Urgent, Expert help needed with unusual CKD symptoms and rapid progression.

My cat was diagnosed 7/20/15 with CKD stage 2.

BUN 55 Creatinine 2.7

No stones found in ultrasound, small oxalate seen that aren't stones yet, 

He has a heart murmur that he didn't have in Dec that he did have in March.

Vet presumed that CKD likely caused by previous infection could be previous stones but not likely. . 

He is still on Clavamox antibiotic. 

Now vet thinks some inflammatory process. Can have inflammation without infection but not inflection will have inflammation.No bacteria in urine.

He was put on fluids (Normosol R-200ml) every other day sub Q 

He wouldn't eat RX food and I couldn't find food he would eat that was close to Rx food in phosphorus and he wouldn't eat homemade.

Vet said Gerber stage 2 meat low in sodium and phosphorus high in protein temporary until he was stabilized. 

He was put on Epatkitin Taurine, Clavamox, Pepcid AC 

He is eating more and gained 4 oz. 

He isn't drinking more which is a CKD symptom; excessive drinking and peeing. He drinks 1/4-1/2 cup water a day 

He is peeing 5 times a day up from 3-4 times a day.

His coat looks good. 

He doesn't "look" like "kidney cat",

I wondered about sub Q at 2.7 creatinine but he would absorb pouch within a few hours.

Then last week it went to legs 2x and he seemed worse instead of better and seemed sick and didn't want to eat at 150ml and took 5 hours to absorb.

Yesterday pouch went to tummy and it didn't dissipate for 12 hours and he was sick the entire time (he had 200 ml at vet) and I was afraid that he was getting too much when vet had said he was "slightly dehydrated". Afraid overloading kidneys and or heart.

Then the blood work came back this afternoon and BUN 57 virtually unchanged but creatinine way up to stage 3 at 4.6!!!!!

I had a consultation with surgeon regarding stem cell therapy two days ago and he didn't think there was any rush and that as an alternative I might try alternative and holistic.

Now with those numbers I am in a total panic.

Should I try fish oil/coconut oil/Ubiquinol (Dr. Mercola for pets - .5% silica)?

Need to address high creatinine immediately but don't know what to do. 

Will try to get him scheduled for stem cell this coming week. The only other thing seems to be transplant. 

HELP 

I am frightened in fact scared to death. My kitty is 10 and I was planning on having him as long as my beautiful gray boy who died between 18-20

You can also email me at [email protected] and put help for CKD in subject line. 

Hi, I'm so sorry you are going through this with your cat.  I am no expert but with no one having responded yet I figured it can't hurt.  I have cared for a CKD cat a couple years ago and I'll share a couple things that may or may not turn out to be useful.

Things I notice in your list above:  heart murmur.  Any chance he has full on congestive heart failure?  This is what my cat had, and it complicates the treatment for CKD, moreso than I realized back at the time.  We were doing large sub-q fluid doses like that as well, 150ml and similar, and although Amber was perfectly happy to have the fluid treatment (as long as it didn't last too long, to get large amounts we used big 18 gauge needles) it didn't seem like she improved afterward and sometimes it seems like she felt worse.  The fluid took a long time to go away as you also describe and what we finally discovered is that it was all down to the heart issue.

It's really good that he's been eating.  This became a fight for us.  The CHF ultimately presents a breathing issue, and a breathing issue that's fairly constant is sure to lead to not eating.  The fluid makes the breathing issue worse, but discontinuing the fluid altogether would also not be best.  If I had it to do over again I would have pushed more to lower the sub-q dose and maybe do it more often.  I had a little bit of advice that way but my vet was not on board.  It gets tricky when some things you've dug up from strangers online contradict what the vet is saying. 

I am not any good at interpreting the lab numbers.  I had numbers back at the time, don't remember what they were.  All I know is, the CKD stage was no more than 2 or borderline 3.  I thought we'd be managing CKD for months or longer.  We had gotten to syringing food, but I thought we'd be looking for the right balance to turn a corner for that.  Instead she passed suddenly at home most likely from a cardiac issue.  We don't know exactly what.  Doesn't matter much.  She was 17 and we'd been trying to treat the CKD for maybe 3-4 months.

Using the Gerber meat is fine.  Chicken has the most calories if trouble getting him enough.  Ham was an interesting hit for Amber a few times. If you're using it significantly, for more than a supplemental food, at least get some taurine in it.  Looks like you have that listed above.  We used Pepcid as well and I was never sure if it helped enough.  Now looking backward I tend to think her lack of eating was not from nausea as much as it was from having trouble breathing.  I did not know as much about that issue back then as I do now.  I would know more what to look for now.

So, you may want to look for signs of breathing issue, like abdominal breathing, that sort of thing.  (If you see his sides moving a lot with breaths, and he's not purring, then there may be an issue.  You can search for abdominal breathing in cats for a better description.)

