# Kidney failure - how to know last stages



## Paisley77 (Jul 27, 2012)

Hi y'all. I'm needing some advice from some of you who have experienced the last stages of kidney failure in kitties.

My 15 yr old Bitsy has not had a good day today. She can't keep food down and has thrown up five times - projectile vomiting. She's acted weak, lethargic and isn't her usual self when we're petting her. She drank really good at one point that I saw though. When I fed her this afternoon (which she couldn't keep down), she seemed to eat good.

I took her to the vet this afternoon to get bloodwork done, I'll know results tomorrow. Her weight was down almost a half pound (10 lbs 11 oz - her normal used to be in the 14-15 lb range) since Aug 24th when she was last in for bloodwork.

Her vomits have smelt very foul & sour. At times I've thought that her body is emitting an odor - her breath is definitely very foul, but it's always had a smell (altho it used to be more of an ammonia smell, now it's more sour & more foul).

She was diagnosed with kidney disease last October (bun 110 & creatinine 6.7). Her last bloodwork on 8/24 her bun was 59 & creatinine was 4.3). She's on sub-q every other day (I'd do it every day but she's developed scar tissue in all the places I've stuck her for the past yr that it's hard to stick her). She's been limping for months and sways and seems to lose her balance at times. I took her in for x-rays at one point to see if she had a sprain or breakage, it showed slight arthritis and that was all. I'm sure she's lost muscle mass since she was on a Hills k/d diet since being diagnosed - until a few weeks ago.

I changed her diet a few weeks ago as I was trying something new for all my kitties and had planned to get her bloodwork done in another week or two to see how she was fairing, but now I have to wonder if it's just too much protein for her body to handle afterall. For now, I've gotten her more k/d wet to eat until I find out results tomorrow and figure out whether I need to put her on another food instead of Wellborne core wet.

People say that you'll know when it's time when your kitty has more bad days than good days...but this sudden change today, it just makes me wonder. I've not had to let go of a pet before now, so this is new for me. I guess I'll know more tomorrow after the test results. Just wondered if anyone had any advice or thoughts. Thanks a bunch!


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## minikin44 (Aug 25, 2012)

I don't know much, really, except that my dog who had kidney failure developed really foul breath at the end too. I'm sorry that your Bitsy is going through this, though, and I hope maybe it was just the food change and she'll be ok again.


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## Paisley77 (Jul 27, 2012)

thanks minikin!


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## laurief (Jun 22, 2008)

I'm very sorry that Bitsy is doing poorly. The bloodwork will tell you a lot about her current condition and what, if anything, could be done to improve it. Make sure you get copies of all of her lab results. It would be very helpful if you would post them here so that we can provide you with relevant insights and suggestions. If you do post the results here, please be sure to include the lab's reference ranges like so:

BUN 50 (18-36)
creatinine 2.9 (0.6-2.0)
phosphorus 4.8 (2.7-7.5)
etc.

One recommendation I will make right now is to give Bitsy fluids every day. Her body needs them in order to maintain adequate hydration and in order for her to feel as good as possible. If you go with a smaller and sharper needle (Terumo Ultra Thin Wall 20 gauge needles are advisable), you may find that they insert more easily. Also, it may be that Bitsy is tightening her skin in anticipation of the needle stick. In that case, spend a few seconds rubbing and scratching the injection spot immediately before you insert the needle. The rubbing should help relax her skin so that needle insertion is much easier.

Laurie


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## Paisley77 (Jul 27, 2012)

Thanks Laurie! Based on her bloodwork from yesterday the vet wanted her to have 24 hr care - to give her IV fluids, antibiotics and to rule out pancreatitis, so I took her in an hour ago. Since yesterday morning she threw up at least 10 times (all of them the projectile liquid type, not little vomits). She was very weak this morning when she was walking - her back legs at one point acted like they wanted to give way and then when she shook her head at another point she looked like she was going to fall over. She's been drinking good and we gave her sub-q fluids again last night (which she seemed to perk up a little after that). 

Here's the bloodwork results from yesterday - I'm including the prior blood work numbers as well for reference. 

Results are listed in this date order - 10/8/12, 8/24/12* & then 10/10/11 (when she was diagnosed with kidney disease, a yr ago). The weight, bun & creat also have a 4th date that I'll note.

*10/8/12 & 10/10/11 have the most data as I did a complete sr blood panel those times. The blood drawn from 8/24 was a jr panel, so if there's only two numbers given it would not be from the 8/24/12 blood. Only 1 number result would be from yesterday's. 

