2/28 Yum Kidney Failure/Seizure/HOME

Status
Not open for further replies.
MJW

MJW

Very Active Member
Yesterday's: http://www.felinediabetes.com/FDMB/threads/1-27-yum-gi-issues.191840/#post-2140912

Yum is hospitalized for kidney failure. I am starting this at the local vet, so she will be on fluids during the day and I will bring her home at night.

On 1/30 her kidneys were holding their own. Now this.

I am pretty sure I read that cabergoline does not affect the kidneys negatively.

She has been getting high phosphorus food for the past week.

They did in-house labs and she was off the scale so they did dilutions. Maybe her creatinine was 6.
Her hematocrit was down to 23. Her 1/30 labs on her chart weren't bad.
She wouldn't eat this morning at all.
 
I'm so sorry. Are they checking for a kidney infection? Sometimes that can trigger sudden change in kidney values. The best way to diagnose a kidney infection is with an ultrasound.

Tons and tons of prayers....
 
Sending all the vines to you and Yum. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:

I second suspect a kidney infection for sudden changes in numbers. I think Asia had a UTI that turned in to a kidney infection, it went undiagnosed for several months. Lab values didn’t show anything other than increased BUN and creatinine, ultrasound confirmed the suspicion. I know Yum has had some UTIs recently as well, so not a crazy suspicion at all.
 
  • Like
Reactions: MJW
MJW said:
Yesterday's: http://www.felinediabetes.com/FDMB/threads/1-27-yum-gi-issues.191840/#post-2140912

Yum is hospitalized for kidney failure. I am starting this at the local vet, so she will be on fluids during the day and I will bring her home at night.

On 1/30 her kidneys were holding their own. Now this.

I am pretty sure I read that cabergoline does not affect the kidneys negatively.

She has been getting high phosphorus food for the past week.

They did in-house labs and she was off the scale so they did dilutions. Maybe her creatinine was 6.
Her hematocrit was down to 23. Her 1/30 labs on her chart weren't bad.
She wouldn't eat this morning at all.
Click to expand...

This sounds so sudden and with readings that are "off the charts", that I would suspect an acute kidney infection. That hematocrit is not critical, though it is worrisome. Are they administering anti-biotics, just in case it is an acute infection?
 
Kathy and TiTi said:
This sounds so sudden and with readings that are "off the charts", that I would suspect an acute kidney infection. That hematocrit is not critical, though it is worrisome. Are they administering anti-biotics, just in case it is an acute infection?
Click to expand...

Oh, and I forgot to ask, if they are administering fluid iv, or sub-q? It's often recommended that an iv be used in acute cases, because it gets into the cat faster and more evenly.
 
Amy&TrixieCat said:
I'm so sorry. Are they checking for a kidney infection? Sometimes that can trigger sudden change in kidney values. The best way to diagnose a kidney infection is with an ultrasound.

Tons and tons of prayers....
Click to expand...
I drove back there with her food and glucometer and test strips.
They don't believe in using their ultrasound to check for kidney infections.
They will do a urinalysis and send it out for culture.
Her WBC was not elevated.
 
Kathy and TiTi said:
This sounds so sudden and with readings that are "off the charts", that I would suspect an acute kidney infection. That hematocrit is not critical, though it is worrisome. Are they administering anti-biotics, just in case it is an acute infection?
Click to expand...
She can't tolerate Orbax or Zeniquin. She gets severe diarrhea that is hard to cure. They will do a urine culture before administering antibiotics.
 
Kathy and TiTi said:
Oh, and I forgot to ask, if they are administering fluid iv, or sub-q? It's often recommended that an iv be used in acute cases, because it gets into the cat faster and more evenly.
Click to expand...
They said I could not do the fluids at home, and there will be a catheter in a vein that they will tape over when I bring her home overnight.
I guess that indicates fluid iv?
I hope it's not a mistake that I am opting for day treatments so she can be at the familiar clinic during the day and with me at night.
I can change my mind of course if she doesn't respond or when the weekend arrives.
 
I googled cabergoline and renal failure again.
I again did not find it contraindicated for patients with kidney disease.
I did find this:

Get medical help right away if you have any serious side effects, including: chest pain, signs of kidney problems (such as change in the amount of urine, lower back/flank pain).

Also
Extracardiac Fibrotic Reactions
Postmarketing cases of pleural, pericardial, and retroperitoneal fibrosis have been reported following administration of DOSTINEX. Some reports were in patients previously treated with other ergotinic dopamine agonists. DOSTINEX should not be used in patients with a history of cardiac or extracardiac fibrotic disorders.

