Looking for any hope for my cat...hospitalized with pyelonephritis

Hi. I'm posting out of desperate. My 12 year old cat is hospitalized with his 2nd bout of pyelonephritis in 8 months. This time, he's not turning around and he's been hospitalized since Thursday night (meds were started in the wee hours of Friday morning). He's on prednisolone, IV fluids with potassium replacement @ 20ml/hour, IV Unasyn, and IV pepcid. He continues to be lethargic and vomits after eating. They have not redrawn labs since Friday, but he had a white count of 23,000 with 19,000 neutrophis. HIs BUN was 66 and creatinine was 3.0....UA showed some red blood cells but no infection. His electrolytes were also off from all of the vomiting. This episode came on VERY suddenly without warning in less than 24 hours. They gave him Cerenia and Zofran for the vomiting. We went to see him today and he was purring but won't eat, is withdrawn, and his eyes are still sunken. We will have results on a new set of labs in the morning. I hope and pray he will start to turn around...I don't want to prolong his suffering but the vets have not mentioned euthanasia and we are not ready to give up just yet. 

How many days does it take for a cat with a bad pyelonephritis to turn around? Should we see an improvement by now? I mentioned the possibility of adding an additional antibiotic or maybe Flagyl with his history of IBD since the pyelonephritis can't be confirmed. I'm grasping at straws for anything that might make him better. We miss him SO much.

Just as a background he has a history of UTIs (has a perineal urethrostomy from a history of blockages) and IBD...is on daily prednisolone and Pepcid. His labs have always been normal with his kidney function midrange normal.

Hi GusMaggie and welcome to the forum !

The first thing that strikes me is that this cat has been without food for four days (+ ?) already - now, cats are almost unique in that they do not metabolize body fat very well...actually extremely poorly. Their livers did not evolve with the enzymes required to do this. The liver will draw the fat but, instead of metabolizing it, the liver itself becomes fatty. 'Fatty Liver Disease' or "Hepatic Lipidosis" is the result.....that is very dangerous for any cat, let alone one with severe kidney infection.

So, right off the top, I would ask that a feeding tube be put in asap - in fact, I' would insist on it.

Here's some reliable, plain English reading for you: http://catinfo.org/?link=feedingtubes

I'm sending you a message as well, so be on the lookout for that.

Here's some reliable reading on Pyelonephritis (near page bottom) - in the fourth paragraph there, you'll see a link to a specialist's coverage of thesese infections....also, note what is said about the need for extra time when treating kidney infections, and why that is. Here you go:  http://www.felinecrf.org/diagnosis_urinalysis.htm#utis

I certainly would not even be allowing any suggestion of halting treatment - forget pulling any plugs.

Feeding tube, read, ask questions and hang in there !

Definitely given good information.  With kidney infections they should be on antibiotics for 4-6 weeks.  My cat DeeJay is prone to them and just got over one.  It is critical that your cat eat it's normal daily amount so I would insist on a feeding tube and/or syringe feeding while your cat is at the vet.  Unfortunately being on steroids makes your cat more prone to infections.  I have my cat on Glucosamine for irritation in her bladder as well as give her probiotics.

I'm so sorry that your boy is hospitalized.

Now, I don't know much about pyelonephritis, and don't want to make it seem like I'm questioning your vet, but are they sure it's pyelonephritis? You said the pyelonephritis can't be confirmed. I'm only asking because the symptoms and condition of your cat that you described sound a lot like my Sebastian when he was hospitalized several days for pancreatitis. Pancreatitis can go hand-in-hand with IBD.    It surfaced overnight and his symptoms were vomiting, lethargy, anorexia, increased WBCs and neutrophils (at about the same counts as your cat), and gastric loss of potassium (from the vomiting).

Did they perform an ultrasound of abdominal organs and kidneys?