Possible Early Renail Failure?

[FallingSilver02]

Hello all -

I have been poking through past posts looking for advice on my sweet girl, Kitty. Kitty was diagnosed with cancer (apocrine carcinoma) late last August and we opted for a low-dose chemo therapy. Since then, she has had monthly check-ups and bloodwork, and has not shown any signs of disease, which is wonderful! She did, however, slowly begin to lose weight from month to month from about 10+ to 9.4 lbs from Sept to January.

Because of this, we decided (with our oncologist) to remove Kitty from her chemo regimen. At her last appointment, we found out she had been able to maintain her previousy weight with no signs of cancer recurrence (good news!), but our vet also reported that some of her blood work was not ideal, specifically her kidney values. The items that were out of range were:

BUN 38 (14 - 36 mg/dL)
CREA 2.5 (0.6 - 2.4 mg/dL)
Cholesterol 239 (75-220 mg/dL)

Based on this, our oncologist has recommended that we contact our local vet to do an urinalysis as this might be indicitative of early renal failure. I should also note that I have noticed Kitty hanging around her water bowl alot more, and she has vomited white foam a few times in the past weeks (which I have read are also possible symptoms).

Does anyone have thoughts on this, given that her levels are pretty borderline? (And what causes high cholesterol in a cat??) Has anyone been through this process before? I have reached out to my local vet for her opinion on the results, but she is out of the office until Tuesday. Is there anything I can do in the meantime to help bring these levels down (new food, etc.)? I am also going to start monitoring her food/water intake much more closely.

Thanks so much for any advice you can offer!

[westfayetteville]

Hi FallingSilver02
First off sorry Kitty is having trouble. I don't know much about CRF but here is a site you can get info Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Symptoms, Diagnosis, Treatments and How to Cope With It I do know if you mix cooked egg whites with there food, it will help lower the phosphorus levels

[juventas]

I'm no vet, but from a human perspective, common causes of acute renal failure include dehydration/low blood pressure and infection (upper respiratory infection, strep, etc). As everyone knows, chemo is poisonous and depending on the type can also cause renal failure.

For humans, generally you want to push fluids and check labs frequently. It often takes a whole day for labs to reflect a change in creatinine, but I don't know about cats, clearly. In many cases, renal failure will resolve itself as the illness improves or hydration improves. If this is caused by chemo, your cat may have some permanent renal impairment (although this does not necessarily mean she needs drastic or emergent treatment).

Unfortunately, there's little that someone without medical knowledge can do other than encourage your cat to drink more (if that's even possible, and it's not like you can put in an IV line). If you have anything that can help nausea, you might also want to try that. I assume she has not been having diarrhea? Make sure there aren't any other causes of water loss in your cat.

Cholesterol is not something you can change in a day or even weeks/months (unless you are talking about triglycerides, which is caused by eating fatty foods). If it is caused by renal failure, I suspect it will be more of a chronic, long term issue. I would not worry about that urgently, but check her thyroid, adrenals, and blood sugars when your vet gets back.

Obviously, if symptoms get worse quickly, you may need to find another vet in the short term. But if symptoms improve, then mild lab abnormalities are just lab abnormalities without any real significance. I know if a human has a mild bump in creatinine and BUN, you would just recheck them in a couple of days (sometimes even a week or two). Trend of labs is also important. If your cat's creatinine was 1.0 on last check, I might be more worried than if it was 2.0 previous to the 2.5.

[FallingSilver02]

Thanks westfayetteville - I just stumbled on that site earlier and it has been really helpful in terms of giving me the background I needed on what exactly might be going on in Kitty's little kidneys!

Juventas - Yes, we went into chemo with the knowledge that it could have some nasty side effects, which is why she was having blood work done monthly to catch any internal side effects early on. I'm making sure to keep her water fresh, and she's been pretty good about her intake - we also only feed her canned, which helps too! I'll mention your cholesterol monitoring advice to my vet. Her creatinine levels have been at a "high" normal for at least a few months (2.4), which is giving me a little comfort. I've asked for past bloodwork to see her recent BUN and cholesterol levels, since those have never been mentioned as a concern before - hopefully there won't be a huge movement on either.

Thanks so much to you both for the advice!

[laurief]

I'm sorry to hear of Kitty's health issues. I know quite a lot about Chronic Renal Failure (CRF), but nothing at all about apocrine carcinoma or chemotherapy. I am happy to share everything I know and/or have experienced relative to CRF, but my information may or may not be relevant to your Kitty due to the potential influences of cancer and/or chemo on her blood values and kidney function. So please, run any information I provide past your oncologist so that (s)he may evaluate it relative to Kitty's cancer diagnosis and treatment. For the sake of my contributions to this thread, I will necessarily have to disregard your girl's cancer diagnosis and treatment, and discuss only the renal issues with which I am familiar.

Originally Posted by FallingSilver02

our vet also reported that some of her blood work was not ideal, specifically her kidney values. The items that were out of range were:

BUN 38 (14 - 36 mg/dL)
CREA 2.5 (0.6 - 2.4 mg/dL)
Cholesterol 239 (75-220 mg/dL)

The renal value that is of primary concern is creatinine, which is kidney-specific. BUN can elevate for non-renal-related reasons, so it is not necessarily indicative of renal function unless supported by an elevated creatinine value. As a rule, elevations in creat are not seen in bloodwork until at least 2/3 of renal function has already been lost. Fortunately, most cats can manage quite well with significantly reduced renal function if they are properly managed and diagnosed before reaching end-stage renal disease (as your girl has been), so take heart.

