Bloodwork came back with possible signs of early CKD

[Nicole and Mochi]

Hi everyone, we got the full bloodworks panel back from the vet that we had gotten Mochi the day we found out she had diabetes. The vet had some pretty upsetting things to relay, including the fact that her creatinine was elevated at 1.8 vs the normal 1.5. They checked her urine concentration's gravity and hers was on the lower end at 1.022 vs the normal 1.035. The said that this was consistent with early kidney disease, but that the elevations were mild at this time.

I don't know what to do or what anything means anymore. We just found out that she's diabetic and are taking the steps to change her lifestyle and diet.. We had some small victories today too were super hopeful that things were going to get better.. but now we have even more stuff to worry about including more expensive tests (vet quoted us $1100 for ultrasound and blood pressure check) and food that I can't afford.. I'm so lost and upset. Mochi deserves only the best but I don't have those resources. I know that this is a diabetic group, but has anyone got any experience with this in conjuction to a sugar cat? Where do I go from here? If she's going to keep steadily declining... what do I do, I'm so devastated, she's literally all I have here..

[edit]: not to mention hyperthyriodism was mentioned in the email. This is so much..

 

[Bron and Sheba (GA)]

Can you post the lab results for us to see.?
If the vet has not emailed them to you ask him to do so. They are yours and you have paid for them so I’m sure he will. If you can copy and paste them into this space we can see them.
Quite a few of our kitties have early CRD. The best thing you can do is get the diabetes under control so that any pressure is taken off the kidney. My Sheba had early CRD and I put her on a low phosphorus diet and it did not progress any further.
And there is no need to feed expensive prescription food for the CRD. If it is early CRD you may need to feed a low phosphorus food and we can help you with that. There are foods available from the pet store for that.

Here is your first thread for continuity https://www.felinediabetes.com/FDMB/threads/new-member-7-18.292257/#post-3194307

 

[Nicole and Mochi]

Can you post the lab results for us to see.?
If the vet has not emailed them to you ask him to do so. They are yours and you have paid for them so I’m sure he will. If you can copy and paste them into this space we can see them.
Quite a few of our kitties have early CRD. The best thing you can do is get the diabetes under control so that any pressure is taken off the kidney. My Sheba had early CRD and I put her on a low phosphorus diet and it did not progress any further.
And there is no need to feed expensive prescription food for the CRD. If it is early CRD you may need to feed a low phosphorus food and we can help you with that. There are foods available from the pet store for that.

Here is your first thread for continuity https://www.felinediabetes.com/FDMB/threads/new-member-7-18.292257/#post-3194307

Yes, I've posted her labs on a separate tab on her sheet right here: https://docs.google.com/spreadsheets/d/17FxtVMklLwcMgTJuiRIfDv2kReDn9wuzx48vBnT1fkM/edit?usp=sharing

Right now I'm looking into transitioning Mochi from eating Tiki Cat and Fancy Feast to Tiki Cat and Weruva Wx Phos Focused. I heard that Wx or a few other Weruva products are pretty good at keeping low phosphorus levels in their food.

And just to clarify for future reference, should I only be posting any new updates in my first thread from now on instead of making a new one?

 

[Daphne and Aida]

Hi Nicole,
For CKD the best info is on Tanya's website: https://www.felinecrf.org/

For concurrent CKD and diabetes, Tanya's site states: "If you are dealing with both diabetes and CKD, it is more important that the diabetes should be regulated, and in fact, once this is achieved, you may find the CKD improves too."

Her labs show normal phosphorus levels, which means that you do not necessarily need to feed a renal food yet. The calcium is on the high limit, and you don't want her to get hypercalcemia.
A list of US commercial food that has both controlled carbs and phosphorus: https://docs.google.com/spreadsheets/d/1E_HZnTcJdsr20Gpivo2ID1KQ9wlZAe1Xy3LDTDVRofU/edit?gid=0#gid=0

The CKD group is amazingly helpful, some have experience with diabetes & CKD: http://felinecrf.org/tanyas_support_group.htm
I strongly recommend that you join!

From what I see in the labs, her tT4 (total T4) is within range. Free T4 isn't a reliable diagnostic tool for hyperthyroidism, it can increase due to non-thyroidal issues.

Why did your vet want to do the ultrasound?
BP SHOULD be measured, it is essential to see if there is hypertension in order to start treatment (typically with amlodipine). BP measurement shouldn't cost more than $100, even in the US.

