Kidney Disease

orientalslave · Jul 31, 2012

The progress of PKD in people is quite variable. A friend of my father's lost his wife when she was in either her very late 70s or (more likely) her 80s. She knew she had PKD for quite some time, but it was only in her last few years it caused her problems and she had to start dialysis, which lead to other problems.

I suspect it's equally variable in cats. When the FAB started their ultrasound screening program (before the gene test was available) some cats still slipped through as when they were scanned they have very, very tiny cysts or no cysts.

http://www.fabcats.org/breeders/infosheets/pkd/pkd_scheme.php

http://www.fabcats.org/breeders/infosheets/pkd/pkd.html

However I suspect most cats that have kidney failure don't have PKD.

daddyincr · Aug 9, 2012

is it possible for a cat to have a creatinine level of 2.5 and not show any outward problematic symptoms?

eating and drinking normal. urine and feces normall. no vomiting, no diarhea. playing normally with his "sister."

i don't get it! meanwhile some sites say 2.4 is at the maximum range and others say 1.8 and others even less.

what is the normal creatinine level???

stephanietx · Aug 9, 2012

Did you get a printout from the vet's office? If so, it should have the range on it of what's normal and all that. On paperwork that I've gotten, it says that 0.8-2.3 is normal. If your kitty's creat is 2.5 most likely you won't see many symptoms, but it does need to be monitored.

daddyincr · Aug 9, 2012

they don't do that in costa rica. i checked out different sites and have had bllod test results from different labs and each

and every source has a different range. torture. looks like myn son will be caged - in my bedroom--i bought the biggest cage i could fine--

and put on iv's for 4 days. too much stress for cat to put in and take out iv on daily basis. this f'in sucks

stephanietx · Aug 9, 2012

Each lab has its own range of what's considered "normal".

whollycat · Aug 9, 2012

daddyincr said:
they don't do that in costa rica. i checked out different sites and have had bllod test results from different labs and each

and every source has a different range. torture. looks like myn son will be caged - in my bedroom--i bought the biggest cage i could fine--

and put on iv's for 4 days. too much stress for cat to put in and take out iv on daily basis. this f'in sucks

Is it that the results are in Spanish, not in English, and you don't speak/read Spanish?

You are going to administer the IV? How will you do this? Most kitties with CRF/CKD are given sub-Q fluids once per day, not continuous fluids. Sub-Q fluids are not the same as IV fluids.

daddyincr · Aug 10, 2012

stephanietx said:
Each lab has its own range of what's considered "normal".

you're right!!! i just discovered that this morning

tjcarst · Aug 10, 2012

I would not do IV fluids for days. If your cat has "crashed" (creatine 3-4) is when IV fluids are used as rescue, not as maintenance.

Lactated Ringers given 50-100 ml each day is about the most I would give subcutaneously. This is not a one time fix, this is a daily or every other day necessity.

The actual process should only take 2-5 minutes. If it is takiong longer, you need to figure out why.

http://www.felinecrf.org/subcutaneous_fluids_tips.htm

daddyincr · Aug 10, 2012

as if you can't tell, i'm in love with both my cats, but, here i'm speaking of my 2 year old male, darwin.

just had the creatinine level checked at two separate labs. one result was 2.4 and one 2.5.

to say i'm sad is an understatement.

we're looking at sodium chloride and ringer lactated.

my vet believes inserting the iv and taking it out on a daily basis would be more stressful

for the cat then caging him, giving him the fluids, watching him closely.

i only want wants less stressful and more healthy for my "son"

just not sure which is best

whollycat · Aug 10, 2012

daddyincr said:
as if you can't tell, i'm in love with both my cats, but, here i'm speaking of my 2 year old male, darwin. just had the creatinine level checked at two separate labs. one result was 2.4 and one 2.5. to say i'm sad is an understatement. we're looking at sodium chloride and ringer lactated. my vet believes inserting the iv and taking it out on a daily basis would be more stressful for the cat then caging him, giving him the fluids, watching him closely. i only want wants less stressful and more healthy for my "son" just not sure which is best

Aw...

don't feel sad, hon. You've come to a great site to give you a helping hand! For what it's worth, a Creatinine of 2.4/2.5 is not terribly high if the lab reference range is .6 - 2.4. It would be at the high end of normal if that is the reference range used by the lab. I'm just guessing as to the lab reference range. At other labs the 2.4/2.5 would be considered high, but not in the end stage of renal failure, more like the second stage of CRF. That is why it is vital to have these for the specific lab used.

