? 1/16 Help with kidney problem

[Really Riley (GA)]

@Wendy&Neko @Marje and Gracie Hope you don't mind that I tagged you - you've been kind enough to answer my questions and give great advice. I took Riley to the vet for a possible ear infection in December, at which time I asked her if there were some type of test for his urine to see how his kidneys are handling the high glucose. She took a urine sample and called me a week later to tell me that she had found granular casts. She said that could mean a kidney infection or kidney failure. She gave me an antibiotic to give him and told me that he would need to take it for one month. At that time she took a blood sample to test for WBC. She called to tell me that the WBC were high and he should be getting subcutaneous fluid in addition to the antibiotic. We have an appointment to have a vet tech show how to do the subcutaneous fluid. Is there something the vet is not telling me here? Is there something else that we should be doing? (And regarding the ear infection - she gave me ear drops that she had concocted which she said contained prednisone. I think, but am not totally certain, that these ear drops may have caused a rise in his blood sugar. So I discontinued.)

 

[Carol in Chicago]

Hi - Would you be able to add the BW results to the labs tab of your SS? That would really help to understand the basis for the vet recommendation to start fluids. It would also be good to understand Riley's weight and how much fluid the vet is recommending to give.

 

[Wendy&Neko]

at which time I asked her if there were some type of test for his urine to see how his kidneys are handling the high glucose. She took a urine sample and called me a week later to tell me that she had found granular casts. She said that could mean a kidney infection or kidney failure.

OK, your vet is rushing things. First of all, you can get Ketodiastix and human pharmacies. Besides testing for ketones, they also test for glucose in the urine and can tell you when your kitty is above renal threshold (where sugar is spilled to the urine). Your goal is to eventually get ot a dose where you don't see sugar in the urine.

Second, to really get a snapshot of how the kidneys are doing, the vet should do a full senior blood panel, and a urinalysis. If the vet goes to Idexx for labs, one of the values they include is the SDMA, a fairly new test that is a good indicator of kidney function. The urine specific gravity from the urine test will also tell you how well Riley is concentrating his urine, thus how effective his kidneys are working. But it's best to do that with a urine sample first thing in the morning. You can even collect the sample at home and take it to the lab for that test. If the vet suspects infection, a culture and sensitivity test should be run on the urine sample, to try to see if there is any bacteria present, and if so, which type of bacteria so they know what antibiotic to treat it with. Which antibiotic are you giving now?

 

[Really Riley (GA)]

Would you be able to add the BW results to the labs tab of your SS? That would really help to understand the basis for the vet recommendation to start fluids. It would also be good to understand Riley's weight and how much fluid the vet is recommending to give

I haven't seen the BW results. I will ask for a copy from the vet's office and add the info to the SS. He weighs 10 pounds - I'll know more about the fluids after his appointment on Thursday.

Which antibiotic are you giving now?

I have no idea what the antibiotic is because it was given to me in a small, plain brown glass container. That bothers me because I'm not sure if the vet has concocted something like the eardrops or did she just mix up a name-brand powdered antibiotic with water. I do have Ketodiastix (or something similar) that show presence of ketones and amount of glucose in urine. I don't measure as often as I should, but when I have there is lots of glucose but no ketones. She evidently did her own labs on the urine for such things as ketones (none), leukocytes, nitrites, protein, pH, blood, etc. because the Urinalysis Report Form her office gave me has her practice name on it. Regarding specific gravity, there is a list of numbers on the report, the last number being 1.030, and after that she added 1.035. None of the numbers is circled so I don't know if she didn't do SG or if she added 1.035 because that's what it is - I have not had the chance to question her on this. She apparently sent some urine out to a lab (ANTECH Diagnostics) to check for bacteria growth and the report shows "no aerobic growth found after 72 hours". She certainly did not send the urine to Idexx. I don't know what she did with the blood that was drawn - I have a receipt from the office visit showing "Abaxis: CBC (Complete Blood Count)" and "Abaxis: Comprehensive Diagnostic Profile". The charges for these are far less than I have paid other vets for blood work. Maybe she did the blood work herself. That would explain why she called me with only the WBC info. I'll find out on Thursday.

