My Persian cat with polycystic liver, Giardia and Ca oxalate

Jeanpierre

Hello,

My male Persian cat is 6 years old.

- He is eating the Kidney Disease Hill´s food since two years.

- He does not go out; he lives in an apartment.

- When he was one year or two years old, the analysis of urine showed that it contained proteins. At this time, his weight decreased. Since this time, I give him 100-120 milliliters of mineral water everyday with a syringe. Some months after this "water treatment" began, his weight increased and the amount of proteins found in the urine was significantly reduced.

- When he was one year old, he has been treated against parasite Giardia with Giardicid. After this treatment, no more blood was found in the feces. It seemed that the parasite was killed by the treatment.

- On april 2009, he had cystitis. The analysis showed that urine contained calcium oxalate crystals. At the time, he was taking silybin. This medication has been made in a pharmacy. The cystitis began some weeks after he began to take silybin. So, I stopped giving this to my cat and I observed that the cystitis stopped. I saw with a microscope that this pharmacy made silybin contained a lot of crystals which had the shape of cystin crystals (hexagonal). This was very strange. The ultrasonography showed two stones of 2 millimeters in the urinary bladder.

- During the year 2009, a brazilian laboratory used PCR to determine if my cat was positive for polycistic kidney disease. This laboratory said he was PKD positive. This sounds weird. The disorder seems to be polycystic liver desease. He has no cysts in the kidneys, but he has a lot of cysts in his liver. I am wondering if this laboratory really used the best primers in PCR for the diagnosis.

- The parasite Giardia and blood were found in his feces 2 weeks ago. The first time that they were found was 5 years ago, as wrote previously. My veterinarian indicated a treatment with metronidazol (25mg/kg twice a day during 5 days – two capsules daily with 100 mg per capsule). He stopped eating at the third day of treatment (january 11 2010). At this time, he weight 4,2 kilograms while he weight 4,4 kilograms at the beginning of the treatment. So, I stopped the treatment and I took him back to the veterinarian. She said that the antibiotic was not good for his polycystic liver, as the liver was not 100 % efficient to metabolize the metronidazole which reached the blood. It was not a surprise for me. The last analysis of feces done on january 13 showed that the Giardia was not eliminated. I gave him the K/D Hill´s food dissolved in mineral water until january 15 using a syringue.

- The analysis done since two years ago until january 15 2010 showed that the alanine transaminase level and the alkaline phosphatase level are higher than the levels of reference. He is taking Denosyl SD4 everyday since one year. He will begin to take Denamarin (Denosyl DS4 + Silybin) from Protexin (British firm) soon. May be it will help his liver. I do not know.

- On january 13 2010, my veterinarian felt a liquid in his belly. She took a small quantity of this liquid with a syringue. It was yellow. She sent it to be analysed in a laboratory. The analysis showed that it has no smell, it was limpid, its density was 1,036, its pH was 8.0, it contained a small clot of fibrin, an protein amount of 4,6 g /dl, a glucose amount of 500 mg/dl, 1700 leucocytes /mm3. It contained also bacterias which were suspected to be contaminating. It did not contain bilirubin and hemoglobin. The cytologic analysis showed that this liquid contained a large number of mesothelial cells which were highly reactive, macrophages; lymphocytes (some of them were young), red blood cells and epithelial cells without nucleus; a small number of neutrophils and eosinophils; stripes of fibrin. The laboratory concluded that the cell characteristics and other aspects of the analysis suggested that this cyst liquid is a septiq exudate. The lab finally wrote that it is common to find more neutrophils than lymphocytes in this kind of liquid, and that is why the bacterias can be contaminating.

- An ultrasonography performed on january 15 showed that the size of one of the cysts of the liver grew very much and was compressing other organs. Almost 100 milliters of a yellow liquid were removed from this big cyst using syringues and ultrasonography on january 15. Liquid from other 3 cysts was also partially removed. The size of the biggest cystS (in plural) is now 4 to 5 centimeters. The total of the removed cyst liquid was 150 milliliters. After this operation, my cat was better and he was able to eat by himself. No stones were observed in the urinary bladder with ultrasonography on january 15 2010, while 2 stones of 2 millimeters were seen on april 2009 in the urinary bladder.

