Kidney problems and pancreatitis diagnosis

[Nancy Lynne]

Hi all
Grandma had been doing fairly well since her diabetes diagnosis in June, and her numbers were decent on a .25 dose. But in the last few weeks her numbers started consistently going over 300, so I upped her dose to .5 but other than a couple good readings her numbers will still all over the place. A couple days ago I noticed she had vomited bile two nights in a row, and on the second occasion the bile appeared to have blood in it. She also started limping, with weakness in her back left leg. I took her to the vet and her bloodwork suggested her kidneys are not functioning properly and she appears to have pancreatitis. The vet recommended I change her food from only the Fancy Feast classic pate to include some diabetic formula so she gets more fiber and fat in her diet. That was the only thing she suggested. While the vet didn't say it, it appears this is the beginning of the end for Grandma and there wasn't much that could be done but that the end could stretch out quite awhile. Grandma is still mobile, has a healthy appetite and loves her lap time in the morning and evening after being fed (she's still 100% outdoors). But she is frail and spends most of her days sleeping, but she's been that way for a very long time. I know there is a wealth of knowledge amongst all of you and appreciate any feedback. I have also attached her bloodwork. Thanks so much.

 

[Bron and Sheba (GA)]

Hi and welcome Nancy and Grandma.
With a fPL of 17.9 that does indicate Grandma does have pancreatitis. I am very surprised your vet did not commence some treatment for Grandma. Treatment for pancreatitis is supportive while the pancreas settles and includes subQ fluids to correct and prevent dehydration, cerenia and /or ondansetron for nausea and some pain medications as pancreatitis is painful.

With the kidney issues I am going to tag @Marje and Gracie as she will be able to help you with the path results and give you many suggestions as to how to move forward. We have many kitties here with varying degrees of kidney issues which can be managed so don’t lose heart.
It is not necessary to give a prescription diet to Grandma .....they are usually low in protein which is old thinking. A low phosphorus diet is what is needed. I will post a link which has the amounts of phosphorus in the food. Look for amounts of phosphorus 200mg phosphorus / 100 kcal or under.
Click on the second one on the list
https://www.felinediabetes.com/FDMB/threads/links-to-food-charts.174182/

 

[Critter Mom]

Hi Nancy,

Here are some very helpful resources for managing pancreatitis:

IDEXX Feline Pancreatitis Treatment Guidelines

Nausea and inappetence - symptoms and treatments (good to learn the signs - helpful for management of both pancreatitis and CKD).

Best site on the web for all things feline CKD (there's a lot you can do to help this condition):

Tanya's Site

Tanya's Site has an extraordinary amount of information and I'd suggest going through it in steady, bitesize pieces. (I took a bit of a running jump at it and I was left reeling afterwards.)

Based on my initial look at Grandma's kidney markers in the labs, as a precaution I would strongly recommend that you get Grandma's blood pressure and eye health checked ASAP. Hypertension can be managed with meds. Keeping BP in a safer range is better for the kidneys and is protective of the eyes.


Mogs
.

 

[Marje and Gracie]

Hi and welcome Nancy and Grandma.
With a fPL of 17.9 that does indicate Grandma does have pancreatitis. I am very surprised your vet did not commence some treatment for Grandma. Treatment for pancreatitis is supportive while the pancreas settles and includes subQ fluids to correct and prevent dehydration, cerenia and /or ondansetron for nausea and some pain medications as pancreatitis is painful.

With the kidney issues I am going to tag @Marje and Gracie as she will be able to help you with the path results and give you many suggestions as to how to move forward. We have many kitties here with varying degrees of kidney issues which can be managed so don’t lose heart.
It is not necessary to give a prescription diet to Grandma .....they are usually low in protein which is old thinking. A low phosphorus diet is what is needed. I will post a link which has the amounts of phosphorus in the food. Look for amounts of phosphorus 200mg phosphorus / 100 kcal or under.
Click on the second one on the list
https://www.felinediabetes.com/FDMB/threads/links-to-food-charts.174182/

Thanks for the tag, Bron.

You might want to read this Primer on Pancreatitis. I wrote it for the members of this site and it includes the info Mogs linked.

It looks like Grandma definitely has CKD but you’ve caught it plenty early and, with treatment, you can keep her stable for many years. My last CKD cat had a higher creatinine but because we kept the phosphorus under control and also stayed on top of the anemia, he lived well over four years, very stable, and was still stable with CKD when he passed from another health issue.

Mogs linked Tanya’s and it is the gold standard for CKD treatment. Many vets are not aware of the full array of treatments that can keep kitty doing well and stable for years. Here is where I see you need to focus and I’ll link the specific pages on Tanya’s.

Phosphorus: controlling the P levels and keeping it down at 4-4.5 is crucial for longevity and stability with CKD.

