Week apart lab results, are these significant changes?

Hi again all. I just got Starburst back from the vet, they determined no UTI and reran her blood work from her ER vet visit and gave her subq fluid. Looking at the lab numbers I wonder if the kidney issues and anemia are progressing rapidly? Her crea especially has shot up as well as amylase and her RBC/HGB/HCT have lowered what seems to me to be significant amounts (results are in lab tab of ss). I do have a follow-up appt Saturday with my longterm vet, but I'm wondering if anyone has experience/knowledge in these results. The vet I saw today seems to think we are looking at 1-2 years of life max, IF I can get her diabetes controlled.

 

I will ask @Marje and Gracie if she can have a look for you.
She is very good at interpreting blood results.

 

Thank you!

 

Maegan, Marje just contacted me to say she will definitely have a look at your lab results but because of prior commitments it may not be until tomorrow afternoon.
So hang in there. Some vets can be very pessimistic so I would wait and see what Marje and your regular vet have to say.
Is she getting any treatment for the anaemia at the moment?

 

No treatment for the anemia. I asked about b vitamin shot and she said that wouldn't help. I have a list of questions for my normal vet on Saturday. Thanks again

 

Marje will be able to assist you with some questions to ask the vet and how to move forward.

 

I’m sorry it took me so long to respond.

Yes, that much of an increase in creatinine in a week is rather a large jump. There can be many reasons for that including things like a kidney infection. A kidney infection likely won’t show up on tests for a UTI. It usually requires an ultrasound.

B12 shots won’t help because typically cyanocobalamin is given in the **** form and that form of B12 is for intestinal issues. To fight anemia, if it’s nonregenerative, she needs methylcobalamin given in pill or powder form and a multiB vitamin. You can slow anemia (nonregenerative) down with these combined B vitamin treatments.

Anemia is not treated with the big guns until the HCT falls below 20%

It’s really important to get her phosphorus levels down and it’s time to use binders.

BTW, I wouldn’t worry about the amylase.

I hope that helps.

 

Thank you so much! I have added possible kidney infection, phosphorus binders, B supplements, and potassium supplement to my list of things to bring up with my vet.

 

You’re welcome. Just keep in mind it can be difficult to determine if low potassium is due to CKD or diabetes. Insulin can cause the uptake of potassium into cells which means the serum (blood) levels would be lower. However, I might assume because if the other values, it could be CKD.

I have to say her HCT is pretty low for a cat whose creatinine isn’t that bad. That’s why it’s important to determine if it’s regenerative or nonregenerative anemia. The vet is not likely to know much about B Vit supplements die CKD and, once they figure out the type of anemia, you can do that on your own. Regenerative anemia is often treated differently i.e. iron supplements.

BTW, I’ve had cats with CKD that I caught early and they lived quite a long time thanks to the help of Tanya’s website. My last kitty with CKD was 18 when he crossed and his CKD was still stable after being dx four years earlier. He passed from something else. The most important things to control are phosphorus levels, anemia, and proteinuria. Also, it’s important with CKD cats to keep an eye in blood pressure.

Lastly….I don’t know what “norm (UBG)” is on her urine. There should be an actual value as normal has a wide range.

 

Thanks again. Her urinanalysis results are at https://linksharing.samsungcloud.com/6zh9On5MJTkr
I didn't see what else that item could be. Honestly I wasn't impressed with the vet I saw Wednesday, her only concern was BG and she told me to not test at home, only give her 1 Unit 2x/day and schedule a glucose curve at the vet (said it takes a while for it to kick in, which if I'm reading the info on here right is not the case with prozinc). I'm hoping my normal vet tomorrow will be better (he knows me well, knows my thinking/priorities, etc). I will ask how we can determine which anemia and I already ordered the Jarrows, should be here tomorrow. I'm debating ordering phos-bind via Amazon this morning (will get here tomorrow) but will call tge vet to see if they have any binders in stock, in case he recommends a different brand.

