CKD numbers

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Mollycat
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CKD numbers

Post by Mollycat »

Sorry, another question!

I am reviewing the few blood tests we have for Molly ahead of looming vet visit. Most of the few numbers I have are meaningless and I am missing one set, but the detail I'm scowling at is creatinine:

8th November 2018, creatinine not tested but urea 11.9 (top of normal range)
This is unreliable because she was at the vets for what I call her "crash" with dramatic weight loss (? pre-hepatic lipidosis, high bilirubin, next to no platelets, & ALT high plus hyperthyroidism) so all readings were likely a bit skewed

1st October 2019 (6 months post radioiodine) ALT still high
Urea 11.7 (ref 6.5-10.5) so HIGH
Creatinine 131 (ref 133-175) slightly low
I was advised NOT to put her on renal food at this stage.

then
2nd March 2021 - blood taken just after a meal
Urea 15.4 (ref 6.1-12.5) (also glucose high) limited use because of effect of a meal
Creatinine 138 (ref now 44-194)
In response to this test I was advised to put her on renal support food.

First question - anyone any ideas why the reference range for creatinine has changed?

Second question - creatinine is a little bit higher but still well within the normal range, is this enough to warrant renal support food?
The vets themselves gave me a leaflet about CKD that clearly states creatinine is used because urea is affected by other factors and so is unreliable as a CKD marker.

And third question - just how high does urea go from stress and after a meal, is the urea number any use at all?

Obviously my next decision depends on fresh bloods but now we have a weight problem and some joint discomfort I have to make decisions about priorities. My gut feeling is kidneys are going to come second, at the age of 15, because they still seem to be relatively early stage, and supporting joints for comfort is more important to good comfortable quality of life. But thoughts are most welcome.
Last edited by Mollycat on Thu Feb 03, 2022 10:45 am, edited 1 time in total.
booktigger
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Re: CKD numbers

Post by booktigger »

The range change might be that they have a different machine, or one was done in house and one sent to a lab. I wouldn't have thought that would have gone up enough to warrant a decision to put on renal food, especially as the marker had also gone up. I know what affects urea, but not to what extent. I would say joints are primary to kidneys, and I have had a cat with CKD on long term Metacam, with just changing her dry to renal dry and leaving her wet (she only ate one pouch of wet a day anyway), no meds and her values actually came down to normal limits.
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Re: CKD numbers

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booktigger wrote: Thu Feb 03, 2022 7:19 am The range change might be that they have a different machine, or one was done in house and one sent to a lab. I wouldn't have thought that would have gone up enough to warrant a decision to put on renal food, especially as the marker had also gone up. I know what affects urea, but not to what extent. I would say joints are primary to kidneys, and I have had a cat with CKD on long term Metacam, with just changing her dry to renal dry and leaving her wet (she only ate one pouch of wet a day anyway), no meds and her values actually came down to normal limits.
Thank you, much along the same lines as my own thoughts - and yes it was a different machine, thought the low reference seems very very different. October 19 was the hospital where she had her I131 and it's their immediately post treatment set of results that is missing. March 21 was my vets in-house machine.

It might be the increased reliance on dry tipping the scales, now that you mention it, not just the increased calories in renal food, because the renal wet is only ever half eaten so she is eating a lot more dry.
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Re: CKD numbers

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I would be tempted to do a similar diet to Lucy's, keep wet what she will eat and just keep with the renal dry - I am going to insist on bloods for her next month, but she is 5 years after diagnosis and while she does drink immediately after eating, and she is sometimes mouth chews (although I suspect some of that is to make me give her something to eat), she has no obvious signs of deterioration and the vet refused to do bloods last year as she had gained weight.
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Re: CKD numbers

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Refusing to do bloods makes no sense at all to me, I thought renal patients were supposed to be monitored up to the rate of biannually and you wouldn't think they would pass up the chance of charging for tests.

I am keeping everything as it is until we see Vickivet but that seems like a good plan to me, possibly even a brief month or so on diet food to bring her weight down a bit but if that's not a good idea we won't of course. And if we do go this route I have 8 unopened boxes of Pro-Plan still in their bundle shrink-wraps, one bundle of 4 salmon and one the same of chicken. Too much to donate, I've done an awful lot of donating over the past 2 years, but they will still be offered cheaper than I paid for them. Cats damn cats and expenses!
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Re: CKD numbers

Post by booktigger »

I can see her logic, and it is nice to have a vet who won't run up an unnecessary bill! I ended up having to throw a box of renal wet away as it was out of date
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Re: CKD numbers

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Provisional date Friday 18th. Bloods, urine, thorough exam. Husband to be the bad guy chucking her in the carrier.

