Baby UTI-Common for CKD Cats

Baby woke up today urinating blood. The vet said she has a raging UTI with plenty of bacteria. She had shown no previous symptoms. This is the third one in a year. With the previous two, she was lethargic and seemed unhappy and ill. But she wasn't urinating blood nor having small ones in the box like today. At the Internist last week, her urine was fine.

The vet has her on Zeniquin, an antibiotic, for 14 days.

At vet

Katharine Hepburn Possible Gastro Issues-More Tests in the Future are Needed

During COVID quarantine, my cats thought it would be a really good time to come down with other issues. Three cats-Jimmy, Baby, and Katharine have been to the vet during this time.

Katharine has been seizure free since May 2018. She sees the cardiologist annually due to a heart murmur and has no issues or causes. But since she went on phenobarbital in May 2018, she has had issues eating. She has been on increasing doses of Mirtazapine appetite stimulant ever since. Now she takes a weekly dose. She is also very low on vitamin D. She has gone from one drop a day to five. Since she and Baby are both on vitamin D, I give each a .1ml dose-which as well as I could figure, is close to five drops. They will be retested in a few weeks and we'll know more then.

In March her gastro test results-for cobalamin/folate and PLI-came back with possible IBD or pancreatitis. Baby had close to the same results and was put on Metronidazole. Katharine was not and somehow it slipped through the cracks, likely because the COVID virus shut down the state just as we got back the results. Being too busy in general, and then dealing with Baby's CKD vet appointments, I forgot to tell the vet I was ok with Katharine going on the medication. So, we will discuss this tomorrow when another cat goes to the vet for his latest issues.

Katharine's cobalamin was normal; PLI was normal; but folate was too high, possibly indicating an infection or issue. Given the other two were normal, pancreatitis was not indicated per the vet's notes. It could also mean she's absorbing too much of the nutrient which means there's another issue.

Her kidney values are good. SDMA is 5, creatinine is 1.5, BUN is 22. Potassium is good at 4.3 but with supplementation (which we've been giving her since May 2018 because no one could find a cause for the seizures. Insufficient electrolytes was a possible cause, and potassium was easy to give by mouth using Renal K.) I need to check her hyperaldosteronism next time. As we learned with Baby, when potassium is low, a cause could by hyperaldosteronism. Given that Katharine is on a potassium supplement, her level should be higher than it is-or possibly should be higher.

Jimmy Has An Eye Issue but No Infection Detected

Earlier in April, Jimmy was at the vet because his left eye was acting up. He was favoring it by closing it. It was also watery, goopy, but no blood or other eyelid closing over it was present. Unlike a few months ago, he had no cornea scratch this time. But given that there was swelling under the eye, and how it was leaking, they gave him antibiotic drops for a possible infection. Since he was exposed to the herpes virus as a kitten, he has been prone to getting related complications-gastro upsets, eye infections, lethargy. So, I have been giving him extra lysine daily. We use lysine gel by Vetoquinol. 

It is wise to always take a cat into the vet when you see any of these symptoms: goopy eye, blood in the eye, a closing of an inner eyelid over the eye, or when the cat favors the eye by closing the regular lid, or paws at it. The eye could be damaged, scratched, infected, etc. The doctor will put drops in the eye and shine a UV light into the eye to check for scratches and internal issues. Medications and lysine might be recommended. Sometimes steroid drops are needed. These should be used cautiously with HCM cats as steroids are typically avoided for HCM cats. It's rare that steroid drops are needed unless there is a serious infection, such as conjunctivitis or injury to the eye. 

Baby-More Lesions, Higher CKD Test Results; the Importance of Monitoring Kidney Function

Baby has ongoing illnesses: CKD, Bowenoid in situ-cancerous skin lesions, hyperaldosteronism, and possibly mast cells/lymphoma of the gastro system (cancer) or simply IBD.

While she does not have heart disease, many of the same tests are ones that HCM cats should have to test kidney function; and the same medications and supplements that she takes for CKD are ones that HCM cats should also take to help and protect the kidneys while they struggle to do the load of the work of diuretics to rid the body of fluid buildup, and help the heart function better. For more on medications and supplements, please read the Med tab here at the blog.

