Help interpret bloodwork please

[bettyandhank]

Can I get some feedback on these labs please? We have just had advance bloodwork done ahead of a dental.
Can anyone help interpret and/or help with any follow up questions that should be asked?

I think I understood Albumin is concern if low not high. The cause for high is supposedly dehydration however, which makes no sense for a cat who eats only canned food with water added. The Spec gravity was mentioned but with caveat that it can be skewed by many things and you may have gotten a different number even only hours later. My main concern is if there are signs of possible early kidney issues here, which was eluded to but I am not at all clear what any of it means. Is this signaling anything?
I noted the out of range items below however also a couple others that were barely on the cusp of being in range. They had not mentioned the Cholesterol and Tryglyceride (which is off the charts) so was not aware until I actually received copy of lab late today. OMG this looks awful- what does it mean?

Do these point to any issues, kidney or otherwise? The vet seemed to indicate this then later supposed perhaps the (slightly) low spec gravity was due to adding water to feedings. But most of us do that, right? Do your kitties have low Spec gravity?
PH is only BARELY within range. Is a single glucose number same as Fructosamine? His was in range but high for him if it represents a 3-week average.

Biggest concerns are if these are kidney issue indicators and if so what specifically. (infection, crf, kd?)
I do not even understand what to ask. And if so, what do you do for it?
This was done with a new vet we just met. Appreciate any wisdom.


Albumin 4.1 H (Range: 2.5- 3.9 g/dL)
Na/K Ratio 31 L (Range: 32- 41)
Cholesterol 284 H (Range 75- 220 mg/dL)
Triglyceride 708 H (Range 25 160 mg/dL)
Bands 0 range 0-3
Basophils 0 range 0-1
Urinalysis (included w/ panel)
Specific Gravity 1.014 L (Range 1.015 -1.060)
pH 7.0 (Range 5.5 -7.0

 

[rhiannon and shadow (GA)]

This is not my area of vast knowledge. I'm learning this stuff now.
But from my notes, When Albumin is elevated, it is usually due to dehydration.
If you can get him to eat it with even more water added, all the better.

I think overall you look okay. Everthing is the same as my last labwork except for the cholesterol/triglyceride
which I don't think is a big concern.
Cats are different than humans in that regard.

I will tag a couple of people to look .... but they probably won't show up until tomorrow.

 

[katiesmom]

Hi,
What was his Creatinine and BUN numbers? Those represent kidney values. I dont see those listed.

A Fructosamine number range is much different than a single BG reading. Did you get a Fructosamine test?

Also, my vet told me the PH of the urine can change quickly from one void to the next. Depends on when they ate, etc., so I wouldn't worry too much about the PH.

If you are worried about kidney issues, there is a Early Renal Detection test, called ERD that is available. Its suppose to detect kidney problems earlier before it effects the BUN and creatinine. I have never used it, but have been aware of it for a while and was considering having it done for both my kitties on their next trip to the vet, as they are turning 8 and 9 years old next month. It's just an in house urine test. Here is a link http://www.heska.com/Products/Renal-HealthScreen/ERD-HealthScreen.aspx and an article here http://manhattancats.com/Articles/erd_heska.html

 

[BJM]

Just like with humans, too much fat may result in elevated cholesterol and triglycerides. You may replace 1/5th of a canned cat food with straight protein (poultry, rabbit, beef, lamb, pork, etc) to reduce the fat in the mix fed.

And just a note for all of us - cholesterol can block ANY blood vessels, not just those around the heart. This includes blood supply to the kidneys, which may decrease kidney function.

 

[bettyandhank]

So no one sees any kidney/early-kidney indicators here? That was an impression I sort of got, but am not really clear. So of course looking for insight from the pros.

For those that asked. His BUN/CRE is not out of range, but my (very minimal) understanding is that by the time they show out of range, you have lost 75% of the functionality and have serious trouble.

BUN 29 Range 14-36 mg/dL
Creatinine 2.3 Range 0.6- 2.4 mg/dL


I do give some boiled chicken in addition but not necessarily every single week. But I am feeding all the good stuff (i thought) Wellness, instinct, core, some (old formula) merrick, and lately even a little FF. My dry food addict civvie began to eat a little of this recently after all previous efforts at canned failed..so now has ruined Hank who had been totally satisfied previously eating his health food. He now wants only chicken feet, beaks and by products.

Are these Triglycerides a concern? I mean 700's!
That part of lab wasn't even mentioned when we spoke to them..they were focused on spec gravity and Albumin. So I am trying to get feedback on what it means.
kidney infection, crf?...early stage something?
anything/nothing to worry about?

thanks

 

[BJM]

I looked up hypercholesterolemia in the Merck Veterinary Manual online.

Glomerular Disease in Small Animals

"Animals with primary glomerular disease as a cause of chronic kidney disease may have somewhat different clinical and laboratory abnormalities than those with primary tubulointerstitial disease. Damage to the glomerular basement membrane results in albuminuria, which may lead to hypoalbuminemia. Animals may then exhibit signs related to hypoalbuminemia (eg, peripheral edema, hypercoagulability with thrombosis, hypercholesterolemia) instead of or in addition to uremia."

For a less technical resource, Merck's Pet Owner manual is available online, too.
Noninfectious Diseases of the Urinary System of Cats

 

[rhiannon and shadow (GA)]

Here are 3 examples of low urine specific gravity.....
These 3 quotes are from advice Marje has given to others dealing with the same issue.

with renal insufficiency. The first hint is usually a lower urine specific gravity.

