? Sister's Urine Protein Testing High

Hi, Sister has been off insulin since September 2021. She transitioned to Dr. Elsey's CleanProtein food after several food trials and has stayed regulated. Her senior wellness tests last week showed protein in her urine. The vet did further urine testing (creatinine?) and that came back today showing protein a little high, but to confirm this diagnosis and rule out other issues, the urine test must be repeated 2 more times within 2 weeks.

Here is my question: With Sister eating food that is low carb, high protein (59% protein according to the ingredients), could this be the reason she has "more than expected" protein in her urine samples?? If the other 2 tests show high protein levels, the vet will want nutritional changes (i.e. food) and or prescribe medication. I am totally not on board with altering Sister's diet. I am thinking that if Dr. Elsey's low carb food is the cause of the excessive protein, what good would medicating do if she continues to eat it? Hungry for your input. Thanks bunches.
(I was about to upload sister's lab results when I saw that the vet office sent me results for a female Australian Shepherd named Sister done in 2018!!! Not happy.)

 

Sister may have kidney deficiency.
This may help:
https://vcahospitals.com/know-your-pet/urine-proteincreatinine-ratios
Urine Protein:Creatinine Ratios
and
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9219505/
Urinary Protein/Creatinine Ratio in Feline Medicine: Reasons to Perform It and Its Role in Clinical Practice—A Retrospective Study

 

What was her UPCR (urine protein creatinine ratio) test value? As Larry said, kidneys are one possible issue. Has she had her blood pressure tested recently? They will have to diagnose why it's high (provided repeat tests show the same) before treating. It's not a food issue.

 

I have read the results a few times. No place on that form is UPCR. Yet the document is titled Urine Protein Creatinine Ratio. I can see Creatine Kinase is 786 when the range is 64-440 UL. The BUN is 42 when the range is 16-37. And Cloride is 112 with a range of 114-126. Those are the values in red. I am not aware that her blood pressure was checked. See no test results on that. Hope that helps you. Glad food is not the issue.

 

UPCR should be a separate line item. Can you call and ask them? Blood pressure would likely be a follow on activity if she hasn't had it checked recently.

 

I will have to since I cannot find that line item. Thx.

 

Wow, that is a lot of data. Not going to say I understood much of it. My understanding is that kidney deficiency comes with aging. Cats and humans, both. My 94-year-old dad who passed in 2022 was losing protein in his urine that last 3 months. I remember discussing it with him. Thanks a bunch for the articles.

 

@Wendy&Neko The vet was out 2 days and those in charge when asked did not recognize UPCR as a line item. Today, I took Sister in for her second, in a series of 3, special Urine Protein Creatinine Ratio tests as they suggested. Once there, a vet tech came out to advise there was a miscommunication. The urine tests should be done EVERY 2 weeks rather than 3 WITHIN 2 weeks as the sub vet said. (I actually think Dr. Vanessa said that, too.) They apologized. But went on to say I should put Sister on high carb Hills Science Diet KD to see if the protein seen in her urine decreases. Apparently, the vet forgot she is a diabetic and is on LOW carb, high protein food to keep her off insulin. The vet tech had no idea Sister is a diabetic. They still wanted me to switch foods and then retest urine in 2 weeks. Their opinion is that nutrition COULD INDEED be the cause of protein in her urine. I said I would think about it. Frankly, I might be done with this vet, but I sure would like some input here. So thankful for you guys.
UPDATE: I FOUND THE UPCR DATA!
UC 67.3 mg/dL
UP 80.8 mg/dL
UR PRO/CREAT 1.2
COLOR: Yellow
But says "requires proof" with further testing.
Hope this helps!

 

Neko's vet, when proteinuria was confirmed (after testing 2 weeks later) did NOT try to push K/D on me. I didn't read the articles Larry posted. I find Tanya's page on the subject easy to read: http://www.felinecrf.org/proteinuria.htm

As it says, there are several possible causes for proteinuria. Different causes mean different treatments. One possible cause is hypertension, hence my question about blood pressure testing.

I would not give K/D. Besides, until you've had the three UPCR tests done, proteinuria has not even been diagnosed yet. I would keep things the same on the retests. Even if proteinuria does get diagnosed, and all other possible causes are eliminated and Sister needs reduced protein, you can look for low carb foods that have lower protein and higher fat content.

 

Thanks, no vet has ever tested Sister's BP. I find no notes on that. I am reading Tanya's article now; finally understand more. Thanks for thinking this through for me. You are right. There is NO proteinuria diagnosis. I can look for a different food, but after a year of trying low carb food on Sister's tummy, Dr. Elsey's seemed like a magic potion. She digests it fine, the other cats want it, too, and it keeps her BG lower. The others, Wysong, Young Again, etc. all gave her diarrhea including LC treats (so treats are totally off the menu).

 

@Wendy&Neko Thanks for the great advice. I did not switch Sister's food to high carb Hills K/D that the vet was pushing. Her second Urine Protein Creatine Ratio test was yesterday, and her results have improved. She went from 1.2 to 0.6. One more test to go in two weeks.

 

Great news! Still a little high, it should be below 0.5 but much better than before.

 

Update: Sister had her 3rd Urine Protein Creatine Ratio test this week. It was 0.7. (Anything above 0.5 is considered high in a cat.)
Previous two tests were: 1.2 and 0.6.
The current vet says we now have confirmed proteinuria diagnosis.
I asked if she took Sister's blood pressure and her answer was, "Well, now that we have a diagnosis, now would be the time to do that." The vet had never suggested that before.
That said, the vet's recommendation (again) is changing Sister's diet to Hills K/D (which she insisted is not high carb). (I decided not to argue the point.)
She said trying a diet change is preferable to prescribing drugs (she mentioned omega fatty acids which I think is a supplement, not a drug).
I reminded her that Sister is a diabetic. The vet said when a cat is in remission, they do not have diabetes. (I always thought once a diabetic, always a diabetic and have considered Sister a diabetic cat regulated by diet.)
Have you ever been so confused that you don't even KNOW what question to ask? That is me right now.
My first idea: Feed half K/D and half high protein, no carb Dr. Elsey's to address "failing kidneys" which will lower protein in her diet and test her BG regularly.
I am interested in hearing what your next steps would be. Thanks bunches.

 

Now that you know it's proteinuria, the vet has to figure out what causes it. A quote from Tanya's page I linked above:

Hypertension is one such possibility that can cause it, without the kidneys being an issue. So confirm there is a problem - done, identify the cause of the problem - next step, then look at solutions relevant to cause. Proteinuria can be pre-renal (not kidneys), renal (kidneys), or post renal (not kidneys).

Once a diabetic, a cat in remission is a diet controlled diabetic. Kidney diets may not be a relevant solution if kidneys are not the the cause of the proteinuria, or even the best solution if early stage CKD.

 

Thanks so much. I think my next step is Monkeydo's internist in Ventura. I will be more confident taking sister to her for further evaluation.