Renal failure

Status
Not open for further replies.
@Zoey & Carol :bighug::bighug::bighug: CRF is a tough diagnosis, especially when it's only diagnosed because a cat crashes. But there is much that can be done to keep her feeling good in the longer-term. Were you able to get hold of the lab results at all? As she's weak and not eating, I'm thinking specifically of electrolyte imbalances, or very high phosphorus levels. If potassium levels are off, a cat can appear to be at death's door - we went through 3 potassium crashes with one CKD cat, and 2 episodes of high potassium with another so I've seen it for myself - but once the imbalance is corrected, they bounce right back as though nothing had ever been wrong. Don't give up yet - it's very early days after her diagnosis. Healing vines coming your way from all of us here. And a few more hugs, because you can't have too many of those :bighug::bighug::bighug:
 
April, thanks for your message. Most of what you said is what is occurring. I didn't get a copy of the labs, but the vet called me last night with detailed information. This is what I know as of last night: Her creatinine is high (I think he said it was over 11?). Her BUN is too high to measure. Her phosphorus and bilirubin are elevated, and her pancreas is inflamed. Her whole system is involved: kidneys, liver, and pancreas. Her BG was over 600, and there were abnormalities in her electrolytes. Also, her body temperature was low. He said her case is extremely complicated.

She is in "intensive care" right now. He is trying to flush out the toxins from her body (diuresis?). He gave her insulin and an antibiotic injection, and has her on a warming bed. He said that the next 48-72 hours are critical and will tell if she is going to make it or not. Of course, I spent last night crying and trying to get my other cat (Maine Coon Marley) to come in and snuggle with me. He's not sure he wants to take her place!

I'm going to try to see her today and take with me a towel that I slept with last night! I'll see if I can get a copy of the lab work also.

Thank you all for your support!
 
Zoey & Carol said:
Also, her body temperature was low.
Click to expand...
That might be due to the pancreatitis.

My heart goes out to you, Carol. I know what it's like to be sick with worry and unable to stop crying. :bighug::bighug::bighug:

It sounds like this different vet is really switched on and working hard to help your precious girl. Are they able to give her pain relief for the pancreatic inflammation?

I hope you'll be able to visit with Zoey today. Prayers for you both continue. Sending more healing vibes across the pond.

(((Zoey & Carol)))


Mogs
.
 
Fingers and paws crossed over here, too.

If you can get copies of the labs and post a copy here then April (@manxcat419) might be able to look at them for you.

(((Carol and Zoey)))

:bighug::bighug::bighug:


Mogs
.
 
Just got back from visiting Zoey. She is feeling and looking a little better. I was able to get her to eat some "high energy" food. The vet said she had eaten a little of it earlier in the day, so that is some good news. I did get the results of the blood tests from yesterday and today and have posted them with my spreadsheet. I did the best I could with the very limited knowledge I have of these tests! Something that wasn't listed on the template was the fPL test which was "abnormal". The vet said there is some progress with some of the tests, but he is still waiting to see if her kidneys will function. They are giving her constant IV fluids but he said they are probably just running right through her at this point.

She is in very good hands. The vet said he wasn't sure she would make it through the night last night. (I wasn't either!) But some progress provides a little optimism. (I think I even heard a little purr from her while I was holding her!)

He said the next 24 hours should tell whether or not her kidneys will start working again.

Thanks so much for your knowledge, support, hugs, and prayers!
 
So glad you got to visit with Zoey, that she's brighter and eating a little. I know she'll have been very happy to see you - and she gave you a little purr! :)

I'm tagging April for you to see whether she can give you more information or suggestions (@manxcat419 - April, if you're online could you look at the lab results in Zoey's spreadsheet for Carol, please?).

Here's a link to the Yahoo support group for CKD kitties. They're quite good at interpreting labs. You should be able to post the link to Zoey's labs for them to check out.

https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

Will post a link or two from Tanya's Site for you tomorrow (have sleep meds on board so I'm about to pass out). The site does stress the importance of giving enough time on IV support to give labs a chance to improve.

Sending more prayers, healing vibes and :bighug::bighug::bighug:.


Mogs
.
 
