Early stage kidney problems

txcats

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Hi all, one of our kitties was listless and tired yesterday, ate in the a.m., but refused her dinner. She was no better this morning, so we took her to the vet and her labs were normal, except creatinine is 2.5. She received a b12 injection and a mirataz injection and ate a bit as soon as we came home. We also have transdermal mirataz to administer as needed. She was well hydrated and did not need fluids.

So my question is, does anyone here know of any new supplements or treatments to slow this down? We were sent home with 2 cans of the dreaded renal diet, but no other suggestions except monitoring, b12, appetite stimulant as necessary. Our most recent renal patient was also given regular b12 injections and, eventually, daily fluids. But that was back in 2012, so I am hoping maybe there have been some advances in meds or supplements that have worked for some of you?

The vet also said we need to feed her a low protein diet (and canned only) if she will eat it, but I thought that was kind of outdated, and the quality of the protein is more important?

Thanks much for suggestions, I am kind of stunned and very sad as she is only 8 and would like to keep her alive and happy/comfortable for as long as possible.
 

Furballsmom

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Hello -
The vet also said we need to feed her a low protein diet (and canned only) if she will eat it, but I thought that was kind of outdated, and the quality of the protein is more important?
You're correct, it is outdated, at least until the kidney disease has really progressed.

A lot of people will suggest felinecrf.org to use (if you aren't already familiar with it), and it can be helpful.
This particular page I'm giving you a link to was written by that site's owner to provide an easier look into the wealth of information available there.
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - What You Need to Know First

The short version, however, is that there are several commercial foods that don't require a prescription which will meet your and your vet's criteria such as Evanger's, Dave's and Weruva (Weruva can be low in calories so may need supplemented, or fed more of) including Weruva WX which is uber low in phosphorus (this variety needed to have a statement added that it isn't a complete food, however all the other nutrients in the can meet aafco regs). Additionally the Weruva varities are also as low in iodine as they can be and still meet aafco requirements which can be useful since Hyperthyroidism can become an issue with kidney kitties.
 
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FeebysOwner

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Hi. Not sure that her creatinine level would explain the listlessness, but all cats are different. What is her phosphorus level?

A noted above, the lower protein concept is a bit outdated and is generally thought to be something one doesn't do until the late stage of CKD. Lower phosphorus foods would be better than the renal foods, but canned is the right way to go for the added moisture (over dry foods). Even 'regular' canned foods can be fed to a CKD cat, and if their phosphorus level is high, there are phosphorus binders that can be added to the food to help.

You really should start to read the information on Tanya's web site to help with information regarding care for a CKD cat - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). There is also a section on lower phosphorus foods that you might want to check out too - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Cat Food Data Tables Overview (felinecrf.org). There is a ton of data, but it is well worth taking the time to read the information provided.

Once you have read enough to become somewhat familiar with that web site, you can always join the CKD forum that is affiliated to it to ask more specific questions. I direct you to them as CKD is their 'thing' and they have lots of members dealing with CKD at all stages. [email protected] | Home.

IMO, there is really nothing out there to 'slow' progression per se - other than all the recommendations on what to do to make your cat feel better and help reduce strain on the kidneys. Things like canned food, plenty of water, toxin/phosphorus reducing supplements, anti-nausea meds if/when needed, appetite stimulants, sub-Q fluids when deemed necessary, and so on. My cat (18+ yo) who was diagnosed about 2 years ago, is on most of these items, excluding sub-Q fluids (so far), but she has other medical conditions as well that cause similar 'symptoms'.
 
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txcats

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Thanks so much for your posts, furballsmom and feebysowner. I was hoping there may have been some sort of advance I am not aware of, but it sounds about the same as a decade ago.

I am familiar with Tanya’s site, it was very helpful when I had no clue about crf. Previous crf kitty was crazy for fancy feast and I was happy to find out the pate was on the “okay for crf cats” list. I also used to sprinkle fortiflora on his food, which seemed to stimulate his appetite. I might try that with her.

I don’t know what the other test values were, should have asked for a copy of the results but I was pretty stunned it’s her kidneys at a fairly young age, so I wasn‘t thinking. The vet just said they are okay, but that the creatinine is elevated, which I know may not entirely be the case. I will call Monday and ask for a copy.

She ate a bit more, but is still very listless and just not herself so I am very worried. I hope the injections kick in to make her feel better. The vet said she has a bit of upper respiratory congestion, but her lungs sound good. Maybe that is making her tired.
 

