Bitsy has kidney stones and possibly CKD… how to proceed

[Biomehanika]

I cannot catch a break with my kitties over the past few months…

Bitsy had a routine wellness urinalysis a few months ago and was shown to have a UTI despite no symptoms. After it was cleared up she was still presenting with microscopic blood in her urine after both needle retest and an at home collection, so we’ve been investigating that further. She was actually supposed to have a dental yesterday but I called it off last week after learning she still had blood in her urine from the at home collection test. I wanted to figure out what was going on there before putting her under anaesthesia since that’s always risky, especially in senior cats, but even more so if some unknown underlying condition is going on, so I took her in for a bladder X-ray yesterday instead. I’ve just heard back from my vet with the results and it is showing stones in her kidneys. Vet is pretty positive that’s the source of the blood. Almost guaranteed to be calcium oxalate, so not dissolvable with food. Her kidneys are also small/irregular in size, so probably CKD too, despite blood/urinalysis not showing that, but from what I’ve read those tests will still show as normal until the kidneys drop below 40%-ish functionality, so there’s that.

When Bentley was alive (my sweet old boy who had to be put to rest in January) he was on Urinary S/O food for a blockage he had years ago. Bitsy was on it too because she liked it and she’s a picky girl and it was just convenient… I found a normal food she liked once Bentley passed and switched her to that because I thought it would be healthier for her and now I’m kicking myself thinking that has caused the stone formation over the past few months. However, maybe not, because the blood was already present in her urine just two-ish weeks after the food switch, but I can’t help but think this is at least partially my doing.

Vet has said she can contact a large speciality clinic a few hours away to see if she’d be a candidate for shockwave therapy to try to break up the stones. Apparently it isn’t nearly as effective with cats as it is dogs, though, and then that would also run the risk of dislodging the stones and possibly blocking her ureters with the pieces or full stones trying to pass, which could lead to a big emergency, surgery, and possibly death. I don’t want to do more harm than good here. She has not said anything about a food switch yet but I will ask about that to see if it could at least stop the growth of additional stones or help her overall kidney function.

I don’t know what to do for her. She will be 13 this summer and is for the most part herself, but “herself” has also been different in general since her best friend Bentley passed away. She’s also been a little more grumpy than usual lately with Moose so I’m worried maybe that means she’s in pain and not just generally annoyed with him (they’ve never been the best of friends, I’ve only had him a few months), but he IS being more annoying towards her, so maybe it’s just that.

Has anyone done shockwave therapy on the kidneys or bladder before for their cat? How did it go? How would you proceed if you were in this situation? Any advice/recommendations regarding CKD kitties/kidney stones in general or the general prognosis? I really don’t know what to do and have never dealt with anything like this before so any advice is appreciated, at the end of the day I want the best QOL possible for my girl, regardless of how long it’s for.

 

[FeebysOwner]

Hi. First off, I would have a chemistry panel done to see what Bitsy's kidney numbers are. Abnormalities in the kidneys may or may not have anything to do with CKD. Her urine specific gravity (USG) number from her urinalysis is often a clue too.

Although my cat (19+ yo) does have CKD now, back when she was 5yo she had to have surgery to remove oxalate stones from her bladder. However, later on due to unrelated reasons, an ultrasound showed she had malformed kidneys and damaged ureters, probably from passing the stones to her bladder where they remained. Luckily for her, she has never had another stone formation incident. She was on urinary care food for many years in the hopes of preventing more stones from forming, but has been off that food for years now.

While I only know of what you are talking about as it relates to a human (my husband) it would fall under the category of a lithotripsy procedure, which usually requires anesthesia and generally what broken up stones that cannot be collected during the procedure involves stents being placed in the ureters and/or the urethra for a period of time afterward, which requires another procedure to remove them.

Have you read up on all this? I have included an article in case you haven't. It might be helpful for when you have a consult with a urology vet specialist, who will give you all of your possible options.
Cystoscopy and Lithotripsy in Dogs and Cats (vetspecialists.com)

I did a search on this site and only came up with one thread, but admittedly I searched using the word lithotripsy.
Anyone with personal experience in dealing with kidney stones in your kitty? | TheCatSite

 

[Biomehanika]

Hi. First off, I would have a chemistry panel done to see what Bitsy's kidney numbers are. Abnormalities in the kidneys may or may not have anything to do with CKD. Her urine specific gravity (USG) number from her urinalysis is often a clue too.

Although my cat (19+ yo) does have CKD now, back when she was 5yo she had to have surgery to remove oxalate stones from her bladder. However, later on due to unrelated reasons, an ultrasound showed she had malformed kidneys and damaged ureters, probably from passing the stones to her bladder where they remained. Luckily for her, she has never had another stone formation incident. She was on urinary care food for many years in the hopes of preventing more stones from forming, but has been off that food for years now.

While I only know of what you are talking about as it relates to a human (my husband) it would fall under the category of a lithotripsy procedure, which usually requires anesthesia and generally what broken up stones that cannot be collected during the procedure involves stents being placed in the ureters and/or the urethra for a period of time afterward, which requires another procedure to remove them.

Have you read up on all this? I have included an article in case you haven't. It might be helpful for when you have a consult with a urology vet specialist, who will give you all of your possible options.
Cystoscopy and Lithotripsy in Dogs and Cats (vetspecialists.com)

I did a search on this site and only came up with one thread, but admittedly I searched using the word lithotripsy.
Anyone with personal experience in dealing with kidney stones in your kitty? | TheCatSite

Hey thank you, she had her last senior bloodwork done just back in mid February at the same time as the initial urinalysis I mentioned, just forgot to mention it specifically sorry, I believe that’s the chemistry panel you’re referring to but if it’s not and that’s something additional I should have done let me know. I’ll post the results of her bloodwork and initial urinalysis below. The results were mostly in normal ranges I think, but some in the high normal range, minus the UTI related issues that are now gone. The notes that the lab technician left definitely originally pointed to the possibility of what we now know are her issues.

She did have a UPCR done on her last urine sample (not the one posted) and it was normal ratio.

I found this website that WhiteShadow posted in another kidney stone related thread Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Kidney Stones and apparently lithotripsy doesn’t generally work in cats because the stones are usually too small to break into pieces small enough to pass through their tiny ureters which are only .3 mm in diameter. From what I understand this is only offered as a “non invasive” treatment so no stents/actual surgery is involved. The more I read the more I’m thinking it’s too risky/won’t work/she won’t be a candidate. The vet did note that the stones in her kidneys are “tiny” as well, I will mention this all to her and see what she has to say though, and if she can confirm this with the team who does the litho’s at the specialty hospital.

 

[FeebysOwner]

There is nothing earth-shattering in those results. Technically, the creatinine level could indicate very, very early stage 2 CKD. Her USG is not bad but the footnotes on the labs suggest it is a bit low - which is one indicator of possible CKD. The T-4, which represents thyroid function, is something to keep an eye on too - just with follow up testing.
You can continue to use the entire web site that white shadow offered to you to learn more about all facets of CKD, when you feel the need to go there.

For now, having Bitsy eat urinary care foods that help to prevent new oxalate crystals might be the way to go. It would be preferable if they were canned food vs. dry due to the moisture in the former. These foods are intended to help balance urine PH, which Bitsy's is a bit high, which can be a contributor to oxalate stone formation.

 

[Biomehanika]

For now, having Bitsy eat urinary care foods that help to prevent new oxalate crystals might be the way to go. It would be preferable if they were canned food vs. dry due to the moisture in the former. These foods are intended to help balance urine PH, which Bitsy's is a bit high, which can be a contributor to oxalate stone formation.

And this is where I totally hate myself. She was eating urinary food unnecessarily for YEARS, which may have kept her PH high. It was the Royal Canin urinary S/O so technically it’s for oxalate stones as well as struvite I guess, but yeah, I don’t know if I helped or harmed her there. Ugh. She had only been off of it a couple weeks when that bloodwork and urinalysis was done.

