Kidney Health questions

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taran80

Member Since 2012
Hi, my cat Gizzy was diagnosed with Diabetes in May of last year. He was 28 pounds and on a diet of fancy feast elegant medleys wet canned food, Wellness dryed food and kitty snacks. i changed his diet to only fancy feast classics wet canned food and provided baked chicken or roast beef as snacks. because of the diet change and insulin he was in remission in a few weeks and not on insulin very long. His blood sugar now ranges from like 65-80 without any insulin. I brought him in for a check up this week (first time since May of last year) because he has been acting a little weird (stalking/attacking me randomly) and I was interested in his weight loss. He is now 22 pounds...loss of 6 pounds! they did blood work and got the results today. blood sugar was 180 (not sure how this is possible unless its related to stress going to the vet since it is usually under 80) He also mentioned thyroid was slightly elevated but not cause for concern. His concern was his kidneys. The Dr said his kidney levels are elevated. The creatinine level is 2.7 and the BUN is 47. he now wants me to try and gather a urine sample for further testing. he recommended a litter box or ladle. he said if i cant do it on my own i can bring him in and they can try by needle and ultrasound, but he said the only person who can do it is only working with them for 2 more days and then they have to find someone else and dont know who long it would be before they hire someone who can do that test (thought this was odd). is collecting on my own going to be easy? should i just bring him in today and let them try the needle method? if i don't decide to do it today and cant get the urine on my own i may need to go to another vet. anyone know if these levels are of high concern? I asked about knowing how to tell if he is dehydrated and he said we could try sub Qs. do you think this is necessary with creatinine level is 2.7 and the BUN is 47? i am blaming myself thinking the high protein diet i have been feeding him caused the kidney issues. can anyone recommend a food that wont spike his blood sugar but is low Phosphorus? i tried looking at the spreadsheets but am confused and would like to know what others are feeding their cats with these issues. should i allow the vet to sell me on some type of prescription diet or find something on my own? i am assuming a diet for the kidneys is more important then his blood sugar rising from the carbs? i am sorry for so many questions, but i am really upset of the news and trying to process this. i did looks at tanyas website and it is helpful. Tara
 
Good job so far, on keeping your kitty healthy and happy and diet controlled! Your post is a a bit hard to read with no line breaks -- hit enter to add some white space between questions etc.

First, the whole thing about the pee is weird (your vet's office). I haven't had to catch it, so I'll let someone else answer that.

I don't think the kidney values are that horrible - just my opinion.

I have one diabetic guy and 2 civilians -- all are over 14 years old, and have early renal disease, which is very common in older cats. My cats free - feed, so it is important that I find canned food that all 3 can eat.

So... before laying out the diet changes - I'll let you know that my vet just did blood work on my worst kidney guy, and said "Keep doing what you're doing!" because his kidney values did not get worse and his Phosphorous and calcium got better.

Go to http://www.catinfo.org and look for the food list that is sorted for PHOSPHOROUS content.

I used to feed Wellness Chicken and Turkey and FF Classic (no fish, no beef due to allergies)

CHANGES: The FF Classic were all higher in Phosphorous - so we stopped that
Tried several Low Carb AND Low Phos foods, and we settled on Pinnacle Chicken & White Fish (my fish-allergy kitty passed away in Oct) and BG Turkey.
The Wellness Chicken and Turkey are still OK.
 
The blood sugar of 180 may well represent vet stress. Some cats do go up 100 points at the vet.

Use a clean litterbox filled with aquarium gravel and wait for him to use it. As soon as he uses it, take a scoop and push the litter to one end, tilt, and voila - your urine sample aways. You want to get the specimen withing 30 minutes.

Some other methods:
- Put plastic wrap over the litter and make a depression that will catch a puddle. Wait for him to use the box and then attempt retrieval.
- Stalk him and when he goes to use the litterbox, place a serving spoon under him and catch. Some cats will let you do this; others won't.
 
Go with what BJ said. Maybe your vet thinks they may have a hard time doing a cystocentesis without ultrasound since your kitty is on the larger side. Just guessing. I've never heard that suggested before. Brie's creat has been hanging around 2.4 and his BUN is 45 to 60. He get subq fluids every other day. I'm guessing Gizzy had other bloodwork done as well. Hopefully that was normal. I had a cat who would get totally stressed out any time he had to go to the vet. He would get stress induced hyperglycemia. His sugars would be 180 plus. He was never diabetic. One time he was sitting on me at the vet's office and just started peeing right on my lap. The poor boy was so scared. You should have seen the look on the vet's face. Good job keeping on top of things and asking questions.