CKD does progress differently in any given cat so any one other experience isn't necessarily representative.  I'm guessing you may be familiar with the http://www.felinecrf.org web site which has lots of info on many different situations arising with CKD.

It is a rough ride no doubt.  I can't tell you how it'll turn out.  I do know that in addition to my above experience I personally know people who gave sub-q fluids to a CKD cat for some 4 years.  If things can be stabilized, it is possible to have months or years of life left.  Do not lose hope yet, but at the same time be realistic about what may happen.  Hang in there.

i'm also not an expert, though i do have a cat (snick) who has CKD -- between stage 2 and 3 at this time, and she's on at-home/hospice care as she no longer tolerates vet appointments.

my snick gets 150ml every other day fluids, though snick is currently getting sodium chloride. snick does absorb all of the 150ml in two days, but it's well into the second day before she's fully absorbed it. i've told my vet that when it comes time to increase snick's fluids again, that i'd prefer to give snick 100ml every day as opposed to 200ml every other day. in our case, i feel that there would be more benefit to snick's kidneys to have the fluids flush them out every day and snick does better handling being given 100ml every day than she does being given 150ml every other day. you might consider discussing with your vet trying 100ml fluids every day for your boy. i mean, it's the same amount of fluids total for every three days so you wouldn't be reducing the amount of fluids given. and you and your vet could see how your boy does with absorbing the fluids this way, and see if there's a noticeable improvement in how he's looking (ie, if he's looking, like you wrote, sick) after getting the fluids.

i don't have any experience with CHF.

we understand how hard this is for you, and we're here for you in any way we're able to be.   

edited to add:  my snick is one of those cats who is just over 4 years now after being diagnosed with 'the beginnings of kidney issues'. snick is currently 15 years old and has been given sub-q's for just over 4 years.

I also have a kidney cat, and her creatinine has been steadily increasing over the years, but not as rapidly as your little one's. Her last figure was 4.2, I think.   I honestly don't know what would be causing that quick rise, unless he really does have some sort of kidney infection, or possible kidney stones.  But your Vet doesn't think it's an infection, so why is he still on Clavamox?  Did they suggest possible CURRENT stones in his kidney?  You said they thought it might have been brought on be previous stones.  Did he HAVE them previously, and if so, were they in his kidneys, or bladder? 

I must say I'm a little surprised by the amount of fluids you are to give at one time with a "heart" cat.  200 seems a little high, since it IS a fine line.  We give our old girl between 100 and 150 ml twice a week, and we give Lactated Ringers vs Normosol.  I read that the main difference is that Normosol burns going in .  With my girl, she feels noticeably better on fluid days.  But all in all,she's been feeling better lately in general.  I've been getting her to take Slippery Elm Bark along with her Pepcid A/C and appetite enhancer, so she's eating a LOT better than she used to. 

when our girls Creatinine continued to rise, I asked our Vet what's the best thing we could do for that, and she said "fluids".  So, not only do we give sub-q's, but we also add water (filtered) to every meal she eats, and she eats between 6 and 7 small meals per day, as well as drinks occasionally from her fountain.  Are you adding any water to your guy's food?  At least he is eating!    That's HUGE  !  I try to buy foods that are fairly low in phosphorus (under 1% on the chart at the website posted by 2bcat, but sometimes it doesn't work out.  Our Vet said let her eat anything, just get her to eat, so we do.  We figure with the smorgasbord she eats, it all balances out, since some are low and some aren't

I checked that website I just referenced, and there may be some reasons why his creatinine might show high.  Here is that page:  http://www.felinecrf.org/diagnosis_test_ranges_factors.htm#factors_affecting_results  You should really familiarize yourself with that website.  I use it constantly....certainly before every Vet visit, or everytime anything new happens with Callie, then I'm armed with info.  Sometimes I just call my Vet and ask her if we can try this or that based on what I've read.  (for instance, we use injectable Pepcid A/C, called Famotudine, since Callie is impossible to pill.  I didn't know it was available until I happened upon it one day on that website!)

Hope all of what I am typing today makes sense as  I'm drugged  for a migraine

I have a holistic vet coming to the house now (twice so far) and she said that fluids every three days or twice a week would be enough. His murmur and bp were checked Friday (today is Sunday) and they are both the same as the week he was diagnosed with CKD going on six weeks ago. That is good thank God. I try to put water in his food and he gets about 3 ounces of water a day plus the food is 75% moisture. The pepcid I crush (1/4 tablet) and make a paste with a tiny bit of baby food and rub it inside his lip on his gums. He used to eat the pill in Greenies and then wouldn't. He is difficult to pill even with the device that the vet sold me or having someone hold him. He snaps his head back and forth like a marlin. 