So...that brings me to my next questions:

Besides his Creatinine, what was his BUN (blood urea nitrogen), Specific Gravity (urine), Ca (calcium), P (phosphorus), K (potassium), Na (sodium), and any other values you can get out of your vet. He should furnish these records--just request them and don't quit requesting them until the vet gives them to you.

Oh man, that is just absurd thinking on your vet's part about the fluids. You won't be doing a long drawn out process (around 5 minutes to administer the fluids!), you will do sub-Q fluids where the needle is inserted under the skin, not IV drip where it needs to be in a vein. It would be more stressful to have Darwin hooked up to a needle, etc. in a small cage for days on end when all he needs is a small amount of fluid (50-75mL) given once a day or every other day. Plus, how the heck would the needle stay in for that extended amount of time--my kitties would be bouncing off the walls of any cage! Honestly, I think you need to find a different vet. Your vet sounds utterly clueless when it comes to giving CRF kitties sub-Q fluids.

You need "ringer lactated" (Lactated Ringers Solution [LRS]), not sodium chloride because sodium chloride burns. Here's a link to different common sub-Q fluids. You want LRS because for one thing, that is closer in pH to what a kitty's body pH is. The sodium one, besides burning, has a very low pH--which you don't want.

Here's a video on how to administer sub-Q fluids demonstrated by a vet (one thing I should mention that he didn't is that you should always use a NEW sterile needle each time--never re-use a needle):

That being said, if you can add extra water to Darwin's food (and daily keep track of how much--you would have a log of how much for every day and how much each time by the end of that day) and/or use a dropper or needle-less syringe and syringe water by mouth (again, keep track of how much), you may not need to do the sub-Q fluids. You could aim for 5-10mL (cc's) per pound of Darwin's weight per day. Just add to his food and/or dropper/syringe by mouth that amount per day. Say he weighs 10 pounds, if you did 5mL per pound that would be 50mL per day. If doing 10mL it would be 100mL per day. You just spread it out the daily amount by adding to his food and by mouth with the syringe. Hope that made sense. If not, let me know and I'll try to explain it better.

I've got to say that my Tuffy hated getting sub-Q fluids, so on those days when he wasn't cooperating, I mixed extra water into his canned food, and if that wasn't enough I syringed water at the back side (between his back teeth on one side) of his mouth in small amounts--if I was going to give him 20mL/cc's I would do about 5mL at a time to make sure he didn't choke. I ended up doing it this way 90% of the time because it just wasn't worth the battle and stress that took place for my little guy giving sub-Q's.

Hang in there, sweetie, we're here to help!

tjcarst · Aug 11, 2012

Please see the site I sent you in my post above. My cat hated to be handled and she tolerated daily subq fluids. If you warm the fluid a little it is better, just have the tube immersed in warm water, not the bag, as the fluid travels to the needle. The cats do not mind much if the needle is of good quality, sharp, and large enough for fluids to pass quickly, but not so large as to cause pain when inserting. The site felinecrf.org has a ton of info. Giving subq fluids is quite common.

I cannot stress enough how much I am against giving a large quantity of fluids non-stop to a cat. My cat died after a 2 day infusion and I have encountered at least two other cat owners who recently experienced the same thing. Cats often cannot handle a large volume of fluid all at once. It enters their lungs and causes them to suffocate.

My cat was fine when I picked her up from the vet Monday evening. Tuesday evening she had labored breathing. She was gone Wednesday morning. She was strong physically, but her body could not process the fluids. Knowing how much to give is hard to gauge when you give so much at once as it takes a long time to see the symptoms. By then it is too late. Giving her Lasix/Salix/Fluorosemide did not help.

daddyincr · Aug 12, 2012

WhollyCat said:
Aw...

don't feel sad, hon. You've come to a great site to give you a helping hand! For what it's worth, a Creatinine of 2.4/2.5 is not terribly high if the lab reference range is .6 - 2.4. It would be at the high end of normal if that is the reference range used by the lab. I'm just guessing as to the lab reference range. At other labs the 2.4/2.5 would be considered high, but not in the end stage of renal failure, more like the second stage of CRF. That is why it is vital to have these for the specific lab used.

So...that brings me to my next questions:

Besides his Creatinine, what was his BUN (blood urea nitrogen), Specific Gravity (urine), Ca (calcium), P (phosphorus), K (potassium), Na (sodium), and any other values you can get out of your vet. He should furnish these records--just request them and don't quit requesting them until the vet gives them to you.

