Acute Renal Failure in 5yo

My cat Spike is 5, and had developed vomiting last weekend, but seemed to be eating and acting fine, so I figured it was a little bug and gave it a few days. Tuesday morning, I noticed he seemed a little lethargic and didn't want to eat, so went ahead and booked a vet appt that afternoon. The vet noticed his bladder was huge and blocked - and was shocked when he did the pre-catheterization blood work that my guy's creatinine and BUN were literally off the charts (over 13 and 300 respectively, no way to tell exactly how high). He was hoping this was just a result of pressure on the kidneys from the bladder, and put him on immediate agressive IV fluids after unblocking him. But after a day a half they still hadn't come down in to the readable level. Spike at this point was still eating some, producing lots of urine, and acting a little under the weather but not horrible, despite the high levels. Vet was alluding to putting him down over the phone - I decided to get a second opinion, and transfered him to an ICU clinic with better facilities and more experience.

After ultrasound, the second vet determined that both kidneys are enlarged (right more than left), but there were no signs that this had been chronic (i.e. it wasn't a crash on an undiagnosed CRF cat). He's definitely not gotten in to anything poisionous, and his CBC values are normal indicating it's probably not an infection. We'll probably never know 100%, as they don't think the bladder blockage was severe enough to have caused this much damage. But, the vet suggested that due to his age and other small good things going for him, we continue treatment through antibiotics (just in case) and heavy IV fluids and not give up yet. Re-check of creatinine on admittance was 12.8.

As of this morning (day 5, day 2 in ICU), his levels are still extremely high (10.8 creatinine, 120 BUN), but are dropping. Potassium, BP, etc. are fine and he's still eating on his own, producing lots of urine, and acting...well, normal. It's going as well as it could given the circumstances. The vet seems cautiously optimistic that he'll continue to improve.

I've been reading up on acute and chronic renal failure the past couple of days. I know how bad his renal values are, and the likelihood that they will return to normal or even moderate CRF level is extremely slim. But at the same time, he's clearly fighting. He shouldn't be doing as well as he is with as bad as his numbers are. Because of that, I just can't put him down at this point and am glad I didn't Friday...I just want to give him a chance. But I also can't keep him in the ICU for much longer. I'm at a bit of a loss, honestly...

I don't know what I'm looking for here, but just support from fellow cat lovers, or similar stories would be good. It has been a rough week, and if I hear "it's just a cat" (IRL) again I will scream. I have second cat at home who is not handling this well either (distressed by Spike's absence and being very clingy), so advice for him would help too.

TIA

Thanks for the quick reply, Mews2Much. I'm sorry you've gone through this too, and have another very sick cat right now. It is really tough - especially with it being so sudden, and at a relatively young age. I just wasn't prepared for it - he's been so healthy. I didn't even notice any of the signs of a blockage besides the vomiting. We just lost our 9-yo mini schnauzer to congestive heart failure 6 months or so ago too.

I hadn't heard or seen much about doing transfusions - I'll have to ask. I don't have any of his recent values besides the creatinine and BUN from earlier today (vet just gave them to me over the phone) - they're rerunning everything tomorrow so I'm planning to ask for a copy of the lab results when I go in to visit him. I'll post them.

Thanks again.

They were down to 10.8 (creatinine) and 120 (BUN) as of this morning, so there has been some improvement. It's just going slowly. I'm hoping tomorrow shows another drop.

Thanks everyone for the info/thoughts. Just got off the phone with the vet, and it's not great - Spike's values haven't dropped much since yesterday and he's not eating much today. Not good news, but the vet is still even hesitant to suggest putting him down b/c he's acting so fine. It doesn't make sense. I am planning to go visit him this afternoon and get more info - vet is recommending I either leave him in for a few more days, or bring him home and try subQs.

I am going to find a way to keep him where he needs to be if at all possible - I will probably just have to transfer him back to the original clinic instead of the ICU and see if we can continue his course of treatment there at least for a while longer. At the same time I've heard of cats continuing to improve more at home, and at least we would get a few days here instead of in the hospital, worst case scenario. I don't know.

Violet - thanks for reminding me of the pet food recalls and the cats who made it through that. There are not a whole lot of ARF survival stories out there, so that helps. I hadn't thought about home care - I'll have to check in to that too.

Otto - I have some Feliway I'll dig out, I'd forgotten about it. I have been off work most of the week (vacation that didn't happen), so I have a feeling it's going to get worse when I go back and am not home as much. Ned's an extremely needy "momma's cat" in general, and bringing in Spike was really good for him (finally calmed him down to the point where he could handle me being gone without hiding all day and being literally on top of me meowing every second when I was home).

His renal values today were 10.6 creatinine and 110 BUN. I unfortunately wasn't able to make it in to the office to see him today due to another emergency that came up, so I didn't get any of the other numbers, but per vet everything was well within normal ranges and nothing concerning (including no signs of anemia right now). His weight's stable (13lb 8oz), and he did manage to eat some later in the day.

Unfortunately, after crunching numbers, I ended up deciding I had to take him out of the hospital tomorrow - just no way I could afford to keep him there any longer (he's been in the hosp for 6 days now, ICU for 3). It kills me but this could not have been at a worst time of year money-wise (tuition, car insurance & registration, etc.), and I've already dug up everything I can (way over my "cat emergency fund").

After spending time meditating on it, the chances of him recovering are so slim, and at least if I came give him time at home at this point while he's feeling okay I think it's a gift for both of us. That's how I'm trying to feel about it right now anyway. Vet agreed this was reasonable and is checking in to in-home care for me now - I am going to do as much as I can still. If anyone here knows of resources in the Dallas area, LMK. I will also remember the possibility of a feeding tube if he won't eat.

