Does elevated Creatinine mean kidney disease?

[CharlottesHooman]

Hi everyone!
My 3 year old cat has been having elevated creatinine level (still within normal range) since September last year and my vet is suggesting us to lower the phos level in her diet. She's been eating wet food and freeze-dried food ever since I got her when she was 3 month old. The wet food brands she's been eating are ziwi (most of the time), weruva and lotus. Recently I'm also giving her more tiki cat since it has lower phos level than ziwi. The freeze-dried brands are Primal and fresh is best.
I know that CKD usually happens with senior cats so I don't know why her kidney levels are elevated when she's still so young... Her creatinine level was 1.4 last March, 1.9 last September and 2.0 in the recent bloodwork results in January this year. Her SDMA was 6 last March, 11 last September and 13 in the recent bloodwork results in January this year. Her albumin has been a little elevated too (4.0) but I'm not sure if it has any significant meaning. Her RBC and Hematocrit were always on the higher side too.
Her urinalysis results were normal. She was tested 2 times and USG were 1.059 and 1.069. No UTI was detected. Proteins were detected in her urine but Urine Protein: Creatinine Ratio was normal (0.1).
She's been eating a lot more freeze-dried meat treats since last March so I'd say her diet has higher protein.
Does anyone know if it means she has kidney disease?
Thank you!!

 

[LTS3]

Take a look through this: Looking for the links with info about elevated BUN/crea in raw fed cats

Raw fed cats, even just some freeze dried raw in the diet, can cause elevated kidney values in cats. Keep in mind that normal blood work reference ranges were created decades ago when cats primarily ate dry food. Reference ranges have not been changed while cat diets have. Slight elevated kidney levels for a cat who eats raw of some kind may not be worrisome at all.

 

[kittyprincesss]

It could mean beginning signs of Kidney Disease. A lot of things factor into it, even her genetics. Sadly, most cats are prone to having CKD (Chronic Kidney Disease aka Kidney Failure) in their life and especially towards the end. I would keep an eye on it, its not unusual for some poor babies to start early. Lowering the phos would not hurt. Its more cushion for the kidneys. How was their WBC? Sometimes those values being high mean infection and the kidneys working harder. Best of luck.

 

[CharlottesHooman]

Date	Crea	BUN	Crea:BUN	SDMA	Phos	USG	Urine P:Crea
3/4/2020	1.6	28	18		4.5
2/27/2021	1.4	24	17.1	6	4.3
9/26/2021	1.9	21	11.1	11	4.6
1/17/2011	2	29	14.5	13	4.5	1.059	0.1
1/29/2022						1.069

adding her lab results over the past 3 years..

 

[CharlottesHooman]

It could mean beginning signs of Kidney Disease. A lot of things factor into it, even her genetics. Sadly, most cats are prone to having CKD (Chronic Kidney Disease aka Kidney Failure) in their life and especially towards the end. I would keep an eye on it, its not unusual for some poor babies to start early. Lowering the phos would not hurt. Its more cushion for the kidneys. How was their WBC? Sometimes those values being high mean infection and the kidneys working harder. Best of luck.

Her WBC is normal so there's no infection!

 

[kittyprincesss]

Here is some info regarding her SDMA: Interpreting Your SDMA Results - IDEXX US

 

[CharlottesHooman]

Take a look through this: Looking for the links with info about elevated BUN/crea in raw fed cats

Raw fed cats, even just some freeze dried raw in the diet, can cause elevated kidney values in cats. Keep in mind that normal blood work reference ranges were created decades ago when cats primarily ate dry food. Reference ranges have not been changed while cat diets have. Slight elevated kidney levels for a cat who eats raw of some kind may not be worrisome at all.

Thanks I really hope that's the case..

 

[10thomer]

My cat has had very similar lab results to yours for several years now. From the ages of 4-6, his labs are as follows:

• Creatinine: ~2.2
• BUN: Was normal (in the middle of the range) for a while until I switched him from Blue Buffalo to Tiki Cat, then it went just slightly above the reference range (38)
• SMDA: Was 15 when we tested it once (he was having a pancreatic/IBD flare up at this point), then dropped back to 14
• Phos: Ranges from 4.3-4.7
• Albumin: Has always been exactly 4.0
• Hematocrit and Hemoglobin have been a little high in the majority of tests
• USG: Ranges from 1.019 (had low blood sodium at this point so I think this is what caused it to be this low) to 1.030

My cat has always been fairly muscle-y and is quite large (13-15lbs is a healthy weight for him). He has IBD and pancreatitis so he absolutely does not eat any dry food because that will set off his vomiting (which is why we took him into the vet to get the labs when he was 4 y.o.). My vets have been confused by these numbers, and they have not been confident enough to diagnose him with CKD. As was mentioned above, a lot of these ranges were established by cats on high carb, dry foods that are species inappropriate.

