high BUN but 'normal' CREA?

hello, i'm new here! long time lurker but first time poster. originally from the UK but now living in singapore with my cat (well, we had moved both of our family cats over... but shortly after they arrived we lost one to bone cancer... horrible). i'm sorry, this could be a really long post...

before they flew, they had a checkup and we discovered my sasha (darling, love of my life - 17 years old) had a tooth decaying. all good in the end, we had a blood test done here in singapore before they removed it and all was fine, she recovered really well despite me having several panic attacks during the process. anyway. the vet kept warning me her kidneys WILL GET WORSE because age etc... at the time, her readings were BUN 51 mg/dl (normal 10-30) and CREA 2.4 mg/dl (normal 0.3-2.1). 3 months later, her BUN has gone up to 66 mg/dl and her CREA has gone down to 2.1 mg/dl. the vet wasn't too worried and said it was still in a normal range (how?) but the psycho cat mum in me is terrified.

since her initial diagnosis she's been taking one vetriscience renal supplement a day as well as an azodyl tablet. IV fluids once a week (we need to step this up but she hates it and so do we). but i haven't changed her food. i have spent hours researching what is best yet still tasty, but in singapore it seems we have really limited high quality cat food. she's quite fussy (despite eating like a horse) and refused all prescription food to the point she was losing weight. not good. she now happily gobbles almost 2 tins of fancy feast grilled food a day (i made sure it was the most reasonable in terms of protein, phosphorus and sodium), as well as some prescription dry food which she eats out of sufferance if she's really hungry. she drinks plenty of water. she also has 2 puffs of ventolin a day thanks to asthma. she used to eat the fancy feast pate which was extremely high in phosporus but obviously has a higher water content...

how do we get her BUN down? is there anything else that could contribute to it going up? she's totally fine otherwise, most vets or nurses who meet her can't believe she's 17. (touches wood... i have had her since i was 10 years old and i cannot fathom the thought of saying goodbye anytime soon especially as we just had to say goodbye to monty).

so what can we do? more fluids? a change in food? (very difficult). phosporus binders? it's not a case of money at all, i'd fly in pet food from the US if i knew she'd eat it!!! we're basically doing all we can at this early stage, to help slow the deterioration. 

thanks in advance for all your wonderful advice.

joannac said:

 
hello, i'm new here! long time lurker but first time poster. originally from the UK but now living in singapore with my cat (well, we had moved both of our family cats over... but shortly after they arrived we lost one to bone cancer... horrible). i'm sorry, this could be a really long post...

before they flew, they had a checkup and we discovered my sasha (darling, love of my life - 17 years old) had a tooth decaying. all good in the end, we had a blood test done here in singapore before they removed it and all was fine, she recovered really well despite me having several panic attacks during the process. anyway. the vet kept warning me her kidneys WILL GET WORSE because age etc... at the time, her readings were BUN 51 mg/dl (normal 10-30) and CREA 2.4 mg/dl (normal 0.3-2.1). 3 months later, her BUN has gone up to 66 mg/dl and her CREA has gone down to 2.1 mg/dl. the vet wasn't too worried and said it was still in a normal range (how?) but the psycho cat mum in me is terrified.

since her initial diagnosis she's been taking one vetriscience renal supplement a day as well as an azodyl tablet. IV fluids once a week (we need to step this up but she hates it and so do we). but i haven't changed her food. i have spent hours researching what is best yet still tasty, but in singapore it seems we have really limited high quality cat food. she's quite fussy (despite eating like a horse) and refused all prescription food to the point she was losing weight. not good. she now happily gobbles almost 2 tins of fancy feast grilled food a day (i made sure it was the most reasonable in terms of protein, phosphorus and sodium), as well as some prescription dry food which she eats out of sufferance if she's really hungry. she drinks plenty of water. she also has 2 puffs of ventolin a day thanks to asthma. she used to eat the fancy feast pate which was extremely high in phosporus but obviously has a higher water content...

how do we get her BUN down? is there anything else that could contribute to it going up? she's totally fine otherwise, most vets or nurses who meet her can't believe she's 17. (touches wood... i have had her since i was 10 years old and i cannot fathom the thought of saying goodbye anytime soon especially as we just had to say goodbye to monty).

so what can we do? more fluids? a change in food? (very difficult). phosporus binders? it's not a case of money at all, i'd fly in pet food from the US if i knew she'd eat it!!! we're basically doing all we can at this early stage, to help slow the deterioration. 

thanks in advance for all your wonderful advice.

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Hi

You're doing a lot for her and that's good.  If your vet thinks its time to increase the sub Q fluids (frequency) that is probably the best single treatment you can give a cat with kidney issues.  Your vet can teach you how to do it at home, and there are also good youtube videos showing how to do it. If she is ok in a carrier, you can place her in a carrier that opens at the top as a way of helping to keep her restrained while you do it.

Cat water fountains can encourage drinking too.

Our Vet told us it's the creatinine that is the more worrisome number, so the fact that's is going down is a wonderful thing.  You are to be congratulated on that.     How is her Urine Specific Gravity Test?  That is also one that is a better measure of how her kidneys are working, rather than just taking into consideration the individual numbers. 

Have you looked at this website:  http://www.felinecrf.org/index.htm  This is my "go to" for anything kidney related, as I'm currently on my 3rd kidney cat (My girl will be 16 in January).  Per the info in this website, high BUN can mean a cat is dehydrated, can mean they have gastro-intestinal bleeding, can mean their food is too high in protein (don't think that's the case with fancy feast).  But my question to you is, does your Vet consider her rise in BUN to be worrisome?  Was your Vet visit perhaps right before she needed her sub-qs?  If so, then she probably WAS a little dehydrated, which might explain it. 

