Possible Pyelonephritis, we can't find a solution

[luca79]

Hei there,
I read articles in this great and very useful forum in the past. I have decided to post here out of desperation.
About one month ago our 5 y.o. cat Aprikos started vomiting almost every second day for 10 days or so. We went to vet and she took blood test that resulted to be perfect. We got some medicines for sensitive and stomach and changed to a lighter "digestive" food (although we have always fed her with pretty decent food), she was then good for 10 days. After that the vomiting started again. We went back to the vet, he took an X-ray that didn't show anything and we got some more medicines for the stomach. They couldn't really find a reason for the vomiting, maybe hairballs, maybe allergies, sensitive stomach?

After 4 days since the last visit she vomited a lot and stopped eating completely. She's the kind of cat who would eat everything...this happened on a Friday and when we took her to the vet on Monday she was dehydrated, had fever and lost weight, although we gave her water with a syringe together with a "reconvalescence" paste during the weekend.
The surgeon on Monday decided to open her as they were sure she had something serious. The organs all look good apart from one kidney that was particularly swollen. She got drip, Amoxicillin and painkillers.
On Tuesday the vet then suggested that she may have Pyelonephritis after finding also bacterias in the urines, she got drip, Amoxicillin and painkillers.
On Wednesday she got feeding tube through the nose because she refused to eat although she received anti nausea injections. Also the vet switched Amoxicillin to Baytril to tackle the (possible?) Pyelonephritis. The feeding through the tube on Thursday went quite well, she was quite and relaxed at home, getting food and water every 2 hours. Bought FelineWay and set up her favourite room like a 5 star hotel
We should have kept the feeding tube until Friday but on Thursday evening on the way back from the vet Aprikos managed to remove the tube during transportation, due to logistical problems they couldn't put it back. On Friday she didn't eat anything although i prepared lot of different food, she smelled and then ignored it.
On Friday evening the vet decided to try to let Aprikos decide about food, as we had been forcing to eat her the entire week. She also got injections against nausea, another one to stimulate hunger and finally added another product: Mirataz (Mirtazapine via gel smeared in the ear). On top of course of another shot of painkiller and the Baytril. On Friday evening she showed some interest for food and ate something, she was also in a good mood.
On Saturday morning she vomited again and now behaves as usual, she refuses to eat and look miserable. Now we are starting again with syringes of water and "reconvalescence" paste as we are getting desperate.

To sum up, after one week we are in the same place. Aprikos is still sick and suffering fort an unknown cause. The situation is taking a toll on us, we do it for her of course, but it's getting though. Money we are ensured but we are reaching the limit. Changing the vet? i don't know, they are nice, not sure i feel like starting all over again with another vet. We are a bit lost really.

Thanks for reading

 

[LTS3]

Here's some info on pyelonephritis:

Pyelonephritis in Dogs and Cats

Pyelonephritis is an inflammation of the kidney that frequently shows no symptoms and thus it is not usually recognized until the signs become severe. It may not be diagnosed until histopathology is done on the kidney after the pet's death.

veterinarypartner.vin.com

You can ask the vet to consult with a veterinary school for help on your cat's case.

When does the vomiting happen? Shortly after eating? Hours later? Is it food or just liquid? Has the vet ever considered gastrointestinal issues such as IBD as a possible cause of the vomiting?

 

[luca79]

Hei LTS3, first of all, thanks for your answer. I read the article that you posted, the condition is serious, maybe we should just be patient and wait for the antibiotics to start working... What troubles us is the lack of appetite, is it possible that a cat refuse to eat for such a long time? i read a similar post in this forum, of a person who struggled for weeks in order to get her cat to eat something.

The vomit happens often with empty stomach overnight, we used to find vomit in the morning. We used to feed her at 20, gave some snack at 23ish and then "breakfast" at 6 when we get up. After talking to the vet we started feeding her more often with smaller portions but that didn't change the scenario much. The vomit is 70% of the time liquid, i have photos but i am not sure it's a nice view

Gastrointestinal issues such as IBD? we discussed it at the beginning but then she shifted focus on the kidney after seeing the kidney enlargement.

