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

[Mac and Cats]

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

Thank you for the feedback on his numbers! That is similar to what our secondary vet said as well. Our primary vet said that because his numbers were higher at his very first appointment when we adopted him 3 years ago (April 2021), that he is still considered to have CKD. He had recently been diagnosed with hyperthyroid a couple months earlier and had been on medication since then while we fostered him (started that in January 2021), I think? He was under the care of the shelter vet prior to April 2021. I just looked it up and his numbers were higher:

• BUN/Crea 20.000
• BUN 41.000 mg/DL
• PHOS 6.1000 mg/DL
• CREA 2.100 mg/DL

So they have gone down quite a bit since 2021 and I think the reason for this is because I worked hard to find foods he would eat that were at or lower than 1% phosphrous on a DMB. I don't know what all he had been eating at the shelter. Before that someone had found him in a back alley near a dumpster. He was 7.5 pounds when we got him. His healthy weight should be about 12-13 based on his frame. Thanks so much for the information on that as it's good to know that his numbers don't scream CKD right now. Right now, I feed him whatever he will eat since previously he was so picky. He decided on the kidney food on his own for some reason! Looks like what I have been doing food-wise is working, which like I said, is a combo of some renal food, FF, Tiny Tasters and sometimes Weurva (although, he isn't a huge fan of that one).

We have also tried Cerenia. I have some on hand in case we need it for either of our elder cats (our other also has CKD, but her numbers are a little higher) Before he was diagnosed with possible IBD/SCL, I spent the better part of 2 years trying appetite stimulants, anti-nausea and every food under the sun. It was when he stopped wanting to eat all together that I rushed him to the urgent care and then we did an ultrasound a few days later. We did not do a biopsy because he does not do well under anesthesia. I have not talked to them about Budesonide as I didn't even know that was an option. They only presented me with the pred as a solution. I will look it up. Thanks so much for the response, it was very helpful!

 

[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.

I just re-read your comment. I was on my way to take our youngest in for his vaccinations/check up, so I didn't read it as thoroughly as now. I wonder if the every other day dosing would work ok for my guy vs. the 1.25/day. He did ok on the first 2 days of it, but today is less interested in food. He is still eating some, but just not as much. I will still be upping the dose back up to 2.5mg tomorrow and will think about it and talk to our vet before doing that. Thanks again!

 

[Mac and Cats]

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.

You are correct, he has good muscle mass. When we were at the vet last, she said that he had gained weight in addition to muscle mass. My last CKD kitty had little to no muscle mass at the end. That's good to know about his Creatinine. When we first got him in 2021, it was 2.1. Hopefully, with the addition of him eating some renal food, this will help some. Your concern is also why I am concerned and was attempting to lower his dose.

 

[FeebysOwner]

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.

The SDMA test supposedly indicates the likelihood of CKD earlier than some of the other tests. But, once CKD has been established/diagnosed, its meaningfulness is diminished. IRIS still uses it as part of their stage assessment, but what they don't talk about is that it isn't always 'accurate'. I have a CKD cat that her SDMA was 8.8 (way below the 15.0 threshold) when her creatinine was 3.5 and her BUN was 62. And her SDMA only registered at 13.5 with her most recent blood work (same Creatinine/BUN levels).

 

[FeebysOwner]

he has good muscle mass. When we were at the vet last, she said that he had gained weight in addition to muscle mass. My last CKD kitty had little to no muscle mass at the end. That's good to know about his Creatinine. When we first got him in 2021, it was 2.1. Hopefully, with the addition of him eating some renal food, this will help some. Your concern is also why I am concerned and was attempting to lower his dose.

High muscle mass can elevate creatinine, but if that is the reason for the level, it is not a precursor of CKD. I am not saying you shouldn't be diligent about monitoring his kidney values, but his creatinine level may have lowered due to him eating a lower protein diet, renal food or otherwise. Renal foods tend to be lower in protein.

