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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 27446
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My 14 year old cat has a sodium level of 161, urea nitrogen

Customer Question

Hi, my 14 year old cat has a sodium level of 161, urea nitrogen 58,phoshhorus 9.4,chloride 129, amylase 1412, cpk 611, rbc5.0, hemoglobin 7.9, hematocrit 26 & platelet count of 527. Is he deathly ill? Can he live with his hyperthyroidism and side effects?
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.

I'm sorry that your question wasn't answered in a timely manner. His BUN is moderately elevated, his phosphorus is egregiously elevated, but his other levels are either acceptable or not valuable to assess (amylase, CPK, e.g.). I need to know his creatinine, the specific gravity of his urine and degree of proteinuria to be more accurate but it's reasonable to assume that he's in chronic renal failure with secondary renal hyperparathyroidism. Phosphorus binders and supplemental fluids given subcutaneously at home plus a "kidney diet" are important for such a cat. Please respond with the additional information and further questions or concerns if you wish.

Customer: replied 1 year ago.
What is his BUN? Explain chronic renal failure and what to look for. What is hyperparathyroidism? All of his other numbers were in normal range except the ones I mentioned previously. His creatinine is 2.4, His BUN/Creatinine Ratio is 24. I don't believe my Vet did a urinalysis, so I cannot supply those numbers. His T4 is 6.8. What does it mean that his Phosphorus is so high? How can we care for him? You said he should be given phosphorus and fluids by injection at home? Where are we to get what he needs? What would be considered a kidney diet? Additionally, you did not answer my question which is can he live with his condition or is it a death sentence? What is the life expectancy given the information supplied?
Customer: replied 1 year ago.
What type of treatment should I seek? What is available given his condition. He still eats all the time, he uses the kitty litter, no vomiting, terribly skinny, lethargic, still sleeps with us. I don't know what to do because my Vet said the Thyroid pills rarely work. He offers no further guidance. I am afraid my cat is dying and I want to save him if at all possible. Please offer some suggestions if he has a chance to recover and live some quality of life.
Expert:  Dr. Michael Salkin replied 1 year ago.

BUN = blood urea nitrogen

Chronic renal failure usually occurs due to progressive loss of functioning kidney tissue due to tubulointerstitial degeneration. The cause of such degeneration is currently unknown.

Secondary renal hyperparathyroidism arises for quite a few reasons in association with renal failure. The best understood reason is that the kidneys are unable to excrete phosphorus efficiently. Increased circulating phosphorus inhibits renal synthesis of calcitriol, the active form of vitamin D, effectively increasing PTH (parathormone) concentration = hyperparathyroidism.

A urinalysis is essential to fully understand your cat's prognosis. Please make sure a urinalysis is performed and I then can be more accurate for you vis à vis your cat's prognosis.

A creatinine of 2.4 is elevated. His hyperthyroidism is masking the true health of his kidneys. They're actually functioning better because he's hyperthyroid. Once his hyperthyroidism is controlled, his kidney values are likely to worsen but we can't allow him to be too hyperthyroid as that can damage kidneys.

You wouldn't give phosphorus at home. You would administer a phosphorus binder to your cat - a drug that removes phosphorus from his GI tract before it can be absorbed. Supplemental fluids given subcutaneously at home and a prescription low-protein diet are important as well. Yes, he can live with these conditions but his vet will need to discuss with you how hyperthyroidism is treated and how treating it affects your cat's kidneys. I can't give you a life expectancy until I see the results of a urinalysis and serial measurements of his renal values after treatment is instituted. If he stabilizes with therapy over time, his prognosis is better than if therapy doesn't alter his test results.

The vet misspoke. Methimazole tablets are the usual manner in which we address hyperthyroidism and have a very high rate of success. If you're not satisfied with your current vet, please consider another. You also have the option of having your cat see a specialist veterinary internist as can be found here: www.acvim.

I have to leave my computer for the night but promise to reply tomorrow if need be.

Expert:  Dr. Michael Salkin replied 1 year ago.
Hi Debra,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin