CRF with bad prognosis from Vet. Need advice ASAP, please!!

My female cat, Nala, recently stopped eating and became very lethargic.  We took her into the vet and after bloodwork, he said she has kidney failure and it's very far progressed.  He said we could leave her there for the next few days to try fluid infusion, but he had no indication of the likelihood of success for this option.  Without treatment, he said she would live for a few days to a few weeks.  I don't want to lose her, and if there's still a chance for her to have a longer life, I want to fight for it.  However, I don't want to be selfish and have her suffer more as a result.  The way he phrased it, her chances are not promising, but I've read online that cats have come back from such diagnoses.  I would just like advice on which path to take with her.  If the infusion route is futile and prolongs her suffering, I don't want to put her through it.  Thanks in advance for this group and for any advice you can offer.

Here's the relevant bloodwork info:

WBC - 36.9
BUN - 153
Creatinine - 6.48
Phosphorus - 15.2

Also, she's a relatively young cat.  We don't know her exact age, as we took her in as a stray.  But she's around 4-5 years old.
Thanks again.
 

I'm also checking out the threads and links on CRF in these forums, as well. 

http://www.felinecrf.org/

I'm sorry that you are dealing with this. Please look at the link I've provided. It's a wonderful site and has a lot of good information.

I have a 16 year old who has chronic kidney disease, following both toxic pet food and metacam. She was hospitalized for 2 weeks (6 years ago) with ACUTE kidney failure and came through it beautifully. She has had lots of health issues as a result, but is still with me, although on subq fluids each day and other medications. Overall, she is a happy old girl and we have had a good deal of bonus time with her.

Is your cat in ACUTE kidney failure? There is a difference.

Please check out the site I suggested before you make any decisions.

Hoping for some good news.

catmom5

Thanks for your response!  The vet said the numbers were extremely high (from what I've been reading, it's already Stage 4, though she was also slightly dehydrated at the time the test was taken).   So I don't know if she's too far gone for treatment or not.  She hasn't eaten for at least the past two days and has much less energy than normal. But when she is not sleeping, she still walks around and is alert.  She also drinks water and uses the litter box.  So I'm thinking it's not ARF.

The vet that we took her to says he never actually advises euthanasia for any patients, regardless of the diagnosis, as it's something that he feels is a decision for the family to make.  Unfortunately, that approach leaves me with no point of reference in terms of how to make that decision.  I'm torn based on the information I've read so far, as a lot of the data seems to state that quality of life can be improved and time extended, but that the stage she's at in terms of lab results/not eating is the end stage.  I'm really at a loss for what to do.  As of now, I'm planning on trying the infusion for her for the next few days, unless her situation changes or I get further information on whether or not it's the right way to go. 
 

My philosophy is to treat the cat, not the numbers. I think you are wise to give her a chance and see how she responds, but the sooner you do that, the better. Please do take some time to read the information I gave you. There's a lot of it, but it's well organized and I think you will find some answers to your questions (or at least get enough information to make a decision you can be comfortable with).

Keep us posted!

Thanks again.  We will be dropping her off in the morning for her first round of treatments.  I'm really hoping for a miracle.    I've also been reading the link you sent, and it's definitely helpful. 
 

Also, he mentioned that she had an infection, as well, as her WBC count was high, but didn't mention treatment for it.  Should I press the issue?
 

First off, CRF/CKD is NOT a death sentence. My Tuffy developed CRF when he was around a little over 2 and lived for another 5-1/2 years even though our vet at the time said he had only a couple months at most to live--if I knew then what I know now, he most likely would have lived even longer. It was a roller coaster ride at times, but IMO, so worth the ride.

One thing to note (and please call your vet!): Since the vet is giving intravenous fluids, do NOT let them give more than 100-125mL in a day--make them be conservative and not aggressive in giving these fluids. (My Tuffy suffered ONE TIME from too much fluid*--and my vet got a not-so-nice talking to!) Vets are notorious for over-doing fluids and not monitoring this, especially when they stay overnight. Too much fluid can cause complications and develop fluid in the lungs. Many cats with undiagnosed heart disease (which can be an underlying disease w/CRF kitties) can have complications from fluids.

*Tuffy came home after one overnight stay at the vet for fluids and could hardly breathe, with fluid coming out his little eyes, nose, drooling, and his little legs so full of fluid he could hardly walk. He also was coughing from all the fluid. This NEVER happened again!!

BUN - 153

BUN is a waste product excreted through the kidneys. BUN is more reflective of dietary impacts than creatinine. An increase in BUN can also be due to dehydration (a symptom of CRF and many other diseases and syndromes), so this may be more elevated if she is dehydrated and come down some once hydration is taken care of.

Creatinine - 6.48

Creatinine is a waste product that originates from muscles and is eliminated from the body by the kidneys. An elevation of creatinine is due to kidney disease or dehydration (can somewhat decrease with proper hydration). Both creatinine and BUN increase in the bloodstream at the same time in patients with kidney disease.

