Does my cat have CKD?

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terestrife

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If your vet is going to be out of the office for a few days and you don't want to wait, you can call their office back and ask if another vet can read the results in your vet's absence. I have done that as well when the prescribing vet was going to be out for 3-4 days.
I would rather wait for my vet because i sent him an email with information on kittys diet. So i want him reviewing all her results with that in mind.
 
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terestrife

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Okay, so the vet hasnt sent me the results for the urine test yet, even though it arrived already. But someone that works there responded to my email:

Good afternoon:


Dr. S has reviewed your email, and he does not think the abnormalities in Kitty’s blood are related to her raw diet. We have many patients who are raw fed, and they typically do not exhibit these elevations. The doctor also does not think that the low reticulocytes are a sign of kidney disease. In the absence of any anemia, he is not overly concerned about low reticulocytes. As far as the slight elevation in MCH, this typically does not have clinical relevance, though some possible causes have to do with the processing of the sample (like presence of hemolysis). Dr. mentioned that we can always recheck Kitty’s bloodwork at some point to monitor these values, though he is not overly concerned at this time. Please let us know your thoughts.

Best,

Victoria

----

Ok, I sent back an email. So does Kitty have issues with her kidneys or not? He might not be overly concerned but if he just said her diet isn't affecting her numbers, then what is?

I was thinking things over today and I remembered something that worries me. About a year ago I was living at my sister's house. Kitty kept stealing the dog's gross kibble. I remember a couple of times she peed a large amount of pee into her litter box/ a really big clump. I assumed she was reacting to his food. plus the excess of food she was sneaking. It hasn't happened since and the tests she did during that time came back normal. Now I don't know if I should be concerned.

Note: I have been out of my sisters home for a year or so.
 

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Okay, so the vet hasnt sent me the results for the urine test yet, even though it arrived already. But someone that works there responded to my email:

Good afternoon:


Dr. S has reviewed your email, and he does not think the abnormalities in Kitty’s blood are related to her raw diet. We have many patients who are raw fed, and they typically do not exhibit these elevations. The doctor also does not think that the low reticulocytes are a sign of kidney disease. In the absence of any anemia, he is not overly concerned about low reticulocytes. As far as the slight elevation in MCH, this typically does not have clinical relevance, though some possible causes have to do with the processing of the sample (like presence of hemolysis). Dr. mentioned that we can always recheck Kitty’s bloodwork at some point to monitor these values, though he is not overly concerned at this time. Please let us know your thoughts.

Best,

Victoria

----

Ok, I sent back an email. So does Kitty have issues with her kidneys or not? He might not be overly concerned but if he just said her diet isn't affecting her numbers, then what is?

I was thinking things over today and I remembered something that worries me. About a year ago I was living at my sister's house. Kitty kept stealing the dog's gross kibble. I remember a couple of times she peed a large amount of pee into her litter box/ a really big clump. I assumed she was reacting to his food. plus the excess of food she was sneaking. It hasn't happened since and the tests she did during that time came back normal. Now I don't know if I should be concerned.

Note: I have been out of my sisters home for a year or so.
I'm thinking that the phraseology, "the doctor is not overly concerned" may not be the best way to relieve the fears of a guardian who is feeling anxious.

The upside. While he and his office is not seeing a link between elevated Creatinine levels and a "raw" (or in your case, a high-protein low-carb home cooked diet), I've seen people posting lab work of raw fed dogs (especially) for a very long time, and cats more recently. Slightly elevated BUN (which your cat is not exhibiting) and slightly Creatinine levels are super common. To the point of being expected.

That's why I shared the link, which is consistent with what I've seen anecdotally reported by pet owners for a long time.

The elevated numbers are due to the kidneys of cats on such diets breaking down more protein relative to cats who get a substantial number of calories from carbohydrates in their diet. I'm "not overly concerned." LOL

I honestly had no idea what to make of the low reticulocytes, but the vet doesn't seemed concerned about that.

I wish you'd been able to have a one on one discussion with the vet. Hopefully you will and I hope any concerns and fears are relieved.

I do understand why you feel you've been left hanging.

