? 9/23 Sister PMBG at +4 75: BUN Question

Ann & Sister

Ann & Sister

Member Since 2021
https://www.felinediabetes.com/FDMB/posts/2856504/

Sister actually hit 75 at PMBG +4 yesterday which was nice to see.
Her bloodwork results (pre-dental exam) show elevated BUN.
I am thinking it is the high protein diet (Dr. Elsey's/Epigen90) which was started this summer.
Would you agree?

I am getting her a urinalysis this afternoon as the vet says "there is some increased risk of worsening kidney function with anesthesia so we want to know as much as we can about that function before doing her dental."

I added the new bloodwork numbers to her SS under Labs.
Can anyone take a look?
Thanks!
 
BUN is higher on higher protein but you need to look at creatinine and urine usg as well. Would you add her labs to your ss please?

I’ll look now.
 
Last labs you didn’t list usg. Looks like waiting for results of the urinalysis. The creatinine has gone up quite a bit since last labs too. She MIGHT HAVE VERY EARLY kidney issues starting.
 
tiffmaxee said:
Last labs you didn’t list usg. Looks like waiting for results of the urinalysis. The creatinine has gone up quite a bit since last labs too. She MIGHT HAVE VERY EARLY kidney issues starting.
Click to expand...
I have the May 2021 urinalysis results.
1.031 was the "specific gravity". Did not know where to record that. It is not called usg on the report.
Thanks,
 
The usg was ok in May. It will be interesting to see now. If it’s lower it helps to confirm her kidneys are not 100% but still not bad at all. You can’t base a diagnosis on one set of tests. My vet always retested in a month or two. If she was at all dehydrated they could be normal next time as well.

Do you have a value for phosphorus?
 
It will be important to get that USG and phosphorus to help fill out the picture. It is quite a BUN and creatinine jump. Creatinine is a more reliable indicator. But I definitely agree with Elise about rechecking in a couple of months (any closer together than 30 days is a waste my vet always says.)

Does she drink a lot of water? Is her appetite good?
 
tiffmaxee said:
The usg was ok in May. It will be interesting to see now. If it’s lower it helps to confirm her kidneys are not 100% but still not bad at all. You can’t base a diagnosis on one set of tests. My vet always retested in a month or two. If she was at all dehydrated they could be normal next time as well.

Do you have a value for phosphorus?
Click to expand...
Phos was 4.9 in May.
 
Suzanne & Darcy said:
It will be important to get that USG and phosphorus to help fill out the picture. It is quite a BUN and creatinine jump. Creatinine is a more reliable indicator. But I definitely agree with Elise about rechecking in a couple of months (any closer together than 30 days is a waste my vet always says.)

Does she drink a lot of water? Is her appetite good?
Click to expand...
Sister drinks a lot of water, years before her diabetes diagnosis.
Still drinks more than my other cats and pees more.
Appy is fine.
 
Suzanne & Darcy said:
Didn't they include phosphorus on the blood panel they did a couple of days ago? The May number was fine. I sure hope she's going to be just fine for her dental work! Is it a lot of teeth that need attention or just one or a few?
Click to expand...
The vet suggested the urinalysis this morning after seeing BW results. Just returned from getting that done; results back tomorrow prolly.
Only her upper right back teeth (plaque build-up and red gums, maybe bloody) seem to be the issue.
I hope the dental is a go as well. Really want that taken care of. Her old vet changed her mind about doing it in May--said she needed to get diabetes regulated first.
Thanks,
 
My vet, who is now leaving this clinic, (just when I was beginning to trust...) emailed this morning.
Vet wrote, "Sister's urine is fairly concentrated which shows that the kidneys still have fair function, but given the elevated BUN, the urine should in theory be more concentrated. It is less concentrated than her last urinalysis in May as well."

I am assuming that concentrated urine is good and watery is bad. Is that right??

Tried in vain to get the actual report to add to SS, but it never arrived.

