Penny-End Stage Renal Failure DX-HELP!!

[Robyn and Penny]

Happy Friday!

Penny had stopped eating last week and was having trouble with her mouth so I took her to the vet and exam revealed advanced dental disease (2nd opinion vet mentioned stomatitis) but her chem panel came back that she was in end stage renal failure. Chem panel in June 2015 was all within normal limits. She was not admitted for IV fluids as I didn't want her left unattended overnight due to her low BGs the past especially month. BUN was 138, creatinine 11, phos 12.8, PrecisionPSL suggested pancreatitis (51) but 3 vets at 2 different practices felt that she didn't have p-titis. The treatment is pretty much the same so I did not ask for further testing. She is not anemic and all other levels are within normal limits.

She had her emergency dental two days ago and came through like a champ. The only thing she has been eating the past week is gravy from Weruva Cats in the Kitchen pouches, but her normal diet consisted of Young Again Zero and primarily Weruva low carb (not the pouches lol) food. I am switching her to Young Again Zero Mature (.5%phos dry matter) and Weruva low carb and Fussie Cat, which my kittens eat and I learned it's low phos but it's not on Dr Lisa's list so I have to do some research after I catch up at work today or tomorrow.

Currently she is on bupe .01ml q8-12h PRN pain, although I'm trying to see how she does without it today b/c she eats more without it and I'm trying to prevent fatty liver, Clindamycin 25mg once per day, Cerenia 8mg PRN, mirtazipine PRN, compounded famotidine 2.5mg PRN, subcu fluids 100-150ml daily, B12 injection weekly and still on Adequan injection .04ml q4weeks.

I've been getting a lot of help on the CKD FB page, but a lot of those people are not experienced with diabetes. My vet gave us Epakitin to use, but I'm hearing that's inferior for her high phos level and the first ingredient is lactose. Will that raise her BGs b/c she is also potentially heading for a 2nd remission after breaking through glucose toxicity in October. Do I need to give a binder if she's eating low phos food? And what are your thoughts on aluminum hydroxide? I ordered it and USPS lost it so I have to figure out what to do from here as it is. I read it can cause dementia and heavy metal buildup so I wanted some laymen's experience with CKD and diabetes and what has worked for y'all.

I have to go to work but will be checking in later today and tomorrow. Thanks in advance for your experience and advice! Her SS is in the signature and the meds she's on is listed in the comments section, but i haven't figured out how to get her blood work on there yet.

 

[Amy&TrixieCat]

Trix has had advanced kidney disease for almost 2 years. Penny definitely needs a binder with her phos levels where they are at. When Trix was first diagnosed, I was using aluminum hydroxide binder powder and she did fairly well with it, but last year my vet started carrying a product called ConSeal AIH, which is also aluminum hydroxide, but it's in a "capsule" that also has some sort of flavoring that makes it more palatable for cats. I switched to ConSeal AIH and Trix eats much better with it that she did with the plain aluminum hydroxide powder. The capsules look like a multivitamin, but they aren't as hard as a vitamin. I shave a little bit off with each meal and snack Trix gets. I give her about 2 capsules per day. She's due for a check up and blood work soon, so I don't know what her current phos levels are, but I do know she eats pretty well...high phosphorous can definitely make them feel yucky.

The downside is that this stuff is only available through vets' offices, at least for now. But here's a link to their website: Bock Labs ConSeal AIH . Maybe your vet would be able to get this for you.

Have you had her BP checked? Elevated BP can raise kidney values. And I do wonder if the dental will help improve her values, too.....

 

[Sherry & Zoe (GA)]

I used Aluminum hydroxide powder that I bought through www.thrivingpets.com.

I used for with Zoe for 2 years and just mixed it in her wet food, whichever low carb one she was eating. She did well with it and I didn't have to be so concerned about the phosphorus levels of the food I was buying.... She was extremely finicky and I wanted her to eat, so using the binder was easier than changing her food so much. Her phosphorus levels came back down to low normal.

Good luck to you and Penny. If you have any questions for me, just ask!!

 

[Amy&TrixieCat]

Sherry did remind me....Trix will only eat Fancy Feast and Purina One - both are low carb but very high phosphorous. The binder allows me to feed her those high phosphorous foods rather than trying to force her to eat something she doesn't want to eat. So the binders do open up a wider range of foods you can offer, which can be very helpful.

 

[Janet and Izzy (GA)]

Izzy lived with Renal disease for over 4 years. It's not what took her.

I used to give her the Aluminum Hydroxide power from Thriving Pets. It's supposed to be flavorless, though I admit I didn't try it.

In addition, because she was on and off her food near the end, I would syringe feed her 2x a day with a mixture of baby food, spirulina, Standard Process Rena Food and Zobaline because I wanted to be SURE she at least got those in her

I also did SubQ fluids.

My current civvie has renal disease. He is 18. He is a kibble crack head, and thankfully not diabetic. He does get wet food 2x a day and I am doing SubQs on him as well. His has not progressed enough yet to add the binders.

 

[MommaOfMuse]

Robyn,

Dry food regardless of how low carb it is, is very hard on the kidneys. It has to be rehydrated in the body which pulls fluids from the body. While YA is low enough in carbs to be acceptable for a diabetic, it's going to be tough on her already damaged Kidneys. If I can find it around here I think I still have the list of things my vet recommended with Autumn should we have chosen to treat her end stage renal failure. I will scan it and send it to you. I do know elimination of all dry food and putting her on an all canned diet was one of them, although since she was already a diabetic and had been transitioned to all canned already it was a moot point with her.

Mel and The Fur Gang

 

[Squeaky and KT (GA)]

Robyn, yeah this dx stinks but it can be handled. The hugest thing is to keep as much fluids going THROUGH her body to flush toxins. The dry food is going to interfere with that heavily. Dry food must be rehydrated by the body to digest and move through the colon. This uses water that is needed to flush kidneys. If at all possible, PLEASE consider taking the dry food away. I think I remember that she eats wet food fine?

