Normal SDMA, high creatinine- Is it chronic kidney disease?

[KeeleeCat]

Here’s a quick rundown of what’s going on with my cat, Keelee. If anyone’s experienced this same situation, I’d greatly appreciate your insight!!

About 2 years ago, some elevated creatinine showed up on her blood work (2.4 mg/dL) with normal BUN and SDMA. Her creatinine hovered around 2.4-2.7 for the next 2 years, and always had a BUN and urinalysis within normal limits.

A month ago, my poor baby had to have a full mouth extraction due to severe tooth resorption and possibly some stomatitis. Her pre-op blood work was within the limits I mentioned above, but at her one month follow-up last week, I was SHOCKED to see a creatinine of 3.4!!! The really weird thing is that her SDMA was 11, which was within the normal parameters of 0-14, plus her BUN and urine were still normal as well!

It’s my understanding that the SDMA should be high along with her creatinine if this is CKF. Could this be pointing to something completely different, like cancer?

I love her so much and something is obviously wrong with her, but I want to make sure we aren’t missing the mark here and treating for the wrong thing. I want to have as much time with her as possible while giving her the best quality of life that I can give her.

[booktigger]

Infection and dental issues can cause bloodwork to be skewed, and both only raise one of the kidney levels, although you would expect that to show on her pre-op rather than follow up. What treatment was she given after the dental?

[KeeleeCat]

Thank you so much for your reply!

After her dental surgery, she was given an antibiotic injection that was supposed to work for several weeks. I was also given pain medicine to give her twice a day (I don't recall the name).

I went back in yesterday to double check the creatinine level and it was down a bit to 3.1. The vet has recommended that we start doing subcutaneous fluids twice a week to help support her kidney function.

If there is an infection, would that show up on regular blood work or would I need to request a specific panel?

Thanks again for your help!

[booktigger]

I'm guessing the pain medication was Metacam? Both that and the long lasting ab can cause kidney issues but promising that her values are coming down. Infection should show as the wbc on a standard panel

[KeeleeCat]

I just looked and her WBC wasn't one of the things that they checked. I have another appointment for her next month and I'm going to ask them to check for that as well. I'm kinda surprised that they haven't recommended checking for more things in the last 2 years that this has been going on.
There is even a note at the bottom of her one lab result stating that it's very unusual that her SDMA is normal and the creatinine is high.

[booktigger]

That's unusual, thought that was a standard thing. I've had a few cats with kidney issues and normally just a standard profile done every 6 months, although my current cat with CKD is just weighed monthly and bloods only done if anything unusual, it's an odd concept for me, but better for her. Just remembered dehydration can also cause raised creatinine with everything else normal

[Mollycat]

If dehydration can raise creatinine that would explain what I was about to question, because with CKD there is a long long way to go before resorting to subQs!!

Both - sorry now all 3! of mine with CKD it's been left up to me to decide what we do and we certainly don't go every 6 months or anything. In the first 2 cases we diagnosed then did one follow up, in both levels had improved from diagnosis, so we carried on with diet. First one was never retested for 8 years until she became ill. Second is showing signs of deterioration but has other more pressing issues; third is feral and will get a retest as part of her post thyroid follow up, and no more - testing is important if you have more treatment options but a waste of money if you don't. Obviously this doesn't apply here but don't think you have to follow a retesting programme once stabilised if you don't feel it's appropriate for you and your cat. Hopefully this wil turn out to be something easily remedied and not renal failure, it doesn't sound like it from what you describe but some cats don't get the memo about classic symptoms.

[KeeleeCat]

Do you guys think it's too soon to start subcutaneous fluids? I read that most people don't start until creatinine is consistently over 3.5-4.0, Keelee's was 3.1 when last checked and as booktrigger mentioned, the meds she was on could have something to do with the rise we saw. I asked the vet if she really needed to start this now because I don't want to cause her undue stress and the vet said it's best to start the fluids early on.

