I wish I had a dime for every time vets told me there was nothing to worry about on labs....but there was.
Perhaps worry is too strong of a word here....perhaps "pay attention to" or "monitor" is better. I hope the labs are reliable....if the sample was compromised in any way, it could affect the numbers.
First..I'm thrilled to see his liver values back down!! Although we have no way of knowing for certain, I would highly suspect that the dramatic weight loss over a short time could have triggered a response in the liver.
I think, based on George's labs, if the ones that were run are accurate, that he is in Stage 2 chronic kidney disease. Some times, only one or two values might br indicative of it but could also be attributable to something else. But here is what I see in George's labs:
---the USG (urine specific gravity) is indicating dilute urine. Normally, the USG should be above 1.030 and in most cats without CKD or not receiving any supplemental fluids, it is above 1.040. Low USG is often an early indicator of CKD long before the serum chemistry shows anything. But USG also can vary during the day so if all other labs are normal, it's worth just checking the very first sample of the day as it should be the most concentrated. I think You don't need to do that with George because of his other values.
---he has protein (a lot) in his urine. They did do a protein:creatinine ratio and below 0.2 is normal. However, I've not ever seen one like George's which is 0.018. Did you accidentally add a zero after the decimal? Could it actually be 0.18? Normally, it is reported as 0.1, 0.2, 0.5, etc. The P:C ratio is also a good indicator of CKD when the rest of the picture also points to CKD. It can indicate the progression.
---his BUN is pretty high and when it's high and the creatinine is high, it's not just attributable to high protein diets. He would need to be consistently eating a diet of approx 50% protein (50% of calories from protein not just the DMB or as-fed number) to see it affect the BUN. At this point in time, you would not start subq fluids but try to help Georgr get as much hydration as possible through drinking water or by adding it to his food. Be cautious about using tuna juice, broths, etc, because they likely contain salt and perhaps onion .....neither are good for cats with CKD (I actually don't think any cat needs salt and onions can cause anemia).
---his creatinine clearly indicates an issue. This is the number used to stage CKD and his falls into IRIS stage 2.
---feeding a phosphorus binder doesn't need to be done (and generally should not be done) until P levels are around 6 but, as I have long suspected and they are now finding, phosphorus control is crucial to longevity and QOL for a CKD cat. The goal is to keep it as close to 4 as you possibly can, first with diet, and then with binders as it creeps up (and it will) to 6 but for CKD Stage 2, the target level would be under 4.5. I think this is one area where vets really tend to fail in treating CKD so it's going to fall on you. For now, you want his food to be lower than 1.00% on a DMB (prescription renal diets are around 0.3%). If you have only as-fed numbers, then the P should be lower than 200 mgP/100 kcal and that usually has to be
calculated using the as-feds if you don't have DMB.
---hooray! His HCT looks great! This is another number to closely watch. An anemic cat does not feel well. The goal is to keep it above 20% and this is another area where vets drop the ball. Once he gets around 30%, you want to start supplementing with B vitamins to help keep it up.
Other important numbers which you don't have besides the P are potassium and calcium, for right now.
I find that vets can generally be complacent about numbers like these but I think there are things you can do to start addressing it now. Minor things but things that help QOL and longevity in the long run:
---feed lower P foods but don't skimp on high quality protein
---help George get as much hydration through drinking water/healthy liquid or adding it to his food. Water is best. Be careful about giving bone broth. It's great for them but it will shoot the phosphorus levels up so be conservative.
---while I have never had much luck using
Azodyl, some people say it helps their cat feel better even if it doesn't affect the BUN or creatinine
---elevate his bowls; CKD cats develop acid tummies and often vomit foam early in the day. Elevating bowls can help and it might be a good idea to get him used to it before he might need to have it done
---don't let him go too long without eating; because of the acid, which does seem to be worse in early mornings because kitty has not eaten for several hours, maybe think about getting him use to LC snack like freeze dried chicken from an auto feeder some time half way between his last evening meal and his first morning meal. It's probsbly not necessary now but it won't hurt him and it might delay when he starts to see acid tummy. While Gracie did not have CKD, her IBD caused her to have early morning acid tummy and giving her a LC freeze dried chicken snack early in the morning from her auto feeder completely stopped the problem and didn't affect her BG.
---recheck his labs in a few months at the longest.
---read as much as you can from
Tanya's CKD site or buy her book. Just get familiar with she to find things..it is a lot of material but well organized...don't let it overwhelm you. This site saved my cats' lives in regard to CKD. Three of the four lived a long time with it and were extremely stable.....I never saw creatinine over 3.8, I was able to keep their BUN and P down, and HCT up. Those three crossed from other health issues but their kidneys were hanging in there (2 of them after four years of CKD; the third was 21 and had congestive heart failure so a balancing act with CKD but her kidney values looked great when she crossed). The fourth kitty had polycystic kidney disease which has the same symptoms but it's always fatal and usually pretty fast once the numbers start to go up.
I wish they had done an SDMA as this is the new test for CKD and could have given you the best indicator.
My vet has always said there is not much point in restricting it too much when the blood levels are normal, and so I remain on the fence about what to do for Rosie.
Well, I'm not sure I agree with this because vets will say that a creatinine of 2.4 is normal but actually, if the USG is down, and there is no other reason why the creatinine should be up there (e.g. Kidney infection), then I would suspect CKD and I'd be controlling phosphorus in foods and trying to keep them between 200-250 mgP/100 kcal or around 1.00%. Although healthy cats without CKD should have no issue with a higher P level in food, I actually feed high P foods sparingly. Tobey loves raw rabbit but it's really high in P so it's not a main staple of his diet although it would probably be just fine. I try to keep the level of P in his regular rotation foods below 350 but that's just me. He's no longer a kitten so he doesn't need high P foods for bone formation. Especially with a diabetic cat, I'd try to keep the P levels in food pretty moderate. Has your vet done an SDMA on Rosie?
Sorry this is so long!
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annoyingly we asked for more this time and got less than the first. Vet thinks that the tech that called her from the lab was having a bad day or perhaps new, she was apparently quite rude our vet. 
)(4-7%)
