I have a Persian female, Tasha, 13 years of age. We have battled a “lazy sphincter” muscle in the bladder for the past 10 years. The drip is well contained with an herbal product called “Leaks No More” but we have still had quite a few serious bladder infections. These seem to come on quickly and really get her down. Also there is an esophageal spincter problem that has been treated somewhat successfully with Prednisone (intermittent vomiting) and she does have Arthritis badly in one shoulder. These have also responded well to herbal remedies (Digestive Upsets and Joint Relief, all 3 made by Homeopets). Otherwise she has been healthy. She has always been on premium food, either Innova or Natural Balance and has regular well checks. This past few months has included a divorce and move and has been stressful on her. She has mostly been lethargic, appetite good, and urine fecal output seemed normal. I have attributed it mostly to stress… She has had an increase in vomiting and lethargy the past few days so I took her in for a check up with blood panel. The panel shows the following out of range items:
- BUN …. 35 mg/dL (16. – 36)
slightly elevated but not yet out of normal range - Creatinine …. 2.9 mg/dL (.08 – 2.4)
just slightly elevated out of normal range - PHOS …. 2.9 mg/dL (3.1 – 7.5)
slightly low - MCHC …. 39.2 g/dL (29.0 – 37.5)
elevated - WBC …. 2.82 K/uL (5.5 – 19.50)
very low - NEU …. 1.44 K/uL (2.50 – 12.50)
low
the following are almost out of range:
- LYM …. 0.45 K/uL (0.40 – 6.80)
- MCV …. 42.0 fL (41.0 – 58.0)
Her Dr. seems concerned over the WBC but offered no explanation. Her diagnosis is “kidney problems”, not CRF. She sent us home with Lasix 12.5 mg x 2 day (to increase her urine output) but the first day Tasha staggered as if coming out of anesthesia. I called the following morning and told the Dr. that I believe she may be having a reaction of sorts to the dosage of the Lasix, and possibly might have another bladder infection due to the quick fade/lethargy and loss of appetite. She has lowered the Lasix dose by 1/2 per day and given her Orbax just in case…
I have been through hyperthyroid/renal failure with one of my boys in 2002 and know that approximately 75% of the kidney function is gone by the time anything shows up in blood work-ups. I am hopeful because Tasha’s seems to be in earlier stages but am confused about the other out of range values. I was told to keep her on the Lasix and bring her back in 2 weeks for another check. My gut feeling is that there is more going on than is first apparent. My boy’s kidneys were going fast and my (other) vet would not address that because of the Thyroid issue. By the time I got him to listen the counts were through the roof and fluid collecting on his lungs. He lived 11 days past finding the kidney trouble. I should have been more adamant that the kidneys be addressed but sadly wasn’t.
What tests, etc., can you suggest I have done? Is there anything I should be watching for? I feel the WBC and other values are a real issue but don’t know where to go next. I am not comfortable with a “wait and see” approach. From past experience I know how quickly these things can deteriorate and if there are other issues I wish to address them as soon as possible.
Today, Tasha is eating well but seems really depressed and lethargic. I can tell she doesn’t feel well and don’t know what to do for her. Any help/advice will be most appreciated.
Thank you so much!
If you believe you need a second opinion, request a referral from your veterinarian to a board certified internal medicine specialist for examination and review of the case parameters. It is possible that you may have to travel to attend an appointment with the specialist, but it will give you the peace of mind that you have sought out help if there is anything to be done with the changes in kidney function. Be prepared for less than promising news as you have already deduced. Also understand that the past use of alternative treatments may not be looked upon with favor by the specialist.
Mark Logan, DVM
Baysea Veterinary Hospital
Cape May, NJ
Cats with chronic renal disease and hyperthyoidism are on a tightrope. It is extremely difficult to balance them. Sometimes they fall. Do not blame yourself or your vet.
Tasha:
The WBC is fine. I repeat FINE. Her immune system is not currently stimulated by an infection or inflammation, so the count is a little low. NOT A PROBLEM.
With the exception of BUN and Creatinine, everything else in the blood tests is OK. OK? Ignore them. They are normal variations from normal.
What you need is a urinalysis and, most importantly, urine Specific Gravity (S.G.) This must be obtained at the same time as the blood for BUN and Creatinine. No one can diagnose “kidney problems” based on bloodworm alone.
She does not need lasix. Get her off it.
Let me know what the urine SG is.
Phillip McHugh, DVM
Park Veterinary Hospital
Durham, NC
There are other things that can cause elevations of BUN and Creatinine, and if there is no dehydration and no increase in volume of urine produced, it may not be related to the kidneys. Digestive system problems with bleeding in the digestive tract can elevate creatinine, and blood may not be visible in the stool. A fecal occult blood test may be helpful, as well as a check for intestinal parasites, and you may consider x-rays and/or ultrasound of her abdomen and/or a barium study to evaluate the digestive tract further.
Kidney disease is not called failure until the kidneys are failing to accomplish some of their functions. Has a urine sample been checked for concentration, protein losses, blood cells, etc.? Keep in mind that the Lasix can also dilute the concentration of urine (lower the USG) and can complicate evaluation. It is seldom needed if kidneys are truly failing and is generally used for relieving fluid accumulation in other parts of the body or for creating dilute urine needed to relieve bladder (not kidney) problems such as stone formation. If you want to evaluate the kidneys further, you might consider ultrasound of the abdomen, a urine culture from a sterile sample (usually collected by needle from the bladder directly), and/or an IVP dye test.
WBC counts can be lowered by viral infections or bone marrow problems, or in the early stages of a bacterial infection before drastically rising, or in severe sepsis, which is a critical emergency of shorter term nature than your cat’s described problems. Be sure a test for Feline Leukemia and FIV is run. However, if it is negative, the low WBC may not be of much concern–many older cats run very low WBC counts for no apparent reason and without consequence. Monitoring it periodically can be wise, because when neutrophil (seg) counts drop below 1-1.5 the cat might be less able to handle infectious challenges. Your veterinarian has put your cat on an antibiotic probably as a precaution and/or trial and it would be wise to retest the CBC to see if the WBC and Seg levels have changed after the antibiotic. I do not consider your cat’s other test results likely to be significant.
Melinda R. Burgwardt, DVM
Melinda R. Burgwardt, DVM
Lancaster, NY
We have a 16 year old male feline with what appears to be a weak sphincter rectal muscle. We have two very large litter boxes and keep them clean each day. He uses one for BMs and one exclusively for urine. He appears to be in excellent health with good urine evacuation. He consumes dry food and water during the day and in the evening he gets a small portion of wet food. For the past several months, he has left fully intact BMs on the floor. We are wondering if he has the sensation of a BM and cannot control evacuation because his sphincter muscle is weak. Any thoughts about this will be greatly appreciated. He does use one of the boxes for BMs, but lately they have been partial.
Gratefully
Molly and David Sullivan