The LAST thing I want to do here is end up hurting her with treatments that she doesn't need! At the same time, if this would turn out to be a kidney issue, I want to try to slow that progression as much as possible. Feeling kinda torn as to what the best thing to do is. After the next retest (with the WBC inlcuded!!), I guess it's safe to assume that all the medication should be out of her system, so whatever the result shows should be an accurate reflection of what's going on.

Molly, do you recall what your cats' values were when they were first diagnosed? And did they seem to live normal lives with just a diet change?

Thanks again for the input, guys!

[Mollycat]

My first girl was many years ago when we used to diagnose with a traumatic urine sample first. No idea what her bloods were or even whether they were tested at all at the beginning, but I know she was 8 years old and she never had any other treatment than dry Hills k/d and she remained happy and healthy for another 8 years. My second is a little more complex as he has other health issues, after 18 months on diet we have been forced to take him off it. He was very borderline and responded very well and immediately to the diet though. Third one has only been diagnosed but all her system is still in chaos following thyroid treatment.

It's important to have a vet that you can trust, especially one who supports you in managing a lifetime condition in the way you want for your cat. My multi health problem boy, we're not running countless diagnostics because he has a treatment that is helping his symptoms, he is 15 years old and knowing what the condition is would not change what we're doing - I don't want him treated aggressively for cancer or with antibiotics.

Don't panic about kidneys. Even if it is, it's very manageable and there are lots of options open to you now. I really recommend this for a well researched, supportive and sensible guide to cats' kidneys https://www.felinecrf.org/ and you may well find the answers you're looking for or at least the questions to ask the vet about elevated creatinine.

I wouldn't get too hooked up on blood test readings to be honest, they don't always reflect how sick or how well the cat is, and my own view is that how Puss feels is way more important in most diseases. The best advice I ever got on kidney failure management was from my first cat's vet when i asked if she could still have treats - "Don't make her life a misery" - and I have taken this so close to my heart that 30 years on it still guides me in the treatment of all my animals.

As for fluids, be careful. Some people think a cat should drink as much as possible, that's not necessarily true. I wouldn't overencourage drinking "to help flush the kidneys" for cats ot for that matter even for humans. A large throughput of fluid does not equate to good hydration. Too much water dilutes the urine, and a cat's urine is quite strong to kill bacteria in the urinary tract. Too dilute, not enough killing power, more risk of UTIs. Also, all this water can't be used effectively if it leeches out electrolytes. Cats are a highly evolved species with a weak spot in the kidneys, understandable as pets now live twice as long as their wild ancestors, but they don't always need as much micro-management as we like to give. I certainly wouldn't pump a cat full of fluids if it's not dehydrated, but a sound sensible vet who works with you and your priorities would be top of my priority list even if it means travelling a bit more.

Edit: I just dug up Bobby's bloods for you, as i said very borderline, in fact only one reading above the normal range:
GLU 5.68 (3.94-8.83)
Creatinine - 246 (71-212) I guess that must be International scale units
Urea 12.0 (5.7-12.9)
TP 77 (57-89)
ALT 36 (12-130)
ALKP 17 (14-111)
So his creatinine was also the only result above the normal range, urea was on the higher end of normal.
Creatinine is also interesting because low levels can point to metabolic issues such as liver disease or hyperthyroidism, so I would presume high levels could have other causes than kidney failure. according to this https://www.pethealthnetwork.com/dog-he ... levels-101 the suggestion is that creatinine may actually be a poor indicator of kidney failure on its own and SDMA is more reliable. If your SDMA levels are normal, and as it says SDMA is normally high before creatinine increases, and there can be many causes of raised creatinine, I think it's reasonable to look at other possibilities before assuming kidney failure.

