BUN and Creatinine continuing to rise...problem????

I'm not posting this under the Health Forum because I want to hear from the Raw Feeding group.

Callie had her Senior Panel on Monday, and it seems her BUN and Creatine are continuing to rise.  I fully expected them to be higher than the norm, but is it normal for them to continue to get higher the longer she is on raw? 

                                8/12                  4/13

BUN                          34                      49

CREA                       2.6                     3.1

Nothing else is out of range but these two items.  She HAS lost 1/2 pound in during that time frame, but for any of you familiar with my princess, you will know she is one picky eater

Dr. Christina actually tested her thyroid because her T-4 ratio was a little elevated back in August, but this time it was perfect, and she didn't have any symptoms at all, but she is slightly concerned with these kidney figures, although during her exam, her kidneys felt ok...not shrunken or anything.   We are very worried, simply because we lost Sven to CKD and that's one of the reasons we switched everyone to raw.  I just hope we weren't too late for Callie.  She did, afterall, eat kibble for 11 1/2 years

So, what do you guys think...has anyone noticed the figures continuing to rise in YOUR cats' values?  This is uncharted territory for us, and I cannot seem to find much on the internet in this regard.

Oh yes, no signs of a UTI, and in August she has a Urine Specific Test that came back perfect.  That was done because her creatine was high.  Also, I read that large, muscular cats would naturally have a higher crea, but she is a very petite cat...6.6 lbs. 

Thanks for your input.

Sally, I don't have anyone's numbers handy, so I'll have to call the vet to get them. We're off to NYC today, so it may be later or tomorrow. But I don't recall the vet being concerned about the numbers continuing to rise, which means they probably didn't... though Spooky and Flowerbelle are the only two that have had bloodwork done within the last couple of months. Lazlo and Tuxedo are both due. Every one of the cats has had bloodwork done since being on raw, and I'm pretty sure their BUN and creatinine numbers were at the high end, or slightly higher than "normal," but not a lot higher than normal. All I remember the vet saying is, "I'm not concerned about the numbers; they should be higher as they're on a raw diet."

In the meantime, can you post what the lab had down as the "normal" range? (It's different for each lab).

I don't have the actual lab report, Dr. Christina called us with exactly what I typed .  However, when we were in the office, I was looking at the August report, and I did see that the creatinine at that time was already HIGH, not on the high side of normal...I think the normal ended at 2.4 .  Pretty sure the BUN is that way now too. 

BUT, I realize now that she had just eaten about an ounce of raw chicken within an hour of the tests, which would tend to make both those figures higher, at least slightly .  Hey, their lunch time is 2:30, and her appt was at 2:45.  I fed them all before we left (I honestly didn't even think about that)

Anyway, I told Dr. Christina that I would run these results by the RAW Group and get back with her, and I'll mention that she wasn't fasting at the same time.  She won't be back in the office until Monday anyway.

Thanks!

Well, that probably would make the numbers not comparable (the having eaten just before the appointment). I don't know that having my numbers for comparison would mean anything, but I'll get some of them tomorrow. I've got the paperwork somewhere, but it'll just be easier to call the vet, because we boxed up all of last year's stuff.

Although.... in all honesty, given everything else was normal, and the T-4 was also run.... AND she'd just eaten... everything's probably fine. :nod: You might want to take her in after a month to get a fasting number for comparison... just for peace of mind. :rub:

Sally, I fully realize that, since I'm not a raw feeder, I should not be here in this thread. But...........I'm concerned, so, please, try to forgive the input.

I would be concerned even if a cat with these numbers weighed 20 pounds. With a tiny little thing weighing only 6.6 pounds I feel there is reason to be frantic. Something is not right. I'm tempted to say something is terribly wrong. But, I believe, it's not too late to take several steps now to correct the situation and bring the numbers back to normal.