Thanks again

 

[luca79]

Blood test today is good! no FIV, FHV, nothing, the values of the kidneys infection are going down. However, the cat still refuses to eat and lost already 1 kilo. Yesterday she vomited twice Today i bought some probiotics for unsettled stomach and she seems more interested in food. She's also getting anti nausea and antibiotics injections. I hope she'll get better, fingers crossed.

 

[Antonio65]

Hi luca79 , if your vet thinks Aprikos has a pyelonephritis, then it is a very long road to go, and this issue could need to be treated with stronger meds than Baytril.
Did the meds run a urine culture to see if and what bacteria are involved in the problem?

I have had a very close to me experience with pyelonephritis, in a person, and it took months to get out of that, using strong antibiotics that we couldn't find in any pharmacy, but only through the hospital, and had to be handled by trained staff. Anyway some lingering symptoms still remain after 12 years.

If the kidney levels in Aprikos are going down, then it is possible, however, that the antibiotic is working fine.
As for the food, because it seems it will be a long term treatment, you could ask your vets if they think an E-tube is better than a nasal tube. This will allow you to feed her more food and more easily. You could also be able to pass some crushed pills through it.

 

[luca79]

Ciao Antonio65 , thanks for the answer.

Yes it seems like a challenging sickness...the urine culture is what have shown to the vet the presence of the bacteria.
As for today she is definitively in a better mood, however, she still refuses to eat. She has no feeding tube at the moment. We are feeding her with "Aptus recovery booster" by putting some paste on the finger and smear it in the mouth. She has started drinking a bit. She's getting Baytril, Prevomax (to prevent vomit and nausea) and Mirtazapine gel via ears.

We'll see how it goes during the week, what puzzles me is her lack of interest for food. She's the kind of cat who would eat (and steal) every kind of food, she would even steal bits of crostata or sbrisolona from the table, after gently removing the cake cover

 

[Antonio65]

luca79 ,
sounds like you're a fellow citizen of mine, particularly from the north , though probably you are not living there anymore.

My younger cat is just like your Aprikos, she would steal and eat (and she actually does) just every kind of food, that's why a lack of interest in food is quickly picked up in cases like yours.
Hopefully the mirtazapine will eventually kick in and give your cat a "forced" interest in food. Though I think that feeding her the right amount of food, and calories, is a way to keep her going and avoid further issues.
If I were you, I would consider having an E-tube inserted. However, ask your vet, and if you're not satisfied with them, seek a second opinion. Is there a vet University in your area?

 

[luca79]

Ciao Antonio. We are desperately waiting for the Mirtazapine to kick in, it's really tiring and painful to force her to eat. I hope water and Aptus recovery booster is ok to keep her going. E-Tube i don't know, it feels like aggressive treatment, the vet didn't even mention it. You can imagine but there is also a budget problem. Here in Norway vets are crazy expensive and we have already used up all the 2021 insurance coverage in 2 months, as this is a problem that is going on since February at least. Seek a second opinion is an option though if the issue doesn't get solved.
Aprikos seems ok today too, the refusal to eat still is a problem

 

[Antonio65]

Ciao Antonio. We are desperately waiting for the Mirtazapine to kick in, it's really tiring and painful to force her to eat.

Mirtazapine or the similar Cyproheptadine should kick in quite quickly, matter of hours, not days.
When I had to use it with my cat for her IBD and liver issues, the med would kick in in about an hour. I would give her the pill, say, at 7 am, to have her eat around 8 am, even earlier.

E-Tube i don't know, it feels like aggressive treatment, the vet didn't even mention it. You can imagine but there is also a budget problem. Here in Norway vets are crazy expensive and we have already used up all the 2021 insurance coverage in 2 months, as this is a problem that is going on since February at least.

The E-tube sounds invasive and aggressive, but the cat won't even realize she has it on her. It can be kept on for several days/weeks until it is no longer necessary and the cat recovered fully. Of course it might expensive over there, I don't know the vet fees over there. Here in Italy I paid around 200-250 euro to have it applied to my cats (yes, both cats had to undergo such a thing!).

