Need help understanding cat's rapid CKD decline & vet saying euthanize if no improvement in 2 days

[cowkittymom]

Last August, my nine-year old cat Phoebe was diagnosed with Stage I/II kidney disease. Her creatinine was 1.7. On October 31st, before an endoscopy to diagnose potential IBD, her creatinine was 2.2. After the endoscopy she was started on 5 mg prednisolone/day for advanced IBD per the PARR test. Her appetite improved and she gained some weight, but starting in February, she started getting picky about her food again. I thought it was the IBD flaring up. I started hand-feeding her and giving Mirataz once a week, which seemed to help. She continued to be interested in any special treats that I offered, like the boiled chicken that I give my dog. A week or two ago, I noticed that she seemed to be drinking more (already increased from baseline due to the pred). And then this past weekend, the Mirataz seemed to stop working. Today she looked nauseous, so I took her in. They ran her bloodwork and said her creatinine was 9, she was anemic, low in potassium, etc.

She is in the hospital now. It's unlikely she ingested any toxin. Ultrasound did not show any abnormalities in the intestine and only normal kidney degeneration for her age. They are administering her antibiotics and testing for an infection.

I don't understand how her kidneys declined so quickly. I thought the loss of appetite was due to the IBD. She has never vomited or had diarrhea from the IBD.

They told me that if she doesn't improve in within 2 days, that I should euthanize her! She is my first cat, so I don't have experience with CKD. Could this just bc an acute kidney crisis that she can recover from enough to have an OK quality of life?

Thank you so much for helping me understand what is going on with my sweet girl.

 

[silent meowlook]

Hi. I am sorry your cat is so sick. I have a couple of questions.

When she was first diagnosed with kidney disease, did they have you give any subcutaneous fluids at home?

Did they have you start any treatments for the kidneys at all?

What do you feed her?

Any plants or human medication, even topical, that she could potentially get into?

Is she indoor only? Does she go into a garage ever?

Has your veterinarian offered you a referral to a specialty hospital?

 

[cowkittymom]

Thanks so much for your reply.

They said her kidney disease was early stage and no treatment was necessary yet.
I had to change her kibble last fall because her appetite became finicky. She now eats Hills Adult Chicken Age 7 plus kibble. Also eats some of her brothers urinary rx wet food.

I don’t think she’s gotten into any medication. She’s never shown any interest in eating non-food items and doesn’t get into cabinets or drawers.

She is indoor only but I do give her supervised time in the backyard. No lilies out there. Just weedy grass. No access to a garage.

I went to urgent care at the hospital where her internal medicine specialist for her IBD works. She will be admitted to the IM service tomorrow morning and they will call with an update.

 

[silent meowlook]

Hi. I am glad she is seeing a specialist in the morning, and also that she is in a hospital that will monitor her overnight.

There is something called acute on chronic kidney disease in cats, where a cat with chronic kidney disease will develop acute disease as well. Sometimes a cause can be found, but also it can be a sudden deterioration for unknown reasons.

When you look at her numbers, the creatinine was increasing. Following that rate of increase, it would be expected that it would continue to go up if nothing was happening to prevent it. Even if things were done, it could still go up.

Sometimes the kidneys can be damaged during an anesthetic procedure, if the blood pressure becomes too low, the kidneys do not get the proper blood flow. This can result in damage. But, it sounds like the procedure was done by the specialist, so I am sure they would have monitored blood pressure during anesthesia and they also would have had her on fluids.

Please keep us posted on what the vet finds out tomorrow.

 

[stephanietx]

I would suggest a second opinion, preferably with a cat-only vet. CKD kitties need wet food and lots of water. Dry food sucks the water from their bodies to dissolve and pass the food through the GI tract. If there's not an abundance of fluid in the body, the stool becomes very hard and dry and difficult to pass. Constipation is also an issue with CKD kitties. If the kitty is constipated, it will cause them to be nauseous, which in turn, causes them to not want to eat. This is why so many CKD kitties are on subcutaneous fluids.