Other blood values that should be monitored in CRF cats are potassium, which should be maintained in the upper half of the reference range (above 4.0), and phosphorus, which should be maintained in the lower half of the reference range (below 6.0 - preferably below 4.0). Total Protein at or near the upper end of the reference range typically indicates dehydration, which is a common and easily treatable problem in CRF cats. Hematocrit or Packed Cell Volume should be monitored, as anemia is a relatively common problem in CRF cats, as well.

Mildly elevated cholesterol is most likely the result of a blood sample taken within 8 hrs of eating. It can also occur with a high fat diet. This mild elevation is most likely of no concern.

I should also note that I have noticed Kitty hanging around her water bowl alot more, and she has vomited white foam a few times

As I already noted, dehydration is common in CRF cats, and excessive thirst is an indicator of dehydration. You can help improve her hydration by mixing plenty of warm water into her canned food to make it "canned food soup" that she can lap up. At some point, she most likely won't be able to take in enough water orally to meet her needs. Then, you will need to have your vet teach you how to administer subQ fluids at home to keep her properly hydrated. SubQ fluids are the cornerstone of CRF management for many cats and can do more than any other management strategy to keep these cats comfortable and enjoying a good quality of life for as long as possible.

CRF cats are also prone to excess stomach acid, which results in white foam vomit. Ask your vet about Pepcid AC or Zantac 75 to manage this problem (read about them both on Tanya's site linked earlier in this thread). One of these acid reducers is best administered at bedtime to help control stomach acid overnight. You can minimize acid stomach problems during the day by feeding your girl frequent meals starting as soon as you get up in the morning, continuing throughout the day, and ending immediately before bedtime.

It's now past my bedtime, so I will end here and will check back to answer any more questions you may have tomorrow.

Laurie

[FallingSilver02]

Thank you so much for all the information laurief! I checked your recommendations for potassium (3.9) and phosporous (4.4), which by your recommendations are a little off the mark, but not horribly so. Her total protient is at 6.9, which seems to be mid-range from the "reference range" the lab provided, and I do not see any results for hematocrit/PCV - I will definately mention that to our vet though!

Over the weekend, I was careful to keep her water bowl full and fresh, and make sure her wet food was not sitting out too long. That is interesting about the Pepcid AC/Zantac - I did not know cats could benefit from them as well! I will bring that up to the vet also.

All that said, I heard back from my local vet, and while she says Kitty's elevations are mild, she does want to address them. She said other factors could have caused the elevations (ie, UTI which has ascended into the kidneys, which she notes is possible given her immunosuppressive therapy - which is much easily so I am keeping my fingers crossed for that!). I am going to set up an appointment to have the urine analysis done soon so we have a clearer picture of what we are dealing with. Will definately check back in with the results!

Thank you again so much for your advice and kind words!

[laurief]

[quote]

Originally Posted by FallingSilver02

Thank you so much for all the information laurief! I checked your recommendations for potassium (3.9) and phosporous (4.4), which by your recommendations are a little off the mark, but not horribly so. Her total protient is at 6.9, which seems to be mid-range from the "reference range" the lab provided, and I do not see any results for hematocrit/PCV

Potassium is excreted in urine. Since CRF cats drink a lot of extra water (and/or receive supplemental fluids), they urinate a lot and lose a lot of potassium. For that reason, many CRF cats also receive supplemental potassium gluconate mixed into their food to keep up their potassium level. Your Kitty's potassium level is just slightly below ideal, but do keep an eye on it in future bloodwork so that it doesn't sink any further.

Kitty's phosphorus is fine. We don't generally worry about lowering serum phosphorus until and unless it exceeds 6.0, UNLESS the cat is also receiving Calcitriol (in which case serum phos. should be kept below 5.0).

Kitty's total protein is fine.

Hematocrit/PCV are measured in a CBC, not a normal blood chemistry. Ask your vet if a CBC has been run on Kitty recently.

Over the weekend, I was careful to keep her water bowl full and fresh, and make sure her wet food was not sitting out too long.

Have you tried mixing warm water into her canned food? That's an easy way to increase fluid intake, and most cats love "canned food soup". You can also place more water bowls around your house to prompt her to drink more.

That is interesting about the Pepcid AC/Zantac - I did not know cats could benefit from them as well!

Acid reducers are commonly given to CRF cats, who frequently have a problem with excess stomach acid making them feel nauseous.

She said other factors could have caused the elevations (ie, UTI which has ascended into the kidneys, which she notes is possible given her immunosuppressive therapy

That's possible. However, Kitty's creat has apparently been at the top of the reference range for at least several months, which is more indicative of chronic renal insufficiency than it is of an acute infection. Once you have the results of the urinalysis, her Urine Specific Gravity (USG) should shed a bit more light on her renal condition.

Thank you again so much for your advice and kind words

You're very welcome. We CRF caretakers tend to look out for each other and share information freely for the benefit of our feline kids.

Keep us updated!

Laurie