 

[Larry and Kitties]

The labs includes:
Free T4 normal is 10-50 pmol/L while measured was >100.0
Does your vet say anything about that?
The labs reported that
tT4 normal is 0.8-4.0 ug/dL while measure was within normal as 3.3

 

[Daphne and Aida]

The labs includes:
Free T4 normal is 10-50 pmol/L while measured was >100.0
Does your vet say anything about that?
The labs reported that
tT4 normal is 0.8-4.0 ug/dL while measure was within normal as 3.3

Free T4 isn't a good diagnostic tool for hyperthyroidism in itself because it increases with non-thyroidal issues. It could be >100 due to diabetes, to CKD, or something else.
tT4 is the one showing euthyroidism or hyperthyroidism.
Since tT4 is within range, there is no reason to suspect occult hyperthyroidism.

How is Mochi behaving? If he's constantly hungry, playing, being hyperactive, having difficulty sleeping, miaowing, losing weight, then you could suspect hyperT. If he's himself, no reason to suspect it.

 

[Nicole and Mochi]

Free T4 isn't a good diagnostic tool for hyperthyroidism in itself because it increases with non-thyroidal issues. It could be >100 due to diabetes, to CKD, or something else.
tT4 is the one showing euthyroidism or hyperthyroidism.
Since tT4 is within range, there is no reason to suspect occult hyperthyroidism.

How is Mochi behaving? If he's constantly hungry, playing, being hyperactive, having difficulty sleeping, miaowing, losing weight, then you could suspect hyperT. If he's himself, no reason to suspect it.

Thank you for the resources! I applied yesterday but didn't see the email till now. Just emailed them back and am hoping that it'll be reviewed sooner rather than later.

To answer some questions:
1.Why did your vet want to do the ultrasound?

This is what my vet emailed me:

"If you are interested in getting the best evaluation of Mochi's kidneys I would also recommend getting her in for an ultrasound ($901) so that we can visually evaluate her kidneys/urinary tract and look for evidence of kidney stones, polycystic kidney disease, or any other lesions that might affect prognosis or treatment. I would also recommend a urine culture ($285) collected via a sterile ultrasound-guided cystocentesis ($35) to screen for any occult urinary tract infection that might be damaging the kidneys."​

She also mentioned that:

"The abnormalities of note are increased glucose in her blood and urine (consistent with her recent diabetes diagnosis), an increased kidney value (creatinine), and an increased thyroid level (Free T4). Creatinine should normally remain below 1.5 and Mochi's is 1.8. When we see elevated kidney enzymes we want to differentiate kidney disease from artificial enzyme elevation due to dehydration. This involves assessing the urine concentration (specific gravity). Cats with good urine concentrating ability should have a specific gravity greater than 1.035 and Mochi's is only 1.022 which is abnormally low. This is consistent with early kidney disease which is very common in older cats."​

I'm assuming that my vet wants to do the ultrasound sooner than later so that we can get the full story and devise a treatment plan going forward. Unfortunately, as you can see by the price associated with each test, I can't afford any of those things after having used up a lot of my financial resources to pay for Mochi's diabetes Dx and upfront costs. I was also going to ask if any of these heightened values could be because of her diabetes/stress being at the vets.​

2. BP measurement:

I'm assuming BP is her blood pressure. As mentioned, I'm struggling with finances at the moment so my plan is to get paid soon and will try to get her in for the BP measuring. It should be within the next 3 weeks. I also want to give Mochi some time to relax after having been in and out of the vets last week, as well as getting used to our new norm of insulin/BG testing. From the price that my vet sent, its about $91 to have it done.​

3. How is Mochi behaving?

She's acting the same as she has been before. She's a very calm girl who tends to like to sit around and nap most of the day away. She isn't lethargic and is alert when I do wake her up. One thing that I did notice recently after having started her insulin is that she's a little more active when playing. The reason why I brought her to the vet initially was because she had trouble with her gait/back legs, which I read was common in diabetes. Before starting insulin, she was struggling to walk and her hind legs would slip out forward and to the side from under her. She'd also flop more and almost completely stopped chasing after toys. After insulin, she's been playing with me more and was even able to do a short distance sprint after her toy. Even her gait seems to have improved. It's not by much, but her swaying has definitely subsided. This may not be a sign of improvement because of insulin (maybe it was the toy that interested her and she was far more ready to chase after it lol), but I'd like to be hopeful that she's responding well to treatment.
​

​

 

[Daphne and Aida]

Thank you for the resources! I applied yesterday but didn't see the email till now. Just emailed them back and am hoping that it'll be reviewed sooner rather than later.