 

[Sienne and Gabby (GA)]

Some vets will do in-house labs. They don't have the capability to do the range of tests that would be done if they sent the blood to an outside lab. Antech is one reliable lab, so is Idexx.

SDMA is an easy way to give you an snapshot of what's going on with your cat's kidneys as Wendy said. There are other indicators that are in a blood test -- creatinine, phosphorus, BUN, etc.

If the lab report came back indicating there was no bacterial growth, then your cat is unlikely to have a urinary track infection. It does not rule out a kidney infection though.

 

[Really Riley (GA)]

It does not rule out a kidney infection though

Is there a way to know for sure if it is a kidney infection? Is there another test that could be run? It seems the vet wants to wait until Riley's had one month of antibiotics to be sure there can't be any infection. Is that the only way to handle a possible kidney infection? I don't feel comfortable with what the vet is doing for some reason. Maybe it's because she said "some day you'll find an insulin dose you are comfortable with and then you can test his glucose only once a month". I'm wondering how much experience she has had with this type of thing. Thanks for letting me vent.

 

[tiffmaxee]

Since the urine was sent to Antech, I think she only ran the CGC in house. I hoping she ran a kidney panel but I’m thinking not. I’d call and ask. I’d ask her to emails all lab results she has. Even though she uses Antech, most vets have an IDEXX account as well because they often send blood there to test for pancreatitis. When you return ask that a senior panel with urinalysis be done. If you want the SDMA ask her to send it to IDEXX. Otherwise it can be sent to Antech.

The urine can also be tested for anaerobic growth. I know IDEXX does that test. Antech likely does as well.

 

[Really Riley (GA)]

When you return ask that a senior panel with urinalysis be done. If you want the SDMA ask her to send it to IDEXX. Otherwise it can be sent to Antech.

Thanks so much for the input. I am definitely going to ask her about these things. I don't know what I don't know and that makes it hard to ask her to do what she needs to do. If you think of anything else I should be asking her about, tests she should be running or information she should be giving me, please let me know. By the way, I just remembered something she mentioned to me. She asked if his blood pressure had ever been taken.

 

[Wendy&Neko]

Checking blood pressure is a good idea.

 

[Marje and Gracie]

Is there a way to know for sure if it is a kidney infection? Is there another test that could be run? It seems the vet wants to wait until Riley's had one month of antibiotics to be sure there can't be any infection. Is that the only way to handle a possible kidney infection? I don't feel comfortable with what the vet is doing for some reason. Maybe it's because she said "some day you'll find an insulin dose you are comfortable with and then you can test his glucose only once a month". I'm wondering how much experience she has had with this type of thing. Thanks for letting me vent.

Kidney infections are best diagnosed via ultrasounds. If Riley has a kidney infection, he will need a specific type of antibiotic (Baytril or Zeniquin) for six weeks. Personally, I wouldn’t want my cat on any antibiotics without having a definitive diagnosis. As others have said, the best way to diagnose a urinary tract infection is via cystocentesis and a culture and sensitivity. Kidney infections should be dx via an ultrasound.

I also agree with Wendy and Elise that I would ask for a full senior panel which should include a super chem/cbc/tT4, and a urinalysis. Checking BP is an excellent idea.

BTW, topical steroids “can” cause the BG to rise in some diabetic cats.

 

[tiffmaxee]

That’s good that she asked if he’s ever had his blood pressure taken. Often cats with kidney disease or who are hyper-t have high bp. Max had it for a few years before he was diabetic. I think it’s good to get a baseline with seniors. I asked for a reading and that’s how I find out he had high bp. I wasn’t expextinv that nor was my vet. I will never understand why it’s not standard practice or why so many vets don’t even have the equipment.