Creatinine/BUN level confusion

skylerlark

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After unsuccessfully attempting to treat my CKD cat at home with twice daily subQ, I took him to a nearby 24hr stay vet. He has been on IV for five days. His BUN has reduced from a whopping 154 to 114 (still not good but going in the right direction) but his creatinine has risen from 7.9 to 9.3

What could have caused this?
 
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silent meowlook

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I’m sorry. I don’t have an answer for you. What did the vets say about it? Are you sure it’s chronic and not acute kidney injury? There is a weird phenomenon in people with kidney disease having their creatinine increase with fluids but I found no such thing in cats. Is there any concurrent diseases that are being treated such as hyperthyroidism? Was the blood done through the same lab? Do you know if the blood was done in house or sent to a lab? Have they done a urinalysis? Has he been urinating normaly while hospitalized? If you haven’t already, talk to the vet to see what they think is going on. If not done yet, an ultrasound with a specialist would be a good idea to see what is happening.
Actually, I think I remember a cat with hydronephrosis ( a blocking of the United’s causing a back up into the kidneys) may have had this happen, but it’s been so long ago I don’t remember details.

Please keep us updated ion what happens. I hope your kitty does okay.
 

heatherwillard0614

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S silent meowlook a blocking of what? I know it's autocorrect just letting you know so you can edit it.
S skylerlark is he still on an iv? Is he still at the vets office? If you have already picked him up what did the veterinarians say? Can you call and ask why that would happen?
 

FeebysOwner

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a blocking of what? I know it's autocorrect just letting you know so you can edit it.
Blocking of the ureters - the tubes that drain urine from the kidneys to the bladder. If one is blocked, the urine backs up in the respective kidney and causes it to swell.

This is just speculation, and more information from the vet - as noted above - would be the best approach here to help determine the reason for the increased creatinine level.

It is also possible that the amount/days of IV fluids produced an overload which can actually impair renal function - that might be one explanation for the increase. I don't know how prevalent it is for pets, but when IV fluids are given to humans their urine output is monitored to help prevent fluid overload.
 
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silent meowlook

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Hi. Thanks for the correction. I hate my phone sometimes. But, yes, I meant ureters. The tubes that go from the kidneys to the bladder.

Feeby's Owner; Ins and Outs on animal patients should be monitored, but sadly they often are not. I always would. Because in acute renal failure, they can stop producing urine all together and that is so sad.

Hopefully you are able to get some answers from your veterinarian. Please update us,
 
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skylerlark

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Hi. Thanks for the correction. I hate my phone sometimes. But, yes, I meant ureters. The tubes that go from the kidneys to the bladder.

Feeby's Owner; Ins and Outs on animal patients should be monitored, but sadly they often are not. I always would. Because in acute renal failure, they can stop producing urine all together and that is so sad.

Hopefully you are able to get some answers from your veterinarian. Please update us,
Visited this morning, as I do every day, to find both primary doctors either studying or day off, leaving fresh faced young student only. He told me they were going to check his levels again today, he had no idea what an ureter was but on visiting cat saw they had shaved him and affixed a catheter to his penis. Cat didn't look happy. So back again tomorrow for yet another report and I'll let you know what's going on. They'd given him a diuretic to speed the flushing along and will sample that. However, what I find worrying along with everything else, is that he's not defecating. He'd gone 5 days before I insisted they do something about it. Lo and behold a Watsapp pic appeared with him having 5 days of feces all over the place. They'd given him the enema I'd suggested. I've given them both psyllium and Miralax which they seem reluctant to use. Although nurse did say she'd mixed some psyllium in with his wet food that morning. He's always had a problem with constipation and being unable to exercise is making it worse.
Thanks everyone for your concern.
 
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skylerlark

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Blocking of the ureters - the tubes that drain urine from the kidneys to the bladder. If one is blocked, the urine backs up in the respective kidney and causes it to swell.

This is just speculation, and more information from the vet - as noted above - would be the best approach here to help determine the reason for the increased creatinine level.

It is also possible that the amount/days of IV fluids produced an overload which can actually impair renal function - that might be one explanation for the increase. I don't know how prevalent it is for pets, but when IV fluids are given to humans their urine output is monitored to help prevent fluid overload.
Just had another report and BUN 111 but Cre has risen again to 11.4. I have repeated what you've said and asked them to check both his urerters for blockages (btw, he's never had problems with urinating before, so) and the possibility of fluid overload (he's been on IV for ten days now). They've said if all's as well as it could be he can come home in two days, so, silver linings. And thanks.
 
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skylerlark

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Yet another Watsapp message (with yet another bill) telling me they will keep him and do another creatinine test on 28th July to 'see if his creatinine has gone down' and if so he can go home. His creatinine level keeps rising whilst he's in there and I still don't have any explanation as to why. Keeping him there doesn't seem to be improving his creatinine and I can't get a straight answer out of them. He also has proteinuria which they are treating with Telmiratan. What really is the point of keeping him in there? Yes his BUN's down but this ever rising Creatinine (together with his inability/unwillingness to defecate is confounding. They have been feeding him a renal diet and this evening had to 'assist feed', I don't mind as I've sometimes had to do this myself with him. Although not at all a fan of 'renal food'. Perhaps I'll be lucky enough to speak with someone with a brain tomorrow.

