next steps for potential kidney issues?

[Katdog]

Hi there

I need some help navigating what would be the best next steps for our current situation. I adopted a stray cat about six months ago, who is now 2.5-3 years old. she is indoor only, and eats only wet food. I arranged a dental cleaning appt for her, which vet required bloodwork to make sure her kidney and liver values were healthy as the dental procedure requires anesthesia.

when she got her bloodwork done, her levels for her glucose was 69 (reference value suggested: 72-175), and her creatinine is 2.5 (reference values suggested: .9-2.3). the vet was a bit surprised to see these values for a 2-3 year old cat, so he was a bit perplexed. so we ran a urinalysis. the urinalysis results were a bit harder to understand (for me, per the lab work sheet), but ultimately in conversation with him about it (a week ago), he told me her urine was very diluted which is abnormal given that the urine sample was from a 9AM pee, so it wasn't like she spent the night chugging water (she did not, she spent the evening sleeping with us in bed). the vet stated that none of this was 100% sure tell sign that something is wrong w/ her kidney or another internal organ so he wanted to run both the blood work and urinalysis again before providing a recommended next steps since its so "odd a cat this young would have these issues", so he wanted to be certain before proceeding with further invasive testing (mri, scans, etc) or requiring a lifestyle/dietary change.

the first run for both test cost me $160, and this second set will cost me $170. I haven't committed to the 2nd set of bloodwork & urinalysis. Korra is currently not showing any outward sign of a pain so its made me not act with urgency. she's eating, sleeping, playing per normal, and pooping per her normal constipated schedule (which I'm still wondering if she's constipated or just has a weird bowel schedule; nonetheless entirely separate issue).

my question is- what should I do? run the same tests again for an additional $170- that maybe ultimately give us the same results we already saw on the first test (marginally abnormal numbers) thus feeling like a waste; or go ahead and run a more invasive test that could be more telling but would cost more (maybe double?) so then I'm only $160+$300 down and not $160+$170+$300. per conversation with vet, it sounded like he could recommend more invasive/costly test after these 2nd set if the results were similar (which they most likely will be); so maybe skip this redundancy and go straight to the next level? I'm also wondering that maybe I should put off the second round of tests until June (that would be 4 weeks after the first set of test) to give her body recovery time if the first test was really a fluke. maybe thats a bad idea bc maybe kidney disease (or whatever this other organ issue is) is something that strikes quickly, and dragging it out wouldn't be wise? no one has actually said that, but my brain is analyzing diff scenarios, and it did point out this one; def do not want her to suddenly drop dead (as I've read this has happened before to other people).

I'm not familiar with kidney disease (if this is what it is, or some other organ issue causing additional strain on the kidneys), so not 100% sure what I should do so that its most productive. I'm really busy this week, so I won't have time to read up on kidney disease until this weekend.

thanks for your help.

 

[MissClouseau]

I have recently went through kidney scare at the routine check-up with my cat. From what I learned any single elevation especially when it’s less than 1mg elevated is not enough to diagnose with kidney disease. Some clinics use 1,6mg as the highest point of the normal range. If we go with that, anything less than 2,6mg should be re-tested in a few days to couple weeks because the elevation might be about something else. (Even dehydration might cause such level of elevation.)

And in fact my own cat’s creatinine was 2,0mg on April 5 but 1,4mg on April 27.

SDMA is also recommended although some vets don’t find it reliable. Urine test is the gold standard. If not SDMA, I would re-check creatinine and do another urine test.

 

[fionasmom]

Jamie is having a similar problem with a high BUN reading which has continued on for the last two years. Once we had run a couple of blood tests which showed that it was not a fluke and that it was not coming down sufficiently, we did an ultrasound of his kidneys. Not trying to spend your money. However, I will give you this, we braced for the worst and it showed nothing abnormal. He is still not out of the woods, but the rest of the story will not help you here. I just wondered what invasive tests the vet was thinking of running?