 

[FeebysOwner]

Treatment for acute kidney issues, AKI (acute kidney injury, or when there is a dramatic change in the kidney values, IV fluids are generally recommended, which requires a hospital stay.

A creatinine value of 2.2 doesn't usually require much in the way of treatment, so I can understand why it wasn't necessarily advised to do so by your vet. However, something has changed for Phoebe's creatinine to jump to 9 - and that needs addressed through the IV fluids, and likely more meds used to treat related impacts. It is not uncommon for a cat with AKI to have a creatinine over 10, and if treated properly, a cat can recover, even if there is some residual damage done. So, Phoebe's kidney levels may not go back down to what they were before, and you may need to give her sub-Q fluids at home once she is released from the hospital.

Acute kidney issues can also be caused by an untreated kidney infection (not bladder, but the kidneys), which will require a long term dose of antibiotics too. Kidney stones have been known to be the culprit as well. An ultrasound might help to identify the cause, if it along these lines.

It is doable to bring her numbers back down, but I would seriously question the two-day window, as if this is acute, it can take longer than that to bring it under control.

I don't what is 'out there' data-wise about Prenisolone's impacts on kidneys, but every cat is different, so it is possible Pred has played a role. I would ask about this and see if Phoebe could be placed on Budesonide instead. It works on the intestinal tract much like Pred but has far less impact on the rest of the body comparatively speaking.

 

[cowkittymom]

Hello all, thank you so much for your replies!
I'm still waiting for an update from the internal medicine specialist and will visit Phoebe later this morning.

I also thought the 2-day timeline and recommendation was too strong given that Phoebe hadn't even started supportive treatment. I have insurance, so am prepared to wait longer to see if her values go down.

FeebysOwner , thanks so much for the tip re: possible effects of PRED on the kidney. To my knowledge, the only things that have changed since October are the PRED and her undergoing an endoscopy.

In case it's necessary, I'm also looking into a second opinion from a specialist at another hospital.

 

[cowkittymom]

I had a nice long visit today with Phoebe. She is looking much better and eating well.

The specialist said we will just need to see how well Phoebe's kidneys will recover. Her goal is to get the creatinine down to less than 5 before discharging her. She said this could take 3-5 days. As of this morning, there was already some improvement in her creatinine levels. She is taking the additional fluids well.

 

[FeebysOwner]

So glad to hear this! Well wishes to Phoebe and you. Keep updating us!

 

[Joxer]

Last August, my nine-year old cat Phoebe was diagnosed with Stage I/II kidney disease. Her creatinine was 1.7. On October 31st, before an endoscopy to diagnose potential IBD, her creatinine was 2.2. After the endoscopy she was started on 5 mg prednisolone/day for advanced IBD per the PARR test. Her appetite improved and she gained some weight, but starting in February, she started getting picky about her food again. I thought it was the IBD flaring up. I started hand-feeding her and giving Mirataz once a week, which seemed to help. She continued to be interested in any special treats that I offered, like the boiled chicken that I give my dog. A week or two ago, I noticed that she seemed to be drinking more (already increased from baseline due to the pred). And then this past weekend, the Mirataz seemed to stop working. Today she looked nauseous, so I took her in. They ran her bloodwork and said her creatinine was 9, she was anemic, low in potassium, etc.

She is in the hospital now. It's unlikely she ingested any toxin. Ultrasound did not show any abnormalities in the intestine and only normal kidney degeneration for her age. They are administering her antibiotics and testing for an infection.

I don't understand how her kidneys declined so quickly. I thought the loss of appetite was due to the IBD. She has never vomited or had diarrhea from the IBD.

They told me that if she doesn't improve in within 2 days, that I should euthanize her! She is my first cat, so I don't have experience with CKD. Could this just bc an acute kidney crisis that she can recover from enough to have an OK quality of life?

Thank you so much for helping me understand what is going on with my sweet girl.

