Should we carry on with erythropoietin in this cat?

Re: Should we carry on with erythropoietin in this cat?

Rajat — Fri, 20 Jul 2012 12:14:43 GMT

mineralisation can be normal in older cats without hyperphosphatemia though high ca-P product obv will make this worse

doesnt explain crackles though

any signs of cardiac disease and has it had an echo? crackles may reflect chronic bronchial disease as well not just oedema...

I dont need to tell u this, but uf there is cardiogenic p oedema, frusemide will be needed, azotemia or no azotemia as CHF will kill the cat quicker than its renal disease..tough spot if true. best bet= chronic asthmatic cat which has gone un noticed by its owners so far! steroids and its well again (apart from the failing kidneys bit )

Re: Should we carry on with erythropoietin in this cat?

Laurence Webb — Wed, 18 Jul 2012 12:27:56 GMT

Well it seems that the erythropoietin is not the problem. The cat came in today (planned to give eryhtropoietin and observe it for an allergic reaction) but on auscultation the lungs were crackly, which wasn't present at the previous exam.

X-rays show mineralisation of the thoraxic aorta which would fit with the hyperphosphataemia that we have had difficulty controlling. I guess adding in more phosphorus binders to the diet will help although the cat is a hunter so the phosphorus intake will remain an issue. I expect the owners will be unwilling to force the cat to become a house cat as that will compromise its quality of life.

It is already on Fortekor as it has a very high UPC and hypoalbuminaemia. It's not hypertensive. Not sure what else to do - diuretics for the lungs aren't going to help with dehydration. Between a rock and a hard place methinks!

Re: Should we carry on with erythropoietin in this cat?

Martin Atkinson — Mon, 16 Jul 2012 11:37:10 GMT

Interesting, I've administered tons of Eprex to dozens of cats, had loads of success but never had a suspected reaction obviously could happen though. Nix's approach to this seems sensible.

Re: Should we carry on with erythropoietin in this cat?

Nixthevet — Mon, 16 Jul 2012 10:30:06 GMT

I haven't had a lot of experience of using erythropoeitin myself ( as I haven't worked in daytime practice for some years now) , but I would probably suggest having a (documented) chat with the owner to explain the risk of anaphylaxis and then if they are happy for you to continue then i would carry on giving the injections as they appear to be working. At the end of the day the CRF is going to kill the cat and the side effects/morbidity associated with the process are pretty grim in terms of quality of life- so if it has come to the point of adminstering the erythropoeitin and it seems to be making the cat 'better in itself' then I would say that it's benefits would seem to outweigh the ( significant) risk.

If the cat is in the surgery being monitored then at least you could ( potentially at least) deal with any allergic reaction.

I'd be interested to hear anybodys thoughts on pre-administering a very short acting steroid/antihistamines ( risk vs benefit again as obviously not ideal but is the cat's kidneys are already struggling then any drop in BP/reduced perfusion would potentially be catastrophic).