? Civie Ming- vetty vines needed and lab work questions

[Beenie (GA)]

Hi
My poor little Ming has a growth in his rectum. He's at the vet now getting it biopsied
I hope its just a polyp. Poor guy has had so many poop and tushy issues I'm almost not surprised.
We had bloodwork done Monday and that showed that his kidney function is not so good. I was hoping for some eyes on all of it. He mostly eats Sheba which isn't too high in phosphorus but this is all new territory for me. Is there anything other than offering extra water to help slow down the disease? I already add water to his wet food. I tested his BG recently a few times because he was drinking frequently not knowing that was a symptom of poor kidney function. BG on my human meter was normal.

Thanks for any feedback guys

 

[Beenie (GA)]

No biopsy needed!! Turns out it was his anal glands. One was very firm and full of a thick toothpaste consistency material..yuck . Both were expressed until empty. All good there!

His blood pressure however was very high. Even sedated it was over 200. Started blood pressure meds today.

 

[Julie and Honey]

Good one problem is better.

Copying @Marje and Gracie, think she is knowledgable on labs? If not she may know who is

 

[Christie & Maverick]

Hi Michelle, nice to see you

Poor Ming! Luckily the anal glands weren't abcessed. Been there, with a long haired kitty many years ago, and that was most definitely yucky. Had a quick peek at the labs, but it has been a while since I had CRF kitties, so my memory on things is a bit fuzzy. I'm sure @Marje and Gracie will be of much more help , but in the meantime...

I see it was Antech lab results, I believe Iddexx runs an SDMA test that helps identify early kidney disease. Might be worth keeping in mind if you need to ask your vet in the future. The microalbuminuria was interesting, I'm curious what Marje says, because the report indicates it would be significant if MA is persistent (3 or more positive results, 2 or more weeks apart). If you don't get repeat high MA, then that means a secondary issue of the kidneys...a systemic disease they mentioned was hypertension...you noted Ming was put on meds because his blood pressure was high. As a side note, I think this may be what I used to see as "proetinurea" in my labs, which is considered in assessing kidney disease. The specific gravity of the urine is low, I think, when was the urine sample taken? I believe early morning USG should be the most concentrated. Have you had any previous labs to compare with? The creatinine is in the higher end of normal, but it can go up and down. Mav has had a few labs, I was worried on one that it had gone up, but then 6 months later it had gone back down again. BUN can be a little higher too if the kitty is slightly dehydrated. I remember a few people telling me seeing the trends is sometimes more important than just one test.

That's all I can think of, I really just wanted to say hi anyway, but you'll have to read through my hopefully somewhat helpful message to see this part ... miss you guys!

 

[Beenie (GA)]

Hi Michelle, nice to see you

Poor Ming! Luckily the anal glands weren't abcessed. Been there, with a long haired kitty many years ago, and that was most definitely yucky. Had a quick peek at the labs, but it has been a while since I had CRF kitties, so my memory on things is a bit fuzzy. I'm sure @Marje and Gracie will be of much more help , but in the meantime...

I see it was Antech lab results, I believe Iddexx runs an SDMA test that helps identify early kidney disease. Might be worth keeping in mind if you need to ask your vet in the future. The microalbuminuria was interesting, I'm curious what Marje says, because the report indicates it would be significant if MA is persistent (3 or more positive results, 2 or more weeks apart). If you don't get repeat high MA, then that means a secondary issue of the kidneys...a systemic disease they mentioned was hypertension...you noted Ming was put on meds because his blood pressure was high. As a side note, I think this may be what I used to see as "proetinurea" in my labs, which is considered in assessing kidney disease. The specific gravity of the urine is low, I think, when was the urine sample taken? I believe early morning USG should be the most concentrated. Have you had any previous labs to compare with? The creatinine is in the higher end of normal, but it can go up and down. Mav has had a few labs, I was worried on one that it had gone up, but then 6 months later it had gone back down again. BUN can be a little higher too if the kitty is slightly dehydrated. I remember a few people telling me seeing the trends is sometimes more important than just one test.

That's all I can think of, I really just wanted to say hi anyway, but you'll have to read through my hopefully somewhat helpful message to see this part ... miss you guys!

