May 20, 2015
"What is the stage of kidney failure in my cat?" the young lady asked when I told her that her 12-year-old cat had high serum urea 36.1 (7.2-10.8) and creatinine 423 (71-160).
The cat also had low platelets 226 (300-800). but the red blood cells were normal. Neutrophils were 97% (60-70%) with absolute 13.7 (3-11.5), but the total white cell count was normal.
Vets seldom if ever stage the stage of kidney failure, unlike in human medicine. Her cat came in last week for not eating.
The cat was very thin or emaciated. He had poor appetite for the past one year. For the past 2 days, he stopped eating. There was a bad breath which could be due to teeth and gum infections. The rectal temperature was 37.2C, below normal.
"The kidneys are enlarged but there is little pain on palpation," I said. "A blood test is the minimum to check for kidney disease." I said to the parents who came in with the young girl. "I had a case where the owners did not want the blood test to check for kidney impairment and other diseases. The cat did not recover his appetite and he went to another vet."
I gave the parents some time to think about the blood test. Many Singapore cat owners just want some antibiotic injections but are not happy when the treatment does not work.
In this case, the cat had lost weight for the past year or more. He would be suffering from chronic kidney failure. What is the cause?
He could have hyperthyroidism but my hands are tied as the owners want the least medical costs.
I gave the cat 200 ml of Hartmann's Solution and dextrose saline with vitamin B, antibiotic and anti-inflammatory. In the afternoon, his rectal temperature had gone up to normal 38.3. He went home and it was 3 days later before he ate.
Fortunately, the parents consented to a blood test and we know that the cat has kidney failure and an impending bacterial infection (neutrophilia and low platelet count). But more tests like X-rays, more detailed blood tests and urine tests are needed in the ideal world, to check for urine proteins, blood potassium, calcium, proteins and reviews.
UPDATE ON MAY 21, 2015
The young lady made time to buy the Prescription Diet K/D for her cat. "Measure volume of water intake per 24 hours and record in the chart," I advised. "Hand-feed the K/D mixed with 90% of original canned food first until the cat eats 100%. If you just offer the K/D immediately, the cat will not eat it."
These are the tips of changing over to a new diet. The owner must make an effort to mix the new food at 10% and coax the cat to eat it till 100%. The cat is said to be eating and active. Chronic kidney failure cannot be cured as much depends on the cause which is unknown. It could be toxicity of the environment as the platelet count was low.
Will wait and see.