Update to my previous post: "Suspected IBD in 15 year old Hyperthyroid cat - I have some questions"

[Mac and Cats]

Just wanted to give an update to my last post, in case this helps anyone in the future. I spoke with our regular vet and she said that even though kidney levels are down, he still is considered to have CKD since he previously had levels at "beginning stages". It's a lot of overwhelming stuff, especially with what we have been through with losing 3 other cats since 2020. Anyway, we decided to proceed with the prednisolone for a month since his kidney values were within normal range at his last lab. He will go in at the beginning of March for a check up/blood tests to make sure he is doing ok. Assuming his values haven't changed drastically, I think the plan after that is to taper off the steroid to the lowest dose possible.

Because of the concern with CKD cats and steroids, she told me to keep an eye out for big pees, etc. This is concerning to me because he has been on Prozac for about a year and a half due to spraying issues (trying Prozac was my very, very last resort). I have been nervous to take him off of it before because I was losing my mind having spraying everywhere (I grew up in a hoarder house with a ton of cat pee everywhere and I am not inclined to re-live any part of that as an adult), but our doctor said it would be a good idea to try to ween him off and I agreed. Mostly, the reason I want to ween him off is because I can't get an accurate "reading" on how often or how much he is actually peeing when he is on the Prozac. For whatever reason, Prozac makes our cats (we have had 3 on it before and currently 2 are on it) pee less often, but obviously the output is more since they are peeing less often. I have asked the doctor about this before and she sort of just shrugged and said "We don't really know how it works." This has happened with all 3 of our cats that we had on Prozac. So, we are weening both of our current cats off of it slowly. So far, we have not had any spraying issues.

I'm sure it is due to the steroids, but he has been eating the Purina EN wet food daily and with no complaints. This is shocking because he has NEVER wanted to eat the same food day in and day out since we got him two years ago. I've spent hundreds (maybe even thousands) of dollars trying to find foods he would eat regularly and just when I thought we had gotten somewhere, that's when he stopped wanting to eat any of the foods in his rotation. He still has zero interest in any of the foods he was previously eating. He has gained some weight, which is great. I have been giving him a B-12 supplement with his daily meds and also a probiotic. We have had zero vomiting and zero diarrhea. I have attempted giving him omegas in his food and also psyllium husk. He will eat the psyllium husk mixed in, but he does not like the omega oils. So, I've just been skipping those. The psyllium husk has been added because I'm worried about the "low fiber" in the Purina EN food. I've also been mixing in a very small amount of phosphorus binder as our vet was concerned about the phosphorus in the EN food (although, both flavors are lower than some others - 1.06% and 1.01% on a DMB. I got these numbers directly from Purina). I am a little concerned about trying them because our vet had never heard of phosphorous binders and therefore doesn't really know much about it, but she said that "it wouldn't be a bad idea" to try it. Her lack of knowledge, yet her suggestion to try it anyway, is what concerns me. His phosphorus levels were within the normal range at his last lab test. Since we will be testing his kidney values at the beginning of March, I guess I feel ok about trying the phosphorous binder out for now. I can always stop or reduce the dosing. But I'm also a little paranoid about causing constipation (also a reason for the psyllium husk). If anyone has any thoughts on this, I am open to hearing!

I guess my plan is to keep him on the Purina EN as long as he will continue to eat it/he seems to be doing ok. I don't know what was causing the IBD (although it could still be small cell lymphoma) if it was a food thing. I'm wondering if it was the gums that were in the foods because a lot of the foods he was eating before this were either in pouches (tiny tasters, various BFFs, Tiki Cat) or had a lot of gravy (fancy feast grilled and gravy lovers) and my understanding is those can have a lot of thickeners/gums in them. Although, I don't know much about that stuff.

Anyway, just wanted to give an update that he seems to be doing well for now, although a bit sleepy on the steroids. I'm happy to hear any thoughts/opinions/advice if you have them.