Vet gave me two options since anesthesia "may" worsen kidneys.
One was monitor and retest in 3-6 months. If kidneys worse, do not do dental.
Other option was go ahead with dental.

I think the kidney issues are in early stages, and I want Sister's mouth inflammation to cease.
I am keeping the dental appt for Oct 5. This has been put off long enough.
Do you concur?
Thanks,
 
I know the worse the kidneys get the riskier anesthesia is as it can impact the kidneys. If very early I would not wait if I thought it could make her feel better. Some here have used veterinary dentists but they are much more expensive. I know one who did and I’m not so sure he was any better than a really good vet. It’s a tough call.
While her BUN is elevated her creatinine is just in range. I would probably go ahead with the dental if my cat because if the levels go higher it can impact the kidneys more I think. :bighug:
 
tiffmaxee said:
I know the worse the kidneys get the riskier anesthesia is as it can impact the kidneys. If very early I would not wait if I thought it could make her feel better. Some here have used veterinary dentists but they are much more expensive. I know one who did and I’m not so sure he was any better than a really good vet. It’s a tough call.
While her BUN is elevated her creatinine is just in range. I would probably go ahead with the dental if my cat because if the levels go higher it can impact the kidneys more I think. :bighug:
Click to expand...
I feel the elevated BUN is due to the high protein diet Sister has been on for 2 months. (Elsey's and Epigen90).
This clinic does x-rays as part of the procedure; hopefully they are digital like the dentists use.
But I do not anticipate tooth extractions.
I just cancelled the dental because I do not like the substitute vet.
Now I have to select another unknown vet at that clinic.
Wish Dr. Chang had been honest about quitting BEFORE I had these tests run.
Thanks again.
 
Forgot to answer your question. Healthy cats have very concentrated urine. Dilute means kidney issues. Giving fluids can make the urine dilute.
 
Ann & Sister said:
My vet, who is now leaving this clinic, (just when I was beginning to trust...) emailed this morning.
Vet wrote, "Sister's urine is fairly concentrated which shows that the kidneys still have fair function, but given the elevated BUN, the urine should in theory be more concentrated. It is less concentrated than her last urinalysis in May as well."

I am assuming that concentrated urine is good and watery is bad. Is that right??

Tried in vain to get the actual report to add to SS, but it never arrived.

Vet gave me two options since anesthesia "may" worsen kidneys.
One was monitor and retest in 3-6 months. If kidneys worse, do not do dental.
Other option was go ahead with dental.

I think the kidney issues are in early stages, and I want Sister's mouth inflammation to cease.
I am keeping the dental appt for Oct 5. This has been put off long enough.
Do you concur?
Thanks,
Click to expand...
Yes. Concentrated urine is better than dilute, in general. I agree with you that you should go ahead with the dental now. I have had cats before who needed dental procedures and were not able to have them because of more advanced kidney disease. It’s not a position that you want to be in. Make sure that they plan to put her on IV fluids well in advance of the anesthesia. Then make sure they also plan to keep her on IV fluids for a few hours after she comes out of anesthesia. This will help flush anesthesia drugs out of the kidneys. Also make sure they will be monitoring her blood pressure with the doppler during the anesthesia. It is the drops in blood pressure that can damage the kidneys. Make sure they plan to use Propofol or Alfaxalone as injectable induction drugs because they are excreted by the liver and not the kidneys. There are many other things that the vets can do to make the procedure more safe for Sister. I would ask them their plan so that you can be reassured about the whole thing. The choice of which inhalant drugs to use for maintenance of anesthesia is important, for example - if they plan to use it.

I feel for you. It is nerve wracking. But I think that now is your best chance for a safe procedure.
 
tiffmaxee said:
Forgot to answer your question. Healthy cats have very concentrated urine. Dilute means kidney issues. Giving fluids can make the urine dilute.
Click to expand...
Finally got urinalysis lab report this morning. Keyed in results on SS. The USG is lower than in May.
Dr. Chang said today that the blood in urine is commonly from the needle jabbing her accidentally while taking the specimen. :mad:
Thanks!!
 
