vomiting (elevated creatinine, normal BUN)

Ceracera

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My Cookie has been vomiting. Wondering if anyone has had similar experiences or know what's going on.

She's 3 years old, not spayed.

So my sister has been taking care of her for the past year and I got her back mid-May. She was on what I thought was a poor diet (kibble plus 1 can of Applaws each day) so I switched her to Stella & Chewy's Raw Coated Kibble (chicken) with some Ziwi mixed in mid-June. She was normal at the time and weighed around 4kgs.

About a week after the switch, she started vomiting undigested kibble and yellow every 3-4 days. Appetite was low and she'd kind of squat sit like she was in pain. I took her to the vet and she said it was probably a hairball and to use hairball gel. X-rays showed inflammation in the small intestines and a lot of gas. But she hadn't thrown up any hairballs. I was given 7 days worth of Amoxicillin for the inflammation. She weighed 3.6kgs.

On day 5 of taking the Amoxicillin, she started throwing up a few bits of kibble with lots of pink fluid, which I assumed was blood. I took her to another vet who gave her shots to stop the vomiting, antibiotics (Amoxicillin) and vitamin B. She got a shot of each for 3 days. The last day was July 21st and she was sort of normal after that- appetite was back but she slept a lot. Blood work showed sort of low WBC (5.1). Weight had dropped to 3.2kgs.

(during this time, I switched her food back)

Then yesterday (Aug 1st, exactly a week after the last shot) she threw up yellow and undigested kibble at night again. I don't know if it has anything to do with eating a piece of freeze dried chicken breast the same afternoon.

We went back to the first vet who did more detailed blood work. WBC low 4.1, MCV 53.8FL, MCHC 286g/L.
Creatine was 181umol/L (normal parameters 53-141)
Bun normal at 7.6mmol/L (normal parameters 5.7-11.8)
Snap test for pancreatitis was negative

Weight was 3kgs

Vet said this means kidney issues so now she's on an IV of antibiotics, sub-Q fluids, something to help the stomach lining and acid reflux meds overnight. I'm not sure if I did the right thing keeping her there.

I haven't noticed any increased drinking. She goes to the litter box maybe 4-5 times a day.

Is it just a coincidence that the vomiting starts whenever she eats something high protein? Like the SC kibble and the chicken breast? But she didn't vomit when fed the Applaws canned food. She ate high protein food as a kitten.

She did have a severe small intestine infection when she was 8 months old and threw up yellow at the time. She lost a lot of weight then as well and never regained it.

And yes, I'm a little vague on the medication because I live in China and my Chinese is not that good, so I didn't get all the medication names. I also don't have much faith in the vets because the first one tried to tell me hairball gel would dissolve fur.
 
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Furballsmom

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Hi!
Is it possible that she's allergic/has a sensitivity to chicken - did the applaws have chicken in it?
 
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Ceracera

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Hi!
Is it possible that she's allergic/has a sensitivity to chicken - did the applaws have chicken in it?
Yes, the Applaws had chicken. She would get a different flavour each day. She did vomit the Applaws once the intermittent vomiting started, but not before that. The food that I switched her from and back says 15% chicken and 21% fish on the label.

She ate a lot of food with chicken in it as a kitten, so if she's allergic, it must've happened over time.
 

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Are you able to obtain commercial foods with other types of protein, even such as duck or venison? A lot of foods have some type of chicken ingredient, but trying other proteins may help. Or there are hydrolyzed foods.

You could try an elimination diet, where you literally eliminate ingredients to work out what her system can accept, and not. It takes 13 weeks from what I've read, although there's also an eight week elimination diet as well.

There is this;

and also this, more specifically for your cat due to the kidney issues - this website has a diet/food section, and also a support group;
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat
 
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Ceracera

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Are you able to obtain commercial foods with other types of protein, even such as duck or venison? A lot of foods have some type of chicken ingredient, but trying other proteins may help.

You could try an elimination diet, where you literally eliminate ingredients to work out what her system can accept, and not. It takes 13 weeks from what I've read.
Thanks for replying and helping.

Yes. I bought a bag of air-dried cat food that's mainly beef (17% beef plus a 65% mix of cow heart/bones/liver etc and 5% egg). It's locally made and similar to Ziwi Peak. I was planning to open it once the Ziwi Peak ran out. But it has 42% crude protein and now I'm not sure if I should feed that considering the high creatine?
 

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Was a urinalysis done? I would be hesitant to diagnosis kidney disease based solely on what you described above. Typically, BUN rises before creatinine. So creatinine being elevated with a normal BUN leads me to suspect the high creatinine may be a result of her ongoing muscle wasting since creatinine is also increased by necrosis or atrophy of skeletal muscle.

Eating is really important so if she is not eating or continues to vomit, see if the vet will prescribe an anti-nausea med.

Sorry your kitty is sick and hope she feels better soon!
 
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Ceracera

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Was a urinalysis done? I would be hesitant to diagnosis kidney disease based solely on what you described above. Typically, BUN rises before creatinine. So creatinine being elevated with a normal BUN leads me to suspect the high creatinine may be a result of her ongoing muscle wasting since creatinine is also increased by necrosis or atrophy of skeletal muscle.

Eating is really important so if she is not eating or continues to vomit, see if the vet will prescribe an anti-nausea med.

