RE: Possible protein losing nephropathy in a cat

joanne mcallister — Fri, 05 Mar 2021 16:26:56 GMT

latest UPC is 6. Also wondered about benefit of using Semintra rather than Fortekor

RE: Possible protein losing nephropathy in a cat

joanne mcallister — Thu, 04 Mar 2021 11:00:36 GMT

Hi Andy,

I started this cat on prednisolone 1.3mg/kg BID 2 weeks ago and continued with Fortekor and renal diet. He is much improved and is eating and bright. His bloods have normalized, apart from cholesterol (7.8mmol/L). Urine sg is 1.035 and protein ++ on dipstick. No blood and nothing on microscopy. I just wondered how long I should continue with the prednisolone at this dose. Should I repeat UPC and continue until this is normal? Many thanks again for your help,

RE: Possible protein losing nephropathy in a cat

Andrew Kent — Sat, 20 Feb 2021 20:41:05 GMT

Hi Jo,

Apologies for the slow reply.

[quote userid="4080" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29679/possible-protein-losing-nephropathy-in-a-cat"] Large amount of protein and some blood on dipstick and UPC of 11.6. Awaiting sediment analysis and culture results.[/quote]

Slightly difficult to interpret with the presumed blood contamination but I agree high enough to suggest there is going to be significant renal protein loss.

[quote userid="4080" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29679/possible-protein-losing-nephropathy-in-a-cat"]aPtt 246.0 seconds 65.0-119.0 and PT 21.0 seconds 15.0-22.0. I plan to repeat these to confirm they are true readings.[/quote]

Good plan - most common reason for prolonged PTT with normal PT is poor mixing/incorrect amount of blood relative to citrate so worth repeating for sure.

[quote userid="4080" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29679/possible-protein-losing-nephropathy-in-a-cat"]Fortekor was started yesterday. His bloods have improved (attached) but he is still mildly hypoalbuminaemic [/quote]

The Fortekor won't do anything for the azotaemia and will take some time to address a hypoalbuminaemia so early days.

[quote userid="4080" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29679/possible-protein-losing-nephropathy-in-a-cat"]Is there anything else I should be considering?[/quote]

Its a little unusual that the cat is inappetent as the PLN should be long standing - that has to raise the concern that there is more going on than we currently know.

[quote userid="4080" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29679/possible-protein-losing-nephropathy-in-a-cat"]Is it advisable to get a renal biopsy (would FNAB be good enough?)[/quote]

FNA unlikely to help unless we think there is a renal lymphoma, for example. Histo can certainly give more information about the nature of any kidney disease but is complex and requires specialist processing (need electron microscopy etc). We typically start with conventional therapy then either biopsy or consider immunosuppressive therapy for a presumed immune-mediated cause (membranous nephropathy).

But we would want to be sure there isn't more to the story first! Do keep us posted,

Andy

RE: Possible protein losing nephropathy in a cat

joanne mcallister — Fri, 19 Feb 2021 19:08:45 GMT

sorry results embedded above are from the follow up sample. The initial blood results are under the link for 16th Feb