Renal failure

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Zoey & Carol

Zoey & Carol

Member Since 2015
Zoey is probably in renal failure. We're been out of town and someone has been taking care of her. She quit eating and was very lethargic so my vet came and got her and ran some tests. He just called and said it looks like she's in renal failure. We are stuck in Washington state because of weather and bad roads and I can't get home to her for maybe another day or two. The vet said he could give her fluids and she might bounce back. She doesn't seem to be in pain so I asked him to keep her and do what he can until I get back. Is there any hope that she will get better or am I just keeping her alive until I get home?
 
BUMP!

It might be very helpful if you can upload/ enter her latest Blood Work values in to the SS/ LAB tab - there are some to read it well.

Vets are often go dramatic - the "failure" verdict might not be very accurate - or at least I hope so! (fingers crossed)

Sorry, I have no experience but wanted to bump your post up!

Hang in there!
:bighug:
 
Hi Carol,

It is good that Zoey is under the care of your vet right now.

Zoey & Carol said:
She quit eating and was very lethargic
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Did the vet say if Zoey had ketones in her urine and/or blood?

The following are general things that may or may not be helpful to you:

* If a cat is badly dehydrated it can negatively impact kidney-related values. We've had reports here of cats whose vets said that they were in renal failure but kidney values improved a lot after the cats received fluid therapy (and possibly other appropriate treatments) at the vets.

* A cat producing ketones can go on to develop diabetic ketoacidosis and the cat typically becomes inappetent. This is treatable in a hospital setting (fluids and specialist insulin therapy, electrolyte balancing, anti-nausea and appetite stimulant medications possibly with a period of assisted feeding or an e-tube until cat is stable and eating/drinking on its own again). More info on DKA in this forum sticky:

Are you testing your cat for ketones?

* If chronic/acute kidney problems are the cause of your cat's symptoms here is some information on 'crashing' from Tanya's Site (the go-to place on the web for cats with kidney disease - the whole site is a goldmine of information on symptoms and treatments that can really help CKD cats).

http://www.felinecrf.org/symptoms.htm#crashing

* Another common cause of feline inappetence is pancreatitis. Diagnosis is typically via blood test (SNAP fPL, if your vet offers it, can give an immediate Yes/No indication for pancreatic inflammation; Spec fPL needs to be sent to an external lab but it gives an indication of the severity of the inflammation), ultrasound, and relevant clinical signs. Again, there are treatments available for pancreatitis. Here are links to two resources which I found to be invaluable for nausea/inappetence and pancreatitis information:

IDEXX Pancreatitis Treatment Guidelines

Nausea and Inappetence - Symptoms and Treatments (from Tanya's Site)

Note: I have no idea whether or not any of the above may be helpful to Zoey; just throwing out some things by way of brainstorming.

Sending prayers and positive vibes that Zoey will respond well and quickly to the vet's treatment.

:bighug:


Mogs
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Thank you all for the information and support. I don't have her labs yet because I'm not home. The vet told me several things but I was so flustered I didn't pay a great deal of attention. Creatin? Levels high but liver enzymes ok. I just told the vet to do what's best for her until I get home. I'm hoping she'll bounce back once she gets fluids. I just really wanted to hear that there is hope for her. Thanks for giving me that!
 
Zoey & Carol said:
Creatin? Levels high but liver enzymes ok.
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Creatinine. :)

Here's a link to the Tanya's Site page giving info on creatinine and possible causes of elevated creatinine levels:

Tanya's Site - Creatinine Info

Actually that whole page gives a lot of information about blood chemistry test results.

The page above mentions that sometimes creatinine levels may be elevated in DKA and pancreatitis kitties. Also from the above page:
If creatinine and BUN rise suddenly, you should consider the possibility that your cat has a kidney infection or hypertension. Kidney stones which cause blockages may also result in a sudden and high rise in creatinine and BUN, as may acute kidney injury.
Click to expand...

[Emphasis mine]

Whatever's making Zoey feel poorly, fingers and paws are crossed here for a speedy diagnosis and successful treatment thereafter.


Mogs
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Just spoke to the vet. Zoey is doing better. Her creatinine was off the scale yesterday and her BUN was 80. Her BG was 637 today but no ketones. He gave her 200 cc of IV fluids yesterday. She is drinking on her own now and eating some of her Pate. I will bring her home tomorrow.

I will read the information from the CKD website when I get home. Still driving in snow and ice. Is there anything I should ask the vet about specifically when I see him tomorrow?
 
Hi Carol,

I am very pleased and relieved to read that Zoey is doing better today. IV fluids can make such a difference!

I'd suggest asking your vet to prescribe some anti-nausea and appy stimulant meds to keep at home for use ad hoc just in case her appetite stalls. Breaking the 'nausea --> poor appetite --> worse nausea --> inappetence' cycle can be tough going on both cat and caregiver plus it increases risk of ketosis, DKA and hepatic lipidosis. I've found that it is far, far easier to keep a somewhat queasy kitty eating with the help of supportive meds (and possibly fluids) than it is to get a badly inappetent cat to start eating properly again.

Did the vet give you any diagnosis of the underlying cause of the spike in creatinine and BUN? If not, if it were my kitty in this boat and if the vet hadn't already done so, I'd ask him to test for pancreatitis (Spec fPL), if only to rule it out and provide information that could be put toward making a differential diagnosis. A check on B12/folate levels would also be helpful (and it might be worth asking the vet to give Zoey a B12 jab before going home (assuming it's not contraindicated for any reason) - B12 can give a cat a bit of a boost and it can help with appetite).

Other members may have further suggestions.

Take care on the roads. Wishing you a safe journey home.

:bighug:


Mogs
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Hi, I have managed many cats in renal failure with pretty great success.

I know there is a debate on when to give fluids in controversial on the forum and even vets have a different views.
My experience is as follows-

My vet (whom I have assisted many times) recommends beginning fluids at the very early stage of kidney disease in order to slow the progression but if the cat was already showing significant decline he suggests a more aggressive start and then figuring out how much and how often. I have been told by a few vets that kidney failure doesn't show up on a lab until its function is 75% gone. It is remarkable how they can thrive on a fraction of that.

Some of my fosters have lived another 5 years by giving SQ fluids. They were not diabetic for reference.

My Dre who is 18 and diabetic has BW done regularly and when his BUN was elevated a bit I began fluids a few times a week and his creatnine started creeping up so I upped the fluids. I am happy to report that we had BW done just this past Monday and I was pleasantly surprised. His BUN is slightly elevated but creatinine is back in normal range.

I do want to make clear that if a cat has another condition specifically heart disease it is imperative to use caution and work with your vet/cardiologist.

My Rico is 19 and he also gets SQ fluids in small amounts due to a heart condition from using a steroid. He was getting fluids daily for 5 years prior to the heart issue, I believe the daily fluids prior helped preserve the integrity of his kidneys. His BUN is slightly elevated and the rest of his labs are pretty awesome:cat:
 
jayla-n-Drevon said:
I have been told by a few vets that kidney failure doesn't show up on a lab until its function is 75% gone.
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Glad you mentioned this, Jayla. It has put me in mind of something ...

@Zoey & Carol -

As Jayla mentions above, traditionally it has been very late in the day function-wise that indicators of chronic kidney disease become identifiable in lab results. However, IDEXX Laboratories recently developed the SDMA test which they claim can potentially detect signs of kidney insufficiency when only 40% of function is lost.

Here's the relevant page from Tanya's Site:

CKD - Early Detection

If possible, it might be really helpful for you to read this page before visiting your vets on the morrow. It might provide a helpful foundation for the discussions with your vets and it may give you an idea of whether any of the diagnostic tests mentioned might be beneficial in helping to determine whether or not kidney insufficiency was the root cause of Zoey's clinical signs (nausea, etc.) and elevated blood markers. (For info, since it became available in the UK our vets routinely include the SDMA test when getting blood work done by IDEXX. I think it's a great idea: forewarned is forearmed. ;) )

Be sure to post an update tomorrow (not least of all to let us know that you got home safe!).

:bighug:


Mogs
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Another one for the vet visit hit-list: ask your vet to check Zoey's blood pressure (if not done already).


Mogs
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I take the other view in early fluids. First, it adds sodium not needed. Second if your cat is eating all wet food is is adequately hydrated you risk fluid overload. Pancreatitis can definitely raise the kidney numbers. Not eating can cause dehydration which can falsely raise the kidney values. So can infection. You need to ask for the Spec fPL test for pancreatitis and not the SNAP which is quick but just gives positive or negative so without a number you won’t know if in the gray area.
 
I tend to agree with Elise on early fluids. I did fluids daily with Dakota when we first discovered his CRF but after a few days, they seemed to make him feel worse. I learned that fluids can overload the system with unneeded electrolytes so quit the dailies. I just give now when I notice he's not drinking a lot and/or shows signs of starting dehydration. I encourage lots of drinking....and he cooperates well.
 
