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Feline renal insufficiency (Proceedings)

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Apr 01, 2008

1) I much prefer creatinine over BUN

a) The BUN is influenced by many non-renal factors

i) High protein diet: increase BUN

ii) GI bleeding: increase BUN

iii) Increased protein catabolism: increase BUN

(1) Corticosteroids, burns, fever, tetracycline

iv) Dehydration: increase BUN

v) Prerenal renal failure: increase BUN

vi) Polyuria: decrease BUN

vii) Severe liver disease: decrease BUN

b) Creatinine is lowered when there is extreme weight loss to the point of emaciation.

2) Stages of renal disease

a) Renal insults

i) Bacterial infections, toxins, trauma, aminoglycosides, urethral obstruction, etc.

ii) Generally, these result in loss of some renal function but it is less than 75% so the creatinine and USG remain normal.

iii) There may be a few days of lethargy and anorexia but often PU/PD does not occur.

b) Renal insufficiency

i) Loss of 75-85% of renal function

ii) Creatinine typically = 2.5-5.5 (when the normal range is up to 2.4)

iii) No or mild clinical signs (which may be missed by the owners)

(1) PU/PD, reduced appetite, slight weight loss.

c) Renal failure

i) Loss of >85% of renal function

ii) Lab findings

(1) Creatinine = 5.5 – 20

(2) Hyperphosphatemia

(3) Acidosis (+/-)

(4) Anemia of chronic disease

iii) Clinical findings

(1) Anorexia, dehydration, very sick cat

(2) The clinical signs increase in severity as the creatinine rises.

3) Further diagnostics

a) All of these cats should have a urine culture

i) 22% positive: J Fel Med Surg April 07, p.124.

b) Ultrasound and possibly biopsy should be performed if:

i) The cat is less than 10 years of age.

ii) One or both kidneys are enlarged.

iii) One or both kidneys are painful.

c) Sizing kidneys

i) Palpation

ii) Radiographs: Normal is 2.0-2.5 X the length of the body of L2.

iii) Ultrasound: 38-42 mm in a young cat.

d) Urine culture – by cystocentesis.

4) Home Maintenance

a) Indications

i) Cats presented for PU/PD and treated as above for renal insufficiency.

ii) Cats treated for renal failure in the hospital and converted to renal insufficiency.

iii) Cats diagnosed with renal insufficiency on geriatric profiles.

b) Expectations: to add 1-3 years of life to the cat.