Just one more thing, I assume I will still have to administer subQ daily once he's home. A vet at another swanky clinic told me he should be on 140 mils after I'd told her I was giving him 100 mils twice per day. THIS vet is recommending 280 mils! Whaat?
 

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Hi. Wow, I am sorry you are going through this. If he was not urinating enough due to partial or complete urinary obstruction, that would cause the creatinine to rise. I have seen blocked, urinary obstructed, cats come in with a creatinine of 14 that returns to normal after unblocking them, placing a urinary catheter and aggressive fluid therapy with careful monitoring of the amount urinated and the fluids going into the cat. If by chance he wasn’t urinating, they would have placed a urinary catheter and carefully monitored his urination status through a collection set attached to the urinary catheter.

Allot of times hospitalized cats, especially cats with a urinary catheter won’t have a bowel movement in a hospital setting due to many reasons. Inactivity, fear, stress, lack of enough food intake to keep things “ moving”. This form of constipation along with the other things mentioned ie. fear and stress can make them not want to eat.

He has been in the hospital a long time. They should have some answers for you by now. I hope you get to talk to someone soon about his next steps and get some information as to what is going on with him.
 

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Hi. I can't help much, but I can tell you our experience.
Our cat was in for many long days on IV. He got better, they let him home, then he got worse and everything from the beginning.
SubQ did not work for us at all. One time they gave him too much which caused him a seizure.
My opinion is, that you should ask for an entire investigation from urianalysis to xray.
Also we were told that too much of the iv fluid can be bad if given for a longer time, this is the ringers one. We in the end got NaCl fluids which worked way better for our cat.
I hope your cat survives. Ours did not survive unfortunately... they did a huge malpractice which cost my Lukes life...
 
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skylerlark

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Hi. Wow, I am sorry you are going through this. If he was not urinating enough due to partial or complete urinary obstruction, that would cause the creatinine to rise. I have seen blocked, urinary obstructed, cats come in with a creatinine of 14 that returns to normal after unblocking them, placing a urinary catheter and aggressive fluid therapy with careful monitoring of the amount urinated and the fluids going into the cat. If by chance he wasn’t urinating, they would have placed a urinary catheter and carefully monitored his urination status through a collection set attached to the urinary catheter.

Allot of times hospitalized cats, especially cats with a urinary catheter won’t have a bowel movement in a hospital setting due to many reasons. Inactivity, fear, stress, lack of enough food intake to keep things “ moving”. This form of constipation along with the other things mentioned ie. fear and stress can make them not want to eat.

He has been in the hospital a long time. They should have some answers for you by now. I hope you get to talk to someone soon about his next steps and get some information as to what is going on with him.
Turns out Occam's Razor comes into play. The Ultrasound showed he had 70% kidney function lost, I'd already known that from another vet. You'd think the protocol would be blood test then ultrasound, but no, they left the ultrasound until last. There are no blockages in his urinary tract, they simply attached the catheter to monitor his urine.

Yet another 'he's not eating by himself and we must syringe feed today', along with 'he just sits in the corner of his cage'. Yes, well that makes me feel good doesn't it 0o

He has no hypertension nor vomiting or fever, he does however have constipation again. I've told them to make a plan for when he returns home, the meds and perhaps liquid, I really won't know until I'm able to speak with the primary doctor tomorrow.

I've told them it might be his restricted environment causing all this malaise, so hopefully when he's back home he'll improve. The assistant doctor did mention a phosphorous binder containing aluminum, which I'm adverse to. I did try him on Ipatakin a long time ago and it made him ill. So wary of trying another brand. Have no clue what to feed him other than the renal food, which he had been scarfing down along with kibble, until he didn't.
 

rentuna

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Turns out Occam's Razor comes into play. The Ultrasound showed he had 70% kidney function lost, I'd already known that from another vet. You'd think the protocol would be blood test then ultrasound, but no, they left the ultrasound until last. There are no blockages in his urinary tract, they simply attached the catheter to monitor his urine.

Yet another 'he's not eating by himself and we must syringe feed today', along with 'he just sits in the corner of his cage'. Yes, well that makes me feel good doesn't it 0o

He has no hypertension nor vomiting or fever, he does however have constipation again. I've told them to make a plan for when he returns home, the meds and perhaps liquid, I really won't know until I'm able to speak with the primary doctor tomorrow.

