CKD Civvie Rain

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Tracey&Jones (GA)

Tracey&Jones (GA)

Member Since 2016
https://docs.google.com/spreadsheets/d/16edKi36oA3wvi0RhaRKqSgc0suKE2tuuebg6KUU-usw/edit?usp=sharing


This is her blood results for the last 4 years. Basically from when I took over her care from my sister and she was already diagnosed as CKD. There is no real changes in her behaviour at home outside a slight drop in appetite. Her latest blood work shows an increase in BUN levels but I don't see really changes in the other major markers for CKD but that said, I have not done a lot of research on this disease up until now, so a bit of a newbie. The vet indicated she is now firmly in stage 2 of CKD and there doesn't seem to be any other health concerns right now (anti-jinx). She did suggest further testing of blood pressure test and an urine culture and urine protein creatitine ratio but there doesn't seem to be a push on these. The vet has suggested sub q liquids once a week 100 ml, which some feed back suggests that it is not necessary at this point and is not beneficial - so I am a little :confused:. I don't want to be something that isn't helpful.

I was discussing with @LizzieInTexas and that some SEB would be helpful in ensure a settled stomach (possible reason for the reduced appetite) or maybe a B complex. She does have the white foamy vomit/water vomit now and again (every 3-6 weeks a 1 day instance) and I usually give a dose of pepcid (liquid) for a day or two then stop. She has never been on a consistent dose of pepcid.

She is on KD dry, KD wet and recently added some BFF to mix in the KD wet I would like to eliminate the dry and we all know the complications from that.

Thank you to everyone that has any advice. @Marje and Gracie, can you be so kind to take a look at her results and see if you see anything?

  1. So, I am looking for other food to swap out the dry KD and hopeful entice her to eat more. I have my list from Tanya's site and will be going shopping this week.
  2. If it is thought wise - get some SEB and try adding that daily to her food.
  3. If it is thought wise - get some vit B - complex or 12 to add in appetite.
  4. Do any of the other tests make sense to have done?

I just want to do right by Miss Rain.
 
It's not a bad idea to start fluids 1-2 times a week. This is about where my cat was when I started and it really slowed the progression. B12 certainly can't hurt. No dry food. And I wouldn't do Renal food at this point because it's low in protien and can lead to muscle wasting. Stick with the bff food. Something under 1% phosphorus.
 
What's going on with the low platelets? I'd have them test for protienuria.... She may need Benazapril. And test for high BP too.
 
Not sure on the low platlets. Jones was low too so I asked about it. Vet wasn't worried as there was no other abnormalities. I found it weird. I will call about those tests.
 
I think her labs look pretty good. She is Stage 2 CKD and, really, most vets would not suggest you start fluids until the creatinine is 300-350. That’s because you want her to get as much fluid as possible from drinking water, wet food, etc. Stopping the dry will help but I’d also be adding extra water to all her meals. Once the creatinine gets to the 300 and above level, it’s harder for them to compensate and so they need some help. But if this were my cat, I would not be giving subq fluids yet. I waited until my kitties were above 3.5 (US) which would have been equivalent to about 300 and was glad I did because I gave fluids daily for over four years. You can build up scar tissue even being really careful when you give fluids that long.

You’ve done a great job on the phosphorus and I’d keep trying to give her lower P foods. If she eats the k/d wet, great! You can also get something with a little higher quality ingredients but low P (some cats really like Hi Tor Neo....still not the best nutrition but better than K/D).

Potassium looks good as does her HCT. When she starts getting towards 30-33 on the HCT, you’ll want to start B vitamins orally (250 mcg methylB12 and half of 1/10th Jarrow’s B Right multi B) twice a day to help with anemia.

Frankly, I don’t think she has proteinuria with just a trace of protein in her urine. Do you see anything that refers to Microalbuminaria? If you just wanted to check it, you could certainly have the urine protein:creatinine done just to be on the cautious side. Her platelets being low have nothing to do with proteinuria. Does it say anything on her labs about platelets being clumped or any hemolysis? Sometimes when they draw blood (quite often actually), the way they do it causes the platelets to be clumped and they can’t accurately count them.
Her USG is pretty good for a CKD cat!

I always think it’s a great idea to check the BP on a CKD cat every single time they are in the vet’s office. I’ve seen cats with horrific kidney values and no high BP and also cats with excellent early CKD values and high BP.