Last edited:
:bighug::bighug::bighug:...sending prayers for Zoey:bighug::bighug::bighug:

@Critter Mom ... Hi Mogs:).... I am curious about the dosing you referred to with ondansetron.
I have discussed it with @tiffmaxee a while back about some cats being more resistant and often not given a high enough dose. Rico gets 2-3 mg at least 2x a day and 20 minutes after he goes right to the food:cat:(he is about 13 pounds and 19 yrs). It has been my understanding that ondansetron can last up to 4 hours. He also gets cerenia frequently (3-5x a week) in the same gel cap.. (we are all about preemptive strikes over here at the senior home:rolleyes:)

Just wondering if it is a each cat is different type of thing? I have read some stuff regarding kidneys but I think that would be a very high dose. @manxcat419 may have some wisdom to share:)
 
Zoey & Carol said:
Just got back from visiting Zoey. She is feeling and looking a little better. I was able to get her to eat some "high energy" food. The vet said she had eaten a little of it earlier in the day, so that is some good news. I did get the results of the blood tests from yesterday and today and have posted them with my spreadsheet. I did the best I could with the very limited knowledge I have of these tests! Something that wasn't listed on the template was the fPL test which was "abnormal". The vet said there is some progress with some of the tests, but he is still waiting to see if her kidneys will function. They are giving her constant IV fluids but he said they are probably just running right through her at this point.

She is in very good hands. The vet said he wasn't sure she would make it through the night last night. (I wasn't either!) But some progress provides a little optimism. (I think I even heard a little purr from her while I was holding her!)

He said the next 24 hours should tell whether or not her kidneys will start working again.

Thanks so much for your knowledge, support, hugs, and prayers!
Click to expand...
I am so happy you got to see your baby and that you have comfort that she is in good hands. From your post it sounds like at the very least she is feeling better and with lots of prayer and good vibes coming your way she will get stronger and get the toxins flushed from her system. From my experiences getting those toxins out give her the best chance to bounce back. Sending huge hugs and heartfelt healing for the both of you...:bighug::bighug::bighug:
ps--The vet should have canned AD and that may be helpful as is is high in moisture and is mostly organ meat and about 10% carb. Many of mine would eat that strangely when they seemed to need it most. It is also easy to syringe.
:bighug::bighug:
 
@Zoey & Carol this is the first chance I've had to look in here today - and for some reason I didn't get email notification of being tagged. Reading the labs now...I'll let you know any thoughts I have on them as soon as I can.
 
OK. So there is some good news there - her numbers are improving. It can take anything up to 5 full days on 24/7 IV fluids to see the full improvement too, so I would definitely get new labs in another day or so to see how things have settled. I'm assuming they're supplementing her IV with potassium as that's increasing even though the other numbers are coming down. A couple of things to watch out for though. Her phosphorus is still high - high enough to be making her nauseous and not wanting to eat. She really needs to be getting a phosphorus binder with every bite of food. Aluminum hydroxide in powder form (not the nasty mint-flavored gel that vets usually stock) is a good way of doing that as it can be mixed direct into her food so that even if she only eats a little at a time, she's getting binder with all her food. Although it looks on paper as though her phosphorus isn't too far above range, the range includes the expected levels for kittens who always have a higher blood phosphorus level. With CKD, the aim is to keep the level ideally around 4.5, but definitely below 6 so she has a little way to go with that one yet.

Standard ondansetron dosing is 0.5 mg/kg. However, in some cases 1 mg/kg is needed to gain enough effect from the medication. As long as your vet has prescribed the higher dose, it should be fine to give. The higher dose seems more often to be used in cats receiving chemotherapy drugs, but it is a tested dose for cats. So Rico, at around 5 kg, is still not far off the standard dose. For a 10 lb (4.54 kg) cat, 4 mg would indeed be the maximum daily dose, although of course it is always advisable to give the minimum dose that achieves the desired effect.

One thing I would like you to keep an eye on, in conjunction with the vet, is her hydration level to ensure she doesn't become overhydrated from several days of diuresis (yes, that is the right word). Because her levels are currently Stage 4 and she has high end of normal cholesterol and low albumin, there is a risk of nephrotic syndrome - it's rare, but it can occur. Should she start to develop it, the last thing you want is to add a lot more fluids as the syndrome causes fluid to build in the abdomen.