Bill
 

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No offense to anyone, but the response you got from the vet sounds like 'double talk' - aka, whoever authored that has no idea. I would still press for a conversation with the vet, and also ask for the test results to be sent to you.

I don't think what you have described about the incidents at your sister's house have much to do with anything.
 
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terestrife

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I'm thinking that the phraseology, "the doctor is not overly concerned" may not be the best way to relieve the fears of a guardian who is feeling anxious.

The upside. While he and his office is not seeing a link between elevated Creatinine levels and a "raw" (or in your case, a high-protein low-carb home cooked diet), I've seen people posting lab work of raw fed dogs (especially) for a very long time, and cats more recently. Slightly elevated BUN (which your cat is not exhibiting) and slightly Creatinine levels are super common. To the point of being expected.

That's why I shared the link, which is consistent with what I've seen anecdotally reported by pet owners for a long time.

The elevated numbers are due to the kidneys of cats on such diets breaking down more protein relative to cats who get a substantial number of calories from carbohydrates in their diet. I'm "not overly concerned." LOL

I honestly had no idea what to make of the low reticulocytes, but the vet doesn't seemed concerned about that.

I wish you'd been able to have a one on one discussion with the vet. Hopefully you will and I hope any concerns and fears are relieved.

I do understand why you feel you've been left hanging.

Bill
I still dont understand why he brushed aside the link when it has happened to multiple pets.

No offense to anyone, but the response you got from the vet sounds like 'double talk' - aka, whoever authored that has no idea. I would still press for a conversation with the vet, and also ask for the test results to be sent to you.

I don't think what you have described about the incidents at your sister's house have much to do with anything.
I am going to see the vet next week regarding Elsa I can take that chance and talk to him if necessary.

Update:

they sent me a new email:

Good morning,


The urine came back and upon review, the specific gravity was low at 1.019. This, along with some of the values in the blood do indicate early stages of chronic kidney disease. As Victoria explained, in the absence of anemia and in the presence of a normal phosphorus level, he does not feel intervention is necessary at the moment. We recommend continuing her on her current diet and trying to keep her as hydrated as possible. You can add water to her diet to promote drinking. We can retest blood in 3 months or so and continue to monitor Kitty. Also, we can check her blood pressure at some point going forward. Let us know if you feel comfortable with this plan.


Best,

Julia


I don't know if I should try getting a second opinion. I have to get through Elsas upcoming surgery and the associated costs. And then I can switch back to Kitty. I emailed them requesting the actual urine results. And I did ask if they recommend any supplements that I can give her to improve her kidneys. now they are saying she does have issues with her kidneys. They told me not to change her diet. but they did tell me to add more water to her food. However, I already add 1/4 cup of water to her breakfast and 1/4 cup to her dinner. I started doing this a long time ago to help her feel full. Shes my bigger cat with a voracious appetite. Do i add even more water and water down the food even more?

These are their meals for the day:

Kitty gets 4 cubes for the whole day. 2 in the morning and 2 at night. It only seems like more food because it has a total of 1/2 a cup of water spread into the 4 cubes (1/4 cup in the morning and 1/4 cup at night). Note: Kitty doesnt really seem compelled to drink water on her own, even though she has a water bowl.
kitty.jpg

Elsa.jpg
Elsa gets two cubes of food for the entire day (one in the morning and one at night.) I cant really add water to her food because she never really finishes her food and I am concerned it will lower her overall calories. She also drinks water on her own. She weighs 9 lb.

Edit: i did a quick google search and read this:

Studies suggest that therapeutic diets that are restricted in protein, phosphorus and sodium content and high in water-soluble vitamins, fiber, and antioxidant concentrations may prolong life and improve quality of life in cats with CKD.

Should I be changing her diet? I am so confused.
 
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Box of Rain

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I still dont understand why he brushed aside the link when it has happened to multiple pets.



I am going to see the vet next week regarding Elsa I can take that chance and talk to him if necessary.