HUGS! CKD Doc sends headbutts to Penny...

 

[jayla-n-Drevon]

fluids fluids fluids--
every day for a week--then reevaluate -- with stage 4 you may need to continue daily but you can slow it down ....
AS @Squeaky and KT said dry food is not the friend of a renal cat--it not only does not add moisture it takes away...
there is a semi moist food from waggers that is 12% carbs-
if wet is acceptable I would stick with as much wet as possible and allow to eat as much wet as kitty wants as they will lose weight with renal disease.... again you can slow it-
Rico DX at 11 years-was 13#
It has been 6 years of SQ fluids and he is 10-11# and 17 years old with no kidney issues on his BW as he gets fluids on a very regular basis--I cannot encourage fluids enough and know thy cat--
sometimes although Rico gets them every other day sometimes we still do a "push" where I give daily and start back again every other day-

 

[Robyn and Penny]

Trix has had advanced kidney disease for almost 2 years. Penny definitely needs a binder with her phos levels where they are at. When Trix was first diagnosed, I was using aluminum hydroxide binder powder and she did fairly well with it, but last year my vet started carrying a product called ConSeal AIH, which is also aluminum hydroxide, but it's in a "capsule" that also has some sort of flavoring that makes it more palatable for cats. I switched to ConSeal AIH and Trix eats much better with it that she did with the plain aluminum hydroxide powder. The capsules look like a multivitamin, but they aren't as hard as a vitamin. I shave a little bit off with each meal and snack Trix gets. I give her about 2 capsules per day. She's due for a check up and blood work soon, so I don't know what her current phos levels are, but I do know she eats pretty well...high phosphorous can definitely make them feel yucky.

The downside is that this stuff is only available through vets' offices, at least for now. But here's a link to their website: Bock Labs ConSeal AIH . Maybe your vet would be able to get this for you.

Have you had her BP checked? Elevated BP can raise kidney values. And I do wonder if the dental will help improve her values, too.....

Yes...her BP was normal on three readings. She had her dental on wednesday. I wanted to wait but once she started feeling better you could clearly see her struggle to eat so I took a risk and had it done. I'll def look that up and ask my vet if they will order it for me.

 

[Robyn and Penny]

I used Aluminum hydroxide powder that I bought through www.thrivingpets.com.

I used for with Zoe for 2 years and just mixed it in her wet food, whichever low carb one she was eating. She did well with it and I didn't have to be so concerned about the phosphorus levels of the food I was buying.... She was extremely finicky and I wanted her to eat, so using the binder was easier than changing her food so much. Her phosphorus levels came back down to low normal.

Good luck to you and Penny. If you have any questions for me, just ask!!

Good to know Sherry! I just rec'd my alum hydroxide from Thriving Pets. How much should she be getting a day. The dosing info on their site for this was a little confusing. She's 15lb and her phos was 12.8

 

[Robyn and Penny]

Sherry did remind me....Trix will only eat Fancy Feast and Purina One - both are low carb but very high phosphorous. The binder allows me to feed her those high phosphorous foods rather than trying to force her to eat something she doesn't want to eat. So the binders do open up a wider range of foods you can offer, which can be very helpful.

Penny had started turning her nose up to FF after about 2 yrs on it and then she briefly went back on it but started to turn her nose up again. Hence the expensive Weruva, etc lol

 

[Robyn and Penny]

Robyn,

Dry food regardless of how low carb it is, is very hard on the kidneys. It has to be rehydrated in the body which pulls fluids from the body. While YA is low enough in carbs to be acceptable for a diabetic, it's going to be tough on her already damaged Kidneys. If I can find it around here I think I still have the list of things my vet recommended with Autumn should we have chosen to treat her end stage renal failure. I will scan it and send it to you. I do know elimination of all dry food and putting her on an all canned diet was one of them, although since she was already a diabetic and had been transitioned to all canned already it was a moot point with her.

Mel and The Fur Gang

Thanks Mel! Are you sending via FB? Again, I only let her snack on the YA. She still gets four wet meals per day. Right now more because she can't eat the YA and can't really eat real food so she's eating gravy about every 2 hrs. And this YA is also low phos. .5% dry matter

 

[Robyn and Penny]

Robyn, yeah this dx stinks but it can be handled. The hugest thing is to keep as much fluids going THROUGH her body to flush toxins. The dry food is going to interfere with that heavily. Dry food must be rehydrated by the body to digest and move through the colon. This uses water that is needed to flush kidneys. If at all possible, PLEASE consider taking the dry food away. I think I remember that she eats wet food fine?

HUGS! CKD Doc sends headbutts to Penny...

Right now she's not eating dry b/c she can't anyway. She only snacks on the dry. The majority of her diet is wet food. She eats it fine but tends to get fussy, as all my cats. Especially if I give them the same flavor too often. I was once told by a vet that cats didn't need variety. That's BS. Every cat I ever had has gotten tired of wet food lol

 

[Robyn and Penny]

fluids fluids fluids--
every day for a week--then reevaluate -- with stage 4 you may need to continue daily but you can slow it down ....
AS @Squeaky and KT said dry food is not the friend of a renal cat--it not only does not add moisture it takes away...
there is a semi moist food from waggers that is 12% carbs-
if wet is acceptable I would stick with as much wet as possible and allow to eat as much wet as kitty wants as they will lose weight with renal disease.... again you can slow it-
Rico DX at 11 years-was 13#
It has been 6 years of SQ fluids and he is 10-11# and 17 years old with no kidney issues on his BW as he gets fluids on a very regular basis--I cannot encourage fluids enough and know thy cat--
sometimes although Rico gets them every other day sometimes we still do a "push" where I give daily and start back again every other day-

How do you determine when he gets a "push"? Right now she's getting 100-150ml per day (again she's 15lb) and they wanna recheck her blood work once she's done her Clindamycin in two weeks. I guess from there we will adjust if her numbers come down. the 2nd opinion vet said "dentals have a way of fixing a lot of things" so I'm hoping her numbers go down. And maybe for a 2nd remission but I'm trying not to get my hopes up.