Going by my own experiences, in a situation like this, it can be very helpful to hospitalize a kitty with such numbers on IV fluids for a day or two to help the kidneys and bring down these numbers. After that, sub-q fluids as needed might also be very helpful. (No problem for any cat that doesn't have heart disease.)

If I were you, I would get a copy of the blood work results ((hopefully your vet did a complete chem profile and not just a partial one) and go over all the values with a fine tooth comb. Again, just going by my own experiences, there should be some other values also with some clues in there.

Anyway......about a year or so ago I found some information from a holistic vet with some details I had not seen anywhere else. Not sure how much of that information would be helpful to you but I would like to share it with you just the same. Not all the information will apply, so just take what does and.........

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

Again, please try to forgive the intrusion.

LDG said:

Well, that probably would make the numbers not comparable (the having eaten just before the appointment). I don't know that having my numbers for comparison would mean anything, but I'll get some of them tomorrow. I've got the paperwork somewhere, but it'll just be easier to call the vet, because we boxed up all of last year's stuff.

Although.... in all honesty, given everything else was normal, and the T-4 was also run.... AND she'd just eaten... everything's probably fine.

You might want to take her in after a month to get a fasting number for comparison... just for peace of mind.

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What a cat eats before blood work can alter results; I agree with LDG, next time you take her have the blood work done on a fasting level--or right after she's eaten.  So you can compare apples to apples (chicken breast to chicken breast).

Sally, I'm sure you've seen this page before, but now might be a good time to review it.

http://www.felinecrf.com/tests0.htm

This popped out at me:

Creatinine and BUN are the two most important elements of the blood test for cats with CRF. When these are elevated and the urine is dilute, there is a very real possibility that the cat is in CRF. When the creatinine and BUN are elevated, it is likely that approximately 70% of kidney function is already gone. Since low normal potassium levels, dental disease and high blood pressure are now suspected to be linked to the development of CRF, it is advisable to have these conditions checked, too.

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Oh - and this:

Lab Results

While lab results are certainly indicative of the progression of CRF, it must be remembered that there can be variations on blood tests - different labs can produce somewhat different results from the same samples because of standards and testing methodology. The manner in which the blood was taken may affect the results of blood work testing. How gentle the technician is, from what vein the blood is taken and what size the needle is can all have an effect on test results. Whether or not the animal is severely stressed can affect the results as can when and what the cat ate and when the cat was last hydrated. In some cases, drugs given to a cat within proximity of taking blood can affect results. What is normal for one cat may not be normal for another. You look for trends and then at the long-term trend. We have found, after becoming frantic over lab results, that how the cat is acting is equally important. A friend of ours, who took care of a CRF cat for several years, gave us this valuable advice - "Treat the cat, not the lab work". Blood tests are just one piece (albeit a very valuable one) of the diagnostic puzzle.

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So you may want to schedule another appointment - and, as Ritz says, bring her either in a fasting state or a having-just-eaten state, for apples-to-apples comparison; and have the potassium level checked again, have a urinalysis done to measure urine specific gravity (to see if it's dilute or not), and have her blood pressure checked. Seems this combination of things would be the best indication of whether or not there's a kidney problem, or it's just a raw feeding thing.

Violet said:

Sally, I fully realize that, since I'm not a raw feeder, I should not be here in this thread. But...........I'm concerned, so, please, try to forgive the input.

I would be concerned even if a cat with these numbers weighed 20 pounds. With a tiny little thing weighing only 6.6 pounds I feel there is reason to be frantic. Something is not right. I'm tempted to say something is terribly wrong. But, I believe, it's not too late to take several steps now to correct the situation and bring the numbers back to normal.

Going by my own experiences, in a situation like this, it can be very helpful to hospitalize a kitty with such numbers on IV fluids for a day or two to help the kidneys and bring down these numbers. After that, sub-q fluids as needed might also be very helpful. (No problem for any cat that doesn't have heart disease.)

