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Cat with renal lymphoma.

Species: Cat
Breed: Domestic Short-Haire
Age: 5-8 years
I have a 7 year old female cat who, over the course of the past six months, developed an obssession with water and was occasionally sick. She was last vaccinated in July and we mentioned to the vet that she was drinking a lot, stealing water from cups etc. and occasionally urinating outside the litter box. The vet did not seem overly concerned, listened to her heart, checked for lumps and said she was fine. She was then taken to an outdoor cattery for 9 days in September.

Over the past couple of months we noticed that she was losing weight and the water obsession had worsened. She was also spending more time on her own and seemed withdrawn, although she was eating well and managing to jump to her favourite high places.

When we took her to the vet for bloodwork her readings were over the charts for end stage chronic renal failure: urea > 46.4 mmol/, creatinine 680 ummol/L and phosphorus > 5.19 mmol/L. She was placed on IV fluids for over 24 hours at which point the vet took more blood samples, performed an ultrasound scan on her kidneys and a thin needle biopsy. There was little improvement on the blood results: urea > 46.4 mmol/, creatinine 680 umol/L and phosphorus = 4.25 mmol/L. She is also anaemic, has pale gums and was treated for low grade gingivitis, which had caused a tooth to fall out during her stay.

On the basis of the scan, the vet concluded that it was most likely that she has renal lymphoma in both kidneys since the kidneys were slightly enlarged and he pointed out grey areas which he stated were growths. He suggested that there was little point in sending the biopsy to the lab for testing and that the best course of action would be to euthanize. He sent us home with her having a catheter still in her leg to make it easier to administer the final drug, since she had been struggling previously.

Since coming home she has been quiet but has been eating, coming to us for cuddles and attempting to jump to her favourite high places. The most discomfort she seems to be experiencing is from the catheter. We have decided that since she does not appear to be experiencing a lot of pain we might take a few days to decide on the best course of action and ask other vets for their opinion before taking the irrevocable step of euthanising.

Do you think there is any hope for her at this stage? I have read a few articles online which suggest that chemo could be effective in renal lymphona but is this ruled out by her blood values? The vet was of the opinion that putting her through this, especially with her anaemia, would not be a good idea and that euthanising as soon as possible would be the best course of action. However, based on her behaviour we are not convinced that the time has come for her to go. Please advise.

Online vet, Dr. Marie

Dr. Marie replied:

Oh dear,

I am so sorry to hear about Eiko's illness. The renal enzymes you mentioned are definitely quite high.

However, it is quite unusual that she is eating. Usually this is my indication of how well a cat with a serious illness is doing. If she continues to have a good appetite then I think it is worthwhile to keep trying with her and put off euthanasia. (However, if she is only eating a tiny amount then this is not good. If she is eating well though then I would hold off on euthanasia.)

If this is renal lymphoma then here is a statistic that I found. With chemotherapy there is a 50% chance of surviving 7-8 months. However, this number is a stat for cats that do not have elevated kidney enzymes. Usually, if the kidney enzymes are elevated then this is a very poor sign.

It's a tough call on what to do here. Ideally it would be great to accurately get a diagnosis and do a biopsy of the kidneys as we don't know for certain that this is renal lymphoma. However, for most families, the cost of this is usually higher than what people want to spend considering that the prognosis is poor.

If this were my case I would likely hold off on euthanasia considering that her appetite is good. I would maybe consider putting her back on IV fluids for another day or two to help to flush the kidneys out. If she continues to improve then I would check the bloodwork again and see if the numbers are coming down. If so, there are some long term things that can be done to help to support her kidneys.

It's a long shot though. My gut instinct is that the appetite improvement is temporary and she will likely start to decline again. If that happens then I would not wait too long before considering euthanasia.

I really hope that she does continue to eat though.

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Hi Dr Marie,

She has spent most of the day hiding and sitting on the towel shelves in the bathroom, since we took her to get the catheter out, although she did come out briefly to sit with us at the kitchen table and eat about half of her dinner. It's hard to tell if we should be overly alarmed by this as she has always had a tendency to hide after traumatic events, and the past few days have not been pleasant for her (she hissed and struggled a lot when the catheter was being removed).

She is still drinking (about 50-100ml of water in one sitting) and eating (about half a 70g tin at a time) but her energy levels are very poor. She is unable to jump onto the kitchen units now, for example, although she is still trying.

I suspect it is her anaemia that is causing the poor energy levels and I am seeking the opinion of another vet to see if it would be worthwhile trying ESAs at this stage. I will also ask about more IV fluids, but it is breaking my heart putting her through this. We have also started administering a phosphate binder and we have some steroids to help with the inflammation.

I fear we are just prolonging the inevitable and I am very concerned about her being in pain. She is not whimpering - she purrs when we stroke her head, but growls a little if we touch her elsewhere. Again though, hard to tell if this is unusual as she always was like this until my partner helped to increase her confidence and bring her out of her shell through perserverence.

I will let you know what happens. Thank you so much for your time.

Online vet, Dr. Marie

Dr. Marie replied:

Hmmm...hiding is not a good thing. If this continues or gets worse then this is not a good sign.

From what you have described, I can summarize my advice in two points:

1. If Eiko is eating well and doing less and less hiding then I would say, keep going.

2. If the appetite declines and the hiding continues then I would not wait too long before deciding on euthanasia. If she is not feeling well, it does not benefit her to put off the inevitable.

I pray that she makes the decision easy for you either way.

Dr. Marie.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.