Help with bloodwork please

Here's the skinny on the last few days as background:

Buzz has been OTJ since Dec. 10th. BG on Dec. 31 was 97. BG on Jan. 5 was in the 200s. Made vet appt. to see if she has infection. No infection, so she started on Lantus this morning (former Idexx PZI user, switched to Lantus because of PZI going bye bye). She also has no ketones, although she has had problems with them in the past when she was diagnosed.

The vet called this morning with results of the bloodwork and talked to my fiance. He then went to go pick up a copy of the results because the vet said that Buzz's kidney something was double what it should be. FIance is not great on details. So now I have the bloodwork in front of me, and I see all kinds of things marked "HIGH" and it scares me a little. Here's what we have:

BUN: 66 (14-36)
Creatinine: 3.7 (0.6-2.4)
BUN/Creatinine ratio is normal, at 18 (4-33)
Phosphorus: 8.7 (2.4-8.2)
Cholesterol: 318 (75-220)
Triglyceride: 190 (25-160
Platelet count: 180 (200-500)

I don't think I need to be worried about the platelet count. I've read enough here to know that the other stuff might be bad news. All the vet said on the phone was that if we don't keep her hydrated enough, the kidney thing could be life-threatening. So we got some subQ supplies since it's the weekend and I don't want (and can't afford) a trip to the ER vet.

Any thoughts/advice will be appreciated.

Sarah I can only tell you what I know from human medicine concerning the kidney values of BUN, Creatinine and the BUN/Cr ratio.

BUN (urea nitrogen is a waste product produced by liver and filtered through the kidneys. levels can rise due to increased production from the liver, intenstinal bleeding (ulcers) as blood is broken down the nitrogen compnents are reabsorbed and converted by the liver to urea, elevated BUN is also typical of dehydration, enhanced protien absorbtion and in very high protien diets, steriod use, and some infections.

Creatinine is a more specific marker of kidney function but "normal values are difficult to interpert (Creatinine is dependent on body muscle mass) a normal creatinine in someone with very little muscle mass does not rule out a renal disorder and vice versa.

A normal BUN/Creatinine ratio can indicate a post renal problem such as a blockage within the ureter .

Typically these values alone are not very useful, repeated tests are nessisary to determine if renal function is declining. In other words it's only one number, more important are the trends over a period of time. I would suggest attempting the SubQ's to correct any deydration (as well as using insulin to to lower BG and reduce possible dehydration from PU) then having these tests repeated.

Hope it all turns out ok!

Oh and as for the other things cholesterol etc. dehydration would also explain that. Many things become elevated in dehydration, If you have a glass with 1 cup water and 1/2 cup salt you have a 2:1 ration but if you take out half the water you then have a higher ratio of salt 1:1,.

Sarah

would u be able to link this thread to your condo in LL?
Since Buzz just began on lantus, it will be helpful for eyes over in LL to know what the results were, ok?

Do you know the urine specific gravity? The phosphorous is above the normal range and to me indicates the need for low phoshorous food and/or phosphorous binders.

Larry and Kitties said:

Do you know the urine specific gravity? The phosphorous is above the normal range and to me indicates the need for low phoshorous food and/or phosphorous binders.

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I do not know the USG. I didn't get the results for the UA, but my vet has them since it was done in-house. I can get them on Monday if necessary.

What are phosphorous binders?

Thank you for the input.

Here's another reference Sarah:
http://www.petwave.com/Cats/Cat-Health- ... -Cats.aspx

and (quote: Knowledge of urinary solute concentration is essential for proper interpretation of BUN and serum creatinine...)
http://diaglab.vet.cornell.edu/clinpath ... out/sg.htm

Jess explained the relationship between BUN & CREAT readings and USG in detail a couple of years ago, but without the search function on the old board, I just can't find her explanation.

I still think you should get a blood pressure check, and you can't hurt anything by switching her to a low phosphorus food like Wellness or Nature's Variety raw.

Terri and Lucy said:

Here's another reference Sarah:
http://www.petwave.com/Cats/Cat-Health- ... -Cats.aspx

and (quote: Knowledge of urinary solute concentration is essential for proper interpretation of BUN and serum creatinine...)
http://diaglab.vet.cornell.edu/clinpath ... out/sg.htm

Jess explained the relationship between BUN & CREAT readings and USG in detail a couple of years ago, but without the search function on the old board, I just can't find her explanation.

I still think you should get a blood pressure check, and you can't hurt anything by switching her to a low phosphorus food like Wellness or Nature's Variety raw.