Do not feed the prescription food your vet is recommending. It’s better to look on Tanya’s at the food charts and find a food lower in P, ideally something less than 1.00% P on a dry matter basis or, if you use Dr. Lisa’s tables, less than 200 mg P/100 kcal. But also keep in mind the sodium so if you find a low P food, be sure the sodium is not too high. Also..and this is really important, in addition to the lower P food, Grandma needs a phosphorus binder now. IMHO, the best is aluminum hydroxide powder as it is inexpensive and tasteless. You’ll probably need a prescription from your vet but I used thrivingpets.com. The link above on binders on Tanya’s tells you how to dose it but it’s got to be mixed in with every bit of food she eats to bind the P in the food.

Anemia: her hematocrit (HCT) is just below 30% so you need to take action now to slow that drop down. She needs B vitamins in the form of methylcobalamin and a multiB complex.

Blood pressure: your vet should be checking this and treating it. There are no signs or symptoms until it’s too late.

Proteinuria: fortunately, she has no protein in her urine right now and that’s a very good thing. This is another predictor of longevity and it’s important to keep it at bay.

Tanya’s has an enormous amount of info and that’s why I’ve just steered you to the critical issues. It’s also really important, once you address the above issues, to keep an eye on the potassium and calcium and start giving subq fluids at home when the creatinine gets above 3.5.

CKD does not have to be a death sentence or a “throw up your hands” (as it sounds like the vet is doing) because nothing can be done. You can make changes now that will help her comfort and longevity. Let me know if you have questions but I also strongly urge you to join the Feline CRF group. That’s where I learned about Tanya’s and learned a huge amount from those wonderful people.

 

[Nancy Lynne]

Thank you all so much! This is such great info. I am feeling like my vet is kind of giving up, but it could be she's being money conscious with me because I just spent a LOT of money on another cat who ultimately had to have his eye removed. I think my main question right now is how to choose the best food to balance her various issues: diabetes, CKD and pancreatitis. I had come to the same conclusion about not feeding the Purina Pro DM, the phosphorus was too high. So I've been looking at Lisa's chart to balance the phosphorus and carbs and it's not easy. And I think the vet was saying it was important for her to have some carbs. I had been looking at the Tiki Cat which is low in phosphorus but it has no carbs. Any suggestions or thoughts on this? Also, I did a quick search for a phosphorus binder and it looks like a special order item, it's not something I can find in a local pet store or drugstore. Is that correct? Also, any specific suggestions for the methylcobalamin and a multiB complex? Thanks again,

 

[Critter Mom]

Hi Nancy,

I think my main question right now is how to choose the best food to balance her various issues: diabetes, CKD and pancreatitis.

If you need to choose which condition to prioritise based on your little one's clinical signs and lab results, keep in mind that if push comes to shove and you need a food to help with the other conditions which ends up not being ideal carb-wise, the insulin dose can always be worked around that if necessary.

Another tip: should Grandma need to go onto amlodipine for blood pressure management, it can make a kitty a bit nauseated, especially in the early days of treatment with it. My civvie, Lúnasa (aka The Noodle), is CKD stage III and I found that giving her a dose of ondansetron a couple of hours before giving the amlodipine helped a great deal with this.

You can also check blood pressure at home. Tanya's Site has a recommendation for a relatively reasonably priced oscillometric meter. It wasn't on the market when I needed to start monitoring Saoirse's blood pressure so I ended up forking out for a veterinary BP meter (mucho, mucho dinero). Cost aside, I've found the home meter to be absolutely invaluable in helping me to manage the Noodle's amlodipine dosing and to keep her blood pressure in a good range. It's definitely worth considering getting a meter, especially as less expensive ones are now available. You get more reliable readings because it's less likely that BP will be temporarily elevated by travel/vet stress, and it ultimately saves both time and money since you don't need to keep traipsing in to the vets for BP checks.


Mogs
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[Panic]

Why does she want Grandma to have carbs? That shouldn't be necessary.

 

[Bron and Sheba (GA)]

With diabetes, CRD and pancreatitis you can feed a low carb (10% or less), low phosphorus and higher protein diet and that will be suitable for all three. Marje did mention for you to start a phosphorus binder ASAP as well.
I don’t know why your vet is suggestion higher carbs either.

 

[Nancy Lynne]

OK, I talked to the vet to clarify her food comments, and one concern is grandma getting fiber. She said she has diseases with competing needs so it is a challenge to prioritize. Based on the food chart I had settled on the Purina Pro urinary Turkey in the evening (4% carb and 187 phosphorus) and Tiki Cat Luau selections in the morning (mostly no carb and phosphorus in the 150-175 range). I am a little concerned about the no carb with the Tiki Cat. I would love food recommendations from anyone who have cats with these three diseases as I'm not sure these are the best choices.

