Bloodwork

mmin

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Hello.
I just came back from the vet with routine blood work done. I’m kind of really sad and taken aback right now so would appreciate if anybody can offer some insight into this matter!

noted from the vet his CREA, BUN, and Calcium levels are raised. She sounded really concerned about his raised creatine because he’s still really young (2 years and 3 months old)

i know the next step is to do a urinespecific gravity. I would just like some insight and explanation if anyone is willing to share..

1) if raised crea, bun but USG normal: does it mean its okay?

she suggested to do an ultrasound if his USG is abnormal.

2) speaking about USG.anyone has any recommendations on how to collect his urine?

here are some facts about him
- age: 2 years 3 months
- breed: scottish fold
- diet: ziwipeak, feline natural, freezedried raw and hills T/D (only 15 pieces Per day)

I did not notice any other symptoms like drinking more or peeing more.

attached are pictures of his blood work today and one from a year ago.. i dont know why his creatinine would have went up so much:((

kindly advice! much appreciated
 

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FeebysOwner

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Hi. Until other members come along with their first hand knowledge, you might find this web site (link below) helpful. The link is specifically at the area of the site that discusses USG, as well as 'catch' (urine collection) methods. But, there are lots of other areas within this site that discuss all kinds of aspects of kidney issues, including a section that outlines blood work results. I think the direction your vet is heading is the best option, as it can give her a lot of insight as to whether this is really a specific kidney issue or perhaps something else. It would seem she is wanting to confirm or rule out the most 'obvious' possibilities in order to determine the best steps to take going forward.
I hope it turns out that you don't need this web site in the long term!!
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Urinalysis
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat
 

fionasmom

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When Jamie was about 2 1/2 he had a high BUN reading. We did an ultrasound immediately, bracing for the worst, and they found nothing. His readings have remained on the high side, and the one last week was at 41; however, that is lower and closer to normal than it has been. The vet is now saying that he is an outlier, just the way he is, but we continue to monitor. Creatinine has usually been right at the high end.
BUN.JPG
 

mrsgreenjeens

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When you feed mainly raw, even freeze dried, the BUN and Creatinine will sometimes be at the high end of the normal range just because the protein level in raw is higher than in other cat foods. Looks like his BUN is in that area. Creatinine can be high due to other factors like dehydration, certain infections, etc. Did they run an SDMA check with that bloodwork? Since I've had three kidney cats, I just always have that run with any bloodwork, but you may not have since your's is a young cat. But it's that calcium that is perplexing. What did your Vet say about that? Did she ask you about his diet, etc. I know freeze dried raw does contain quite a lot of bone (calcium) (depending on which brand you are serving), but, honestly, I don't know if that would have any or much effect on that figure or not.

What I CAN tell you is that currently one of my boys has raised BUN and Creatinine, AND SDMA, and his USG is just slightly off, and he was very well hydrated when he went in for his checkup. He also eats freeze dried raw. BUT, he ended up having a kidney infection. He's due to go back for more bloodwork this coming Wednesday and we are all hoping that everything goes back to normal after his 10 day round of a very strong antibiotic. I was absolutely shocked, because he showed no sign of any type of urinary issue. He was peeing as usual, eating as usual, etc. So...maybe your guy has an infection that might show up in a urine sample which is causing this :dunno:?

Here's a thread on how to get a urine sample: Advice on taking a urine sample?

here's another one: Having Trouble Getting Urine - What To Do?
 
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mmin

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When you feed mainly raw, even freeze dried, the BUN and Creatinine will sometimes be at the high end of the normal range just because the protein level in raw is higher than in other cat foods. Looks like his BUN is in that area. Creatinine can be high due to other factors like dehydration, certain infections, etc. Did they run an SDMA check with that bloodwork? Since I've had three kidney cats, I just always have that run with any bloodwork, but you may not have since your's is a young cat. But it's that calcium that is perplexing. What did your Vet say about that? Did she ask you about his diet, etc. I know freeze dried raw does contain quite a lot of bone (calcium) (depending on which brand you are serving), but, honestly, I don't know if that would have any or much effect on that figure or not.

What I CAN tell you is that currently one of my boys has raised BUN and Creatinine, AND SDMA, and his USG is just slightly off, and he was very well hydrated when he went in for his checkup. He also eats freeze dried raw. BUT, he ended up having a kidney infection. He's due to go back for more bloodwork this coming Wednesday and we are all hoping that everything goes back to normal after his 10 day round of a very strong antibiotic. I was absolutely shocked, because he showed no sign of any type of urinary issue. He was peeing as usual, eating as usual, etc. So...maybe your guy has an infection that might show up in a urine sample which is causing this :dunno:?

