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Question about Lasix - Need Advice

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  • Laurie Stead
    Hi. Boo is doing well since she recovered from the stress of our last visit to the cardiologist 5/23.  Just a reminder Boo has DCM, diagnosed Nov 2011.  She
    Message 1 of 3 , Jul 3, 2012
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      Hi.

      Boo is doing well since she recovered from the stress of our last visit to the cardiologist 5/23.  Just a reminder Boo has DCM, diagnosed Nov 2011.  She has been taking lasix since she was diagnosed along with plavix, vetmedin and benazepril. 

      Boo's DCM has not progressed (good news) but her kidney values are now slightly elevated (BUN 48, Creatinine 2.4).  Based on this, I assumed the cardio would agree with reducing the lasix but she felt otherwise (see explanation in bold type below).  My question is 1) do you agree?  and 2) do we wait until there are clinical signs of a problem? What are these clinical signs?  

      I want to be proactive in making sure the kidneys do not worsen yet to the cardio's point, Boo is doing really well and do we want to chance harming
      her heart?  I am so torn about it.  I would really appreciate any advice/experience you have for me.


      "Although lasix is commonly thought of as causing direct damage to
      the kidneys, this is not actually so. Lasix causes dehydration and at
      proper doses this dehydration does not cause any injury to the kidneys.
      However, when lasix is giving intravenously and at high doses to treat
      life-threatening severe heart failure quickly, the dehydration can be
      profound and there can be direct kidney injury secondary to profound
      acute dehydration. 

      What typically happens is that oral lasix causes
      dehydration, which then can unmask chronic kidney dysfunction. Many,
      many cats have a degree of mild to moderate chronic kidney dysfunction
      that occurs with age over time. This chronic kidney dysfunction cannot
      be identified for quite a long time because bloodwork is normal until
      the dysfunction progresses. 

      The change is Boo's mild elevated kidney enzymes
      over the last 6 months tells us that she likely has a degree of mild
      chronic kidney dysfunction, which has been unmasked with her lasix
      medication. This change indicates we should be careful with her lasix
      dosage in the future and we will need to be very careful should Boo
      develop worsened congestive heart failure again in the future by
      balancing her requirement for lasix with the possible worsened kidney
      dysfunction due to the necessary dehydration. 

      The important thing to remember is that Boo's kidney
      enzymes are mildly elevated currently and not causing her any clinical
      problems. We can try to reduce her lasix in the future, after we are
      pleased with her clinical status at home, and this will reduce the level
      of mild dehydration to support her kidneys long-term. But it is very
      important to remember that the goal for Boo will always be to try our
      best to prevent congestive heart failure for as long as possible.
      Congestive heart failure is currently more of a life-threatening concern
      than her mild kidney enzyme elevation. Her medical therapy is always
      about balance. "

      Thanks,
      Laurie and Boo


      [Non-text portions of this message have been removed]
    • r schu
      Laurie, My experience on the crf list indicates that most cats don t need sub q fluids til crea gets into the 3 s. Proper food and water intake can usually
      Message 2 of 3 , Jul 3, 2012
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        Laurie,

        My experience on the crf list indicates that most cats don't 'need' sub q fluids til crea gets into the 3's. Proper food and water intake can usually support compromised kidneys at this stage. I'm not sure if oral water intake with food counts as danger for heart cats. But you have the option of watering the food some, to compensate for the lasix, if you now know Boo has compromised kidneys.

        The basics from the crf list, if you don't already know them, include changing to lower phosphorus food, but not necessarily low protein at Boo's stage.

        Dietary support can go along way to support kidneys; fish oil omegas, b12, etc. As well as the renal cat foods. Sorry if you already know this.

        Hydration is of course key. And it's interesting to read below that lasix doesn't harm kidneys directly, but via dehydration. (I can see that happening in May as we write...)

        So my answer to your #2, is don't wait for clinical signs of crf. Start now supporting those little kidneys.

        Hope this helps some.

        -Lee and May (who is hanging in, but tired)



        --- On Tue, 7/3/12, Laurie Stead <kittykatwhiskas@...> wrote:

        Hi.

        Boo is doing well since she recovered from the stress of our last visit to the cardiologist 5/23.  Just a reminder Boo has DCM, diagnosed Nov 2011.  She has been taking lasix since she was diagnosed along with plavix, vetmedin and benazepril. 

        Boo's DCM has not progressed (good news) but her kidney values are now slightly elevated (BUN 48, Creatinine 2.4).  Based on this, I assumed the cardio would agree with reducing the lasix but she felt otherwise (see explanation in bold type below).  My question is 1) do you agree?  and 2) do we wait until there are clinical signs of a problem? What are these clinical signs?  



        I want to be proactive in making sure the kidneys do not worsen yet to the cardio's point, Boo is doing really well and do we want to chance harming

        her heart?  I am so torn about it.  I would really appreciate any advice/experience you have for me.



        "Although lasix is commonly thought of as causing direct damage to

        the kidneys, this is not actually so. Lasix causes dehydration and at

        proper doses this dehydration does not cause any injury to the kidneys.

        However, when lasix is giving intravenously and at high doses to treat

        life-threatening severe heart failure quickly, the dehydration can be

        profound and there can be direct kidney injury secondary to profound

        acute dehydration. 



        What typically happens is that oral lasix causes

        dehydration, which then can unmask chronic kidney dysfunction. Many,

        many cats have a degree of mild to moderate chronic kidney dysfunction

        that occurs with age over time. This chronic kidney dysfunction cannot

        be identified for quite a long time because bloodwork is normal until

        the dysfunction progresses. 



        The change is Boo's mild elevated kidney enzymes

        over the last 6 months tells us that she likely has a degree of mild

        chronic kidney dysfunction, which has been unmasked with her lasix

        medication. This change indicates we should be careful with her lasix

        dosage in the future and we will need to be very careful should Boo

        develop worsened congestive heart failure again in the future by

        balancing her requirement for lasix with the possible worsened kidney

        dysfunction due to the necessary dehydration. 



        The important thing to remember is that Boo's kidney

        enzymes are mildly elevated currently and not causing her any clinical

        problems. We can try to reduce her lasix in the future, after we are

        pleased with her clinical status at home, and this will reduce the level

        of mild dehydration to support her kidneys long-term. But it is very

        important to remember that the goal for Boo will always be to try our

        best to prevent congestive heart failure for as long as possible.

        Congestive heart failure is currently more of a life-threatening concern

        than her mild kidney enzyme elevation. Her medical therapy is always

        about balance. "



        Thanks,

        Laurie and Boo



        [Non-text portions of this message have been removed]
      • elfinmyst@aol.com
        Hi Laurie I would take the advice of the specialist. Mild elevation is fairly common in cats on lasix and also fairly common in older cats. The report seems to
        Message 3 of 3 , Jul 4, 2012
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          Hi Laurie

          I would take the advice of the specialist. Mild elevation is fairly common
          in cats on lasix and also fairly common in older cats. The report seems to
          stress that the kidney values are not high or dangerous and the lasix
          isn't directly harming the kidneys. If lasix is needed to keep fluid off the
          lungs, that is the priority, but I hope as she gets stable they would reduce
          the lasix then when they feel it would be alright to do so.

          Lyn

          _www.myfurkids.co.uk_ (http://www.myfurkids.co.uk/)

          [Non-text portions of this message have been removed]
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