Am looking for any help on advanced kidney failure

Oh, and forget to mention the "scruff of the neck" test.  If you pull the scruff of his neck, it should snap back pretty easily if he is fully hydrated.  Dehydrated kitties skin has no elasticity and it sort of slowly retracts afterward.   The vets often do this test on them without us noticing.  It is an easy indicator of hydration inbetween bloodworks.  Try practicing on healthy kitties (if you have another) or on him in a rehydrated state to see what it should do.  It is a useful test for seeing if he needs more fluids.

Some of this may be in advance of where you are at the moment but it is good to know later if you get to the point of giving Ringer's drips at home.

Fuzzy is back in the Vets.

Hi all, I am struggling with what to do. The beginning of August Fuzzy had a bladder infection. My vet treated it with Orbax and Clavamox. He was on the Clavamox for three weeks and he is still on the Orbax. At that time we ran his kidney values to see where he was, and I was elated as they were much better than I expected. He was in kidney failure but the vet said stage 2, considering he almost died and the previous vet strongly recommended putting him down saying he had some of the highest values she had ever seen, I was excited. His phos. levels were normal so I thought we were doing OK. He even put on a little weight. His coat seemed better.

On Thursday (29th) he was straining in the box again, so I took him in yesterday morning and he is completely blocked. His kidney values are high again. This seemed to come on very suddenly. I did not see any real signs. My concern is that there is a bigger problem here and maybe it is time to let him go. It is a holiday weekend and my vet does not have 24 hour care, but they don't want me to take him home as he is on IV fluids and catheterized. There is no way to get an ultra sound for at least a week or so. My vet said his urine was quite bloody.

I am having difficulty getting them to discuss the possibility of putting his to sleep. I understand vets don't have a magic ball, but they do have the benefit of experience that I don't have. I have many concerns here. One is the fact that I seemed to have missed this, which makes me question my ability to adequately take care of him - this has a direct bearing on his quality of life. I am concerned that this recent episode has destroyed more of his already damaged kidneys. I am also concerned about cost. We are supposedly going to be hit by another round of cuts from sequestration in October. My husband is retired military and I am a part time college instructor. Our areas are among those hardest hit by sequestration ( there even has been talk of stopping retirement benefits for anyone who took retirement before 65, like my husband  and while my classes are full, enrollment is down because of cuts to financial aid). 

While I know it is fairly common I have never had a blocked cat before. Given that we know he is FIV positive the likelihood of a cancer is higher, right. I guess, the more I know the better my decision making will be. Any thoughts, ideas, previous experiences?
 

It's possible for kidney values to go up due to a blockage, sure. It's possible (but not guaranteed) that the levels can come back down while on fluids and catheterised. I think your vet is doing right by tackling one issue at a time.

When Fuzzy crashed back in May, my vet at the time very definitely wanted to put him down. I made her angry when I refused. She did give him a very high standard of care in the end. I absolutely can not complain about that. But, now I am wondering if maybe she saw something or was aware of something that she just did not communicate well. Kind of like MD's, they get mad when you ask them to explain or justify their diagnosis.

Is there a kidney-bladder connection (ok, maybe not the best choice of words)? I mean is it common to start to have bladder problems once the kidneys start to go or possibly the reverse. The bladder problem was always there and we just missed it.

Hi again Fuzzycat !

From the ideas/thoughts Department: Something that I really liked hearing was the "one issue at a time" approach. Clear thinking is really what's needed at times like these, because we become absolutely overwhelmed. I think that, if I were dealing with him here, the FIV status would not be part of any current decision-making. Neither would I be including any forecasting information...I always need to use my resources prudently, I believe I wouldn't be wasting them by treating a urinary blockage at this point - this is something that can happen to any cat. I would be interested in knowing whether/not giving him fluids at home periodically might have made a difference in this case, how I can test for dehydration (see post #21)....and, these are things you covered here:

One is the fact that I seemed to have missed this, which makes me question my ability to adequately take care of him - this has a direct bearing on his quality of life

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There are some other practical things that need to be done, too. Litterbox deposits need to be monitored - some people keep a diary of sorts, because, without those, all evidence becomes a blur. So, it does take more attention to detail than would an ordinary healthy cat situation.

