Can Lab Values Spike In End Stage Renal Failure, Or Only In The "acute" Version?

[daniel625]

When my cat passed, I was told it was end-stage renal failure. But when I looked at his final blood work results, and then investigated their meanings further (the TanyaCRF site came up more than once), I'm now under the impression that this was not the whole story.

Going by the information I found, I was able to rule out other possible things (I previously thought that his last meal was what finished him off, but my Dad had given the same bag of food to a friend of his to give to her cats, one who had a kidney issue of her own, and they experienced no problem whatsoever), but now my new theory is this:

Somewhere between March of last year, when he last had blood work before this past February, and this past January, when he had a bout of diarrhea and vomiting after eating a can of food he was not used to, resulting in him not eating for the rest of the day (he seemingly returned to normal a day or two after, without any treatment), he had gotten a bacterial infection (sepsis?), which was left unchecked and thus, allowed to spread to his organs, namely, his kidneys, after he had already been diagnosed with CRF. Unfortunately, because he always appeared to be in good spirits, eating well, running around, jumping up on things, etc., it never seemed urgent to get any updated tests done (plus, I was perpetually low on money to afford the testing).

The final blood work showed highly elevated white blood cells, BUN, creatinine, and SDMA, with the vet note "severe infection present". I just can't help thinking that this was not a typical show of what ESRF should look like. I feel like it was something that I missed, or worse yet, something that I was presented with the opportunity to check for in January, but declined, because the vet on duty said that his kidneys felt fine, he just felt some constipation around the bowel area (huh?), which ultimately led to his kidneys shutting down. Anyone have any thoughts or similar experiences?

 

[Mamanyt1953]

First, I am so sorry that you lost your beloved cat. You did the best you could for him, and they are such masters at hiding illnesses that we often see no sign of anything at all until too late. I don't know for sure, but there probably was something else that contributed to the whole issue, but the ESRF was the primary. This is just guesswork, so take it for what it is worth. And NOT something that you could have spotted, from what you have said. Rest easy on that account, at least.

"Constipation around the bowel area"????? Exactly where else would he expect to find that? The cat's ears?

 

[lunaleopard]

I'm so sorry for the loss of your kitty. My job is working in a hospital lab and I can tell you that a high white blood cell count is not good in any situation. BUN and creatinine are kidney markers so if these levels were high, his kidneys were not working to clear your kitty's blood of these toxins. Also, I'm sure he felt really bad because of all these things combined. I think he may have had renal failure after all and losing a kitty is never easy and I know that you always wonder if you "did enough" for them. I'm sure you did everything you could for him and you can find some comfort knowing that you did your best.

 

[daniel625]

Well... that's just it. I don't think I did do everything I could've done for him.
You see, when I took him to the vet in January, before his final visit in February, they asked me if I would like to have blood work done. But because I already knew about the pre-existing chronic kidney condition (his BUN was high and he was always dehydrated), combined with the vet saying that his kidneys still felt okay, and thinking that it may have just been an isolated incident (a temporary stomach bug), I decided it wasn't necessary.

I mean, if antibiotics in his state of health would've potentially made things worse, or if the only means of treatment was the invasive kind (intravenous, dialysis, surgery, etc.), then maybe I did do everything I could.

Otherwise, something tells me I'm going to regret that choice for years to come. :-(

 

[Mamanyt1953]

It is human to second-guess ourselves. You made the decision that you felt was right at the time. It really is all that we can ask of ourselves. Try not to beat yourself up over it, but also vow to remember it for the future. It is about all you can do.

 

[artiemom]

I am so sorry you had to go through this.. I am extremely sorry for your loss.

But I am going to say some things which you may not agree with, but are very true...

Do NOT beat yourself up over this...
You cannot and should not second guess yourself. You did what you thought was the correct thing at the TIME, based on what INFORMATION you had....

You loved your kitty, your kitty loved you... you did your best.. Please leave it at that....

Yes, end stage renal failure can spike lab test results.. if he had a severe infection, that can shut down the kidneys also. There is a fine line between all the organs of the body..You can also get the signs of a severe infection which can be from the kidneys shutting down.. The same with humans...

You absolutely cannot blame yourself, or question yourself or your dad, about what happened.

You kitty was sick, sounds as if he was terribly sick for a long time... Cats hide their sickness from us because they do not want us to worry... You did the best you could under the circumstances...