I hear what you're saying about the FF PATE, and yes, they are pretty high in phosphorus.  Know what... I still feed them on occasion to my girl.  I feed her whatever she is wiling to eat, with the blessing of our Vet.  We figure with the variety of foods she gets, it all evens itself out.  She eats FF Pate, FF Gravies, Earthborn, Iams Purrfect Delights (good on the phos. level), Pinnacle, Weruva, etc..  And recently I started making her Bone Broth, which has really helped her with her appetite.  But her Creatinine is way higher than YOUR girl, and she's had kidney disease already for a couple of years.  And our girl takes Pepcid A/C for an over acidic tummy, AND an appetite stimulant.  Does your girl need either of those?  Doesn't sound like it, which is great! 

I think what you're doing, with the 2 supplements, is good.  Don't think you need to add Phos. Binders at this point, because from what I understand, that works on the Creatinine, which IS improving.  But, of course, if your Vet says otherwise, listen to what they have to say.   And, as StephenQ says, with kidney cats, fluids are the most important thing.  Are you adding any water to her food?  I add a couple of teaspoons to every one of my girls meals, and I feed her between 6 - 10 small meals per day!  One is even in the middle of the night.  I put it in the freezer and take it out right before I go to bed and put it on the nightstand so it's thawed by the time she's ready for it.  ('course, I'm retired so have nothing better to do ).  And with the sub-qs, most cats get used to them and some people even manage to hold them in their laps while giving the fluids.  And the higher you hang the bag, the faster they flow.  We can help you with tip on that if you need.

wow thank you so much for the detailed and comforting replies.

the vet wasn't worried at all but obviously, i am, as no one likes knowing their furbabies are sick. also when i see a figure and when i see the 'normal' range i start panicking! there was nothing to warrant her blood test specifically at this time, we're just getting into the habit of doing it every 3 months. yes you are right, the vet took her blood whilst she WAS dehydrated. she has a bad habit of not drinking much during the day because she's so fast asleep (we have a 'cat cam' to watch her when we're at work!) but during the night she drinks a whole bowl.

when i used to feed her FF pate i did used to add water, but i don't now with the grilled as she doesn't eat it. she seems to prefer the pate 'soup' more. a balance between her getting more fluids but her phosphorus levels going up i suppose!

we'll step up her fluids. the vet taught us how to do it and she was really tolerant there, probably because she was scared but at home she has none of it. really good tip about putting her in the carrier although she's such a slippery cat when she wants to be! my partner administers the fluid while i try to hold/comfort/bribe her. so far we manage about 15 seconds which is on average 50-100ml so not too bad, hopefully it'll get better.

i've tried the water fountain so many times but she hates it. what's the secret??? bearing in mind for 15 years she'd only drink out of a ceramic cup by our head... hahaha!

OK, if you girl likes the Pates' better, try another brand.  Sheba is lower in phos than Fancy Feast.  Maybe she would like that?  Then you can add water.  Or have you tried any of the other FF (other than the Grilled)?  What I find works on the stuff other than the Pates is add the water directly to the can and stir it in, once I take out the first serving.  That way it gets absorbed into the food and just make it more moist.   But there are LOTS of pates out there that she might like.  THIS page of that website I referenced lists canned food in order of low phosphorus:  http://www.felinecrf.org/canned_food_usa.htm#canned_usa.  Problem is, I have no idea what is available to you over there.

As far as fluids, here is an article on how to get cats to drink more...may or may not help.  I have a fountain, and only ONE of my cats will drink from it (luckily it's my kidney cat)   http://www.thecatsite.com/a/tips-to-increase-your-cat-s-water-intake  I will say that I took one of the tips in this article, the one about adding a pingpong ball to the dish so they can see the water level, and tried it, and it made a world of difference.

Now for the sub-q fluids, we do the same thing.  One administers the fluids, and the other tries to keep her occupied.  But the one administering holds her on their lap, with Callie facing forward, then the other person is in front of them, at her head, rubbing her head, 'cause she loves that, and it keeps her  in place.  Treats will work if you have a treat lover, even eating during sub-q's will work.  Anything to keep her occupied.  Then there is the needle.  A good needle goes a long way.  I use Terumo 19G Thin Wall Needles.  They are sharp, sharp, sharp and go into the cat so easily she never seems to even notice .  Also, some cats prefer it if the fluids are warm.  In the summer here, I don't warm it up, but in the winter I do, by simply putting the bag in a bowl of warm water for about 20 minutes.  Just the bag, though, not the IV Set -up part. (I just hang that part over the edge of the bowl)   And as I mentioned before, the higher you hang the bag, the faster the fluids will flow.  We hang ours from the top of the dining room light fixture with a hook that DH configured.  I can barely reach up there to hang it, but it really helps.  We can usually get in about 150 ml from start to finish in less than 5 minutes, and I'm talking about grabbing her, getting settled in, poking her, starting the flow, stopping to administer a shot into the extra port (an extra step you don't need to do), etc.  The key is to just do it as if it's an everyday event.  I always tell Callie it's time for a "fill-up" as if it's a good thing, since it IS, to try to make it like a game, so she won't be scared.  Then I give her treats when she's done.   Our LAST kidney cat would immediately go to his water dish as soon as we set him down on the floor .  We never did figure that one out

Do you know what the phos is in sheba? I don't see it on the list