And lastly, I want to remind you that often with a later-stage CKD cat, we treat the cat not the numbers. If she can get to the point where she's eating and feeling OK in herself, even though her numbers may still look bad, it's perfectly possible for her to live quite some time with kidney values that look very poor on paper. Some cats just seem to adjust to those higher numbers once they're past the initial crash, so any decisions on treatment etc need to be made on a quality of life basis - don't write off all hope just because her numbers don't come back to where you'd like them to. :bighug::bighug::bighug:
 
@jayla-n-Drevon you are right about ondansetron dosing. Max wasn’t getting enough when first diagnosed with pancreatitis. He need 2-3 mg. and he was 14 pounds at the time. Some cats need both cer and ondansetron. They work in different ways.

When Tiffany crashed she was on IV fluids for neatly a week at the ER. They ran blood tests every day. As long as her numbers were improving they kept her there. While in the ER I met a lady whose cat was given too much and had fluid overload so make sure it’s a slow drip. Her numbers were off the charts at first. They came down a lot but not as much as I had hoped. Still it wasn’t the kidneys but rather lymphoma that caused her passing. As said above treat the cat and not the numbers.
 
Last edited:
I'm going to try to see Zoey again this afternoon. The vet said they would run another blood test today. I will get the results from those tests and post them after I've seen her. I'll also ask him about the food, phosphorus binder and nausea medication. I'm feeling a little more optimistic after reading your posts. Thanks!
 
Hi Carol,

Glad to hear you'll be seeing Zoey this afternoon. As promised, here's the Tanya's Site link:

http://felinecrf.org/is_there_any_hope.htm

The key points made include:

* Assess the labs when the cat has been stabilised.

* Treat the cat, not the numbers (as wisely counselled by April and Elise above).

* Make sure that IV treatment during the acute stage is given for a long enough period.

* Once stabilised, with appropriate treatment lab numbers may continue to show improvement with the right treatments in place following the aggressive therapy to get a CKD kitty through a crisis (may take a few weeks).

In particular check the section "Cat in Crisis: Very High Numbers and/or Receiving Intravenous Fluids (IV)". In this section it stresses the importance of seeking any possible reason(s) that may have triggered the acute problems (infection - e.g. urinary tract/kidney infection; kidney stones; hypertension; dental problems) to see whether acute kidney injury is a factor.

I see from your post yesterday that the pancreatitis test was "abnormal". Was this a SNAP fPL test result (sounds like it)? If yes, it would be a good idea for your vet to run a Spec fPL test (if not already in progress - it needs to be sent to an external lab). The Spec fPL result will give a better picture of the degree of inflammation present in the pancreas.

Keeping up the prayers and sending more positive healing vibes. Please give Zoey a very gentle fuss or two from me.

:bighug::bighug::bighug::bighug:


Mogs
.
 
Last edited:
Zoey & Carol said:
I'm going to try to see Zoey again this afternoon. The vet said they would run another blood test today. I will get the results from those tests and post them after I've seen her. I'll also ask him about the food, phosphorus binder and nausea medication. I'm feeling a little more optimistic after reading your posts. Thanks!
Click to expand...

More hugs to you and Zoey.
 
jayla-n-Drevon said:
we are all about preemptive strikes over here at the senior home:rolleyes:
Click to expand...
Nowt wrong wi' pre-emptive strikes, chuck! I'm all for 'em. :)

After the above responses, are you OK on the ondansetron dosing front now, Jayla?

FWIW, if Saoirse needed acute nausea support (ETA: non-constipation-related nausea) I'd start with Cerenia and B12 jabs from the vet (can't get Cerenia tablets for cats in the UK). At about 16 hours after the Cerenia jab I'd start Saoirse (10lb) on 2mg q12 ondansetron and keep her on that dose till she was eating steadily. I'd then try to taper down the dose: 1mg AM/2mg PM then either 1mg q12 or 2mg q24, depending on her clinical signs. Any worsening of symptoms and I'd up the dose to 2mg q12 again. As time progressed I moved her to 1mg q12-24 for maintenance. If I got an iffy batch of food I might increase the maintenance dose to 2mg q12 as a prophylactic measure.