Insofar as SEB, I used it for acid tummy for a very long time. It helps to give it the last thing at night before she goes to bed as long as it’s separated from other supplements and meds by two hours. I used this instead of pepcid for a really long time. You can also set up an auto feeder for her with something as simple as a few freeze dried meat treats for her to eat 4 or so in the morning (you might have to play with the time) so the extra little bit of food absorbs the acid. Sometimes with CKD cats, pepcid becomes necessary but I like to treat it as holistically as I can for as long as I can because pepcid doesn’t just get rid of the excess acid...it gets rid of all of it and they do need some acid to digest food.

There are two different reasons to give B vitamins:
anemia: you’d give the oral ones I’ve referred to above
intestinal issues/poor appetite: usually give as a cyanocobalamin B12 injection once a week for eight weeks and then once a month

I usually don’t get overly caught up in the BUN unless it is crazy high but then you would also expect a lot of the other values to be really high as well. There can be different reasons why BUN is elevated.

I hope that helps. You’re doing great with her. Please tag me if you have other questions.
 
Thank you Marje and Janet,

Marje and Gracie said:
Does it say anything on her labs about platelets being clumped or any hemolysis
Click to expand...
It says:
Platelet count reflects the minimum number, due to platelet clumping.
Platelet Estimate ADEQUATE


Marje and Gracie said:
Do you see anything that refers to Microalbuminaria?
Click to expand...

Microalbuminuria testing is recommended (if sediment is inactive) to help determine the clinical significance of proteinuria.

I don't see a comment on the sediment though...



I think I will get all three of the suggested tests - just to be cautious and know where she stands now. She is due to go back in 6 months, so I call get those in now. I hope the BP isn't too complicated of a process. I will get some SEB and put that in a evening snack - she will like that. I have been giving her some of Jones freeze dried treats before bed, but that didn't help last night as she vomited at 2 AM. I have seen a bit more vomiting lately so if I can nip that in the bud I am sure it will help. Did buy a fountain for her as she likes her water running - that seems to be a hit from the amount of water gone this morning. I will keep adding in a little water to the wet, just to ensure she is getting some.

The consensus is for getting rid of the dry and adding in a low phosphorus more protein diet - which I will add to the KD wet. Which I am all for.
 
Rain is booked in the tests on the 28th I will post the results. I did put some freeze dried treats in her feeder - 3 of the 4 were gone this morning and there was no vomit. I ran out of wet KD so just gave her the BFF - she ate twice the amount she usually does - go figure. Will still mix in the KD wet but I think she is telling me she is tired of it.
 
Marje and Gracie said:
Your plan sounds just fine. BP is easy usually. Good luck and keep us posted!
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Here is the blood pressure and prot/crea result. Vet said overall they looked good. I am not sure on the blood pressure. Your thoughts Marje? It did look like it was coming down by the third test though.

She is doing great - the dried treat trick is really working out - no vomit since we started that. Blending the foods seems to encourage appetite and her coat is just lovely right now. She is gaining some weight back on.

Still waiting on the culture, should hear today, but it was clear after 48 hours.

We have a new Vet now as my vet had to leave on early maternity leave.
 

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Tracey&Jones said:
Here is the blood pressure and prot/crea result. Vet said overall they looked good. I am not sure on the blood pressure. Your thoughts Marje? It did look like it was coming down by the third test though.

She is doing great - the dried treat trick is really working out - no vomit since we started that. Blending the foods seems to encourage appetite and her coat is just lovely right now. She is gaining some weight back on.

Still waiting on the culture, should hear today, but it was clear after 48 hours.

We have a new Vet now as my vet had to leave on early maternity leave.
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We got back late last night but Wendy/Neko is here visiting and that's why I didn't plan to be back until the 6th but I got emailed about something so had to pop in. Thank you, Yong, for letting her know because I didn't plan to be here today. Jet lagged :confused::p

Good report....urine P:C ratio is good. BP is pretty good for a nervous cat although my vet says anything over 180 needs to be checked again within a few days and more calming allowed. So I think you are ok! I had my civvie in as he has an arrhythmia under stress and the first three checks of his BP were well over 200. I took him back a few days later at the n d of the day, we sat in a quiet room in dim light for -0 mins and his systolic BPs were all under 120 so that shows you an sample.

Awesome news!
 
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