So I absolutely have no authority to diagnose your cat, but I can provide some perspective on the lab values because I've done a significant amount of secondary research because of my own cat (I also have a PhD in biochemistry which is helpful).

• Creatinine can mean CKD, but can also be higher for cats with more muscle mass, larger overall size, higher protein/raw diet, and sometimes pancreatitis can cause elevated creatinine levels.
• SDMA is a bit of a controversial biomarker, as human nephrologists don't believe that SDMA is much value in evaluating kidney disease in humans and no independent research has confirmed that it's an earlier read on kidney disease that I'm aware of. It will increase with CKD, but can also increase because of low grade inflammation, IBD, and protein intake so it's a highly sensitive but not specific biomarker.
• Your cat's phosphorous levels look fine. If they were a CKD cat, the goal would to be to keep the levels below 4.5, but a normal healthy cat has levels that can go up to 5.5.
• Your cats USG really suggests that your cat doesn't have CKD in my opinion. In order for the urine to be concentrated, the kidneys are working. However, I believe that this USG is pretty high for a cat on a high moisture/high protein/low carb diet? I think it should be somewhere more in the 1.025-1.040 range, so maybe your cat is a bit dehydrated. What is their Total Protein level? `
• High albumin and hematocrit can mean dehydration, but has also been observed in animals with high protein diets.

So my overall assessment is that your cat is just gaining muscle mass as they get older and also may be suffering from mild/moderate dehydration for some reason, which may be exacerbating the numbers a bit. BUT I would definitely request that your cat undergoes an ultrasound conducted by a certified ultrasound technician (not just the vet!) to see if there are any congenital kidney issues, which is the predominant kidney disease that could be occurring in such a young cat. Otherwise, I think it's premature to start switching to a kidney diet at this time and would just continue to monitor every six months to a year.

Let me know if you have any other questions at all and if you need links to any of the resources I've reference! I'm super happy to share my knowledge since this has been so frustrating and confusing to me as well.

 

[BlackCatOp]

Date	Crea	BUN	Crea:BUN	SDMA	Phos	USG	Urine P:Crea
3/4/2020	1.6	28	18		4.5
2/27/2021	1.4	24	17.1	6	4.3
9/26/2021	1.9	21	11.1	11	4.6
1/17/2011	2	29	14.5	13	4.5	1.059	0.1
1/29/2022						1.069

adding her lab results over the past 3 years..

While Creatinine can fluctuate with muscle mass, I would be concerned that she has been fed the same type of diet since 3 months of age and the creatinine is trending upward. Very small changes in lab value can mean large changes in kidney function. Her USG is highly concentrated- thus kidneys are functioning. However, kidneys have a large reserve function so the kidneys are able be still concentrate but creatinine is slowly increasing due to the possible loss of nephrons. I would definitely monitor bloodwork and USG.

 

[maggie101]

Hi everyone!
My 3 year old cat has been having elevated creatinine level (still within normal range) since September last year and my vet is suggesting us to lower the phos level in her diet. She's been eating wet food and freeze-dried food ever since I got her when she was 3 month old. The wet food brands she's been eating are ziwi (most of the time), weruva and lotus. Recently I'm also giving her more tiki cat since it has lower phos level than ziwi. The freeze-dried brands are Primal and fresh is best.
I know that CKD usually happens with senior cats so I don't know why her kidney levels are elevated when she's still so young... Her creatinine level was 1.4 last March, 1.9 last September and 2.0 in the recent bloodwork results in January this year. Her SDMA was 6 last March, 11 last September and 13 in the recent bloodwork results in January this year. Her albumin has been a little elevated too (4.0) but I'm not sure if it has any significant meaning. Her RBC and Hematocrit were always on the higher side too.
Her urinalysis results were normal. She was tested 2 times and USG were 1.059 and 1.069. No UTI was detected. Proteins were detected in her urine but Urine Protein: Creatinine Ratio was normal (0.1).
She's been eating a lot more freeze-dried meat treats since last March so I'd say her diet has higher protein.
Does anyone know if it means she has kidney disease?
Thank you!!

