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.

NandSTheCats, hi!

I remember when cats developed acute renal failure from the tainted foods back in 2007, vets were able to save some with very aggressive treatment and longer hospitalization. (Not just two or three days in the hospital since there is no effective home treatment for ARF.) So, if his numbers are coming down, if at all possible, please continue hospitalization and treatment, give him the time he needs to hopefully recover.

I'm thinking, if his numbers keep coming down, and hospitalization becomes prohibitively expensive at one point but he is definitely improving, it should be possible for you to continue treating him at home with the help of a tech or a nurse who comes to the house to take care of things like IV fluids, etc, and to do the necessary blood testing.
Please, speak to the vet who is treating him about this. Some hospitals have a tech or a nurse who makes house calls, some hospitals have a regular house call service. Even if this one doesn't, the vet will know where you can find a tech or a nurse, or even recommend someone.

Such a young cat to have to go through this.

for sweet Spike and you.

Hello and welcome to TCS. I am sorry this has happened with Spike, but it sounds like he is in good hands for now. When he is released you can do the sub q fluids at home, many of us have done so and can help you through it as you adjust.

I feel bad for your other kitty too. (what's his name?) Give him lots of lovin and attention and tell him where Spike is, how he is, and how you hope he will be home soon. Talk to him about it every day, uisng Spike's name a lot.

Warn other kitty that Spike will smell funny. Get some feliway plug in diffusers to help with stress, keeping stress down is very important.

Expect that there may be some bickering when Spike comes home as he will not smell like Spike for a few days. You can try with the vanilla trick: cooking vanilla (not perfume) on nose, chin and root of tail of each cat, to help them smell the same to one another to reduce hostility

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).

My heart breaks for you right now. I'll be saying my prayers for you both! Iâ€[emoji]8482[/emoji]ve been there so I do understand. I think it was about a half year ago that my Mowgli had a severe blockage of poop (now has mega colon, but that's another story) and I just about lost him. He made it through the surgery, but his numbers were just as bad as Spikes. He stayed on the sub q's and I ended up deciding to put a feeding tube in so he wouldn't starve and his kidneys and bowels would continue to work. Then I brought him home (his numbers were still not good) and continued with the feeding tube at home. This way he got fluids, food, meds and his home environment. Long story short, his numbers are back to wonderful levels and we just continue with his rechecks every six months. The reason I tell you all this is that there is hope yet. Maybe bringing him home would help (when vet ok's). Sometimes their home environment is that little kick start that they need.

Hang in there!


Babz

Stripe beat ARF at age 9 so some cats can beat it.
She stayed in the ER for 4 days then we took her to our vet for a few more days.
It is very hard to get cats to eat with high numbers.
We had to force feed Stripe.

Click to expand...

This reminds me that a feeding tube for (young) cats who are struggling to recover from ARF can be a life-saving option. I've seen a wonderful, great vet (Dr. Margaret Muns - online on another web site) support this option. So NandSTheCats, piease keep this option in mind as well.

I'm so sorry that you are going through this. I lost a 5 year old to ARF, and like you, we struggled with what could have possibly happened to trigger it. She had no signs of CRF prior to that, had not gotten into any poisonous, and was otherwise a healthy cat that got ill overnight. Ruling out everything else, we know she was born into a feral colony that had interbred, and our assumption was that she had a genetic disorder that triggered it. In spite of over a week in ICU, she did not make it. The cards were against her from the start.

I know you don't want to hear of stories where an ARF cat didn't make it, but still wanted to share a potential trigger for Spike's problem. I am sending healing vibes your way.

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.

You and Spike will be in my prayers.

I'm sorry that you're going through this. If it helps to hear a positive story, I had a cat with a severe blockage from crystals and bladder stones. He hid it VERY well. I have pictures of him playing the day before he almost died. By the time it was noticeable that something was wrong, it was almost too late. On top of being blocked, he had a torn urethra, and his kidneys were failing. I can't remember the numbers offhand but they were off the charts. (just as an example - something that should have been a 15 was 500...and I those numbers aren't accurate, just an example of just how far off the charts they were). The vet gave him less than a 1% chance of living. About 3 hours later, she had increased that chance to 20% after calling in a specialist and doing some of her own research. To make a long story short, after 2 weeks being hospitalized, sub-q fluids and antibiotics for 3 months, he recovered. It was tough going there for a while, and while each recheck at the vet had better news, I was terrified, and upset because I wouldn't let myself believe that he would be ok. I kept preparing myself for the worst. Now, about 8 months later, he's chilled out on my couch, sleeping contently, and is as happy and as healthy as can be.

So while I know that all cats are different, and every situation is different, the one thing my situation taught me was to expect the worst, but hope for the best. But at the same time, never lose hope. The vet had asked me if I wanted him put down when he had the less than 1% chance of survival. When she asked me, I couldn't even process what was going on because it was such a shock, so I said no, that I needed to think about it, and that was the best thing I ever did. It was definitely a rough 3 month period, but the end result was good.

So I hope that you are fortunate enough to have a happy ending like I did. Once again, I'm so sorry that you are going through this. Sending positive vibes your way

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.