Kidney failure

[Laura]

Hi All - I'm new to the board. My 9-year-old Mimi was first found to have elevated BUN and creatinine maybe 4 years ago, but for several years it was mild and we just monitored it. Last spring, she developed a UTI and then nephritis. We nursed her through the acute problems with frequent sub-Q fluids, antibiotics, etc., and she had been doing much better - she gained back weight and was eating pretty well. But for the past three weeks her appetite has gradually declined. She eats some, but most days it's very little, and requires lots of coaxing. We increased her sub-q fluids from twice a week to every other day for the past two weeks, and her appetite has not seemed to improve. Probably because she's not eating much, she's not moving her bowels much either, but every few days seems to have a normal bowel movement. She looks to me to be losing some weight.

What's worrying me the most is that we are scheduled to go out of the country for four days three weeks from now. We have a professional pet sitter who comes everyday, but can't give sub-q fluids. (It's really a 2-person job with Mimi - she's not cooperative.) I suspect Mimi may not eat in our absence.

I guess I'm looking for advice on two points. I'm most upset about the upcoming trip, and am not sure if she can go four days without fluids and us to coax her to eat. But I'm also thinking of the long-term course of her illness and how best to manage it. Any words of wisdom?

[Tina B and crew]

Hi....not very knowledgable on the long term stuff myself, so I hope someone else can advise there...but as far as going out of town is it possible that one of your vet techs at your vet would be willing to come in and do the sub-q fluids with the petsitter? Is there a possibility of someone staying at your home for the 4 days you are gone so they can try to coax her throughout the day? Will the petsitter you have hired stick around until Mimi eats and make sure she eats?? You could be right that Mimi may abstain from eating with you gone...does she know the petsitter who is coming it? I petsit for a CRF cat and and FIV so I know the coaxing routine when it comes to eating...it's tough enough when it's your own cat, even tougher when it's someone elses in your care. But the lady I petsit for always gives me numerous options to coax her cats...she leaves several types of cat food, cooked chicken, babyfood, tuna...anything it might take for me to help coax her kitties. So far I've not had too many problems. I always take the time to make sure the cats eat at least something and report to her what they eat and when. This way she knows if they need to have vet interevention while she's gone. She also leaves me the numbers to several vets she uses and arranges finances with them in case I have to take the cats. Hope all goes well for you and for Mimi

[Traci]

I would strongly suggest a new blood profile right now to determine her kidney function and to rule out other potential causes of illness. You can't risk sudden weight loss and anorexia with a kitty predisposed to CRF. If her kidneys aren't filtering, sub-q fluids are paramount to her recovery.

I would also strongly suggest leaving her with your vet when you are gone. In the event your vet finds the BUN and creatinine elevated again or that she is seriously dehydrated, she would fair better with your vet to ensure she is properly hydrated as well as given proper nutritional support. If she is left home without fluids and is suffering anorexia, she could develop a serious problem induced by stress/dehydration and not getting it treated immediately could prove costly and consequential.

You didn't mention her urination habits, nor her drinking habits. Is she producing a normal volume of urine on a daily basis? When was her last urinalysis? Is she drinking normally or excessively? If the latter, don't wait, get her to your vet immediately for a new exam and full bloodwork + urinalysis. Coupled with weight loss and anorexia (and impending stress if you leave her at home for 4 days), you can't risk a potential developing problem going undetected.

As for managing the condition, only your vet can instruct you...based on her lab results, degree of hydration, extent of kidney disease, and any concurrent bacterial infections if any. CRF cats or those predisposed to them should always be frequently monitored including bloodwork to ensure the kidneys are working as optimally as they can and to treat where necessary.

[Laura]

Thanks to Traci and Tina for the advice. Mimi's drinking and urination started to increase slightly along with the decreased appetite, which is why we increased the frequency of her sub-q fluids. Her general hydration/drinking/urinating seemed improved at that point, although the appetite didn't also improve the way I had hoped. She hasn't had a urinalysis since her UTI (April). She was last at the vet for blood work at the end of August, and at that point her BUN was 59 (down from 87 in April) and her creatinine was 5.9 (down from 9.1) - so they were improved but still elevated. I'll bring her back to the vet on Monday to repeat the blood work and urinalysis. The only reason I haven't yet is because every few days she'll have a "good" day and eat pretty well, and then I'll get optimistic and think she's doing better. The upcoming trip has me pretty worried, though. I suspect boarding her at the vet may be the best thing in terms of her health, though maybe not her quality of life. The only other time she spent any time there (just a day!) she howled, bit, peed on everyone, refused to eat, puked when they force fed her, and generally made herself unpopular. Last time I called for an appointment, the tech asked, "Oh, is that the mean Mimi or a different Mimi?" Yup, she's the mean Mimi, but at least her mommy loves her. Thanks again for all the help.

[Traci]

Laura, I just want to caution you about frequent evaluations and why they are so important. By the time kidney disease/failure is detected, most often over 2/3 of kidney function is lost by the time it is diagnosed. For this reason, CRF kitty-owners must be overly cautious and re-examine their cats frequently because the BUN and creat can rise unexpectedly at any given time (most often under normal circumstances, but stress can play a big role as well, not to mention secondary health conditions). Another common problem with some cats is secondary hyperthyroidism, heart disease, diabetes or liver disease, any of which can occur secdondary to primary kidney disease. Left undetected, keeping the disease managed could be extremely difficult and costly.

Lastly, you want to get her re-evaluated and ask for a thorough oral health exam to make sure she isn't developing potential mouth ulcers or other bacterial problems that could be causing the anorexia (common for some CRF kitties). Being that she is indeed drinking and urinating more than normal, you need to assess her hydration status, kidney enzyme levels and rule out secondary health problems. Both good and bad days can occur with a CRF kitty, never ever assume because a good day or more has occured, that kitty is in fact healthy.....such is not always the case.