[booktigger]

I wouldn't be doing sub-q fluids on just a high creatnine, as that on it's own isn't a sign the kidneys are struggling, and especially as they have come down. I'm guessing you are in the US, sub-q's aren't done routinely in the UK, I've had 4 CRF cats now and never been offered it (well, Lucy was for her calcium, rather than her kidneys). Actually, has she lost weight? Creatnine is associated with muscle mass, so can be skewed if they lose too much weight too quickly. I'm sure my vet said that they aren't classed as having CRF until the SDMA is 20 (or might have been 25, that was a conversation last year), although we did put Lucy on part renal diet to help keep it as early as long as possible, that was 3 years ago and she seems that stable we didn't bother with the annual test this year.

[KeeleeCat]

Wow, Molly! Those wise words from your vet really hit home for me... "Don't make her life a misery"... That's a great guideline to go by when making decisions for our pets. I've never had to deal with a cat that had any kind of chronic issue, and I see how easy it can be to get stuck doing everything we can to "fix" them and, even though we have the best of intentions, end up putting them through more than they'd probably choose for themselves. And thanks so much for taking the time to find Bobby's old blood work! It's helpful to see what other cat's values look like!

Booktigger- Yes, I am in the US, I've heard that they don't do subcutaneous fluids often in the UK. They apparently are very helpful in the more advanced stages of CRF and can really help the cats feel better. I can say that I haven't had a good feeling about starting these fluids right now. Since her surgery, she's finally eating like normal and looks so much healthier now. Giving her fluids at this point, (when all her other values are normal) feels like I'm "jumping the gun" and putting her through undue stress. As for weight-loss, yes, she has lost weight because she had a hard time eating with her tooth issues, but it was stretched out over the last year, not a sudden drop. Would a slow weight-loss still do this? For reference, she was 12.4 pounds in February 2018, was down to 10.5 the day of her surgery, and is now up to 11 pounds.

The next time I see the vet, I will have to talk to her and see if she'll support the idea of looking for causes other than kidney failure. If not, I guess I'll have to look for a new vet. It's kind of funny, because this is actually the second vet I've seen about this. The first one saw her creatinine level and said it was the beginnings of chronic kidney failure and that I should "consider euthanasia"!!!!! No.joke. My cat was very obviously no where near the verge of needing to be euthanized and I never went back there again. That was 2 years ago.

[booktigger]

Ah, thought you might be, also with the terminology as you use BUN and we use Urea. Not sure why doing fluids hasn’t been pushed over here. I have always been one for doing regular bloods etc, but my new vet is more relaxed about it, although I still don’t feel 100% happy about not having up to date numbers for Lucy, but she goes for acupuncture monthly so kind of is monitored, I know if she went and her weight was down she’d be tested. Sorry your original vet was so behind the times with CKF, my friend uses my old vet and she had a similar experience, her cats was the same as Lucy's, but hers was negative where mine was positive.

[KeeleeCat]

I definitely understand wanting to have up to date results! Cats hide illnesses so well and I worry that things are getting worse and I'm completely unaware. My cat strongly dislikes visits to the vet though, so once we confirm what's going on with her I'll have try and let that fear go. May I ask how long Lucy's had CRF and how have you been managing it?

[booktigger]

Yes, it is hard not knowing, although i knew before her initial tests that it was going to show something and when she had her calcium issues I knew from her behaviour. She was diagnosed in March 2016 and we just changed her diet, although her calcium issues mean she shouldn't have any renal, but bet says her kidneys are more important so we have a mix of renal, senior and adult and her weight is stable and no excessive drinking or vomiting so we skipped her bloods in March. She has other issues too, so quite challenging! My last cat needed more regular bloods, one of his kidneys had died and he had little symptoms, luckily I'd forgotten and had his bloods done early which picked it up.

[Polly]

Keeleecat,
My advice to you is ask your vet to completely explain everything and anything to you,and whatever you don’t understand,tell your vet,they will explain it to you, they are there to help you as well as your pets.
Good Luck

[KeeleeCat]

Thank you, everyone, for all the advice! I will give an update once we learn more!

[Mblakely]

Hello!

