Cat with erythrocytosis

RE: Cat with erythrocytosis

Rob Loxley — Fri, 28 Sep 2018 13:53:32 GMT

[quote user="Martin Atkinson"]A raised BUN and Crea in an 11 year old at having a routine blood profile is enough for me to think this cat is at risk of renal failure and to take preemptive action with dietary modification[/quote]

My point was merely to highlight the importance of evaluating urine SG alongside azotemia

RE: Cat with erythrocytosis

Martin Atkinson — Fri, 28 Sep 2018 08:47:09 GMT

Sorry I forgot that we had tested the urine first time around I was more thinking about not having a urine sample at the time of the follow-up test.

As Kate suggests, a Creatinine of 210 is enough to ring alarm bells. I think we need to get our heads around the difference between renal disease and renal failure. A raised BUN and Crea in an 11 year old at having a routine blood profile is enough for me to think this cat is at risk of renal failure and to take preemptive action with dietary modification. It is on a senior diet, I have not reached for the renal diet yet.

RE: Cat with erythrocytosis

Kate Richardson — Thu, 27 Sep 2018 21:40:37 GMT

Agree that a creatinine of 210 would make me sit up (anything above 150 in a normal cat makes me look twice) but equally agree need to assess USG at same time. My experience is that even in the face of clinical dehydration, urea and creat aren't always/usually raised. Lactate is a much better measure of this. Equally have had rare cats with persistent azotaemia (and persistently elevated SDMA) that are well and not clinically dehydrated with a relatively concentrated urine but they do have renal disease as some do retain some renal concentrating ability which is a hard concept to get your head around! But going back to the OP this level of HCT wouldn't alarm me, likely just normal for this cat, but in theory a renal tumour producing EPO could cause it, so worth bearing in mind albeit probably rare. In this case I would advise continued monitoring, repeating bloods every 3 months, see if there is a gradual steady increase, poss scan kidneys early on if O keen.

RE: Cat with erythrocytosis

Rob Loxley — Thu, 27 Sep 2018 18:37:26 GMT

[quote user="Martin Atkinson"]Its USG at the time of the first test was 1.028 which if anything indicates renal insufficiency certainly not dehydration that you suggest[/quote]

I did ask, before commenting, "What was the cats urine SG - thinking more with respect to its initial azotaemia..." and you replied "not able to get a sample yet".

[quote user="Martin Atkinson"]Do you wait until they have a USG < 1.020, a UP/C of >4 and sky high creatinine, BUN and Phosphate before you do anything?[/quote]

From where do you infer this?? As I say, I did ask whether USG had been measured. I'm sure we've all seen cats diagnosed with 'renal failure' based on a single recorded time of azotaemia, without any reference to USG, still going strong with no signs of renal disease 5 years later...

RE: Cat with erythrocytosis

Martin Atkinson — Thu, 27 Sep 2018 16:06:14 GMT

[quote user="robloxley"]we often find mild azotemia with pre-ga bloods[/quote]With a Creatinine of 210 - really? I take your point but I rarely find elevation of BUN or Creatinine in healthy animals on routine pre-surgical blood tests. Its USG at the time of the first test was 1.028 which if anything indicates renal insufficiency certainly not dehydration that you suggest. The cat has been put on a reduced protein/phosphate diet and its azotaemia has improved. Maybe that doesn't prove anything but it is enough for me to at least be confident to continue on that diet in an 11 year old cat. When we get a sample I will test it for UP/C ratio but I would fully expect that to be normal and all that will tell me is that it doesn't need any further intervention at this stage for renal disease (real or imagined)!!

Even a Crea of >140 is stage 2 CKD according to the IRIS criteria. Do you wait until they have a USG < 1.020, a UP/C of >4 and sky high creatinine, BUN and Phosphate before you do anything?

RE: Cat with erythrocytosis

Rob Loxley — Thu, 27 Sep 2018 15:57:39 GMT

[quote user="Martin Atkinson"][quote user="robloxley"]What was the cats urine SG - thinking more with respect to its initial azotaemia than deciding if dehydrated?[/quote]Not able to get a sample yet.[/quote]

Then, maybe to nitpick, how can you have diagnosed it with IRIS stage 2 renal disease, nor suggest its renal function has now improved?
I might suspect the initial azotemia was pre-renal; we often find mild azotemia with pre-ga bloods starved on the morning of the op because the cat's fluid intake has been restricted for 12 hours or so (particularly cats that mainly eat wet food), but looking at urine the SG is normal (concentrated); and that it's 'improved renal function' is just improved hydration?

RE: Cat with erythrocytosis

Martin Atkinson — Thu, 27 Sep 2018 12:53:28 GMT

[quote user="robloxley"]What was the cats urine SG - thinking more with respect to its initial azotaemia than deciding if dehydrated?[/quote]Not able to get a sample yet.

[quote user="Robin Grimmer"]Also measure BP - as polycythaemia can cause hypertension.[/quote]As said in the OP, unable to obtain a BP measurement with the doppler. I don't know why it is but with the same technique some cats I can measure it easily others I can't even the same patient can vary on different occasions. One of life's great mysteries.

RE: Cat with erythrocytosis

Robin Grimmer — Thu, 27 Sep 2018 09:02:19 GMT

Also measure BP - as polycythaemia can cause hypertension.

RE: Cat with erythrocytosis

Rob Loxley — Thu, 27 Sep 2018 08:43:04 GMT

[quote user="Martin Atkinson"]do you think these RBC levels are worth worrying about as it may just be normal for this cat[/quote]

I wouldn't be worried, personally, but maybe worth monitoring

[quote user="Martin Atkinson"]unlikely that this due to dehydration on two separate occasions[/quote]

What was the cats urine SG - thinking more with respect to its initial azotaemia than deciding if dehydrated?

RE: Cat with erythrocytosis

janine redman — Wed, 26 Sep 2018 21:58:13 GMT

We have seen a couple of cats with polycythaemai Vera . Both showed neurological signs due to sludging of blood in the CNS I presume. PCV was over 80% in both patients .

RE: Cat with erythrocytosis

Beats — Wed, 26 Sep 2018 20:04:50 GMT

[quote user="Martin Atkinson"]RBC levels are worth worrying about as it may just be normal for this cat[/quote]

One vote for normal and unremarkable.

You could do a manual PCV if still have the blood sample and a centrifuge that can do that.