I can't tell you that his kidneys weren't further damaged by this blockage....but I can tell you that I doubt it. From what you described, you probably caught this early.....many people don't even notice the straining and think nothing until the cat hasn't been seen in days and, oh, the food dish is still full too......

So, I don't know what else to say. I would not be giving up on him at this point.

I'm glad you're open to talking it out - it's really the only way to stay sane!

My CRF cat did not have any other renal issues. However, like humans, cats are individuals. Has he blocked before? Does he urinate often and in larger than normal quantities?

I know it's a holiday weekend, but can you see him? That might help.

I think UTI's are more common in kidney cats, but that's the only thing I have ever heard of that is "related" in that aspect.  My kidney cat never really had any issues other than bad kidneys. 

Me either, on UTI's related to CRF.  I have had 5 cats with CRF that never had UTI's ever.  I am not sure if a UTI would exacerbate the CRF.  I agree if he has been stable up until now with his CRF, just to deal with the UTI on its own.  Some cats just seem predisposed to UTI's.

I have become a big believer of "picking apart" a sick kitty with multiple issues and dealing with each illness separately when things seem unmanagable.  Sometimes, bringing one issue under control makes the outlook seem much brighter.

Back in May, I made the vets let me see him daily.  But then he was as close to death as I have ever seen an animal. He was not eating or moving etc. except when I visited him. That vet is a larger operation with more staff. They are owned by a veterinary corporation. I have not pressed the issue with this vet in part because when faced with the issue of letting me make payments or possibly letting him pass they chose to let me make payment. I think the vet paniced a little when she realized he was totally blocked - actually I did too. But also they told me that as soon as they catheterized him and got him on fluids he started chowing down his food. They were chuckling about it - so I could tell it made an impression. This vet is a smaller privately owned clinic. Besides actually being closer to the house I find they seem to honestly care about their clients.

They did x-ray him and didn't see any stones or obvious masses. The vet said that is an uncommon kind of stone that is radio-transparent, and it takes an ultra sound to find them. She did suggest the possibility of interstitial cystitis. That could be managed with pred. He was on pred. for a long time for stomatitis, but his stomatitis actually went in to remission.

I was bolising him three times a week and I would check his hydration level in between. Back in May I was hydrating him every other day 150 units, but recently it seemed his hydration was better and I had backed off a little. I was thinking maybe the antibiotics had helped him overall. Great, it probably was because he was not going! Some days I do wish they could talk!

Overall, he is pretty shy about being caught in the litter box. I think that is part of what caught my attention. I saw him in the box. In fact on Thursday,  he was moving from box to box trying to go. It was obvious he was having a problem. Up until then I honestly didn't see a problem. I had bolised him on Wednesday night. I was thinking maybe he was constipated. Ooph!

I forget...how many cats do you have?  Every time we scoop the boxes, between my hubby and myself, we count up the pees and poops. (he scoops the downstairs boxes and I do the upstairs ones)   We have 3 cats, and so always hope to have at least 3 pees and maybe a poop, but since we scoop twice a day, we won't always find a poop .  If we short on pees, then I start hovering to see if there is a problem.  One box is in a bathtub, so I can pretend I'm brushing my hair or something and actually watch in the mirror to see what's happening .  With the other boxes, I can just be doing something else in the room with my back turned and then as soon as they finish up, I'll quickly run over there and see what's in there, even if it means I have to take a scoop to it.   But, yeah, moving from box to box is a definite sign of a problem.    At least he's feeling better now, and eating, the main thing for a kidney cat .  So is he still catheterized?  

He is catheterized until tonight. Then they want a day to make sure he is going normally on his own.

We have one who has IBD and diabetes, one who is FIV positive with allergic stomatitis, Fuzzy and a stray from the neighborhood stray population. He is on the feral side of life. Not too bad, but I have to wait for him to come to me, no loud noises and I have to really watch how I move when he is around.

