Ok, so I have an old cat, around 16. Some slight kidney disease, well managed with prescription food (blue buffalo K/M, dry, apparently wet food is gross 
). In March she started being a little pukey and peeing blood. We went to the vet assuming UTI, got antibiotics and went home. She finished the antibiotics but continued to pee blood intermittently. Went back to the vet paid for the full culture and got different antibiotics. The culture came back no infection. Next visit, full blood work and an x-ray to check for stones. Blood work came back pretty normal and the x-ray showed no stones. We waited a little while then we went back to the vet for an ultrasound, a small amount of inflammation of the GI and urinary tracts was noticed but nothing big. She’s borderline underweight and has never been food motivated. Went back this week due to more vomiting, thyroid was check and looks normal, blood work show general inflammation, nothing else. Vet says next step is to either biopsy the GI tract or try some steroids to reduce the inflammation. She is currently getting 1/4 of a famotidine tablet a day that seems to help a little. Any ideas we’re not thinking of?
Awww, kitties are so hard when they’re nqr. You’ve certainly run through the diagnostics! A couple thoughts from having a few kitties with similar chronic stuff:
Kidney disease makes them feel icky and pukey. You say her kidney disease is managed with diet–what exactly does that mean? How are her values? Has the vet discussed adding sub q fluids at home (if you’re not already doing that?) I’ve also found zofran just great for nausea in kitties, if you need to step it up. Famotidine is a great place to start, but it’s not always going to be enough as her kidney disease progresses.
Do you feel like the antibiotics made a difference? Any change at all? I’ve had some super frustrating “kidney infection” in kitties that just won’t culture. Urine looks clear. I spoke with my favorite vet about it, and there’s some evidence coming out of CSU in kitties like these showing clean urine out of the bladder that won’t culture, but urine retrieved from the kidneys directly with ultrasound guidance DOES culture. So there is an infection, but it’s stuck up in the kidneys and not dropping into the bladder, which makes it super challenging to diagnose. I’ve never gotten to the point of doing that ultrasound guided urine retrieval from the kidneys–thankfully I’ve had a vet willing to rx antibiotics based on symptoms even without a positive culture, and that’s worked for us. What went through 3 or 4 rounds before it finally cleared up, with improvement after each round of antibiotic. I think we finally have it beat now, it’s been over a year since the last episode! It’s sure frustrating to be flying that blind, but if you saw improvement with the antibiotics, only to regress again, it might be worth trying more antibiotics, even with a clean culture.
One other thing that might help, won’t hurt, would be cosequin. It helps soothe the bladder lining, and can work well if there’s a sterile cystitis at play. They make capsules for kitties that aren’t expensive (open and sprinkle the powder on the food) but I just buy the horse version instead. It’s good for bladder health in healthy kitties, too 
I hope you’re able to figure out out!
Thanks for the reply. No sub q fluids, she has a water bowl and 2 different kinds of water fountains that she seems to drink enough out of, she’s never looked dehydrated when I brought her to the vets, even when I had to withhold food and water before the ultrasound! When we started her on the prescription food, her numbers went from just over the line to normal. When we rechecked after the food change they were back in normal range (years ago). They’ve crept up a little bit over the years but her numbers are still in the gray area where some cats would be fine, and some would have kidney disease.