Hi Christie!!!
Yes so happy it wasn’t anything sinister.
He has previous labs but last year was the last time and then older than that.
So I should ask for the SDMA testing? I’ll have to look it up, I assume a different type of blood work up. His urine was taken late morning.
My IM vet was most concerned with his blood pressure today. I called my pet sitter who is a vet tech and she’s going to ask her boss if she can borrow her clinics blood pressure monitor (Doppler) so she can get a reading at my house in about 10-14 days. They’ll never get an acurate reading at the vets office. They did take it before sedation, it was high, and when he was sedated it was still high (218) so that was what was so concerning.
Hopefully the meds will bring it down

Thanks for the info. Hope all is well with you and Mav. Give him lots of chin scritches for me

 

[Christie & Maverick]

If they still have a blood sample, maybe they could send it to Idexx for the SDMA? It is a different lab. Just so they don't have to draw blood again. The SDMA wasn't available a bazillion years ago, when I dealt with CRF kitties, but to me, I think it might be worth getting? There's lots of info on Tanya's CRF website, including this on early detection https://felinecrf.org/early_detection.htm

At the very least, you'll have a benchmark.

The hypertension is worrisome, I think @Wendy&Neko knows about this topic. Mav is awesome as usual, I'll be sure to mention to him where the extra chin scritches are coming from

 

[Marje and Gracie]

Hey Michelle

I just got home and am getting kitties settled in for dinner, etc. I’ll be back in a bit and look at the labs for you. I’m glad it was just his anal glands.....those things can really fill up and oh are they nasty!!!

 

[Marje and Gracie]

Christie is correct on her statements.

First, what do we have that leads us to assume he’s in early CKD:

• Low urine specific gravity
• Increased creatinine
• Increased BUN
• Potential proteinuria (but see below...that can be due to high BP)

He’s definitely got high blood pressure and should be on meds. High blood pressure can cause proteinuria and that might be why you are seeing the MA so high. I would discuss with my vet bringing in additional urine samples in the next couple weeks as he’s on medication for high BP and see if that improves the proteinuria. Control of proteinuria is as important as control of phosphorus.

Right now, his phosphorus and calcium levels are good and you want to try and keep the P level down by feeding a lower P food. The lowest are the renal diets but they are poor quality and also are low protein which is not good for a CKD cat. You won’t find a commercial diet as low in P as the renal diets but you want to try and keep the P level less than 200 mgP/100 kcal or less than 1.00% on a dry matter basis.

I would urge you to get on Tanya’s Comprehensive Guide to CKD and start reading. It’s overwhelming so start with Phosphorus Control, hypertension, proteinuria, and anemia. You’ll learn a lot in those sections and it will help you keep his QOL better.

My one CKD cat who had high BP but did not have proteinuria did really, really well over several years with a low dose of amlodipine

BTW, the SDMA is good if you can get it. It is possible there is something else causing the hypertension and so you are seeing it affect kidney values. It would be unusual, but not impossible, If the SDMA is normal and the creatinine is high. However, the low USG is typically a good indicator of early CKD.

 

[Wendy&Neko]

Hi Michelle. Neko first tested 220+ for her blood pressure at the vet. She had to wait a longish time in a barky waiting room due to a vet emergency, then had a tech who was new to the Doppler. Let's just say we called it an epic failure and I wasn't charged. Attempt #2 was at her acupuncture vet, and unfortunately a puppy jumped her kennel. Sigh, bp 180. Next up, her dental vet, Feliway in the room by herself and in the 140's before her dental. So not hyperT, just very much white coat (and dog) syndrome.

She did have proteinuria however, and that was why we tested the bp. You want to know what is causing the proteinuria first. It wasn't high bp, so Neko went on meds. Neko had a urine protein/creatine ratio test done to test her proteinuria. Urine has to be taken via cysto unfortunately.

 

[Christie & Maverick]

Michelle, just wondering too, what the med was for hypertension? Was it Fortekor (benazepril)?

 

[Beenie (GA)]

Christie is correct on her statements.

First, what do we have that leads us to assume he’s in early CKD:

• Low urine specific gravity
• Increased creatinine
• Increased BUN
• Potential proteinuria (but see below...that can be due to high BP)

He’s definitely got high blood pressure and should be on meds. High blood pressure can cause proteinuria and that might be why you are seeing the MA so high. I would discuss with my vet bringing in additional urine samples in the next couple weeks as he’s on medication for high BP and see if that improves the proteinuria. Control of proteinuria is as important as control of phosphorus.

Right now, his phosphorus and calcium levels are good and you want to try and keep the P level down by feeding a lower P food. The lowest are the renal diets but they are poor quality and also are low protein which is not good for a CKD cat. You won’t find a commercial diet as low in P as the renal diets but you want to try and keep the P level less than 200 mgP/100 kcal or less than 1.00% on a dry matter basis.

I would urge you to get on Tanya’s Comprehensive Guide to CKD and start reading. It’s overwhelming so start with Phosphorus Control, hypertension, proteinuria, and anemia. You’ll learn a lot in those sections and it will help you keep his QOL better.