Here's a thread on how to get a urine sample: Advice on taking a urine sample?

here's another one: Having Trouble Getting Urine - What To Do?
Hi! Thanks for replying.
She said his calcium might be a) due to dietary or b) idiopathic.
She did ask me why i'm feeding more with freeze dried raw when i already feed high protein cannedfoods (ziwi peak and feline natural) and i was unable to respond..

For his freeze dried raw, i feed lamb and emu from raw meow: Complete Meal Freeze Dried Lamb & Emu

I will be sending in his urine sample tomorrow and likely getting a response from the vet someday this coming week so we will see how it goes.

If his BUN and CREA is raised but USG is normal, what does that imply? That it is dietary? Or? I'm still quite confused on this.

Thanks for the thread for the urine sample collection. I will browse through it.

Best of luck to your kitty too!! I hope everything works out fine.
 

mrsgreenjeens

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BlackCatOp

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I posted this on a different thread. Don’t have time tonight to respond throughly but will get back to you later.....

The USG value tells you the concentrating ability of the cat’s kidneys. Cats normally have a high ability to conserve water through concentrating their urine. To say a cat’s kidneys are working adequately, specific gravity should be above 1.035 Values below 1.035 can indicate kidney issues depending on the cat’s hydration status. (If the cat is receiving IV fluids for example then low values are to be expected.)

One reason assessing specific gravity is important that urine concentrating ability declines sooner in kidney disease than blood values rise. Thus, a cat can have normal BUN and Creatinine values but a specific gravity of 1.020 for example.
 
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mmin

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I just came back from the vet with his urineanalysis.
However.. the vet gave me an unreliable impression.. as the USG values kept changing and they had to keep printing new results for me upon retest.

I'm not sure if this is standard practice, but from what i was explained to, they have 2 different forms of measurements for USG, one from the machine, and one where they manually look.
1st result: 1.015 (machine) 1.031 (manual)
2nd result: 1.015 (machine) 1.028 (manual)
3rd result: 1.020 (machine) 1.028 (manual)

The 3rd result slip is the one they eventually let me take home.
His protein/creatinine ratio is good, less than 0.2.

From what i've read up on, i understand that hypercalcaemia (As my cat's blood work shows) can affect the USG and cause it to be dilute? I asked my vet about it, and she wasn't quite sure about that?

Not sure if i should wait for a month and then retake a blood test and urine test at another clinic.. or just proceed with an ultrasound like the vet suggested.
 

mrsgreenjeens

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My understanding is that hypercalcemia can effect the kidneys, but that kidney disease can cause high calcium, so it's really a catch 22. As far as hypercalcemia specifically, here is a quote from a medical website that is tough reading if you aren't in the medical profession. (tough for ME, at least).

"
Hypercalcaemia--calcium causes constriction of the afferent arteriole in the glomerulus thus decreasing GFR and hence causing azotaemia. "

The website is here: Interpreting the Numbers--Azotemia and Urine Specific Gravity - WSAVA2008 - VIN in case you want to have your Vet read if if she's not heard that Hypercalcemia can cause dilute urine.

Did you ask your Vet what she is looking for with the Ultra Sound? I think I would do that and if it sounds valid, then I'd probably get it done sooner than later.

BTW, if you decide to go to another Vet, you might try to find one that is Feline Only. Not saying your Vet isn't good, but Feline Only Vets might have a better knowledge of something like this. Not sure though, I'm thinking this is pretty unusual. Wish I could actually talk to my Vet when Darko has his appointment on Wednesday rather than just having to drop him off. I'd love to get her take on your guy! And our Vet has been with us through all three of our kidney cats, so she'd probably be a great resource. But with the virus everyone is so pressed for time, etc. that I don't think that'll be possible :sigh:.
 