Fibrotic disorders can have an insidious onset and patients should be monitored for manifestations of progressive fibrosis. Therefore, during treatment, attention should be paid to the signs and symptoms of:

  • Pleuro-pulmonary disease such as dyspnea, shortness of breath, persistent cough or chest pain.
  • Renal insufficiency or ureteral/abdominal vascular obstruction that may occur with pain in the loin/flank and lower limb edema as well as any possible abdominal masses or tenderness that may indicate retroperitoneal fibrosis.
  • Cardiac failure: Cases of valvular and pericardial fibrosis have often manifested as cardiac failure. Therefore, valvular fibrosis (and constrictive pericarditis) should be excluded if such symptoms occur.
On reading this the vet wrote back

I do not suspect a kidney infection since her white blood cell count is normal, but I will get a urine sample from her this afternoon. We can submit it for culture which is the gold standard test to rule out potential kidney (and bladder) infections. That information on fibrotic reactions is interesting. When I get the urine sample I will check out her retroperitoneal space (where the kidneys are located in the abdomen) and look for any indication of fibrosis.
 
MJW said:
They said I could not do the fluids at home, and there will be a catheter in a vein that they will tape over when I bring her home overnight.
I guess that indicates fluid iv?
I hope it's not a mistake that I am opting for day treatments so she can be at the familiar clinic during the day and with me at night.
I can change my mind of course if she doesn't respond or when the weekend arrives.
Click to expand...
If Yum were my cat, I'd want her overnight at least for tonight, the first night. But do they have any overnight staff who can check the catheter?
And yes, they are using the correct protocol.
Again, are they administering anti-biotics, in case this is an acute infection, for there is surely a good chance that it is.
 
  • Like
Reactions: MJW
MJW said:
I googled cabergoline and renal failure again.
I again did not find it contraindicated for patients with kidney disease.
I did find this:

Get medical help right away if you have any serious side effects, including: chest pain, signs of kidney problems (such as change in the amount of urine, lower back/flank pain).

Also
Extracardiac Fibrotic Reactions
Postmarketing cases of pleural, pericardial, and retroperitoneal fibrosis have been reported following administration of DOSTINEX. Some reports were in patients previously treated with other ergotinic dopamine agonists. DOSTINEX should not be used in patients with a history of cardiac or extracardiac fibrotic disorders.

Fibrotic disorders can have an insidious onset and patients should be monitored for manifestations of progressive fibrosis. Therefore, during treatment, attention should be paid to the signs and symptoms of:

  • Pleuro-pulmonary disease such as dyspnea, shortness of breath, persistent cough or chest pain.
  • Renal insufficiency or ureteral/abdominal vascular obstruction that may occur with pain in the loin/flank and lower limb edema as well as any possible abdominal masses or tenderness that may indicate retroperitoneal fibrosis.
  • Cardiac failure: Cases of valvular and pericardial fibrosis have often manifested as cardiac failure. Therefore, valvular fibrosis (and constrictive pericarditis) should be excluded if such symptoms occur.
On reading this the vet wrote back

I do not suspect a kidney infection since her white blood cell count is normal, but I will get a urine sample from her this afternoon. We can submit it for culture which is the gold standard test to rule out potential kidney (and bladder) infections. That information on fibrotic reactions is interesting. When I get the urine sample I will check out her retroperitoneal space (where the kidneys are located in the abdomen) and look for any indication of fibrosis.
Click to expand...
Good. s/he sounds very open to techniques. It is telling that her WBS count is normal, and the RBS lowering is also atypical of an acute infection. Still the sudden onset, history of UTIs, and "off the charts" values are suggestive of a kidney infection.
However, it's also possible that Yum was compensating and compensating for kidney problems, and then crashed when compensation no longer worked.
Whichever it is, you can get the values down with the proper procedures. The main goal now is to nurse her thru this crisis. :bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
Kathy and TiTi said:
If Yum were my cat, I'd want her overnight at least for tonight, the first night. But do they have any overnight staff who can check the catheter?
And yes, they are using the correct protocol.
Again, are they administering anti-biotics, in case this is an acute infection, for there is surely a good chance that it is.
Click to expand...
They can't support iv fluids overnight at my local vet. I will pick her up around 5 pm and take her back in the morning.
I will fret over this decision. They really care about Yum there.

They have not automatically started antibiotics because of Yum's past history. She develops severe diarrhea immediately. They could give her a shot of convenia.
I don't think she suffers side effects with convenia.
I believe they will call me after the urinalysis at 3 pm (when they will check her blood glucose).
 
Asia’s WBC were also normal, except when she had a UTI, from what I recall, if the infection is too far up there, it may not show up in a culture. Nothing cultured for Asia either, but her renal pelvis was dilated on the ultrasound. They have other antibiotics they can use if she doesn’t tolerate the first choice ones like zeniquin.