Babz - thanks, that is encouraging. I am not getting my hopes up, but it is nice to hear.

MomofMany - I hadn't thought of that. Spike was a stray from around my old apartment complex (where there were quite a few), so that's entirely a possibility.

Thanks again everyone.

Thanks for sharing your story, Brooklet. I'm glad everything turned out okay for you. I am still trying to keep up hope despite expecting the worse. I really hope we can make him one of those rare cases - he's obviously a strong little dude. I just...am trying not to hope too much. I go back and forth b/w thinking I'm okay and ready for whatever happens, and then suddenly having the reality of what that means hit (comes in waves). I wish it were more clear-cut.

Update for everyone - I am bringing him home tomorrow AM (almost midnight here right now), and I found someone to come do IV in home for a couple of days before switching to subQs if he's okay for it. We'll see how he reacts here. My plan is to spend all day curled up with him on the sofa (or the floor, or wherever he ends up settling, to be honest ).

I appreciate all the good vibes, information, and experience - glad I found this place.

Hi all,

Wanted to update you on how Spike is doing, if anyone was curious. When I brought him home Tuesday, it was iffy at first – he seemed completely worn out and resigned, wasn’t eating, and I was debating whether or not bringing him home was the right decision. However, over the past couple of days he’s improved a lot. His appetite has picked up, he’s producing urine, he’s more active and seems to be getting stronger, he’s put back on a little weight, and he’s really over all acting like himself – not 100%, but maybe 80-90%.

We just switched over to 100-200mL subQs twice a day to start, and that’s been easier than I thought it would be so far. After about 100, he seems to get antsy and ready to run off, but other than that, I haven’t had any problems. He’s also on a heavy duty antibiotic and on 2.5mg Pepcid twice a day.

He won’t eat any of the renal foods I’ve tried, so I’m letting him eat his normal food for now. I’m going to try mixing them gradually to switch him over, but I don’t want to do anything that would put him off food even a little. He’s not eating a lot at a time, but I’ve left food dishes around the house and he nibbles pretty frequently.

The only other issue we’ve had is that my other cat, as much as he seemed to miss Spike, is not adjusting to him being home well. I know that’s not unexpected. I tried the vanilla, but other than having good smelling cats it didn’t seem to work for them. There haven’t been any fights, and they’re sharing general territory okay, but any time they get within 2 or 3 feet of each other Ned starts hissing and runs off. The ‘safe’ area seems to be getting smaller though, so I think he just needs a few more days to adjust.

I don’t know Spike’s current creatinine or BUN values. The vet and I decided Monday to just treat him based on him for a few days – it wasn’t going to change the immediate course of treatment barring any major developments, and I wanted to make any tough decisions I had to make based on how he felt and acted, not on what the numbers were (since at this point financially I can’t do anything drastic treatment-wise).

I have a follow-up appointment with the vet next Tues to decide where we go from here. We’ll obviously start rechecking his values and adjusting fluids and meds if needed. I know it could probably be bumpy, and he could continue to either improve or have another downturn, so I’m not TOO hopeful, but overall it’s looking better than it has in what seems like forever (or a very long 10 days). I’m just glad to have him home and happy for now.

Anyway, thanks again.

Hi Babz -

Thanks for checking in. He's still doing really well (all things considered) - seems to be a little stronger and more like himself everyday. He's been eating normally, playing with my other cat Ned (who finally warmed back up), and loving all the extra attention he's gotten the past 6 days. Right now he's curled up beside me on the sofa, meowing at me because I stopped petting him to type.

Well, today has been a very interesting day.

I took Spike to the vet this morning (moved up appt), and they were all *really* surprised by how much better he seemed on physical exam and from what I was telling them. Temp, BP, etc. all normal. Kidneys didn't seem painful by feel anymore.

The vet did another ultrasound for no charge b/c he was curious to see what was going on under there. There’s still some inflammation and Spike's ureter openings were a little dialated (which the vet hadn't noticed the first time), but it had gone down quite a bit. They went ahead and drew blood and sent it off to have a full panel done.

So, about an hour and a half ago I answered a call from the vet - who's first words were "I have really, really, really good news for you". Spike's creatinine is now 2.7 and his BUN is 45. You read that right - 2.7!! Considering 2 weeks ago it was off the charts and even 6 days ago it was 10.6 and I was being told he likely wouldn't improve, I am ecstatic. I am so glad I didn't give up on him and had a vet who supported that.

The vet thinks it must have been a kidney infection that just wasn't showing up on the bloodwork - that would be consistent with the new ultrasound and the sudden drop. He's truely amazed by how much improvement there's been and how quickly though; he seemed as shocked as I was.

The plan is to keep Spike on antibiotics for several more weeks. We'll also continue subQs at 100mL 2x/day for now since he's handling those fine. Assuming everything continues to go well, I'll take him back in 2 weeks for a recheck and we can start backing off the fluids gradually.

So now I guess it's just a matter of holding my breath and hoping things either stay here or continue to improve. Even if they don't drop more, this is so much more manageable. I'm letting myself start to hope for months or years instead of days or weeks.

Spike and I thank you all again for the info and support. Best thoughts and good vibes go out to you and your cats who are also dealing with renal issues.

I can't add pictures to my profile yet since I'm new, but if anyone's curious who I'm talking about, here is Spike a few years ago and today showing off his shaved legs and belly.

Hi maxiecat - thanks! You must have caught me in the middle of fixing the pictures - they should show up now.