Feline Kidney Stones in young cat

[holtergirl]

Julianna, my 3.5 year old adopted dsh cat was recently diagnosed with kidney stones in both kidneys. The symptoms which caused me to get the x-ray was chronic incodences of blood in her urine. Antibiotics never got rid of the blood problem. She has no crystals or bacteria in her urine, just blood. We put her on S/D for 5 weeks hoping the stones would dissolve if they were struvite stones. A recent x-ray showed they did not dissolve. In fact, she is extremely lethargic and all of a sudden after being on S/D, her gums became extremely red, swollen and had to have 5 teeth pulled. Is this because of the acidity/calcium in S/D? Would this indicate she has Calcium Oxalate stones? My vet referred me to an internist, he is not comfortable removing the kidney stones. Everything I've read suggests the best way to manage & prevent recoccurrent is to remove the stones but there aren't any vets/internists I know of that are comfortable surgically removing stones from a kidney. It seems to create more problems then it's worth. Research I've done on non-surgical procedures (lithotropsy, laser shockwave, etc) might do more harm than good to her kidney. So I'm not sure where to turn. The less invasive solution would be to: 1) eliminate the blood in urine problem without having to remove the kidney stones (if this is even possible), 2) minimize any pain she is having due to the kidney stones through meds and 3) feed her a diet that prevents new stones from forming (but we won't know what kind of stones they are without surgery).

Is anyone familiar with this type of case and any new/advanced procedures on how to non-surgically diagnose and/or dissolve kidney stones? Or have experience in the 'less evasive' procedure I've outlined above?

Thanks in advance.

[Mona]

I really feel for your situation. I have a 5yr old and a 3 monthold both girls.

ALthough I cannot offer medical advice, I wish to offer my prayers to you for your little girl's recovery.

Traci is very experienced and will offer excellent advice to you.

Healing thoughts from,

Mona, Honeybun and Chloe

[Traci]

Well, a high acidifying diet, or urine acidifying supplements used in combination can indeed cause oxalates, but without knowing the nature of the stones at this point, I would suggest ceasing the S/D and trying C/D-s instead, this might promote a more normal pH, halting or preventing the potential for oxalates. Also, you don't want to feed S/D long term for just such reasons (two-three months at most, then can usually be maintained on C/D anyway). Need to ask your vet about that because you don't know the type of stones.

As for the conservative approaches, the blood isn't going to be controlled through diet, acidifiers, or medications, not to the degree you want. The blood is probably coming from the stones' enlargement, the number of stones, tears in lining, irritation from the kidneys. Surgical removal is truly best, in my opinion, for this situation. I can't imagine the specialist not referring you to another specialist with experience and clinical expertise in this area. Please call them back and demand a referral, you may need to be prepared to go elsewhere or even some distance. Or, you could ask your current specialist to consult with a specialized feline urologist (Katherine James, DVM-feline renal and urology specialist, comes to mind), and have the consult review your kitty's health history, current labs and all other medical records.

As for her oral health, not sure I would contribute the problems soley to the S/D, not saying it's impossible, but I'm not sure it's likely. There could also be a secondary bacterial infection unrelated, or, could be another condition surfacing, such as stomatitis, suppressed immune system, (has she been tested for FELV/FIV?) I assume your vet has ruled these out?

In my opinion, you are entitled to, and deserve, to demand a professional consult on your behalf. I would start by asking the specialist to contact the nearest veterinary university for a specialist with case histories of successful surgical intervention.

[holter1019]

All,

Thanks for the feedback and support. My cats are my kids and I will do anything for them...I truly value others' opinion & experiences..I feel like I have to be my own advocate when it comes to healthcare for myself & my 3 cats. Oh, and my husband poor guy, he's 4th on the food chain).

Traci, you wrote:

I would suggest ceasing the S/D and trying C/D-s instead, this might promote a more normal pH, halting or preventing the potential for oxalates. Also, you don't want to feed S/D long term for just such reasons (two-three months at most, then can usually be maintained on C/D anyway). Need to ask your vet about that because you don't know the type of stones.

We had Julianna on C/D-s for 4 weeks or so early on, prior to the S/D hoping it would clear up the blood. It didn't. Next step was to x-ray. The x-ray showed small kidney stones in both kidneys. So we took her off C/D-s and put her on S/D hoping they were struvite & would dissolve. So here we are today: After 6 weeks on S/D, none of the stones have gotten smaller. Vet is waffling on whether to keep her on S/D. My gut feeling is get her off it...2 more weeks isn't going to make that much of a differnece. I have this urgency to get her off S/D simply because of the things I'm seeing since she's been eating S/D: rapid digression of her dental hygiene (no peridontal disease in March gen health checkup then after being on S/D for 6 weeks she has severe peridontal disease??) something doesn't add up. Maybe S/D is creating such an acidic environment for her it could be causing other probs to surface (stomatitis, etc). What's next, stomach ulcers, vomiting?? Plus, every urinalysis they've done on her show normal ph levels, no bacteria just blood.. I thought stones had to have abnormal ph environments to grow? She's current on all vaccs & has tested neg for FELV/FIV.