Oh man, that is just absurd thinking on your vet's part about the fluids. You won't be doing a long drawn out process (around 5 minutes to administer the fluids!), you will do sub-Q fluids where the needle is inserted under the skin, not IV drip where it needs to be in a vein. It would be more stressful to have Darwin hooked up to a needle, etc. in a small cage for days on end when all he needs is a small amount of fluid (50-75mL) given once a day or every other day. Plus, how the heck would the needle stay in for that extended amount of time--my kitties would be bouncing off the walls of any cage! Honestly, I think you need to find a different vet. Your vet sounds utterly clueless when it comes to giving CRF kitties sub-Q fluids.

You need "ringer lactated" (Lactated Ringers Solution [LRS]), not sodium chloride because sodium chloride burns. Here's a link to different common sub-Q fluids. You want LRS because for one thing, that is closer in pH to what a kitty's body pH is. The sodium one, besides burning, has a very low pH--which you don't want.

Here's a video on how to administer sub-Q fluids demonstrated by a vet (one thing I should mention that he didn't is that you should always use a NEW sterile needle each time--never re-use a needle):

That being said, if you can add extra water to Darwin's food (and daily keep track of how much--you would have a log of how much for every day and how much each time by the end of that day) and/or use a dropper or needle-less syringe and syringe water by mouth (again, keep track of how much), you may not need to do the sub-Q fluids. You could aim for 5-10mL (cc's) per pound of Darwin's weight per day. Just add to his food and/or dropper/syringe by mouth that amount per day. Say he weighs 10 pounds, if you did 5mL per pound that would be 50mL per day. If doing 10mL it would be 100mL per day. You just spread it out the daily amount by adding to his food and by mouth with the syringe. Hope that made sense. If not, let me know and I'll try to explain it better.

I've got to say that my Tuffy hated getting sub-Q fluids, so on those days when he wasn't cooperating, I mixed extra water into his canned food, and if that wasn't enough I syringed water at the back side (between his back teeth on one side) of his mouth in small amounts--if I was going to give him 20mL/cc's I would do about 5mL at a time to make sure he didn't choke. I ended up doing it this way 90% of the time because it just wasn't worth the battle and stress that took place for my little guy giving sub-Q's.

Hang in there, sweetie, we're here to help!

creatinine was 2.4 with a reference of .5-1.5

bun 19.2 with a reference of 7-18

my vet feels it best to totally and completely flush and detoxify darwin's kidneys. she wants to keep the IV inserted for 4 complete days using 2 bags each of sodium chloride and lactated ringer .my vet is an animal person. she's a total vegan, yells at owners who don't care properly care for their pets or follow her directions. people who want to put down their pets and she feels it

isn't necessary she goes crazy. people who won't spend money for the proper treatment--she goes ballistic. what i'm getting at she might not have the best bedside manner for owners, but,

for the animal she will do everything and anything in its best interests. she was top in her class and if she has any limitations it's only due to what costa rica lacks in medicines and technology.

i have total confidence in her. it's just my heart goes out to my son who has to go through this treatment. i know it's for his health, so in the long run, it's the best course of action.

i wish darwin would understand what is going on. he's so sweet i don't want him "thinking he's being punished". i'm ******* crazy, aren't i???

thanks so much for taking the time to share all this info. i appreciate your empathy and compassion more than you can realize.

daddyincr · Aug 12, 2012

tjcarst said:
Please see the site I sent you in my post above. My cat hated to be handled and she tolerated daily subq fluids. If you warm the fluid a little it is better, just have the tube immersed in warm water, not the bag, as the fluid travels to the needle. The cats do not mind much if the needle is of good quality, sharp, and large enough for fluids to pass quickly, but not so large as to cause pain when inserting. The site felinecrf.org has a ton of info. Giving subq fluids is quite common.

I cannot stress enough how much I am against giving a large quantity of fluids non-stop to a cat. My cat died after a 2 day infusion and I have encountered at least two other cat owners who recently experienced the same thing. Cats often cannot handle a large volume of fluid all at once. It enters their lungs and causes them to suffocate.

