cat with liver and kidney problems

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Kborg019

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My cat has been having high ALT and ALP values for a long time and also pancreatitis too. Unfortunely in Malta we only have one brand of Hepatic food, which is Vetlife. She had to be given prednisone and was diagnosed with CKD. I feed her Purina renal wet food and subcutaneous fluid twice a day. Her urea is still high but her BUN and Creatinine have gone down to normal range.
I did another blood test her ALT, ALP and urea are increasing however her BUN and creatinine have increased slightly but still in the normal range.
I am confused what to do because the renal diet is low in protein and higher in fats but the hepatic diet is the opposite. Any advice about this please?
Another thing she is losing muscle mass, should i giver her a small 40g portion of boiled chicken breast daily?

The vet would like to give her another course of prednisone I am a bit concerned that the kidney values will go worst.
Any advice please
 

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Hi and welcome to TCS. If it were me, I’d treat her pancreatitis and worry about her kidney issues later, especially since her creatinine and BUN are within normal range at this time.

Getting the pancreatitis under control is paramount and will help if/when it comes time to start to tackle CKD. In the earlier stages of CKD, it has not been determined to be of great benefit to lower the protein level, particularly with older cats who lose muscle mass just by very virtue of the aging process. So that works in your favor in treating the pancreatitis now.

Treatment for panceatitis usually involves good nutrition and fluids. Some cats require pain meds, and others may need an appetite stimulant and anti-nausea meds. I am not familiar with Pred being used as a standard treatment. So, I can’t respond to that part of the vet’s treatment regimen. But, if she is having difficulty eating enough I’d ask about the other potential treatments.

Keep us posted on her progress, please.
 

Furballsmom

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Hi
If you can get her to exercise as I did with my 17.5 year old Poppycat (RIP sweetheart) she may not lose muscle mass due to aging.

Also, if she's reluctant to eat you might ask the vet about both the extra chicken, the anti-nausea and appetite stimulant medicines mentioned above, and also utilize hand-feeding (not with a syringe but with a popsicle stick/tongue depressor which is a better method that my vet told me about). Poppy had bad things going on (liver, pancreas, hyper-thyroid, kidneys) but he and I were able to keep his weight stable, and he was still getting on top of the refrigerator a couple of weeks before he died.
 
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silent meowlook

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Hi. Unfortunately cats with chronic kidney disease lose muscle mass. Often that muscle mass cannot be rebuilt. Getting the cat to excersize more will not build more muscle in a cat with chronic kidney disease as they are using their muscle mass already to feed their body. It’s fine if your cat wants to run from here to their on their own. But know that it won’t change their muscle mass and that you shouldn’t encourage it.
Couple of things to note. First off I am not a veterinarian and all of my suggestions or information is my opinions on what I have learned.
Prednisolone should be used in cats instead of Prednisone. Cats have trouble converting Prednisone into something they can use. Make sure you bottle says Prednisolone. It’s important.

In regards to the kidney values on the bloodwork. There has to be a loss of 70% or more in kidney function before it will appear in the bloodwork. That is with chronic kidney disease. Also, one of the markers for kidney disease is creatinine. There has to be enough muscle in the cat for this to appear elevated. Therefore if your cat has little muscle mass, the result may be falsely low.
I don’t know what you have available where you are. I would see what the phosphorus levels are and if elevated give a phosphate binder with meals. You css as n talk to your vet about that. I would not restrict protein.
Below is a link to information on liver disease on cats. Can you post the bloodwork?
Liver Disease in Cats | International Cat Care
 
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Kborg019

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Hi and welcome to TCS. If it were me, I’d treat her pancreatitis and worry about her kidney issues later, especially since her creatinine and BUN are within normal range at this time.

Getting the pancreatitis under control is paramount and will help if/when it comes time to start to tackle CKD. In the earlier stages of CKD, it has not been determined to be of great benefit to lower the protein level, particularly with older cats who lose muscle mass just by very virtue of the aging process. So that works in your favor in treating the pancreatitis now.