If I were you, I would get a copy of the blood work results ((hopefully your vet did a complete chem profile and not just a partial one) and go over all the values with a fine tooth comb. Again, just going by my own experiences, there should be some other values also with some clues in there.

Anyway......about a year or so ago I found some information from a holistic vet with some details I had not seen anywhere else. Not sure how much of that information would be helpful to you but I would like to share it with you just the same. Not all the information will apply, so just take what does and.........

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

Again, please try to forgive the intrusion.

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Violet, any thoughts are always welcome!   That being said, she is current NOT dehydrated, so doesn't really need the IV fluids yet (but if she ever needs sub-qs, we're prepared, because we lost our Sven to CRF just last year .   We still lots of Terumo needles, IV set-ups, even lactated ringers, although they may have expired by now).  Per that website, we are obviously feeding her a high quality protein (raw), and on those occasions when we DO feed canned, we feed Weruva, so we're covered there.  I think I WILL check into those herbs, though.  Luckily we're in a large metropolitan area, so we do have a few holistic Vets here.

We did get a full chem panel done,and everything else was in the normal range. 

Ritz said:

What a cat eats before blood work can alter results; I agree with LDG, next time you take her have the blood work done on a fasting level--or right after she's eaten.  So you can compare apples to apples (chicken breast to chicken breast).

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chicken breast to chicken breast...cute !  Yes, I completely agree.  But in the meantime, think I'll call a Vet who is familiar with raw and just run it by them, if they let me.  Hopefully they'll lelt me ask the question without having to bring her in.

LDG said:

Sally, I'm sure you've seen this page before, but now might be a good time to review it.

http://www.felinecrf.com/tests0.htm

This popped out at me:

Creatinine and BUN are the two most important elements of the blood test for cats with CRF. When these are elevated and the urine is dilute, there is a very real possibility that the cat is in CRF. When the creatinine and BUN are elevated, it is likely that approximately 70% of kidney function is already gone. Since low normal potassium levels, dental disease and high blood pressure are now suspected to be linked to the development of CRF, it is advisable to have these conditions checked, too.

Click to expand...

Oh - and this:

Lab Results

While lab results are certainly indicative of the progression of CRF, it must be remembered that there can be variations on blood tests - different labs can produce somewhat different results from the same samples because of standards and testing methodology. The manner in which the blood was taken may affect the results of blood work testing. How gentle the technician is, from what vein the blood is taken and what size the needle is can all have an effect on test results. Whether or not the animal is severely stressed can affect the results as can when and what the cat ate and when the cat was last hydrated. In some cases, drugs given to a cat within proximity of taking blood can affect results. What is normal for one cat may not be normal for another. You look for trends and then at the long-term trend. We have found, after becoming frantic over lab results, that how the cat is acting is equally important. A friend of ours, who took care of a CRF cat for several years, gave us this valuable advice - "Treat the cat, not the lab work". Blood tests are just one piece (albeit a very valuable one) of the diagnostic puzzle.

Click to expand...

 

Click to expand...

I have been scouring the felinecrf.org website ever since we got the lab results.   She had the urine specific gravity test done in August when her creatinine was high, and it came back perfectly normal, not dilute.  So...at that time the conclusion was it was her diet.  Now I'm really thinking it's because she had just eaten .  However, I'm still going to make some changes, just because.  For instance, I read that bone is higher in phosphorus than calcium carbonate, so think I may start substituting that.  I need to read more on that, though, because I just read a snipit about that this morning on the PHX BARF page because a dog there has kidney disease.  And did you realize that of the raw meats, chicken apparently has the highest phos content?  Figures, since that's all she likes right now.  And she loves the Wholelife chicken too.  Beef has the lowest.  Red meats are the lowest. Turkey is better than chicken in that arena, and she currently despises turkey.  Wonder if she would like Wholelife beef?  (wonder if they even MAKE it)  OK, my mind is wandering now...time to go

Sally, I'd just like to add a couple of thoughts to the issue regarding fluids.

