Sister, 16, Urinalysis Shows Elevated Protein

[cocoanlace]

Sister is a diabetic, fully regulated (off insulin since 2021) using low carb food (Dr. Elsey's CleanProtein) which contains 59% animal protein.
So her wellness exams last week (BW, urine, xrays) indicated protein in the urine. Vet suggested special urine tests which we just did. Result: Protein a little high. Now we must do 2 more special urine tests within 2 weeks to confirm the "diagnosis" whatever that is. I do understand we are ruling out any other issues. And vet said there is a treatment for "high protein" in urine. Medication or nutritional changes. I won't budge on switching the food. It took us a year to find a food that regulated her diabetes and did not give her diarrhea. (Forget wet food. She doesn't even get excited about fresh chicken, turkey or tuna like my others. She just licks it.).
Here is my question: Can Sister's protein in the urine be caused by the low carb, high protein Dr. Elsey's? Because if it is, we'd possibly be medicating and then causing the issue by continuing the Dr. Elsey's. Awaiting your ideas. Thanks. (I would attach the test results, but the vet office emailed me results for an Australian Shepherd named Sister Ragsdale from 2018!!)

 

[FeebysOwner]

Hi. If all other BW numbers were good, it could be the high protein diet. Other most common things are inflammation or bleeding somewhere in the urinary tract - and may even involve the vagina. Were there WBCs in the urine as well? How was the urine collected? If done by cystocentesis, reproductive tract impacts are less likely.

The other most common cause is kidney disease, but if Sister's kidney numbers are good, then probably not the case. That would be identified in a Chemistry panel, rather than a CBC.

I don't know what these other tests are that your vet is running, but I would find out what they are supposed to identify/rule out, and then go from there. Also, find out more about this treatment of high urine protein. It may be that it is worth it to keep her on the diet she has that is controlling her diabetes, and giving her the treatment too.

If you get the BW results, you are welcome to share them here. If you get any more information that would clarify some of the things I mentioned above, please share those too!

Just curious if they checked her BP. There can be a correlation between protein in a cat's urine and high blood pressure. You might ask the vet about that too.

 

[cocoanlace]

Thanks so much for your input. I have attached the most recent lab results. (I checked all the vet notes. Did not see evidence of BP being checked.)

 

[FeebysOwner]

Thanks for sharing those. BP is an entirely separate test - not totally unlike how a human's BP is checked, only with a cat the tail or leg are used with a very tiny cuff. Let us know when you find out about the other tests.

 

[silent meowlook]

Hi. Sorry I couldn’t open the download. How high was the protein and was there blood? I would imagine the test is a urine protein creatinine ratio.
If the diet has been working, I wouldn’t want to change it either. What was the specific gravity? Depending on all this, your vet could be thinking early kidney disease. If that’s the case I would work with your vet on possible subcutaneous fluids at home to keep the kidneys flushed and hydration good. There has to be around 70% loss of kidney function before it shows on blood work.

 

[FeebysOwner]

Hi. Sorry I couldn’t open the download. How high was the protein and was there blood? I would imagine the test is a urine protein creatinine ratio.If the diet has been working, I wouldn’t want to change it either. What was the specific gravity? Depending on all this, your vet could be thinking early kidney disease. If that’s the case I would work with your vet on possible subcutaneous fluids at home to keep the kidneys flushed and hydration good. There has to be around 70% loss of kidney function before it shows on blood work.

CBC results were unremarkable. Chem panel with the only out of range number being creatine kinase. Chloride was just a tad high. Creatinine was good at 1.6. Urinalysis showed USG of 1.014, which is low, and protein of 2+ - no blood. UPC was 1.2, so report states proteinuria.

Sister might benefit from short term sub-Q fluids for re-hydration now. But, longer term sub-Qs really should be reserved when there is more existence of kidney dysfunction. Sub-Qs are hard on the kidneys and better left for when a cat is further into CKD stages. Of course, that is just a general rule of thumb and can vary by cat.

 

[cocoanlace]

CBC results were unremarkable. Chem panel with the only out of range number being creatine kinase. Chloride was just a tad high. Creatinine was good at 1.6. Urinalysis showed USG of 1.014, which is low, and protein of 2+ - no blood. UPC was 1.2, so report states proteinuria.

Sister might benefit from short term sub-Q fluids for re-hydration now. But, longer term sub-Qs really should be reserved when there is more existence of kidney dysfunction. Sub-Qs are hard on the kidneys and better left for when a cat is further into CKD stages. Of course, that is just a general rule of thumb and can vary by cat.

