Caleb's blood/urine results...CKD?

rockchick2325

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My cat Caleb has recently had a hearty appetite, been active, and urinating more frequently. I thought I just finally found food that he really enjoyed and, since he was looking thinner to me, I tripled his wet food and cut his dry from 1oz to 1/2oz. Since i'm worried about the dry dehydrating him, I always put a few spoons of bottled water in with his food. But the pee just kept coming and I noticed a few times him give a few pants during activity. Then I noticed it more frequently, so I took him to the vet for a workup. The next day, the vet called back and said that Caleb had kidney disease and should be started on a prescription diet. She also mentioned he had elevated alt. For the last couple days I have been doing a ton of research and trying to figure out what to do. I finally got back to the vet and picked up a copy of his results. I have been looking them over and as far as I can tell, if he has kidney disease, it is only in stage 1. And doesn't require such specialized food. But I am a little confused by his results and was wondering if anyone has any experience with results like his. I have a feeling something else is going on and am thinking about getting a second opinion. I would love to get an ultrasound, like the vet suggested, but it is $500 and I can't swing that at the moment. Especially after almost $300 for blood and urine tests.
 

donutte

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I know there are a lot of things that my scream "kidney disease" but I'll be honest, nothing is shouting that at me here. What specifically caused your vet to say it was CKD? Creatinine looks like it could be extremely early Stage 1 range, but can't see anything else indicating that. Usually vets use a combination of things to determine it's CKD.

BUN looks normal, but I'm trying to see if there is anything considered a "grey area". do you know if the urine was dilute? That is pretty common with CKD. ALT has something to do with the liver, although I'm not really sure what.
 

donutte

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Also, please note this (taken from iris-kidney.com website):

"Staging is initially based on fasting blood creatinine assessed on at least two occasions in the stable patient."

My cats all had MULTIPLE sets of labs done this past year, so when they were diagnosed it was based on history. The exception was Lucky, whose numbers were so high, and symptoms so profound (only a month after much less dire bloodwork) it was determined he had acute on chronic renal failure. There was no other blood test needed at that point because every single thing was indicating it.

Has your cat had any other bloodwork done recently? I'm just surprised that your vet said this after one set of labs. Even with Sara, my vet didn't say it until she'd had MULTIPLE sets and the last one which she was slightly hypothyroid (unmasking the kidney numbers) was the one that showed it for sure. She's also had dilute urine though every single time they did a test. And YES it's expensive. Goodness, I can't believe how much it costs. And I'll be doing it again in a week and a half with Sara.
 

donutte

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I also see that Caleb is a tad hypothyroid, just going by what that result is for the T4 (not diagnosing, saying what it appears to be). Did your vet say anything regarding that by any chance?

Actually.... the more I look at this, the more I think you may want to get a second opinion from another vet. Or if you don't want to do that, at the very least, have a chat with your current one to ask about all the other numbers that are off. There are quite a few here (RBC, Platelet Count) that are a bit off.
 
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rockchick2325

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No other bloodwork done, just this. She only pointed out the alt and specific gravity ( which is why she said kidney disease). I was surprised of all the things she didn't mention ( like the t4 and rbc, etc.) I really am thinking about getting a second opinion and maybe waiting a little while and seeing about redoing the tests. It just doesn't make sense to me and I really wish I knew what was going on.
 

donutte

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No other bloodwork done, just this. She only pointed out the alt and specific gravity ( which is why she said kidney disease). I was surprised of all the things she didn't mention ( like the t4 and rbc, etc.) I really am thinking about getting a second opinion and maybe waiting a little while and seeing about redoing the tests. It just doesn't make sense to me and I really wish I knew what was going on.
I'm not a vet, and will never claim to be, but just going by my experience this year (and have had way too much of it) it takes a lot more than one test with those two things that the mentioned to indicate kidney disease. While high ALT can be found in cats with kidney disease, it's not an indicator of kidney disease because it has to do with the liver. My Lucky had normal values on the low end of ALT (29 on the very last one) the entire time. And he was Stage V kidney disease when he died. So, there's not a direct correlation between kidney disease and high ALT. Only that it is something seen in some cats with kidney disease.

Creatinine, BUN, SMDA, those are things that typically are indicators in bloodwork of kidney function.