 

[mrsgreenjeens]

I've had three kidney cats and currently have one who keeps going in and out of "possible kidney disease". What I mean by that is sometimes his SDMA (the supposed "pre" test for kidney disease) is too high, sometimes his creatinine is higher than it should be, and sometimes his Urine Specific Gravity is too low. But the last time two of these things occurred at the same time he actually ended up having a UTI which caused the problems. Once we got that squared away, his numbers went back where they belongs. BUT having had three cats with confirmed kidney disease and all that details, I worry constantly that it'll happen again, so never hesitate to get the full tests done if I think it might uncover something. If I were you, I wouldn't bother with the $170 test but would go straight to the next one, but I don't know your financial situation. And if kidney disease is the only suspect at this time, you could certainly wait until June because that is normally a slow progressor. Cats can live many years with it. And our Vet told us the kidney disease itself isn't painful, They don't necessarily feel well as it progresses, but from what you describe, she's not there. Most people have no idea their cats have kidney disease until they start to notice they have lost weight and are drinking water all the time.

When you get some time, here is a great website to acquaint yourself with kidney disease and cats. Let's hope you never really need it.

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat

 

[Katdog]

MissClouseau mrsgreenjeens fionasmom

thanks for all your responses! It was very helpful! I had time to read tanyas website; very informative. Will def reference it in the future. Korra went in for her second blood lab 10 days ago and her creatinine levels came back at 1.6 so they relieved her of any further testing needed. I’ll prolly do it again another 6 months and just track it to make sure we are on the safe side. Meanwhile, I’ll prolly start looking into food types that she can switch to with lower contents of the protein and phosphorous (I may be wrong on those elements, have forgotten since my initial read through); as a way to be proactive. She has food allergies and is constipated so I’m still figuring out that food adjustment to lessen constipation so all this will take a minute. Le sigh, work in progress but least we’re not in the woods! Appreciate your help, much so!

 

[Stephanie36]

I'm glad she's doing well!!
Tex's kidney values hav been borderline for years and he was put on a prescription food Hills K/D Kidney Care. It comes in wet and dry, and the wet comes in a stew or pate form. He loves it! Although he will only eat th stew, while my friend's cat would only eat the pate.

 

[Katdog]

TLDR- is it common for cats at 4 years old to have stage 3/4 ckd? What about 6 years? I adopted her 2 years ago and they told me she was 2, but maybe they got it wrong and she was really 4. If not, any guesses on what it could be instead? She does not show symptoms of urinary infection. Does not use litter box frequently or cries when she uses it. Consuming water normal amount. No frequent licking of her bottom side. Not lethargic. Still playful, eating fine. Other than uti, I’m not sure what else could have this ckd result…

Long version-
Resurrecting this one folks. I took Korra in for blood work as it had been a year since her last blood work ever since this potential ckd exposure. Results came back super bad- cretinine is 4.2 (May 2021 was 1.5 and April 2021 was 2.5), sdma is now 35 (prev 13, 13), bun is 82 (prev 22, 30), bun ratio is 19.5 ( prev 14.7, 12). Is it common to see this much if a jump only in one year?

last year I read over Tanya stuff but when the vet came back and said just follow it no change or major concerns, I kinda spaced the research of ckd and didn’t think much anymore about it. Now it has all these red flags- I’m super worried. Read up on Tanya yesterday and last year Korras result was between stage 1-2 and now it’s well into stage 3 according to IRIS.

when the vet called on Tuesday and discussed all this, she wanted a urine analysis as the next steps. We got a sample Thursday night and submitted it to the vet Friday( yesterday). I suspect they will call me Tuesday/Wednesday.

I started researching last night about ckd again. I read only 10% of cats at age 3 will have ckd, and the vet during last years test said it’s odd for a cat if her age to have ckd. So I’m really wondering- are we really in the unfortunate 10%? what other issue could it be?