Sandy
 
My goodness, you do have a big kitty, don't you?!

Anyway, I get a clean catch using a little Dixie cup. Of course, this all depends if your cat will be offended by you holding a cup under the urine stream. However, you really don't need all that much (maybe just 1/4 of the little cup), and it beats having to disinfect a ladle afterwards.

Then, adhere a piece of plastic wrap to the cup with a rubber band. If you can't drop it off at the vet within an hour, refrigerate it. However, you don't want to refrigerate it longer than overnight, because it will start to crystalize. With respect to kidneys, what your vet is looking for in the urine is PH and specific gravity (and possibly a protein to creatinine ratio - test not always done).

In the beginning, I used the hydrophobic sand. It worked fine, but it is very expensive and you need at least three bags of it to barely cover the bottom of the litter box. I also tried the aquarium gravel, but it was cumbersome and actually hurt my little girl's paw pads. On a whim, I tried the cup. It was so darn easy, I did a head slap for not trying it sooner.

As far as the levels, the BUN suggests possible dehydration. However, the creatinine is a little high but not horrible. You didn't provide the phosphorus level. That is another kidney indicator. Also, how are your cat's teeth? Needing a good dental cleaning can also create numbers that mimic kidney insufficiency as well as raise glucose (not to mention the stress from going to the vet).

I hear you on the protein diet. However, you can't beat yourself up, because kidney issues are very common in kitties, especially as they age. A decent food, if Gizzy's phosphorus is not too high, is Hi-Tor Neo. Unfortunately, it can only be ordered online. But, my girl really likes it (as well as several other kitties I know). If Gizzy's phosphorus is high, you will need to add a phosphorus binder of some sort to any food you select, regardless of the phosphorus content. You will need to get the phosphorus down for Gizzy to feel better. Once it is in a good range, and you are feeding a low phosphorus food, you might be able to stop the binder.

Okay, here's what you don't want to hear: the diabetes can be controlled with insulin easily. The kidney disease, if not transient due to a need for a dental cleaning and/or infection, will only continue to get worse if you don't address it. I have been doing this double-whammy juggling act since early November, and it is indeed possible (my Sarah was diagnosed with kidney disease first about 18 months ago). She is very tightly controlled with only .75 units of Lantus, and she is fed a prescription renal food as well as the Hi-Tor Neo. So, it is indeed possible.

I will warn you, however, my life revolves around kitty's food timing, home testing, etc. I do what I can with automatic feeders, but insulin 2x a day, sub-cutaneous fluids multiple times a week, well, you get the picture.

Here’s a good website for you to research the possible kidney issues: http://www.felinecrf.org/index.htm

DZ and Sarah
 
Hello. I made a shortcut list to help myself and others.
The phosphorus values are at the end of each food item.... You want the ones under 250.

shortcut shopping list

There is one friskies ....
Special diet friskies pate turkey and giblets 5% carb... 189 phosphorus...
make sure it's the special diet variety....
there is a turkey and giblets dinner that looks very similar, same color can (purple) ...
the only difference is you want the one that says "special diet" on it...


If your cat likes raw at all... that would be a better choice than canned.
 
thank you for all the suggestions, i really appreciate it!!!

luckily...i was able to catch some urine in a ladle last night. i dropped it off at the vet and waiting for those results.

the blood test was just the typical feline wellness test (calcium/cbc/miniscreen/t4/wellness screen). i did ask the Dr for the phosphorus level and he told me that is a separate test. do you think i should ask the vet to do any additional testing except for the regular blood test and urine test that he already did? i have learned i really need to bring up ideas to my vet, he doesn't seem to typically suggest doing things on his own.

thank you for the shortcut shopping list...very helpful! as for the PHOSPHORUS ASCENDING ORDER chart on catinfo, it is very confusing! should i look for numbers under 250 in the "mg Phos per 100 calories" column? are all of these on this list low carb or do I need to also look at other columns to figure out the carbs/protein? are these foods better than a prescription diet? i am willing to pay some extra money for good quality canned food that will help him stay healthy. i don't think i could do raw...i read about it but can't imagine grinding bones, etc. i do bake chicken breast as a snack for him.
 
The phosphorus ascending order chart has all the other values on it just the same as Dr. Lisas regular food chart.
They are not in order for the carbs... or fat... or protein....
you do have to decipher it all.