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Tanya's web site does do updates, so you may want to take another look around. The other thing, which I am sure you are aware of, is that high protein foods can impact creatinine too. The more muscular a cat is tends to increase the creatinine level.

Fancy Feast pates - which is one of Feeby's 'staples' - tends to run on the high side for phosphorus. But, I feed my cat what she will eat.

If you are concerned about weight loss, you can supplement with baby food meats (Gerber Stage 2 or Beechnut). Other than the chicken version, due to calcium content, EZ Complete is a good way to make the baby food meat nutritionally complete for a cat. Based on Feeby's off and on poor eating habits (despite Mirataz and ondansetron - an anti-nausea med as a precaution), she never refuses her baby food meat meals (knock on wood).

I hope the respiratory congestion is playing a role in her inappetence and can be reversed if she gets treatment. Have you tried sitting with her in a hot, steamy bathroom a couple times a day for 5-10 minutes?
 
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txcats

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She is not doing better at all, I think she is worse than this morning. She did drink water and pee but that is about the only positive. She is hiding in the cat playhouse, she usually does not hang out in there. We are trying to decide if we should go to the emergency vet. I am so afraid we are going to lose her. Sometimes being a pet person really sucks.
 
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txcats

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Quick update, she is slowly improving, knock wood it continues. Syringe feeding, plus I made slippery elm syrup which I started her on 3 x per day, and applying the mirataz once a day. She also likes the hot water bottle and heated towels. I have the honest kitchen goats milk powder with probiotic so i am mixing a little of that into her syringe food.

She is still not eating on her own, but she is walking around, more responsive, and slept on the bed with us last night. Already bought a bunch of different meat baby foods (no onion no garlic) yesterday to tempt her, and I am going to pick up fortiflora and lots of different cans of food today, we already have several different kinds at home but she is not interested to eat on her own.

It has been a long, exhausting weekend with little sleep and many tears, but I am so grateful there is some improvement and she is still with us. I will try to update regarding her outcome, we have house guests arriving in a day (BAD timing, but can’t reschedule and it has been arranged that husband will tour around with them while I stay with her) and I didn’t do much prep this weekend so have to hustle today. If anything changes I will pop in and update, til then a big THANK YOU for all the advice and concern.
 
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txcats

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Another update, no improvement this morning so we took her in to have additional testing done. I am a little perturbed, the 2.5 creatinine we were told Saturday was actually 3.1?? That is a big difference.

They are re-running tests, so we’ll see if today’s numbers are different. The vet she saw today also said she has a heart murmur, and that her BUN and urine gravity were not checked. So we are having that done, as well as thyroid. She is staying there over night, they will call about the test results tomorrow. If they can stabilize her and get her to eat on her own, she is coming home. We are very much hoping for that.
 

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That is very odd - usually the blood work done to check creatinine includes the BUN element as well (Chemistry panel). The urine specific gravity it normally part of a urinalysis. But typically, the thyroid check is an additional add on.

She is staying overnight because?
 

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I might have missed it, how old is your kitty? Any flowers she could have got into? Anything change in the house she could have got into? Essential oils? Human topical treatments that she could have had contact with?

Please make sure someone will be watching her overnight at the vets. If not, take her home. She should not be left overnight on fluids without being closely monitored. She has a heart murmur so fluids must be given cautiously.
I am so sorry your kitty is ill.

Did they do a urinalysis prior? Did they screw up the results and tell you the wrong number on the creatinine? Any raise in creatinine is cause for concern. Even 0.1 over the normal is concerning.

Is there any chance you can take her to a specialist?

I feel so sorry for your kitty.
 
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txcats

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Another update, the vet called with test results and stated her prognosis is grave. Thyroid is normal, but BUN is 130, creatinine has gone up to 6.4, (what could cause that, from 3.1 to 6.4 in 3 days?) urine is dilute 1.016, and phosphorus is high. He said the fluids will help her feel a little better, but he believes there isn’t anything more we can do and she will deteriorate quickly again once she goes home. So we are going back early a.m. tomorrow to put her to sleep. NOT the outcome we were hoping for, but at least we know now.

Feeby, we took her for an overnight for fluids and in hopes they could stabilize her and get her to eat on her own which we haven’t been able to do. She is very resistant to being syringe fed and clenches her teeth and growls and gets very stressed, so for her to eat on her own is vital.

meowlock, she is between 8 and 10, she showed up in our backyard almost 6 years ago and the initial vet thought she was about 2, but this vet thinks she is likely around 10.