Treatment for panceatitis usually involves good nutrition and fluids. Some cats require pain meds, and others may need an appetite stimulant and anti-nausea meds. I am not familiar with Pred being used as a standard treatment. So, I can’t respond to that part of the vet’s treatment regimen. But, if she is having difficulty eating enough I’d ask about the other potential treatments.

Keep us posted on her progress, please.
 
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Kborg019

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Thank you for your reply, I really appreciated it. I had to give her the prednisone for a week as the vet believed it helps control the pancreatitis however her BUN and creatinine have gone unexpectedly too high from stage 2 ckd she is now in stage 3. Her eating is on and off, I have stopped giving her hepatic food and I am urging her to take renal wet food however she is being very fussy and for her to eat something I had to resort to giving her Royal Canine gastrintestinal wet food, one pouch per day. I am very worried as I can't understand how the kidney values when so high from the last blood test. Could it be because the Phosphate binder powder was not to her liking and I was not giving it to her everyday? Could it be the gastrointestinal food? I was and still am giving her twice a day subcutaneous fluid for 15minutes on high flow. I am scared that she will get worst
 

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When you say you are giving sub-q fluids for 15 mins twice per day, how many mils is that? I have never heard of giving the fluids for a specific amount of time, but rather giving a specific amount of millimeters, like 50, or 100. It IS possible to give a cat too many fluids.

Was her phosphorus level high, is that why you were trying to give phos binders? None of my kidney cats ever ate a kidney diet, nor did they ever need phos binders, that's why I ask. As mentioned above, the general consensus here was to treat the liver and pancreatitis first, then worry about the kidneys. Did your Vet advise otherwise? My Vet always said to just get them to eat, period. And kidney values tend to fluctuate, so I'm not sure I would worry too much, especially since she is on other medication and has other issues at the moment :alright:. Do you have copies of her bloodwork that you could post here?
 

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I echo everything mrsgreenjeens mrsgreenjeens said. The fluid process Is unfamiliar to me and I suspect is/was more for treating the pancreatitis. I also agree that kidney values can fluctuate, so repeating blood work in a few months is probably warranted. But, yes, if you have copies of her past 2-3 blood test results, that would be very helpful.
 
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Kborg019

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When you say you are giving sub-q fluids for 15 mins twice per day, how many mils is that? I have never heard of giving the fluids for a specific amount of time, but rather giving a specific amount of millimeters, like 50, or 100. It IS possible to give a cat too many fluids.

Was her phosphorus level high, is that why you were trying to give phos binders? None of my kidney cats ever ate a kidney diet, nor did they ever need phos binders, that's why I ask. As mentioned above, the general consensus here was to treat the liver and pancreatitis first, then worry about the kidneys. Did your Vet advise otherwise? My Vet always said to just get them to eat, period. And kidney values tend to fluctuate, so I'm not sure I would worry too much, especially since she is on other medication and has other issues at the moment :alright:. Do you have copies of her bloodwork that you could post here?
Like you the vet has emphasised to try to solve the liver and the pancreatitis however the shooting up of the kidney values is now very concerning. When she was first diagnosed with CKD last year the vet had instructed me to give phosphate binder powder on dialy basis, Cardioli renal combi powder. However she was not to keen to take it with food so sometimes i skipped a day or two. With regards to the fluids, its drip under the skin and that is how the vet instructed me to do it, with time not with volume and i have been doing it since last year. Thank you so much for helping me out, i really appreciate it.
 

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Kborg019

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I echo everything mrsgreenjeens mrsgreenjeens said. The fluid process Is unfamiliar to me and I suspect is/was more for treating the pancreatitis. I also agree that kidney values can fluctuate, so repeating blood work in a few months is probably warranted. But, yes, if you have copies of her past 2-3 blood test results, that would be very helpful.
Thank you so much for replying. I posted all the recent blood results. What do you think pls?
 

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Cuddles’ creatinine and Bun are jumping all over the place, and if I didn’t mix up report dates she had reasonable numbers earlier in May before they skyrocketed in late May. Has there been any more recent testing to see if they went back down some?