I normally scoop once a day, occasionally twice. But, I have also been trying to get my husband to help. I do try to watch the boxes but with two on pred. I get some very large pees. Diabetes and kidney failure don't help. It seems I have more pee than cats. And, I have to admit I have been more focused on solid stools.

Does the type of litter make a difference?

A received a call from the vet this morning.....they are closed today but she was checking up on him. They took the catheter out last night and he is peeing well and is eating well and is perky. But, she said his kidney values are worse.

Her take is that he is not acting like a normal kidney/bladder infection cat. That something else was driving this. One possibility she suggested was Amyloidosis (amlyoidosis sp?). From the little I read it is considered rare in cats with the exception of Abyssinian. In humans, there is a kind of Amyloidosis that is the result of dialysis. Apparently, the fatter folded proteins don't get removed and will build up in the kidneys. Mereks didn't mention this but could it be true also for cats?  One thing is clear is that there is a connection between Amyloidosis and chronic infection and inflammation and with his stomatitis and FIV, Fuzzy fits that pattern.

Now, either in an earlier post or from Tanya's website it was pointed out that it can take time for kidney values to come back down in the blood work. So, I don't want to rush to judgment. Argh!

Can they run any tests to confirm their thoughts on the proteins?

The vet said a biopsy. On-line with humans it said that protein in the urine is an indicator. My vet is pushing for an ultra-sound but I don't think that will tell us anything about Amyloidosis. She also mentioned he had a large number of epithelial cells in his urine. Again from my limited reading I get the impression that this could be simply from the process of being catheterized or it could be the result of something more serious. I got the impression that it is possible to do a stain on the urine culture to see what kind of epithelial cells exist, which is important. I also got the impression there are some rare forms of bladder cancer in cats and dogs and cause epithelial cells to be shed.

This may be why she is pushing for an ultra-sound.

I wish vets (and doctors) would just tell us what they know. I hate having to do the research on-line. I don't have a medical back ground so I know the information I am getting is not going to be accurate. I feel like the story of the blind men each touching only one part of an elephant (tail, trunk, tusks etc.)  and being asked what kind of animal it is.

At our last blood draw, the beginning of August, he was not anemic and there were no other indicators that his FIV was active. But.........

We put our 14 year old dog down the beginning of the month as still have a little bit of phantom dog syndrome. My husband is taking all this hard.

Have you mentioned all this with the vet? I ask because the vet may not be aware of your interest in trying to understand the tests. I wish I could be of more help with what's going on with your kitty, but it's hard enough with humans.

I can't remember if I asked or not, is Care Credit a possibility?

I'm very sorry about your dog. That sure can complicate matters.

Do you belong to Tanya's kidney yahoo group?  If so, I would ask them about the Amyloidosis.  They have tons of people in that group and one or more of them may have encountered this before.  It's worth the question to that group. 

I have tried to, but I am sure it is difficult to know how much information is too much.

The other vet in the clinic had mentioned that there is a kind of stone that is 'radio transparent'. Again from a limited amount of research I learned that uric acid stones don't show up on x-rays. They are the feline version of gout. Interestingly enough I have been in the process of switching everyone onto a raw food diet. I am thinking raw foods are higher in organ meats which in turn could lead to uric acid stones. This supports her reasons for wanting an ultra sound.

I also read something about a new test for bladder cancer called the V-TBA test or the tumor bladder antigen test. If my guess is right it may rule some of the scarier stuff out for less money. I just don't see how we can do another $400 for an ultra sound this month. We ultra sounded another cat the end of July.

I am thinking of leaving a short list of questions with her in the morning and then when we connect tomorrow afternoon she might be able to answer them.

I don't think this vet takes credit care but it won't hurt to look into it.

Is there an Abyssinian group here? Since Abyssinians are predisposed to it, maybe someone has had experience.

I will check Tanya's Kidney site and ask.

I love Tanya's site but to get info from the support group you have to join Yahoo. I use my computer for work and I worry about Yahoo.

From what I've found, amyloidosis with Abyssinian cats is familial and systemic. However, I have found links when Googling FIV and amyloidosis (renal, specifically).