Suzanne & Darcy said:
Yes. Concentrated urine is better than dilute, in general. I agree with you that you should go ahead with the dental now. I have had cats before who needed dental procedures and were not able to have them because of more advanced kidney disease. It’s not a position that you want to be in. Make sure that they plan to put her on IV fluids well in advance of the anesthesia. Then make sure they also plan to keep her on IV fluids for a few hours after she comes out of anesthesia. This will help flush anesthesia drugs out of the kidneys. Also make sure they will be monitoring her blood pressure with the doppler during the anesthesia. It is the drops in blood pressure that can damage the kidneys. Make sure they plan to use Propofol or Alfaxalone as injectable induction drugs because they are excreted by the liver and not the kidneys. There are many other things that the vets can do to make the procedure more safe for Sister. I would ask them their plan so that you can be reassured about the whole thing. The choice of which inhalant drugs to use for maintenance of anesthesia is important, for example - if they plan to use it.

I feel for you. It is nerve wracking. But I think that now is your best chance for a safe procedure.
Click to expand...
I know it was not your intent, but I am even more worried than I was before. I am absolutely certain this clinic is not going to allow me to suggest which drugs they use.
I have rescheduled the dental with their "senior" vet who has been there the longest and has great reviews.
No confirmation, but hoping.
I voiced my opinion on Dr. Chang's not revealing that she would not be doing the dental but had me schedule the exam and tests with her.
The front twerp said: "Dr. Chang has no obligation to inform clients about her personal life." :eek:
 
Hi there. I do know that USG can vary from test to test at times. I was just looking over a spreadsheet that I have with many tests that I had done on my cat over a period of more than a year. His USG sometimes went up and down a little. It’s an overall downward trend that would be of concern. Sister may be in the early stages of kidney disease.

That’s correct about blood in the urine. The only way to rule it out would be to get a free catch sample. But you really don’t need that right now. You have enough data to proceed.
 
Ann & Sister said:
I know it was not your intent, but I am even more worried than I was before. I am absolutely certain this clinic is not going to allow me to suggest which drugs they use.
I have rescheduled the dental with their "senior" vet who has been there the longest and has great reviews.
No confirmation, but hoping.
I voiced my opinion on Dr. Chang's not revealing that she would not be doing the dental but had me schedule the exam and tests with her.
The front twerp said: "Dr. Chang has no obligation to inform clients about her personal life." :eek:
Click to expand...
I am so sorry. I always have long discussions with my vet about drugs and conditions and options, etc. she’s always willing to tell me what her plan is. But she knows how interested in this stuff that I am. I had a cat with a heart condition- HCM - and I was so nervous when she needed a dental. My vet went over every thing they were going to do to make it as safe as possible. I’m sorry!!!
 
I just today read that the creatinine can be elevated if fed a high protein meal before testing. That’s why fasting labs are best but that’s hard with a diabetic cat. I think if she has ckd it is early and I would go ahead with the dental if my cat. I would be upset if they will not tell me what they use as far as anesthesia and monitoring. There is a section on dentals so look on the where can I find sticky. My vet uses gas only which others feel is not right. It clears quickly so less effect on the kidneys. Hr does not do the dental himself though but is there and oversees it. That did not give me a warm fuzzy feeling either but I have never had a problem.

Their response about your vet leaving the practice would make me angry as well.
 
I hope you can find a vet that you can have confidence in… I know a lot of people live in areas where they don’t have a lot of choices.
 
Suzanne & Darcy said:
I am so sorry. I always have long discussions with my vet about drugs and conditions and options, etc. she’s always willing to tell me what her plan is. But she knows how interested in this stuff that I am. I had a cat with a heart condition- HCM - and I was so nervous when she needed a dental. My vet went over every thing they were going to do to make it as safe as possible. I’m sorry!!!
Click to expand...
NO WORRIES. I appreciate the insight.
 
You must log in or register to reply here.
Back
Top