From Tanya’s:

“Even if you suspect that your cat might have an infection, it is quite common for tests to indicate that this does not appear to be the case when in fact one is present. Unfortunately not every vet accepts that this may happen. One human study,Establishment of a persistent Escherichia coli reservoir during the acute phase of a bladder infection(2001) Mulvey MA, Schilling JD & Hultgren SJ Infection and Immunity 69(7) pp 4572-9, found that in some cases the bacteria that cause urinary tract infections can burrow so deep into the bladder lining that they cannot be detected in the usual tests. In a later (2004) study reported byScience Daily, researchers found that the bacteria commonly involved in UTIs pass through four distinct developmental stages, including a dormant stage in some cases, which may help explain why UTIs often recur.

It is also quite common for nothing to grow in a culture if the cat has pyelonephritis rather than a lower urinary tract infection, particularly if the infection is chronic rather than acute. Some types of bacteria do not grow in a culture, or levels are too low to measure easily. Pyelonephritis in small animals (2016) Brown SA Merck Veterinary Manual says of chronic pyelonephritis "Although abnormalities in the urinalysis are present, they are often less dramatic than with acute kidney infection. A single urine culture can be negative if bacterial numbers are low."

http://www.felinecrf.org/pyelonephritis_utis.htm
 
Kathy and TiTi said:
This sounds so sudden and with readings that are "off the charts", that I would suspect an acute kidney infection. That hematocrit is not critical, though it is worrisome. Are they administering anti-biotics, just in case it is an acute infection?
Click to expand...
Yum's hematocrit was 28 on 1/30 at IDEXX and 23 today in-house. She gets a weekly shot of cyanocobalamin. She is due for her shot tomorrow.
 
Stacy & Asia said:
Asia’s WBC were also normal, except when she had a UTI, from what I recall, if the infection is too far up there, it may not show up in a culture. Nothing cultured for Asia either, but her renal pelvis was dilated on the ultrasound. They have other antibiotics they can use if she doesn’t tolerate the first choice ones like zeniquin.

From Tanya’s:

“Even if you suspect that your cat might have an infection, it is quite common for tests to indicate that this does not appear to be the case when in fact one is present. Unfortunately not every vet accepts that this may happen. One human study,Establishment of a persistent Escherichia coli reservoir during the acute phase of a bladder infection(2001) Mulvey MA, Schilling JD & Hultgren SJ Infection and Immunity 69(7) pp 4572-9, found that in some cases the bacteria that cause urinary tract infections can burrow so deep into the bladder lining that they cannot be detected in the usual tests. In a later (2004) study reported byScience Daily, researchers found that the bacteria commonly involved in UTIs pass through four distinct developmental stages, including a dormant stage in some cases, which may help explain why UTIs often recur.

It is also quite common for nothing to grow in a culture if the cat has pyelonephritis rather than a lower urinary tract infection, particularly if the infection is chronic rather than acute. Some types of bacteria do not grow in a culture, or levels are too low to measure easily. Pyelonephritis in small animals (2016) Brown SA Merck Veterinary Manual says of chronic pyelonephritis "Although abnormalities in the urinalysis are present, they are often less dramatic than with acute kidney infection. A single urine culture can be negative if bacterial numbers are low."

http://www.felinecrf.org/pyelonephritis_utis.htm
Click to expand...
Oh dear. Should I second guess the junior vet already?
I will send them your post.
 
MJW said:
Yum's hematocrit was 28 on 1/30 at IDEXX and 23 today in-house. She gets a weekly shot of cyanocobalamin. She is due for her shot tomorrow.
Click to expand...
In-house and IDEXX results often do not match. I'd be inclined, if I could afford it, to have an IDEXX value. But that's a big " if".
 
  • Like
Reactions: MJW
MJW said:
Oh dear. Should I second guess the junior vet already?
I will send them your post.
Click to expand...
I think you might want to take in a copy of the report Beth found. In such situations, I often say, Well, I understand what you're saying, but I'm very worried, so can you, please, just humor me, and start some antibiotics. This is said after s/he's read the material.
 
Kathy and TiTi said:
In-house and IDEXX results often do not match. I'd be inclined, if I could afford it, to have an IDEXX value. But that's a big " if".
Click to expand...
I can request that. You don't think it will take too much blood? I think they have to test her blood again tomorrow to check progress. The IDEXX result has a 1 day turnaround. In-house it is 15 minutes. But you're right, I have seen questionable results in-house.
 
They did an ultrasound of her kidneys to check for cabergoline related fibrosis. They didn't see any evidence for fibrosis. I guess they looked for signs of infection too, but she didn't mention that.
Yum peed right before they took her out so no urinalysis yet.
Her BG was 91 at AMPS+8.5.
 