As you noted in your other CKD cat, muscle mass can deteriorate with the disease (and age, among other conditions), and it has now been deemed that lowering protein levels too much to try to help delay the progression of CKD is unproductive and can actually exacerbate muscle mass loss - which affects most all other organs, including the heart. It seems to be the thought process now that lowering the protein is best to do so only in the final stages when the kidneys need all the help they can get - and muscle mass loss at that point is not as crucial of a concern.

 

[Mac and Cats]

High muscle mass can elevate creatinine, but if that is the reason for the level, it is not a precursor of CKD. I am not saying you shouldn't be diligent about monitoring his kidney values, but his creatinine level may have lowered due to him eating a lower protein diet, renal food or otherwise. Renal foods tend to be lower in protein.

As you noted in your other CKD cat, muscle mass can deteriorate with the disease (and age, among other conditions), and it has now been deemed that lowering protein levels too much to try to help delay the progression of CKD is unproductive and can actually exacerbate muscle mass loss. It seems to be the thought process now that lowering the protein is best to do so only in the final stages when the kidneys need all the help they can get - and muscle mass loss at that point is not as crucial of a concern.

That is something I have been thinking about in the past year or so. My past CKD cat was on renal food for several years (I don't recall exactly how long). He lost a lot of muscle mass in his hind legs and you could hardly feel any muscle in his hind legs for the last year or maybe it was months. I previously, was not aware about the lower protein recommendation. The vet told me when to feed him renal food, so I did and he ate it. Then she told me, stop feeding him dry food all together. So, I did and he ate it. I didn't ask any further questions. I didn't realize how lucky I was that he was eating the renal food, much less how lucky I was that I didn't have any trouble getting him to eat even toward the end. We said goodbye to him at age 18 back in November of 2021.

When we got our current guy, Benji, the only reason I learned any of this is because he refused to eat renal food when the vet told me to start feeding it to him, so I had to search high and low on the internet for other food recommendations. That's when I learned all this and also came across the Tanya page. I still don't really understand all the lab numbers and rely on the vet to tell me when the numbers are good or bad. It's just a lot of information and I'm not really science minded in that way. For Benji, I haven't been focusing on reducing protein at all even though the vet told me I should also be focusing on that part. Part of this is because like you said, I worried that starting him with low protein so soon in his disease, that he would lose too much muscle mass too early like Bub did.

When I started trying to find other foods he would eat, I started with foods that had lower phosphorous levels similar to that or just a bit above the prescription foods. That proved to be futile because he refused to eat any of them. I kept raising the limit that I was ok with and we both finally settled on some food options that were a little less or a little more on 1% DMB. That is why I haven't totally freaked out about him being put on pred, because I'd rather have him on pred with it controling his symptoms than to not have him on it and have him not eat at all. I mentioned in another comment that he doesn't respond to the appetite stimulants for more than a total of 20 minutes, if he does respond to it at all. Cerenia may help with his nausea if and when he has it, but it doesn't encourage him to eat either. So, I just had to come to terms with that his situation isn't perfect and I won't be able to make it perfect no matter how hard I try. At least now, we have found foods that he is willing to eat on a regular basis and I'm not throwing out cans and cans of food every day just trying to find one he will take 5 bites of.

Thanks very much for your responses. It is helpful to have all of you explain and walk me through it and I appreciate it very much.

 

[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.

Good morning! I just wanted to let you know that I found one resource for why the every other day for dosing Pred is preferable if possible. Here is an explanation. It is under the "Do corticosteroids cause side-effects in cats?" Thanks again for your help!

 

[silent meowlook]

Great, so it’s basically what I thought. So glad you were actually able to find something that states that.

 

[Mac and Cats]

Just wanted to update everyone that I've since tried giving our Orangie 2.5mg of pred every other day and it's working great. Much better than the 1.25 every day. He is still eating like a champ and comes to snuggle. I still don't know if it's IBD or SCL, but he seems to be doing ok for now and I will accept that. He's eating and that's what matters.