Mogs
.
 
Last edited:
Critter Mom said:
Nowt wrong wi' pre-emptive strikes, chuck! I'm all for 'em. :)

After the above responses, are you OK on the ondansetron dosing front now, Jayla?

FWIW, if Saoirse needed acute nausea support I'd start with Cerenia and B12 jabs from the vet (can't get Cerenia tablets for cats in the UK). At about 16 hours after the Cerenia jab I'd start Saoirse (10lb) on 2mg q12 ondansetron and keep her on that dose till she was eating steadily. I'd then try to taper down the dose: 1mg AM/2mg PM then either 1mg q12 or 2mg q24, depending on her clinical signs. Any worsening of symptoms and I'd up the dose to 2mg q12 again. As time progressed I moved her to 1mg q24 for maintenance. If I got an iffy batch of food I might increase the maintenance dose to 1mg q12.


Mogs
.
Click to expand...
Hi Mogs:)
Yes--thank you for checking :cat:

Sometimes I just can't believe my Rico will be 20 this summer.... I remember everything from the exact day I rescued him:smuggrin:
I taper down as well unless I see his signs of what is usually nausea or a vomit episode. Since doing the preemptive strikes we are (knock on wood) having very few episodes. Still playing with his dose of budesonide to keep the IBD in control while not rising his bg and give small amounts of fluids.
I am pretty sure the dog cerenia is the same as the cat-

I also do the B12 and adequan shots weekly.... I clock in to the senior facility after work :rolleyes:
:bighug:

Been thinking of you all day Carol --I hope you have a good visit:bighug:
 
Thanks, Mogs. It was a SNAP fPL test. I will add that to the list of questions I have for the vet today. I'm so glad I took her to this clinic. We have a rescue dog who needed two knee surgeries a couple of years ago, and this clinic performed them. He's doing great! The only problem is the clinic is about 20 miles from my house!
 
Visited with Zoey again, and she is eating more and looking better! They had not done the blood test at that time, but I just got a call from the vet. I didn't get the whole blood test, but he gave me the most important information over the phone. I posted it on the spreadsheet. Her creatinine is down to 3.9. Still too high, but a big decrease from over 11. BUN is still high but down to 89. Phosphorus is still a little high@ 9.8 He is going to start her on some aluminum hydroxide. And an added bonus, at +8 her BG is 100! She hasn't been that low for a while. He thinks she may be able to come home tomorrow. I will have to watch her carefully and she may need to come in for diuresis again, but now that I've seen how it works, I'm comfortable with that.

I'll let you know if she gets to come home! Thanks for all of the kind words and advice. I'm registered with the CRF Group on Yahoo, so I'm sure I'll learn lots more about how to deal with this. Diabetes and kidney disease - whew! I'm learning way more about medicine than I ever wanted to know! I'm a retired English teacher. Math and science were not my forte!
 
I'm really glad you took her there too, Carol. :) The team there seem really responsive and keen to do all they can to help their patients. It's actually quite frightening when circumstances lead one to realise just how much variation there can be in treatment approach/veterinary expertise from clinic to clinic (and even from vet to vet within a given practice).

:bighug:


Mogs
.
 
Last edited:
That new set of numbers is looking way better, Carol. :) That sort of drop when the IV fluids really kicked in was exactly what I was hoping to see. I think with her creatinine settling around 3.9, the vet may well want you to give sub-q fluids at home long-term. But if you can give insulin, you can learn to give sub-q. And the aluminum hydroxide should help her to feel better each day as her phosphorus level comes down.
 
What an encouraging update, Carol. And the best bit?

Zoey & Carol said:
she is eating more and looking better!
Click to expand...
Numbers schmumbers. It's all about the cat! :)

((((((((Zoey))))))))

I'm so pleased that Zoey is responding to her treatment. :) Blessings to her veterinary team and, most of all, to her wonderful mama!

((((((((Carol))))))))


Mogs
.
 