 

Just called the vet and they had no idea what phosphorus binders are (asked me to spell it out because they had never heard of it). This isn't a good sign. I'm ordering it on my own now I guess.

 

https://www.thrivingpets.com/catalo...droxide-powder-usp-200-gram-jar/category/135/

This jar will last a very long as you only put a very small amount in their food. And it's on sale!
The gels that most vets sell are mainly for dogs and have sweetener.

 

I used this for Tyler's brother Perry who had CKD, I joined Tanya's Group for CKD and they told me to divide one capsule into 10 doses, but then I was told to buy the spoons and use the spoon that says drop on it, it would be close enough.
I'll show you the spoons


I see Vitacost.com has the Jarrows cheaper than Amazon

 

https://www.amazon.com/Norpro-Stainless-Measuring-Spoons-smidgen/dp/B0009X1P9S
Here are the spoons

 

Thank you! I already ordered the Jarrows but will need the scoops.
Actually, I have a food grade scale, I wonder if that will work?

 

really don't know, the members from Tanya's CKD group told me to use the spoons

 

The USG is urine specific gravity which is shown as specific gravity on the report you linked. Perhaps you can put it in her urine results on her lab tab as 1.028.

While that is below normal, it’s not nearly as low as I see some cats with CKD. It is also somewhat time dependent so if the urine was taken after she received fluids or later in the day when she might have had more to drink, the urine will be more dilute and the USG lower.

You can’t just give the Jarrows by itself. You also have to give the methylcobalamin and the Jarrows doesn’t have enough of it.

 

Thanks, I caught that this morning and updated her spreadsheet with it. At the time of the urine sample she did not have subq fluids or drink water shortly before, so that's good. Thanks for the info on tge methylcobalami

 

A USG of 1.028 is good for a old kitty. That value means the kidneys are working OK and would not be a cause of non-regenerative anemia. My Dulce's USG has been in the 1.022 going down to 1.019 over 2 years and his kidney blood values are OK (creatinine is 1.9 with normal being 0.9-2.4) and his HTC is 37%. These are values from this Wednesday.

 

Again, it depends on the time of day you take the urine sample. To determine if a cat us capable of concentrating urine, the very first urine of the day would have to be tested. If done so, a cat, of any age, with a USG of 1.028 first thing in the a.m. is not concentrating their urine. Then it would up to the vet to determine why the urine wasn’t being concentrated.

I did not equate USG with anemia. You would need to read the entire thread. We were discussing Starbursts’s low HCT earlier and independent of USG. Please be sure you read the entire thread before you make a comment.

 

Thank you for your help on this. My vet (yesterday) wants to focus on getting her BG down first, everything else doesn't matter if we can't get it down quickly and he didn't seem concerned by the phosphorus or potassium levels since they are technically in range. Too many variables to tackle at once. So, that's where I am...upping her insulin. She did get another dose of subQ fluids yesterday but it doesn't seem to be helping like earlier in the week and she is still drinking a lot today (but her BG is still off the charts so that's expected I guess). My anxiety has been through the roof, I am barely sleeping, worried I am hurting or damaging her (last night the shot did not go well and she had some "coughing" when I first grabbed her scruff), deflated every time I see that black box on her ss. Since she had 2 subQ fluids this week I am freaking out that she may be overhydrated or that her potassium is even lower from dilution. She seems ok, just sleeps alot (normal), interested in food, drinking too much and still peeing/pooing (loose but formed this morning...switched her to truluxe steak frites Friday)...I'm going a bit crazy

 

I’m sorry but your vet is way off base on this. The ranges for phosphorus include that for kittens which often might have a P value of 8. An adult cat’s phosphorus should be 4-4.5. Her HCT also needs to be addressed as it is pretty low. With her USG being 1.028 and her creatinine where it is, that definitely looks like CKD. The only way to know for sure is to run an SDMA with IDEXX.