- A small quantity of the 150 ml collected cyst liquid was send to a laboratory to be analysed. The analysis showed that it was yellow, it has no smell, it was limpid, its density was 1,034, its pH was 7,5, an protein amount of 4,6 g /dl, a glucose amount of 500 mg/dl, 300 leucocytes/ mm3. It does not contain any clot. It also contained a large number of bacterias which were suspected to be contaminating. It did not contain bilirubin and hemoglobin. The cytologic analysis showed that this liquid contained a small number of mesothelial cells and macrophages; a small number of neutrophils and lymphocytes ; a large number of red blood cells; superficial cells without nucleus. It also said that there was no signal of obvious malignancy in the analysed liquid. The laboratory concluded that the cell characteristics and other aspects of the analysis suggested that this cyst liquid is an septiq exudate. It was finally wrote that the number of cells is low, and that it is common to find more neutrophils than lymphocytes in this kind of liquid, and that is why the bacterias can be contaminating.

- My veterinarian said that “... an antibiogram should be done when the next collect of cyst liquid will be realised, in order to use the specific antibiotic; the only explanation for the contamination of the cyst liquid is the blood stream; this does not indicate necessarily that the cat is infected now; he is not infected because the hemogram was normal; probably he has been infected in the past”.

- The blood analysis done on january 2010 showed that the lymphocyte level was 1190/mm3 while the reference level varies from 1500 to 7000 lymphocytes/mm3, and that the basophil level was 476/mm3, while the reference level is 0/mm3.

- These blood analysis also showed that the creatinine level was normal. So, the function of the kidney appeared to be normal. However, the last analysis of urine done on the same day showed that it contained crystals of calcium oxalate, a protein amount of 30 mg/dl, and that it had a density of 1,016 and a pH of 5,5.

- It exists a treatment with potassium citrate that is able to raise the pH of the urine and to prevent the formation of calcium oxalate stones. My veterinarian said me that the pH of the urine is low, that the best pH is 6,5 to 6,8, that the dose of potassium citrate for cats varies from 50 to 75 mg/kg, that she will prescribe a dose of 50 mg/kg to be administered twice a day, until obtaining a urinary pH 6,8 - 7,0, and that this dose will be placed in a capsule. My cat weighs 4 kilograms . So he should be administered two capsules with 200 mg of potassium citrate in each capsule during every 24 hours period (total ingested amount = 400 mg per 24hours).

Please, I would like to ask the following questions :

- Should my cat continue to eat K/D Hill´s food ?

- Can I give Denosyl DS4 or Denamarin to my cat with polycystic liver?

- I read that potassium citrate can not be used in cats that do not already have a history of stone formation, that the presence of calcium oxalate crystals in the absence of symptoms is felt to be normal. I do not know if it is correct. If it is true, can we say that there is enough clear indication for using it on my cat?

- My veterinarian prescribed 2 capsules containing 200 mg of potassium citrate for every 24 hours period (total ingested amount = 400 mg per 24hours), until obtaining a urinary pH 6,8 - 7,0. Can this prescription be considered as satisfactory?

- Two analysis showed that bacterias have been found in the cyst liquid. Is this possible that the cyst liquid has been contaminated during the syringue collect by bacterias of the air, by the bacterias of the skin or the hairs of my cat, etc.? Why bacterias could be in the cysts and why the hemogram (blood analysis) would be normal, as it was mentionned previously?

- Why the lymphocyte level was a little reduced and why the basophil level was increased?

- Does it exist a specific medication against Giardia for my cat with polycystic liver?

- Is this possible that a mistake (choice of primers, etc.) in a PCR diagnosis to screen for PKD from blood collected from a cat with polycystic liver disease indicates that this cat has PKD, while in fact he has no PKD or a less dangerous form of PKD?

All observations, even those who are not related to my questions, are of course wellcome !!! :smile

Jean

Ellie

Oh, I'm am so sorry for all of these reports on your baby.
I think Celeste and others may have more information for you so check in again,please.

JoaneWing

Celeste has a cat with PKD that has cysts in her liver. She also has a cat with PKD and the cysts are in his kidneys and he suffers from many urinary infections. I had a cat with PKD but passed from HCM.

As Ellie said, please check back as Celeste is quite an authority on this topic. I wish you the best of luck with your cat.

Celeste

I am going to answer your questions to the best of my ability. I wouldn't call myself an authority in this area, but I have been taking care of an almost 18 year old persian cat who was diagnosed with PLD (final stages) 4 years ago. She has been cared for by a specialist of internal medicine during this time.

- Should my cat continue to eat K/D Hill´s food?