I've told them it might be his restricted environment causing all this malaise, so hopefully when he's back home he'll improve. The assistant doctor did mention a phosphorous binder containing aluminum, which I'm adverse to. I did try him on Ipatakin a long time ago and it made him ill. So wary of trying another brand. Have no clue what to feed him other than the renal food, which he had been scarfing down along with kibble, until he didn't.
Our little Luke went through the not eating phase. Turned out he only needed meds for his stomach ache and nausea because of the BUN and crea levels...after the first dose he started eating a lot and even put some weight back on himself.
You should ask them about it...
I would also advise you to find another vet. I do not like how they are treating the entire situation. And I tell you,this same thing went thru with my Luke. Time is important ,very important and in a situation like this , it can cost your cats life like it did my Lukes.
Those vets really are treating the situation poorly unfortunately:( we went through this exact same thing.. it was horrible. 4 vets and all of them, all 4 of them treated the situation poorly. When we got to the 5th vet, who finally took it seriously and really was up to help us, it was already too late for Luke. Those other 4 vets took away precious time in which he could have healed with proper care, proper medication and proper investigation -diagnosis.
 
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skylerlark

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Our little Luke went through the not eating phase. Turned out he only needed meds for his stomach ache and nausea because of the BUN and crea levels...after the first dose he started eating a lot and even put some weight back on himself.
You should ask them about it...
I would also advise you to find another vet. I do not like how they are treating the entire situation. And I tell you,this same thing went thru with my Luke. Time is important ,very important and in a situation like this , it can cost your cats life like it did my Lukes.
Those vets really are treating the situation poorly unfortunately:( we went through this exact same thing.. it was horrible. 4 vets and all of them, all 4 of them treated the situation poorly. When we got to the 5th vet, who finally took it seriously and really was up to help us, it was already too late for Luke. Those other 4 vets took away precious time in which he could have healed with proper care, proper medication and proper investigation -diagnosis.
Another 'had to feed by syringe' post today accompanying a video of one of the nurses holding him in her lap and cuddling him. He looked terrified haha. Anyway, he's made friends.

I've been told he has acidosis and that he sometimes eats 'when they're not watching him'. Yes, I know he does that occasionally with me. I once heard him meowing plaintively near my doors, went out to see what was up, and he was laying on his side lifting his head slightly, but soon moved around when I'd got him on his paws. Tricky little bugger he can be.

I've already been told he has acidosis, but can scarf down food when in the mood/not unwell. I will mention it to the doctor. Food is my only concern right now. He had been eating renal food at the hospital which and I've been giving him Krill Oil and B12 injections weekly. This particular vet had recommended so many supplements at one time they made him sick so I only keep these two. There is a video on raw feeding on YT but I very much doubt he'd eat it.

As for yet another vet, no way. I've been to every vet here and they'll all tell you 'He has CKD' 'Yes, I know that', but only one recommended subQ on which he improved in activity (after long sleep) appetite and mood. So will ask dr about that too. But as far as I'm concerned, they're all a waste of time and money 'number one' in particular.

He's coming home today and as far as I can see this has all been a long waste of time and money. Albeit his BUN came down. Nothing else I can do except give him his meds (hopefully right ones this time) and care for him as best I'm able. Anyway, thanks everyone for your input.
 
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silent meowlook

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Are they doing anything to address the acidosis?
I would strongly recommend that you don’t do a raw diet with this cat. A cat that is not well has a compromised immune system. They are not able to fight off the normal bacteria and things that would be in raw foo. Also, unless you are farming and butchering the meat source, you really don’t know how it has even handled before you got it. I personally would not want to risk it. Salmonella is a horrible sickness and it does happen with raw diets. Maybe not everyone’s experience. If you look up cat food recalls, you will see what I mean.
 
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skylerlark

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Are they doing anything to address the acidosis?
I would strongly recommend that you don’t do a raw diet with this cat. A cat that is not well has a compromised immune system. They are not able to fight off the normal bacteria and things that would be in raw foo. Also, unless you are farming and butchering the meat source, you really don’t know how it has even handled before you got it. I personally would not want to risk it. Salmonella is a horrible sickness and it does happen with raw diets. Maybe not everyone’s experience. If you look up cat food recalls, you will see what I mean.
No it was just a thought, he's far too long in the tooth to change diets that drastically. I did mention 'home made' but vet said that it would be very difficult to get the amounts of ingredients right for each individual cat. They gave me some 'Gastric protectants' for his acidosis.

Anyway, brought him home this afternoon, dreading dinner time, he'd sniffed at it, I tried forcing a syringe but he growled at me and blatantly refused. Never done that before. So I gave up. He'd pooped (painfully) earlier and it's his first day back home so I'm leaving him to sleep off the trauma of it all in a spare room he likes. I don't want to make things worse. The hospital said he was not dehydrated when he left.

They reiterated the 257 mils of subQ perhaps subdivided into two lots per day but I'd been giving him 100 mils twice per day and that didn't help, albeit he was mostly on now jettisoned kibble and is now on Semintra to clean his urea daily. Another vet had suggested 140 mils once per day so I'll try that first. When I had been told to give 200 mils every other day he went berserk, so I'd split it to 100 mils every day. I'm certainly not up for 257 (I think his little chart said for a 4.6 kilo cat).

Anyway, here's really nothing else I can do but leave him be until he's ready and willing to eat, hopefully after tomorrow's subQ. Kids eh?
 
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