Can my cat recover?

[toriley]

My 6 year old cat Tommy was incredibly lethargic Tuesday so I took him to the vets. Blood test showed crazy high readings throughout and he was severely dehydrated. He's been on IV for 48 hours now, and although absolutely full of life and energy, his BUN is still 46 (UK) and his phosphate 5.19 (UK). All of his other levels have came down. Vet is continuing with IV for another 48 hours and said if there's no change I'll have to make a decision... I'm not an idiot, nor in denial, but I can't imagine Tommy being put to sleep because these levels are still high? He has so much energy. If he was in pain or still lethargic then I would be inclined to agree, but he isn't. How long can it take for these levels to come down? Is 4 days really enough time?
Many thanks

[Aleda M Cheng, D.V.M., C.V.A]

I think that more time is warranted.  It could take a week or so.  If he is acting normally and eating there is always a chance, especially if he will allow you to give him the supplements, sub C fluids, etc.  As I mentioned in my answer his positive response may not show in his blood levels.

[toriley]

Thank you so much for your quick response. I was initially told his creatinine level was off the chart on Tuesday, but he had a second blood test today which showed it had decreased ( I didn't get this number, sorry). The Urea (BUN) and phosphate haven't changed at all, and it was this in which the vet was concerned. It's only been 48hours since he began fluids, is it not possible that he simply needs more time? Thank you

[Aleda M Cheng, D.V.M., C.V.A]

Your cat does seem to have kidney failure although you did not list the Creatinine level.  Has the Creatinine level become normalized after his IV fluids?  Creatinine level is the most important prognostic indicator for survival.

Many cats can live with kidney disease.  Affected cat's require life long medications and therapies, but it isn't effective for all cats.  It is worth a try.  Affected cats will continue to have elevated BUN, Phosphate and Creatinine in their bloodwork.

The following treatment may help:
1. Subcutaneous fluid therapy daily, given at home after instruction by your vet.
2. Daily Azodyl medication which helps with kidney disease and elevated phosphate levels.
3. Daily Rehmannia 8 (Chinese Herbal Supplement) this is available online or over the counter.
4. Renal Diet
5. Daily Epakitin, PhosLo, aluminum hydroxide, or other phosphate binder medication,may be required if Azodyl is not effective or only partially effective in lowering phosphate levels.
6. Monitoring urine for urinary tract infections and to treat infections rapidly.
7. Providing in vet hospital treatment when symptomatic.
8. Vitamin B-12 and B complex supplementation
9. Check often for anemia.  If anemic Erythropoietin can be supplemented
10. Possible enalapril therapy.

Please ask your vet about these options and if they would help your cat.  A vet who has studied holistic therapies and acupuncture may also help.