kitty kidney's

[maria]

A month ago Rocky became blocked as a result of bladder stones. He had surgery to remove them. The last stone became lodged in Rocky's urethra. As his vet tried to flush the stone out, it tore an area in the urethra. Rocky continued to stay in the hospital for 10 days until, thanksfully he was urinating without a cathader. That was 3 weeks ago. He has been on all canned food diet, with tons of water. A week ago, I noticed a pouch forming where he had surgery. I took him in and his vet extracted the fluid, stating it was just post-surgical fluid. He then tested Rocky's urine and blood. The urine came back crystal-free but rocky's kidney levels are raised. I have been giving him fluid therapy for the last week. He seems to be doing awesome, good appetite, etc. I am so concerned for his well-being. Will fluid therapy help to lower his kidney levels? I just need to know if this will be successful. He is an awesome kitty who just lost his buddy to renal failure 2 weeks ago. Any advice would be helpful. thanks Maria

[Traci]

Maria, how old is Rocky, and how elevated were the kidney enzymes? Were they both the BUN and creatinine? Does or has Rocky had a history of urinary tract infections and/or blockages?

[maria]

He is only 5 years old. He has not had a history of blockage but a year ago did have stones in his bladder and had them removed. Both of the levels were slightly high. This morning I took him back into the vet so he could run an xray and see if the tear is fully healed, thinking maybe that has something to do with the raised levels.

[Traci]

Well, it could be a kidney infection (rather than urinary)....your vet will probably want to recheck the kidney enzymes in another couple weeks or so, or sooner if you feel Rocky is developing a urinary tract infection or other signs of illness (i.e., dehydration)

What were the type of stones (struvite, oxalate or otherwise)...and is Rocky on a prescription diet now? Can you also clarify that Rocky had surgery both a month ago and last year as well, or was this a typo?

[Guest]

Rocky did have surgery to remove 2 big stones in December 2002. He was not blocked, but I noticed blood in his urine and found out that he had 2 stones. After his surgery in 2002 his vet told me to put him on Hill's Prescription Diet x/d (formerly c/d-oxl) dry food. He had been on that for a year when he became blocked in January of this year. He has since been on the canned version of x/d mixed with tuna fish. I also purchased a petflow water fountain.

I do not recall what type of stone he has. The vet did mention that it is a rare case.

[Traci]

Oxalate crystals, they are the most difficult to manage. The canned version may help to some degree this time.

Might I suggest asking your vet for tips on testing Rocky's urine pH at home...I normally don't advise this, but with the difficulty in oxalate management, you might benefit from monitoring with urine regent strips at home and should persistenly abnormal pH be problematic, you can get Rocky evaluated sooner rather than wait for potential signs or a crisis. He can discuss this with you in greater detail as well as followup urinalysis if necessary.

Since this is a grey area right now with the kidney enzyme levels, it would be nearly impossible to predict if the stones have anything to do with it, as opposed to early renal impairment. For this reason, it is of course important to manage the oxalates and prevention, but equally important is monitoring the kidneys with bloodwork maybe more frequently to keep one step ahead of early renal disease. (is Rocky, by chance, a purebred?)

In answer to your question about the fluids administration, it probably would be beneficial at this point (sub-q fluids at home), especially if your vet also felt there was a high degree of dehydration....be sure to discuss the fluids with him and to ensure the appropriate amounts and fluids type are given (i.e., lactated vs NaCL etc), I'm wondering why he never mentioned that with you when evaluating the blood results.

[Guest]

Yes, Rocky is a persian. His vet has brought this up too. Is this a factor in Rocky's condition?

He was there yesterday and his vet has come to two possible conclusions. Either Rocky has acute kidney problems as a result of his surgery, etc. Or early signs of renal failure. Breaks my heart. I am giving him 200 mls of fluids morning and night. Rocky REALLY does seem ok. He is acting himself. I am having his blood checked in a week. My question is if I continue to give him fluids daily, what are the chances he will pull out of this? Is it something that possibly can be reversed.. if not and he has to be on fluids for a long period of time.. will it prolong his life significantly?

thanks for all of your help. He has been through so much it seems, in the last month.

[Guest]

I want to also add that giving Rocky fluids is very stressful for both of us. He tends to be a difficult kitty and I am not much of a needle person. He doesn't like to be held much less being poked. So any advice on how to make this process easier, especially for him would help.

[Traci]

Some purebreed cats do have a predilection for early renal disease, as in, congenital.

I think it would be rare for surgery complications to actually cause renal impairment, unless of course infection was relentless or treated inappropriately. Assuming this was not open abdominal surgery, but rather catheterization through the urethra to remove the crystals?

Another possibility is unrelated toxicity of some sort. Was there ever a chance that Rocky could have ingested a toxic substance?

As for fluid maintenance, had the BUN and creatinine been abnormally high or in critical range, or, if he felt that renal failure was a potential, your vet would have opted to diurese the kidneys with IV fluids for a 24-48 hour period in the clinic. In that event, sub-q fluids are not appropriate, they don't compensate for the true needs for diuresing the kidneys. However, if the kidney enzyme levels were only slightly above normal range and all other bloodwork was normal, with no apparent clinical signs of illness, then sub-q fluid maintenance at home could benefit greatly.

Without knowing the true cause to why the levels are high at this point, it is impossible to predict the needs for continued fluid maintenance. A recheck on the bloodwork will tell your vet more. Other factors would also be taken into consideration to diagnose renal failure, such as persistently high BUN, creatinine, severe dehydration, changes in urination, changes in eating/drinking/behavior, etc, weight loss, size and shape of the kidneys, presence of anemia, and other obvious signs of renal failure.

As for reversal, it depends on the cause. In toxicity for example, agressive treatment can often reverse the effects and damage if treated promptly and agressively at the onset. On the other hand, most cases of renal impairment/failure are already advanced by the time it is diagnosed, with up to 2/3 of kidney function loss already occuring. However, agressive treatment and maintenance can help slow the progression.

If your vet is uncertain or unwilling to persue further diagnostics to confirm, I would seek a second opinion on this so that you know you are one step ahead and that all other causes have been ruled out.

[Traci]

Maria, just saw your last post... here is another post from this forum on Tips for giving sub-q fluids

The key is to try to make the experience as pleasurable as possible....try to do it when he is most relaxed, comfortable, and make it rewarding by giving him a treat, extra attention afterwards, playtime, etc.