You didn't mention if you still have Phoebe on the 5 mg per day of Prednisolone, but in my experience (and confirmed by my vet) that can cause anemia. Once the current crisis is past, you might try bringing down the Prednisolone dose (in consultation with your vet, of course).

 

[cowkittymom]

Thank you, J Joxer , for the suggestion. They have taken her off of the Prednisolone for now. The specialist also mentioned the possibility that it is what triggered the current crisis. I presume that the IBD treatment regimen will be adjusted.

Since Phoebe's only symptom this entire time has been appetite loss, I'm starting to wonder if we found advanced IBD because we went looking for it, and the appetite loss was entirely, or at least partly, due to her worsening CKD.

The urgent care vet noted that Phoebe had three visible resorptive lesions above the gum-line, which is a new development. Phoebe's general practice vet doesn't have a great bedside manner, but she is very sharp, so I think she would have noticed if they were there during her annual exam in August. I wonder if they were also contributing to the appetite loss. I asked the specialist whether these could somehow be related to the kidney crisis, and she didn't think so.

 

[cowkittymom]

I would suggest a second opinion, preferably with a cat-only vet. CKD kitties need wet food and lots of water. Dry food sucks the water from their bodies to dissolve and pass the food through the GI tract. If there's not an abundance of fluid in the body, the stool becomes very hard and dry and difficult to pass. Constipation is also an issue with CKD kitties. If the kitty is constipated, it will cause them to be nauseous, which in turn, causes them to not want to eat. This is why so many CKD kitties are on subcutaneous fluids.

Hi stephanietx , I did try to switch Phoebe & her littermate brother to wet food only several years ago. I did it very gradually, but she went on a hunger strike and started losing weight, so I gave up. She does seem to enjoy wet food more these days, maybe due to the resorptive lesions that have developed. I'm hopeful that she'll like eating the renal wet food.

 

[cowkittymom]

I'm pleased to report that after IV fluids since Thursday night, Phoebe's creatinine has gone down from 9 to 6.6 as of this morning. Hopefully there will be further improvement over the next two days, and it will stick after she's taken off the IV.

 

[cowkittymom]

Phoebe is now home! After 3 nights of hospitalization, Phoebe's creatinine is now 5.7. Not great, but given Phoebe's nervous nature (the nurses said she seemed terrified the entire time she was there), the negatives of continued hospitalization seemed to outweigh the potential benefits. She will get daily sub-Q fluids and have a recheck in a week.

 

[FeebysOwner]

Thank you for the good update! Continue to keep us posted. Rooting for Phoebe and you!!!

 

[stephanietx]

Hooray!! So glad she's home!

As for the food, we feed both wet and dry. Their main meals are wet, but we do supplement with dry. The key is that she's eating.

 

[cowkittymom]

Thank you all for your support! She is of course exhausted & mostly sleeping, but eating in between her naps. Despite all of that time on the IV fluids, her thirst drive is still quite high. Both times that I visited her, she meowed at me for the water in my bottle, and I've seen her drink multiple times since she's been home.

 

[cowkittymom]

The vet gave Phoebe iron & B12, and put her on a ESA, darbepoietin, for anemia. Does anyone have anyone have experience with this treatment and how long it takes to work? It breaks my heart to see her so weak.

 

[silent meowlook]

Hi. It can take a few weeks. It is important that you limit activity until she feels better. She needs to use her strength she has to build blood cells. So, were she mine, I would make sure everything she needs is within reach for her. Keep in mind her immune system is poor right now. Wash your hands before handling her. Be sure to warm her fluids before giving them to her.

 

[cowkittymom]

Do you think I should restrict her to one room? I’ve already closed off the downstairs since she seemed wobbly on the stairs. The upper level is only 900 square feet. There is water in every room and 2 litter boxes, which she has been using. I have been hand-feeding and she is eager to eat.

The vet mentioned transfusion as a later option. I’m going to call and ask how to know when she needs one to tide her over.

I’m having her cat sitter, who is a very experienced veterinary nurse, administer her fluids daily.