? Diabetes in remission but now Kidney Disease Cropping Up

[steph_frances]

Hello all. First, I'd like to thank everyone on here who was so extremely supportive and helpful back when Puddy was initially diagnosed with diabetes. You guys were amazing, and Puddy has been in remission for nearly six months.

Unfortunately, a strange thing has occurred. He had no markers for kidney disease when he was diagnosed with diabetes (August 2021), but in the last couple months his markers for SDMA, Bun, and Creatine are all high and steadily increasing (in one months time). I've attached his most recent bloodwork. Back when he was diagnosed with diabetes his Creatine was 1.9 (so it's a fairly drastic shift). Also, his specific gravity came back low on his urine test.

I'm just wondering what, if anything, I might be doing wrong. Might the diet be impacting this in some way? He now is on all wet food (mostly Wellness and Weruva) in the last month I've even tried to shift to lower phos foods. I always add water to his wet food, and he has a water fountain. He now weighs 16.25 lbs, and when he started his diabetes journey he was 19. I thought we were moving in the right direction.

He has very few outward symptoms of kidney disease. It was picked on March 3rd because he had a major episode of vomiting all night and we took him to emergency. I thought he had a possible obstruction from eating something plastic, but this was not found.

Any and all insights and thoughts are extremely appreciated. Thanks so very much.

 

[Bron and Sheba (GA)]

I’ll tag @Suzanne & Darcy as she may have some ideas.

 

[Suzanne & Darcy]

Do you have any other labs you can share. What are you feeding him? You probably need to use low phosphorus food (but I see his phosphorus is already very good... this is unusual for a cat with a BUN/Crea that high.) Has he been checked for a UTI? Anything else going on? Is there any chance he was dehydrated at the time these labs were drawn? What are his usual BG numbers? I would like to see the earlier labs, if possible. You could add them to your labs tab on your spreadsheet if you can (just make sure the reference ranges are the same as the lab your vet uses.)

 

[Suzanne & Darcy]

What was the USG?

 

[steph_frances]

Do you have any other labs you can share. What are you feeding him? You probably need to use low phosphorus food (but I see his phosphorus is already very good... this is unusual for a cat with a BUN/Crea that high.) Has he been checked for a UTI? Anything else going on? Is there any chance he was dehydrated at the time these labs were drawn? What are his usual BG numbers? I would like to see the earlier labs, if possible. You could add them to your labs tab on your spreadsheet if you can (just make sure the reference ranges are the same as the lab your vet uses.)

Hi - thank you so much for this response. Here are his labs when he was diagnosed with diabetes (about seven months ago). I have one more lab record I can pull (from the morning in March when he got really sick and had to go to emergency) but I don't have it on hand currently.

-The vet looked at the UA for a UTI and even though there was something showing, she doubted this given the levels were not terribly high (it was free catch where I used a ladle at home, so there could have been some cross contamination(?))
-I doubt he is dehydrated at the time of the test. He's been drinking a lot of water that I put in his food and he also drinks from his fountain (not excessively though).
-As far as anything else going on, I really don't know. He's lazy and maybe a bit lethargic, but he's always been that way. He howls occasionally, and I've seen him twitch at times (not recently). He's generally quite hungry at mealtimes. He has some periods of activity, where he will roam around the backyard or entertain himself. He likes sitting at the window and bird or squirrel watching. He's extremely sweet, per usual.
-I haven't been doing any regular ear pricks, but anytime his glucose has been tested its been totally normal. (109 at the vet's office an hour or so after breakfast)

 

[steph_frances]

What was the USG?

1.016

Here's a side by side (from a couple weeks ago on the left to seven months ago on the right)

It does seem like there are some other factors present on this UA, though I don't know the significance of them and the vet did not discuss these factors further as she is pretty convinced of a CKD diagnosis.

 

[steph_frances]

I continue to wonder if he had some sort of exposure to a toxin on March 3rd... could that have set this into motion (in terms of the SDMA, creatine, and BUN levels)?

 

[Suzanne & Darcy]

I continue to wonder if he had some sort of exposure to a toxin on March 3rd... could that have set this into motion (in terms of the SDMA, creatine, and BUN levels)?

Yes. But what do you think was the possible toxin exposure. You seem to know the date that you suspect it.

 

[Suzanne & Darcy]

1.016

Here's a side by side (from a couple weeks ago on the left to seven months ago on the right)

It does seem like there are some other factors present on this UA, though I don't know the significance of them and the vet did not discuss these factors further as she is pretty convinced of a CKD diagnosis.

I don't see anything really important in the current UA except the significant drop in USG which indicates that he's not concentrating urine as well as he should. I agree that the white cells were really minimal and, as you said, it was free catch and not cysto. The previous UA doesn't surprise me because of the unregulated diabetes at the time.

 

[Suzanne & Darcy]

Send the March labs if you can. That was when you first saw the higher kidney numbers, right?

 

[steph_frances]

Send the March labs if you can. That was when you first saw the higher kidney numbers, right?