A low specific gravity (ie, dilute urine) can be an early indicator of kidney disease. CAN be, doesn't mean it is for sure. Hyperthyroidism can cause it, but if I were to give my non-professional opinion, your cat has the opposite problem. Sara has had dilute urine all year, as I said, but until bloodwork indicated that there was early kidney disease present as well, we didn't even discuss treatment for it. Only a couple weeks back did she even get put on a kidney diet. She does have hyperthyroidism and didn't want to treat for kidney disease until absolutely sure.

I'm still shocked that the low T4 wasn't even mentioned.

I'm not sure I'd wait too long on re-doing tests, but agree 100% with getting a second opinion. And glad you got a copy of the results. I'm not saying your cat does or does not have kidney disease, it's kinda wicked in the sense that it takes a long time for it to show on blood results (and it doesn't really show on these ones from my POV). I'm more worried that you cat may have other issues though that are not being addressed.
 

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Hi, I think you should get Caleb tested again we got our cat scanned  once and blood /urine tested three times before CKD was diagnosed.
 

donutte

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Hi, I think you should get Caleb tested again we got our cat scanned  once and blood /urine tested three times before CKD was diagnosed.
True, the "chronic" aspect of Lucky's kidney disease was diagnosed after an x-ray. He had one very shriveled kidney and one huge kidney. This was in addition to blood and urine results that had been taken twice previous to that. The blood taken that day that was tested was what showed the "acute" aspect.

I've lost count of how much testing Sara's had this year. At least five sets of blood/urine tests. And another one coming up a week from Tuesday.
 

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I've got a kidney cat, and I agree with everything Donutte has said....I can't see any evidence of kidney disease.  Even the Urine Specific Gravity Test is within normal ranges...it's leaning towards low, but isn't there yet. 

However, upon further research, it appears that increased RBC, combined with high protein in the urine CAN be suspect for kidney disease.  I refer you to these articles that I found on the subject:

http://www.petmd.com/cat/conditions/cardiovascular/c_ct_polycythemia

http://www.petwave.com/Cats/Health/Polycythemia/Treatment.aspx

http://www.pethealthnetwork.com/cat-health/cat-diseases-conditions-a-z/glomerular-disease-cats

I would say that IF he does have it, it is, indeed, in the very early stages, and that's a very good thing.  It can't be reversed,but can be slowed down with the right care.  BUT, I would still get another opinion, because it could just be that he was dehydrated at the time of the test, or afraid, or both, or something else entirely.  PLUS, there is still that lowish T4 to discuss.   And the ALT.  What did she suggest about that?  My kidney cat gets higher than normal ALT every now and again,and she always gets an antibiotic and it goes back into normal range.  No one knows WHY, it just happens. . Did your Vet put Caleb on an antibiotic or anything?  Was he dehydrated?  

BTW, prescription kidney food is one way to go, but there are other foods out there that are almost as low in phosphorus as the prescription foods, and have better ingredients, IMHO.  If you want to start investigating kidney disease, this is my "go to" place:  http://www.felinecrf.org/canned_food_usa.htm#canned_usa 
 

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I've got a kidney cat, and I agree with everything Donutte has said....I can't see any evidence of kidney disease.  Even the Urine Specific Gravity Test is within normal ranges...it's leaning towards low, but isn't there yet. 

However, upon further research, it appears that increased RBC, combined with high protein in the urine CAN be suspect for kidney disease.  I refer you to these articles that I found on the subject:

http://www.petmd.com/cat/conditions/cardiovascular/c_ct_polycythemia

http://www.petwave.com/Cats/Health/Polycythemia/Treatment.aspx

http://www.pethealthnetwork.com/cat-health/cat-diseases-conditions-a-z/glomerular-disease-cats

I would say that IF he does have it, it is, indeed, in the very early stages, and that's a very good thing.  It can't be reversed,but can be slowed down with the right care.  BUT, I would still get another opinion, because it could just be that he was dehydrated at the time of the test, or afraid, or both, or something else entirely.  PLUS, there is still that lowish T4 to discuss.   And the ALT.  What did she suggest about that?  My kidney cat gets higher than normal ALT every now and again,and she always gets an antibiotic and it goes back into normal range.  No one knows WHY, it just happens. . Did your Vet put Caleb on an antibiotic or anything?  Was he dehydrated?  

BTW, prescription kidney food is one way to go, but there are other foods out there that are almost as low in phosphorus as the prescription foods, and have better ingredients, IMHO.  If you want to start investigating kidney disease, this is my "go to" place:  http://www.felinecrf.org/canned_food_usa.htm#canned_usa 
I always thought the low RBC would be more with advanced kidney disease, although like high ALT, it doesn't seem to happen with all kidney cats. However, it doesn't sound like the vet even mentioned that part.