Prescription foods are not better except for certain health issues.... and diabetes isn't one of them.
I would stay away from those.

I just sat and pulled out all the lowest phosphorus ones from my own list ( which was taken from Dr. Lisa's list)

If (the big IF :lol: ) you could get your cat to eat a variety of these.... just try not to focus on beef only. Dr. Lisa recommends using poultry the most.
( and the seafoods always have higher phosphorus)

And depending on where you live... there are a variety of raw foods available in stores now.
Nature's Variety has raw chicken. I know what you mean about making it yourself.



1% Eukanuba adult with gourmet chicken 239
6% Nutro Natural Choice Mature Health Chicken & Turkey Formula chunks in gravy 204
0% - Natura Evo chicken and turkey 155
4% - Wellness Beef and chicken 226
8% - Wellness Core chicken/turkey/chicken liver 215
4% - Wellness chicken 219
4% - Wellness turkey 201
2%- Merrick Before Grain cat 96% turkey – 178
1%- Merrick Before Grain cat 96% beef – 163
5% - Merrick Cowboy cookout 202
8% - Merrick Grammy's pot pie 237
3% - Merrick Surf n Turf 229
5% - Friskies Special diet Turkey and Giblets dinner pate 189
5% - Friskies Special diet Beef and Chicken Entree pate 242
 
Congratulations on a successful clean catch!

As far as blood tests, here are some definitive and important kidney labs beyond the BUN and creatinine:

phosphorus, potassium, calcium, amylase and lipase (also helps detect pancreatitis), RBC, HCT (hematocrit), TC02 (bicarbonate - helps detect metabolic acidosis which occurs when a cat gets too acidic = occurs in kidney cats on high protein diets, as the kidneys cannot metabolize too much protein). Also, a T3 or T4 to detect possible thyroid issues.

When the urinalysis comes back, the specific gravity and PH could also be definitive for kidney disease (both would be on the low side).

Regarding the Friskies special diet: if indeed your cat has kidney issues, this is the wrong food, as it contains ingredients to help with urinary tract health. While this sounds great, these ingredients are too acidifying for a cat with kidney disease (it is what I was feeding my cat when she was first diagnosed with kidney disease).

The benefit of a prescription kidney diet (or the Hi-Tor Neo) is it contains extra potassium, b vitamins, and other vitamins and minerals needed for a kidney cat. If your cat does indeed have CKD/CRF, the creatinine at this juncture is not too bad, so you could get away with mixing a prescription kidney food with a non-prescription food to get the best of both worlds.

So, please do take a look at the link I provided previously on kidney disease; it will be very helpful for you to know what to discuss with your vet.

DZ and Sarah
 
thank you all again. i did buy some of the food on your lists including some of the merrick, wellness and soulistic canned food i was able to find at petco.

i just received the urine results back. the specific gravity is 1.014 which the Dr said is really bad. he suggested this along with the blood results (The creatinine level is 2.7 and the BUN is 47) is a really bad prognosis.

the only other number he gave me regarding the urine test was the ph level which was 6. he said that was really bad. i asked about other urine results and asked about protein to creatinine ratio which he said they did not do. shouldn't they have tested this?

i mentioned to him that i thought the creatinine level, BUN and ph were bad but not horrible yet. he said they were horrible. is this true? i think he was kind of annoyed that i was asking so many questions. he seems to get irritated when i ask about additional blood/urine testing.

he wants me to bring gizmo to the vet tomorrow. he said we will discuss starting him on KD or NF canned prescription food. he is also going to show me how to do sub q fluids. he did mention starting at 150ml but didnt mention how often. anyone know about how much/how often these should be done? i would like to go in knowledgeable.

is there anything else that i should do? if anyone has anything else to suggest i bring up with the vet tomorrow morning i would really appreciate it.
 
The BUN and Creatinine are not that bad. I really would not be concerned about the pH either. The USG is not good.
Last July my civi Stuart was DX'd with renal insufficiency.
His USG was 1.011
pH 6
Bun 59 (15-34 is range)
Creatinine 3.6 (0.8-2.3)
Phosphorous 7.7 (3-7)
Potassium 3.3 (3.9-5.3)

Stuart is still with me. His is on potassium supplement, phosphorous binder and Mirlax since the AlOH binder causes constipation. He is also on a Mirtazapine as an appetite stimulant and sub-q fluids EOD.
 