Made it home safely. Zoey is back home but not doing well. The vet gave her another IV infusion. He also gave her convenia .1 ml and cyanocobalamin injections. She drank a slight amount but has no interest in eating. He gave me mirtazapine for her appetite. So far it hasn’t done much. She is resting but I’m not sure she’ll make it through the night.
 
I’m so sorry to read this. Has your vet diagnosed anything besides kidney failure? Were IV fluids given or sub-q? If severely dehydrated she might need a drip for a few days but it sounded like this was early kidney disease so I’m confused. Did he test for pancreatitis?
 
Zoey & Carol said:
She drank a slight amount but has no interest in eating. He gave me mirtazapine for her appetite. So far it hasn’t done much. She is resting but I’m not sure she’ll make it through the night.
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I'm sorry, too, and I'm asking the same questions as Elise.

Is there an ER vets nearby? Could you get Zoey there - and do all you can to get anti-nausea meds into Zoey - ? (The appetite stimulant alone won't do anything much if she is too nauseated to eat. We often see cats here whose vets don't fully grasp the importance of specific anti-nausea treatment. Many vets claim that mirtazapine is sufficient as an anti-emetic but, based on my own experience and many cases I've seen here, treatment with Cerenia and/or ondansetron alongside the appy stimulant works much better.

A Cerenia injection might start to work faster than ondansetron (although some members here have, I believe, used both at the same time; can't comment because I've not done so). With Saoirse, I'd start anti-nausea with a Cerenia injection (lasts about 24 hours) because it got into her system faster and then I'd start her on ondansetron tablets the following day. Ondansetron had a stronger anti-nausea effect in Saoirse but given orally it took a few doses to build up its full therapeutic effect. Ondansetron is available as an injectable for humans. I'm not sure if it can be given as an injectable to cats (but the ER vets might know more).

The ER vets might be able to do a SNAP fPL test for pancreatitis or, if push comes to shove and there's no differential Dx, maybe they might treat for pancreatitis on an 'as if' basis? If pancreatitis is the problem then pain may very much be part of the reason why Zoey is not keen to eat. Administration of buprenorphine for pain relief can help a great deal to get the cat back to eating again.

I'm not trying to give you unrealistic expectations here but if you find out pancreatitis is the problem then I'd just like to add that a cat can seem sooo ill but then really turn the corner when the right meds/fluids are finally put in place. I've seen it happen in Saoirse (I really thought I might lose her during her first pancreatitis flare - until I got her nausea under control) and I've seen it in other cats here.

If a vet trip isn't possible maybe try offering Zoey food from your hand? Perhaps dab a little food on the end of her nose just to let her lick it off and get a taste for it; sometimes that can trigger interest in food and if you can start a kitty eating at all then by giving tiny, frequent amounts of food you can help them build up a bit of momentum until they want to eat again under their own steam. If she does go for her food or water bowls, try raising them up a few inches off the ground (e.g. stick a few paperbacks under them) - helps a lot when a kitty's queasy if they don't have to drop their heads down to eat and drink. Warming the food a little can sometimes encourage a kitty to eat (or the heat from your hand can do similar).

I really feel for you. Sorry I can't think of anything else to suggest to you. Sending healing vibes to little Zoey.

(((Carol)))


Mogs
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When Max first got pancreatitis I didn’t know what was wrong. He just stopped eating. One vet had me bring him for an uultrasound and even though I fasted him didn’t run the test for pancreatitis because her rotten traveling vet who did the ultrasound found everything BUT pancreatitis wrong with him. He recommended surgical biopsies. I went back to my previous vet and he had his radiologist do another ultrasound and ran the right test. Diagnosis pancreatitis. Max never had a biopsy and lived the next 7 years never having cancer and only thevlast with CKD.

Mogs is right. You need nausea medication and it can take a few doses for it to start working. You need to assist feed small amounts often until the meds kick in. I also would like to see all the labs. Not eating can cause fatty liver disease in just a few days.
 
Another couple of thoughts:

Is there any chance that Zoey might be constipated? If she is then that could be another thing putting her off her food (it can sometimes cause vomiting if a cat tries to eat) and normal anti-nausea/appy stimulant meds are unlikely to help until the constipation is sorted out. You'd need to get a vet to check that there's no obstruction or impacted faeces but a few doses of metoclopramide (Reglan) can speed up gastric emptying and help restore normal gut motility. Thereafter normal anti-nausea and appy stimulant meds should start doing their job properly.

If the anti-nausea and appy stimulant meds don't kick in and Zoey still needs help with eating, there is always the possibility of putting in a feeding tube; they make assist feeding much more straightforward and reliable (protecting the liver). They can and do save the lives of severely inappetent cats. If Zoey is a candidate for a feeding tube it's better not to wait too long to get it placed. Here's a link to more information about feeding tubes:

Feeding Tubes For Cats (from Lisa Pierson DVM's site, catinfo.org)

Sending more healing vibes for Zoey and a :bighug: for you.


