Kidney failure dx - Meloxicam and first time with UK vet

[marciaj]

I adopted Shilo from a rescue in Egypt in mid-March. He was adopted as a special needs cat, as he is blind in one eye. I was told that he had no other physical problems, and his medical records showed that he is around 2 years old. Later, however, a vet at my vet’s office called him elderly and another vet said that his teeth showed that he was around 5.

Regarding my vet, this is a new vet. I am in the UK, however I am originally from America and this is the first pet I have had in the UK, so I am unfamiliar with UK vets. In the US, I had a diabetic cat and a cat with hypertrophic cardiomyopathy and hyperthyroidism. Both lived to be over 20 years old under my care.

After I'd had Shilo for a couple of days, he started having bloody diarrhea, which the vet chalked up to stress and getting used to new food. In Egypt, he was eating dry food with chicken. So as not to stress him to much, I continued to give him dry (Iams) but tried to wean him slowly onto wet food. He was moody and sometimes would want only wet and sometimes only dry.

He went through a stage where he was eating only dry food and refusing to drink water. (I did everything I could to encourage him to drink and even tried syringing water into him.) He then switched to wet food but still wouldn’t drink (at which point the vet said it didn’t matter because he was getting enough water form his wet food, but I was still worried.)

He then develped cystisis (with blood in urine) and a urinary blockage for which he had to be hospitalised and catheterised.

After he was hospitalised, I was advised to give him Metacam (meloxicam) and hyphovase. I did this, but after a few days he started acting weird. Finally, he started acting very poorly. He would just lie in an out of the way spot, curled up, get annoyed if he was touched. (He was cuddly and affectionate from the moment I got him, not like the typical rescue cat) then fall right back asleep. His good eye was dilated and he seemed very dazed, so I stopped giving him the meds and he was OK the next day.(I understand that meloxicam is considered for cats in the US, but it is given to UK cats at a lower dosage).

Later on, he began drinking huge amounts of water and urinating dilute liquid constantly. He was then diagnosed with renal failure and given up to 6 months to live. (This wasd yesterday.) The vet put him on K/D and gave me Semintra to give him, although she said that the K/D was more important than the Semintra, and that I shouldn’t give it to Shilo if it stresses him out. . She also told me that the Semintra is a phosphate binder and my research shows that it isn’t, it’s for reducing blood pressure. (Unless I’m mistaken.) The vet said that Shilo should occasionally come back for IV fluids. I asked if he should be given sub-qs at home, and the vet said that it was painful and not as helpful as IV, so no. He is also scratching constantly, which I have read could be due to high phosphorous making him itchy.

I also asked if the kidney failure could have been caused by the Meloxicam, and was told no.

However, I’ve gotten copies of his blood work and on 30 March (before he was hospitalised) his creatinine and phosphorous were normal, and on 19 April, after the Meloxicam, they were high throughout. HIs BUN has always been high, but my thoughts are that he could have just been dehydrated from refusing to drink water.

These are his numbers:

30 March 2018 – BUN 13.7, Phos 2.21, Cre 149
19 April 2018 – BUN 21.9, Phos 2.88, Cre 190

What do you think? Is the vet lying to me about the Meloxicam? What about sub-qs?. Does the highish BUN on 30 March mean that he already had kidney disease? I live in a small UK town and there is only one other vet, which I’ve heard good things about. Would it help to switch to the other vet?

[booktigger]

It's hard to tell off those numbers, as you need the range to tell how high. You are right about sementra, and it is only useful if they are losing protein in their urine, did they test a urine sample? Metacam is linked to kidney issues but surprised they have said he will only have 6 months, renal diets can get values back in normal range - if he is fussy with kd, there are other brands. Sub-q's don't seem to be done that often here

[fjm]

There is research showing that while long term use of Meloxicam may damage kidneys, and a higher than prescribed dose is definitely dangerous, a low dose can actually help to preserve kidney function once they have started to fail: https://www.petmd.com/blogs/fullyvetted ... rugs-29460 Some cats do react badly to it, but I don't think it is helpful to think your vet is lying - much more that he or she is assessing the risk according to the best evidence. I agree 6 months seems short, but perhaps the vet is basing the prognosis on rapid progression to date. In any case, if you do not have confidence in the practice it would be better to either seek a second opinion, or to change vets - you need someone with whom you bhave a rapport and that you feel you can trust to support you through this difficult time.

[booktigger]

That's an interesting article - my vet had told me about one showing it helps cats with arthritis, based on the fact that pain levels would affect their appetite

[Antonio]

As far as I know, long term use of Metacam can lead to renal failure.
My cat was given Metacam daily for weeks, but she was terminally ill, so the kidney issue was minor.

So, what I think, is that the Metacam migh thave damaged Shilo's kidneys, and as far as i know the damage is irreversible. You can help him wit hrenal food (Hill's K/D, Royal Canin Renal, Trovet Renal), with Semintra or Fortekor, and with sub-Qs.
I would give my cat sub-Qs daily or every second day, and I did it for 10 years, so I can assure you they are useful. You can also add some vitamin B nad also some probiotics.

And regular blood works, especially in the beginning of the therapy, to see if you need adjustments.

Best of luck to your Shilo!