My neighbours who kindly gave me some of their out of date Metacam just to check if she would take it have told me to keep the rest (on the understanding that once I have some prescribed in the house I will obviously reciprocate if need be for their 20 cats, yes twenty) so I gave her another half dose this morning. She has been using her scratch post a lot and ventured up onto the second level of her cat tree, which was always her favourite but she has not been there much if at all for the last few months. Now she is sleeping peacefully with her head twisted upside down cuddled up against the radiator. And so another question comes to mind.
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Re: CKD numbers

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Update!
We got there on the 4th attempt!!!

The numbers are good news - I was right about high urea being meaningless, this time it was normal. Creatinine a little higher but still only IRIS stage 2. And for the first time we had SDMA and that was 12, putting her into IRIS stage 1. Not bad for 3 years since diagnosis and only 11 months on a not strict at all renal diet at 15 years of age.

In terms of electrolytes it's more good news, potassium is now above 4 for the first time since records began 3 years ago, despite my cutting the dose to a half, and sodium still high but low enough to bring the ratio down to acceptable.

So now we are armed with a bottle of Loxicom and that's all the good news. I was so happy ................

and then


........................ the vet said she wanted to see her again in about a month :shock:
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Re: CKD numbers

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That's good - good luck getting her there again in a month!
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Re: CKD numbers

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booktigger wrote: Mon Feb 21, 2022 8:00 pm That's good - good luck getting her there again in a month!
Thank you! She held on for 14 hours but finally delivered a urine sample, which is off to the vets this morning.

Edit - and specific gravity 1.034 so vet is even happier, and so am I.
It wasn't checked for anything else as blood results covered all that.
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Re: CKD numbers

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Even better - we had hoped that as Lucy fights bloods so much that we could have used urine samples to monitor her, but she doesn't oblige with those either!
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Re: CKD numbers

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booktigger wrote: Tue Feb 22, 2022 1:21 pm Even better - we had hoped that as Lucy fights bloods so much that we could have used urine samples to monitor her, but she doesn't oblige with those either!
Molly was quite upset and kept pleading with me to give her back her litter trays. The 14 hours I knew she was holding and holding was hard for me, I nearly caved in. Luckily it's not a time critical sample the way crystals are.

How have you tried Lucy? Kit and test cost me £24. Sounds a lot but the full blood panel is so much more!
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Re: CKD numbers

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Well, we haven't tried for a while, one of the main struggles is that it is a bit time sensitive for me, as I have limited time to get it to the vets around working, and Lucy goes out - while she doesn't normally go outside, I suspect she might given the alternative. My last cat Buster, was easy, he couldn't resist what he thought was someone else's tray, so you could just put an empty tray in a slightly different location and he couldn't resist.
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Re: CKD numbers

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Yes that is quite challenging. Though I do wonder sometimes just how useful it really is to know every detail, and you have more than enough experience with cats to know if something is amiss and checks are really needed.
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Re: CKD numbers

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Well, that was kind of my vets logic last year, if she can gain that much weight, her kidneys aren't too bad (and probably didn't relish taking blood from her when I wasn't allowed in the room!), I will be insisting this year though, she does drink straight after eating and has been sick a few times (she likes to go and eat grass so it's not proper sick), although the drinking thing had started last year and hasn't got worse. At the end of the day though, she is a 14 year old cat 5 years after diagnosis and other health issues, but happily played with my friends son earlier!
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Re: CKD numbers

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Humour me - try growing wheat grass for her and pick or snip it into short pieces, and see if it still makes her sick.

Hubby was really surprised, having heard Molly's language when being put in the carrier, to discover how utterly docile she is at the vets. Is Lucy really that fierce?
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Re: CKD numbers

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Not sure it'd work, she has her grass pot outside the front door, and if it is a bit low, she goes to the bottom of the street and eats it from there.