Thanks so much. Good to know. (I thought the chloride was a tad low, not high. But I don't know what that is.) Vet has not mentioned subQ fluids as a possible treatment, yet. Sister's urine is not very concentrated (she said). Sis drinks a lot and pees a lot. Has for many years, even before her diabetes diagnosis.

 

[FeebysOwner]

Oops - you are correct, chloride was low, but just barely out of range. My mistake. According to IDEXX, the lab that was used, chloride is important for acid/base balance, cellular fluid transport, and nerve function. It could be from a bit of dehydration, but not low enough to really warrant concern all by itself. It can be decreased in cats with diabetes, and Sister's glucose count is just at the top of the 'normal' range. I don't know where Sister's glucose has been running since she was taken off insulin, so this might be normal for her.

Low urine concentration is usually a sign of possible kidney issues. But, the SDMA - a test to help identify potential future kidney dysfunction, is well below the reference interval. Although, some vets don't rely on SDMA while others do.

I am just a layperson, so any time you see something on her blood work that you aren't sure of, you can always ask your vet. It does sound like she discusses points of concern with you, but if you ever need her to elaborate on what she has said, don't hesitate to ask for more information.

 

[silent meowlook]

Hi. The urine specific gravity is very low, meaning that the kidneys are not doing their job and cannot concentrate the urine. This could be from kidney damage, or disease. You said she had been diabetic. Was she uncontrolled for a while? A high blood glucose level can damage the kidneys.

I am not a vet. But, if she was my cat, I would get an abdominal ultrasound with a board certified veterinary internal medicine specialist to see what is going on with the kidneys.

I have to disagree about subcutaneous fluids being hard on the kidneys. I have seen it be a life savor for many cats remaining on it for many years. My own included.

 

[FeebysOwner]

I have to disagree about subcutaneous fluids being hard on the kidneys. I have seen it be a life savor for many cats remaining on it for many years. My own included.

My own cat is on daily sub-Qs now, but it wasn't advised to be started until she reached certain parameters (creatinine, most specifically) which included how she presented via overall health conditions because it is asking the kidneys to work harder. It is not as common to start a cat on routine sub-Q fluids even before they have been diagnosed with CKD - unless there is another underlying reason to do so. And it is more likely when CKD has progressed beyond Stage 2. There are numerous data available on this aspect, including IRIS (International Renal Interest Society). I understand/appreciate not all folks, including some vets, agree on when to start routine sub-Q fluids. It is a fine-line balancing act and the best source for getting that proper balance is a combination of the cat's current overall state, the vet, and the caretaker.

Often what warrants sub-Q fluids is when a cat reaches a stage where they cannot drink enough to compensate and are therefore in a constant state of dehydration.

There is no harm in the OP consulting with their vet about sub-Q fluids to see what they say. There is also no harm in asking the vet about an ultrasound. If it weren't so cost prohibitive, it might be advisable to have periodic ultrasounds done on all cats for the sake of overall organ function comparisons over time. The same thing applies to humans as well, but unless the physician sees a need, it won't be approved.

 

[silent meowlook]

That’s where the ultrasound comes in. It can show damage to the kidneys. If they are damaged and the cat is dehydrated SQ fluids are started.

 

[FeebysOwner]

I am sorry for some of the information you are being given that you might feel is a bit conflicting - none of us are vets. So, you are just getting various opinions and ideas to share and discuss with your vet - as I said before.

I do know that an ultrasound on Feeby showed kidney damage, but it was not of the manner to require sub-Q fluids and she was not then showing any signs of dehydration. Every cat is different though, and there is no firm rule on any of this other than to work with your vet on the specifics as they pertain to Sister.

I hope you keep us to date on Sister's progress and continue to dialog with us with your concerns and questions.

 

[cocoanlace]

I am just a layperson, so any time you see something on her blood work that you aren't sure of, you can always ask your vet. It does sound like she discusses points of concern with you, but if you ever need her to elaborate on what she has said, don't hesitate to ask for more information.

Thanks, great input. Often, I am trying to absorb/understand the new terms she is telling me, and she is already on the next topic, and it is overwhelming. I leave thinking I will be able to sort it all out with my own research, always hoping that I have found a vet that is not just running tests to run up more charges unnecessarily. I have had conservative vets in the past that did not take the initiative to explore symptoms (ended up with an asthma cat that was continually diagnosed/treated for URI for way too long and another cat with extreme biliary dysfunction that was diagnosed with simple, harmless cysts on his liver. That vet was actually draining bile from his bile duct!). I need the purrfect vet. Prolly doesn't exist.