My cat was fine when I picked her up from the vet Monday evening. Tuesday evening she had labored breathing. She was gone Wednesday morning. She was strong physically, but her body could not process the fluids. Knowing how much to give is hard to gauge when you give so much at once as it takes a long time to see the symptoms. By then it is too late. Giving her Lasix/Salix/Fluorosemide did not help.

tjcarst--- please read my response to the post with the video. i would say the same to you, especially the part where i say i am grateful to you for your empathy and compassion. special

people take the time to share as you have in this thread. gracias, gracias, gracias...

pat · Aug 12, 2012

Let me also add my experience with sub-q fluids has been it's not been that stressful for my cats. I clear a spot off my kitchen counter (near the sink),have a cup holder on the side of the cabinet there, I hang the bag of fluids from that hanger - height works out just about right. I get kitty in the position I need on a nice comfy towel, gently pull up the skin a bit where I want to go (between shoulder blades) and insert the needle (bevel side up) and open the flow clamp. I talk to my kitty throughout, and usually give some wet food or a treat for them to eat during treatment.

Be SURE, if you can, to use ultra-thinwall terumo needles (UTW terumo). Monoject needles are NOT as comfy. Unfortunately, the company I've used, I do not know if they ship outside the us.Just ask your vet if they get/can get Terumo brand. It is a consistent comment you will see if you look over the various websites on crf (hope you've checked out the first posts on the sticky on CRF I believe I mentioned..many links in those first posts) to use thinwall or ultra thin wall needles, and Terumo's are often the recommended brand.

tjcarst · Aug 12, 2012

My vet also believed a flush was necessary for my cat. She was doing what she thought best to save my cat, not harm her.

My cat did not like strangers, did not like handled, etc. Caging her up and leaving her for a weekend of IV fluids still causes me deep regret and pain. It was the wrong decision for her. Some cats cannot process the fluids. Mine was one of them. My vet would not have knowingly caused harm to my cat.

If you go to holisticat and read this persn's opinions on what she believes is best for a daily amount, this is the same info I am sharing with you. I am in no way saying your cat will not do well with 4 days of fluids. I only wish I had read this information before making my decision. I thought the three day fluids at the vet would give me several months without worry. This is not the case. Daily fluids will likely still be needed.

You will need to trust your vet, I know. I am not a vet or tech and am not trained medically, just sharing my experience and wishing someone had pointed me in the direction to do more research. By the time the fluids were stopped, it was too late.

I really hope the fluids given to your cat make a world of positive difference in health and give you much more time together.

whollycat · Aug 12, 2012

daddyincr said:
creatinine was 2.4 with a reference of .5-1.5

bun 19.2 with a reference of 7-18

my vet feels it best to totally and completely flush and detoxify darwin's kidneys. she wants to keep the IV inserted for 4 complete days using 2 bags each of sodium chloride and lactated ringer .my vet is an animal person. she's a total vegan, yells at owners who don't care properly care for their pets or follow her directions. people who want to put down their pets and she feels it
...

Her values aren't that terribly bad actually. That is good!

Boy do I have to strongly disagree with giving two bags each of sodium chloride and LR. That is a total of 4000mL over the course of a few days (even half that would not be good!). That is 1000mL per day of fluids--or if you meant two bags total, that is still 500mL per day. I understand your vet's reasoning, but this is WAY too much fluid for a kitty's body to handle. Please read the following on the problems with giving too much fluid to a kitty. And an excerpt from Helen's website from that link:

[size=-0]Fluid retention may be a sign of worsening kidney values or of heart problems, but in many cases it is actually a sign of overhydration from either intravenous fluids (IV fluids) or subcutaneous fluids (sub-Qs). [/size] Some vets believe it is impossible to overhydrate a cat through sub-Q fluids but unfortunately this is simply not true. Over the years, I've heard from quite a few people whose cats developed precisely this problem. In Renal disease (2006), Dr D Polzin states "Chronic subcutaneous fluid therapy can result in fluid overload in some patients, particularly when fluid volumes in excess of those recommended here are used. We have seen several cats given large quantities of fluid (200 to 400 ml/day) present with severe dyspnea due to pleural effusion. This condition can usually be avoided by reducing the volume of fluids administered."