 

[FeebysOwner]

I can only offer a few tidbits. First, and most importantly to me, is the commiseration I have for you in that when there are multiple conditions involved - all at varying degrees - each cat/case starts to become so unique that is hard to parallel/compare with another. So, it makes is much harder to find helpful information because of all the variables involved - each affecting the other.

Aside from that, phosphorus binders probably should not be added until they are needed. But the typical lab ranges far exceed what is considered 'good' for a CKD cat. That kind of more reliable data comes from Tanya's web site - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). Secondly, depending on his CKD numbers, if they are still in fact 'in range' (also data available at this same web site), odds are his phosphorus level doesn't warrant treatment.

I can only say if you are getting favorable results with the Purina EN that is a good thing. But I will tell you that the wet version does contain guar gum (considered one of the least offensive) as well as carrageenan (thought to be one of the worst). Some of the products you mentioned don't have gums at all, or if they do it is guar gum. I can't offer anything about the Prozac.

 

[Mac and Cats]

I can only offer a few tidbits. First, and most importantly to me, is the commiseration I have for you in that when there are multiple conditions involved - all at varying degrees - each cat/case starts to become so unique that is hard to parallel/compare with another. So, it makes is much harder to find helpful information because of all the variables involved - each affecting the other.

Aside from that, phosphorus binders probably should not be added until they are needed. But the typical lab ranges far exceed what is considered 'good' for a CKD cat. That kind of more reliable data comes from Tanya's web site - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). Secondly, depending on his CKD numbers, if they are still in fact 'in range' (also data available at this same web site), odds are his phosphorus level doesn't warrant treatment.

I can only say if you are getting favorable results with the Purina EN that is a good thing. But I will tell you that the wet version does contain guar gum (considered one of the least offensive) as well as carrageenan (thought to be one of the worst). Some of the products you mentioned don't have gums at all, or if they do it is guar gum. I can't offer anything about the Prozac.

Thank you for your comment and the insight! I am familiar with that website and have seen you or someone say that about the binders and totally see your reasoning. Maybe I should stop giving it to him and just wait to see what his levels are at when we go back to the vet. His levels at the urgent care (just two weeks ago) were BUN 19, PHOS 3.4, CRE 1.2, which are all down from back in November. I don't think the phosphorus is high enough to warrant the binders. I am not asking for medical advice, but do you think those levels are low enough to not warrant the binders? Our other kitty who eats some dry food and some wet is at BUN 39, PHOS 5.3, CRE 1.6. I did not realize her numbers were that high until recently. So, I am working on completely switching her over to kidney dry (she's a crunchy addict) and am working to get her to eat more wet food by giving her less dry food. I have also been mixing the binder into her wet food for a few days, but now I'm second guessing that? It's a little confusing to me and I wish that our current vet was more familiar with the binders.

The EN versions I am giving him are these, which do not have carrageenan. I did try the version that has carrageenan and he didn't like it very much anyway. I just looked over the ingredients on the two I am giving him and I don't see guar gum either? Of course, I could very well be blind and have low reading comprehension! I'm glad that most of the foods I mentioned don't have gums. That makes me feel a little better that maybe I didn't "cause" his IBD (if that's even what it is) and that I am still feeding those foods to our other cats.

Anyway, thanks so much for your reply! I will look at this website again, specifically about the binders. I really appreciate your response!

 

[FeebysOwner]

A lot of how to gauge the levels depends on the lab and their given ranges, so look at the ranges too. The only reason the phosphorus range is 'misleading' is it because it also includes kittens, which should have a higher level.

BUN can vary by many things like stress and even slight dehydration, so those numbers mean more when the other kidney related ones are high as well. But the presiding number is creatinine and neither of your cats have high values, if I use my lab's ranges, which are 0.6 - 2.4. The closest to borderline (very borderline) would be the 1.6 cat/kitten. BUT, if this is an actual kitten, then the numbers are expected to be higher. If an adult cat, she is on the very, very border of Stage 2 CKD with 1.6 and her phosphorus level should be no higher than 5.0, but there can be wiggle room on that as well, and a food change might be all that is needed to drop the level a bit.