Sorry your kitty is sick and hope she feels better soon!
It wasnt done. I asked about it but they said the sample had to be extracted from the bladder and she was really feisty when they drew the blood sample.

i could ask them to do a urinalysis tomorrow. What parameters should i be looking for?
 

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i could ask them to do a urinalysis tomorrow. What parameters should i be looking for?
A urinalysis would reveal to name a few: WBC, glucose, protein, bilirubin, possible infection/bacteria, as well as any sediment (indicating things like crystal formation) and blood.

But, a simple, gentle squeezing of the bladder can also result on obtaining a sample without having to do an extraction. Most vets know how to accomplish this and would try that before having to take a needle for extraction.
 

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It wasnt done. I asked about it but they said the sample had to be extracted from the bladder and she was really feisty when they drew the blood sample.

i could ask them to do a urinalysis tomorrow. What parameters should i be looking for?
In addition to what FeebysOwner FeebysOwner said, an important value for determining kidney function is Urine Specific Gravity which is also included on a urinalysis. This value tells you the concentrating ability of the cat’s kidneys. Cats normally have a high ability to conserve water through concentrating their urine. To say a cat’s kidneys are working adequately, specific gravity should be above 1.035 Values below 1.035 can indicate kidney issues depending on the cat’s hydration status. (If the cat is receiving IV fluids for example then low values are to be expected.)

One reason assessing specific gravity is important that urine concentrating ability declines sooner in kidney disease than blood values rise. Thus, a cat can have normal BUN and Creatinine values but a specific gravity of 1.020 for example.

If your vet had difficulty obtaining a clean sample then a “free catch” may suffice. Ask your vet if bringing in a sample would be worth it. You can get non-absorbing litter to temporarily place in her litter box so you don’t have to stress her out with another vet trip. (Litter and Litter)

Hope that helps and wishing her a speedy recovery!
 
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Ceracera

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Thanks for all the help. The vet says they can only get a sample directly from the bladder. And i looked up that special cat litter- it isnt available here.

her bloodwork said wbc was low at 4.1

im going to go to the vet again this afternoon

does anyone know why her wbc is low while crea is high, but everything else is normal?
 
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Good news is I managed to find the kit4kat that BlackCatOp BlackCatOp recommended! I'll do the urinalysis once it arrives. Thanks everyone for your help
 

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does anyone know why her wbc is low while crea is high, but everything else is normal?
Vomiting can cause dehydration which can elevate the creatinine level, so that might be the cause. Extremely high levels of protein intake can also cause it, but there are probably many other possibilities as well. Low WBC can have many causes, but some sort of infection is a typical one. Has she been tested in the past for any viral infections?
 
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Ceracera

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Vomiting can cause dehydration which can elevate the creatinine level, so that might be the cause. Extremely high levels of protein intake can also cause it, but there are probably many other possibilities as well. Low WBC can have many causes, but some sort of infection is a typical one. Has she been tested in the past for any viral infections?
She tested positive for calici when she was 2 months old but she hasnt shown any symptoms since I got her and bloodwork when she was healthy has been normal
 
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Ceracera

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And it seems she went to the litter box a bit more than usual on the days when she was getting shots at the second vet. I have an automatic box that counts the number of times it gets used per day, but sometimes it doesnt get the cat right. I assumed that the 2 cats were going an equal number of times. But since Cookie has been staying overnight at the vet, I've realised my other kitten only uses the box around 3-4 times every 24 hours. So that means Cookie went to the toilet around 6-8 times every 24 hours when she was getting the shots. She went around 4 times when she wasn't.
 
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I found another thread with similar "normal BUN, high creatinine". As mentioned there too, having only one elavated might mean dehydration. https://thecatsite.com/threads/normal-bun-high-creatinine.218749/ More tests are needed to diagnose.

Do you have a copy of the blood test result? Did they check for more things? Did they do the test on empty stomach? Our vet doesn't trust kidney values result if the cat ate in the last 8-10 hours prior to the blood test.

She's 3 years old, not spayed.
Could she be on heat?

X-rays showed inflammation in the small intestines and a lot of gas. But she hadn't thrown up any hairballs.
It's a common but false belief they always throw up hairballs when there is a hairball-related problem. Sometimes they vomit but the hair just doesn't come up. Sometimes the excess amount of hair cause constipation and/or hydration problems. My own cat puked her still-fully-formed kibbles late at night as well couple weeks ago and I believe it was mostly due to dehydration mixed with stress earlier that day (there was a thunderstorm.)

She did have a severe small intestine infection when she was 8 months old and threw up yellow at the time. She lost a lot of weight then as well and never regained it.
Also, did they check her for worms? Is she on a dewormer?

Without diagnostic tests it's just speculation but based on your description to me it sounds like there is more than one thing going on. One of them being inflammation which might be food intolerance, worms, or both.
 
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Yes they did a fecal test and didn't find worms. She just got a dose of revolution last month and she doesn't go outside.

I dont think it was dehydration cause she didn't have diarrehea and she only vomited once a week after she got the shots at the second vet. That means she'd only vomited once before the test showed low Crea levels. She was peeing normally.
 
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Ceracera

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Wanted to give you guys an update and thanks again for all the help. Cookie has been home for 3 days now and she hsnt vomited. The vet did another tests before she left and crea was within normal parameters but still on the side side. Im going to watch her
 
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