She went on over the counter renal dry food diet yesterday (forza10)- doesnt seem like she likes the dry kibble much. Since I just started, I’m transitioning her so hopefully she move over well with it. Gave her, her reg kibble for meal #4 last night (she gets four meals a day- two meals, and 2 “snacks”). I read it can be bad to feed cat with no ckd, a ckd diet but for now I feel like this is the best thing I can do for now until we get more confirmation of ckd or not. On a separate note- she has a chicken allergy so I’m pretty sure all our ckd food options are gonna be a major struggle.

I also changed her litter wondering maybe it’s contributing from a chemical stand point. She wasn’t using typically cat litter. I used purina start and grow starter chick medicated feed crumble (couldn’t often find the non-medicated kind) , as her litter bc I read once it was a greater safer and more economical alternative to clay. I got worried the medicated part was causing impacts? Since it’s for chicken after-all and not cats. But I could be over analyzing.

any answer to my question or general insight would be appreciated, thanks.

 

[Katdog]

The vet called! Her urine specific gravity was fine, she was/just very dehydrated for the blood panel! They said to come back in 4 weeks and don’t change anything about her diet and routine to ensure it isn’t her food. Weird thing is, she’s been drinking water per usual so idk how she’s dehydrated!! But they did fine some stones… bleh.

 

[WMM201]

The vet called! Her urine specific gravity was fine, she was/just very dehydrated for the blood panel! They said to come back in 4 weeks and don’t change anything about her diet and routine to ensure it isn’t her food. Weird thing is, she’s been drinking water per usual so idk how she’s dehydrated!! But they did fine some stones… bleh.

Hi K Katdog great that her tests came back fine. Since Korra was severely dehydrated despite drinking water and has a history of constipation, did your vet say anything about subcutaneous fluids for her? It may be too early in her CKD to give a lot regularly, but maybe small amount like 50 ml a couple times a week might help her. At least it would be important to make sure she is well hydrated before her next bloodwork so the values aren't affected and you don't worry and spend more money on follow up tests.

 

[mrsgreenjeens]

when you first got her, wasn't she eating only wet food? When did you transition her to dry food? I ask this because cats who eat kibble need to drink a LOT of water to offset it. By a LOT I mean at least 8 oz per day, which most cats don't do. If possible, since she was very dehydrated, I would try to switch her back to wet food, or at least add some wet food back into her diet, and even add some water into that wet food. I've had three kidney cats, so with my latest cats, I only feed wet and do add water into every single meal trying to avoid having any more.

Didn't you also say she has constipation issues. The extra hydration can help with that too.

As to the medicated chicken feed as litter, that could be adding to the issue as so many chemicals that are used in and around the world can be harmful. If you can, try to use the plain.

 

[Katdog]

when you first got her, wasn't she eating only wet food? When did you transition her to dry food? I ask this because cats who eat kibble need to drink a LOT of water to offset it. By a LOT I mean at least 8 oz per day, which most cats don't do. If possible, since she was very dehydrated, I would try to switch her back to wet food, or at least add some wet food back into her diet, and even add some water into that wet food. I've had three kidney cats, so with my latest cats, I only feed wet and do add water into every single meal trying to avoid having any more.

Didn't you also say she has constipation issues. The extra hydration can help with that too.

As to the medicated chicken feed as litter, that could be adding to the issue as so many chemicals that are used in and around the world can be harmful. If you can, try to use the plain.

no she has always eaten a mix of wet and dry- even when I first got her. Some days she eats more wet than dry, other days more dry than wet. Nothing changes between these days, maybe the weather maybe play time- truly hard to tell.However of recent, she’s been eating more dry than wet. Frustrating. Yesterday I got her a new cat fountain, a few months ago I got rid of her old one bc she never used it. She has been drinking out of water cups, one in particular next to my bed stand but apparently not enough. We saw her use the new fountain briefly yesterday so maybe there’s hope; but it’s really too soon to tell.

this whole cat (in general as a specie) not drinking water and causing health issues out of it feels way out of my control and idk what else to do if behaviorally they just don’t drink water.

 

[mrsgreenjeens]

Maybe there is something here that will help: Tips To Increase Your Cat’s Water Intake – TheCatSite Articles