For low phosphorus food, tiki is still too high. Weruva trulex steak frites is lowest phosphorus commercial food I could find and is suggested on Tanya's website. .5 I think

 

[CharlottesHooman]

My cat has had very similar lab results to yours for several years now. From the ages of 4-6, his labs are as follows:

• Creatinine: ~2.2
• BUN: Was normal (in the middle of the range) for a while until I switched him from Blue Buffalo to Tiki Cat, then it went just slightly above the reference range (38)
• SMDA: Was 15 when we tested it once (he was having a pancreatic/IBD flare up at this point), then dropped back to 14
• Phos: Ranges from 4.3-4.7
• Albumin: Has always been exactly 4.0
• Hematocrit and Hemoglobin have been a little high in the majority of tests
• USG: Ranges from 1.019 (had low blood sodium at this point so I think this is what caused it to be this low) to 1.030

My cat has always been fairly muscle-y and is quite large (13-15lbs is a healthy weight for him). He has IBD and pancreatitis so he absolutely does not eat any dry food because that will set off his vomiting (which is why we took him into the vet to get the labs when he was 4 y.o.). My vets have been confused by these numbers, and they have not been confident enough to diagnose him with CKD. As was mentioned above, a lot of these ranges were established by cats on high carb, dry foods that are species inappropriate.

So I absolutely have no authority to diagnose your cat, but I can provide some perspective on the lab values because I've done a significant amount of secondary research because of my own cat (I also have a PhD in biochemistry which is helpful).

• Creatinine can mean CKD, but can also be higher for cats with more muscle mass, larger overall size, higher protein/raw diet, and sometimes pancreatitis can cause elevated creatinine levels.
• SDMA is a bit of a controversial biomarker, as human nephrologists don't believe that SDMA is much value in evaluating kidney disease in humans and no independent research has confirmed that it's an earlier read on kidney disease that I'm aware of. It will increase with CKD, but can also increase because of low grade inflammation, IBD, and protein intake so it's a highly sensitive but not specific biomarker.
• Your cat's phosphorous levels look fine. If they were a CKD cat, the goal would to be to keep the levels below 4.5, but a normal healthy cat has levels that can go up to 5.5.
• Your cats USG really suggests that your cat doesn't have CKD in my opinion. In order for the urine to be concentrated, the kidneys are working. However, I believe that this USG is pretty high for a cat on a high moisture/high protein/low carb diet? I think it should be somewhere more in the 1.025-1.040 range, so maybe your cat is a bit dehydrated. What is their Total Protein level? `
• High albumin and hematocrit can mean dehydration, but has also been observed in animals with high protein diets.

So my overall assessment is that your cat is just gaining muscle mass as they get older and also may be suffering from mild/moderate dehydration for some reason, which may be exacerbating the numbers a bit. BUT I would definitely request that your cat undergoes an ultrasound conducted by a certified ultrasound technician (not just the vet!) to see if there are any congenital kidney issues, which is the predominant kidney disease that could be occurring in such a young cat. Otherwise, I think it's premature to start switching to a kidney diet at this time and would just continue to monitor every six months to a year.

Let me know if you have any other questions at all and if you need links to any of the resources I've reference! I'm super happy to share my knowledge since this has been so frustrating and confusing to me as well.

First of all, thank you for your super long response! Really appreciate that you are sharing your experience with your cat
She definitely has been gaining weight! From February last year to Jan this year, her weight increased from 9.3 to 9.68 to 10.38 lbs. She still looks pretty fit thought so she's not overweight. I have an ultrasound appointment scheduled for her this month with an internal medicine vet! She eats freeze-dried food during the day without adding water so she may not be getting enough water. At night she gets wet food and I usually add more water in it. I'm giver her some kitty soup every day so hopefully it will help. Her total protein level is 7.4 which is in the range.
For the past a few days I reached out to a few CKD groups and shared her complete bloodwork results over the past 3 years. They are not vets but they don't think she has CKD based on her numbers. I really hope that's the case!!
I'd be happy to read the resources you've used to get all the info! I'm quite used to reading research papers

 

[CharlottesHooman]

While Creatinine can fluctuate with muscle mass, I would be concerned that she has been fed the same type of diet since 3 months of age and the creatinine is trending upward. Very small changes in lab value can mean large changes in kidney function. Her USG is highly concentrated- thus kidneys are functioning. However, kidneys have a large reserve function so the kidneys are able be still concentrate but creatinine is slowly increasing due to the possible loss of nephrons. I would definitely monitor bloodwork and USG.

Yeah I'll definitely monitor her bloodwork and urinalysis results. Will get her tested again!