Ugh! I usually don't say this, but please do get a second opinion and/or switch to a cat only vet. No, absoutely not are those horrible numbers. Arg.

My cat had the same numbers (pre-diabetes) a year and a half ago, and she's still going strong. Good grief. While the PH and SG are a bit low, they are not horrible. 5.0 is horrible and would suggest getting tested for metabolic acidosis, which can occur with a high protein diet.

Of course, you do need to get on the stick here, and if you choose to ingore the kidneys and concentrate only on the diabetes, your kitty will get worse.

Plus, the labs I mentioned in my previous post (potassium, amylase, lipase, TC02, phosphorus), and a full CBC are extremely important at this juncture, so you know what supplements are necessary.

I am going to say this again: for your kitty's sake, PLEASE join the CRF group. If I didn't belong to both groups, no way would my cat be doing so well.

Right now, your kitty's kidneys should be the priority. You already know how to deal with the insulin, now it's tiime to deal with the kidneys. Trust me, going the other direction (kidneys to diabetes) is a lot tougher.

It is possible to regulate on a prescription renal diet -- my cat is proof of that (her numbers range from 100-170, and that's using an AlphaTrak which reads higher than a human meter). You can start out mixing the current food with 50% prescription renal and get new labs in a month (full chem as well as CBC). That will knock down the protein and phosphorus in the regular food, while knocking down the carbs in the renal diet. All-the while, kitty will still be getting the extra necessary nutrients provided in the renal food.

Also, yes, the sub-q's are a very good idea, provided your kitty is indeed dehydrated (scruff tent takes too long to go back to normal position; gums are tacky instead of moist).

However, if you choose to ignore the kidneys and concentrate mainly on the diabetes, your cat's kidneys will worsen quickly, and, your vet will be correct.

DZ and Sarah
 
had my appointment saturday morning. the vet seemed to be a little more helpful and agreed with treatment his levels weren't horrible. i brought up the additional blood tests again. he said to feed the prescription food and give the subq for 2 weeks then bring gizmo back and he will run all the blood tests i asked about. still seems odd to me...how can you compare the levels of phosphorus if there is nothing to compare to. not sure if i want to bring gizmo back that soon either. bringing gizmo to the vet causes huge stress on him. his head and ears get hot, his ears were red, he was shaking, etc. i have been going to this vet because its only a 15 minute drive and gizmo hates being in the car. most of the cat only vets i have found online are a much longer drive but i think i may need to consider them at this point or look into a vet that comes to the house.

they showed us how to give the sub q fluids. he said to give 150 ml every 2-3 days. they sold us 2 things of 1000ml lactated ringers solution, 2 venosets and 20 needles. i did ask for him to write me prescriptions so i could buy supplies on my own. he said that would be fine but then seemed to forget to write them. the office was busy and lots of dogs barking so i just wanted to get out of there so i will go back and get the prescriptions this week when i go back to buy more food.

i bought hills k/d and purina NF. so far i have been giving him about half of his old food and half of the prescription food. gizmo seems to be taking to it ok so far.

i have been reading the felinecrf.org website and just now joined the group. thanks again everyone!
 
So glad to hear all is progressing well. You will need to do curves for a couple of days to see if the food is spiking Gizmo's BG's. Most likely, you will need to go up at least .25 units. And, after switching food, three weeks is a good amount of time to retest the labs.

Ugh, I hear you on the vet. Sarah gets horribly stressed out too (hot ears, shakes uncontrollably) and has never been the same since she had her first curve done at the vet at the start.

Do you have any mobile vets in your area? I finally did so for Sarah. Generally, they are not the kind of people to use as your principal vet, but it is so much less stressful on kitty. Mine is kind of a glorified vet tech, and she agrees that I know a lot more about all of Sarah's issues thank she does.

My mobile vet will do a wellness exam, blood draw, blood pressure and probably vaccines (once the kidney issues hit, it is pretty much across-the-board for vets to decide vaccines are no longer necessary and can be harmful).

There is also a moble ultrasound option. Of course, all of the mobile alternatives are more expensive, but I decided my cat's well-being is worth it.

Generally, the mobile vets will have labs sent to your regular vet.

Hope mobile is an option for you!

Oh, on the sub-q's, you might want to start out with 100ml. In the CRF group, most of us have found that over 100ml is too much and either gets pee'd out immediately or makes the cat very uncomfortable and lethargic. If you are experiencing low humidity, you might find that sub-q's are needed daily instead of every other day.

DZ and Sarah
 
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