Please do not question your decision... it will eat you up.. be kind to yourself...

(((hugs)) and know your baby is always watching over you... always with you... never to leave the people they love...

 

[daniel625]

Thank you all for your kind words and condolences.

If it was a case of "all I'd have to do", i.e. "just give him this antibiotic and he'll be fine", then I'd feel like I let him down, but truthfully, he had been having kidney issues for quite a while. Most of the signs that one would find on a feline crf site (hint, hint) were present with him. He had chronic dehydration for the last three years (years!), and it was because of a can of, ironically, prescription diet food designed to dissolve struvite crystals he had eaten at the time. He had a violent episode of vomiting and diarrhea from it, and lost an incredible amount of water and about three pounds of weight in very short time. Rather than put him on emergency IV fluids (which admittedly, I didn't know about at the time), the vet just gave him a hydration shot with antibiotics and sent him home. Since then, he had been living on borrowed time. But at least the crystals never came back. As bad as that was though, I don't harbor any feelings of guilt over it as I could never have predicted that happening nor known for myself what the proper remedy would've been.

My point being he had a lot to contend with during the last year. Despite his kidney disease status, he was still very active, ate well, and went to the litter box without any apparent trouble. It wasn't until this past January that his eliminations got much smaller. Shortly after that, he had the incident I mentioned in my first post, which I'm sure, dehydrated him more than he already was. So, like I said before, if the treatment for that would have been antibiotics, PLUS something major like an operation or daily hydration, then I guess I wouldn't feel like I let him down. Because then, we would be getting into "quality of life" matters, and to be honest, my cat hated being stuck with hydration needles. And personally, I wouldn't have liked it if my last memories of him involved him effectively being on life support.

 

[happilyretired]

I would like to repeat what's been said before--please don't second guess your choices because renal failure can be really complicated.

My 7-year-old rescue was diagnosed in early stage renal failure, and I delayed another blood test for almost a year so that it could be done at the same time he got his annual shots. My vet agreed with this--i.e., not to stress him too much with vet visits. However, the labs came back that he had escalated almost to stage 4, and from that time on, he continued to fail until it was 'time' to let him go. I've worried that his very weak kidneys couldn't deal with the effects of the vaccines and that hastened his death [i.e., I should have just done the labs and not the vaccines]--but there's absolutely no way to know.

Similarly, if your cat had an infection, weak kidneys might not have been able to filter antibiotics so that renal failure would have been inevitable. Again, there's no way to know.

One of my cats lived with a diagnosis of renal failure for an additional 7 years, but my last cat 'failed' only 18 months after diagnosis. Vets have told me that it's impossible to predict the course of renal failure in any particular cat because there are so many variables.

We just love them and make the best choices we can for them.

 

[daniel625]

First of all, pleased to meet a fellow New Yorker!

I guess that makes good sense. Interesting comment about the antibiotics on weakened kidneys, very good point there. I'll be honest, he was already a geriatric cat, and with all that was going on, I didn't expect him to go on for much longer than maybe a year or two. Not to mention that the persistent dehydration had me thinking that Summer heat exhaustion may have taken him first. For what it's worth, I was happy that I was able to rule out other causes (cancer, FIV, severe allergic reactions, etc.), so I'm at least glad for that. And I'm glad that my last memories of him were of him still acting like himself and not slowly deteriorating to where he was like a shell of his former self.

I'll tell you something funny; I used to give him this dental gel for his teeth and gums (which, even at the end, the vet remarked were in excellent shape!). He wasn't crazy about it, whether it was the potent peppermint-like smell or he didn't like how it felt, or he just didn't like anyone, including me, sticking their fingers in his mouth, is anyone's guess. Nevertheless, even close to his last days, dehydrated and with kidney issues, he STILL had the strength to get up and make me CHASE AFTER him to give it to him!

He was always a strong cat, which I'm eternally grateful for. The only time his discomfort was ever really obvious to me was the day I took him to the vet two years ago and found out that he had crystals, right before taking him. He was yowling, struggling to walk, and had a sad look on his face, almost as if to say "help me!". Well, I definitely rose to that occasion and we dissolved those crystals for good, and he went back to being his happy self from then on.

 

[Mamanyt1953]

Then be at peace. You have done right by him, down through all the days of his life. And he knows, oh, he knows.