Seeking second opinion on my cat's CKD, T4, and medication changes.

Hello, I am sorry I misunderstood your question earlier. I hope this response helps you. In order to stage renal failure, we need to know the urine specific gravity, blood pressure, and urine protein to creatinine ratio. Based on the values you provided, she has chronic kidney disease but I cannot stage it without further information. If the free T4 was elevated that is consistent with hyperthyroidism which often masks underlying kidney disease. Therefore, her kidney disease could be worse than we suspect based on the info you provided above. Realistically, she has two diseases and fortunately both are treatable. Ultimately, the prognosis depends on response to therapy. It is not uncommon for some patients to do well for a few years with appropriate therapy and kidney diet. Prior to treating her hyperthyroidism, her kidney disease should be treated (at home) with subcutaneous fluid therapy, antibiotics to cover for an underlying kidney infection, and vitamin B12 supplementation. After she feels better and begins eating consistently, discuss treatment for hyperthyroidism.

From what the blood results are showing your cat is not having any important renal issue at this stage. Hyperthyroidism is well controlled as well. It will be good anyway to keep monitoring renal parameters (Urea and Crea) but adding also the so called SDMA which can indicate early stage renal failure (more sensitive than the other two). I think is a good idea to increase anyway the amount of wet food he is having, and if he likes sardines, of course that is a good option. Hope this answer was helpful, but please do not hesitate to contact us again on the forum or by requesting a consultation if you have any more questions or to discuss it any further.

Unfortunately kidney values can not be interpreted without a urinalysis and specific gravity. Elevated BUN is not always CKD but this would be more likely in the face of poorly concentrated urine ( pred will also effect this). CKD is staged via what is called IRIS. This takes in to account creatinine, protein in the urine, and blood prressure. SDMA is newer and thought to be an earlier indicator then BUN/creatinine as these as insensitive markers of kidney function. This has now been incorporated in to the new IRIS scheme. What i would recommend for your kitty is a urinalysis and blood pressure to better stage. For early stage CKD kitties a renal diet is recommended. It is also important to treat any high blood preesure or significant protein in the urine as these can worsen kidney function. I hope this helps and thank you for using Petco Pet Education Center, formerly Petcoach!

Hi, thanks for using Petco Pet Education Center, formerly Petcoach! I would basically call that stable as long as Tony is feeling well. I would be sure that your vet has done a urinanalysis to check for protein and have checked his blood pressure. There are medications to control those things and thus prevent further kidney damage. Otherwise the plan sounds reasonable. Good luck!

I don’t think this shows renal disease. His creatine is normal with a slightly elevated BUN. To me this is more an indication of mild dehydration than kidney disease. He is slightly anemic also which is not uncommon in senior animals but may indicate a chronic medical problem. The eosinophils are slightly elevated which can be due to allergies or intestinal parasites. Basically for a thirteen year old cat there is nothing here that is overly concerning. Bloodwork is just a moment in time though so if you’re concerned I would repeat it again in a month or two so you can see if there is a trend indicating progression of a medical problem or kidney disease. Thanks for using Petco Pet Education Center, formerly Petcoach to help you care for Beau.

Thank you for submitting your question regarding Sundari. Her BUN and Cr are mildly elevated. This can indicate early kidney disease, but there are other causes as well. Simple dehydration will make these values increase. I would recommend that she has a urinalysis performed on a first morning urine sample. This sample will be the most concentrated and give you more information regarding how the kidneys are functioning. There is also a new blood parameter known as SDMA. This is much more sensitive indicator of kidney function than BUN/Cr. I would recheck her blood work in 1-3 months to monitor the liver value (ALT) that is slightly elevated to see if this is a consistent finding. Liver enzymes can fluctuate in the blood stream so this may not be significant. I hope this information helps!

Poor guy. I see elevate liver enzymes (ALT,AST) and kidney values on the paperwork you have attached here. Low hgb means that the red blood cells are not oxygenating well, but if the RBC count is also low (anemic) then that is a sign of chronic kidney failure. Cats can recover from kidney disease depending on the underlying cause. An abdominal ultrasound is needed to determine the cause of the kidney failure exactly, or a positive response to bloodwork is used as a means of determining a positive outcome. In most situations we treat the pet with fluid therapy to help idurese (flush out) the harmful toxins (BUN, CREA), get the pet started on a prescription kidney diet (ie. Hill's K/D, Royal Canin Renal) and also a supplement (Azodyl- which helps to remove toxins from the gut) can be given as well. The most concerning values for me on this bloodwork are the liver values (AST, ALT). It is not common for a cat to be in both kidney failure and to have abnormal liver values concurrently. THis raises suspicions for infectious diseases such as any number of tick diseases. I would recommend discussing with your vet about possibly doing a tick panel, if the history indicates tick exposure is probable. Also a FeLV/FIV test may also be indicated, depending on the complete CBC results, which you didn't post here. At the very least a liver protectant medication should be started, which is typically a medicine called Denamarin. Additional treatment may be needed depending on the underlying cause for the liver abnormalities. If you would like to discuss Toby's case further, then please feel free to request a consultatoin with either myself or another expert here. Toby's case is definitely a more complicated case where it is best to have a complete dialogue back and forth to get all the information you need to make the best decision moving forward with his care. I wish you all the best moving forward with Toby's care and I hope that he makes a full and speedy recovery. Take care.