I just had this occur today at my vet with my 8 year old male cat. Blood work was all normal, SDMA level 7 but his Creatinine was high. She said if his sdma was high, he'd be diagnosed as stage 3 chronic kidney disease.

Doing a urine sample tomorrow.

This is the only post online I could find that was similar to his situation. What ended up happening? I'm absolutely in a panic over this to be honest as my cat is my fur baby!!

Thank you

[Mollycat]

What ended up happening?

In January this year Keeleecat posted about other health problems and has not posted since.

Don't panic. For one thing high creatinine on its own does not necessarily point straight to kidney problems, especially if SDMA is normal or low. It can even be affected by how recently the cat has eaten. Stage 3 renal failure would have significant symptoms and raised urea/BUN as well as a list of other highs and lows. The urine test will tell you much more but even a mild kidney or urinary infection or dehydration can give false readings. Out of interest what is this high creatinine, do you have a number? Do you have any other test results?

[Mblakely]

Thank you for replying Mollycat!

I don't have the exact number. Now that I'm home I realized I should have asked for the sheet with the blood work results. I will ask for a copy when I drop off the urinary sample.

When I saw the chart, as well as the vet explained, his creatinine was abnormally high (out of the mid range. Had a red line marking it. I'd say approx 70% on the bar?)

They checked for diabetes, his thyroid, and a bunch of other chemicals as well. All came back clear. Just his creatinine was super high, but everything else (including SDMA was normal)

About a month ago, when peeing, his back leg would just get soaked. It happened about 6 times. It stopped after a week and wasn't consistent when it was happening. I called the vet then and this was the earliest they could see me.

He has no other symptoms. Super big appetite, energetic, and chatty cat as usual.

He did have a fancy feast tin and temptation treats before going to the vet. Do you think that could have something to do with it?

Also will the urine test rule out CKD? They also said they would like to do an abdominal ultrasound depending on his urine test results.

[Mollycat]

Reduced kidney function can't be ruled out, but it certainly can't be confirmed by one reading of high creatinine. SDMA normally gets high before creatinine does, and is normally considered to be more accurate and an earlier indicator of kidney problems. Without any other symptoms or readings outside of reference range, a large meaty meal just before the sample was taken could well produce that result. The main thing is to wait for all the results together and a cool level headed look at them.

In the meantime, this website http://felinecrf.org/diagnosis.htm is a really good guide to CKD from healthy all the way through, it's tremendously well researched, reassuring, informative and helpful. There is lots more to it but I have linked the page summarising results with links for more detail on each subject. Hopefully it's not time for you to be reading it yet but it might help reassure you that even if there is early kidney function loss, it's not something to panic about.

[booktigger]

The vet should have explained to you that eating can affect blood results, they should be done on an empty stomach for best results (my old vet wouldn't do them unless the cat had been starved first for that reason), but as said, if he had CKD, the SDMA would have been high too.

[Mblakely]

Are there any other medical probabilities for just high creatinine without high SDMA ? (I.e. cancer)

Wasn't able to get a urine sample from him today so will try again tomorrow. Anxious to hopefully have some answers from the vet that he is okay!

[Mollycat]

How are you trying to get the sample, did the vet give you special litter crystals? You shouldn't need to be running around after him with a little sample tube! Many many years ago when the urine sample was the main diagnostic tool, my vet had us take away the litter tray the night before then see her in the morning and she massaged his bladder so that he delivered the sample in a dish at the surgery. Why they don't do this any more is beyond me. None of the risks of a poo in the special crystals, no risk of another cat going in it, none of the risks of a fine needle sample. I feel I'm becoming old and grumpy but really, I ask myself sometimes what they teach vets these days.

I'm afraid I think your vet's communication and people skills might be lacking somewhat too, sorry to be so blunt. It's irresponsible to leave you in such a state of anxiety with scary sounding suggestions that (at the moment) don't even make much sense.

Yes there are lots of things far more likely to cause high creatinine and normal SDMA, the most likely being a big meal and none of it being worth getting yourself in a tizz over.

What were your cat's symptoms that made you take him to the vets?

[Mblakely]

Vet tried to get a urine sample at his appt but they said his bladder was empty.. so I had to purchase a urine sample kit with litter that doesn't absorb urine. Problem is if he poops in it, it's null and void so I'd have to go buy and pick up another kit.

My cats caught on to me changing his litter and now won't use it during the hours the vet is open, where I can deliver the sample *they said it has to be within 4 hrs of him urinating and they're only open 830am-400pm.

Very frustrating.

Symptoms were from 1 month ago. He peed on his back leg about 3-5 times, like soaked ! I called and I couldn't get in until 3 weeks later which was also frustrating.

It stopped happening after a week and hasn't happened since.

The other concern was his weight. He weighed in at 4.55kg and is very thin in my opinion. He eats 1 full fancy feast tin a day, about 20 temptation treats, and a full bowl of food (approx 1.5 cup). Just is not adding up that he can't seem to gain any weight.

And please don't apologize for being blunt. You've been very helpful and reassuring, so thank you!

[Mollycat]

Still none of this is pointing towards ckd as a first choice, perhaps a urinary infection.

All I can suggest to encourage him to go at a more convenient time would be to take away the tray overnight, assuming he is a clean cat he would rather hold on till morning when you give him the crystals rather than anywhere else and he should produce a sample for you by lunchtime.

[Fifi2021]

Hello, I'm so glad I found this thread as my cat has the same issue and it's really puzzling me and her vet!

My cat is 1.5 years old. A few months ago she had a full blood test as a precaution following an infection with fever. She'd lost significant weight, down to 3.3kg from 3.7kg. The blood test showed normal SDMA (10 μg/dL) but elevated creatinine (169 μmol/L) and very slightly elevated urea (10.3 mmol/L, the reference is 2.5-9.9 mmol/L). The vet then did a urine concentration test which came back normal.

A repeated blood test 8 weeks later has just shown that SDMA is slightly higher at 11, urea is now 9 but creatinine has gone up even more to 184 μmol/L. So the vet has suggested another urine test and then perhaps an ultrasound of her kidneys. Since the first test she has gained weight back up to 3.5kg, has no fever and is eating, drinking and behaving normally so the infection has seemingly cleared.

I'm so worried that she might have something wrong with her. The normal SDMA and urea but with high and increasing creatinine seem to be very unusual and I don't want to put her through unnecessary tests for nothing. I'm not sure if her weight loss and the fact that she wasn't fasted before the tests might be impacting creatinine, or if there's something more sinister going on.

If anyone with a similar experience can share a diagnosis or any more info I'd be so very grateful!

[booktigger]

Fingers crossed for her - creatnine can certainly be related to weight loss as it is connected to muscle metabolism.

[Mblakely]

Update!

Urine test came back normal.

He has been great all summer. I changed his wet food to blue true solutions (pink and purple cans). His coat is noticeably a lot shinier. Much better than fancy feast is my understanding.

Today he went in for dental cleaning, blood work and an ultrasound. I'll get the results tomorrow

He's home now but whenever he lays down he gurgles everytime he breathes. It's late at night here but I called the vet worried. They said it's either mucus in his throat from the tube, or water is in his lungs from his stomach.

I'm concerned as ever. He occasionally tries to clear his throat and it just sounds super watery and uncomfortable. I'm hoping it just mucus but will be calling them first thing again in the morning. This is not normal from what the night vet said.

Wish us luck

[Mollycat]

Surely if he had water in his lungs he would be coughing not gurgling. And if he was properly starved for a dental his stomach should be empty anyway. Be interesting to see what the final verdict is on his kidney function, after anaesthesia ... we normally have blood work before, so that if there is any kidney issue they can be put on a drip overnight before and after to aid recovery.

It is normal to have a sore throat for a while, possibly several days, after intubation. It's not a very nice thing to have done! How is he recovering, other than the gurgle?