Question Details
Worsening Renal Azotemia In A Cat
by CorinneC - August 11, 2023    View Case Report
Kitty is an 18yo FS Tortoiseshell. She has been decently controlled for hyperthyroidism for the past 5 years with am transdermal Methimazole and pm oral compounded Methimazole. Her kidneys started to become affected soon after the meds were started so I put her on Rehmannia 8 as well as Thyroid Control drops (western herbal concoction with dandelion root, Bugleweed, Lemonbalm, Motherwort). She did very well with this, Creat stayed mostly in the 200 range for a few years, but this year her Creat, BUN, and SDMA have been creeping up while her weight goes down. She also started to have a mild non-regenerative anemia. She is lively for her age, has a decent appetite (raw beef and canned). When her weight and RBCs started to drop I added Yi Guan Jian as well.

Her Creat, BUN, and SDMA climbed even higher so I took her off Rehm 8 and YGJ and tried Rehm 6 only to have her values climb yet again and her weight drop again!!! Her tongue is so hard to see (she is very tiny and only 2kg) but I think I see moist crimped sides, looks pretty pink, maybe a little reddish? Pulses are hard to feed on her as she's very wiggly, her medial right saphenous is usually the best veins to take blood on as it stands out, so I assume her right sided pulses are the best?

He owners are really stressed by her climbing kidney values, as am I. Last bloodwork yesterday also had her T4 elevated at 70 (older clients, may not be getting her meds regularly), Creat 526, BUN 48, SDMA 32! She is still eating decently but will skip the occasional meal now too. She vomits pretty regularly, not huge amounts. She is still BAR and lively at home. I put her back on Rehm 8 and YGJ, but I think I am missing something. With that Damp looking tongue should I be switching the YGJ for San Ten Tang??
by naturevet
August 18, 2023
Hi there

If they aren't getting the meds in properly for some reason, that won't help and may be enough of an explanation for why the kidneys are struggling.

SRT is never wrong when used with Rehmannia. If she still seems to be relentlessly shrinking despite seeming good control of the hyperthyroidism, you could try Zhi Bai Di Huang Wan (APR Nourishing) instead as your Rehmannia source. It can compensate for incompletely treated glands.

Also make sure you're using enough herbs. If, for example, you were using Kan products, the dose on the label is often too low, in my experience.

Another idea is probably to check the cat's BP if you can. If it's high, an anti-hypertensive like Benazepril can help. Lastly, check the urine protein:creatinine ratio. if it's through the roof then the kidneys are inflamed, calling perhaps for Benefit Hips and Knees.

Speaking of which, has the urine been cultured to make sure there is no pyelonephritis?

Hopefully these ideas help you out

by CorinneC
August 29, 2023
Ok, we have started her today on ZBDHW. Owners are strongly considering radioactive iodine as well.
by CorinneC
August 31, 2023
Nevermind, I131 won't take her because her kidneys are too far gone. I may be being a little hard on myself as she turns 19 next week but she's been such a rock star until lately.
by naturevet
September 3, 2023
Hang in there. If the ZBDHW kicks in, her kidneys could improve if you can also get the drugs right. If she does, then you can re-look at I131, but she will need vigorous kidney support (e.g., with Rehmannia Eight) after I131 treatment. Potentially subcutaneous fluids, too.

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