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I took my cat to the vet last Saturday. She had dropped from…

I took my cat...

I took my cat to the vet last Saturday. She had dropped from 8.4 to 6.7 in weight. The vet thinks she has CKD as her creatine was elevated to 2.6 and her BUN was normal. The other elevated labs were her hemocrit and another value. I need to pull the labs. She initially described miratazpine for improved appetite; however, the med made her really agitated and upset. Yesterday I asked the doc for a prescription for Cerenia and she advised to give it as a PRN.

Veterinarian's Assistant: I'll do all I can to help. What seems to be the problem with your cat?

She has emesis, lost weight, lost interest in eating, appears to want to eat, and is urinating a lot. The vet thinks it's CKD but I am wondering it it could be anything else?

Veterinarian's Assistant: What is your cat's name and age?

Verde, 14 years old Domestic short hair cat

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about your cat?

Hold on.

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Answered in 13 minutes by:
3/24/2018
Dr. B.
Dr. B., Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 23,227
Experience: Small animal veterinarian with a special interest in cats, happy to discuss any questions you have.
Verified

Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you today.

As the BUN was normal, did they check an SDMA? Was that elevated?

Did they test her thyroid levels?

Had she been drinking more or had more dilute/watery urine?

Have you given the Cerenia and Mirtazapine together?

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Customer reply replied 4 months ago
Not they did not check her thyroid; however, she does not have an increased appetite and is not giving indications of hyperthyroid. The only other thing I could think is hypothyroid. The mirtazapine made her agitated the first day but then that subsided. No the vet did not put them together as I called yesterday and requested she order the cerenia. However, she stated she wants to get the cat in for a UA and indicates the creatine would not make the cat nausea. She has increased urnine, but I can't say it is dilute as I have not seen it. We attempted to get a UA but her bladder was empty when they did the cyontisis. I have already looked at the SDMA test but I am searching for a new vet as I am not pleased with her level of care.

Hello again,

Apologies for my delay in replying (the site ate my previous reply, so I needed to retype).

Now these results are not straight forward. Its true creatinine can increase with renal issues but usually will do so with BUN (though both raise when >75% of kidney function is lost). However, in earlier stages of the disease, its usually BUN that elevates. So, to see just creatinine up and to see that with increased HCT is more indicative of dehydration. Though I'd note albumin should also be up, so its being reduced suggests its been lost (and may actually be lower then the test detects due to dehydration masking the loss). Therefore, with this all in mind, we'd want to check an SDMA since this will be the most sensitive option to assess kidney function and let us know if we have an early stage kidney disease (and how severe that it is). Otherwise, also checking a urinalysis would be reasonable but make sure the protein levels (via UPC ratio) are checked so we can determine if that is where the albumin is being loss. And at the same time, I would suggest testing for hyperthyroidism since it is suspect even without an elevated appetite, especially as cats with both kidney and thyroid issues often have muddled signs with both conditions ongoing at the same time.

Furthermore, I agree that the blood results are not as severe as we'd expect for cats with these signs. Still it depends on Verde as an individual and how fast this has come on. As well, my suspicion with her in particular is that we may have a secondary opportunistic infection taking advantage of her and worsening this. Often we see bladder infections with these cases and there are bacterial strains that can secrete toxins that leach into the blood causing nausea/vomiting. So, when the urine is taken it should be cultured to determine if we have an infection here and so we can target treatment if needed.

Finally, I am glad you aren't using the 2 drugs together as that is when we usually see agitation in cats. Still if she is sensitive to Mirtazapine, speak to the new vet about Cyproheptadine as an alternative option she may tolerate better. And just to aid you in finding a local vet, here is a wee database - http://www.vetlocator.com/

Kind regards,

Dr. B.
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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 23,227
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