Renal failure cat - any way back?!

Re: Renal failure cat - any way back?!

Kate Richardson — Thu, 06 Jun 2013 14:53:27 GMT

[quote user="Mark Holmes"]This is really pedantic - I appreciate that but don't we monitor liver enzymes ( mostly) and renal parameters? I have always found calling urea, creatinine and phosphate "kidney enzymes" difficult. Anyway I am going back to my greenhouse now where I can throw stones and break windows.

[/quote]

Absolutely right, I stand corrected! I do usually call them parameters!

Re: Renal failure cat - any way back?!

bob lehner — Wed, 05 Jun 2013 08:48:55 GMT

[/quote] Not pedantic at all - urea, creatinine and phosphate haver never been enzymes and are never likely to be...!

Re: Renal failure cat - any way back?!

Michael Woodhouse — Tue, 04 Jun 2013 23:49:13 GMT

BB - for the best! :D

Re: Renal failure cat - any way back?!

Busybee — Tue, 04 Jun 2013 23:35:36 GMT

Cat was PTS this morning.

I did give maropitant and buprenorphine last night (and I'd already stopped the fortekor) as a last-ditch attempt to encourage some improvement but to no avail - still completely inappetant.

[quote user="Kate Richardson"]I don't know if you checked electrolytes other than Ca[/quote]

Yep, potassium checked and amazingly was normal (I think 4.0 from memory).

[quote user="Kate Richardson"]Also worth antibiotics, as pyelonephritis cases are ones that respond well to fluids and antibiosis[/quote]

Sorry, should have said, cat was on amoxy/clav (I think) as well.

Re: Renal failure cat - any way back?!

Mark Holmes — Tue, 04 Jun 2013 23:23:32 GMT

This is really pedantic - I appreciate that but don't we monitor liver enzymes ( mostly) and renal parameters? I have always found calling urea, creatinine and phosphate "kidney enzymes" difficult. Anyway I am going back to my greenhouse now where I can throw stones and break windows.

Re: Renal failure cat - any way back?!

Kate Richardson — Tue, 04 Jun 2013 22:27:52 GMT

Probably too late now- cat either better or R-ing IP, but a couple of comments.

It is rare for cats with renal enzymes and particularly such extreme hyperphosphataemia to respond to tx- the phosphate in my experience is often more of a reliable prognostic indicator that the urea/creat. However you get the occasional case that does respond to treatment. Echo the use of anti nausea therapy and also agree not to be using fortekor in such a case. I don't know if you checked electrolytes other than Ca, but hypokalaemia is common in renal cats and will cause inappetance and anorexia, and then is further exacerbated by the reduced intake, so if the owners want to do everything, you must check potassium levels and supplement if necessary. Also worth antibiotics, as pyelonephritis cases are ones that respond well to fluids and antibiosis. Personally I don't use mirtazipine or other appetite stimulants (although there is a case for the anti-nausea effects of mirtazipine) in these cases as I want to correct what I can correct and if they still won't eat, I think euthanasia should be advised.

Re: Renal failure cat - any way back?!

Martin Atkinson — Tue, 04 Jun 2013 12:32:43 GMT

Could try a Skin Button so the owners can give fluids easily at home, might buy it a couple of weeks.

Re: Renal failure cat - any way back?!

Busybee — Mon, 03 Jun 2013 23:06:32 GMT

[quote user="robloxley"]

[quote user="Busybee"]The rate was lower due to worries about the heart murmur but this cat needs fluids![/quote]

Is the cat anaemic and the murmer haemic rather than primary heart disease?

[/quote]

PCV an Hb low normal, RBC normal.

Re: Renal failure cat - any way back?!

Rob Loxley — Mon, 03 Jun 2013 23:04:47 GMT

[quote user="Busybee"]The rate was lower due to worries about the heart murmur but this cat needs fluids![/quote]

Is the cat anaemic and the murmer haemic rather than primary heart disease?

Re: Renal failure cat - any way back?!

Busybee — Mon, 03 Jun 2013 21:47:02 GMT

And yes, urinating a good few times a day.

Re: Renal failure cat - any way back?!

Busybee — Mon, 03 Jun 2013 21:46:30 GMT

Thanks for all the advice everyone!

[quote user="Michael Woodhouse"]

What sort of fluid rate have you got the cat on, and is it urinating regularly?

I've had some cats improve dramatically when they have altered position and the drip gone in faster than I intended.

[/quote]

At the moment, 30ml/hr (3kg cat). The rate was lower due to worries about the heart murmur but this cat needs fluids!

I feel he will be put to sleep in the morning :(

Re: Renal failure cat - any way back?!

Michael Woodhouse — Mon, 03 Jun 2013 21:34:28 GMT

What sort of fluid rate have you got the cat on, and is it urinating regularly?

I've had some cats improve dramatically when they have altered position and the drip gone in faster than I intended.

Re: Renal failure cat - any way back?!

Mark Hedberg — Mon, 03 Jun 2013 21:32:56 GMT

I would probably elect to PTS, if you have an owner who would wait for 3 weeks, that cat probably won't get proper home care. Sure, you can pull out the stops to get things back on track but if the cat's just going to go home to suffer again, it's not fair for the cat.

Re: Renal failure cat - any way back?!

Louise6732 — Mon, 03 Jun 2013 21:25:24 GMT

If the urea and creat are so high despite being on IVFT I think it's time to let it go. It is highly unlikely to survive (especially survive comfortably with an acceptable QoL) for more than 24hrs once off IVFT. I don't think this cat is likely to eat with urea and creat so high.

One thing I would say for the future, and it is purely personal preference, I would use maropitant (1st) or metoclopramide (2nd) for V+/nauseous cat, rather than go for ranitidine. I think they are more potent. Also always use buprenorphine in these cases as I'd image there are plenty of ureamic ulcers in the stomach etc that we can't see.

Louise

Re: Renal failure cat - any way back?!

Andrew Kent — Mon, 03 Jun 2013 21:20:04 GMT

Probably this cat is beyond help but the one sentiment I would strongly agree with is that Benazepril should not be used in a case like this. It will drop GFR and so make azotaemia worse. It should only be used in stable CRF cases.