I can’t use the phosphorus level as a gauge as I could only find one reading in all of the various dates tests were done. It could be impacting it somewhat, but I think there is another reason for the sudden jump and you need to discuss possible reasons with your vet.

The other common reason for a jump might be fluids. But, I don’t see how she needs any more fluids than you are giving her. However, that is hard for me to gauge since my cat gets 100ml of fluids a day and it only takes about 3 minutes. I suppose too much fluids could cause an issue, but if she has been receiving this same amount throughout all these tests, I wouldn’t imagine it would just now cause a problem.

I’ll have to look at the CBC counts later, as I am cross-eyed after jumping back and forth between the reports to find what her kidney numbers have been chronologically.
 

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It appears the WBC has increased to abnormal ranges. What did your Vet say about that? There could be some sort of kidney infection going on, which could cause the increase in SDMA, Creatinine and Urea. I'm just guessing here, but it is a possibility. And I'm still concerned about the amount of sub-q fluids she is getting. I am quite aware of what sub-q fluids are, having had three kidney cats myself. But giving too much fluids can be dangerous and bring on other health issues. I'm not saying you are giving too much, since we don't know how much you are giving yet. When you give them next time, can you look at the bag when you start, see where the fluids are, then see where they are when you stop and determine the amount?

Here are two websites for your perusal. One is on reading bloodwork, in case you need it. The other is about sub-q fluids. About the middle of that page discusses what could happen if the Vet recommends large amounts.



If I am reading everything properly on the lab work, the good news is it appears the liver issues are getting better.
 
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Kborg019

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I am so sorry I gues when I uploaded the files thye got mixed up. Yes in the beginning of May the values increased and by the end of May they got worst. I did not retake the bloods as she is quite weak I am not sure if its a good idea to stress her further. Furthermore since she is much eating less than she is supposed to I don't think the values have improved. She is drinking a lot and peeing a lot. The vet thinks she might have cancer in the kidneys. She is eating thanks to the Mitraz transdermal cream. Regarding the phosphorous level it flactuated from a bit high to normal. She has been on the fluids twice a day for 15 minutes since May 2023 as per vet instruction. I also noticed that she is losing her balance she is like a walking drunk. Thank you so much for all your help, I appreciate a lot
 
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Kborg019

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It appears the WBC has increased to abnormal ranges. What did your Vet say about that? There could be some sort of kidney infection going on, which could cause the increase in SDMA, Creatinine and Urea. I'm just guessing here, but it is a possibility. And I'm still concerned about the amount of sub-q fluids she is getting. I am quite aware of what sub-q fluids are, having had three kidney cats myself. But giving too much fluids can be dangerous and bring on other health issues. I'm not saying you are giving too much, since we don't know how much you are giving yet. When you give them next time, can you look at the bag when you start, see where the fluids are, then see where they are when you stop and determine the amount?

Here are two websites for your perusal. One is on reading bloodwork, in case you need it. The other is about sub-q fluids. About the middle of that page discusses what could happen if the Vet recommends large amounts.

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If I am reading everything properly on the lab work, the good news is it appears the liver issues are getting better.
Thank you for your reply. The vet told me that there is an infection but she is not eating much so she was not too happy that she takes antibiotics. Basically she suggested that i think of euthanasia as Cuddles is being lethargic but I am not sure. I read both articles you sent me, I pinch her skin and compare it to the other cats. The other cats the skin jumps back in place and hers it goes slowly down so i always thought she was dehydrated now that I read the articles I am very very confused. Maybe too much fluids caused her values to spike? Maybe I should give the antibiotics even though she is eating a portion of 50g a day?
 

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Well, I'm not sure what to advise you here. The Vet doesn't want you to give the antibiotics because she isn't eating enough? I'm guessing they think she will get sick to her tummy from them if she doesn't have enough food in her stomach? Is that what they said? Could you give an anti-nausea medication along with the antibiotic? I would think it is worth a try, before going straight to euthanasia, since if it IS an infection that is causing the problems, she could come out of this possibly. What medications is she on now aside from the Mirataz?
 

