clarity Clear
Specific Gravity 1.024
pH 6.5
Protein Negative
Glucose 3+
Ketones Negative
Bilirubin Negative
Blood Trace
WBC Rare /hpf
RBC 0-4 /hpf
Epithelial Cells Few /hpf
Bacteria Negative
Casts Negative
Crystals ...Sodium Urate Rare /hpf
Mucous Negative /hpf
Yeasts Negative /hpf
Sperm Negative /hpf
Fructosamine
428.0 HI 166.0 - 298.0 umol/L
FELINE: < 400 umol/L = Suggests good regulation; 400 - 490 umol/L = Suggests fair regulation; > 490
umol/L = Suggests poor regulation;
GI Panel
Pending
 
I put the rest of the test details under a new tab in my spreadsheet (August 2024 LABS). If anyone can please take a look and let me know what you think, I would greatly appreciate it!
 
What time of day was the urine drawn? Ideally it should be first thing in the morning when it's more concentrated. As they eat and drink during the day, it can become more dilute. You can always capture an early morning pee at home and run it to your general practice vet to get a USG done.

I liked keeping labs from different tests on the same page, so I can compare one set of tests to the previous ones.
 
Hi RJ!
For the USG that is low, you can check tanya’s list of potential reasons:
https://www.felinecrf.org/diagnosis_urinalysis.htm#usg

Then his serum protein is a bit higher than the regular range. The phosphorus is ok but it’s gone up fron last year, so you might need to keep an eye on that.

the best is really to post your results in tanya’s ckd group, i think i saw one post from you? They’re going to ask you a couple of questions and be super helpful.
 
Wendy&Neko said:
What time of day was the urine drawn? Ideally it should be first thing in the morning when it's more concentrated. As they eat and drink during the day, it can become more dilute. You can always capture an early morning pee at home and run it to your general practice vet to get a USG done.

I liked keeping labs from different tests on the same page, so I can compare one set of tests to the previous ones.
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Our appointment was at 1030 am and I think they ran the tests either late morning or early afternoon.
I do have a tab called LABS where I tried to input the information from this lab next to last years lab, if you would like to see. The issue I found, though, is that I had trouble finding all the same things so there are some blanks.
 
babyg said:
I see diabetes is on her list as a potential cause. I do know lately Baby has been peeing more because her BGs are high, and once we get that back down the peeing should come down too. Could that explain it?

I will try posting my labs there and see what they think.
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They can help you set up your spreadsheet, I'm sure they'll soon come back to you with answers and technical solutions.

Low USG cause: yes of course it could be DM. High BUN could be caused by a high-protein diet, by stress, or by DM. BUN is not a very reliable indicator of renal disease.
CREA can be elevated for a number of reasons other than renal.
Both BUN and CREA are elevated, which could indicate something related to DM.
High Cholesterol might also be related to DM.

High serum protein can indicate infection or inflammation, and with Baby's high eosiniophils, something indicates that Baby's immune system is fighting - allergy, parasites, IBD, asthma…

How is Baby feeling/eating/pooping/drinking?

I'm definitely not an expert, if I were you I'd wait for the renal group's responses. Just want to reassure you that for now, you'd probably best try to get Baby's BG under control, many of the "high"s might be gone once you've achieved it.
And explore the infection/inflammation route, ask your vet if there could be something.
 
Thank you. Yes, she is finishing healing and recovering from an anal gland rupture, so I wonder if that may be part of it. Initially she had a fever, which went away with fluids, and at her follow-up a week after I was told it was infected, so in total she received antibiotic for 16 days. Our most recent check-up shows it's healing very well, though, thankfully.
She was starting to eat really good and put some weight back on until I gave her Weruva Mack and Jack yesterday. She threw up, had diarrhea, and didn't eat well the rest of the day and last night. Every time I try to convert her to wet food we run into digestive issues, plus she's not a consistent eater of anything other than dry.
 
babyg said:
Thank you. Yes, she is finishing healing and recovering from an anal gland rupture, so I wonder if that may be part of it. Initially she had a fever, which went away with fluids, and at her follow-up a week after I was told it was infected, so in total she received antibiotic for 16 days. Our most recent check-up shows it's healing very well, though, thankfully.
She was starting to eat really good and put some weight back on until I gave her Weruva Mack and Jack yesterday. She threw up, had diarrhea, and didn't eat well the rest of the day and last night. Every time I try to convert her to wet food we run into digestive issues, plus she's not a consistent eater of anything other than dry.
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Oh that might be a reason!
But like I said, I'm not an expert…!

It's difficult to convince them to eat something that we really really want them to eat but they really really want to stick to their McDonald's version of nutrition! Have you ever tried to do it slowly? Like, start with wetting the kibble to get her used to a wetter version, slowly adding wet food in a very small percentage, and work your way up? It can take 3 months, but it gives the necessary time to a 15yo's GI tract to adjust itself to the change.
 
babyg said:
I haven't received the lab results yet so am going to call today and request them again.
I'm having her try Weruva now; we've tried Tiki Cat in the past and she didn't care for it, sadly. I think it will be an achievement in itself if I can get her fully on canned food in general lol. I'm making a log book of all the brands and flavors we are trying so I can see what she likes and dislikes and hopefully build an array of food to keep her happy.
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It can take a long time to transition to any different foods. Give it a lot of time.
 