Phosphorus - 15.2

Phosphorus in the bloodstream originates from bones and is controlled by the same hormone, PTH (parathyroid hormone) which controls blood calcium (having the calcium (CA) value can help in determining more). Excess phosphorus intake can make CRF worse, so phosphorus levels should be monitored on a regular basis. There are dietary changes (do not restrict protein, which is very old school nowadays for treating CRF) and supplements you can do and use which can help with controlling high phosphorus levels, so don't let this value scare you. My bet is that the high phos level is part of what is making her feel so crummy. Excess phosphorus intake can make CRF worse and these levels should be monitored on a regular basis.

Phos binders can be mixed in food, so this can help bring levels down.
                                                     
Can you post these values, please, and include reference ranges:

Calcium (Ca)
Potassium (K)
Sodium (Na)
PCV (Packed Cell Volume) or HCT (Hematocrit)
and...

Specific Gravity of her urine

Tanya's site (Helen is the owner of the site), recommended by catmom5 has a lot of great information, and well worth taking your time to go through the site. You might also check out: http://www.holisticat.com/crf.html

Aw, many (((HUGS))) to you, honey. Please do talk to the vet about the fluids--you have to be your kitty's advocate right now. Once she is home there is a LOT that can be done to help her.

again, and gentle headbutts from my babies,

blueangel479 said:

Also, he mentioned that she had an infection, as well, as her WBC count was high, but didn't mention treatment for it.  Should I press the issue?
 

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Only if he does a Culture and Sensitivity to find out what type of infection to give the proper antibiotic--and one that is kidney friendly.

Hugs again!

catmom5 said:

My philosophy is to treat the cat, not the numbers.

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Amen, sistah!

blueangel479 said:

But when she is not sleeping, she still walks around and is alert.  She also drinks water and uses the litter box.
 

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That is great news to hear and indicative of how she's doing. You should be very happy about this--like catmom5 said, "Treat the cat and not the numbers."

The vet that we took her to says he never actually advises euthanasia for any patients, regardless of the diagnosis, as it's something that he feels is a decision for the family to make.  Unfortunately, that approach leaves me with no point of reference in terms of how to make that decision.  I'm torn based on the information I've read so far, as a lot of the data seems to state that quality of life can be improved and time extended, but that the stage she's at in terms of lab results/not eating is the end stage.  I'm really at a loss for what to do.  As of now, I'm planning on trying the infusion for her for the next few days, unless her situation changes or I get further information on whether or not it's the right way to go.

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For each of us, this is the hardest decision to make. My 2-cents is that even though she has declined, do NOT look at the numbers, but how she is acting--can't emphasize that enough--there are many, many things you can do to help her feel better, the numbers are only one part of the equation: they provide information on what way to go with providing things that will help her. For example, getting her phos number down will help her feel better because it plays such a big role in how they feel and the progression of CRF. The good news: Phos binders can help with that.

Sorry if I've posted so much--CRF/CKD kitties are near and dear to my heart. I miss my Tuffy so much, and the biggest part of what I do on kitty forums is because of him, to honor him and the wonderful little guy that he was.

And again, more of these...

Thank you so much, WhollyCat!  There is definitely no need to apologize for posting so much.  Every single post is helpful and very much appreciated, as are your hugs and support!  I will make sure to ask the vet about fluid amounts and phosphorous binders.  He actually hasn't done a urine analysis, only blood, so I don't have the specific gravity.

Here are the other values:

Calcium: 8.9

Potassium: 5.4

Sodium: 150

HCT:  33

Thanks, everyone.  This has been a really tough day and you have helped me get through it.
 

Me again.

Could you provide the reference ranges to go with the values you provided, purrty please? I can go off approximate reference ranges, but we need to be very exact here and each lab has their own set of reference ranges--and US ranges differ from International ones. The reference ranges would be on the lab reports next to each test done.
 

BUN 153...(reference range)
Creatinine 6.48...(reference range)
Calcium (Ca) 8.9...(reference range)
Phosphorus (P) 15.2...(reference range)
Potassium (K) 5.4...(reference range)
Sodium (Na) 150...(reference range)
Packed Cell Volume (PCV) / Hematocrit (HCT) 33...(reference range)

I will make sure to ask the vet about fluid amounts and phosphorous binders.

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Sounds good; just don't let your vet run over ya like a truck when it comes to fluids--just tell him to be conservative given her weight, etc. You might take a look-see at the phos binders recommended here: http://www.felinecrf.org/phosphorus.htm#high_phosphorus Please note that there are diet tweaks also that can be done, and Helen has info about that on the same page.

With Tuffy, I actually used Egg Shell Powder (ESP) because it doesn't raise blood calcium numbers (studies have shown this to be effective, and Tuffy did well with this). This isn't listed on Helen's site, but I am more holistically oriented. I would suggest an Aluminium Hydroxide (can read about it at the above website) binder because you can buy it over the counter, it is tasteless and odorless, so kitties accept in food better. Discuss with your vet--you can always change later to something else. Don't get sucked into giving her Tums or anything like that. (Kinda bossy, ain't I?)

According to Helen on Tanya's site:

"I recommend instead that you look into buying aluminium hydroxide binders which are tasteless and odourless, and which most cats do not seem to notice in their food. See below for information on the various brands and links to mail order suppliers who can ship to UK, USA, Canada and Australia. Contrary to what some vets and pharmacists seem to believe, you do not need a prescription to buy these products."