I am taking Grandma in on Wed to get her blood pressure taken, and the vet was on board with a phosphorus binder and B vitamins. She said we really should test her cobalamin and folate levels first, but it's going to cost $250 so I'm going to proceed without it and we'll include those two items when we re-do her bloodwork in two weeks. I am having problems with Grandma's BG numbers and the vet said the pancreatitis can do that. I'm a little hesitant to keep increasing her dose because she's always been susceptible to BG bounces (I'm not able to do any curves at this time) and would love any thoughts on that. The vet also suggested I try some CBD with her as well. The very good news is that Grandma has a voracious appetite so I don't have to worry about how to keep her fed.

 

[Critter Mom]

If you haven't already done so, I'd suggest asking the vet to give Grandma's eyes an exam when she's in for the BP check. Hope it goes OK.


Mogs
.

 

[JanetNJ]

Thank you all so much! This is such great info. I am feeling like my vet is kind of giving up, but it could be she's being money conscious with me because I just spent a LOT of money on another cat who ultimately had to have his eye removed. I think my main question right now is how to choose the best food to balance her various issues: diabetes, CKD and pancreatitis. I had come to the same conclusion about not feeding the Purina Pro DM, the phosphorus was too high. So I've been looking at Lisa's chart to balance the phosphorus and carbs and it's not easy. And I think the vet was saying it was important for her to have some carbs. I had been looking at the Tiki Cat which is low in phosphorus but it has no carbs. Any suggestions or thoughts on this? Also, I did a quick search for a phosphorus binder and it looks like a special order item, it's not something I can find in a local pet store or drugstore. Is that correct? Also, any specific suggestions for the methylcobalamin and a multiB complex? Thanks again,

My cat has diabetes and ckd.... About the same level as yours. I feed weruva foods because they are low carb and low phosphorus.
Weruva slide and serve pate foods Family Food (.97 phosphorus and 0 carb). Also Jeopurrdy Chicken (0.97 P 6.1 carb)

Goody stew shoes 0.71 phosphorus, 8.5 carb. This one is a big hit

Weruva Steak Frites (0.57 phosphorus 5.5 carb although I take out any big pieces of potatoes to try to limit the carbs just a bit)

Weruva LA isla Bonita - phosphorus 0.77 carb 4.5 (used to like, not a favorite anymore)
Glam and punk 1% carb, 0.93 phosphorous.

Weruva paw lickin chicken 3.3 carb 0.82 p and
Press your lunch 5.9 carb. 0.82 phosphorous

Bff play Laugh Out Loud chicken and lamb 7.7 carb, 0.82 phosphorous

BFF play destiny (chicken and duck) 0.87 phosphorus 7.7 carb

Bff play chicken cherish 0.71 phosphorus 7.6 carb

Bff play best buds chicken and beef 7.9 carb 0.9 phosphorus

Bff play chicken Checkmate. 7.7 carb 0.7 phos

New favorite On the Cat Wok 3.8 carb 0.74 phos


I also started a bit of sub q fluids at home. I'm just doing 50 ml 3 times a week right now (she has a heart murmur so got to be careful not to over hydrate. I give her probiotics once a day and vitamin b twice a day.

Do keep an eye on blood pressure


For pancreatitis the treatment is usually cerenia for nausea, bupe for pain and daily sub q's

 

[Nancy Lynne]

I got Grandma back to the vet today for blood pressure and eye check. Vet said eyes looked pretty good, and here are the three BP readings she did: 164/121, 166/121, 159/113. The vet said she'd consider this borderline, especially considering the stress she was probably under (I also had to bring her in with another cat in the car who she's not acquainted with, so I'm sure that didn't help). The vet suggested a chest xray, but it was expensive and she said if her heart was enlarged there probably wouldn't be any treatment so I decided to wait. The current plan is to re-do her bloodwork in a couple weeks, and fingers crossed the new food, B vitamins and phosphorus binder help with her numbers. I did give her .05 bupeprenex yesterday and today (2x/day) and her numbers have been in the 200-range for the first time so fingers crossed that's helping with her pancreatitis pain. I have also ordered some CBD for her as well since I want to keep the bupe to a minimum. She is still acting normally and has a great appetite. Thoughts?

 

[Critter Mom]

Hi Nancy,

here are the three BP readings she did: 164/121, 166/121, 159/113. The vet said she'd consider this borderline, especially considering the stress she was probably under

Indeed, those systolic blood pressure value are right on the boundary between pre-hypertensive and hypertensive. From the IRIS website page on systemic hypertension:

The IRIS substaging does not give a lower bound for the normotensive range, but the following document gives a value of 120, below which the dose of any hypertensive treatment should be reduced. It also provides a good, if somewhat technical, overview of treatment of hypertension in cats, including criteria for when to initiate anti-hypertensive treatment:

ACVIM Consensus Statement: Guidelines for Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats

Also, in my travels round the interweb, I did find a note advising when blood pressure is lower it may lead to poor appetite. I'm sorry I can't find the original source for that claim, but by way of anecdotal evidence I've certainly found this to be the case in my own civvie, Lúnasa (aka The Noodle).


Mogs
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