I don’t really feel like the antibiotics made a difference (except the first one gave her diarrhea, and no she won’t eat probiotics I’ve tried.) I can’t remember the name of the first one off the top of my head, they said it would be easier on her stomach, it wasn’t. The second was clavamox. My vet did say that it could be an infection higher up, but since her symptoms didn’t really get any better (peeing blood every few days the whole time) she didn’t think it was that. The bleeding can be from the inflammation of urinary tract. The most recent thought was thyroid, since it was boarder line high last time it was checked, 2.3, but as of yesterday it was 1.7 so probably not that, still waiting on one more blood test to get back but we are expecting it to be normal. They did note that there was inflamation of the GI tract during the ultrasound so now they are thinking IBS or maybe even cancer (but more of her blood work SHOULD be weird if it was cancer). They told me I could try omega’s to help with the inflammation, but I can’t get her to actually eat anything but the kibbles! I got some treats, she sniffed and walked away, I got wild caught Alaskan salmon oil, she took 1 sniff, looked at me like I was trying to poison her, and left. She will occasionally eat some of the canned wet blue buffalo prescription K/M, but if she detects I mixed any powders into it, forget it. The only way to get that kind of stuff into her to mix it with tuna fish, not the broth, the actual fish. Which she’s not supposed to have, because kidneys! I’ll ask about the cosequin, I’ll try pretty much anything. But I’m not sure I want to put her through a stomach biopsy. Last time she had anesthesia, teeth cleaning and removal (she has terrible teeth), she got a small hole in her wind pipe when they took out the breathing tube and air leaked into her chest. She was fine and we just had to wait for it to heal on it’s own, but it was scary (for me, she was acting totally normal) and require multiple trips back to the vet for x-rays to make sure it was healing (they did not charge me for those follow ups).
Yep, that bladder inflammation the vet mentioned is sterile cystitis. Treating with cosequin can be helpful, as can treating for anxiety. Any changes in the house that might be upsetting your kitty?
Mirtazipine is an old antidepressant that’s used in cats for it’s side effect of stimulating the appetite, but it can be doubly helpful when there’s some anxiety. It’s cheap in pills (available through your local people pharmacy) or through Wedgewood as a transdermal cream that’s applied to the inner ear flap (useful if your cat can’t be pilled.)
If you don’t think you can get a powder into her every day, you could use adequan instead of cosequin. Your vet should be able to set you up to give the injections at home.
By the time changes are seen on bloodwork, a very significant amount of kidney function has been lost. The IRIS staging scale is useful:
http://www.iris-kidney.com/guidelines/staging.html
Are you tracking her SDMA? That can be a good tool when the other values are borderline. If her inappetence and nausea are due to her kidney values (a reasonable assumption!), sub q fluids will very likely make her feel a little better, even though you think her hydration is okay.
Something I always ask when facing invasive diagnostics is how the result will change our treatment. Do biopsy results really change the direction, given your kitty’s age and your own personal desires? For example, your vet may say a steroid trial is the next step regardless of biopsy results. The biopsy may provide additional details, but not change treatment. In that case, I skip diagnostics and go straight to treatment. For a 16 year old cat with a history of difficult anesthesias, there really may be very little to gain by putting her through any invasive diagnostics.
Something else for you to consider is pancreatitis. I had a cat that presented as IBD and ultrasound appeared to confirm that without any other obvious problem. We treated her as such, but when she died unexpectedly due to an error at the vet, I had her necropsied. No IBD at all, but evidence of pancreatitis. Something I’ll always keep in mind for future kitties who present like that!
@Simkie Thank you for the ideas! The big change is that I’m now here, ALL THE TIME! pre March, I was at work all day and I rode 5 days a week. Then Covid, I now work from the living room and I stopped leasing my weekday horse and only had the weekend horse (nothing to do with Covid, but the timing wasn’t great to find a new ride). We did talk about anxiety. But she seems to have acclimated now. At first she seemed to think I needed company all the time, after a few months she started ditching me to go back to bed. We’ve also discussed the appetite stimulant, we’re good with pills. We’re not there yet, she’s still technically at a healthy weight and eating her kibble, she’s just on the skinny side and refusing wet food, but she’s never liked wet food. She weighs about 6.5lbs, but her frame is super small. I don’t have a copy of the lab results, but I’ll call tomorrow and ask them to email them to me. I’ll also ask about the cosequin, adequan and pancreatitis. I know they test for a couple of things for the kidneys, its not just one. Her numbers have barely changed over the past couple years. I pay extra for the “geriatric blood panel” every time she goes so we would know if her numbers are getting worse. I should also mention that the vomiting and bloody urination are really intermittent, like every few month we have a little bout of it. I tend to take her to the vet at the tiniest thing, I prefer preventative care. 
I agree with you about the diagnostic treatment vs how you treat. The treatment would be different if she has cancer. Based on the lack of tumor on the x-ray and ultrsound plus “normal” bloodwork I really don’t think that’s what it is, neither does my vet but she had to say it. She’s recommending that we try a low dose of steroids to bring down the inflammation provided that the last thyroid test comes back normal as suspected. The steroids are not ideal with the kidney issues but I guess it’s a case of what makes her comfortable now, not that she seems uncomfortable except when she’s actively vomiting.