Seek a second opinion is an option though if the issue doesn't get solved. Aprikos seems ok today too, the refusal to eat still is a problem

Refusing the food is a big problem indeed, because not eating could lead to what is called the Hepatic Lipidosis, which is a potentially life-threatening condition in cats.

 

[luca79]

Apri has eaten something today, we are meeting the vet on Friday. I may ask to switch between Mirataz® (mirtazapine transdermal ointment) – Mirataz to proper Mirtazapine if it is more effective, i'll also ask about Cyproheptadine. Do you have more positive experience with the latter?

 

[Antonio65]

I only used the Cyproheptadine in pill form. The dosage was 1/4 to 1/2 pill before each main meal, that was morning and dinner, with wet food. During the day the cat had dry food available, but she would hardly touch it.
What I remember is that most of times she would eat her main meals with a good appetite, and when I would notice she wasn't interested enough, I would add another quarter of a pill. The pill worked fine for the three to four months my cat needed it.
She was suffering from an IBD and a nasty liver disease, which, at the end, took her away from me.

I have no experience with the Mirtazapine, apart from one single administration to a very sick cat 8 years ago. It worked fine and quickly after that single time. Unfortunately I hadn't the chance to use it again. The prescription was a quarter of a pill every three days... The cat went to the Rainbow Bridge two days later...

For my last cat, as I mentioned at the beginning of my post, I used the Cyproheptadine only because it was an OTC drug and I didn't even ask the vet before using it, I followed the advice of other members of this wonderful forum.

Is the Mirataz being given to Aprikos according to a suggested dosage?

 

[luca79]

Thanks for all the useful info! i see that you had a lot of experience with cats. We are using Mirtazapine in transdermal ointment form., once per day as prescribed. We'll talk with the vet tomorrow, hopefully we'll have some goog news

 

[Antonio65]

I hope to read from you soon and with wonderful news!

 

[luca79]

I hope to read from you soon and with wonderful news!

Apri hasn't lost weight, she has also started eating something. We continue this week with the medications, but at some point we'll have to stop and see if she manages without them. We were positive as she seems a bit better lately, however, the vet said few times that she cannot promise anything since it's a tough illness...we left the clinic quite sad. We'll see how it goes this week.

 

[Antonio65]

I think you'll have to run some follow up blood tests to see if there's any improvement in the infection course.
Your case it's one of those compromises, balances, between treating her properly and having her eating enough to be strong and not fall into a liver disease.
Fingers crossed here. Please, keep us posted.

 

[luca79]

Apri is better! she has increased her food intake steadily, today she looks good, she even started cleaning herself yesterday. We are meeting the vet on Friday, she has already mentioned the possibility to continue with Baytril, as it takes a long time to heal from a kidney infection.
We have to keep her monitored, but we see improvements

I received the journal from the vet and i can see already an improvement in the blood test she took one week ago:
Values on the 12th of April:
Hematology clearly shows leukocytosis: WBC 41,16 (2,87-17,02)
Nøy 34,68 (2,3-10,29)
Mon 1,42 (0,05-0,67)
Eos 0,13 (0,17-1,57) Baso 0,66 (0,01-0,26)
Serology:
Kreat 279 (71-212)
Urea 15,3 (5,7-12,9)
low ALT and ALP

Values on the 23th of April:
Hematology shows an improvement of the leukocytosis:: Wbc 23,07 (2,87-17,02) last 41,16
Nøytr 20,03 (2,3-10,29) last 34,68
Monoc 0,89 (0,05-0,67) last 1,42
Serologi shows and improvement of the kidney values: Kreat 218 (71-212) last 279
Urea 11,2 (5,7-12,9)
Tot prot 56 (57-89) alb 25, glob 30

 

[Antonio65]

It seems Aprikos is on the mend now, that's fantastic!
Yes, her levels are going down quite quickly, the therapy is working, so I think it's wise to keep following your vet's advice.
All the best to you and Aprikos!

 

[luca79]

Update: Aprikos is better, her life is somehow back to normal. All the tests are good and her mood also. The only problem is that she still vomit grass and fur almost every night it's a lot of cleaning in the morning. We never had this problem before she got sick. We brush her regularly and feed her well...