On that note, there is no guideline in terms of phosphorus for a cat with a 1.2 creatinine, so strictly speaking from a non-vet, personal, perspective I would not be giving my cat a phosphorus binder.

I did not see those particular foods you provided a link to, but just looked at them; they do not seem to contain any gums. Good going there!!

 

[Mac and Cats]

A lot of how to gauge the levels depends on the lab and their given ranges, so look at the ranges too. The only reason the phosphorus range is 'misleading' is it because it also includes kittens, which should have a higher level.

BUN can vary by many things like stress and even slight dehydration, so those numbers mean more when the other kidney related ones are high as well. But the presiding number is creatinine and neither of your cats have high values, if I use my lab's ranges, which are 0.6 - 2.4. The closest to borderline (very borderline) would be the 1.6 cat/kitten. BUT, if this is an actual kitten, then the numbers are expected to be higher. If an adult cat, she is on the very, very border of Stage 2 CKD with 1.6 and her phosphorus level should be no higher than 5.0, but there can be wiggle room on that as well, and a food change might be all that is needed to drop the level a bit.

On that note, there is no guideline in terms of phosphorus for a cat with a 1.2 creatinine, so strictly speaking from a non-vet, personal, perspective I would not be giving my cat a phosphorus binder.

I did not see those particular foods you provided a link to, but just looked at them; they do not seem to contain any gums. Good going there!!

Thank you so, so, so much for explaining that to me! I cannot tell you how much I appreciate that. I have been working with Benji for the entire two years we have had him to get him to eat lower phos foods, but I wasn't concerned about Molly (the one with the higher levels) because our vet BARELY mentioned it to me concerning her. It wasn't until I recently looked at her labs and compared them to Benji's that I was alarmed. I'm going to skip the binders from now on and just work on getting Molly to eat less dry (and only renal if she does) and more wet food. She's the least picky out of any of the cats I've had and I have been known to call her my little garbage disposal because she would eat whatever someone else wasn't willing to. She does like wet food if there is no dry available, so I'm hoping it won't be a struggle to switch her over to mostly wet. I really appreciate you explaining that to me, thank you again!

 

[Mac and Cats]

Just wanted to give an update here, but didn't want to make a whole new post. Benji has been on prednisolone for a month. We were giving him 5mg per day. We went in for a check up on Friday where they tested his renal values. They were up a bit from when we tested last time, but not a crazy amount. He has gained a pound and is weighing in at 10.3 pounds! I'm thrilled with this. He has been eating the Purina EN. When he first started the pred he was eating 3-4 cans a day (I think he really only needs 2 for his weight). I was just letting him eat however much he wanted because I wanted him to gain as much weight as possible before we started to ween him down off the pred. He has since slowed down on the amount, so he's eating around 2-ish cans a day. Although, it may have lessened since we have reduced the pred.

The vet had us reduce his dose of pred to 2.5mg once per day and if all has gone well for two weeks, we will cut it in half again. He always has a couple days after the vet where he is lethargic and not as interested in food. This time was no different. He is still eating the EN, but I think his interest is starting to fade in it. Those of you who have struggled with picky or not eating cats can probably understand my anxiety over this. I've seen him eat some bites of the kitten's (he's almost 1 year) Fancy Feast, which I have just let him eat. The doctor told me to keep him on the EN, but in the past 2 years since I have had him (he just turned 15 this week!) he has never been consistent with what he wants to eat and it's been a struggle/fight the entire 2 years. So, I'm inclined to just let him eat whatever he wants as long as he is eating it. Do you think that is ok to do? Obviously, I want to keep him on the EN as that is what the doctor suggested and that is what he is wanting to eat. I will give him the EN as long as he eats it, but I'm a little worried he is going to stop wanting to eat it the lower we go in prednisolone. Does anyone have any advice/input/thoughts on this? I suppose I will just have to take it day by day and revisit the question with his doctor the further we get in this process.