I am picking up Zoey in about 2 hours. I spoke to the vet early because he will be busy when I pick her up. He is going to run one more round of tests before she leaves, so I will post those numbers when I get them. He said she is eating KD food, both dry and canned. I'm going to buy some canned for her to eat at home. She is getting aluminum hydroxide 3 / day, but it sounds like it is a gel. I won't be able to do the mid-day gel every day, but someone stated there is a powder form? The vet doesn't have that available. Is there somewhere I can buy it?

He is also giving me an antibiotic to give her. Apparently on top of everything else, she had a bladder infection! He said her BG numbers have been pretty good at 1.5 units of ProZinc, so I'll stay with that and try to check her midday when I can. He wants her back in a week for the whole day to check her numbers and give her fluids if she needs them. At that time I'll ask him about Sub Q if it looks like it might be necessary.

She was a very sick kitty, so I think this vet is a miracle worker! I'll let you know over the weekend how she's doing. (She was also down to 6 1/2 pounds when I took her in.)

Thank everyone for their caring and advice. I know this is not a short-term problem and that it adds another layer to her care. But I'm willing to take this on and do the best I can for her for as long as she is with me!
 
Zoey is blessed to have such a loving and dedicated mama! :)

I've just posted a thread on Feline Health asking members to make recommendations on where to buy powdered aluminium hydroxide (Al OH). Here's a link to the thread:

http://www.felinediabetes.com/FDMB/...nium-hydroxide-for-phosphorus-control.189171/

With the powdered AlOH you should be able to mix it into wet food for Zoey and leave some out for her to eat any time you need to be away from the house.

Re the bladder infection, that is one of the things mentioned on Tanya's Site that can sometimes be the cause of an acute kidney injury.


Re the food, I wonder whether it might be an idea to get a small bag of the k/d Dry food as well as the canned version? It might be helpful to ask the vet/vet techs who have been looking after Zoey how much she ate of the wet and the dry as a guide. (I'm suggesting this as a 'belt 'n' braces move so that you've got as many weapons in your home nursing arsenal as possible to help Zoey maintain momentum. If she eats well on the canned that'll be great but the dry would be there for a fallback. If you don't need to open the bag of dry I think I've read here that Hill's offer some sort of refund guarantee for their prescription foods so you may be able to return it.)

REALLY IMPORTANT!!!

In addition to the food and the antibiotic Rx, I can't recommend strongly enough that you make sure the vet gives you a prescription for anti-nausea medication and an appetite stimulant (assuming not contraindicated) to make sure that Zoey continues to be able to eat well when she gets home. She may not need the meds but it is much safer to have them to hand at home so that you can give Zoey a little support straight away should she show any signs of nausea again. (It is far easier - and safer - to keep a nauseated kitty eating with appropriate support than trying to get a completely inappetent cat to start taking food again.) ​

Also, did the vet run a Spec fPL test? Has Zoey been receiving any pain meds for the pancreatic/bladder inflammation? If yes to the latter then I suggest asking the vet about what her needs for pain management will be for the next few days and to prescribe as necessary. (I don't know whether with the CRF buprenorphine may be contraindicated. Metacam would definitely be contraindicated because it's bad for the kidneys.)

When you're getting the lab results make sure that they let you know what Zoey's ketone status is (and getting hold of a supply of ketostix or similar from a regular pharmacy for use at home is very much recommended).

Keep a close eye on Zoey's BG levels because, as the infection clears, her numbers may show further improvement.

I'm so grateful you found such good vets, and I'm thankful to them for helping your darling girl.

Sending scritches for Zoey, :bighug::bighug::bighug: for you, and blessings for you both - plus more prayers for Zoey to continue to make a strong and steady recovery upon her return home. Will look out for updates.


Mogs
.
 
Last edited:
Zoey & Carol said:
I am picking up Zoey in about 2 hours.
She was a very sick kitty, so I think this vet is a miracle worker! I'll let you know over the weekend how she's doing. (She was also down to 6 1/2 pounds when I took her in.)

Thank everyone for their caring and advice. I know this is not a short-term problem and that it adds another layer to her care. But I'm willing to take this on and do the best I can for her for as long as she is with me!
Click to expand...

