? What is going on? Is this kidney disease? I need guidance!

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Tosca

Tosca

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My dear Tosca (10 years old) was well managed for long periods of time. She was very well regulated with 0.25 units of Lantus until May. And then her glucose became unpredictable.

I kept increasing her insuline, so now we are at 2 units, and her glucose is still unpredictable. Her behavior is unchanged for the most part. As always she has a good appetite, she is active, cuddling, asking to play. Maybe she is a little more vocal asking for attention, and sometimes she seems agitated. And I noticed that she started to drink water, which she didn't do since she was diagnosed and transitioned to exclusively wet food.

I completed the section of blood work in spreadsheet. Her last blood tests were done on August 14th this year. That day we went to the vet for her recurrent constipation issue, she had an enema. The vet noticed an increase in creatinine over the years but no other issue.

I try to understand what to do next!? I am planning to do an urine test. I read that creatinine increase and thirst could suggest kidney issues. What else can I do? Ultrasound is needed to diagnose kidney disease? Any suggestions?

And for the insuline, should I keep increasing? Or is there a chance that there is bouncing? I am so confused and worried. Thank you so much everyone!
 
Getting a urine test done, to see if Tosca is concentrating her urine is a good idea. A first thing in the morning pee is best. It's part of an indication of kidney disease. So is SDMA if you had it done too - Idexx always includes SDMA if that is the labs your vet uses. I wouldn't worry about a slightly higher, but normal creatinine. It could be she was slightly dehydrated.

You don't need an ultrasound done to diagnose kidney disease. Lot of good information on this website:
https://felinecrf.org/

Has the vet checked her mouth to see if she needs a dental? Needing a dental are one of the most common reasons for a cat falling out of regulation. As is any other type of infection/inflammation. That urine test will also help indicate if there is a urinary tract infection.

As for insulin dose, you may need to keep increasing. I would follow the guidelines of TR, which means quicker increases than you have been doing.
 
Hi Maria,
Definetly not super experienced in feline CKD however one of mine has CKD and I’m a member of Tanya’s group -> the link Wendy gave you is the CKD bible for any information on CKD. And no, you don’t need an ultrasound.
From the labs your vet run it cannot be concluded that Tosca has kidney issues. The SDMA wasn’t run this year, the two previous years it was stable though, as is protein. BUN and CREA keep increasing, but as Wendy said, it could be simply that Tosca was dehydrated.

For CKD it is important to check urine concentration - normal for cats is 1035 to 1050. Below 1035 we see dilute urine, which is indicative of kidney issues, but again not necessarily CKD. You can purchase a refractometer on Amazon and home test urine concentration (like this one: https://www.amazon.com/Clinical-Refractometer-Measuring-Specific-Veterinary/dp/B07DLCYZMW) or bring urine to the vet and have them test it.
To check for UTI it would be best to get urine via cystocentesis.

Even if Tosca starts having kidney issues, there is no need to panic. CKD is nasty, but with proper management a CKD cat can live for many years, and in Tanya’s group, many cats ultimately pass from other causes. For now, just take a deep breath and have her urine checked, her teeth checked, and her glucose regulated. Her phosphorus levels are fine so no need to change anything in her feeding habits.

My diabetic cat Aida needed a dental, and her insuline needs have dramatically decreased since then. Teeth have a huge impact on the entire system, glucose and kidneys and everything.
 
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