Results that are abnormal are bolded.

Weight:
10.11 | 11.4 | 12.4 (5/5/12) | 11.5

BUN (range 15-34)
*65* | *59* | *46 *(5/5/12) | *110*

Creatinine (range 0.8-2.3)
*3.8* | *4.3* | *3.6 *(5/5/12) | *6.7*

ALK Phosphatase (range 0-62)
44 | 14

ALT (range 28-100)
*206* | 51

AST (range 5-55)
*99* | 31

CK (range 64-440)
81

GGT (range 0-6)
2

Albumin (range 2.3-3.9)
3.2 | 3.4 | 3.5

Total protein (range 5.9-8.5)
7.7 | 7.7 | 8.1

Globulin (range 3.0-5.6)
4.5 | 4.3 | 4.6

Total bilirubin (range 0-.4)
.2

Direct bilirubin (range 0-.2)
.1

Cholesterol (range 82-218 )
121 | 116 | 118

Glucose (range 70-150)
*190*

Calcium (range 8.2-11.8 )
10.3 | 10.3 | 9.3

Phosphorus (range 3-7)
5 | 4.3 | 6.8

TCO2 (range 13-25)
19 | 18 | 10

Chloride (range 111-125)
121 | 116 | 122

Potassium (range 3.9-5.3)
3.9 | 4.9 | 4.1

Sodium (range 147-156)
156 | 148 | 145

A/G ratio (range .4-.8 )
.7 | .8 | .8

B/C ratio (range not given)
17.1 | 13.7 | 16.4

Indirect Bilirubin (range 0-.3)
.1

NA/K ratio (range not given)
40 | 30 | 35

Anion Gap (range 13-27)
20 | 19 | 17

T4 (range .8-4.7)
.8

WBC (range 4.2-15.6)
*28.7* | *16.0* | 13.1

RBC (range 6-10)
6.85 | 6.79 | 6.93

HGB (range 9.5-15)
11.1 | 11.0 | 11.2

HCT (range 29-45%)
37.3 | 37.0 | 37.7

MCV (range 41-58 )
55 | 55 | 54

MCH (range 11-17.5)
16.2 | 16.2 | 16.2

MCHC (range 29-36)
29.8 | 29.7 | 29.7

Reticulocyte (range 3-50)
14 

Neutrophil Seg (range 35-75%)
*84* | *81* | *78*

Neutrophil Bands (range 0-3%)
*4.0* 

Lymphocytes (range 20-55%)
*4.0* | *10* | *14*

Monocytes (range 1-4%)
*7* | *7* | *6*

Eosinophil (2-12%)
*1.0* | 2 | 3

Basphil (range 0-1%)
0 | 0 | 0

Auto platelet (range 170-600)
*609* | 526 | 443
(10/8/12 note - platelets - clumped, neutrophils appear slightly toxic)

Absolute neutrophil seg (range 2500-12500)
*24108* | *12960* | 10218

Absolute neutrophil band (range 0-300)
*1148* 

Absolute lymphocyte (range 1500-7000)
*1148* | 1600 | 1834

Absolute monocyte (range 0-850)
*2009* | *1120* | 786

Absolute eosinophil (range 0-1500)
287 | 320 | 393

Absolute basophil (range 0-100)
0 | 0 | 0


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## Paisley77 (Jul 27, 2012)

oops, the TCO2 & Sodium results from 10/10/11 were abnormal and weren't bolded. 

Also, a reminder that for the past year she's been on the wet & dry Hill's k/d (prior to that it was the Hill's m/d), until 3 weeks ago when I put my kitties on wet Wellborne Core, no dry.


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## westfayetteville (Sep 22, 2011)

I'm so sorry to hear Bitzy is not feeling well, If it were me I would be giving her 1/4 tablet of pepcid A/C twice a day, it may help her keep food down


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## laurief (Jun 22, 2008)

Hmm, the way you described her current condition, I expected her renal values to be a lot more elevated than they are, along with very high phos and probably severe anemia ... but none of those things are present. What does seem clear to me from the bloodwork (bearing in mind that I am NOT a vet) is that, in addition to Stage 3 CRF, she has a serious infection, most likely involving her liver (and/or possibly her pancreas). After doing some research on her blood values, I would also recommend that you have her tested for feline leukemia.