 

[manxcat419]

I was once told by a vet that cats didn't need variety. That's BS. Every cat I ever had has gotten tired of wet food lol

What I've found is that if they're prescribing you a dry food while they tell you that, they're probably right. My 2 ate nothing but Royal Canin urinary S/O dry for years...it never, ever bothered them that it was the same thing every day. But with wet food, I have to change it up at every meal - if I give the same flavor 2 meals in a row, the second lot will be ignored.

 

[Larry and Kitties]

The dosing info on their site for this was a little confusing. She's 15lb and her phos was 12.8

Tanya's site says with phorohorous level between 8 and 10 dose is 100 mg/lb that would be 1500 mg/day, However, you are over that and the site says discuss with your vet.
Thriving Pets Al hydroxide is 1/4 teaspoon is 300 mg. 1500 mg would be 1 1/4 teaspoons.
I would discuss with your vet.

 

[jayla-n-Drevon]

How do you determine when he gets a "push"? Right now she's getting 100-150ml per day (again she's 15lb) and they wanna recheck her blood work once she's done her Clindamycin in two weeks. I guess from there we will adjust if her numbers come down. the 2nd opinion vet said "dentals have a way of fixing a lot of things" so I'm hoping her numbers go down. And maybe for a 2nd remission but I'm trying not to get my hopes up.

I can tell when he is just the slightest bit off--if I go to pick him up and he is like a rag doll or not fussing at all it is usually the early part of him needing a push-if it goes on longer he will not want to eat much and hide even when I am home....if I am ever in doubt I do at least 5 days in a row. (about 100 as his is 10#) I know a dental would be good for him but I just am not convinced he would wake up or ever be the same at his age-
As for your situation.... I am not a vet and I do think dentals help many things but stage 4 renal failure is a bit more challenging as kidneys are the 1 organ that can not revert. However, as I mentioned it can be greatly slowed down. I think daily fluids and a recheck in 2 weeks is a good plan. 1 thing I would advise is not to "stop" even if the values are "normal" -- watching the behavior is key--
From my experience I would think after the 2 weeks I would try every 3 days (unless they are clearly needed sooner) and go from there-
FYI a case of fluids from walgreens is 80$ lines and needles KV Vet Supply-

 

[RenaRF]

Hi Robyn. I haven't had time to read everyone's posts, so I apologize if some of this is duplicative.

You had asked on the FB page specifically about phosphorus. Given the blood level you quote, your girl Penny is definitely in need of a binder. High phosphorus values in a kidney kitty are a major red flag in that a) they make a cat feel like crap - flu-ish - and they go off their food; and b) high phosphorus actually speeds the degredation of the kidney tissue. In senior kitties we really like to see that phosphorus valued at 6.0 or below - smack in the middle of the normal range. anything above that mid-range point is binder-worthy. The very best binder is the aluminum hydroxide powder - it is odorless and tasteless and is dosed on your kitty's weight and current phosphorus value. You just mix it right in with food - I know you said you had to feed dry at this time, and you CAN get that binder to "stick" to the dry food. Just start putting, for example, your kitty's breakfast portion in a plastic baggie the night before, add the proper amount of the binder, shake it up and then put it in the freezer overnight. The binder will kind of fuse/stick to the dry food, and voila - you have binder on board! Here's the binder dosing chart that I believe a few others referenced: http://www.felinecrf.org/phosphorus.htm#aluminium_hydroxide. And I see also that Thriving pets was referenced as a good source, and I concur. They are very affordable for ALL CKD-related supplies including Lactated Ringers Solution (LRS), IV admin sets and needles (more on that later). Also per your note - Epakitin is not as good at binding the phosphorus and carrying it out in the body, and it is also calcium-based, which can become an issue later one if calcium levels elevate.

You are familiar with Tanya's site - www.felinecrf.org? Did you also know that there are two great groups/listservs where you are going to get far better advice than on the Facebook page? The first is Tanya's list - https://groups.io/g/tanyackd. The second is the Feline CRF Support list: https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info.

Those values you list ARE high, but I find it highly weird that she went from normal to those levels in 8 months. Not impossible, I suppose - but very very unusual. Did she by chance have a urine culture to rule in or out a pernicious kidney infection? Any chance you would get an ultrasound for her to check the relative size and shape of her kidneys, which will tell you a lot? Finally, do you have a urine specific gravity on her?

How is she eating? How is her weight, her overall demeanor, her coat quality?

Rena

 

[RenaRF]

Tanya's site says with phorohorous level between 8 and 10 dose is 100 mg/lb that would be 1500 mg/day, However, you are over that and the site says discuss with your vet.
Thriving Pets Al hydroxide is 1/4 teaspoon is 300 mg. 1500 mg would be 1 1/4 teaspoons.
I would discuss with your vet.

Definitely a phone call is in order - BUT - when you have a phosphorus value that is above the dosing chart's range, I always just went with the 100mg/lb. per day and then rechecked bloodwork after two weeks, then again a month later. Getting a handle on how different treatments affect her bloodwork will be a key for you - PLEASE see my other post to you and join the two groups I linked. Also PLEASE go to the felinecrf.org site and start reading through the newbie section.

 

[RenaRF]

How do you determine when he gets a "push"? Right now she's getting 100-150ml per day (again she's 15lb) and they wanna recheck her blood work once she's done her Clindamycin in two weeks. I guess from there we will adjust if her numbers come down. the 2nd opinion vet said "dentals have a way of fixing a lot of things" so I'm hoping her numbers go down. And maybe for a 2nd remission but I'm trying not to get my hopes up.