Fluids are also used to flush out waste products from the body regardless of dehydration.

Also, sub-q fluids can be used in very small, tiny amounts, as needed, to help the kidneys. The amount can be tailored and fine tuned to specific needs. (Many times large, unnecessary amounts can actually do a lot of harm.)

Anyway, the numbers you have posted are elevated - way above the numbers one would expect from a healthy diet. Please don't try to ignore them and think very seriously about bringing them down because these numbers are telling you something is not right.

Changing from bone to calcium carbonate might be extremely helpful and hopefully it will help with getting the numbers down.

I have totally different information about the phosphorus content of foods, so I'm really surprised at and concerned about the information you have. (It also goes against everything you'll find in holistic information and advice.)

Anyway......just one more thing. When I decided to post to you I was not thinking of kidney failure, even though the numbers are disturbingly high. I was only thinking, the kidneys are having a hard time with some parts of the diet, whatever they may be. And I fully believe the problem can be fixed with the proper changes and some holistic help. I really hope you'll be able to bring the numbers down to a far more normal level.

Violet, thank you so much.  I understand what you are saying, and perhaps we should go ahead and give her sub-qs. I'll bring that up with Dr. Christina on Monday.   I DO know that too much fluid is very bad. 

Interesting on the reverse info on low phos food.  What info do you have?  Mine says higher fat food equals lower phos food (in meat), so high fat beef, lamb, and pork are good, plus the dark meat of poultry w/skin is better than skinless breasts.  Egg whites are much better than yolks (I give her egg yolk lecithin which she really loves) Naturally she doesn't like egg whites, even cooked , fish oils are good...I give her Krill Oil, but she's not really crazy about it

Sally, I was helping another TCS member with a raw diet in a CRF kitty. I had mschauer run my diet analysis substituting just eggshell powder (calcium carbonate) for the MCHA/bone. And on a DMB basis, it came out to 0.8% phosphorus. So using no bone, and eggshell powder as the source of calcium makes a big impact. :nod:

The meats I have in rotation are chicken breast, thigh, gizzards, turkey breast, turkey thigh; beef one meal a week, goat one meal a week, llama one meal a week, pork one meal a week, and rabbit two meals a week. The organs in the analysis were liver and kidney.

FYI, they were really busy at the vet, so I didn't get anything other than Flowerbelle's most recent numbers. Her BUN was 31, and her creatinine was 1.8. But don't forget - I use eggshell as half of their source of calcium.

LDG said:

Sally, I was helping another TCS member with a raw diet in a CRF kitty. I had mschauer run my diet analysis substituting just eggshell powder (calcium carbonate) for the MCHA/bone. And on a DMB basis, it came out to 0.8% phosphorus. So using no bone, and eggshell powder as the source of calcium makes a big impact.

The meats I have in rotation are chicken breast, thigh, gizzards, turkey breast, turkey thigh; beef one meal a week, goat one meal a week, llama one meal a week, pork one meal a week, and rabbit two meals a week. The organs in the analysis were liver and kidney.

FYI, they were really busy at the vet, so I didn't get anything other than Flowerbelle's most recent numbers. Her BUN was 31, and her creatinine was 1.8. But don't forget - I use eggshell as half of their source of calcium.

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Oh, Laurie, bless your heart .   It's amazing what a little change can do, huh?  Not that now finding foods she will eat that don't include ground bone will be easy, but I'll give it a shot.  If only she would eat boneless Frankenprey , then I could work with something like you did for the other CRF raw eating kitty. 

Got a couple of questions for you still.  Did this diet include egg yolk lecithin?  When you talk about chicken and turkey, does that mean including the skin?  I don't think I have ever seen boneless chicken with the skin on, but maybe you and others actually buy bone-in and then cut it off the bone so that they get the fat in the skin?  I know they need quite a bit of fat in their diets, so lean chicken wouldn't necessily be enough.   

