Kidney Bypass Issue

[tonyt]

Hi,
My 13.5 year old cat has had a kidney bypass operation about 18 months ago. The problem was that she had a kidney stone that was obstructing the draining of one of her kidneys that went misdiagnosed for almost a year. By the time it was discovered I was told the recommended option was to install a device that can bypass the obstructed tube and then the affected kidney can drain normally. The after care of this procedure is this device needs to be flushed out every three months. This involves sedating the cat and she spends the day in a specialist hospital. Fortunately I have insurance and it covers most of the expenses. Her kidney function has gone back to normal and continues to be.
There has been a recurring problem of her getting a bacterial infection in this device. The treatment was a long course of antibiotics over a 2 month period. Which is a bit traumatizing for the cat to have to shove a pill down her throat twice a day for several months. Each time when when getting a urine analysis run a month after finishing it shows the infection has been cleared. However, each time she goes back to her her device flushed out again, I'm told the infection is then still present. This has happened ever since she had the device installed and not once has she had an all clear after having the device flushed. The vet is now recommending a more serious course of action of a combination of antibiotics and a weekly flushing of the device for a month. The cost for each flushing procedure is $2,000 Australian. I'm very hesitant to agree to this procedure, expenses aside, what kind of quality of life is this for the cat? It takes her a few days after each procedure to get back to being herself. So having to do this every week for a month I think would be a bit much. Thinking back I feel I should have recommended they remove the affected kidney and none of the above would have occurred. Cats can live a normal life on one kidney.

All that said, I am wondering if anyone has had a similar experience to a cat having a kidney bypass operation.

 

[Furballsmom]

Hello, I don't have any experience with this but wanted to express that I'm sending you both my thoughts and prayers

 

[fionasmom]

I have never faced this, and there is nothing that I can find on TCS that addresses this with any specific information.

You sound very well informed about the procedure and treatment of your cat. I found three articles which address problems with the procedure and it seems as if recurrent infections are one of them. If you look them over, I don't know if anything will resonate about the condition or procedure as it relates to your cat.

Urine cultures in cats with subcutaneous ureteral bypass systems - EveryCat Health Foundation
Risk factors and clinical relevance of positive urine cultures in cats with subcutaneous ureteral bypass - BMC Veterinary Research
Infection and extrusion of a subcutaneous access port in a cat: a long-term postoperative complication of a subcutaneous ureteral bypass device

This pamphlet is designed for veterinarians and provided by one of the companies that provides a flush kit.
https://advetis-medical.com/wp-cont...avec-tetra-EDTA-utilisation-et-protocoles.pdf

I don't know if any of this is relevant for your cat. You said that all of this was done by a specialist and am not sure if a second opinion/consultation would help. Do you feel that the device is not properly placed, not flushed properly, something continues to cause these infections?

 

[mrsgreenjeens]

I did a search query in this site but didn't really find much. Then I searched google and did find that most cats do NOT need to be sedated for the flushing of the SUB, since it is very similar to them receiving an injection, and the tubing seems to be just under the skin. Not sure why your little one has to be there for the entire day, unless they are squeezing her in as they can, kind of like when I have to drop mine off for an ultra sound. I also read that the most common infection with these, which ARE pretty common, is caused by E-coli. I am guessing they do a urine culture each time to make sure they give you the correct antibiotic to combat it? If not, just throwing any antibiotic at a urine infection won't work. I know, because one of mine went through that until we had a culture run and determined there were only two antibiotics that would work. Once we got him on one of those, voila!

I'm wondering if your Vet could try consulting with a Veterinary School to see if they have any thoughts on why this is happening. Usually the schools are up on all the latest and greatest and might have some thoughts on it.

 

[fionasmom]

The articles I found seemed to be suggesting the same points...flushing is not a huge procedure if done correctly and that the antibiotic has to be specific to the bacteria. If you think that everything is not in place, another consultation might be the best thing to do.

 

[silent meowlook]

Hi. I have not experienced the procedure you are describing. I would assume that she had a blocked ureter and that they placed a SUB.

I am curious as to why they would do that if only one kidney was affected.

I am not a vet and am only spit balling here.

When they test the urine a month after completing the antibiotics, how are they obtaining that sample?

There is some information on using edta to flush the device as it can get a film buildup of bacteria that is hard to clear. But I am sure all those options have been explored already.

This is a complicated surgery and I am sure the specialist you used is quite advanced in their knowledge.

What I would do is if you are able to talk directly to the specialist, explain your concerns to them and discuss quality of life etc. with them, as sometimes I think they can forget there is a living creature with feelings attached to the advanced procedure they did. Just be honest, friendly and open about how you feel and I am sure they can answer any questions and perhaps alter their plan to be more accommodating to your cat.

Do you know what the bacteria cultured is? Are they doing cultures at recheck?
Does your cat show signs of a urinary tract infection?

 

[tonyt]

I have never faced this, and there is nothing that I can find on TCS that addresses this with any specific information.

You sound very well informed about the procedure and treatment of your cat. I found three articles which address problems with the procedure and it seems as if recurrent infections are one of them. If you look them over, I don't know if anything will resonate about the condition or procedure as it relates to your cat.

Urine cultures in cats with subcutaneous ureteral bypass systems - EveryCat Health Foundation
Risk factors and clinical relevance of positive urine cultures in cats with subcutaneous ureteral bypass - BMC Veterinary Research
Infection and extrusion of a subcutaneous access port in a cat: a long-term postoperative complication of a subcutaneous ureteral bypass device

This pamphlet is designed for veterinarians and provided by one of the companies that provides a flush kit.
https://advetis-medical.com/wp-content/uploads/2018/08/Rinçage-du-SUB-avec-tetra-EDTA-utilisation-et-protocoles.pdf

I don't know if any of this is relevant for your cat. You said that all of this was done by a specialist and am not sure if a second opinion/consultation would help. Do you feel that the device is not properly placed, not flushed properly, something continues to cause these infections?

Hi,
Thank you for all the info. This is similar to what the vet specialist has been telling me. As for a second opinion, i have done that. I initially went to a teaching hospital for the initial procedures and follow ups. However, the nature of these places is the specialists don't stay very long as it's usually a short internships to progress in their career. So most times I went I had a new doctor each time with different opinions. So I found another facility that my general vet referred me to. While I now have the same doctor every time, the results haven't changed.
This was a quote from the vet specialist about the current course of action.
"Infections can be very difficult to treat in cats with SUB's and may be recurrent despite multiple types of treatments, unfortunately. We don't have good data from large numbers of cats to be able to quote % success rates. After long courses of antibiotics (which she has previously been treated with), antibiotics + frequent flushes (this weekly protocol) is the next recommended treatment. If this fails to clear infections there are protocols described for even more frequent flushing, or ultimately some refractory infections can require removal/replacement of the SUB. That is obviously a major intervention and I would find that difficult to recommend for her at this time."

So at this stage I think I will proceed with the weekly flushes and take it from there.

Thanks,
Tony

 

[Furballsmom]

Please let us know how things go.