I'm aware that his possible IBD is likely from something in whatever he's been eating (assuming it isn't small cell lymphoma), but I have no faith that I would ever be able to narrow down what it is that is actually causing inflammation. I cannot tell you how many different foods we have tried over the past 2 years just to get him to eat ANYTHING, but it's been a LOT. The better quality/expensive food has never been on his short list, unfortunately. That's the reason I'm inclined to just let him eat whatever he is willing to eat. Is this the wrong approach?

Anyway, he seems to be doing well on the track that we are currently on for now. He's eating, drinking, using the litter box all normally. He's actually even out and about in the main part of the house most days, which hasn't been the case since the arrival of our dog last May. I think he is finally getting use to the idea of this dog thing now that the dog is less interested in him.

I am still trying to ween him off of prozac or at least the least amount possible that he can be on and have it still "work." As a reminder, he was originally put on this because he was spraying and bullying our 18 year old late stage CKD cat in the litter box and none of the other recommended solutions were working. It was a last resort. I had gotten him down to every 3 days in the weening process when I caught him bullying our lady girl while she was in the litter box. So, I took a step back. I reduced the actual dose by half and started the process over. I'm now doing every other day and may just leave it at that, which our vet said would be ok to do. The reason I am trying to ween him off is because I cannot get an accurate gauge on his urine output because the Prozac causes him to urinate less throughout the day, which in turn, causes his urine output at one time seem larger. So, I wanted to ween him off completely if possible due to the pred so that I could keep a better eye on his urine situation.

Anyway, I just wanted to update his progress in case anyone is interested and/or it will help anyone in the future when searching for any kind of answers or anecdotal information. The bottom line is, he seems to be doing well for now!

 

[fionasmom]

Thank you so much for letting us know and I hope that he continues to make good progress. Very often members ask if updates are available and this will certainly help. Keep us posted!

 

[silent meowlook]

Hi. Something to remember is that hyperthyroidism will mask kidney disease. Also a cat has to have enough muscle mass to elevate the creatinine.
for GI issues vitamin B 12 injections are helpful.

 

[Mac and Cats]

Hi. Something to remember is that hyperthyroidism will mask kidney disease. Also a cat has to have enough muscle mass to elevate the creatinine.
for GI issues vitamin B 12 injections are helpful.

Thank you! I've had two different vets tell me that it won't mask the kidney disease if the hyperthyroid is treated properly, which his is. We get him tested several times a year and the last time was one month ago and he was on the proper dose. We give him a B12 supplement daily and he had a shot of it one month ago. He has already had his kidneys tested twice this year. I can't vouch for his muscle mass except for my experience with our last kitty who clearly had lost muscle mass and Benji's seems normal for now. We will see where he is at in two weeks and go from there. I'm always the first to suggest testing his T4 and Kidneys again as I don't mind if it was only a month ago that we tested. I actually suggested we test his T4 a few months ago when it had been tested a month prior and the vet talked me out of it. I was back a week later and they tested it. Turns out we needed to up his meds. Thanks for your suggestions and I will for sure keep an eye on it!

Sorry, I wanted to edit this to say he technically has CKD. Yet his kidney levels have been normal and not within the CKD range for the past year. Which is the only reason why our vet agreed to try the steroids.

 

[Mac and Cats]

Hi to everyone reading this. I didn't want to make a new post to ask my question, so I'm posting it on my old post in hopes someone will see/respond. First, an update on my sweet orange boy. He's been doing great! He was up to 12.25 pounds at his last vet visit in August! This is up from 9.5-ish +/- from when he was diagnosed with potential IBD (or possible SCL) back in March. He can still be a little picky about his food, but for the most part, I've figured out which foods he is willing to eat on a regular basis. He still doesn't really like to have the same meal twice in a row. His greasy fur is looking worlds better, ie. it's filled in more and only his belly/chest is a little greasy. We've also had a recent development in that he is now willing to eat some RC renal wet food, which is great!