The holistic vet has done laser acupuncture which he likes. She has tried needle acupuncture and the first time she couldn't get him to sit for any needles and today she used shorter finer needles and got six in him for about five minutes. She will try one more time with different needles and if that doesn't work stick with laser. It is supposed to reduce inflammation. His kidney disease is the inflammatory kind rather than the ischemic kind.  

So far his breathing is ok. It was 21 a minute last night when I counted with a stopwatch app while he was resting. His murmur and bp are the same as last month when he had the ultrasound. The ultrasound showed the beginnings of oxalate formations but not yet stones.The Clavamox he is on is called "pulse" therapy and he takes it and then goes off a week then back on a week. He was on it straight for two months and I was told that if he has a infection deep in the kidney he could do six months straight but the only way to know is to take him off and "wash out" the antibiotic for ten days and then do a culture and sensitivity. That risks a flare up and more damage to kidney if he does have an infection deep in the kidney. 

I'm glad you are able to cut back on the sub-q fluids since he's got that heart murmur. 

Along with adding the water to his food, is he still drinking quite a bit on his own?  I would be surprised if he is.

That's quite an interesting way to give him his Pepcid.  He doesn't have any issues with it?  No foaming at the mouth because of the bitter taste, even with the baby food? 

So...what exactly is the laser or needle acupuncture FOR? Is it to help the kidneys, or for arthritis, or just what?  (sorry if I missed the purpose)

I saw someone pill a cat the way I do the Pepcid on Youtube. He doesn't foam but he hates the bitter taste. I prefer he eat the pill in a greenie pill pocket but he won't anymore.

He drinks 3 oz a day sometimes 4 and has moisture in his 4 jars of baby food (sometimes 5 jars). The acupuncture is supposed to help with inflammation. He likes the laser. 

Stem cell collection Monday. Phase II of a trial. 85% success on the very small Phase I but only 25 cats. Everyone cross your fingers, keep positive thoughts, pray or whatever you personally

believe in.

Please read: One of my cats has lymphoma in the kidneys, and also has a murmur. When she was initially diagnosed she was in acute failure. They put her on IV fluids in the hospital and sent her home on 100 ml of sub q fluids a day. 2 days later she was back in the hospital with pulmonary edema. Due to the murmur she could not handle that much fluid. Be careful with too much fluid if your cat is squishy because they could end up with other problems. Keep an eye out for rapid breathing and if you notice very rapid breathing bring them to the ER. 

Thank you. Sorry about your cat and I hope that she is doing better. I went to a Holistic Vet today and he said fluids twice a week not every other day and 150ml not 200 to not drown him. He said that he was hydrated today and he hasn't had any fluids since Sunday. Monday he had stem collection surgery and had carefully monitored IV. Wednesday he had IV but only a slow drip for 10 or 15 minutes while they infused the 5ml of stem cells. Twice a week should be enough if not more than enough and safe. 

Thank you. Sorry about your cat and I hope that she is doing better. I went to a Holistic Vet today and he said fluids twice a week not every other day and 150ml not 200 to not drown him. He said that he was hydrated today and he hasn't had any fluids since Sunday. Monday he had stem collection surgery and had carefully monitored IV. Wednesday he had IV but only a slow drip for 10 or 15 minutes while they infused the 5ml of stem cells. Twice a week should be enough if not more than enough and safe. 

All my best to you and your sweet boy!  I look forward to reading about your experience with stem cell therapy. My 1.5 yr. old girl has underdeveloped kidneys and it's very touch-and-go these days. Besides sub-q, the thing that's helped her the most is Azodyl.  She was close to expiring before we gave it a try and now she's hanging in there. V. important to give it on an empty stomach. 

 for healthier days ahead   

Pepcid(famatodine) is exceptionally bitter!  Once a kitty tastes it, especially if you try to mask it with food, they will never accept that food again, and I am including pill pockets.  I would highly recommend getting gel caps(size 4 should work for 1/4 of pepcid ac) either at Thriving Pets or Amazon- dip it in butter so it will slide easier; and chase it down with a spoonful of baby food or carefully syringed water.

RuthM said:

 
Pepcid(famatodine) is exceptionally bitter!  Once a kitty tastes it, especially if you try to mask it with food, they will never accept that food again, and I am including pill pockets.  I would highly recommend getting gel caps(size 4 should work for 1/4 of pepcid ac) either at Thriving Pets or Amazon- dip it in butter so it will slide easier; and chase it down with a spoonful of baby food or carefully syringed water.

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Pbi, size 3 caps work like a charm and they're a tad smaller.  We like "Herb Affair" brand at Amazon    The size 3 fit perfectly in the pill guns with the green plunger, btw.

I invested in the pill plunger and it can get it in his mouth but he will hold it and spit it out. So far the nasty bitter Pepcid AC on the gums has worked to get it in him. A Holistic vet has me trying a ginger tincture. He hates that taste too but once I can get that in him consistently I will try and see if he can go without the Pepcid. It will be a week or two probably.