The peanut in question.
She’s beautiful. Bless her. I hope she feels better soon.
Following this thread with interest. Have a cat battling sterile cystitis now. Hoping it is not pyelonephritis which she is prone to.
Yes. The vomiting and peeing blood might be signs of diabetes in your cat. Ask your Veterinarian to run tests for that.
Healing wishes.
The peanut is adorable! I have no suggestions but wanted to send best wishes. I have a cat with kidney failure but his symptoms are different. Hope you and the vet can get it figured out soon.
First antibiotic may have been Cerenia.
This sounds to me like it could be just the progression of kidney disease (kidney disease is the worst). I don’t see a reason at home subQ fluids would be harmful and they would be helpful for the renal condition even if they don’t cure the vomiting. I would look into that.
I suppose it also couldn’t hurt to have the Texas A&M GI panel run (it’s $$$) or to treat for worms. Unlikely but possible. I have a 9 month old indoor only purebred cat. He was vomiting intermittently and we ruled everything out and then treated for worms (it’s just strongid). He’s been fine since (knock on wood).
@shiloh I’m sorry to hear about your kitty. I hope they feel better soon.
@Moneypitt Her blood glucose levels are low and they checked her urine last time and there was no glucose. So no diabetes thank goodness.
@ravenclaw I’m sorry to hear about your boy.
@Simkie On the bottom of the lab results it says pancreatitis not likely, so I guess they thought of that one. It does not show SDMA for the most recent blood work, but they checked it in March it was high, at 23. I’m not sure why that wasn’t rechecked. I’ll definitely be following up with the vet about that. She’s supposed to call me back when the free T4 values get in. Her BUN/UREA has gone up since March from 33 (range is listed at 16-37) to 40, CREA went from 2.1 to 2.5 to 2.3 most recently (range listed 0.6-2.4). I’m thinking it’s kidney related.
She puked this morning, but then took her famotidine and ate most of the 1/8th of a can of wet food I put out! (I realize she’s supposed to eat a can a day, but since she usually sniffs, give maybe a lick or two, I’m happy if she eats anything!) If she pukes again in the next 24 hours, I’ll give her Cerenia, an anti nausea medication that the vet prescribed. I did manage to convince her to eat a treat with drop of salmon oil on it. It has the good omegas and a crap ton of calories so I’d really like it if she would eat it!
First antibiotic was zeniquin. We’ve gotten some Cerenia as an anti nausea med. She is also indoor only as is my other cat. I’m the only one who comes and goes. I will talk to the vet about the sub q fluids, like you I don’t see how it would hurt. They did a stool check, it came back negative. I told them that I was concerned that maybe she licked something off of a riding boot. She loves to sniff shoes. I’m glad your guys is doing good now!
You’re right, duh. I got the names mixed up.
They suspected my cat had a relatively uncommon parasite that does not test on stool samples. Hence why we just went ahead and treated. I cannot find the paperwork but if you want to know I can call the vet and ask them the name of the worm. I’ve had cats my whole life and never heard of it before. And, like I said, he’s a purebred indoor cat (and he has a sister who never showed any symptoms) so it seemed unlikely to me. Still… I treated and he’s been right as rain so I’m ok with the outcome even if I never know 100% what the cause was. I’m still waiting for his GI panel to come back. Texas A&M is apparrently running really slow because of COVID.
I hope your cat is ok!
Increasing BUN/UREA and CREA going up suggests chronic renal failure is worsening. This seems like a fairly good sign of that, unfortunately 
Renal failure can really hit different cats differently. I have now had to PTS 3 different cats due to chronic renal failure. One really just SLOWED DOWN when she got the disease. But otherwise she was basically normal. She just seemed really old. She didn’t vomit more/less as it progressed. Vomited here and there, but that was typical for her. Not hugely interested in food. Picked at it. She didn’t seem uncomfortable. She just seemed OLD.