It is very hard when we are dealing with unregulated diabetes to also have to worry about something else. But, I know from experience that ignoring that level of P is not a good idea. You might want to read the stickys in the Prozinc forum to help with some dosing but one of the big issues is that you are not getting any nighttime data at all. You are missing half your data. It’s possible (although hard to say with her) that she can be dipping down lower at night and bouncing back up into these high numbers. I’ve seen it so many times. A few nights of a +3 or before bedtime test will give you some data (be sure to get the PMPS). If she is staying high, she might need to be fast tracked up in the dose.

What kind of fluids is she getting? If it’s lactated Ringer’s, it has potassium. And why is she getting fluids? If it’s to help with the BG, that might work although I never have found it does much. If it’s for CKD, it’s way too soon to be giving her fluids. If she’s had vomiting and diarrhea and needs to replenish electrolytes, that’s a good reason as well.

 

He disagrees. He won't address the HCT unless it is under 20. I did get the Jarrows B-right today, the spoons come tomorrow and I ordered the B12 (methylcobalamin) from vitacost today (as well as smaller gauge U-100 needles, I am trying to find the best place to get the freestyle libre). She faught me again on PM shot...eventually I got it but it's hard.

On the phosphorus, this blood sample was taken before I had been able to switch her over to lower phosphorus food....she now mainly eats Truluxe Steak Frites and I just received the phos-bind so I can start mixing that in when I feed her anything closer to 1.0 phosphorus (she loves the tiki cat manana grill...which is like 1.17). But her diet change wasn't complete yet. It did go from 6.1 to 6.0 between 7/6 and 7/14 so was starting to get lower.

She had a SDMA test from the week prior (7/6) and it was 22, so already diagnosed as stage 2 ckd. As for the fluids, she presented as dehydrated on Wednesday and they gave her fluids to help....and it really seemed to, she became more bright and social. I asked yesterday if they would help her again and he felt that they wouldn't hurt (although I do regret that now because I have no idea how it affected her blood panel and it didn't brighten her up like it did earlier). The statement says fluids - LRS so I assume that to be Ringers. (Oh good, that should help a bit with potassium).

He is concerned that she may not survive long enough to deal with these other issues if I don't get the Glucose down and although I am reading everything on here and Tanya's CKD page as fast as I can (that's all I have been doing for the last week) it is too much information to make all these informed decisions so quickly. There are so many options on potassium supplements and I can't tell if any have carbs....if you have a recommendation on one that I can purchase quickly I would love to hear it. What can I get on my own (with no prescription) to help the best that won't impact her BG?

I did get her PMPS (the first two stabs didn't produce enough blood BUT she didn't even flinch) 498. I will try and get a nightime reading tonight but the more I mess with her BG tests the more she gets pissy, which doesn't help insulin shots. I really want that Freestyle Libre so I can get a good picture. Thanks

 

As I mentioned before, vets won’t take out the big guns to treat anemia until the HCT is below 20% and many are not aware that it can be halted, if it is nonregenerative associated with CKD, with B vitamins.

Glad you are addressing the P levels. If that little bit of fluids made her feel better, that’s great. He should be your guide on potassium supplements because you can get into big issues that compromise her health if you aren’t careful. I never suggest to anyone which potassium supplements to use or how much. The vet needs to do that.

We have lots of help to give on testing and you might want to look through these resources on testing and shooting.

 

Thanks, yes the videos are very helpful and I hope Starburst and I get to that place, but neither of us are comfortable with it yet. If I give her her favorite food she will act like it's no big deal but any other food or treats and she isn't interested, so it's a dance we are learning right now. I'm more concerned with her fighting me on the injections the last few days but I have both 8mm and 6mm 31g syringes coming this week (I'd rather use 6mm but worry fur shots may be more common due to shallow depth) so hopefully that will help.
I'm hoping the Ringers fluids helped her out on her K levels for now, honestly since she's had fluids twice now I feel like her values may all be different from the last panel. I'll ask for another set of labs in 2 weeks (starting phos binder tomorrow). Thanks again