Hi Amie
Wendy/Neko asked me to pop over and help you out. I've had several CKD cats and my current one was dx almost four years ago and is doing well.
First, congrats that Grady is OTJ!
Are you able to scan and attach his blood and urine labwork results? Alternatively, although more work, is to do a tab on his SS for labs. If you look at Gracies SS, you'll see a tab labelled "labs". Whether you decide to put lab results on this SS or do another one, I strongly suggest you keep a SS for Grady with all values pertinent to his kidneys. I've always done this for my CKD cats so I can see the changes more clearly. It would also be helpful if you have his labs prior to the current ones.
If you've never seen
Tanyas Comprehensive Guide to Feline CKD, I highly recommend it. It is the gold standard and "bible" for treating CKD in cats. There is also a yahoo CRF group which I belong to although I am no longer active in....but the amount I learned from them (and they use Tanya's) is huge. However, it is very different from this forum, it is extremely high volume, and it can get overwhelming because many cats cross. I learned what I could and then stepped away.
Ok..so what is Grady's labwork telling us? First, his urine specific gravity (USG) should not be a range, and the numbers you gave look more like the normal range to me and that's where we want him to be. My guess is his USG is probably less than 1.032 (which is read as "1032"). The fact that he has protein in his urine may or may not be kidney related. You will need the vet to check his protein:creatinine ratio to determine if the protein is because his kidneys are leaking it (which suggests abnormal kidney function). He might also check the microalbuminaria which is another urine test that indicates kidney function. If you can free catch a sample of urine, he can have the lab run those tests from it. You don't need to take him in for the vet to get a sample as you are not looking for bacteria, etc.
There is a staging system for CKD and Grady's creatinine indicates he is in Stage 3 of 4 and has likely lost 76-90% of kidney function but before you get upset, my Gus has been in Stage 3 for three years and has been stable and there is potential to bring the numbers down a bit. Typically, you would want to see two tests (after fasting) with the cat hydrated, to dx CKD and stage but we don't like to fast our CKD/FD/hyperT cats and really, most vets dx CKD based on one, nonfasted test. BTW, if you elect to test again, the max I would fast would be six hours. His current creatinine tells me he needs subcutaneous fluids at home, at the least. Your vet could put him in the clinic for a few days and give him IV fluids which should bring the creatinine down but you can also elect to see what progress you can make with subq fluids at home. You should start those as soon as possible. You will need to discuss with your vet how much but he should get daily fluids. Lactated Ringers Solution is the best option. It's important to know if Grady has any heart issues because giving subq fluids to a cat with heart issues can be problematic and you have to balance kidney/heart so the kidneys get fluids but the heart is not overwhelmed. If all is good with his heart, then fluids should be fine. Remember that hyperT can cause some cardiomyopathy until the thyroid is under control and I don't know where Grady is with his hyperT. I'd also urge you to read the section on hydration on Tanya's just in case there any other things going on with Grady that would warrant using another fluid like Normosol.
I'm actually surprised his BUN is not higher than 29.1 considering his creatinine. Are his gums slick? Does his scruff pop back into place quickly if you pull it up? Is he drinking/peeing a lot?
Grady's phosphorus is way too high and so I would concentrate on getting it down, I have found phosphorus control is critical in longevity in a CKD cat and largely affects how they feel. Grady's phosphorus needs to, ideally, be no higher than 1.8 mmol/L. I believe the best binder is aluminum hydroxide powder. It is tasteless and you mix it in their food and it binds the phosphorus. The thinking used to be that CKD cats need a low protein diet but that is old school. They need a high quality protein/low phosphorus diet. Dr. Lisa's
Phosphorus Charts are another gold standard. You want to feed as low a phosphorus food as he will eat. My CKD kitties have never been willing to eat the prescription diets so I feed foods that are less than 200 mg P/100 cal or less than 1.00% P...however....the lowest you can get that, the better but you have to balance that with LC as well. As a note, foods with P levels above are not "low" P. They are lower and give you options for feeding but the only "low" P diets are the prescription diets. Binders cannot bind every morsel of food but they help. The only Natures variety that I would feed a CKD cat would be the duck. Of the old Merrick, the Cowboy Cookout but the new Cowboy Cookout is way too high in carbs and P. If you can get the Merrick Before Grain, the old 96% Beef or 96% Turkey works. The BFFs are a little high in P but with a binder, they would be "ok". I, personally, would not use any binder other then aluminum hydroxide powder. For where his P level is, if you use aluminum hydroxide, he needs 100 mg/lb or 100 mg/0.5 kg sprinkled on his food throughout the day. If he weighs 5 kg, for example, that would be 1000 mg P per day (5kg/0.5kg x 100mg). That is a really high level of binder and I would discuss that with my vet before giving that amount. 1000 mg/day would be roughly 3/4 of a US tsp....again...alot of binder. You don't need a prescription in the US for that binder but I'd really want a vet on board for giving that much. You could safely use 50mg/0.5 kg or about 1/2 tsp daily but I don't know how much it would bring his P down. And yes....you would have to do bloodwork to see if it was coming down. It usually takes about 10 days to see the binder having an effect.
There are many other numbers I'd like to see....his calcium, his potassium, his HCT/PCV (not sure which your lab uses). There are other things you can do which can go towards maintaining him. If he vomits...especially if it is clear, foamy vomit, he likely needs something for his tummy as CKD cats with high P usually produce too much stomach acid. The treatment would be 1/4 of a 10 mg Pepcid AC (famotidine) starting out once a day ...not Pepcid complete or any other Pepcid..it must be Pepcid AC. There are other acid reducers you can use because I don't know what is available in Canada and you could find them on Tanya's. I also suspect he may have anemia we need to address but need his HCT/PCV to know.
I would also have the vet check his blood pressure because CKD cats often have high BP....my Gus does and it has been easily controlled with a small dose of amlodipine. If Grady does have high BP, you will also need to look at the sodium level in foods and keep that down. Tanya's has food charts as well which have sodium values but they don't have carbs.
A major caveat I would like to add....I'm giving you suggestions but you need to work with your vet. Take him the info and work with him as much as you can. Like FD, some vets just aren't up on current treatments of CKD but you need to try.
Resources:
I can buy a case of 1000 mg LRS bags at Walgreens pharmacy for $23. I have to have a prescription. I don't know what you can get where in Canada but it is usually cheaper to go through a pharmacy than the vet.
I buy my lines for the fluid, my 21g needles (vets usually use 18g which are like harpoons), and my binder from thrivingpets.com.
Here is a video we made with our cat, Gus, on
How to Give subcutaneous Fluids.
Please let me know what questions you have and how I can help. I know this seems overwhelming on top of everything else but I'd first try and get fluids started ASAP and get his P down as priorities.