One progressed rapidly and was just a shell of herself. Never vomited ever. Never stopped wanting to wolf down food. Never changed in any way except the last week she barely had the energy to get up and that’s when we knew it was time. Prior to that, only symptom was that we could not get the weight on her. Otherwise normal.
One had what I would consider a typical progression. As it worsened he drank more and more, started to vomit more frequently, had some litterbox issues, slowed down a lot and seemed like he might be in discomfort. One day he literally would not eat or drink and that was the end (I wanted to PTS much sooner but my husband was really attached and not an “animal person” in the sense that he feels a day too soon is better than a day too late-- he always wants to see “a sign.” I fought him for weeks about putting this cat to sleep).
@vxf111 I’m sorry about your kitties. I’m thinking kidneys as well. I’m going to grill the vet a bit. I’m guessing she’ll want to send more blood out for SDMA but will go with IV fluids while we wait. I like my vet, they’re big on options and will tell you what treatments you can try without more diagnostics, but I will say, I think they only look at the most recent blood work, so they don’t always see “trends”. She’s definitely slowed down some, but she’s also old, this has been part of our discussion. Is she sleeping more, well, how much do you expect a 16 year old cat to sleep? She doesn’t seem to sleep anymore than the 11 year old, but she’s certainly not hanging from the window screens anymore. She usually ignores the stairs I put next to the bed for her so she wouldn’t have to jump. The shelter I got her from said she was about one, but they were wrong about some other stuff. I think they though she was young because she was small, but she never got any bigger so she could have been older. I’ve had her for just over 15 years so we are putting her min at 16. She still has the occasional zoomies (had some last night) and she’s picked at her food the entire time I’ve had her. She’s never been a vomitter. Some hairballs since she’s been on the prescription food (she doesn’t like to be brushed) but this bile vomit is new.
I have figured out for now how to get some of the salmon oil into her! It’s one drip at a time but I’ll take it!
I agree in principle with the “better a day too early than a day too late” but she’s my first pet. I wasn’t allowed to have any growing up so this is my first experience with this. I got her after I graduated college. Other than when she’s actively vomiting she seems fine, knocking everything off my nightstands, batting around pens that she steals, making impromptu appearances in work meetings and attempting to “chat” with my coworkers by sitting on my keyboard.
@Simkie I think the cosequin might be unnecessary, the blue buffalo K/M is kidney and mobility, it has added omega 3, 6, DHA, glucosamine, and chondroitin sulfate.
edited because spell check is my friend!
Why did God make something as wonderful as a cat and give it such SHITTY kidneys? Renal failure seems to get most cats before anything else can. It’s awful.
Sounds like your cat still has good quality of life overall.
@vxf111 I know! Or at least give us a cure for it! I wish I had been more forceful about trying to feed her wet food over the years, maybe that would have made a difference? The problem has always been that she’ll eat about 3 kibbles, then wander off. Her “little” sister on the other hand, is fat. I had to get her a puzzle feeder to keep her from eating so fast she’d puke it all back up right away! That one’s been on diet forever, but never seems to loose much. I had to be really creative over the years to get enough kibble to the skinny one without letting the chonker get to it! FYI for anyone who needs to know, the answer is a REALLY big clear bin with cover, cut a small hole in the bin, one that’s big enough that the skinny cat fits, but small enough the big cat doesn’t. 
Oh my former fatcat would have chuckled internally and then sat on or chewed through the bin until he had gotten inside.
My cat is the same way. He has always been a grazer and usually only eats a few bites at a time. He only wants dry food. I know now that dry food is supposedly harder on the kidneys (especially if they don’t drink much water to go with it). But what can you do when they won’t eat wet food?
I feel you, in my case? Cry a little? I’ve tried mixing in tuna, fish flavored wet food (non-prescription) and lastly, buying fish oil to see if that encourages her. So far, nothings really worked. But I have discovered that she’ll sometime eat a little, but it must be mixed with boiling water. Not warm water from the sink, boiling. I worry she’ll burn her tongue, but that’s what she likes, so that’s what she gets! I have found a way to sneak droplets of the salmon oil into her. I put it on the one treat she’s never turned down, then wait her out. She eats it eventually.