 

[10thomer]

First of all, thank you for your super long response! Really appreciate that you are sharing your experience with your cat
She definitely has been gaining weight! From February last year to Jan this year, her weight increased from 9.3 to 9.68 to 10.38 lbs. She still looks pretty fit thought so she's not overweight. I have an ultrasound appointment scheduled for her this month with an internal medicine vet! She eats freeze-dried food during the day without adding water so she may not be getting enough water. At night she gets wet food and I usually add more water in it. I'm giver her some kitty soup every day so hopefully it will help. Her total protein level is 7.4 which is in the range.
For the past a few days I reached out to a few CKD groups and shared her complete bloodwork results over the past 3 years. They are not vets but they don't think she has CKD based on her numbers. I really hope that's the case!!
I'd be happy to read the resources you've used to get all the info! I'm quite used to reading research papers

My pleasure!! I've obviously spent a lot of time needlessly stressed out about this and I wish the vets I've spoken with would take a little time to think outside of their regular decision trees, but I understand that this is pretty complicated and we've only relatively recently started transitioning cats to more species-appropriate diets. The last I spoke with my vet I was like... gosh this is all so weird for a 6 year old cat, right? And she responded "Well I've been seeing this more and more in younger cats, sometimes even only one year old." And I was like, okay I doubt more young cats are getting CKD and I bet it has something more to do with kitties improved diets, but we really are in need of some reevaluations of standard biomarker ranges taking into account multiple variables, including diet, age, weight, and body composition.

Anyways, these are the resources I've been referencing to help me try and shed a little light on this mystery. Happy to answer questions/have a discussion/send PDFs your way in case you can't access something:

• SDMA
  • Not an academic paper but a website that nicely summarizes several potential issues with SDMA including citations:
    • The SDMA Test - What Abnormal Results Mean And What They Don't Mean -
  • Better nutritional status/higher protein intake correlates w higher SDMA in humans:
    • Dimethylarginine levels and nutritional status in hemodialysis patients - PubMed
  • SDMA increases correlate w IBD in humans:
    • Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), arginine, and 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha) level in patients with inflammatory bowel diseases - PubMed
• Creatinine/Albumin
  • Muscle-y cats would have been diagnosed with stage II kidney disease just based off of creatinine levels AND higher protein diet increases albumin levels:
    • https://intl.acana.com/wp-content/t...rces/Protein-and-Renal-Parameters-in-Cats.pdf
    • To note: urine specific gravity was higher in the high protein diet group BUT both diets were dry Purina food which I don't love for assessing hydration parameters. Additionally, while creatinine did decrease on the high protein diet, many of the cats in this study just had high creatinine to begin with, quote from the paper: "An important feature to note regarding the cats used in this research project is that they were all of good body condition with stout muscle mass likely due to their constant activity (climbing, jumping, etc) in their large housing areas. Were the evaluation for renal disease to be based solely on a one-time reading of creatinine levels, a number of these cats would be classified as having stage II CKD according to IRIS standards."
  • Creatinine correlates with weight while SDMA stays stable in hyperthyroid cats:
    • A retrospective evaluation of the relationship between symmetric dimethylarginine, creatinine and body weight in hyperthyroid cats
    • Be cautious about the SDMA conclusions here because it is funded by IDEXX and assessed in hyperthyroid cats but the creatinine observation is interesting enough to share
• Hemoglobin & hematocrit increases in rats:
  • Effects of Dietary Protein, Fat and Energy on Blood Hemoglobin and Hematocrit in the Rat
    • VERY old but the science seems solid enough
• Urine Specific Gravity (want to share this with you in case you fully switch to wet and are like…. Wait now why does my cat have low USG, do they have kidney disease now?):
  • USG decreases when cats are fed a wet diet:
    • Evaluation of the efficacy of a commercial diet in the dissolution of feline struvite bladder uroliths - PubMed
    • This is not the best wet diet because it is still fairly high carb, but it does show a clear decrease in USG compared to dry diet
  • (CAUTION, THIS IS NOT A PUBLISHED STUDY) Interesting USG numbers from cats on a dry low/no-carbohydrate diet:
    • Hydration - Young Again Pet Food
  • I've noticed an interesting juxtaposition between the CKD and urine crystal communities with regards to USG. Individuals in some CKD communities will say that anything less than 1.035 is indicative of kidney issues (particularly with any mild azotemia) but those that are treating/dealing with cats with crystals will recommend trying to get the USG down to 1.020 with proper diet & hydration. Just another topic to consider in this weird gray area. Some guideline examples are as follows:
    • Diet and Calcium Oxalate Bladder Stones in Cats | PetMD
    • Calcium Oxalate Stones (Feline) - Mar Vista Animal Medical Center

 

[CharlottesHooman]

My pleasure!! I've obviously spent a lot of time needlessly stressed out about this and I wish the vets I've spoken with would take a little time to think outside of their regular decision trees, but I understand that this is pretty complicated and we've only relatively recently started transitioning cats to more species-appropriate diets. The last I spoke with my vet I was like... gosh this is all so weird for a 6 year old cat, right? And she responded "Well I've been seeing this more and more in younger cats, sometimes even only one year old." And I was like, okay I doubt more young cats are getting CKD and I bet it has something more to do with kitties improved diets, but we really are in need of some reevaluations of standard biomarker ranges taking into account multiple variables, including diet, age, weight, and body composition.