Update:

they sent me a new email:

Good morning,


The urine came back and upon review, the specific gravity was low at 1.019. This, along with some of the values in the blood do indicate early stages of chronic kidney disease. As Victoria explained, in the absence of anemia and in the presence of a normal phosphorus level, he does not feel intervention is necessary at the moment. We recommend continuing her on her current diet and trying to keep her as hydrated as possible. You can add water to her diet to promote drinking. We can retest blood in 3 months or so and continue to monitor Kitty. Also, we can check her blood pressure at some point going forward. Let us know if you feel comfortable with this plan.


Best,

Julia


I don't know if I should try getting a second opinion. I have to get through Elsas upcoming surgery and the associated costs. And then I can switch back to Kitty. I emailed them requesting the actual urine results. And I did ask if they recommend any supplements that I can give her to improve her kidneys. now they are saying she does have issues with her kidneys. They told me not to change her diet. but they did tell me to add more water to her food. However, I already add 1/4 cup of water to her breakfast and 1/4 cup to her dinner. I started doing this a long time ago to help her feel full. Shes my bigger cat with a voracious appetite. Do i add even more water and water down the food even more?

These are their meals for the day:

Kitty gets 4 cubes for the whole day. 2 in the morning and 2 at night. It only seems like more food because it has a total of 1/2 a cup of water spread into the 4 cubes (1/4 cup in the morning and 1/4 cup at night). Note: Kitty doesnt really seem compelled to drink water on her own, even though she has a water bowl.
View attachment 428433

View attachment 428434
Elsa gets two cubes of food for the entire day (one in the morning and one at night.) I cant really add water to her food because she never really finishes her food and I am concerned it will lower her overall calories. She also drinks water on her own. She weighs 9 lb.

Edit: i did a quick google search and read this:

Studies suggest that therapeutic diets that are restricted in protein, phosphorus and sodium content and high in water-soluble vitamins, fiber, and antioxidant concentrations may prolong life and improve quality of life in cats with CKD.

Should I be changing her diet? I am so confused.
I'd stick with the vet's advice and stay the course with your current feeding. Most of the bloodwork is excellent.

The Calcium/Phosphorus numbers are spot on.

I've been reading about low levels of Reticulocytes and it seems that levels of 0-1% are not unusual for cats who don't have anemia, and the blood panel shows anemia is not an issue.

We've already discussed mildly elevated Creatinine levels in cats being fed high protein diets not being a sign of kidney disease, but rather a normal expectation.

The specific gravity of the urine is not unusual and is something that can be all over the map.

In your shoes, I would feel relieved. I'd take the vet's advice and continue to monitor the situation.

If you could cut a little salt (if possible) and slowly trim a little excess weight, it sounds like those would be positives.

Bill
 
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I'd stick with the vet's advice and stay the course with your current feeding. Most of the bloodwork is excellent.

The Calcium/Phosphorus numbers are spot on.

I've been reading about low levels of Reticulocytes and it seems that levels of 0-1% are not unusual for cats who don't have anemia, and the blood panel shows anemia is not an issue.

We've already discussed mildly elevated Creatinine levels in cats being fed high protein diets not being a sign of kidney disease, but rather a normal expectation.

The specific gravity of the urine is not unusual and is something that can be all over the map.

In your shoes, I would feel relieved. I'd take the vet's advice and continue to monitor the situation.

If you could cut a little salt (if possible) and slowly trim a little excess weight, it sounds like those would be positives.

Bill
Thank you, and everyone here for keeping me calm. I was panicking after the first results. The knowledge everyone here has helped to calm me.

I am for sure relieved! I was expecting her to have stage 3 kidney failure after using google. I was panicking thinking she didn't have long to live. Kitty sensed my panic and completely freaked out on the drive to the vet.

I have helped her lose a little weight recently. She went from 15 lbs to 13.2 lbs. Been working on improving her health. Been increasing their movement by forcing them to jump to get to their eating areas and their trees. They get playtime every single day. I removed a couple of teaspoons from her food. She seems a lot happier after losing some weight. She's actually awake more during the day now. I may just work on maintaining her weight so I don't stress her body by making her lose more weight.