Bitsy's potassium is low (CRF cats' potassium should be maintained in the upper half of the reference range), which may account for some or all of her hind end weakness. You should discuss potassium supplementation with your vet. If you're not also supplementing B vitamins, you should be doing that, as well. Cats who receive supplemental fluids are often deficient in both potassium and vit. B, because both are excreted in urine. All of that extra urine that Bitsy is producing is flushing potassium and vit. B out of her system at a faster rate than her current diet is replacing it. KD, by the way, contains extra potassium and B vits, as well as reduced protein.

Hopefully the antibiotics that she's taking now will successfully address her infection, wherever it may be. I wonder, though, why your vet has apparently targeted the pancreas as the source of the problem rather than her liver. Did she explain that?

Laurie

In case you don't have this link, here is a page that provides very useful downloadable explanations of various blood values. Just click on the name of each relevant value to download its explanation:

Broadway Veterinary Hospital / Laboratory Assessment Descriptions


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## Paisley77 (Jul 27, 2012)

I know - I expected her kidney values to be alot worse too. I was surprised.

The reason they're looking at the pancreas especially right now (waiting on the test result from that) is to rule it out so that it's not throwing off the blood numbers. If she were to have pancreatitis it can make numbers look worse. That's what I understood for why.

They've talked about doing an ultrasound on the liver, but I think they're waiting to see what her blood counts will say after being on iv fluids, antibiotics for 24 hrs (and after they find out if she has pancreatitis).

Today they gave her Cerenia, Baytril & Famotidine. I got to see her and take her to the emergency clinic where she'll stay overnight. She was cranky of course at first, but then finally was more herself before I left her. She seemed more alert.

I asked about the supplements and for now they said let's wait. They mentioned that the sub-q have those supplements in them (plus, you mentioned the foods). With her vomiting like she has been, they said that the potassium count could be down because of that. I'm definitely keeping that in my mind though to look into after we know more of what's going on with her.

Oh, on the leukemia thing - they said that since she's almost 16 yrs old (and vaccinated for it yrs ago - and an inside only cat all of her life) that the chance of her having that would be very remote. That usually cats contract it early in life and she would have died from it by now if she would have had it.

I appreciate all your help Laurie!


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## Paisley77 (Jul 27, 2012)

oh, and thanks Troy. I think they gave her some of that today.


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## Paisley77 (Jul 27, 2012)

I finally got a copy of the lab results from blood drawn on 5/15/12. Here's some of those numbers - her WBC started to rise back then.

Alk - 11 (range 0-62)
ALT - 66 (range 28-100)
BUN - *46* (range 15-34)
Creat - *3.6* (range .8-2.3)
Total protein - 7.6 (range 5.9-8.5)
Glucose - 105 (range 70-150)
Potassium - 4.8 (range 3.9-5.3)
A/G Ratio - .8 (range .4-.8 )
WBC - *15.9 *(range 4.2-15.6)
Neutrophil Seg - *81* (range 35-75%)
Lymphocytes - *11* (range 20-55%)
Monocytes - *5* (range 1-4%)
Absolute Neutrophil Seg - *12879* (range 2500-12500)

Another thing I remembered that she's been doing alot more of lately - in the evenings she'll just cry. It seems to happen before she lies down, she'll just stand there, meowing like she's crying out for someone or something. Some nights she does it quite a bit before she'll settle down.

I'll let you know what they say tomorrow.


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## Paisley77 (Jul 27, 2012)

Just got back from dropping Bitsy off at the vet from the overnight hospital. She did good overnight, no problems. Her pancreas test is back - it was pretty high. It's suppose to be under 3.5 and it was *44*. So, she's got pancreatitis (which they said can make other numbers elevated and there not really be problems with those areas...like the liver numbers being high). 

I don't know what this means yet. I don't know if pancreatitis is a condition that she'll always suffer with or it's just something that its treated and she's better (like an infection). They're going to draw more bloodwork today to see how her numbers are since the fluids & antibiotics. So far they've told me that keeping the vomiting at bay and her eating & drinking are key. I'm sure they'll tell me more later about pancreatitis (both regular vets are gone today & tomorrow, so there's a back-up person) - in the meantime I'll do some research online. As long as Bitsy isn't vomiting they said she can come home this afternoon. She hasn't eaten anything since 4pm on Monday - hopefully they can get her to eat today, but she's a shy eater, so I'm sure I can probably get her to eat.


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