Any special kidney diet is going to be lower in protein. If bloodwork performed does not indicate that he is not in clinical renal failure, then I personally would not. Longterm use of lower protein diets will eventually lead you to administer supplements due to other deficiencies. Hill's W/D prescription diet along with others can be used for cats with PLD.

- Can I give Denosyl DS4 or Denamarin to my cat with polycystic liver?

Denosyl does not help a cat that has polycystic liver disease. I can't emphasis this enough since it made my cat very ill. This is a common drug used for other liver diseases since it helps regenerate liver cells. A cat with PLD has a healthy liver which is being consumed by cysts due to this genetic disease. The eventuality with time passing, there will be more cyst growth. The unknown factor is that there is no specified time period of how quickly they may grow or how long they may lie dominant.

- I read that potassium citrate can not be used in cats that do not already have a history of stone formation, that the presence of calcium oxalate crystals in the absence of symptoms is felt to be normal. I do not know if it is correct. If it is true, can we say that there is enough clear indication for using it on my cat?

I'm not familiar with the use of this for calcium oxalate crystals. My 5 year old boy who has PKD (polycystic kidney disease) also has this problem. His levels have been maintained by using a steroid. Since his kidney values have escalated and this steroid cannot be used daily any longer, we will be trying a new drug that is approved for use on humans, however, has not received approval for use on felines.

- My veterinarian prescribed 2 capsules containing 200 mg of potassium citrate for every 24 hours period (total ingested amount = 400 mg per 24hours), until obtaining a urinary pH 6,8 - 7,0. Can this prescription be considered as satisfactory?

- Two analysis showed that bacterias have been found in the cyst liquid. Is this possible that the cyst liquid has been contaminated during the syringue collect by bacterias of the air, by the bacterias of the skin or the hairs of my cat, etc.? Why bacterias could be in the cysts and why the hemogram (blood analysis) would be normal, as it was mentionned previously?

If the sampling has been taken via needle guided ultrasound, I am going to say no since the sampling is not exposed to air. When cyst fluids are sampled they are sampled for 2 reasons. One to make sure there isn't any cancer growth and the other to see if the fluids are sterile and clear. The reason for this is in the event that one were to rupture on its own, it is required to know if the fluids can be absorbed by the body without any other ill effects. The draining of liver cysts will become a common event if they are active. I have had this procedure done numerous times.

- Why the lymphocyte level was a little reduced and why the basophil level was increased?

- Does it exist a specific medication against Giardia for my cat with polycystic liver?

The diagnosis of Giardia bothers me here unless you have a multi-cat household or your water is contaminated. Diarrhea is common with cats that have PLD. It needs to be controlled with a special diet. If Giardia is a true finding, the medication of choice here is Metronidazole for 7 days and I believe there is a vaccine for dogs and they were working on having one for cats.

- Is this possible that a mistake (choice of primers, etc.) in a PCR diagnosis to screen for PKD from blood collected from a cat with polycystic liver disease indicates that this cat has PKD, while in fact he has no PKD or a less dangerous form of PKD?

I'm not sure I fully understand your question here. A 100% mistake proof way of making sure your cat does really have PLD/PKD is to have a DNA test done. This can be accomplished at the cost of $40.00. There is specific information relating to this subject matter in our Library Section here. Whether there are different levels of PKD, one being less dangerous than another, this is not the case. It still remains a mystery on why some cats will succumb to this disease rather early in life and some just live a full life and will probably have another medical issue take their life at the end.

I hope this helps you and if there are any other questions you have that I can answer, feel free to ask.

JoaneWing

I knew you could help Jean Pierre, Celeste. You have really made a difference and a huge contribution in enlightening cat owners about PKD.

I can't tell you how many times I do a Google Search and this site comes up.

Jean Pierre, we are all here to help and support you. We continue to wish you the best.

Bon Chance Mon Ami,
Joane

simbakui

PCR is used to amplify a small amount of DNA. When doing a DNA test for PKD, they first run the DNA through a PCR so they amplify the particular gene of interest (in this case PKD1), and then sequence the gene to determine if the cat has the mutation that causes the disease PKD. Polycystic liver disease is not that uncommon in cats with the PKD1 mutation. Although PKD stands for polycystic kidney disease, cysts can also grow in the liver as well. There are probably modifier alleles that contribute to the severity of PKD, and whether the cysts grow in the liver or kidneys, but no modifier loci have been discovered to date.