My one CKD cat who had high BP but did not have proteinuria did really, really well over several years with a low dose of amlodipine

BTW, the SDMA is good if you can get it. It is possible there is something else causing the hypertension and so you are seeing it affect kidney values. It would be unusual, but not impossible, If the SDMA is normal and the creatinine is high. However, the low USG is typically a good indicator of early CKD.

Thank you Marje!
I just emailed my IM vet to request the SDMA test. Ming is on an all wet diet and mostly eats Sheba pate which is just slightly above 200 mgP/100 kcal but I will try to find something lower without compromising protein. IM vet feels the MA is high due to the high blood pressure. I guess we'll know for sure once we get it under control with meds and re-check. She prescribed AmLodipine 2.5 mg/once a day.

I will be reading Tanya's Guide this weekend

Thanks again!!

 

[Beenie (GA)]

Hi Michelle. Neko first tested 220+ for her blood pressure at the vet. She had to wait a longish time in a barky waiting room due to a vet emergency, then had a tech who was new to the Doppler. Let's just say we called it an epic failure and I wasn't charged. Attempt #2 was at her acupuncture vet, and unfortunately a puppy jumped her kennel. Sigh, bp 180. Next up, her dental vet, Feliway in the room by herself and in the 140's before her dental. So not hyperT, just very much white coat (and dog) syndrome.

Hi Wendy!!!
Yep seems almost impossible to get an accurate reading at the vets office. The vet tech yesterday said she got three readings on Ming. The first was 190, then 220, and the final was when he was sedated and it was 218.

Hoping it works out that my pet sitter can borrow the Doppler from her office and take it at my place so we can get a more accurate reading in about 10 days.

I've got lots of reading to do now on Tanys'a site. These kitties

Thanks Wendy

 

[Beenie (GA)]

Michelle, just wondering too, what the med was for hypertension? Was it Fortekor (benazepril)?

They gave us AmLodipine 2.5mg/once a day. Sound like a standard med for BP??

Have a great day Christie

 

[Marje and Gracie]

Hi Wendy!!!
Yep seems almost impossible to get an accurate reading at the vets office. The vet tech yesterday said she got three readings on Ming. The first was 190, then 220, and the final was when he was sedated and it was 218.

Hoping it works out that my pet sitter can borrow the Doppler from her office and take it at my place so we can get a more accurate reading in about 10 days.

I've got lots of reading to do now on Tanys'a site. These kitties

Thanks Wendy

They should take the BP 3-5 times and take the average. On one visit, my Tobey averaged about 200 but he was clearly stressed. I took him back two more days in a row, late in the day, and we sat in a quiet room for 10 minutes and his average was 120. Now we know that’s how we have to do his BP.

I’m with your vet that there’s likely a connection between the high BP and the elevated MA. Please tag me when you get the next tests. I’d love vet to see if the MA comes down as the BP is treated.

There are different drugs to treat high BP but amlodipine is a common one to start with. I have seen it not control the high BP in some cats and so they might need to add another or change drugs in some cats.

 

[Beenie (GA)]

They should take the BP 3-5 times and take the average. On one visit, my Tobey averaged about 200 but he was clearly stressed. I took him back two more days in a row, late in the day, and we sat in a quiet room for 10 minutes and his average was 120. Now we know that’s how we have to do his BP.

I’m with your vet that there’s likely a connection between the high BP and the elevated MA. Please tag me when you get the next tests. I’d love vet to see if the MA comes down as the BP is treated.

There are different drugs to treat high BP but amlodipine is a common one to start with. I have seen it not control the high BP in some cats and so they might need to add another or change drugs in some cats.

Thanks Marje!
What about the BP reading while Ming was sedated? It was still over 200. He was sedated because vet was expecting to biopsy what she felt in first rectal exam. Under sedation is where she discovered it was just his left anal gland. Could a cat still be “stressed” for a certain lenghth of time after being sedated giving a false BP reading? I ask her she said no. Was hoping there was a possibility
I’ll keep you posted

 

[Marje and Gracie]

Thanks Marje!
What about the BP reading while Ming was sedated? It was still over 200. He was sedated because vet was expecting to biopsy what she felt in first rectal exam. Under sedation is where she discovered it was just his left anal gland. Could a cat still be “stressed” for a certain lenghth of time after being sedated giving a false BP reading? I ask her she said no. Was hoping there was a possibility
I’ll keep you posted

No, he’s probably got high BP. I just wanted you to know they should take several readings even at one visit. My vet redid Tobey because he was young and healthy and had no reason for his BP to be high.

Just be sure you get it rechecked to make sure the dose is right.