Yes- here they are. This was March 3rd when he went to Emergency. They first detected elevated creatine & BUN here.

 

[steph_frances]

Yes. But what do you think was the possible toxin exposure. You seem to know the date that you suspect it.

The reason I'm wondering about toxic exposure is when we woke up in the morning we found vomit all over the house (there was blood in it), which is what sent us to emergency in the first place. Just throwing it out there as a potential. They were more focused on him having some sort of obstruction due to ingesting plastic or some such object.

I'm wondering if there is a way to mop up toxins from a cat's system. If that would potentially help him at all?

 

[steph_frances]

I just got back from the holistic vet (a different vet than we went to two weeks ago). She's running another UA on him just to be sure it isn't an infection (but that doesn't seem particularly likely)

She gave us some Chinese herbs to try, in the event that this is kidney disease. I'm feeling pretty sad; he's young for this.

 

[Suzanne & Darcy]

I just got back from the holistic vet (a different vet than we went to two weeks ago). She's running another UA on him just to be sure it isn't an infection (but that doesn't seem particularly likely)

She gave us some Chinese herbs to try, in the event that this is kidney disease. I'm feeling pretty sad; he's young for this.

I am going to send you some information on Acute Kidney Injury.

 

[Suzanne & Darcy]

http://felinecrf.org/acute_kidney_injury.htm

 

[Suzanne & Darcy]

Those March labs were not horrible. BUN was on the higher end but still within the reference range. Creatine was elevated but without a USG from the urinalysis at the time, it is hard to interpret.

 

[steph_frances]

http://felinecrf.org/acute_kidney_injury.htm

Thank you so much. I appreciate your help.

 

[Suzanne & Darcy]

But his creatinine has gotten much worse now (as of April 13). He is young for this to happen. I did lose my boy at age 10 (in 2021) to complications from kidney disease… but I had attributed that to the acromegaly trashing his kidneys.

 

[Suzanne & Darcy]

It’s strange how his phosphorus is so low when his other kidney values are so high.

A high protein diet and also just being a large cat can cause creatinine to be higher. But that doesn’t explain how he had such a jump.

So you say he doesn’t show signs of kidney disease like drinking lots of water and urinating in very large quantities? His appetite is still good? I would be thankful for that. I would “treat the cat and not the numbers” at this point. Sometimes the numbers just don’t seem to reflect what’s actually going on with our cats.

Did the holistic vet have any comments on his various bloodwork results? I’m glad she wants to culture the urine - just to make sure.

 

[steph_frances]

It’s strange how his phosphorus is so low when his other kidney values are so high.

A high protein diet and also just being a large cat can cause creatinine to be higher. But that doesn’t explain how he had such a jump.

So you say he doesn’t show signs of kidney disease like drinking lots of water and urinating in very large quantities? His appetite is still good? I would be thankful for that. I would “treat the cat and not the numbers” at this point. Sometimes the numbers just don’t seem to reflect what’s actually going on with our cats.

Did the holistic vet have any comments on his various bloodwork results? I’m glad she wants to culture the urine - just to make sure.

I'm so sorry for the loss of your cat. He was young also.

So, yeah- he really isn't exhibiting the signs one would expect. He's hungry, eats well. Normal bowel movements and urination. I'm definitely thankful for the way he is at this point.

The creatinine rising so drastically is worrisome; I'm really confused by this whole thing honestly. Though, in my reading it did mention somewhere that creatinine can vary somewhat largely throughout the day. Is that true?

The holistic vet gave us Rehmannia 6 (which is mentioned on Tanya's website). She said she would get back by Friday if the culture looked like there was evidence of any infection. If you have any further thoughts or suggestions I'm open to any insights. Thanks again!

 

[Suzanne & Darcy]

Did anyone suggest sub-q fluids yet? Since he seems to feel well, I am not sure it’s warranted yet.

 

[steph_frances]

Did anyone suggest sub-q fluids yet? Since he seems to feel well, I am not sure it’s warranted yet.

No, no mention of that yet. Both vets said he seemed well hydrated.

 

[Suzanne & Darcy]

No, no mention of that yet. Both vets said he seemed well hydrated.

That’s good. It’s like I almost don’t believe the bloodwork!

 

[Suzanne & Darcy]

I would just use those herbs, wait to see if the herbs seem to help, and recheck bloodwork in 30 days if he continues to do fine. Of course, if they find anything in the UA then you’d get antibiotics, but other than that there’s not anything different to do.

 

[steph_frances]

That’s good. It’s like I almost don’t believe the bloodwork!

I know; that's how I feel too.

 

[Larry and Kitties]

The relatively high TP 8.7 (5.7-8.9) and high HCT 52.7% (30.3-52.9) tend to indicate dehydration.

 

[steph_frances]

The relatively high TP 8.7 (5.7-8.9) and high HCT 52.7% (30.3-52.9) tend to indicate dehydration.

Yes, I believe he was dehydrated at that visit- that was the emergency room visit after he had been vomiting all night. Those are not his most recent values. The most recent blood work is attached to the first post. Thanks!