BTW, I already emailed a local Vet who treats animals on a raw diet (and does holistic treatments as well ) and am waiting to hear back from her.  Gave her all the info I currently have, and asked if she consults with existing  Vets, because we really love Dr. Christina and don't necessarily want to change, but maybe have two, like you,   If I don't hear back from her, I may just have Dr. Christina call her.  I don't know why, but she really likes us, and LOVES Callie, just like she loved Sven.  Everytime we go see her, she always gives us big hugs when we arrive AND again when we leave .  I guess she knows we really care about our fur kids and appreciates that.

Well, back to HT now to hunt for boneless ground meats/organs to see what I can do. Unless I get a grinder, now my local resources won't work, since all their already ground stuff includes bone.   Darn! 

Yeah, you may have to invest in a grinder. But don't forget - you don't need one that will grind bone! So you don't need some huge heavy-duty thing. Gary and I have something in storage that he used to make sausage, actually, or grind his own meat for meatloaf.

Also, you probably know this because of Sven, but you can also substitute some of the meat with egg whites. In addition to keeping the protein high and further reducing the phosphorus, they're a phos binder. http://www.renalandurologynews.com/egg-whites-may-help-lower-phosphorus/article/111024/

Raw or cooked, doesn't matter.

The analysis did NOT include the lecithin from a phos perspective, because we don't know how much phos is in it. But I doubt it adds much, as it is the lecithin part of the egg: the amount of choline egg yolk lecithin adds is MUCH less than the amount of choline an egg yolk provides. And the amount of alnutrin you use, which is egg yolk-based, is so very, very small in comparison to the amount of food, I doubt it contributes much, either. The analysis DID include 1 egg yolk per cat per week, because that's what I feed them to bump the choline in their diet. (It also included sardines once a week, and salmon oil every day). Oh - I forgot to include (in the list of proteins, above) that they get lamb once a week also.

And no, I don't include skin. In fact, the diet is about 72.7% protein and just 19% fat on a DMB basis. But including more fat and less meat would also bring down the phos %, while providing the nutrition she needs - cats do well with fat, and the diet I feed is really low in it. :nod:

But a grinder might not be a bad idea, Sally. A meat, not bone, grinder. You can play around with proteins (and organs)/egg whites (either cooked or raw) to see if you can find mixes she likes...

For the meat grinder, I have a suggestion. If you already have a KitchenAid mixer which a lot of people do, there's a grinder attachment that's about $50. That's what I used when I was grinding meat only, and it worked well. I wouldn't want to do large batches with it though. It comes with both a coarse and fine grinding plates.

I don't have a KitchenAide.  I DO have a food processor, but it's so old that I don't have any idea where the directions are though.   And so far, I'm not having any luck finding already ground chicken anywhere (like Hare-Today) other than just ground breast.  I want a combo breast/thigh for the fat content.  HT sells a package of ground chicken organs (hearts/liver/kidney), which would be great to add to more ground (I already do, actually, but to their ground mix with bones. 

I'm wondering if I could just add some egg whites to the mix with bones, since the egg whites are a phos binder, and maybe that would help offset the bones.  Maybe I will contact mschauer to see if she can run that by her spreadsheet and see what happens.  Wonder if I could use those egg whites in the carton that they sell for human use?  Probably they are really plain old egg whites...does anyone know?  Eggbeaters,  think they are called.

I probably should just calm down and wait until I speak with the Vets next week, huh.  Deep breaths.  Oh, but did I mention that Radcat has changed their ingredients and no longer uses bone meal?  I guess I could order some more in chicken (now that I just gave away a bunch of lamb )

Just a thought since you have other cats that you may want to grind your own meat and bone for, what about getting a Tasin grinder? Grind your own local meats and buy the others online?

Substituting egg whites for some of the ground will help, but not nearly as much as substituting the bone for eggshell.