I’ve just sent a very long winded and somewhat neurotic (lol) response email to my vet asking about how she wants to proceed regarding diet and stuff and my concerns regarding the potential complications of the shock wave lithotripsy (which she doesn’t seem to believe will be very effective anyways). I’m going to see what she has to say about food, and then I guess our next step for now is just to monitor her labs and blood pressure regularly to see how things progress, and see if the stones are static/moving/growing with semi-regular X-rays, and to see if more develop. I want to do whatever I can for her but I also don’t want to put her through too much, especially if it runs risks of complications.

Speaking of complications… how risky is a dental/going under anaesthesia for her now? She needs a cleaning and some extractions but I put it off to figure out what was going on here, and now I don’t know how to proceed about that either.

 

[FeebysOwner]

And this is where I totally hate myself. She was eating urinary food unnecessarily for YEARS, which may have kept her PH high. It was the Royal Canin urinary S/O so technically it’s for oxalate stones as well as struvite I guess, but yeah, I don’t know if I helped or harmed her there.

That food as best I know is what would be prescribed - preferably wet - and wouldn't have exacerbated her PH level. So, I don't see how it would have posed a problem, and maybe she would have been worse off if she hadn't eaten it all this time.

Speaking of complications… how risky is a dental/going under anaesthesia for her now? She needs a cleaning and some extractions but I put it off to figure out what was going on here, and now I don’t know how to proceed about that either.

That is above my knowledge level, and best discussed with your vet. I am not sure her stones would have much to do with dental related treatments, but your vet would know better than me.

 

[Biomehanika]

That food as best I know is what would be prescribed - preferably wet - and wouldn't have exacerbated her PH level. So, I don't see how it would have posed a problem, and maybe she would have been worse off if she hadn't eaten it all this time.

That is above my knowledge level, and best discussed with your vet. I am not sure her stones would have much to do with dental related treatments, but your vet would know better than me.

Thanks Feeby, I will update when I hear back from my vet and ask her about the dental/any new risks with that too. When she was on the S/O it was just the dry, and that’s the majority of what she ate, with a non-urinary wet food just once a day. Since joining this site I have seriously changed my feeding habits so both cats have been getting wet food 3x a day with added water and only a tiny bit of dry at night for a few months now, so I will definitely get her on the urinary wet food if that’s the route the vet thinks we should go.

 

[fionasmom]

Burst wave lithotripsy for treatment of ureteroliths in cats
Lithotripsy in Dogs and Cats

I have no experience with burst wave lithotripsy in cats, but what I found interesting is that these two articles both mentioned conditions which would be immediate exclusions.

 

[Biomehanika]

Thanks fionasmom

At this point neither me or my vet really think she’d be a candidate, the stones are very small plus I don’t think the risks involved should the fragments possibly block her ureters would make it be worth attempting right now. At this point shaking them up and breaking them may do more harm than good. She doesn’t currently have any blockage/the stones are not currently at the entrance to her ureters. If this changes though it will be something we explore.

I just spoke to my vet again today and for now we are going to start supplementing her diet with some RX early stages kidney wet food, and will do routine labwork/blood pressure/X-ray every 6 months going forward to monitor how things are progressing, and reevaluate the risk vs reward with the shock wave litho should things change with the stones/if they start growing or moving closer to her ureters. As of right now she seems to be totally herself, we caught this all through routine testing, she wasn’t showing any signs of anything being wrong, so I’m hoping she remains healthy and happy for years to come and that the stupid stones just stay in her kidneys, don’t grow, and don’t start to bother her too much, maybe that’s a lot to ask/unrealistic but I am not mentally prepared to lose another cat right now and the vet seems to think that she very well could remain asymptomatic for at least some time. But at least I know they are there and that she likely has some early stage CKD, and what is likely going on if she suddenly starts acting weird.

 

[fionasmom]

the stones are very small plus I don’t think the risks involved should the fragments possibly block her ureters would make it be worth attempting right now.

I almost sounds like that human procedure where they scrape plaque out of the neck arteries, but the risk is that if a small piece floats off you might have a stroke regardless.