Anyways, these are the resources I've been referencing to help me try and shed a little light on this mystery. Happy to answer questions/have a discussion/send PDFs your way in case you can't access something:

• SDMA
  • Not an academic paper but a website that nicely summarizes several potential issues with SDMA including citations:
    • The SDMA Test - What Abnormal Results Mean And What They Don't Mean -
  • Better nutritional status/higher protein intake correlates w higher SDMA in humans:
    • Dimethylarginine levels and nutritional status in hemodialysis patients - PubMed
  • SDMA increases correlate w IBD in humans:
    • Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), arginine, and 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha) level in patients with inflammatory bowel diseases - PubMed
• Creatinine/Albumin
  • Muscle-y cats would have been diagnosed with stage II kidney disease just based off of creatinine levels AND higher protein diet increases albumin levels:
    • https://intl.acana.com/wp-content/t...rces/Protein-and-Renal-Parameters-in-Cats.pdf
    • To note: urine specific gravity was higher in the high protein diet group BUT both diets were dry Purina food which I don't love for assessing hydration parameters. Additionally, while creatinine did decrease on the high protein diet, many of the cats in this study just had high creatinine to begin with, quote from the paper: "An important feature to note regarding the cats used in this research project is that they were all of good body condition with stout muscle mass likely due to their constant activity (climbing, jumping, etc) in their large housing areas. Were the evaluation for renal disease to be based solely on a one-time reading of creatinine levels, a number of these cats would be classified as having stage II CKD according to IRIS standards."
  • Creatinine correlates with weight while SDMA stays stable in hyperthyroid cats:
    • A retrospective evaluation of the relationship between symmetric dimethylarginine, creatinine and body weight in hyperthyroid cats
    • Be cautious about the SDMA conclusions here because it is funded by IDEXX and assessed in hyperthyroid cats but the creatinine observation is interesting enough to share
• Hemoglobin & hematocrit increases in rats:
  • Effects of Dietary Protein, Fat and Energy on Blood Hemoglobin and Hematocrit in the Rat
    • VERY old but the science seems solid enough
• Urine Specific Gravity (want to share this with you in case you fully switch to wet and are like…. Wait now why does my cat have low USG, do they have kidney disease now?):
  • USG decreases when cats are fed a wet diet:
    • Evaluation of the efficacy of a commercial diet in the dissolution of feline struvite bladder uroliths - PubMed
    • This is not the best wet diet because it is still fairly high carb, but it does show a clear decrease in USG compared to dry diet
  • (CAUTION, THIS IS NOT A PUBLISHED STUDY) Interesting USG numbers from cats on a dry low/no-carbohydrate diet:
    • Hydration - Young Again Pet Food
  • I've noticed an interesting juxtaposition between the CKD and urine crystal communities with regards to USG. Individuals in some CKD communities will say that anything less than 1.035 is indicative of kidney issues (particularly with any mild azotemia) but those that are treating/dealing with cats with crystals will recommend trying to get the USG down to 1.020 with proper diet & hydration. Just another topic to consider in this weird gray area. Some guideline examples are as follows:
    • Diet and Calcium Oxalate Bladder Stones in Cats | PetMD
    • Calcium Oxalate Stones (Feline) - Mar Vista Animal Medical Center

Omg thank you so much for sharing the resources! I've been looking for the articles regarding all the tests and came across some of the articles, but this collection is perfect and so comprehensive!!! I totally agree with that the vets are not thinking outside of box.. I talked to 2 vets and people in CKD groups. Both vets said she's in early stage of CKD and I should switch her to a renal diet, but people from the CKD groups don't think so based on her gaining weight and slight dehydration. And when I asked the vets if giving her more single source meat treats (hence higher level of protein intake in her diet) and gaining weight will influence her creatinine level, they said no. They also said that CKD could be observed in some young cats (but she's only 3 years old!!).
I'm not gonna fully switch her to wet food. I'll still give her freeze-dried because I think the composition is just better (but I'm choosing those with lower phos level and giving her more liquid in a different way).
Thanks again for the resources! I'll definitely read them all