Tabs to the vet’s (polycystic kidney disease, PKD)

I took Tabs for the kidney ultrasound today and also for other checks at our regular vet.

This is going to be a long, long story.

Tabs’ kidney condition: 

The ultrasound was done and the vet was surprised to see MANY cysts in both Tabs’ kidneys, more on her left. This is totally and absolutely unexpected. The presence of many cysts in the kidneys is a condition known as Polycystic Kidney Disease (PKD for short). I have heard about this from a friend before. It is also a degenerative kidney condition and can progress even faster than the more common Chronic Kidney Disease (CKD).

There is also a large cyst in Tabs’ liver.

This was all unexpected and the vet too did not expect it, but on hindsight now, Tabs had never had any kidney ultrasound done before (because there was no need to do so) and the vet said normally Persian cats are prone to PKD, and so are some purebreds. Tabs has some purebreed mix in her, probably some British shorthair. So, on hindsight, this might explain it. It is a genetic condition.

The vet says we do not really know when it started, but Tabs could have had it all her life and only now, because of age, it is deteriorating (as evidenced by the kidney readings).

How PKD impedes kidney functions is that there is no nephron degeneration as in CKD, but the growing cysts “take over” the place of the kidney cells thereby destroying them. So as the cysts increase in size or number, the kidney cells die. This causes the kidney degeneration.

Here’s something from the internet about PKD:

Polycystic kidney disease (PKD) is a disease that affects felines and other mammals, such as humans. The common name is autosomal dominant polycystic kidney disease (ADPKD) and causes a progressive development of fluid-filled cysts in the kidney and sometimes in other organs as the liver and pancreas.

How long do cats live with polycystic kidney disease?
Just as the age at which we first see signs of PKD is variable, so is the progression of the disease from this point. Some cats with slow progression may live for many years after diagnosis, particularly with appropriate treatment. In other cases, it can progress very fast (just weeks to months after diagnosis).

Feline polycystic kidney disease is a disease with high prevalence in some feline breeds such as the Persian breed. This disease is characterized by chronic renal failure, appears in animals between three and ten years of age and leads to severe and irreversible kidney failure. Current treatment is only palliative.

Is polycystic kidney disease curable in cats?
PKD can be managed with palliative care but it cannot be cured. Your vet can prescribe medications to reduce pain and discomfort, but the disease will eventually become terminal.

There is no cure for PKD. The remaining lifespan could be weeks, months or if lucky, years after diagnosis. The only thing we can do is to treat the cat for kidney degeneration (like CKD) and the vet said we could add fish oil as an anti-inflammatory and later on, the vet did some research and said Chitosan Oligosaccharide might also help slow down cystic growth (but insufficient data on this, though no harm trying). Since coming home, I have enquired at local pharmacies, but they do not sell this product anymore (not popular). It is, however, available online. But we do not know what dosage to give and also the human formulation might contain other components too. So we need to tread with caution before giving it to her. My pharmacist is helping me with this and have identified a brand from, but I cannot for the life of me get into their website. Arrrgh…

For her fish oil, I opted for Coatex for Tabs instead of Astro’s because Coatex is in a capsule (it is also formulated for pets) and Tabs is easier to feed capsules than liquids.

Take a look at the astounding number of cysts in Tabs’ kidneys.

Left kidney – all the black parts are the cysts.

Left kidney.

Right kidney.

The vet says it does not look like lymphoma, which is the most common cancer in cats.

Liver – one big cyst.

The same cyst in the liver, from another angle.

Because of the presence of so many cysts in the kidneys, it was prudent to do a fine needle aspiration to extract some fluids out for testing. If there is cancerous cells, it can be detected. If there is none, it still isn’t conclusively negative for cancer because we can only extract fluids from one cyst. There are indeed SO many cysts. So this was done and no cancerous cells were seen. Still, we cannot celebrate prematurely – there may still be cancer in the other cysts. We will just have to repeat the ultrasound in 1-2 months to check the growth of the cysts in size and number. Another way to determine definitively if Tabs has the cysts are cancerous is to do a biopsy, which is a surgery where some sample is removed and tested for cancer. The vet does not recommend this option as there are risks in the surgery. I agree too. Even if we find out there is cancer, what can we do? At Tabs’ age, we are not going to subject her to chemotherapy and its side effects.

So, we will just manage the multiple cysts as best we can with supplements and the appropriate non-invasive treatment.

So, to summarise here, Tabs’ kidney degeneration is not due to the degeneration of her kidney nephrons, it is because of the cysts. The number and size of the cysts will take up space in her kidneys, thereby destroying her healthy kidney cells. This causes the kidney function to be impeded.

It’s sad, but it happens. It is a genetic condition, the vet said, and she could have had it all her life too, unknown to us.

I later reflected over this and I think perhaps raw food has played an important role in giving all our cats good health such that they could live with these conditions and it only shows at the later stages when the deterioration has become advanced. For example, Indy has had CKD for four-and-a-half years now and it only shows up in the readings now, and yet, he is still clinically okay. Perhaps food did play a role. Just my guess. The same goes for Cleo, Bunny and Pole too.