Ok. Are you asking about when to administer subQ fluids? This is actually a very important question. Bear in mind that subQ fluids and IV fluids are not the same - I'm sure you know that, but just in case. IV fluids actually CAN push out high blood levels of creatinine and such, and a kitty in crisis often needs that. SubQ, however, are not the same. They don't "push" anything out. Rather, subQ fluids are used to maintain consistent, even hydration in a cat that can no longer do that for herself through simple eating and drinking. Cats in the earlier stages of chronic kidney insufficiency actually do a good job of supplementing their own hydration by simply drinking more water. They maintain consistent, even hydration on their own. At some point, however, all CKD cats will just get to a point where they can't drink enough water orally to keep up with what they're peeing out. that leads to a consistent state of dehydration, which is bad for every system in the body, including the kidneys. Since the goal of treating kidney insufficiency is to lower the strain on the kidneys so that we get as much out of what's left as possible, dehydration is bad because it works counter to that goal. An important detail that many people overlook is that just as DEhydration is bad for all body systems, so too is OVERhydration. So, you need to get in the habit of daily checking Penny's hydration status. Fortunately, that's an easy thing to do.

The very best way to test hydration is to put your fingertip on Penny's gums prior to a meal (typically). They should feel slick and moist to your fingertip, just like your own would feel if you did it to yourself. However, since Penny is a cat, she may not enjoy that (smile). So a second way to test is called the skin turgor test. Simply gather a bunch of fur/skin from her scruff/between her shoulderblades into your fist. Once gathered, let go. The skin should instantly go back to its normal position. It shouldn't hold a crease or bunch or take time to smooth back down. If her gums feel stick or tacky or if her skin takes time to return to its original position, you may be looking at some level of dehydration. The important thing here is to start testing her at home and write down your results. Over a period of a few days, if she is consistently coming back with dehydration markers, you can be pretty sure that she is generally dehydrated and is going to need ongoing subQ fluid therapy to help her with her hydration. BUT - you want to ensure you are discussing with the vet the concept of OVER hydrating so that you know you aren't doing that, either. At those creatinine values, I would expect she needs regular subQ fluid support. But - but - as I mentioned in my other comment, it's very very unusual to go to those levels in such a short period of time, so I am somewhat suspicious that your girl Penny may being having some kind of acute flare-up that can be gotten back under control. You just want to make sure that you're in the sweet spot on fluid therapy. There's a whole, great read about the subject here: http://www.felinecrf.org/fluid_therapy.htm.

For what it's worth, your girl sounds thick and healthy outside of the dental issue. Ask more questions - ask about an acute onset over chronic kidney insufficiency, where a cat has low-level CKD but then something - an infection, whatever - creates a kidney crisis that shoots those values up.

 

[Olive & Paula]

How did you know it was glucose toxicity? And what did you do to break it?

 

[Anitafrnhamer]

Go to felinecrf.org and this group on yahoo: https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

It is best if you can get full lab results.

Is Penny currently on sub-q fluids? Sometimes that can help to reduce the BUN and Crea which may be artificially elevated if she is dehydrated. You do need to start treatment for the high phosphorus. Read here: http://www.felinecrf.org/phosphorus_binders.htm

So much more can be done but the lab results are a very important source of information. Please join the group and post all info so we can assist you with caring for Penny.

Squeaker was diabetic and also in renal failure, I just lost him in January.

ALOH (aluminum hydroxide) is needed for Penny at this point to bring down the phosphorus. It does not induce any type of "poisoning" if used correctly. It is superior to other binders in that it is the most effective at lowering the phosphorus levels.

 

[Anitafrnhamer]

How much should she be getting a day. The dosing info on their site for this was a little confusing. She's 15lb and her phos was 12.8

You should begin by giving 100 mg per lb (your cat's weight) divide this among however many meals you give Penny every day. Example: If the cat weighs 10 pounds and eats 2 meals per day, you would put 500 mg of ALOH in each meal. You would continue this dosing and check phosphorus level in 2 weeks, then adjust the dose as the phosphorus level drops. http://www.felinecrf.org/phosphorus_binders.htm#aloh_dosage

 

[jayla-n-Drevon]

I know this is controversial but it has been my experience that a cat (including my Rico) was able to be "flushed" without IV fluids by daily therapy, his creat. was high enough that my vet said "start fluids". He is not a very compliant patient and my vet agreed we would do best to treat at home as to avoid the stress. It is 6 years later so I am glad we went with our plan. I am sure others disagree but every cat is different and as your vet has already said 150 every day for 2 weeks and re evaluate-I agree with your vet. With sub Q the body uses the fluid as needed/able-IV is faster but it all comes out thru the kidneys. Just my experience. (and not just with Rico)

 

[jayla-n-Drevon]

Rico is the grey and white-he is 16.5 here.... SQ since 11-

 

[manxcat419]

ALOH (aluminum hydroxide) is needed for Penny at this point to bring down the phosphorus. It does not induce any type of "poisoning" if used correctly.

To the best of my knowledge, the danger of aluminum toxicity has only occurred in humans who are also on dialysis. I don't think there's any precedent of it showing up in cats - maybe because they have a shorter lifespan, or maybe because they don't have it build in their system the same. Used as a binder in the correct quantity, it's safe. That said, I've never dosed anywhere near as high as 100 mg per lb - the maximum dose I've used is 200 mg per day for a 10lb cat which actually falls right in the middle of the IRIS recommended dosing on Tanya's site at 20 mg per lb (we started at the lower end of the dosing scale, worked up it gradually and found Rosa's levels were fine by the time we got to 20 mg per lb). Personally, the dosing method I prefer is to use the minimum possible of anything like ALOH, just in case.

 

[Robyn and Penny]

Tanya's site says with phorohorous level between 8 and 10 dose is 100 mg/lb that would be 1500 mg/day, However, you are over that and the site says discuss with your vet.
Thriving Pets Al hydroxide is 1/4 teaspoon is 300 mg. 1500 mg would be 1 1/4 teaspoons.
I would discuss with your vet.