But yeah, I'd take a few deep breaths, and follow-up with the vet(s) before making any decisions. :rub:

OH! You order from HT, right? They have a number of boneless ground proteins. I mean... for the meantime. And FYI, the eggshell powder, I purchase here: http://www.knowwhatyoufeed.com/shop_online.html

And as you use Alnutrin, you could just buy the Alnutrin with eggshell....

I already checked HT for their boneless meats...nothing much in their ground that I think we could use...BUT I just found out that Wholefoods will grind meat for you, like boneless chicken thighs!

Look what I ran across. http://felineinstincts.com/store/products-page/my-natural-cat-with-chicken-liver-premix/   It's similar to Alnutrin, but for kidney support.  Comes with or without powdered liver, and they also sell just powdered liver.  I have an email in to them to see what their source of calcium is for the kidney support product, among other things.  They also sell just a regular premix, with or without powdered liver, and with or without calcium (like Alnutrin).

Their recipe for the kidney diet has you add twice as much salmon oil as the regular recipe, since kidney cats needs extra omega 3 fatty acids, and pumpkin or squash, since they also need soluble fiber

(I already use the Alnutrin with eggshell powder for Darko, who is eating boneless Frankenprey) 

Sally, all my cats (Mac has no history yet) had their numbers increased in both cases, in different blood tests. Since all of them were eating raw, I expected and my vet is not concerned. Hope is above the "high" mark as well. Their urine is not dilute; if it was, that would indicate a problem. I am not sure how much higher the numbers usually are, or when my cats will reach a plateau (or if they already did); but I know how well they are doing, that the studies show that the numbers are normally higher, and that my vet has the same knowledge I have and is not concerned because of their diet and health. With that said, egg whites is used by crf raw fed cats to lower the phos. Levels. It has to he cooked. All you do is substitute 1oz of meat a couple/few meals per week for cooked or slighted cooked egg whites. It is high quality protein, but very low phosphorus.
Obviously I am not a vet, so I can't say your baby is well or not... But I would keep this in mind... There have been cases of animals who were fed raw with skewed numbers because of the diet who were completely health that the vet diagnosed with kidney problems based purely on the numbers.... As you can imagine, no one would like that stress.... That is a disservice for you and for the cat....
I would say take a step back a two a good look at your baby. Is she sick? If all her other numbers, urinalysis, blood pressure checks in ok, I would take a deep breath and relax.
If you want to play safe, I think eggshell and egg whites are an excellent plan for any elderly kitty :nod:

OK, had a very long talk with Dr. Christina this morning, and she said considering that ALL Callie's other numbers were so perfectly in line, and since her August urine specific gravity test was PERFECT, she really doesn't think there is kidney disease.  We discussed ways to lower her phos, etc. and she said she didn't really  think it was necessary because there was no real evidence, and ever her phos registered perfect on the blood test .  

I asked if, since we have unopened sub-q fluids from Sven that haven't expired, we should give her some just in case, she said since Callie likes to drink and showed absolutely NO signs of dehydration, she didn't think it was necessary. 

I guess I really do just need to stop panicking .  (she had left a voicemail with the numbers and then was gone for the rest of the week...that's what started all of this)   However, I am still going to change her diet, and maybe add in some Renal Support...am thinking about this http://www.onlynaturalpet.com/products/only-natural-pet-kidney-support/999178.aspx#pr-header-999178, and then in three months we'll take her back in and have her BUN and Creatinine checked, and at the same time do another urine specific gravity test. 

I really trust Dr. Christina, she KNOWS what we went thru with Sven (3 years of CRF) because she was there every step of the way, including crying with us when he died, and I truly think if she thought we should do anything right now, she would have us do it.  And she knows we're willing to do whatever it takes.  She's even going to do some research and call me back later because I asked her what would be a good fat to add to her raw diet for her to gain some weight.  (she already knows we add Krill Oil to her food).