Baby's vitamin D is too low, also. We were told to increase her dose from one drop a day to five drops a day. I figured out that .1ml is about equivalent to five drops more or less. Instead of putting it in her food and hoping she eats it, I give it to her by mouth. She is also taking B vitamin complex at 1.0ml a day; 3ml of water/bicarb a day (stomach acid).

CKD:
Baby has kidney disease. We have been trying to fight this and help her since May 2019. She has had scans and tests from her regular vet, a cancer specialist, a vet hospital, and recently, an Internist. The results are the same-she has CKD and there's nothing we can do about it. And no one can tell me what she should be on or not on or take more of or less of, except for two specific medications.

What they have said is this: she needs blood pressure medication Amlodipine; she needs Spironolactone to try to control her hyperaldosteronism; she needs to eat only kidney disease diet food to help control the disease; she does and now does not need her inhaler Albuterol twice a day; she does not and now does need her Buprenex once a day; she should not use Forta Flora because it's not good for kidney disease; she needs Mirtazapine, an appetite stimulant to help her eat.

Her blood tests results have increased despite giving her supplements and medications to control the disease. 

The urine specific gravity keeps falling-currently at 1.012-which means kidneys are not able to concentrate urine, which means the glomular filtration rate is falling likely due to fewer nephrons working properly, a sign of poor kidney function.

The SDMA-a test for kidney disease-is now 31 in April, up from 29 in February.
BUN-now 38 from 32 in February.
Creatinine-now 2.8 from 2.7
Phos-now 4.7 from 4.0-despite using a phosphorous binder

But the Internist believes her CKD is fine for now, to be expected. I'm the only one not impressed.

Hyperaldosteronism:
The Internist now thinks that Baby's hyperaldosteronism is secondary to CKD and not the other way around. Her gastro/kidney scan in April did not reveal any changes in her adrenal glands and no presence of any nodules that would lead to a diagnoses of cancer to cause hyperaldosteronism. She believes it is due to underlying chronic stimulation of her RAAS system, the system responsible for balancing water and blood pressure in the body.

Skin Cancer:
Baby also has skin lesions-Bowenoid in situ-which are cancerous. If they are not removed, they can become malignant. She had them removed in November, and March; and more will need to be removed in May. They continue to pop up in new places which are hard to find under her long, thick hair. They must get rather large like a knot before I am able to tell that a lesion vs. a regular knot, is present.

Gastro Issues:
The folate level for Baby has increased again and will need to be retested in a few weeks. She took Metronidazole for IBD in February after her cobalamine/folate test showed elevated levels.

BUT she does have mast cells and possibly lymphoma of the gastro system. They could do another needle punch biopsy but they believe that may not lead to a large enough sampling to determine if cancer exists. They want to do an upper and lower GI where they could take out a large sample. It's invasive but not open surgery. But it also costs around $3100. We are not sure that at this time-with everyone's jobs on the line due to the COVID-that we should proceed with this. Also, I need time to set money aside in our budget. So, perhaps late summer/early fall.

Meanwhile, we will give her Mirtazapine so that she eats; monitor her overall health for any signs of an increase of CKD; and take her back again in June to have everything repeated.

When our HCM cat Myrna Loy had some CKD with heart disease, I was able to handle it-which did show up near the end due to diuretics and failing heart-by pushing more supplements and vitamins, and iron. None of that is having the same effect on Baby's results as they did for Myrna. The difference is that Myrna didn't have CKD as a primary disease, just an organ that was affected by her heart disease. But Baby has primary CKD which does not want to respond to most of what I am trying to do. While heart disease gave me the sense of a more pressing issue, one that needed constant monitoring, one that could suddenly strike Myrna and cause an issue-CHF, heart attack, thrombosis-CKD alone does not have the same sense of urgency. But I find it far more frustrating. With Myrna, we saw results for the first few years when her heart disease was stable. With Baby, nothing, except the blood pressure medication. But even that isn't working as well. Her BP was down to 120 from 240 in May 2019 but is now up to 140, high but not yet a concern until it reaches over 160. Then her medication will be changed or increased.