Mogs
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She drank a little bit and licked up some sauce from a turkey cat food. She talked to me a little and seems a little brighter. She has been peeing some but no bm’s that I know of. I don’t think she’s eaten much for a few days. Maybe tomorrow will be a better day now that she’s home.

If not I’ll try the emergency vet. Thanks.
 
Zoey & Carol said:
licked up some sauce from a turkey cat food.
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Attagirl, Zoey! Any interest in food is very welcome! :)

Even if you can keep offering her some of the gravy to lick from your fingers it may help her to get a little bit more down than she might without the prompting. Keeping some little bit going into her tum will reduce the chance of stomach acid building up and making nausea worse.

If Zoey's still only licking the gravy off the food tomorrow then hopefully an ER vet will be able to prescribe an appropriate nausea treatment (and maybe pain meds if they suspect pancreatitis might be the culprit).

I'm glad to read that Zoey's a little brighter in herself. Fingers and paws crossed here that you'll both have a better day tomorrow.

:bighug:


Mogs
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Zoey & Carol said:
Just spoke to the vet. Zoey is doing better. Her creatinine was off the scale yesterday and her BUN was 80. Her BG was 637 today but no ketones. He gave her 200 cc of IV fluids yesterday. She is drinking on her own now and eating some of her Pate. I will bring her home tomorrow.

I will read the information from the CKD website when I get home. Still driving in snow and ice. Is there anything I should ask the vet about specifically when I see him tomorrow?
Click to expand...
For support with the ckd, Facebook has a great group called Cats with Chronic Renal Failure. Join and they can help
 
Zoey is not much better but I is drinking water and a little chicken broth. 1/2 cup since last night. That seems pretty good but I’m not sure. She’s very weak and occasionally seems to be in pain especially if I pick her up.

If she’s not feeling better by tomorrow I’m taking her to another vet clinic- one we use for our dogs. I will request a test for pancreatitis, something for nausea, and something for pain. If I can get her through this I will definitely join the cry group. I haven’t even checked her blood glucose since she got home. Seem like a lower priority right now.

Thanks for your support. I appreciate your suggestions and taking them all into consideration.
 
Zoey & Carol said:
Zoey is not much better but I is drinking water and a little chicken broth. 1/2 cup since last night. That seems pretty good but I’m not sure. She’s very weak and occasionally seems to be in pain especially if I pick her up.
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I don't know whether this might help but if you poach a chicken breast, chop it up really, really finely and add it to the broth she might manage to lap up a bit of protein when she's drinking. Another idea might be to blitz the chicken breast in a blender and add a lot of broth to make a fairly watery chicken soup for her. If you can manage, try to get her to lick a little of the gravy from the cat food like she did yesterday evening because it will have some calories in it. Every tiny bit can help. (((Zoey)))

It's good that Zoey's getting some fluids down under her own steam.

If she’s not feeling better by tomorrow I’m taking her to another vet clinic- one we use for our dogs. I will request a test for pancreatitis, something for nausea, and something for pain. If I can get her through this I will definitely join the cry group. I haven’t even checked her blood glucose since she got home. Seem like a lower priority right now
Click to expand...

Have you got any ketone strips at home? If yes, be sure to test Zoey's urine the next time she pees. If you don't, then be sure to get her tested tomorrow at the vets.

Sending more healing vibes and prayers for you to get a really helpful vet tomorrow.

:bighug:


Mogs
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I can’t catch her peeing because she’s not using the litter box. She’s just peeing on her towels. She just had a little more broth and water. She’s avoiding even tiny pieces of chicken. I’ll try the blender trick.

So tomorrow I want the vet to do these things:
Test for pancreatitis
Test for ketones
Cerenia for nausea
Something for pain
Check for IV fluids and/or feeding tube

Anything else I should ask?

And Happy New Year to you all! Thanks for your support!
 
Zoey & Carol said:
Cerenia for nausea
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Also ask for a prescription for ondansetron. (The generic is much cheaper than the branded Zofran version.) It's a human medication so if the vet doesn't stock it you could ask for a written prescription and get it filled at a regular pharmacy. Dosing for a 10lb cat is 1-2mg every 8-12 hours, to a maximum of 4mg per day.