Goodness, when Lucky was diagnosed with kidney disease, my vet had me come in to learn how to do subqs during his lunch so he could have more than a five-minute discussion with me about it. I would have gone bonkers if everything was only relayed over a short phone call. He explained what I would expect to have happen, what to do if x/y/z happened, etc.

I agree about Tanya's site though (the link given by @mrsgreenjeens). It's like the bible of feline kidney disease. It's a bit intimidating to look at it all. I spent many long nights studying it while Lucky was sick.

 
 

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 I always thought the low RBC would be more with advanced kidney disease, although like high ALT, it doesn't seem to happen with all kidney cats. However, it doesn't sound like the vet even mentioned that part.

Goodness, when Lucky was diagnosed with kidney disease, my vet had me come in to learn how to do subqs during his lunch so he could have more than a five-minute discussion with me about it. I would have gone bonkers if everything was only relayed over a short phone call. He explained what I would expect to have happen, what to do if x/y/z happened, etc.

I agree about Tanya's site though (the link given by @mrsgreenjeens). It's like the bible of feline kidney disease. It's a bit intimidating to look at it all. I spent many long nights studying it while Lucky was sick.

 
Yes,  I think low RBC, and H & H is associated with advanced kidney disease because so many of them get anemia along with it
.    Very few cats get diagnosed in early stage.  Usually their kidneys are already pretty much shot when diagnosed, so sub-qs are needed sooner than later.  Early stage might not need them, or only need them once every few months.  That's why I wondered if he was dehydrated.  (and if so, dehydration could have actually caused those numbers to be high...no wonder it takes a medical degree to read labs
)
 

donutte

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With Lucky, he was stage IV when diagnosed. Creatinine was 8.3, BUN was 128 and SDMA was 75. So he was on daily subqs from the get-go.

With Sara, we got lucky (no pun intended) with her I think. She already was having lots of blood and urine testing because she's being treated for hyper-thyroidism, along with other issues. So, we have caught it kinda early with her. She's not really showing symptoms with it even at this point, thank goodness. She loves to eat. She has only had subqs at the vet, and that was earlier in the year when she was pretty sick.

Omg, isn't it scary that we start to understand these lab results??? And analyzing cat vomit on top of that. I remember going to my vet asking if Lucky had metabolic acidosis after seeing his lab results - I think that absolutely shocked him!

@Rockchick2325, you're gonna become a pro at this soon too. Even if you kitty doesn't have kidney disease, you are certainly gonna know what to look for in the future! We never try to diagnose our babies, but being informed at least helps us formulate better questions for our vets, especially on second opinions where we don't necessarily know the vet.
 
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rockchick2325

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Thanks for sharing your experiences. I'm going to get a second opinion from the place where my mom takes her dog. We had a death in the family, so we've been trying to deal with that. It was very sudden and unexpected. It won't be until after christmas that I will be able to get Caleb in. They are a busy place. I'll try to get another $300 together so they can do another work up. It stinks that I felt good/confident about this vet and now I am feeling less trusting. Especially being that I got my other cats bloodwork from them that they did last year and things aren't all within range and she had told me everything looked good. Granted from what I researched it seemed like those values were probably off from being dehydrated, but it would have been nice to have been told that. Looking at their results, I am also questioning their handling and testing practices. Maybe I am just over reacting though.
 

donutte

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Thanks for sharing your experiences. I'm going to get a second opinion from the place where my mom takes her dog. We had a death in the family, so we've been trying to deal with that. It was very sudden and unexpected. It won't be until after christmas that I will be able to get Caleb in. They are a busy place. I'll try to get another $300 together so they can do another work up. It stinks that I felt good/confident about this vet and now I am feeling less trusting. Especially being that I got my other cats bloodwork from them that they did last year and things aren't all within range and she had told me everything looked good. Granted from what I researched it seemed like those values were probably off from being dehydrated, but it would have been nice to have been told that. Looking at their results, I am also questioning their handling and testing practices. Maybe I am just over reacting though.
Sorry to hear about the death in the family :(

Glad yo're able to get Caleb in for a 2nd opinion. Not sure what values were off on your other kitty. I am not sure if it's common practice to not mention things that may be "routinely" off if it's due to dehydration or the like. My vet pretty much tells me every little thing, unless there is something else huge staring at him like the headlights of a big truck. Like when Lucky's Creatinine was 8.3.
 
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