She can be, she is the first cat I've had that you have to battle with to get back in the carrier at the end of the app, vet normally wanders off laughing and leaving me to it, worst was when she got in a gap and poo'd! Mind you, with her acupuncture, she'd often let the vet put the needles in, then start hissing when she went to take them out. She went for a blood test and it was using a special machine for her calcium, so the vet said to have her there for the full day, she drew blood on both the nurse and the vet and I was told not to leave her there for bloods again. She has got better at being put in the carrier at home though, she doesn't draw blood anymore, you just have to time it well, so she doesn't twig, as you have to block off the bedroom, or she's under the bed and you have no chance, before I learnt that we had to cancel a few apps. Ironically, she hates being brushed at home, but while she swears at me doing it at the vets, she will sit there and accept it.
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Re: CKD numbers

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Yes ok so Lucy sounds a lot like what I am so grateful Molly isn't - Molly doesn't lash out though she could accidentally hurt or get hurt, but yes the element of surprise is key and just the same is M gets wind of my intentions she will be gone under the bed just the same.

Don't know if this is an idea at all for Lucy, I am starting Molly on a programme of brush desensitisation - sniff the toothbrush, gently do cheeks for scent, and we've got as far as a few strokes under the chin. Long way to go. Also I found with previous cats a small comb seemed more acceptable than a brush, if that's any help.
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Re: CKD numbers

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Unfortunately Lucy is more fight than flight - even a simple play session yesterday got her worked up enough to lash out at me. She is better at Molly than being stroked and picked up, however if she isn't in the mood for it, she will let you know. Over the years, she has got better, now she will sometimes be wound up, put her teeth round your hand but stop herself from breaking the skin, and sometimes she can be good enough to hit without claws. She's also funny about being spoken to, being told 'I love you' can be enough for her to get off your knee, which makes me sad.
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Re: CKD numbers

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Bullet bit and appointment made for re-check Friday 25th - 5 weeks deliberately because I wanted 4 weeks clear on the same food as before, and I gave her a break for a week post visit with AGAIL before getting back on the renal. Muscle wastage against overall weight gain is a big concern too.

Oh and in the meantime we now have steps alongside the big cat tree and window sill, steps alongside the bed, larger steps up to the mid height wardrobe den, and a small stool to be cut down as a step up to the radiator bed.

Mostly note to self here, until today I have had her on a half dose of Metacam/Loxicom, so for the next 10 days I am putting her on the almost full dose, for 5kg (she is 5.8) so that we can really see if there is any impact on the kidneys. But I hope we can shift our focus onto her surplus ounces for the benefit of her joints after this blood test.
booktigger wrote: Thu Feb 24, 2022 1:06 pm being told 'I love you' can be enough for her to get off your knee, which makes me sad.
Yes that is rather sad, makes you wonder what could have started that in her past. How are the other girls doing?
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Re: CKD numbers

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Fingers crossed - I need to get Lucy in for her boosters and bloods, not going to accept no for an answer this year!

The others are doing well thanks - they still only interact in their own way, and don't like being touched, but Chanel has started sitting in the entrance to the bathroom when I'm brushing my teeth again, they were little tealeaves the other day though, Lucy has two rainbow cords and they have one (friend's son gave Lucy one, bless him), and on Sun, they had pinched both of hers even though they have one of their own! We did have a close call one day though, I wasn't quick enough to stop Lucy escaping, luckily they were both in their room, they looked a bit perplexed when I went and shut the door!
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Re: CKD numbers

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So the girls now have the run of upstairs? Or was that one of their free range of the house nights?

Lucy reminded me of this wonderful little kitten - especially the way it comes back after the vet is all done, and the lovely way the vet handles it https://www.youtube.com/watch?v=l79F7G5 ... naryclinic
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Re: CKD numbers

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No, sadly the house isn't set up to be able to block off the upstairs, that was their night out
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Re: CKD numbers

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We've been back today and expect results next week, this is just to check the Loxicom isn't causing any issues with her kidneys, which I don't think it is, and then we can talk about losing a kilo which she needs to do.

Booktigger - I appreciate it's the least of your worries with Lucy, but does your vet take blood from the paw, or neck? I have to say it really does look so much less stressful for them from the neck.

Managed to get a good clump of loose mat out of her back, too, while we were there. I have managed to get her used to a toothbrush but the metal comb will be quite a different matter (or de--matter?)