To answer some questions:
1.Why did your vet want to do the ultrasound?

This is what my vet emailed me:

"If you are interested in getting the best evaluation of Mochi's kidneys I would also recommend getting her in for an ultrasound ($901) so that we can visually evaluate her kidneys/urinary tract and look for evidence of kidney stones, polycystic kidney disease, or any other lesions that might affect prognosis or treatment. I would also recommend a urine culture ($285) collected via a sterile ultrasound-guided cystocentesis ($35) to screen for any occult urinary tract infection that might be damaging the kidneys."​

She also mentioned that:

"The abnormalities of note are increased glucose in her blood and urine (consistent with her recent diabetes diagnosis), an increased kidney value (creatinine), and an increased thyroid level (Free T4). Creatinine should normally remain below 1.5 and Mochi's is 1.8. When we see elevated kidney enzymes we want to differentiate kidney disease from artificial enzyme elevation due to dehydration. This involves assessing the urine concentration (specific gravity). Cats with good urine concentrating ability should have a specific gravity greater than 1.035 and Mochi's is only 1.022 which is abnormally low. This is consistent with early kidney disease which is very common in older cats."​

I'm assuming that my vet wants to do the ultrasound sooner than later so that we can get the full story and devise a treatment plan going forward. Unfortunately, as you can see by the price associated with each test, I can't afford any of those things after having used up a lot of my financial resources to pay for Mochi's diabetes Dx and upfront costs. I was also going to ask if any of these heightened values could be because of her diabetes/stress being at the vets.​

2. BP measurement:

I'm assuming BP is her blood pressure. As mentioned, I'm struggling with finances at the moment so my plan is to get paid soon and will try to get her in for the BP measuring. It should be within the next 3 weeks. I also want to give Mochi some time to relax after having been in and out of the vets last week, as well as getting used to our new norm of insulin/BG testing. From the price that my vet sent, its about $91 to have it done.​

3. How is Mochi behaving?

She's acting the same as she has been before. She's a very calm girl who tends to like to sit around and nap most of the day away. She isn't lethargic and is alert when I do wake her up. One thing that I did notice recently after having started her insulin is that she's a little more active when playing. The reason why I brought her to the vet initially was because she had trouble with her gait/back legs, which I read was common in diabetes. Before starting insulin, she was struggling to walk and her hind legs would slip out forward and to the side from under her. She'd also flop more and almost completely stopped chasing after toys. After insulin, she's been playing with me more and was even able to do a short distance sprint after her toy. Even her gait seems to have improved. It's not by much, but her swaying has definitely subsided. This may not be a sign of improvement because of insulin (maybe it was the toy that interested her and she was far more ready to chase after it lol), but I'd like to be hopeful that she's responding well to treatment.
​

​

I'm really not an expert regarding diabetes, my Aida has only recently been diagnosed so I can not claim to understand the relation between back leg weakness and diabetes. From CKD, I know that low potassium levels can provoke it, but her potassium is good, so it's definitely not that!

I'm sure that you'll get excellent advice in Tanya's group, I'm there too and they have been precious for my Feloro's CKD. I'm pretty confident that they'll advise you to prioritize BP (yes! Sorry, it is blood pressure!), as CKD often provokes hypertension, and hypertension worsens CKD. It's ok to wait 3 weeks for it.

Overall, her blood results are very good, she's not in any advanced stage, so don't worry. For now, diabetes. In 3 weeks BP. And from then on, Tanya's and this group's guidance. It will all turn out well for Mochi!

And, in my opinion, you can strike hyperthyroidism out. If you really want to be sure you could also ask the worldwide hyperT guru Dr. Marc Peterson on his website (https://animalendocrine.com/contact-us/contact-us/), he probably won't answer personally but I got very good advice and a precious address for treating Feloro in Europe.

 

[Bron and Sheba (GA)]

I’m going to ask @Suzanne & Darcy to have a look at your lab results

 

[Nicole and Mochi]

I’m going to ask @Suzanne & Darcy to have a look at your lab results

Thank you Bron!!