MJW said:
I can request that. You don't think it will take too much blood? I think they have to test her blood again tomorrow to check progress. The IDEXX result has a 1 day turnaround. In-house it is 15 minutes. But you're right, I have seen questionable results in-house.
Click to expand...
Well, not necessarily questionable ( though it is possible) , just different. You are comparing apples to oranges, and you need to compare oranges to oranges. You might want to, get their check in-house, because it will compare the results that the same machine gets. I'd also get the IDEXX, because it is more accurate. No, it won't be too much blood taken.
 
  • Like
Reactions: MJW
I've requested the extra IDEXX blood draw. Thanks.
I should probably switch to SLGS from TR while she is hospitalized and not eating.
 
Wendy&Neko said:
What part of TR wouldn't work for you? I did TR with Neko when she was inappetant. You can always raise the reduction point a bit if you want, that's what I did at times. Don't forget to ask for ondansetron today.
Click to expand...
How did you bring her BG up when she went hypo? Just Karo syrup in the mouth? I kind of wish I had done that instead of feeding her high phosphorus high carb foods.
They gave her a half a pill of cerenia instead of the Ondansetron. (I had been giving 1/4 pills.). It was late when I asked for it. We'll see.
 
The last time Gizmo was hospitalized with panc after 3 days of not eating on his own and calling me in to force feed because he wouldn't let the techs near him, they allowed the over night home releases. Same as what is planned for Yum. They left the catheter in. I would pick him up after work and take him back in the morning. Gizmo did very good on this plan. This was pre FD so that wasn't in the mix. I would offer him any of servral foods and then force feed. By the 2nd night he was eating a bit on his own and the 4th night he finished a 3 oz can in one sitting.

Praying for you and Yum :bighug:
 
There were bacteria in Yum's urine (rods and cocci)!!! Maybe her kidneys will bounce back some when we cure the infection.
They sent it out for culture. They gave her a shot of convenia in the meantime, which she has tolerated well in the past.
She has had such bad reactions to other antibiotics in the past they are worried about treating her with the wrong one.
I will take her back for more IV fluids early in the morning. They gave her subq fluids for overnight.

Their in-house bloodwork machine is an IDEXX. So they feel it gives results comparable to the lab.
They will do the SDMA tomorrow.

Thank you everyone her for all your suggestions and support. I thought it was all over this morning.
 
Last edited:
LizzieInTexas said:
The last time Gizmo was hospitalized with panc after 3 days of not eating on his own and calling me in to force feed because he wouldn't let the techs near him, they allowed the over night home releases. Same as what is planned for Yum. They left the catheter in. I would pick him up after work and take him back in the morning. Gizmo did very good on this plan. This was pre FD so that wasn't in the mix. I would offer him any of servral foods and then force feed. By the 2nd night he was eating a bit on his own and the 4th night he finished a 3 oz can in one sitting.

Praying for you and Yum :bighug:
Click to expand...
Thank you for describing your experience. I have been fretting about my decision to bring her home. She is very happy to be here.
She walks funny with the catheter, wrapped in a pretty purple stretch bandage. I hope she can get comfortable.
They haven't advised me to force feed her yet, since she ate a little yesterday.
 
I suggest leaving food out (free feed). Put is in close proximity to her but not in her face. Same with water. Also move the LB close (same room).

Are you using phos binder? If so, let her eat anything at this point. Got to get her eating. But will defer to others advise. Petco now carries Tiki Cat mousse (zero carb). That is a good one. The a/d is another (6%). Gizmo lived on it for about two weeks. A/D is rx and you need a prescription of get it from the vet office. Both are low phos also.
 
For future reference...

WERUVA Cats in the Kitchen pouch Chick Magnet is a good medium carb food.

16% carb, 157 phos and has really good gravy. Not cheap but you don't use it often and I put it in the fridge for a few days in case I need it again.
 
  • Like
Reactions: MJW
I used Chick Magnet with Neko. I also had some Weruva Grandma's Chicken Soup around, it's over 20% carbs and renal friendly with no wheat which Neko's GI didn't like. But Neko was carb sensitive, Chick Magnet was usually enough. I did a drop of karo/syrup on food if below 40.

Glad Yum is home. :bighug:
 
  • Like
Reactions: MJW
As usual praying for Yum. Shocked to read what's been going on. Sounds like you're doing the right things and we always second guess and blame ourselves. Remember you would never do anything or make any decision that would do any harm. You make the decision based on what is best at the time. Kisses for sweet Yum
 
It sounds like the infection was caught early. Hope the fluids help and she bounces back. I'm glad she will be comfortable at home with you tonight and you are confident in the care from your vet. Sending vines and prayer for a quick recovery!
 
  • Like
Reactions: MJW
downloadfile-3.png
FB_IMG_1516299285274.jpg
downloadfile-3.png
 
  • Like
Reactions: MJW
Status
Not open for further replies.
Back
Top