Will do! I was thinking 1500mg, as well, so I'll check with my vet

 

[MommaOfMuse]

Robyn,

With Autumn I found a really easy way to remember to check her hydration was when I was getting ready to shoot. I would give her a real quick scruff, then tent and shoot. Which was pretty much our routine anyhow because her Meowjesty would only allow her Princess Pretty Paw self to be shot in the scruff. But seriously, just gather a handful of her skin and fur wherever you normally tent to shoot. She already use to you handling her skin there. If she has the same tortieude as her twin sister by a different mother. If you try grabbing anywhere else she's not going to be happy about. Especially since she is fresh off a dental with fresh extractions, I wouldn't attempt the gum check until her mouth completely healed.

And Ya, if I still have it and can find it, I'll scan that sheet from my vet's into a PDF file and in-box it to you on FB. I'm not even sure if I still have it, I cleaned out a bunches of papers the other day and I don't remember if I filed it for future reference or not. Although with her levels I'm not sure how much of it's going to apply to her case. Autumn was already stage 2 when we did her emergency FME and while she came through it like a champ and rallied for a couple months. When they pulled that tooth that had been capping that encapsulated abscess that had apparently been there for the 4 years I had here, since I noticed the lump within the first few days I had her, the resulting infections in her mouth and jaw where just too much and she jumped from stage 2 to stage 4 and she let us know it was time to stop fighting, but she was also way older than Penny. So this sheet would be more geared treatment in the early stages.

Mel and The Fur Gang

 

[Robyn and Penny]

I can tell when he is just the slightest bit off--if I go to pick him up and he is like a rag doll or not fussing at all it is usually the early part of him needing a push-if it goes on longer he will not want to eat much and hide even when I am home....if I am ever in doubt I do at least 5 days in a row. (about 100 as his is 10#) I know a dental would be good for him but I just am not convinced he would wake up or ever be the same at his age-
As for your situation.... I am not a vet and I do think dentals help many things but stage 4 renal failure is a bit more challenging as kidneys are the 1 organ that can not revert. However, as I mentioned it can be greatly slowed down. I think daily fluids and a recheck in 2 weeks is a good plan. 1 thing I would advise is not to "stop" even if the values are "normal" -- watching the behavior is key--
From my experience I would think after the 2 weeks I would try every 3 days (unless they are clearly needed sooner) and go from there-
FYI a case of fluids from walgreens is 80$ lines and needles KV Vet Supply-

A case as in 24?

 

[Robyn and Penny]

I can tell when he is just the slightest bit off--if I go to pick him up and he is like a rag doll or not fussing at all it is usually the early part of him needing a push-if it goes on longer he will not want to eat much and hide even when I am home....if I am ever in doubt I do at least 5 days in a row. (about 100 as his is 10#) I know a dental would be good for him but I just am not convinced he would wake up or ever be the same at his age-
As for your situation.... I am not a vet and I do think dentals help many things but stage 4 renal failure is a bit more challenging as kidneys are the 1 organ that can not revert. However, as I mentioned it can be greatly slowed down. I think daily fluids and a recheck in 2 weeks is a good plan. 1 thing I would advise is not to "stop" even if the values are "normal" -- watching the behavior is key--
From my experience I would think after the 2 weeks I would try every 3 days (unless they are clearly needed sooner) and go from there-
FYI a case of fluids from walgreens is 80$ lines and needles KV Vet Supply-

What kind/gauge needles do you use? I'm afraid using these 18g harpoons are gonna give her an aversion to her insulin/B12/Adequan injections. I heard some ppl on the CKD FB page saying something about a 19g that's more smooth or something? It only takes a couple of mins to get the fluid in her with the 18g though

 

[jayla-n-Drevon]

A case as in 24?

12

 

[Robyn and Penny]

Hi Robyn. I haven't had time to read everyone's posts, so I apologize if some of this is duplicative.

You had asked on the FB page specifically about phosphorus. Given the blood level you quote, your girl Penny is definitely in need of a binder. High phosphorus values in a kidney kitty are a major red flag in that a) they make a cat feel like crap - flu-ish - and they go off their food; and b) high phosphorus actually speeds the degredation of the kidney tissue. In senior kitties we really like to see that phosphorus valued at 6.0 or below - smack in the middle of the normal range. anything above that mid-range point is binder-worthy. The very best binder is the aluminum hydroxide powder - it is odorless and tasteless and is dosed on your kitty's weight and current phosphorus value. You just mix it right in with food - I know you said you had to feed dry at this time, and you CAN get that binder to "stick" to the dry food. Just start putting, for example, your kitty's breakfast portion in a plastic baggie the night before, add the proper amount of the binder, shake it up and then put it in the freezer overnight. The binder will kind of fuse/stick to the dry food, and voila - you have binder on board! Here's the binder dosing chart that I believe a few others referenced: http://www.felinecrf.org/phosphorus.htm#aluminium_hydroxide. And I see also that Thriving pets was referenced as a good source, and I concur. They are very affordable for ALL CKD-related supplies including Lactated Ringers Solution (LRS), IV admin sets and needles (more on that later). Also per your note - Epakitin is not as good at binding the phosphorus and carrying it out in the body, and it is also calcium-based, which can become an issue later one if calcium levels elevate.

You are familiar with Tanya's site - www.felinecrf.org? Did you also know that there are two great groups/listservs where you are going to get far better advice than on the Facebook page? The first is Tanya's list - https://groups.io/g/tanyackd. The second is the Feline CRF Support list: https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info.

Those values you list ARE high, but I find it highly weird that she went from normal to those levels in 8 months. Not impossible, I suppose - but very very unusual. Did she by chance have a urine culture to rule in or out a pernicious kidney infection? Any chance you would get an ultrasound for her to check the relative size and shape of her kidneys, which will tell you a lot? Finally, do you have a urine specific gravity on her?

How is she eating? How is her weight, her overall demeanor, her coat quality?