Back to Tabs, using ultrasound, the vet tried to aspirate some urine from Tabs’ bladder but it was not successful as there is a bit too many layers of fat. Later at home, I was able to collect Tabs’ urine in a bottle, but the clinic had already closed by then. But the colour of the urine looked “okay” to me. It didn’t look too diluted.

Tabs also had a repeat test for her creatinine and urea as well as SDMA.

Creatinine 185 (normal, but on the high side)
Urea 10.5 (normal, also a bit high)
SDMA 12 (previously 8) – on the increase, but still within the normal range.

Based on the above readings, Tabs ought to be at Stage 2 CKD, but this staging is now very helpful now since she has PKD. This now becomes a different ball game altogether. From these readings, compared to the one in September this year, all the kidney readings have increased in just three months, so something is definitely happening in her kidneys. In a way, I am glad we caught it.  At least we can do something about it, even if it’s palliative care.

The vet also says Tabs should be on Renal-P to control her phosphate (it is normal now, but a bit high, so it would be better if it goes down).

In short, for her PKD, Tabs is on exactly the same supplements and dosage as Indy.

Before the PKD was diagnosed, we had plans to put Tabs on the stemcell treatment for CKD if she is at Stage 1 or 2. The vet says they have begun administering this to other dogs and cats too with good results, but there is one condition – there cannot be any cancer. The stemcell injection can slow down the progression of CKD, but it cannot cure it. It just slows it down significantly.

Now, with the many cysts that she has, we cannot take the risk on administering the stemcell treatment for Tabs anymore. It is just too risky as it would accelerate the growth of cancer cells and we aren’t sure if Tabs is cancer-free.

Tabs’ blood pressure was taken too and her systolic is 170mmHg, which is high. This could be due to the kidney condition and must be controlled so Tabs will be on a low-dose of Amlodipine – 1/8th tablet (just like Indy and Cow Mau).

Next, was her heart check

Tabs’ heart condition

The plan earlier was to take Tabs to the veterinary cardiologist for a complete and indepth heart scan. But since we are back at our regular vet now, she can do an echocardiogram first to determine if that specialised scan is needed. That might save us the trip (and costs and stress) of the specialised heart scan.

So Tabs was given a rest after the kidney scans, and after about 5-10 minutes, the vet did the heart scan.

Good news here – everything is normal except for a slight enlargement of the left ventricle.

Tabs’ pro-BNP (blood test for the heart) also came back normal, at a reading of 79.3. Only a reading above 100 is abnormal.

So our vet says the specialised heart scan is no longer needed for now. What a relief, as that clinic is quite far away. And I do not want to subject Tabs to any unnecessary procedure given that she’s so easily stressed out.

So, from now on, Tabs will be on kidney supplements and Amlodipine for her high blood pressure. The next check is in 1-2 months and I will also try again to collect her urine on a day when the clinic is open so that I can send it straight away for the urinalysis.

PKD supplements: Renal-N, Renal-P (phosphate binder), Astro’s NC-Scrub, Kidney Support Gold, Coatex Fish Oil and Chitosan Oligosaccharides (if I can find a reliable brand – please see next post).

High blood medicine: Amlodipine.

Pain management: Transdermal Gabapentin (daily). The vet suspects there is some pain due to the kidney condition so this pain will be managed so that Tabs is more comfortable. I totally agree with pain management. Even though cats are so tough and they often hide their pain, this doesn’t mean they don’t feel it. They do. And if we can do something, surely we don’t want them to be in pain.

On hindsight, the vet mused that for geriatric check-up, besides the usual blood test, perhaps it is equally important to do an ultrasound too, especially of the kidneys so that whatever condition the pet might have can be identified earlier and treated.

In Tabs’ case, she might have had the multiple cysts all her life and we are only seeing it now because of the ultrasound. She was also able to cope well with it (assuming it’s been there all this while) probably due to her youth and health condition.

Many parts are shaven for the kidney and heart ultrasound today. No worries, Tabs, your beautiful fur will grow back.

Keep shining, keep smiling, Tabs. Your comfort is the most important thing now.

Moments are what we all have and moments when we are comfortable and happy are precious ones!

Note: The vet says PKD is not commonly seen, but if it is, it is usually in purebred cats because of the genetic code. She has not seen this condition in kucing kampungs. For example, Ginger has only one kidney cyst and after one year, it is still that one single cyst which is growing very slowly. This would be another reason to stop breeding purebreds and just adopt the many available kucing kampungs and anjing AhWongs in our midst! Even purebred dogs have specific health problems which are peculiar to their breed.

Stop breeding. Adopt from the street.

For new readers, Tabs found her way to our house way back in November 2011. She came with a red collar and a bell, so we assume she must have been a lost or abandoned pet. She went house to house looking for a home, but other cat owners turned her away and chased her out. When she came to our house, she quickly touched noses with Uncle Bobby, our dog (the one who makes all the decisions in the house). Uncle Bobby accepted her but Cow Mau and Cleo chased her out until she defecated along the way, running for her life. I later went down the road to look for her and found her digging someone’s dustbin and clutching a drumstick (with no more meat on it). I took her in and the rest….is history. Our life has been so much richer with Tabs in it! We love her to the moon and back!