Monday, March 16, 2015

** 1138. A 1.5-year-old cat has kidney failuare - nephritis & proteinuria. Had FLUTD 10 days ago.

10 days ago, the 1.5-year-old male, not neutered cat had obstructed bladder. A vet had relieved the blocked bladder after hospitalising the cat for 5 days. Now, the cat "cannot walk" and has throat pain.

The other vet's history showed the cat had septicaemia and kidney disorder (high creatinine).   The cat is very thin, at 4.1 kg now and hypothermic. The cat had dropped around 1 kg of bodyweight since 10 days ago.  The cat still peed blood but had no blocked bladder. 

X-rays showed enlarged kidneys. .

The first vet had  prescribed resistant antibiotics. When the cat was lame 4 days ago, the vet prescribed Tramadol 50 mg (1/6 twice a day for one week.).

But the cat was peeing blood.
Urine tests showed protein 3+, bacteria, blood, and white cells, spermatozoa + (cat is not neutered).

The vet had discharged the cat after 5 days of inpatient treatment. He prescribed clavamox 62.5 mg 1 table two times per day and Danzen once a day. The clavamox is usually given orally to cats by most vets in Singapore. In this case, it was ineffective based on the antibiotic sensitivity test (see below).

Hence the cat still passed blood in the urine for the last 10 days, became weaker and the inflamed penile area was really painful. So, the cat could not walk properly. The penile area was still inflamed and enlarged (see x-rays). The kidneys became more inflamed and hence palpable as 3X enlarged. The kidneys were damaged as protein is found in the urine test.

No blood test was done again to reduce medical costs. The first vet had done blood test showing septicaemia and kidney disorders.


BACTERIAL CULTURE AND SENSITIVITY TEST
At this stage, I did a bacterial culture and sensitivity test. Sometimes, there is the cost considerations and the test is not routinely done.


Bacterial culture of urine - showed Enterobacter aerogenes bacteria  resistant to amoxycillin+clavulanic acid (clavulox, clavamox), cefuroxime, nitrofurantoin, ampicillin + sulbactam and ampicillin.
It was sensitive to ciprofloxacin, gentamicin, cotrimoxazole, fosfomycin.


KIDNEY FAILURE means that the kidneys is unable to remove waste products from the blood. The kidneys have not stopped working and making urine. Early clinical signs are increased thirst and urination. Advanced kidney failure cause uraemia and signs include loss of appetite,vomiting, diarrhoea, very bad breath and ulcers in the mouth.

A high blood urea nitrogen (BUN) and creatinine levels mean kidney failure. 


TREATMENT
Thin lethargic, dehydrated.
In patient 2 days.
1. Diuresis.  At least 200 ml of sucutaneous fluids twic a day are given to "flush out" the kidneys. The flushing process is called diuresis is used to stimulate the kidney cells to function again. If enough kidney cells are functional, diuresis "restart" the kidneys. Replacement of various electrolytes  esp. potassium must be done. Proper low protein nutrition and drugs to control vomiting and diarrhoa.


2. A low protein diet to decrese the work load on the kidneys.
3. A phosphate binder to prevent phosphorous accumulating in the blood.
4. Fluids subcutaeously given at home. Not done in this case..
5. A drug to regulate the parathyroid gland and calcium levels.
6. A drug to stimulate the bone marrow to produce new red blood cells if the cat is anaemic.  
Baytril and drips.


MAR 24, 2015 FOLLOW UP - (7 DAYS AFTER CONSULTATION AT TOA PAYOH VETS).
1. No more blood in the urine since my treatment on Mar 17, 2015 (10 days after treatment by first vet).
2. Cat needs to be hand fed.
3. Cat does not poop.
Admitted: Wt 3.5 kg. Lost 600g since 7 days ago as the cat did not eat.
Temp 35.1 C compared to 36.7C 7 days ago. Severe dehydration. R lip commissure abscess, R gum ulcers behind R U canine tooth, central tongue ulcer. Rehydrate. Check FIV, FeLV but these were negative.  Poor prognosis.

Need to order only Royal Canin Dry Food for kidneys (no pork). The Royal Canin canned food and the Science diet K/D can and dry has pork.


4 cats in the household. This cat was the new introduction but had been with the other 3 cats for 15 months.

CAUSE OF FLUTD

The vet had diagnosed FLUTD (Feline Lower Urinary Tract Infection). However, the vet's blood tests showed septicaemia and kidney infections. This means that this cat has a much more serious illness than the ordinary FLUTD cases where, after relieving the bladder obstruction through catherisation, the cat bounces back and starts eating.

The owner had changed Fancy Feast to Pro Nature dry food 3-4 days before the bladder obstruction. There was no Fancy Feast available.  A change of diet suddenly may cause FLUTD leading to bladder obstruction. The other 3 cats were not affected. The husband could not recall till I asked him to recall and he confirmed that there was a change of brand of dry cat food. The vet had recorded this in his case sheet.

With kidney pain, the cat cannot walk normally. I felt an enlarged kidney but no pain. This is because the vet had prescribed oral Tramadol for the last 2 days. 









Urine test showed bacterial infection of the bladder. After 2 days of inpatient treatment with drips and medication, the kidneys have reduced in size by 50%. The cat can sit up and ate a bit of the other vet's prescribed diet for struvites. He could sit up and meowed.

The owner confined him at home, away from the other 3 cats and hand feed 6X/day, mixing Fancy Feast with prescribed Royal Canin Renal diet. Water is available freely.

FOLLOW UP ON APRIL 23, 2015
The cat is back to normal health and eating Royal Canine Renal Diet. The Science Diet K/D contains pork and so cannot be given on religious grounds.

FOLLOW UP ON MAY 12, 2015
The cat was back to normal. The daughter brought him in for neutering. "I thought your father likes him as a non-neutered cat as he responds to his attention," I said. She wanted him neutered to prevent any pregancies. So, he was neutered. His kidneys were no longer painful. I presumed he had recovered. No blood or urine tests were done to save on medical costs.  

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