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I just want to add to mrsgreenjeens mrsgreenjeens questions and comments that Cuddles’ balance issues are most likely the direct result of her high creatinine level. But, her numbers could be impacted by an infection, so getting her to take the antibiotics may help.

As said above, going this route before euthanasia is considered seems logical to me. Why did the vet mention kidney cancer??

Baby food meat – Gerber Stage 2 or Beechnut – is a good way to get calories in her, and help with keeping food in her stomach while she is on antibiotics. A jar can range anywhere from 50 to 90 calories, depending on which one you give her. It is not nutritionally complete, so not a long term option unless you add a supplement like EZ Complete, which I do for my CKD cat to help get more more calories in her. She’ll eat more of the baby food meat in one sitting than she will her regular cat food. My cat also gets Mirataz (half dose every other day) to help with her appetite.
 
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Kborg019

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Well, I'm not sure what to advise you here. The Vet doesn't want you to give the antibiotics because she isn't eating enough? I'm guessing they think she will get sick to her tummy from them if she doesn't have enough food in her stomach? Is that what they said? Could you give an anti-nausea medication along with the antibiotic? I would think it is worth a try, before going straight to euthanasia, since if it IS an infection that is causing the problems, she could come out of this possibly. What medications is she on now aside from the Mirataz?
From the 28th May till the 31st May she was in house at the vet. She took intravenoius drip and intravenious antibiotics. 1st and 2nd June she was at home with us, I was instructed to give her Cerenia for the nausea, Phosphate binder tablets and the vet just mentioned the antibiotic and did not give it to me she said to me to see how she goes. Cuddles was less lethargic but still ate 60g throughout the day. 3rd June I took her again she was given intravenous drip and intravenious antibiotic. The vet never mentioned kidney infection she just said she had an infection somewhere and that she felt a mass when she checked her abdomen but was not sure exactly where it was. Her pancreas still marked as abnormal in the last blood results. I will give try to give her the antibiotic as a liquid under her skin since she is not eating hopefully its not too late. Thank you for your advice much appreciated!
 
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Kborg019

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I just want to add to mrsgreenjeens mrsgreenjeens questions and comments that Cuddles’ balance issues are most likely the direct result of her high creatinine level. But, her numbers could be impacted by an infection, so getting her to take the antibiotics may help.

As said above, going this route before euthanasia is considered seems logical to me. Why did the vet mention kidney cancer??

Baby food meat – Gerber Stage 2 or Beechnut – is a good way to get calories in her, and help with keeping food in her stomach while she is on antibiotics. A jar can range anywhere from 50 to 90 calories, depending on which one you give her. It is not nutritionally complete, so not a long term option unless you add a supplement like EZ Complete, which I do for my CKD cat to help get more more calories in her. She’ll eat more of the baby food meat in one sitting than she will her regular cat food. My cat also gets Mirataz (half dose every other day) to help with her appetite.
She mentioned kidney cancer because when she checked her abdomen she felt a mass but not sure were it was exactly, she told me to do an untrasound but Cuddles is so weak that I am scared of losing her because of the sedation.
I made a mistake not insisting on the antibiotics but since the vet never mentioned kindney infection and she gave her 5 shots of antibiotics intravenous I thought it would not have made a difference. I don't think you will believe me when I tell you how limited we are her in Malta when it comes to pet care. We do not have any baby food meat nor EZ complete. We only have 3 brands of renal prescribed diet, its hopeless here. I will try to get antibiotics as a shot under the skin hopefully its not too late now. Thank you for your advice, much appreciated
 

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If it were to be a kidney infection, that can take weeks, if not months of antibiotics to clear.

I don’t know how things work in Malta, but here in the US, a mild calm00ing agent can be used in lieu of actual sedation for an ultrasound. My cat has had 3 ultrasounds and only one of them required a mild calming agent, mostly due to the shaving of the belly. They used an agent called butorphanol, which was fast acting and of short duration.

I wish I could offer more, maybe others will.

Keep us posted.
 
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