Rena

She completely stopped eating last week but we suspect that was due more to the dental issue than her crash. Coat quality, demeanor, activity were great up until two weeks ago. If you look on her SS, even her urine output was normal till she started getting fluids. She was mildly dehydrated when she got her blood work done, had 200ml sub cu fluids 2 days before her 2nd opinion vet saw her and I asked him if she was dehydrated and he said "not at all". She's always been a big water drinker, even when she was OTJ, so I didn't think much about that. She was eating less the past few months but if you look at her SS you'll see she wa s45rrrr675555555 (Patchy typed that lol) her BGs were primarily over 300 for 9 months before she broke through that glass bottom in October. 2nd opinion vet had said that sometimes kidney infections don't show up in urinalysis and he also said "dentals have a way of fixing a lot of things" so I think he was thinking exactly what you're thinking, Rena. So I asked Vet #1 after her dental whether there was a possibility that this was an acute renal failure vs chronic and he said it's possible but he can't make any promises. She was on marbofloxacin before her dental but they switched her to Clindamycin after her dental. Her urine specific gravity was 1.013 so it was dilute. the last urinalysis she had was in Fall of 2014 and I remember doc mentioning it was ver concentrated, which is typical for a cat who eats dry food. There was trace protein in that urinalysis in 2014, but she was on gabapentin at the time and gaba can show false positives for protein in urinalysis so we didn't think much of it. There was NO protein in her urinalysis last week. Nothing remarkable in her urinalysis. It was a free catch. They tried to get it there but she was rather uncooperative lol

 

[Robyn and Penny]

She completely stopped eating last week but we suspect that was due more to the dental issue than her crash. Coat quality, demeanor, activity were great up until two weeks ago. If you look on her SS, even her urine output was normal till she started getting fluids. She was mildly dehydrated when she got her blood work done, had 200ml sub cu fluids 2 days before her 2nd opinion vet saw her and I asked him if she was dehydrated and he said "not at all". She's always been a big water drinker, even when she was OTJ, so I didn't think much about that. She was eating less the past few months but if you look at her SS you'll see she wa s45rrrr675555555 (Patchy typed that lol) her BGs were primarily over 300 for 9 months before she broke through that glass bottom in October. 2nd opinion vet had said that sometimes kidney infections don't show up in urinalysis and he also said "dentals have a way of fixing a lot of things" so I think he was thinking exactly what you're thinking, Rena. So I asked Vet #1 after her dental whether there was a possibility that this was an acute renal failure vs chronic and he said it's possible but he can't make any promises. She was on marbofloxacin before her dental but they switched her to Clindamycin after her dental. Her urine specific gravity was 1.013 so it was dilute. the last urinalysis she had was in Fall of 2014 and I remember doc mentioning it was ver concentrated, which is typical for a cat who eats dry food. There was trace protein in that urinalysis in 2014, but she was on gabapentin at the time and gaba can show false positives for protein in urinalysis so we didn't think much of it. There was NO protein in her urinalysis last week. Nothing remarkable in her urinalysis. It was a free catch. They tried to get it there but she was rather uncooperative lol

When she was sick last week, she was withdrawn and starting to act funny by going down the cellar and sitting by the back door down there. She got some fluids a few days and even though she was still unable to eat, she had a huge bounce back Mon night into Tuesday and started participating in all the family activities again. She's a rather social cat who has to be with me almost ALL THE TIME lol. She's doing all her usual stuff right now but still can't eat solid food. Only Weruva gravy food She's blowing through 6-8 packets a day lol

 

[jayla-n-Drevon]

What kind/gauge needles do you use? I'm afraid using these 18g harpoons are gonna give her an aversion to her insulin/B12/Adequan injections. I heard some ppl on the CKD FB page saying something about a 19g that's more smooth or something? It only takes a couple of mins to get the fluid in her with the 18g though

For Rico I use the 18 G x 1-1/2 because he doesn't care and it is fast-
My other guy is more sensitive and newer to fluids (the longer you do it the skin will get tougher) I use 20G x 1-1/2 on him-
For other injections like adequan/cerenia I use 25 G x 5/8
I throw a few needles in the freezer each day as it will dull the pinch going in--
You only need to get the bevel in and if you face the opening of the needle up it will be smoother--it is very fast.... once it is in they usually do not care. I hang bag up high as it runs on gravity (either a draper rod or a tall dresser/ back of a door--I sit on the floor with them. (and sing

 

[jayla-n-Drevon]

When she was sick last week, she was withdrawn and starting to act funny by going down the cellar and sitting by the back door down there. She got some fluids a few days and even though she was still unable to eat, she had a huge bounce back Mon night into Tuesday and started participating in all the family activities again. She's a rather social cat who has to be with me almost ALL THE TIME lol. She's doing all her usual stuff right now but still can't eat solid food. Only Weruva gravy food She's blowing through 6-8 packets a day lol

amazing what water will do---working in rescue I have seen cats on their last days make a turn around with just fluids-
Rico is living proof

 

[Robyn and Penny]

How did you know it was glucose toxicity? And what did you do to break it?

Someone hear had mentioned it before and referred me to someone else's condo from a couple of years ago whose cat had the same issue. I could have broken it a lot sooner had I been more aggressive with tight regulation. I was still treating her like a newly diagnosed diabetic instead of a long term. If you go back in my SS from June 2015 you'll see that I broke through and reduced her dose too quickly and blew it. Then I dilly-dallied around rather than taking her back to the last good dose and doing it right. Now I'm being more aggressive than I ever thought I would be, even with her not eating, and giving my vets a heart attack in the process ha ha. I work from home and get up to test every night so I can be more aggressive most of the time.

 

[Robyn and Penny]

Go to felinecrf.org and this group on yahoo: https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

It is best if you can get full lab results.