Your phosphorus, while still within the normal range, is a little higher than the optimal range that we look for to protect the kidneys — 4 to 4.5 — so that means feeding lower phosphorus food like the ones I sent you on a list — but I understand that she’s a strong-willed eater with ideas of her own!
As for the Eosinophils, they are only mildly elevated so I would not focus too much on that — there could be an inflammatory or allergic (even parasitic) response going on, but I would expect to see either an increasing elevation or a higher elevation before worrying. If she already has skin allergy problems, then that may explain it, but I don’t see her white cell count also elevated so I am not focusing on that but more on the kidney values.
 
Suzanne & Darcy said:
What is the USG? I can’t see it — and what is the reference range for your laboratory?
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USG= Urine Specific Gravity
It's the number that, if below 1035, there is some trouble with the kidneys concentrating the urine. In Baby's case, it's 1024, but it's not necessarily a kidney chronic disease, diabetes and many other things can contribute to it.
It took me quite a few months to accept that Feloro has indeed CKD, I was adamant that his crea was elevated and his usg low because of xy reasons!
 
Daphne and Aida said:
USG= Urine Specific Gravity
It's the number that, if below 1035, there is some trouble with the kidneys concentrating the urine. In Baby's case, it's 1024, but it's not necessarily a kidney chronic disease, diabetes and many other things can contribute to it.
It took me quite a few months to accept that Feloro has indeed CKD, I was adamant that his crea was elevated and his usg low because of xy reasons!
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Yes. I certainly know what USG means!! I ought to know with 125 cats! Just teasing Not quite that many. I was asking for the number! I couldn’t see it on the labs so I wanted to know what the USG number was — I have found it now. I also wanted the reference range for her lab — for the other tests that do have a range (ETA because I wrote this in a confusing way since usg does not work like that, but I wanted the ref. Range for the other rests that have one). I know what the reference range is for my lab (IDEXX) but I don’t know what lab her vet uses.

and sadly, I have had quite a few cats now with CKD (a hazard of having too many cats and elderly ones, too) and have been a member of the Tanya CKD support group for many years.

And it’s true that different things can affect urine specific gravity, so we need to look at trends over time as well as the specific number. Baby G’s USG has decreased not the way we want that number going. And all the values need to be taken together CREA, BUN, USG and others.
 
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Suzanne & Darcy said:
And the SDMA? Did they give you an SDMA value? I didn’t see it on your labs tab.
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I'm surprised they didn't run that test. My local primary vet automatically includes that in their bloodwork, so I have an appointment with them tomorrow to get the SDMA and also a urine protein creatine ratio test. So hopefully tomorrow or the next day we should have more data. If there are any other tests I should get, please let me know, but so far that is what the internal med vet recommended.
Today I should also be hearing from him regarding the GI panel. Sounded like they wanted that run because they felt her symptoms were more in line with IBD than with chronic pancreatitis, but every time I have had her checked for that in the past it always came back as pancreatitis, and to my knowledge there is no real way to diagnose IBD without a biopsy, which I'm not doing, so I personally am not too concerned about that. My main thing is the kidneys.
I will create a new thread with the new lab results after our appointment tomorrow.
 
Hi there. I saw your post over on the CKD group. I could read the labs with the reference ranges well. For IBD diagnosis the GI panel is helpful and an abdominal ultrasound is really recommended. I don’t know if she’s had one before, but they can measure intestinal thickness and also look all around at all the GI tract. Good luck at the vet tomorrow!
 
Thanks. Still haven't heard yet from internal medicine but left them a message. She's had ultrasounds in the past, and sometimes they mentioned the walls were a little thicker, but I believe the last time they didn't.
 
Now I don't know that it's worth going today and getting the SDMA and urine protein creatine ratio tests done? Since she's not leaking protein, what's the point of the ratio test, and according to the Tanya forum the SDMA is pointless other than being an early indicator. The only thing that seems good about the SDMA--to my understanding--is that it's not as variable like the other factors (creatine and BUN), which can go up and down from things not CKD. (actually I think I'm wrong on that based on an article I just came across so never mind!) I'm thinking of rescheduling today's appointment until I finally hear back from her internal medicine specialist, because I don't want to put her through unnecessary testing and stress. But I really want to know for sure that she has CKD and if so, what stage and what to do next.
@Suzanne & Darcy any thoughts?
I've been reading here and there on the Tanya site but it's pretty big and complicated. Today I plan to go through each tab and print out and highlight info I think really relevant and try to get my bearings. It's like going through a whole other learning curve again. :arghh: And unfortunately the kidney forum still has me on moderation since I'm new, so it takes a while for me to be able to post or ask anything.
 
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Hi. I was wondering why they would do a UPC test at this point when the urine said negative for protein. Maybe the IM vet can explain that. And the SDMA should have already been included in the previous panel, but probably is a waste of money at this point. I definitely have seen the SDMA number fluctuating in my own cats. I kind of hate those tests that tell you your cat is going to get CKD and there’s nothing you can do about it except be worried for possibly years ahead of time (except maybe low phosphorus food which I already put all of my cats on as soon as they are not kittens anymore.) but that’s beside the point. I think it is a good idea to let her have a break from vets for the time being unless they give you a compelling reason why they want to do the UPC ratio.
 
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