Thursday, May 26, 2016

Muffin, her kidneys, and #SDMA



Well, Muffin's bloodwork came back and we have very disappointing news. She has the start of kidney disease according to her SDMA levels.


The vet started talking about a low protein diet, which shut my brain right off from listening to her because I know full well that low protein is not appropriate for a cat.  She did talk about fish oil, which we had talked about before if she has the beginning stages of arthritis. She talked about other anti-inflammatories as well as weight loss, which we had also talked about with the possible beginning of arthritis.

Muffin is NOT a fan of the weight loss idea

Muffin weighs almost fourteen pounds, which is big for a cat, but she has always been a large cat. When we were giving dry food as treats she weighed even more. Lately, she has been screaming at me for canned food, which I had been giving Fleurp because of her anemia. I would give Fleurp canned food with liqui-tinic (an iron supplement) in my bathroom every few days and Muffin figured out what was going on. She was originally content to lick the empty can and Fleurp's leftovers, but in the last few months to a year, she would come and stand where the food was put down and whine continually.  She would also whine at me in other rooms and when I would go over to see what she was doing, she would lead me into the bathroom and ask for a can of food.  I was so confused. When do you decide that behavior is driven by personality and not physiological need? Did she want the food or did she need the food for some reason?  I tried to tell her no, I tried not to give it to her, but she became more and more insistent.  I would give in and she would be quiet for a while, and then start in again.

To facilitate the change of 'no more bathroom food' for Muffin, I have rearranged the bathroom and where the food went down is now a cat bed.  This seems to have helped a bit but she still whines.


Seriously? How can you resist this face?!?! It helps a little bit that she is getting fish oil so she is getting treats afterwards to ensure she swallows the capsule. a little bit. not much.

Anyway, my main dilemma here is what do I do?  SDMA is so very new there is not a lot of information on what we should be doing at this stage. There isn't a lot of information on how much damage is going on with an 18 vs a 14 which is the upper range. Her last blood test on 11/15 had her SMDA of 13. Is that an excessive jump in six months? I have no idea, and I'm not sure who would. I suppose I could contact Idexx (I emailed them but haven't heard anything), as they have the most experience with this test. Back in November her blood work report said this:


The specific gravity of her urine was 1.019 (and now it is 1.035). Her creatinine level is 2.4 (0.9-2.5) and BUN is 32 (16-37). She has no protein in her urine.


So now I am in full-on research mode. It is not helping that I'm overwhelmed and there is SOOO much information out there.. According to one site I'm doing pretty much everything I should be doing at this point and we'll do a recheck in a few months, but if you want to make any recommendations or suggestions, I'd be happy to hear them..





(found on internet after post was generated)
From Idexx's own PDF:
How much does SDMA vary normally over time or with repeated testing? What constitutes a significant change? SDMA, like creatinine and GFR, has a biologic variability of 15%–20% from measurement to measurement in the same patient over a week or more. Therefore, changes need to be greater than this to indicate a true change. For example, with 20% biologic variability, an initial SDMA result of 14 µg/dL could recheck anywhere from 11–17 µg/dL based on biologic variability alone, just like a creatinine of 1.5 mg/dL could vary from 1.2–1.8 mg/dL.
So there is a chance that her high reading was just a variant. Even if it is, it still means that her levels are high... but it could mean that we are still in the earliest of beginning stages and for a just about 14 yr old cat, I can accept that. I'll have her blood tested again in a few months and we'll go from there.. but I'm still very happy to hear recommendations/suggestions/ideas, etc.

22 comments:

  1. We have nothing right now, but my human will be interested to hear what others might have to say.

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  2. Well, I'll tell you what I WOULDN'T do (besides feed a low protein diet! Bullshit). I wouldn't get on the Feline CRF boards (from Tanya's Feline CRF site, felinecrf.org - not to be confused with felinecrf.com). Those people will drive you crazy with all their tests and results and cries for help when their cat is practically dead. I went down that path 2 years ago with my most favorite cat ever (also gray, like Jack) and I won't go there again. Tried to regulate phosphorus (and BUN and Creatine), deal with constipation and puking up bile....even gave him a blood transfusion for anemia (and the really expensive anemia drug afterwards, Aranesp). Fluids started out a couple of times a week and ended up every day. B Vitamin and Iron injections. He was really good about taking his meds and supplements mixed up in strawberry probiotic yogurt and transitioned to raw food fairly enthusiastically at first (he'd eaten grain free Wellness, no dry food, for years). But the more I stressed about his latest bloodwork, the more stressed he got and, in the end, we really didn't gain much. Would the outcome have been different with an earlier diagnosis? Probably not because I was already doing the most important thing ((feeding no dry food (he'd had a couple of bouts of "UTI's"), daily Vitamin C and Wysong F biotic)). I'm still open to some supplements as long as they'll take them willingly mixed in food. Probiotics of course. I have half a bottle of Azodyl that's been in the fridge (has no expiration date) since Bingo's passing if you want it. I'd do fluids no more than twice a week and only if the cat was very compliant. I'll admit that I've never even heard of the SDMA test. When I found Bingo in 2001, age unknown (anywhere from 5-7?), his CRE was 1.82, BUN 39.1 (in house). 10 years later, in 2011, CRE was 2.6, BUN 32. By 2013 (switched vets, labs by ANTECH), CRE 2.6, BUN 54. That's when he was also diagnosed as hyperthyroid and after I put him on methimazole, everything went to hell (2014, CRE 6.9, BUN 125). He was euthanized on June 3, 2014 (somewhere between the age of 17 and 20?). She looks happy. Try to keep her weight up. Don't stress and don't doubt yourself. I've been following your blog enough to know that you know a lot already without going into full-on research mode. Trust your gut.