I am not sure how to decrease the salt in her diet. This is the powder I use for their meat (Know Better Pet Food | Healthy Homemade Pet Food Products)
 

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Thank you, and everyone here for keeping me calm. I was panicking after the first results. The knowledge everyone here has helped to calm me.

I am for sure relieved! I was expecting her to have stage 3 kidney failure after using google. I was panicking thinking she didn't have long to live. Kitty sensed my panic and completely freaked out on the drive to the vet.

I have helped her lose a little weight recently. She went from 15 lbs to 13.2 lbs. Been working on improving her health. Been increasing their movement by forcing them to jump to get to their eating areas and their trees. They get playtime every single day. I removed a couple of teaspoons from her food. She seems a lot happier after losing some weight. She's actually awake more during the day now. I may just work on maintaining her weight so I don't stress her body by making her lose more weight.

I am not sure how to decrease the salt in her diet. This is the powder I use for their meat (Know Better Pet Food | Healthy Homemade Pet Food Products)
I'm glad you are relieved. I think you should be. I would be.

I think there may be a little CYA when it comes to the way they are expressing the possibility of kidney disease. I'd take the vet's suggestion to monitor the situation--but would not worry unduly.

What do you put into your mixes (aside from the supplement)?

Chicken can sometimes be "enhanced" (essentially brined with a salt solution) especially with large economy size bags.

Not carrying excess weight is important for pets and especially for seniors.

Bill
 
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BJ's Wholesale Club
boneless chicken thigh
BJ's Wholesale Club
Chicken thighs

I do 5 lbs of skinless chicken thighs and 5 lbs of chicken thighs with skin. The two links are for the chicken i use. I have looked the package over and never see salt listed in the ingredients. How can I know for sure? contacting the company?

Once i grind up that meat, i add this powder Buy Homemade Cat Food

and that is it.

I asked if I should start Kitty on supplements and they recommended these. I just have to look into them before I do anything. I'm not sure about the pills because I don't want to have to start harassing her into taking pills.



RX VITAMINS Rx Renal Capsules Kidney Supplement for Cats, 120 count - Chewy.com



Renal Essentials Feline
 

Box of Rain

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BJ's Wholesale Club
boneless chicken thigh
BJ's Wholesale Club
Chicken thighs

I do 5 lbs of skinless chicken thighs and 5 lbs of chicken thighs with skin. The two links are for the chicken i use. I have looked the package over and never see salt listed in the ingredients. How can I know for sure? contacting the company?

Once i grind up that meat, i add this powder Buy Homemade Cat Food

and that is it.

I asked if I should start Kitty on supplements and they recommended these. I just have to look into them before I do anything. I'm not sure about the pills because I don't want to have to start harassing her into taking pills.



RX VITAMINS Rx Renal Capsules Kidney Supplement for Cats, 120 count - Chewy.com



Renal Essentials Feline
The BJ's Wellsley Farms Boneless Skinless Chicken Thighs (Perdue) have 105 mg of sodium per serving (per 4 oz) the skin-on thighs are better with 90 mg per serving.

Ideally that number would be under 60-70 mg per 4 oz. Seems likely that the chicken is the source of the slightly elevated sodium levels.

If you wish to lower the sodium levels (I would) look at the number of milligrams of sodium per serving on the nutrition labels.

Bill
 

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Thanks for the update! I concur with the others about following the vet's advice at this point. I think doing anything else right now would be 'overkill'.

I'd even stick with your current amount of added water to Kitty's food. But I gather the water that is added is to 're-hydrate' the food? That being the case, you could always sneak in an additional tsp of water just to see what she does. If it goes over well then fine, if not then don't do it.

Regarding the renal vitamins, you should be able to open up a capsule and sprinkle it onto her food, if you choose to use them. Just do what I do and taste it so you know what it tastes like and that will help you to determine if it might alter the flavor of her food. The information about it says they are flavorless, so that would be good!
 
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I'm glad you are relieved. I think you should be. I would be.

I think there may be a little CYA when it comes to the way they are expressing the possibility of kidney disease. I'd take the vet's suggestion to monitor the situation--but would not worry unduly.

What do you put into your mixes (aside from the supplement)?