Zoey & Carol said:
Anything else I should ask?
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Thorough physical exam, in particular to assess where Zoey is feeling pain. Also ask vet to check that she's not constipated/obstructed (really important WRT nausea management so that all appropriate treatment(s) can be put in place - may need initial few doses of Reglan followed by ondansetron/Cerenia). Also check whites of eyes and gums to make sure there's no yellowing.

Ask vet to assess Zoey's hydration levels. Be guided by the vet if he recommends IV fluids (although maybe sub-q fluids might be an alternative, allowing Zoey to come home sooner).

Get her blood glucose levels checked at the vets, too. And ask about how to manage Zoey's insulin needs while her appetite is poor (some insulin is better than none at all (ketones) so the vet may be able to advise you on a suitable reduced dose).

I think asking about the feeding tube is a very good idea.

Zoey & Carol said:
I can’t catch her peeing because she’s not using the litter box. She’s just peeing on her towels.
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If you have ketone test strips at home it might be worth trying to rub one on the towels? No idea how reliable the result would be (just chucking out ideas). Try sniffing her breath for fruity/nail polish remover type smells (though not all ketones manifest in the breath). Keeping her drinking (broth if possible) will help keep her system flushed out.

Sending more healing vibes.

:bighug:


Mogs
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Just checked her bg and it was 510 so I gave her a reduced dose of 1 unit. Still drinking water. Blended some gravy food with water and she took a few licks. I’ll check her bg again in a couple of hours. Maybe I’ll put some plastic wrap under her to see if I can catch a few drops. Found 3 small hard stools stuck to her bottom.
 
Keeping fingers crossed over here that the insulin dose might perk Zoey's appetite up a little bit when it kicks in.

With Zoey licking the blended 'gravy food' that's good; she has interest in food. Maybe try some of the gravy on its own as well to see which she might prefer (anything to keep calories going in to tide her over till tomorrow's vet visit). It's also good that she's taking fluids onboard by herself.

Zoey & Carol said:
Maybe I’ll put some plastic wrap under her to see if I can catch a few drops.
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That's a clever idea!

Zoey & Carol said:
Found 3 small hard stools stuck to her bottom.
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Poor love! (((Zoey))) Good that Zoey's passing stool. It's tricky trying to gauge what's going on bowel-wise when a kitty's had very little to eat for a few days. Hopefully the vet exam will tell you more.

Rooting for the two of you.

:bighug:


Mogs
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Took Zoey to another vet today. He said she is a pretty sick kitty.:( He will keep her for a few days to try to stabilize her and run some tests to see what is going on. Probably kidney failure, but I should know for sure in a day or two.

She's such a sweetie! I hate to put her through this, but if there is a chance for her to get better, it will be worth it.

Thanks.
 
Zoey & Carol said:
Took Zoey to another vet today. He said she is a pretty sick kitty.:( He will keep her for a few days to try to stabilize her and run some tests to see what is going on. Probably kidney failure, but I should know for sure in a day or two.

She's such a sweetie! I hate to put her through this, but if there is a chance for her to get better, it will be worth it.

Thanks.
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Lots of prayers :bighug::bighug::bighug:
 
Zoey & Carol said:
Took Zoey to another vet today. He said she is a pretty sick kitty.:( He will keep her for a few days to try to stabilize her and run some tests to see what is going on. Probably kidney failure, but I should know for sure in a day or two.

She's such a sweetie! I hate to put her through this, but if there is a chance for her to get better, it will be worth it.

Thanks.
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You have a hug & I hope Zoey stablises and picks up.
 
(((Carol)))

Thanks for letting us know how you both got on today. Hopefully the new vets will be very proactive in their efforts to help Zoey get some nourishment into her.

I really feel for you. It's so hard seeing our little ones being so poorly but where there's life, there's hope. While the vets are looking after Zoey, try as best you can to get some decent sleep yourself. You need to look after you in order to be able to look after your precious girl.

A thought: when you go in to visit Zoey it's a good idea to bring in a t-shirt or similar with your scent on it so that you can pop it into her kennel to provide a little comfort and reassurance.

Keeping fingers and paws crossed and sending lots of positive vibes for the new vet to help Zoey feel better asap.

:bighug:


Mogs
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I left her with a towel that I have been using to cuddle her with. Hopefully that will make her feel better. She walked a little today, meowing for something, and when I picked her up and cuddled her, she quieted down. We have definitely become closer through dealing with her diabetes.

Thanks so much for all of your hugs and prayers. I will keep you updated.
 
We can feel how much you both love each other. :)

Keeping you both in my prayers. I know how difficult it is when one is so worried but I hope you manage to get some bit of restorative sleep tonight.

(((Carol and Zoey)))

:bighug::bighug::bighug:


Mogs
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