Now for the question portion. He has been on 2.5mg of Prednisolone since the beginning of March. I did try to reduce it to 1.25mg about a month (or maybe 6 weeks?) after he had started it at the advice of our vet, but he got a little less willing to eat when I did that for a couple days. This made me panic so I bumped it back up to the 2.5 and left it there. I didn't give it very long because I was nervous about reducing it and he was still fairly too thin at that point. His main symptom for his possible IBD/SCL is not eating. He really only had a one-time bowel movement that was half-diarrhea in the beginning and only vomited once or twice. He has had none of those issues since being on the pred. I know the lack of diarrhea and vomiting is not typical compared to other's IBD/SCL cats. Anyway, here are my questions:

• Is 2.5mg per day considered a low, medium or high dose?
• I am attempting to reduce his pred to 1.25mg per day currently to see how he does at this level now that he has gained some weight and evened out, which makes me feel less panicked about trying it. I am fully aware he will need to be on Pred for the rest of his life, so I am not trying to remove it completely. Our vet said, we should try to have him on the lowest possible dose that still works for him. So with that in mind, if it was not working at a lower dose, how soon would you think I would start to see that it wasn't working? Within a couple days or would it take longer than that? I'm only on day two of the reduced pred and so far so good, which is different than last time. He's actually been a little more active. If he does start to snub food and/or eat less, I will bump it back up to 2.5mg and leave it there.

And now for some cat tax:

 

[silent meowlook]

My cat is 7 lbs and gets Prednisolone 5 mg. every other day. She was on 10 mg a day and after 3 months reduced to 5 mg every day and then down to 5 mg every other day. My cat is also on Chlorambucil 2 mg every other day.

Prednisolone 2.5 mg every day is not a high dose. I do wonder if it might benefit your cat to try an every other day dosing. You would have to discuss that with your vet.

Prednisolone is well tolerated by cats. It is much better than the alternative of having a set back in the disease process.

 

[Mac and Cats]

My cat is 7 lbs and gets Prednisolone 5 mg. every other day. She was on 10 mg a day and after 3 months reduced to 5 mg every day and then down to 5 mg every other day. My cat is also on Chlorambucil 2 mg every other day.

Prednisolone 2.5 mg every day is not a high dose. I do wonder if it might benefit your cat to try an every other day dosing. You would have to discuss that with your vet.

Prednisolone is well tolerated by cats. It is much better than the alternative of having a set back in the disease process.

Thank you! My worry with pred is that he has CKD as well as Hyperthryoid, which is why I was trying to decrease it by as much as I could. I wonder what the difference is between every other day and once a day would be. For example, taking 1.25mg per day vs. 2.5mg every other day? I've tried googling those questions, but don't come up with many answers.

 

[silent meowlook]

The every other day dosing is used to avoid the side effects of long term steroid use.

The why? I’m sorry, I don’t know. I would assume it prevents a constant inhibition of the immune system and lets the cat have some time on their own rouse their natural occurring hormones.I don’t know that for a fact.

I have spent the last hour looking for this information, but nothing I can find so far.

 

[silent meowlook]

Also for what it’s worth, my cat also is hyperthyroid with kidney issues.

 

[Mac and Cats]

The every other day dosing is used to avoid the side effects of long term steroid use.

The why? I’m sorry, I don’t know. I would assume it prevents a constant inhibition of the immune system and lets the cat have some time on their own rouse their natural occurring hormones.I don’t know that for a fact.

I have spent the last hour looking for this information, but nothing I can find so far.

Thanks for answering and for spending time trying to find the answer! That makes sense to me.

 

[FeebysOwner]

I can't speak to the Pred, but with your cat having CKD - depending on what stage it is in - he could benefit from taking mirtazapine/mirataz (appetite stimulant) which may help reduce the lack of appetite that is resulting from a lower dose of the Pred.