Is Penny currently on sub-q fluids? Sometimes that can help to reduce the BUN and Crea which may be artificially elevated if she is dehydrated. You do need to start treatment for the high phosphorus. Read here: http://www.felinecrf.org/phosphorus_binders.htm

So much more can be done but the lab results are a very important source of information. Please join the group and post all info so we can assist you with caring for Penny.

Squeaker was diabetic and also in renal failure, I just lost him in January.

ALOH (aluminum hydroxide) is needed for Penny at this point to bring down the phosphorus. It does not induce any type of "poisoning" if used correctly. It is superior to other binders in that it is the most effective at lowering the phosphorus levels.

Anita I'm so sorry for the loss of your Squeaker. That's my one feral kit Spunky's nickname! She's on fluids now. 100-150ml every day till her recheck in a couple of weeks. I was concerned about giving her too much and hurting her so he said to feel to see if she's absorbed them and decide how much from there (but between 100-150ml). The problem is, I'm giving them in her flank. And it's settling into her belly. which is big to begin with lol. I guess I just have to feel how squishy it is in the morning.

 

[Robyn and Penny]

For Rico I use the 18 G x 1-1/2 because he doesn't care and it is fast-
My other guy is more sensitive and newer to fluids (the longer you do it the skin will get tougher) I use 20G x 1-1/2 on him-
For other injections like adequan/cerenia I use 25 G x 5/8
I throw a few needles in the freezer each day as it will dull the pinch going in--
You only need to get the bevel in and if you face the opening of the needle up it will be smoother--it is very fast.... once it is in they usually do not care. I hang bag up high as it runs on gravity (either a draper rod or a tall dresser/ back of a door--I sit on the floor with them. (and sing

Once I get it in she's good. It's when I stick her she yelps a bit and I can't distract her with food like I do with shots b/c we are using her top load carrier to do this since Penny is stronger than Mom and Mom is holding her down. She can't run away that way. So far she's been pretty good. we let her have ONE Temptations treat afterwards (which have been taboo for her since her diabetes dx) since she can't quite eat her beloved raw chicken yet and she doesn't like freeze dried treats. We open the door when she's done and she doesn't run away or anything. Today she jumped down and rubbed up against my leg when we were done. I saw my vet give in the flank, above the hip but further back than where I do her other shots, and since she hates anything near the scruff and is super sensitive up there and her skin is more taught back there, I do the flank. I think that helps. I don't think it would go as smoothly if I did between her shoulders. Her skin is really rubber band-like up there. I use 27g for her B12 and Adequan injections.

 

[jayla-n-Drevon]

Anita I'm so sorry for the loss of your Squeaker. That's my one feral kit Spunky's nickname! She's on fluids now. 100-150ml every day till her recheck in a couple of weeks. I was concerned about giving her too much and hurting her so he said to feel to see if she's absorbed them and decide how much from there (but between 100-150ml). The problem is, I'm giving them in her flank. And it's settling into her belly. which is big to begin with lol. I guess I just have to feel how squishy it is in the morning.

Does she have a heart issue?? Is there a reason your doing flank as opposed to scruff/shoulder area??

If you feel it is not absorbed by the time she is due for the next dose of fluids you may want to call your vet and ask if you can gauge it by absorption. If she is holding too much water the vet may suggest cutting down to 100 or 125.... probably have you gauge what works. But if there is a large amount of fluids not being absorbed she should be looked at for any other reason as a 15# cat should be able to absorb 150 (at least 100) in 24 hours..... it seems like you are fully capable of gauging her needs

 

[jayla-n-Drevon]

Once I get it in she's good. It's when I stick her she yelps a bit and I can't distract her with food like I do with shots b/c we are using her top load carrier to do this since Penny is stronger than Mom and Mom is holding her down. She can't run away that way. So far she's been pretty good. we let her have ONE Temptations treat afterwards (which have been taboo for her since her diabetes dx) since she can't quite eat her beloved raw chicken yet and she doesn't like freeze dried treats. We open the door when she's done and she doesn't run away or anything. Today she jumped down and rubbed up against my leg when we were done. I saw my vet give in the flank, above the hip but further back than where I do her other shots, and since she hates anything near the scruff and is super sensitive up there and her skin is more taught back there, I do the flank. I think that helps. I don't think it would go as smoothly if I did between her shoulders. Her skin is really rubber band-like up there. I use 27g for her B12 and Adequan injections.

gotcha---my boys hate the flank
goes to show ECID
freezing the needle may help??

 

[Robyn and Penny]

Rico is the grey and white-he is 16.5 here.... SQ since 11-View attachment 18876

Awww...they're both adorable! I caught a lot of crap on the CKD FB page that I didn't admit her for IV fluids and b/c I did her dental with her creatinine so high but once she started feeling better you could clearly see she was in pain and struggling to eat even gravy food and drink water. Look at her BGs. I've prevented several possible hypos over the past few months and many overnight. No way was I leaving her unattended overnight and with this almost $800 dental, cost was definitely an issue. Penny is also not a very complaint patient unless she's looped up on pain meds like she was after her dental (they had nicknamed her Love Muffin b/c she was high as a kite and sweet as could be after her dental the other day lol) She was with a rescue for 3 yrs and I felt that the stress of being there at the vets in a cage would do more harm than good and my vet agreed to let me do sub cu at home. It says right on Tanya's site that her Thomas didn't go down after four days of IV fluids at the vet but he started going down when they did sub cu at home, so I really hope this works. She IS smelling A LOT less "uremic" or whatever that smell was. That smell started to fade after her 2nd fluid therapy.