She is not an outdoor kitty, so it is unlikely she ate something. We don’t have toxic indoor plants or essential oils or treatments/meds she could have gotten into. The vet said they are giving fluids at a slow rate. don’t think they did a urinalysis Saturday, the only number we were given was creatinine 2.5, and apparently that was incorrect.
 

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So sorry this is happening, I agree with FeebysOwner regarding the blood tests, I also find it very odd that the BUN and specific gravity were not checked, are you seeing a feline only vet, if not, and if that is an option for you I would seek one out.
 
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txcats

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Thanks so much for the link, I probably read it a decade ago when our ckd boy was still alive, but had forgotten. Saturday the vet said she was not dehydrated, todays vet said she is slightly dehydrated, therefore we decided on the fluids pending test results. If it was an infection, wouldn’t her white blood cells be elevated and tip the vet off? He said he was doing a blood panel so I expect that would have been part of it, but who knows.

Re. the other symptoms, she is occasionally in the meatloaf position, but she also curls up or sleeps on her side. Her breath isn’t awful, no body odor, still drinking but not eating. She has never made much eye contact, so that’s hard to tell.

I showed the article to husband and he thinks maybe she is in the early stage of this, so maybe she will pull out of it with fluids and other vet treatment? Even if we only have her for another few weeks, but with decent quality of life until the end, that would be fantastic.
 
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txcats

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So sorry this is happening, I agree with FeebysOwner regarding the blood tests, I also find it very odd that the BUN and specific gravity were not checked, are you seeing a feline only vet, if not, and if that is an option for you I would seek one out.
No, we don’t have a feline only vet in our rural area. Saturday‘s vet was a very nice young vet, today’s was one of the owners of the vet clinic who has a lot of experience. I think we would have been better off if he’d been there Saturday. I know for a fact she said 2.5 creatine on Saturday because I wanted to remember it to look up. She said the other numbers were okay and I was so worried and out of sorts that I did not question, nor ask for a copy of results.
 

silent meowlook

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In my experience the only thing that causes that high a jump in a cat’s creatinine is toxicity or urinary blockage or trauma.
She is your cat and only you know what is best for her. There are treatments available, but it would probably involve a specialist. I have seen cats survive a creatinine of 14 before with phosphorus sky high. Usually it takes aggressive fluid therapy, but in your cat's case that has to be handled very carefully because of the heart murmur. The blood pressure needs to be checked and managed. I am thinking it is probably very high as well. Cats with azotemia often get an acid reflux sort of thing, so that has to be managed as well usually with famotidine. Cerenia is also good for the nausea that goes along with renal disease or failure. That is most likely why your cat isn't eating. There are blood gasses and electrolytes that should be checked, and the fluids adjusted to make up for any abnormalities. Electrolyte imbalance will cause all sorts of issues. The potassium will be abnormal but if it is low, you still have to be careful with supplementation because of the heart murmur. An ultrasound would need to be done to try to figure out what is going on with the kidneys. The heart should be checked to see what is up there as well. All of this needs to be done at a pace that will not over stress the cat and push her over the edge. You can do all of this and she can improve or not and then you have lost a ton of money, which is not the issue when it comes to her life, but she will have been stressed out for who knows how long. This is why I say, it has to be your decision and I think you will figure out the best for your cat.

Crazy question, but does anyone in your household use Rogaine or any product containing minoxil? Is she urinating? Is there anyone there with her tonight?

I want to say how sorry I am that you and your cat are going through this. I think everyone here can in some way relate to what you are going through. I am truly sorry. I had to euthanize the best boy kitty in the world, my Rusty, when he was 17 years old after 3 years of renal failure. I miss him still and always will. it was a horrible decision that I had to make and I waited way to long. So please know, everyone is here for you and will support what ever decision you make.
 
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txcats

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Thank you, meowlook. No rogaine/minoxil or anything of that nature. She is urinating, so no blockage. Injury is very unlikely, she is not a climber (arthritis) and she is an indoor kitty.

That is a very daunting list of treatments you described, I can see why it would take a specialist. The vet was pretty blunt and stated while he will do what we want him to, he does not feel good about the likely outcome and does not feel there is much that can be done for her because of the concurrent crf and heart murmur. It just really sucks and I feel helpless and angry because she does not deserve this.
 
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