Oy. I better get to bed.

HCT - 33.0          Ref: 30-45

Sodium - 150      Ref: 148-159

Potassium - 5.4   Ref: 3.5-5.5

BUN - 153          Ref: 10-40

Creatinine - 6.48  Ref: 0.4-1.6

Phosphorus -  15.2  Ref: 2.6 - 5.7

She's at the vet for the day right now.  They don't stay overnight, so I'm thinking about checking around to find a vet who does.  Even the choice of vet is a tough decision.

blueangel479 said:

HCT - 33.0          Ref: 30-45

Sodium - 150      Ref: 148-159

Potassium - 5.4   Ref: 3.5-5.5

BUN - 153          Ref: 10-40

Creatinine - 6.48  Ref: 0.4-1.6

Phosphorus -  15.2  Ref: 2.6 - 5.7

She's at the vet for the day right now.  They don't stay overnight, so I'm thinking about checking around to find a vet who does.  Even the choice of vet is a tough decision.

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How about Calcium (CA) 8.9 (reference range)?

Actually, it's not bad that she's not staying overnight. If you do look for a different vet, and live in a large enough area, you could look for one that specializes in kitties or has someone on staff that does.

I don't know Iowa very well, but I take my cats to Michigan State Vet Teaching Hospital (fortunately I live close) and they have amazing resources (both in staff and facilities). I wonder if there is a vet teaching hospital close to you. A second opinion doesn't hurt either.

When CJ first went into ARF, she was on iv fluids 24/7. Not sure, but that might be different from the subq that I now do at home. The only problem we had with that was that she had trouble controlling when she had to pee. That was temporary and has not been a problem since. Not a biggie to me.

Keep your hopes up and let us know how your girl is doing.

Prayers and healing vibes headed your way.

catmom5

Sorry about that.  Calcium is 8.9 and reference range is 8.2-10.6.  She's with the vet now, and we will be picking her up in a few hours.  I've been trying to a find a feline specialist in the meantime.  Hopefully, I'll have one by tomorrow.  A really nice vet wrote me back with some hope.  She is two hours away from here, so I'm checking to see if she can recommend someone close by if they're not 24-hours so that I don't put Nala through daily road trips on top of everything else.   I'm going to ask the current vet tonight if we can keep up with the fluids at home through the subq method.  Nala hates being restrained, but I'm hoping some of the tips on the Feline CRF site will help.  I can't thank you all enough for your support and advice!
 

IF you are able to do the subq fluids at home, I can share how it works here (I live alone - I mean I'm the only PERSON) so I manage CJ's fluids by myself. To be honest, she enjoys getting them and even sits in the bathroom asking for them, but we've worked out a system that seems to work well. Just let me know and I'll explain.

Hoping you can find someone closer to home . . .

Thanks for keeping us posted!

catmom5

Sorry I got the states mixed up - I see now you are in Arizona.

I'm actually in Maryland now.  I created a login years ago when Smokey and Blue came along (my other two cats) and forgot to update the information.  The vet I spoke with earlier was able to recommend a vet a little closer, so we will be talking to her tomorrow.  In the meantime, Nala still hasn't eaten anything.  The current vet said they tried twice to feed her, but she wouldn't eat.  I'm getting really concerned about the potential for hepatic lipidosis at this point.  I read online that baby food might help as long as it doesn't contain onion or garlic powder.  The only one at the store we were able to find is Beechnut Chicken Noodle.    This is the link : http://www.beechnut.com/Our Baby Fo...ducts&ListValue=1&SearchType=By Age&ProdType=   .  Does anyone know if this is safe for a cat with kidney failure?  I would just wait for the vet info tomorrow, but as they are not feeding her either, I'm very leery about waiting too long to try something.  (We're taking her to the same vet tomorrow, to make sure she keeps up with the liquids on schedule, but going to speak to the new vet on our own to get more info.)  I can also try forcefeeding her the Hill's wet food if that's a better way to approach it, but I don't want to get her too upset if that's a bad idea.

I don't know if you've seen this thread, also active - someone dealing with renal failure: http://www.thecatsite.com/t/243675/poor-appetite-weight-loss

I think there's a lot of helpful information in there. And Violet's post with informative links may be especially helpful:

Violet said:

Elssa, I really hope this information will be helpful to you

http://www.allthebestpetcare.com/kidney-failure-in-cats/

http://www.littlebigcat.com/health/kidney-disease-in-older-cats/

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You can't find any Stage 1 (pure meat) babyfoods? Almost any supermarket should have them! Beechnut or Gerber's. I don't see anything in the Chicken noodle that is toxic to cats - but I think you'd rather avoid the rice flour, whole grain brown rice flour, rice bran extract, green beans, and heavy cream if possible.

What about boiling and shredding some chicken? Or just put it in a blender?

Thanks LDG.  We did try chicken, but she wouldn't eat it, either.  I'll check the pharmacy for the stage 1 baby food.  Will check out that thread now as well.