I am very relieved for you both . Your vet sounds amazing.
 
You can buy the aluminum hydroxide powder under the brand name Phos-Bind from either vetrxdirect or Amazon online. Or you can buy it just as aluminum hydroxide powder from Thriving Pets (also online). The dose does vary depending on which you get as they're slightly different strengths, so once you have it in hand, let me know which you have and what dose of the gel you're giving and I'll help you figure out how much powder to use each day.

I am very, very happy to hear that Zoey is on her way home to you. She, you and the vet have all done a great job in getting her feeling better again. Long may it continue. :bighug::bighug::bighug:
 
Great news. I boug my aluminum hydroxide powder from thrivingpets.com. Look at gveurs if you buy elsewhere to make sure it’s the same.

It looks like you will need to give fluids at home. You can buy them by the case with a pet discount card at Walgreens. Get terumo needles 20 gauge. The harpoons the gets hsvd are not what you want.
 
Hoping that Zoey is settling in well back at home. Please let us know how she's doing when you get a chance, Carol.

:bighug:


Mogs
.
 
Zoey is snuggled on my lap right now. She seems to be doing so much better. She’s using the litter box again and talking to me. She’s eating on her own. She seems to prefer the dry KD so that’s what I’ve been giving her. Her BG last night was 296 before her shot. This morning it was 452. I’m going to check it a couple of times today. She’s getting 1.5 units. I’m going to keep it at that until she goes to the vet next Friday.
I can’t figure out how to get a new spreadsheet for 2018. Can someone help me out?
Thanks so much for your help. I’ll keep everyone updated but I’m so happy to remove the 911 from my post. By the way...Zoey is now worth about $300 per pound!
 
Zoey & Carol said:
By the way...Zoey is now worth about $300 per pound!
Click to expand...
Bargain! :cat:

Zoey & Carol said:
I’m so happy to remove the 911 from my post.
Click to expand...
I just have to do this ---> :D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D

Absolutely thrilled for both of you. And well done, that vet! :cat:

I'm glad you got the dry food as well as the wet.

Looking forward to seeing the latest lab results when you get a chance to add them to your spreadsheet. Talking of which ...

@Marje and Gracie - Could you please help Carol with set-up of a 2018 tab on Zoey's spreadsheet when you have a moment?


Mogs
.
 
Dry k/d is a very high carb food. I believe about 35%. It was kitty crack for Rover. – he wanted to just sit and devour every little bit. The phosphorus binder gel is mainly designed for dogs and contains sweetener. That could be why you are sing the higher number this morning. It's a tough act to juggle kidney disease and diabetes, but it can be done.
 
She's not too interested in food today. A few bites of the KD dry and a few bites of my other kitty's dry food. A lick or two of wet KD. Anything she'll eat at this point is good! I just checked her BG at +6 and it was 306. I gave her some Mirtazapine so that might make her more interested. She is feeling much better than a week ago!
 
I just updated Zoey's labs from the last 2 days. The vet said things are moving in the right direction. I'm a little concerned about her BG being so high. He said to keep her at 1.5 until next Friday when he will do a curve in his office.
 
Hi Carol,

Just had a gander at the labs. Such an improvement! Good to see that phosphorus level came down a bit, too.

The k/d food is quite carby so that will be influencing the BG levels. As a precautionary measure be sure to test daily for ketones in the urine. With variable appetite and new food in the mix it makes things a bit tricky. The most important thing is that Zoey eats. If she needs the k/d food then your vet will be able to help you work her insulin dosing around that. The BG data you gather at home over the next few days will help inform dosing decisions. Needless to say, be sure to call the vet for advice if you're concerned about anything and also post here to see if we can help.

Also, did the vet run a Spec fPL test?

Sorry to hear Zoey's appetite is a bit sluggish today. Is she showing any signs of nausea (useful link to symptom checker here). I see you gave Zoey her mirtazapine about 90 minutes ago. Has it kicked in yet? Also, did the vet prescribe any anti-nausea medication for use alongside the appetite stimulant?

:bighug:


Mogs
.
 
Status
Not open for further replies.
Back
Top