Click to expand...

Thank you for the links! She is actually already on Wellness, and has been exclusively since her dx. The civvies have recently switched to FF (they went on strike with the Wellness) and occasionally Buzz will get a bite or two of some food they have left behind. Of course the FF is LC (and gluten-free) as well, so I have not been too worried about that.

I will be speaking to the vet on Monday regarding these results and at that time, I will ask her about the BP, whether she can do it or if I have to find someone else who has the equipment.

A phosphorous binder is a substance (frequently aluminium hydroxide powder or gel) that you mix with food. The binder binds with some of the phosphorous in the food and prevents it absorption by the intestines.

Larry and Kitties said:

A phosphorous binder is a substance (frequently aluminium hydroxide powder or gel) that you mix with food. The binder binds with some of the phosphorous in the food and prevents it absorption by the intestines.

Click to expand...

Ahh, ok, thank you!

Hi Sarah

From what I understand, your cat has been acting normal and was only taken in now because of her rising BG. Correct? When was your cat's last bloodwork (before this) and was it normal? There is nothing to tell us whether or not your cat has a primary kidney problem or another problem which is causing the azotemia, and this is obviously a vital distinction. "Other problems" include urinary tract disease (bladder infection, kidney infection, bladder stones, kidney stones, hydronephrosis) and diseases that cause marked dehydration . Your cat (AFAIK) isn't on any meds or has any symptoms of other major diseases so I think the first step is to get a urinalysis and a urine culture and a T4 (if your cat didn't get it with the last test). Personally I'd also repeat the blood chemistry if this is a totally new problem and you have somewhat recent bloodwork which shows normal kidney values to make sure you don't have an abnormal result here.

Once these tests are done and the conclusion is that your kitty does have renal disease, treatments such as diet and SQ fluids and phos binders can be worked out. Have you started teh SQ fluids? This will negate the result of the USG in the urinalysis since the urine will be artificially diluted.

Jess & Earl said:

Hi Sarah

From what I understand, your cat has been acting normal and was only taken in now because of her rising BG. Correct? When was your cat's last bloodwork (before this) and was it normal? There is nothing to tell us whether or not your cat has a primary kidney problem or another problem which is causing the azotemia, and this is obviously a vital distinction. "Other problems" include urinary tract disease (bladder infection, kidney infection, bladder stones, kidney stones, hydronephrosis) and diseases that cause marked dehydration . Your cat (AFAIK) isn't on any meds or has any symptoms of other major diseases so I think the first step is to get a urinalysis and a urine culture and a T4 (if your cat didn't get it with the last test). Personally I'd also repeat the blood chemistry if this is a totally new problem and you have somewhat recent bloodwork which shows normal kidney values to make sure you don't have an abnormal result here.

Once these tests are done and the conclusion is that your kitty does have renal disease, treatments such as diet and SQ fluids and phos binders can be worked out. Have you started teh SQ fluids? This will negate the result of the USG in the urinalysis since the urine will be artificially diluted.

Click to expand...

Hi Jess!

Yes, she has been acting normal. The only sign of anything wrong was her high BGs. We took her in to make sure there was no infection. She is not on any other meds and has no other diseases or health problems.

Her last BW was at dx, which was 7/27/09. I just went to get it and make sure I'm right that everything was normal, and it was. The ALT was high, though, at 139 (ref=10-100) and the phosphorous was on the high end of normal at 98 (ref=6-102). Otherwise, everything except glucose was picture perfect at that time. She also had a T4 done then, and it was normal at 1.1 (ref=0.8-4.0). A T4 result was not on the BW from yesterday.

She had a cystocentesis done yesterday but I do not have that report. All the vet said regarding that was that there was no infection and no ketones. The vet commented how nice and yellow her urine was, and I guess that would mean it did not appear to be dilute? I plan to get the UA results on Monday so I have them here at home.

Her blood was taken after the cystocentesis, and thus after her freak-out. She was peeing and throwing up, making awful noises and just generally not right. She was off all day yesterday, not eating until 8 hours after the appt. This is VERY unusual for her and has never happened before. She rarely exhibits stress at the vet, and she has NEVER refused to eat before. I mention all of this to ask, is it possible that her extreme stress somehow contributed to the results of the bloodwork? It seems unlikely to me that BUN and creatinine would be affected by stress, but my medical knowledge is next to nothing, so I can't completely discount that possibility.

Thanks for responding.