Has he had more recent blood tests done to see where his kidney levels are now?

 

[Mac and Cats]

I can't speak to the Pred, but with your cat having CKD - depending on what stage it is in - he could benefit from taking mirtazapine/mirataz (appetite stimulant) which may help reduce the lack of appetite that is resulting from a lower dose of the Pred.

Has he had more recent blood tests done to see where his kidney levels are now?

Thanks for the suggestion. We have tried mirtazapine and elura. Unfortunately, both have little to no effect on him. They work for about 20 minutes and that's it. Today is the third day with the half dose of Pred and I can already tell he's a lot less interested in eating. So, I think that's it for the trial. I'll start him back at 2.5mg tomorrow, unless he suddenly starts wanting to eat more today, which I doubt.

His kidney levels were within the normal range, I think. I don't fully understand the values, except they are all within the "normal" range according to the paper I have. Here's what his values were if that helps:

• BUN/Crea 19.000
• BUN 29.000 mg/DL
• PHOS 4.5000 mg/DL
• CREA 1.500 mg/DL

I think those are the only numbers you'd need to know to see what his kidney values were like, yeah? This was from August 6th and he has been on the pred since March. His values from March were:

• BUN/Crea none listed
• BUN 33.000 mg/DL
• PHOS 4.7000 mg/DL
• CREA 1.000 mg/DL

He's only recently started wanting to eat the prescription food. So, I'm giving him anywhere from a full can to half a can of that a day, plus he eats some Fancy Feast and Tiny Tasters depending on what I can get him to eat.

 

[FeebysOwner]

He really doesn't even 'qualify' for having CKD with those numbers! So, I wouldn't go overboard with the renal food at this juncture, especially if he eats other foods better. Not saying he will be like other cats, but many of them who will eat renal foods get tired of them quickly, so keep that in mind too. Since appetite stimulants don't work, I suppose you could try an anti-nausea med instead, just to see if it might help maintain his appetite while reducing the Prednisolone dose.

Have you talked to the vet about Budesonide in lieu of Pred? Budesonide has a more localized effect - focusing on the intestinal tract. With the way it is metabolized, it keeps it from reaching high concentrations throughout the rest of the body, meaning there is a less causal effect related to cardiac conditions, as well as diabetes. These are things that can happen with long term Pred use.
Budesonide for Cats: Dosage, Safety & Side Effects - Cats.com

 

[silent meowlook]

Hi. So the thing with chronic kidney disease is that you have to have 70% loss of kidney function before it shows up on the bloodwork.
A urine specific gravity is checking to see if he can concentrate his urine. It is a helpful test in determining kidney function. An abdominal ultrasound with a board certified internist is a very good way of seeing what is going on with the kidneys.
In order for the creatinine to be elevated, there has to be enough muscle in the cat. I don’t think your cat is under muscled from the impression I got from your posts. So that wouldn’t apply.

What I do see that concerns me is that the creatinine has gone from 1.0 to 1.5. Even though both of these numbers are technically within normal range, it is still something to be concerned about. Because at that rate he will be above normal the next time you check.

 

[IndyJones]

Hi. So the thing with chronic kidney disease is that you have to have 70% loss of kidney function before it shows up on the bloodwork.
A urine specific gravity is checking to see if he can concentrate his urine. It is a helpful test in determining kidney function. An abdominal ultrasound with a board certified internist is a very good way of seeing what is going on with the kidneys.
In order for the creatinine to be elevated, there has to be enough muscle in the cat. I don’t think your cat is under muscled from the impression I got from your posts. So that wouldn’t apply.

What I do see that concerns me is that the creatinine has gone from 1.0 to 1.5. Even though both of these numbers are technically within normal range, it is still something to be concerned about. Because at that rate he will be above normal the next time you check.

The SDMA test is the successor to the creatin one. It shows as early as 25% loss of function. It is a better test imo.