To my surprise, and Molly will always have another surprise up her sleeve for us, it seems going back so soon after the last time was actually easier for her. I will never fully understand her, and in a way I'm glad.
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Re: CKD numbers

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Tilly-cat has also just had blood tests - results today. She is very easy to take to the vet - comes when called, settles in the crate with barely a murmur, purrs through the examination and accepts having her neck shaved and blood drawn as long as no one tries to restrain her too tightly - she will co-operate, but on her terms!

Her last tests were pre-Covid in 2019 when she was borderline CKD - weight loss, drinking a lot, and some key test results a little high. Since then she has lost another half kilo, dropping from 3.5 to 2.85 kilos, so I feared the worst, but all her results came back within normal range, and most right in the middle of the range. As she will be 19 in a few months her vet and I have agreed it is best to add more protein and highly palatable food into her diet to build her weight back up, rather than trying to get her to eat enough of just the renal diets she doesn't much like, so when we got home we celebrated with Gourmet and chicken breast! My plan is to feed renal dry and at least 50% renal wet, plus high protein, high calorie, reasonably low phosphorus foods. Next job is to concoct and test some recipes...
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Re: CKD numbers

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Love it when they come up with good news after we get ourselves all in a tizz in advance!

Come on Lucy, Tilly and Molly have both been good girls and got really good news, it's your turn now!
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Re: CKD numbers

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Fingers crossed her levels come back fine.

Glad Tilly is OK, and good luck getting weight on her.

Well, Lucy should have been going for her booster and bloods on Monday, but I'm insisting that they test her calcium levels as she's had no bloods since pre Covid, they rang on Thu to say there was a delay in the cartridges for the EPOCH machine (the one they use for calcium levels, the external lab test is quite fiddly apparently, requiring frozen samples!), so I could either take her for her booster on Mon and then back for bloods when the machine is ready, or wait till we can do both in one go, you can imagine what my response was. My vet prefers taking blood from the leg, but we have to do neck for Lucy, she has a real issue with her front legs being touched - when she had her hip operation, she allowed the vet to check the wound with no problem, but drew blood when we tried to remove the bandage/pain patch from her front leg, I wonder because she has arthritis in her back legs, whether the imbalance is either painful or makes her feel uncomfortable? Funnily enough, Lucy tolerates being brushed at the vet, whereas at home she bites, fortunately she gets the brush rather than my hand. I do need to clip her claws this weekend, I tend to do them after her weekly meds, when I've already upset her.
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Re: CKD numbers

Post by Mollycat »

I'm impressed from what you say of Lucy that you're able to trim her claws at all. Hoping their machine is fixed and you can get in soon.

Fjm I read but didn't really register "pre-Covid in 2019 when she was borderline CKD - weight loss, drinking a lot, and some key test results a little high" - so weight loss was one of Tilly's first early symptoms? Weight loss is something I have always associated with advanced stages, just because mine have never had any significant weight loss and Molly's could be attributed to her HT because it's only muscle loss and she still has a surplus kg of pure fat. Progression isn't linear at all with this thing.
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Re: CKD numbers

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Certainly wasn't something I was keen to try, but when we realised she'd need regular blood tests, it seemed essential so I didn't have to drive to the vets bleeding and prevent her drawing blood on the vet, it's normally done just before a vet visit, the trick seems to be to wait till she's just woken up, so she's still a bit sleepy, ignore the growling, have rainbow cord handy so when you finish, you can throw it across the room so she can take her displeasure out on that and not me, then give her a treat. Today I was brave enough to clip her claws and brush her, the brushing was the one she hated most, she's never liked it, but unfortunately now she gets clumps over her bad hip, which must be painful
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Re: CKD numbers

Post by fjm »

I think even very early CKD can lead to inappetence, and so to weight loss. In 2019 she had lost weight, had runny eyes and was constantly drinking, but didn't have the sort of appetite that would lead one to suspect diabetes - in fact her appetite was worse then than now. Her test results in 2019 were mostly high end normal, although urea hit 21.5 in June (back down to 10 last week). I wish now I had taken her for more tests as soon as the Covid restrictions eased a bit, rather than struggling so with renal diets. She did very well for years on home cooked, and I think that is where we are heading again, adjusted to bring the phosphorus level down a little. With a bit of fiddling I can get the protein:fat balance the same as a mouse (7:5), and pack at least 120 kcals into a small pot.
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