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  3. I would just carry on as you are and just get her checked out every so often,because she could stay at this stage for years or it could just be a blip that could level out on its own.As long as she is eating and drinking well and is happy in herself that is the most important thing,you know your cats so you know when they aren't felling well,xx Rachel

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  4. I'm so sorry to hear about Muffin and her kidney problem. I know it's hard to resist that angel face and meowing for food. Does she eat raw, Connie? Muffin is in good hands but I know how stressful this is on you. You are doing everything possible to help her.

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  5. I have no insights, but we will purr and pray for her. We never knew anything was wrong with Star's kidneys until she was in full blown failure and a trip to the ER vet was her last day. Sounds like you're on top of things anyway, forewarned is forearmed, right?
    This is just my opinion, but 14 pounds does not sound all that big to me (unless her bone structure is tiny), and having a little pudge buffer in case she becomes ill is not necessarily a bad thing. I'd say at her age, let her snack if she wants! But as I said, just my opinion as a non-medical person.

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  6. I'm so sorry to hear that Muffin's numbers were off like that. I empathize with research mode. When Pierre's levels had spiked, part of my frustration with my regular vet was their blowing off the research about intraglomerular hypertension chronic renal disease. They didn't have to agree, but they didn't listen, which ultimately drove me to another vet. I've got the lecture notes that were on the Abaxis site for a while but don't seem to be up any more. Let me know if you want them.

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  7. I'm so sorry to hear of this. Feline medical issues - one of the most frustrating things on earth.

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  8. I'll be interested in what your research shows as well. Wally is in early kidney issue stages as well. SDMA was 16, though his creatinine was still within normal at 2.2 and USG was 1.031. Can't remember BUN. Yes, my vet recommended the low protein diet as well, which I have passed on at this time and am trying to feed him a good quality food canned food and add a little water to it. He does drink water which is good. Someone once told me this...treat the cat...not the numbers. :)

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  9. We agree with The Island Cats....treat the cat. You know her better than anyone. Trust yourself.

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  10. I had a bad experience with PKD.
    I would suggest you to check thyroid function, and if you do the analysis of the blood, the level of potassium and electrolytes.

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  11. I'm sorry to hear about Muffin. Unfortunately I don't have any advice that can help. Sending good thoughts.

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  12. I wish I could offer some advice, but as you know, I haven't had to deal with this (yet, though I fear Benny will be heading that way soon).

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  13. I am so sorry to hear about Muffin. We all will keep up the purrs.

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  14. First off, I send my condolences to Hilda for the loss of her special kitty. When we had the ultrasound done on Chucky (along with his echocardiogram), the vet says one of his kidney's isn't working right. I am sure the blood tests show something, but we all know his heart issue trumps everything else. All of the 'regular' vet's info has gone with me to the holistic vet, so he too knows what is what. I too feel on overload with all of the info available out there, but one thing I DO KNOW: Muffin couldn't be in a better place! Your love and hard work will keep her as healthy as she can possibly be!

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  15. We're sorry to hear about Muffin's disease. We cannot help a lot, because we have no experience with PKD. We know she's in the best place and in the best hands with you, and send her tons of purrs. Purrs

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  16. Anonymous6:05 PM

    Oh dear. I am so sorry about Muffin! I lost my heart cat Molly from kidney disease two weeks ago - she blew through Stage 2 to Stage 4 in as many months. She had just turned 16 years old. I agree with everyone else here - do NOT subscribe to the boards, and you know your kitty best. I hope and pray that this is a blip. Oh - I do want to share some information I found invaluable - you can have fish- or chicken-flavored Pepcid made up at the compounding pharmacy to help with excess stomach acid.

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  17. That face would be hard to say no to. I will be praying for her. After losing Spooky to kidney disease last month, I still don't know a lot about it because it happened so fast.

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  18. I'm sorry Muffin's blood work is showing possible kidney problems. When my Waddles was about 14 or 15, she was diagnosed with chronic renal failure. The vet wanted her on the renal diet food. She wouldn't eat it. The vet eventually said the best diet for a cat with kidney disease was whatever she would eat. At one point in the years after, her kidney numbers actually got better. She lived to be 21 years old.

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  19. I'm so sorry to hear about Muffin. I've had cats with CRF but I'm clueless to advise you since you know so much more than I do. It sounds like it could be a blip. Our cats had regular tests but we didn't follow the numbers, we just listened to our vet's assessment. Our cats were on a crappy diet because we didn't know any better then, and they still all lived happily for MANY years with very little intervention until the final years when we gave fluids and so on, which was pretty easy since we worked on our technique. Since you feed Muffin a quality diet and know so much more about treating this than we did, I can only assume that Muffin will have a long, comfortable life despite the problem. If anyone can manage her care, you can.

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  20. There is something I don't understand. You wrote of giving Muffin dry food in the past tense, but you aren't giving her canned food. What is she eating? And is not canned food better for a cat who needs to lose weight than dry food?

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    Replies
    1. John, I feed my cats raw food, which is far superior in nutrition to canned, which is far superior in nutrition to dry.

      Yes, canned food is better for a cat who needs to lose weight vs dry.. because it has fewer plant based ingredients in it. The raw I feed has very little plant matter, just a small amount of low glycemic greens (either parsley, green beans or cooked broccoli) to keep the pica at bay.

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  21. Ah, I see. I recall now reading about feeding the raw to your cats. Thank you.

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