BlackCatOp

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So from what I can tell is:


  1. your kitty is not likely dehydrated. Dehydration can be ruled out by looking at hematocrit and albumin. Your kitty’s hematocrit and albumin are normal.
  2. Since your kitty has a normal albumin, the elevated calcium is probably significant. Calcium is in two forms - bound and free (ionized). The bound form is bound to albumin so changes in albumin can artificially cause changes in calcium. We really only care about the free calcium as the is the calcium that is biologically active. So a high free calcium means the active calcium is high.
  3. The IRIS (international renal society) states that cats can have early CKD with a creatinine of 140 umol/l if they are not concentrating their urine. However, as you pointed out - USG cannot be interpreted when calcium is elevated. Hypercalcemia prevents anti-diuretic hormone from being active on the kidneys. Thus, the urine produced will be dilute even if the cat’s kidneys are functionally normally.
  4. Your cat having a USG in the 1.015-1.030 range indicates that the urine is not ideally concentrating. Whether that is due to the calcium or not cannot be said. Cats are really good at concentrating their urine being that they are desert animals and should have an ideal USG of 1.060.
  5. I would be concerned with the lab results you provided in a 2 year old cat. I definitely would repeat blood work in 2-3 months and also look into having an SDMA included. The hypercalcemia is also concerning and would recommend having a ionized calcium level checked as well.
  6. What is your vet recommending as the next step?
 
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mmin

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So from what I can tell is:


  1. your kitty is not likely dehydrated. Dehydration can be ruled out by looking at hematocrit and albumin. Your kitty’s hematocrit and albumin are normal.
  2. Since your kitty has a normal albumin, the elevated calcium is probably significant. Calcium is in two forms - bound and free (ionized). The bound form is bound to albumin so changes in albumin can artificially cause changes in calcium. We really only care about the free calcium as the is the calcium that is biologically active. So a high free calcium means the active calcium is high.
  3. The IRIS (international renal society) states that cats can have early CKD with a creatinine of 140 umol/l if they are not concentrating their urine. However, as you pointed out - USG cannot be interpreted when calcium is elevated. Hypercalcemia prevents anti-diuretic hormone from being active on the kidneys. Thus, the urine produced will be dilute even if the cat’s kidneys are functionally normally.
  4. Your cat having a USG in the 1.015-1.030 range indicates that the urine is not ideally concentrating. Whether that is due to the calcium or not cannot be said. Cats are really good at concentrating their urine being that they are desert animals and should have an ideal USG of 1.060.
  5. I would be concerned with the lab results you provided in a 2 year old cat. I definitely would repeat blood work in 2-3 months and also look into having an SDMA included. The hypercalcemia is also concerning and would recommend having a ionized calcium level checked as well.
  6. What is your vet recommending as the next step?
Just an update!
I just went to another vet today to get a repeat Crea, ionized calcium and SDMA checked out.

His SDMA is within the range at 11.
Crea is still high - at 2.1
Ionized calcium unfortuntately, is also high at 1.73mmol/L (Range: 1.13-1.38)

This vet managed to point out that there is no point in taking a USG/urine analysis at this point because of the hypercalcaemia. He referred me to a specialist whom i have an appointment with this coming wednesday :(

Hopefully its nothing too serious..
 

BlackCatOp

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Just an update!
I just went to another vet today to get a repeat Crea, ionized calcium and SDMA checked out.

His SDMA is within the range at 11.
Crea is still high - at 2.1
Ionized calcium unfortuntately, is also high at 1.73mmol/L (Range: 1.13-1.38)

This vet managed to point out that there is no point in taking a USG/urine analysis at this point because of the hypercalcaemia. He referred me to a specialist whom i have an appointment with this coming wednesday :(

Hopefully its nothing too serious..
Thanks for keeping us updated! Sorry the bloodwork still shows an elevated calcium. Hopefully the specialist can shine some light on why.
 

mrsgreenjeens

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So definitely sounds like it's the hypercalcemia causing the kidney issues versus kidney issues causing the hypercalcemia. Which kind of specialist did they refer you to? We also hope it's nothing too serious :crossfingers: Anxious to hear from you after that Wednesday visit
 
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mmin

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Hello! back for updates.

He did a hypercalcaemia of malignancy panel.
PTH and PTHRP were both very low, suggesting that it is likely idiopathic.
The vet seems not to be too worried about his high creatinine just because his SDMA is within range. as for his calcium, she is suggesting a diet change prior to starting life long medications..

She suggested w/d. But from what i've researched and tried calculating. W/d's calcium, while lower, is similar to the food he's already currently on! hence, i'm not too sure if diet change will be of too muchuse..

Anyone has any insight or any recommendations for food with lower calcium?
 

mrsgreenjeens

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Calcium isn't usually one of the items listed on the food label, so for this info you normally need to contact the manufacturer or check the website, AND for a good comparison, you need to look or ask about the calcium percentage on a Dry Matter basis versus Guaranteed Analysis.

Off hand, I don't know of any specific foods that are lower in calcium. But glad to hear that apparently that are calcium lowering medications.
 
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