I can't imagine the specialist not referring you to another specialist with experience and clinical expertise in this area. Please call them back and demand a referral, you may need to be prepared to go elsewhere or even some distance. Or, you could ask your current specialist to consult with a specialized feline urologist (Katherine James, DVM-feline renal and urology specialist, comes to mind), and have the consult review your kitty's health history, current labs and all other medical records.

Sorry, my vet did refer me to an internist team here in Dallas. No one on their staff specializes in Nephrology/Urology which is important to me; to find an internist with this specialization. There's a Dr Lee's at Texas A&M that I've heard & read really good things about but he's not on rotation till next year (it's a teaching animal hospital) My vet is going to call & see if there's someone else 'as qualified' at A&M. I'm almost tempted to take her to Purdue University for the surgery. They recommended to my vet that we do kidney surgery as opposed to lithotropsy which they have been successful at. I will definately ask for case histories. Where is Katherine James located?

Thanks again!!!

[Traci]

Kathy James can be found HERE....she is currently at U of Wisconsin, and is also currently actively consulting for VIN (one of the leading veterinary professional portals on the web, your vet or specialist probably has membership, if not, they can simply contact her for a consult). Her contact information can also be found in the link. She is a leading expert in the field of nephrology/urology.

The thing about the S/D, is that it could still be a potential struvite dietary approach, but given your account of her recent oral problems, I would tend to agree with ceasing it in the event it is causing the problems. I would still strongly suggest ruling out stomatitis and immunological problems on the offchance that a secondary problem is surfacing. Not sure if you know, but if you haven't currently tested for FELV/FIV, this can be a precursor to stomatitis in some cats, so I strongly recommend getting her tested, at least to help rule out stomatitis. In a kitty this young, the gum inflammation and number of extractions are extremely concerning and you need to make sure other rule-outs have been explored. On the offchance she may be positive for FELV/FIV, stress can bring about the actual virus (if previously undetected) and an FELV+ cat can develop a miriad of secondary health conditions under stress or due to an already compromised immune system. Not wanting to alarm you or jump the gun, just want you to cover all your bases.

As for Texas A&M, check out This Link and maybe opt for a consult with Alice Wolf, DVM if possible, or any of the specialty surgeons. Your vet should be able to consult with one or more of the surgeons for more input.

[holterg]

Julianna tested negative for FeLV/FIV on 4/23/01 per the adoption contract. What do you mean by currently tested? Why would she need to get retested? She's a strictly indoor cat as well as my other 2.. Regarding stomatitis: I would think after her dental cleaning & extractions last week my vet would have alterted me of any stomatitis symptoms: ulcers, lesions in throat, etc. Her chart read: sever peridontal disease. I'm thinking her dental probs are either related to the acidity/calcium deficiency caused by the S/D or her kidney probs. Can't explain why it's so bad this young...vet didn't have an explanation...

Thanks for the specialist referrals.

Renee

[Traci]

It never hurts to retest for FELV/FIV at any time you might suspect immunological problems. I don't know if a suppressed immune function is truly a concern at this point, don't know if your vet has thought about it. But, I did want to mention the possible connection between the oral problems and potential stomatitis, simply to get it ruled out.....and there are various causes to severe peridontal disease, immunologial function would be one thing to rule out. Stomatitis also is not always accompanied by ulcerations, least of all in early development.

As for the FELV/FIV testing, a snap test is usually accurate and reliable, but sometimes, they do produce false positives and false negatives, so for this reason, it wouldn't hurt to retest in the diagnosing process. For example, I had a kitty with a compromised immune function, and had her tested at least 4 times within a 3 year period, based on her clinical symptoms, suppression, labs, etc (and because we couldn't accurately determine FELV was a rule-out). I don't mean to harp on the subject, not my intention, just want you to discuss it with your vet.

If you have a second vet confirm your suspicions concerning the present diet, then you may be able to rule in the acidity as the cause of her oral problems, but until then, at least talk about it with your vet.

[holtergirl731]

I'm going to ask my vet today if he's considered this.

Thanks.

[holtergirl]

Traci,

When I asked my vet what we could do to get rid of the blood in her urine, which has been present for over 4 months now, he said "nothing". Before we x-rayed, he put her on Baytril which didn't clear it up. She's on it for 10 days then we recheck urine. He said as long as the kidney stones are there she will continue to have blood. Interestingly she hasn't every had bacteria. Is this "lack of treatment" consistent with your experience?


Thanks.

[Traci]

Your vet is correct. As long as there are no bacteria present in the urine, antibiotics are essentially useless at this point (unless there are other secondary infections). As I mentioned earlier, the blood is a result of irritation, size and number of the stones, possible tearing in the lining, inflammation, etc. Without surgical removal, I suspect the blood will continue. You could ask your vet about anti-inflammatories, but again, don't know if that would be an appropriate approach (especially if her immune system is suppressed, while anti-inflammatories can help with that, in severe cases, they can actually do more harm than good)

What have you found out yet about potential consults??? I really want to stress the importance of timing here....it seems you've been dealing with this for an ungodly amount of time...those stones need to come out (in my honest opinion)