So, let me tell you a short version of my Tuffy's story when my vet gave him "fluids to flush his kidneys" [just] overnight:

My sweet boy went in for IV hydration to "help" his kidneys. When I picked him up and brought him home, instead of being more alert and feeling better, he was in distress. His front legs were double the size they should be. He had liquid seeping from his eyes and nose. He was coughing. He was having trouble breathing and had a raspy sound when he breathed. In a panic I called the vet. I asked how much fluid was given to him. Got a non-answer in response because they knew I was po'd. Tuffy only weighed 8 pounds at the time, so logically I thought he would get around 80-150mL (tops!) of fluids over the course of this time. I didn't state that that was all that I wanted given to him--huge mistake on my part because that was clearly not the case. I came unglued and told them to never, ever give him so much fluid that he was literally drowning in it. I started Tuffy on a herb known for its diuretic properties, and thankfully, Tuffy didn't die unlike tjcarst's poor kitty. (I still have the same vet(s) to this day, but they are much more interested in treating my kitties as individuals instead of going by what was outdated thinking at the time with regards to IV fluids. We are actually friends now.)

Here's the link to Holisticat and the information tjcarst is talking about and a quote from that page with the accompanying link to WS University:

Amount of fluids - As per Washington State Univ college of veterinary medicine, cats should get 5-10ml of subq daily per lb of body weight. I would be very careful going above this because we have had cats on my list develop fluids in the lungs. Many cats with undiagnosed heart disease can have complications from fluids. If you know your cat has heart disease, you can do what I did, and instead of subq, give fluids orally using a plastic syringe.

Please, for your kitty's sake, do NOT give the amount of fluids your vet is recommending. You are setting yourself (and your kitty) up for disaster. You are your kitty's advocate, so please don't be afraid to disagree with your vet. Any good vet is going to listen to you, as your kitty's guardian, and re-think their stance on the amount of fluids when given evidence to the contrary.

tjcarst · Aug 12, 2012

Thank you, Whollycat. I found this site after losing my cat to too much fluid given to her one year 4 months ago. It still causes me so much pain that I made such an un-wise decision that I cannot post on what a wonder my cat was for me, my soul mate kitty. My husband's "one and only" best bud.

How could I not know to do more research. Vets are supposed to know best. Now I know I should have researched more. My heart still aches.

OP - please do as much research as possible before heading down this path. At least try the sub q fluids. Your cat should be able to tolerate 2-5 min of treatment daily or every other day. Your kittlys kidney values are early in the stages of failure, so I really would not chance a "flush". If the sub q fluids do not work, then I would consider resorting to the more drastic measures of IV fluids. As a last resort. Your kitty does not seem to be at this stage.

whollycat · Aug 12, 2012

tjcarst said:
Thank you, Whollycat. I found this site after losing my cat to too much fluid given to her one year 4 months ago. It still causes me so much pain that I made such an un-wise decision that I cannot post on what a wonder my cat was for me, my soul mate kitty. My husband's "one and only" best bud.

How could I not know to do more research. Vets are supposed to know best. Now I know I should have researched more. My heart still aches.

OP - please do as much research as possible before heading down this path. At least try the sub q fluids. Your cat should be able to tolerate 2-5 min of treatment daily or every other day. Your kittlys kidney values are early in the stages of failure, so I really would not chance a "flush". If the sub q fluids do not work, then I would consider resorting to the more drastic measures of IV fluids. As a last resort. Your kitty does not seem to be at this stage.

I totally agree with doing sub-Q instead of IV for four days and everything else regarding OP's post.

tjcarst, you did the best you could for your baby with the knowledge you had then. Please don't feel bad.

We all at some point have the mentality that vets know best, but discover later that this is simply not the case. Thinking evolves and vets just can't keep up with current information, so it is up to us to be proactive and research, research, research. I'm so, so very sorry for the loss of your sweet baby under these awful circumstances...

daddyincr · Aug 13, 2012

perhaps i haven't explained everything clearly. i don't want darwin to be an inpatient. so i set up my bedroom as a mini clinic. my vet

came yesterday and put in the IV she set it for 250ml of ringers a day. basically the program is to flushout and detoxify his kidneys.

after that we'll see about the maintenance. my son in the states has had cats forever. i had him speak to his cat's vet, he said

this procedure is normal, but, usually done with the cat staying over, as mentioned previously i believe my home is cleaner

and he never has to be alone--i am taking time off from work until IV comes out. the first day he had @ 7 urine outputs first day. he's eating

great. strangely he cries when he sees me, and is quiet when i leave the room. i am his nurse. i check the flow of fluid, and clean out

his litter box as often as he urinates or eliminates. it's hard seeing him in this way, but i know it's for his health.

emilymaywilcha · Aug 13, 2012

Awww, he probably is scared you will do something to him. My first cat Emily ran away from Mom when she was going to the vet every day for antibiotics.

I am glad Darwin can stay home with you during the flush and wish other CRF cats could do the same thing.

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