 

[cocoanlace]

Took Sister for her second UPCR test today. Vet tech said there was a miscommunication. The tests are to be done every two weeks, NOT 3 tests within 2 weeks. So the sub vet Dr. Clark was incorrect. I think the INDEXX report also reads within 2 weeks. The vet tech says Sister's vet believes nutrition may be causing protein in urine and suggests buying Hills Science Diet KD formula, which they sell. I cannot switch. High carb would put Sister back on insulin. I ran this idea by the great thinkers on the Feline Diabetes Message Board, and they do NOT believe the high protein food would cause issues being seen in Sister's urine. So there we are. I wonder if the magic potion, Dr. Elsey's CleanProtein dry food, which was the answer to our prayers in 2021 is now causing issues. I might be done with this vet. But the purrfect vet prolly does not exist. Still, they emailed me test results for an Australian Shepherd???!!

 

[FeebysOwner]

The vet tech says Sister's vet believes nutrition may be causing protein in urine and suggests buying Hills Science Diet KD formula, which they sell. I cannot switch. High carb would put Sister back on insulin. I ran this idea by the great thinkers on the Feline Diabetes Message Board, and they do NOT believe the high protein food would cause issues being seen in Sister's urine.

Personally, I agree. But, I don't where that leaves you in terms of options. The vet suggesting the KD food seems to think that this may be from kidney disease, but then they need to explain why most of her kidney related numbers aren't showing that.

What about the question that was asked earlier? Was Sister's diabetes ever out of control - perhaps when she was first diagnosed? This could lead to high blood pressure which can also impact the kidneys. So, that is something to consider. I think you might benefit from reading about proteinuria (protein in the urine) to see what you can glean from that and perhaps help you to find some questions you want to ask of the vet.
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Proteinuria (felinecrf.org)

 

[cocoanlace]

Personally, I agree. But, I don't where that leaves you in terms of options. The vet suggesting the KD food seems to think that this may be from kidney disease, but then they need to explain why most of her kidney related numbers aren't showing that.

What about the question that was asked earlier? Was Sister's diabetes ever out of control - perhaps when she was first diagnosed? This could lead to high blood pressure which can also impact the kidneys. So, that is something to consider. I think you might benefit from reading about proteinuria (protein in the urine) to see what you can glean from that and perhaps help you to find some questions you want to ask of the vet.
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Proteinuria (felinecrf.org)

Thanks. The current vet does not know if Sister has kidney disease. She is testing/guessing. I know that diabetes can damage them. But I did not know it was BP that did it. When Sis suddenly had hind end neuropathy in 2021, I thought she had an injury. Went to vet ASAP. Her BG was 476, something like that. Within days, she got onto Lantus, and as I started doing daily BG checks, she got down to 140, then 120, then 100. When she was floating between 80-90, after 3 months, she was weaned off insulin. (In 2018 & 2019, she was tested for diabetes because she drank and peed so much. I was concerned. Tests were negative.) So was there damage before the diagnosis? I do not know. No vet has ever tested blood pressure. I did not even know vets did that. And you are right. Not sure what my options going forward are. I need a very low carb (under 10%), medium protein & fat food. Not sure it exists or the thousands of cat owners on FDMB would have found it by now.

 

[FeebysOwner]

What was ever elaborated on about this 'med' to offset the high protein in the food she likes and is working for her? Sometimes, those type solutions are the best alternatives. For example, my cat takes a phosphorus binder to help with her CKD, and now has to take Miralax to offset the constipation that a binder can cause. Not unlike some human meds that are beneficial but have side effects that require other meds.

 

[cocoanlace]

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Proteinuria (felinecrf.org)

Wow, I am understanding UPCR so much better! Thanks for the article.

 

[cocoanlace]

What was ever elaborated on about this 'med' to offset the high protein in the food she likes and is working for her? Sometimes, those type solutions are the best alternatives. For example, my cat takes a phosphorus binder to help with her CKD, and now has to take Miralax to offset the constipation that a binder can cause. Not unlike some human meds that are beneficial but have side effects that require other meds.

I have not met with the vet since Feb 2. So not sure what the medication is. Her voicemail today only discussed my changing to Hills as a trial.

 

[FeebysOwner]

Wow, I am understanding UPCR so much better! Thanks for the article.

That isn't just an article, it is a whole web site dedicated to cats with kidney issues and all the possible aspects. Continue to read through it as you get time. To help with the abundance of data contained, start with the areas that interest you the most and work from there. I

I have not met with the vet since Feb 2. So not sure what the medication is. Her voicemail today only discussed my changing to Hills as a trial.

If you are interested, go back and see if you can find out what they were proposing at that time. I am still not thinking a food change is the solution for Sister, so alternatives need to be looked at and researched.