While I hesitate to say this because I don't want to be a Debbie Downer, "typically" (but not always) simple dehydration is indicated by an elevated BUN but a normal creatinine. Also, if a cat is fed a really high protein diet, BUN is usually elevated to some extent. Most often (but not always), if you see the creat starting to creep up, it's an indicator of CKD. That's why the urine specific gravity is so important because it's another piece of the puzzle. If her USG is totally normal, then I'd agree that the creat and BUN are elevated due to dehydration. If the USG is low, indicating she isn't concentrating her urine, I'd consider that. along with the barely elevated creat, an early sign that she might be starting with some renal issues.

So still crossing paws that the USG comes back that she is totally concentrating her urine like she should be! You want to see it above 1.040. Again...the lab often shows the limits of normal being 1.008-1.060 but if a cat is below 1.040, they aren't fully concentrating their urine as they should be.

and 2 of them come from this post.... http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=90569&p=970732&hilit=specific+gravity#p970732


I did send Marje a pm last night but I know she has company and isn't online for a few days..... I had hoped she would
pop in and see it by now.

I started to quote these last night but they were directed at someone else's questions..... but I think you can still
benefit from it.
I think I am maybe a step behind you with the same issues so I've been tuned in to it.

 

[katiesmom]

If you are worried about kidney issues, there is a Early Renal Detection test, called ERD that is available. Its suppose to detect kidney problems earlier, before it effects the BUN and creatinine. I have never used it, but have been aware of it for a while and was considering having it done for both my kitties on their next trip to the vet, as they are turning 8 and 9 years old next month. It's just an in house urine test. Here is a link http://www.heska.com/Products/Renal-HealthScreen/ERD-HealthScreen.aspx and an article here http://manhattancats.com/Articles/erd_heska.html

Again, perhaps ask your vet about the ERD test I mentioned earlier (In the quote above) to further investigate the kidneys.

You are right, about 70% of the renal function is gone by the time it shows up in the BUN and creatinine values.

The high cholesterol and triglycerides could be diabetes related. I have had 3 different vets tell me that lipemia (high fat in blood) is common in diabetics cats, which I assume would lead to high cholesterol and triglycerides. Was there a lipemia index on the bloodwork? High lipemia also can skew the results.

 

[bettyandhank]

Ok. thanks everyone. I have heard MArje is tied up and will not bother her right now.
BJ, I read your post and my eyes crossed. I am quite a smart girl and didn't absorb a thing. Guess I need to follow the link to the less technical version and see if I can figure out why you are pointing out hypercholesterolemia.

I am trying to get to point if we have early CKD, CRF, Kidney infection or none of the above.
Per Rhiannon's copy of marje's reply, at least a couple of our counts wouldn't be optimum. I just don't have my arms around it clearly yet.
to see in full context what it says, if anything

But right now honestly our dental is most urgent thing.
We are trying to work toward next available time within a week if we can get logistics worked out.



edited to add: Hemolysis 2+, Lipemia 3+ No significant interference. in answer to Katie's mom whose post I didn't see until about to send this.
And BTW, Hank is OTJ for 3+ years..so not sure how that factors for any diabetic connections.
But of course once a diabetic- always a diabetic.

I love all the insight so thanks

 

[BJM]

Think of all the human ads about high cholesterol and your heart - it may lead to heart attacks by blocking a artery, right?

Well, cholesterol can block ANY artery, not just the ones to the heart.

If it blocks the arteries going into the kidney, the blood flow reduces and it filters more slowly.
This could let toxins build up and it could increase blood pressure.

Obviously, this is not good for cat nor human.

Maybe check the fat content of the food you are feeding and replace 1/5 with plain, low fat chicken or other lean protein to reduce the fat content a tad. Its OK to do this per Dr Pierson of Cat Info.

 

[Larry and Kitties]

One cause of high cholesterol

Diabetes mellitus: Insulin stimulates lipoprotein lipase, which is responsible for hydrolysis of chylomicrons (CM) and VLDL. Insulin also antagonizes hormone sensitive lipase, the hormone responsible for lipolysis of adipose tissue. Insulin lack results in elevated concentrations of CM and VLDL in the blood, with high triglyceride and cholesterol concentrations (although CM and VLDL consist mostly of triglycerides, they also contain small amounts of cholesterol). Lack of inhibition of hormone sensitive lipase causes increased lipolysis, with increased non-esterified fatty acid presentation to the liver and VLDL production. In addition, LDL receptors on hepatocytes are downregulated, resulting in increased LDL levels.
Above from:
https://ahdc.vet.cornell.edu/clinpath/m ... holest.htm

Unlike in us humans, high circulating cholesterol levels in our pets rarely cause heart and blood vessel disease. Both dogs and cats are carnivores that seem to have adapted well to a diet high in saturated animal fat – a rich source of cholesterol. However, a cholesterol concentration (> 750 mg/dL) can be associated with a risk of atherosclerosis - even in dogs and cats (most of those pets will be dogs and most will turn out to have hypothyroidism).
Above from:
http://www.2ndchance.info/dxme-Cholesterol.htm

Cholesterol (Chol)
High cholesterol levels do not have the same significance for cats as they do for humans, but are usually secondary to some other disease. As in humans, bloodwork results will vary depending upon whether the blood is taken after fasting. It is not uncommon for CKD cats to also have increased cholesterol levels.

Occasionally, high cholesterol levels are seen in cats with nephrotic syndrome, but this syndrome is quite rare in cats.

Approximate normal levels (precise ranges vary from laboratory to laboratory) for cats are in this table.

Cornell University College of Veterinary Medicine has some information about cholesterol levels.
Pet MD discusses cholesterol levels in cats.
Above from:
http://www.felinecrf.org/diagnosis_blood_chemistry.htm