Chicken can sometimes be "enhanced" (essentially brined with a salt solution) especially with large economy size bags.

Not carrying excess weight is important for pets and especially for seniors.

Bill
The BJ's Wellsley Farms Boneless Skinless Chicken Thighs (Perdue) have 105 mg of sodium per serving (per 4 oz) the skin-on thighs are better with 90 mg per serving.

Ideally that number would be under 60-70 mg per 4 oz. Seems likely that the chicken is the source of the slightly elevated sodium levels.

If you wish to lower the sodium levels (I would) look at the number of milligrams of sodium per serving on the nutrition labels.

Bill
Thank you so much for taking the time to read the label for me. I assumed if the ingredients didn't list salt added then it didn't have any. i feel so dumb. I am so grateful that you caught that. what sucks is that I just grinded so much meat recently. 60 lbs. :sigh: Will have to find another use for it. i will make this change as soon as I can find meat with less sodium.

Thanks for the update! I concur with the others about following the vet's advice at this point. I think doing anything else right now would be 'overkill'.

I'd even stick with your current amount of added water to Kitty's food. But I gather the water that is added is to 're-hydrate' the food? That being the case, you could always sneak in an additional tsp of water just to see what she does. If it goes over well then fine, if not then don't do it.

Regarding the renal vitamins, you should be able to open up a capsule and sprinkle it onto her food, if you choose to use them. Just do what I do and taste it so you know what it tastes like and that will help you to determine if it might alter the flavor of her food. The information about it says they are flavorless, so that would be good!
No, it's not to rehydrate their food. I freeze their food and when it defrosts it still has moisture and looks the same as when I froze it. I add water to Kitty's food to force her to feel full and not want to eat more. :lol: This was the only way to get her satisfied with her meals while losing weight at the same time. She would panic every time I would lessen her food intake. But she handled it well when I added water, and split her meals into four times a day. She loves her food so much she licks up the extra water i add because it has flavor from her food. :blush:

Edit: I was looking around online and it says it's possible to remove salt from chicken by soaking it in water. Is that something you think I could do with the chicken I have just so it's not wasted meat? I am also looking around and every chicken I find online has high sodium. :sigh:
 
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Thank you so much for taking the time to read the label for me. I assumed if the ingredients didn't list salt added then it didn't have any. i feel so dumb. I am so grateful that you caught that. what sucks is that I just grinded so much meat recently. 60 lbs. :sigh: Will have to find another use for it. i will make this change as soon as I can find meat with less sodium.



No, it's not to rehydrate their food. I freeze their food and when it defrosts it still has moisture and looks the same as when I froze it. I add water to Kitty's food to force her to feel full and not want to eat more. :lol: This was the only way to get her satisfied with her meals while losing weight at the same time. She would panic every time I would lessen her food intake. But she handled it well when I added water, and split her meals into four times a day. She loves her food so much she licks up the extra water i add because it has flavor from her food. :blush:
Some packaged chicken can be much worse. Over 400 mg. I'd hate to see you need to divert so much food. At least something to be mindful of in the future.

Your cat's blood sodium was in the normal rage. Higher-end of normal, but...

Bill
 
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Some packaged chicken can be much worse. Over 400 mg. I'd hate to see you need to divert so much food. At least something to be mindful of in the future.

Your cat's blood sodium was in the normal rage. Higher-end of normal, but...

Bill
No, I appreciate you mentioning it. I am going to start looking around from now so when the time comes it will be easier to switch to something with less sodium. You never know what effect that could be having on them.
 

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Edit: I was looking around online and it says it's possible to remove salt from chicken by soaking it in water. Is that something you think I could do with the chicken I have just so it's not wasted meat? I am also looking around and every chicken I find online has high sodium. :sigh:
One of those trade offs, as soaking the chicken would almost certainly reduce the amount of (highly soluble) taurine in the chicken along with reducing the sodium content.

But you are supplementing taurine with your pre-mix. So maybe.

If I were to do so, I'd do it using whole pieces only in very cold (iced) water.

Hopefully you can find a source of future chicken thighs that has less added sodium.

Bill
 
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