 

[jayla-n-Drevon]

Awww...they're both adorable! I caught a lot of crap on the CKD FB page that I didn't admit her for IV fluids and b/c I did her dental with her creatinine so high but once she started feeling better you could clearly see she was in pain and struggling to eat even gravy food and drink water. Look at her BGs. I've prevented several possible hypos over the past few months and many overnight. No way was I leaving her unattended overnight and with this almost $800 dental, cost was definitely an issue. Penny is also not a very complaint patient unless she's looped up on pain meds like she was after her dental (they had nicknamed her Love Muffin b/c she was high as a kite and sweet as could be after her dental the other day lol) She was with a rescue for 3 yrs and I felt that the stress of being there at the vets in a cage would do more harm than good and my vet agreed to let me do sub cu at home. It says right on Tanya's site that her Thomas didn't go down after four days of IV fluids at the vet but he started going down when they did sub cu at home, so I really hope this works. She IS smelling A LOT less "uremic" or whatever that smell was. That smell started to fade after her 2nd fluid therapy.

Again--I know this is controversial but it all goes thru the kidneys.... I have been a tech for my vet and he is a HUGE proponent of sq at home. SO much less stress... of course at times IV is required but I think you will get this under control--your doing great.
Ricos labs come back perfect--if a different vet does them they do not even know he has a kidney issue and he has never had IV fluids.

 

[Robyn and Penny]

Does she have a heart issue?? Is there a reason your doing flank as opposed to scruff/shoulder area??

If you feel it is not absorbed by the time she is due for the next dose of fluids you may want to call your vet and ask if you can gauge it by absorption. If she is holding too much water the vet may suggest cutting down to 100 or 125.... probably have you gauge what works. But if there is a large amount of fluids not being absorbed she should be looked at for any other reason as a 15# cat should be able to absorb 150 (at least 100) in 24 hours..... it seems like you are fully capable of gauging her needs

No heart condition. She just doesn't do well with being scruffed or needles up there. She fought the vet like hell last Sat when she did scruff fluids, but then on Monday when my 2nd opinion vet did them in the flank , he barely had to hold her still. I felt much more confident doing it that way and I believe that's why it's been smooth so far (we've only done it twice at home so I hope I don't jinx myself here lol). The vet and I talked about making sure I don't give too much b/c I caught a lot of crap from the CKD FB page on that, too. They thought 150ml per day was too much even though Tanya's site even says 150ml for a 15lb cat. So now I'm all paranoid that I'll collapse her lungs or give her a heart attack.

 

[jayla-n-Drevon]

No heart condition. She just doesn't do well with being scruffed or needles up there. She fought the vet like hell last Sat when she did scruff fluids, but then on Monday when my 2nd opinion vet did them in the flank , he barely had to hold her still. I felt much more confident doing it that way and I believe that's why it's been smooth so far (we've only done it twice at home so I hope I don't jinx myself here lol). The vet and I talked about making sure I don't give too much b/c I caught a lot of crap from the CKD FB page on that, too. They thought 150ml per day was too much even though Tanya's site even says 150ml for a 15lb cat. So now I'm all paranoid that I'll collapse her lungs or give her a heart attack.

you can always try 100 if your unsure--can always add or do 150 /100 every other day--sounds like you have this under control

 

[jayla-n-Drevon]

by the way.... ask 20 people get 20 opinions....

 

[Robyn and Penny]

Again--I know this is controversial but it all goes thru the kidneys.... I have been a tech for my vet and he is a HUGE proponent of sq at home. SO much less stress... of course at times IV is required but I think you will get this under control--your doing great.
Ricos labs come back perfect--if a different vet does them they do not even know he has a kidney issue and he has never had IV fluids.

Thanks! I agree that stress on a sick kitty can only make things worse. And Penny has her "issues", for sure. Including separation anxiety. She's better off here and hopefully this does the trick. Especially b/c I still believe this was acute rather than chronic but time and tests will tell.

 

[Robyn and Penny]

by the way.... ask 20 people get 20 opinions....

So true! I couldn't decide between 100 and 150 today so I did 125 lol

 

[manxcat419]

I caught a lot of crap on the CKD FB page that I didn't admit her for IV fluids and b/c I did her dental with her creatinine so high but once she started feeling better you could clearly see she was in pain and struggling to eat even gravy food and drink water. Look at her BGs. I've prevented several possible hypos over the past few months and many overnight.

Yes, and you and Penny proved them all wrong. You had an excellent vet on the case, obviously, even though some others didn't believe it. And she did just fine with them - they wouldn't have let her come home the same day if they weren't happy with how she came out of anesthesia. If the sub-q's weren't working then, yes, you might have to reconsider IV but clearly they are helping her. And, as Jayla says, all extra fluid that goes into the body goes through the kidneys one way or another - it has to, it's basic biology. It might take a little longer to get her where you want her, but it will happen. Just keep trusting your instincts - you haven't gone wrong with her yet that way.

150 ml per day is right for a 15 lb cat - I think some people were concerned by the vet's suggestion that you do more than that if you could. But you know what you're doing - and yes, if you can't decide go somewhere in between for amount.

 

[Robyn and Penny]

gotcha---my boys hate the flank
goes to show ECID
freezing the needle may help??

I hear that on youtube, as well. I'm gonna stick one in the freezer now and try that in the morning.

 

[Robyn and Penny]

Yes, and you and Penny proved them all wrong. You had an excellent vet on the case, obviously, even though some others didn't believe it. And she did just fine with them - they wouldn't have let her come home the same day if they weren't happy with how she came out of anesthesia. If the sub-q's weren't working then, yes, you might have to reconsider IV but clearly they are helping her. And, as Jayla says, all extra fluid that goes into the body goes through the kidneys one way or another - it has to, it's basic biology. It might take a little longer to get her where you want her, but it will happen. Just keep trusting your instincts - you haven't gone wrong with her yet that way.

150 ml per day is right for a 15 lb cat - I think some people were concerned by the vet's suggestion that you do more than that if you could. But you know what you're doing - and yes, if you can't decide go somewhere in between for amount.

Thank you!! She's peeing up a storm so hopefully SOMETHING is getting cleaned out! lol I may try to weight her daily before fluids but she hates getting weighed. I have a baby scale she fits right in but she HATES it. But that would give me an idea of how much fluids to give, as well. I'll try it and see if she cooperates with that plan. Or just feel around and go with my gut lol