TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 
   

DIAGNOSIS: TEST RANGES,

AND FACTORS WHICH MAY AFFECT TEST RESULTS

 

ON THIS PAGE:


Factors Which May Affect Test Results


Converting International Values to US Values


Normal Ranges for Tests


Veterinary Links About Test Results


 

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Home > Diagnosis > Test Ranges, and Factors Which May Affect Results

 


Overview


  • There are a number of factors which may affect test results. This page discusses the pros and cons of these factors, such as whether it is necessary to fast a cat before blood tests.

  • This page gives a rough idea of normal ranges for tests commonly run on CKD cats, and explains why there are differences between various laboratories. It also has veterinary links explaining more about test results.

  • Ranges for test results differ between the USA and the rest of the world. This page explains those differences.


Factors that May Affect Test Results                                                               Back to Page Index


 

Certain factors may affect test results, and in certain cases may make the results somewhat inaccurate. Stress, fasting before a test, or how the test is handled by the laboratory may all have an effect. This section covers some of the more commonly seen issues.

 

Cornell University College of Veterinary Medicine has more information on these factors. Click on the links on the left for more information.

Fasting a Cat Before Tests


If cats are not fasted before blood draws, then lipaemia may occur, particularly if the cat has eaten a meal rich in fat. This means that lipids (fats) are suspended in the blood, which may make the sample thicker and harder to test.

 

However, lipaemia is relatively rare in feline blood samples, and even if it is present, it is unlikely to make a major difference to the test results. Therefore it is not usually necessary for a cat to fast before the usual tests for CKD, and overall I think it is a bad idea because an empty stomach can increase the risk of stomach acid; plus when they are being fasted, cats simply do not understand why we won't feed them, which is stressful for them, especially if other family cats continue to get fed whilst they do not. However, for certain specialised tests, such as those for parathyroid hormone or pancreatitis, fasting for twelve hours may be necessary; be guided by your vet.

 

Cornell University College of Veterinary Medicine has more information on lipaemia.

 

Stopping Fluids Before Testing


I have heard of some vets asking that people not give their cats fluids for a day or two (in one case, a week!) before bloodwork. I do not understand this: since the cat normally receives fluids, surely you will obtain more accurate results, reflecting how the cat's bloodwork normally looks, if the cat has his/her usual levels of hydration. But I do recommend that you try to be consistent i.e. always have the tests done before sub-Qs or after sub-Qs, at the same time of day if possible.

 

Stressed Cats or Cats Who Fight Blood Draws


If your cat fights at the vet, or gets very stressed, this may have an effect on some of the test results. For example, blood glucose levels are often raised in stressed cats, so they do not automatically indicate that diabetes is present. Similarly, CK or CPK, a muscle enzyme, may be raised because of a bad blood draw.

 

Haemolysis


Occasionally bloodtest results will mention that they are haemolysed. This means the blood cells being tested have ruptured, often as a result of poor handling. Mild haemolysis should not have any real effect, but a grossly haemolysed sample may affect results, causing some values (such as phosphorus) to appear higher than they are and others (such as creatinine) to appear lower. Potassium will usually appear higher than it really is, but occasionally it will appear lower. If a sample has been haemolysed, you might wish to ask your vet to take new blood samples and run the tests again.

 

Cornell University College of Veterinary Medicine has information on the impact of haemolysis.

BD Tech Talk has more information on haemolysed samples.

 

Clumping Platelets


Platelets are the component of blood which causes it to clot. If they were not present, we would bleed to death whenever we got cut.

 

Unfortunately when a sample of blood is taken, some of the platelets may "clump" (stick together), especially if the blood sample is not mixed with the anticoagulant immediately. Clumping platelets are extremely common in cats  - they occur in as many as 75% of cat blood draws. They are even more likely if it is difficult to get blood from the cat. Taking them from a leg rather than from the neck may also be a factor.

 

The clumping means that it can be difficult to count the platelets accurately, which in turn means that the number may appear low. However, you may sometimes see platelet counts listed as low, followed by a comment that the platelet estimate is "adequate." This means that the person running the test could not tell the platelets apart enough to be able to count them, but could see that overall there are enough.

 

If a cat truly has low platelets, then you may see increased bleeding e.g. from the nose, gums or in urine.

 

Cornell University College of Veterinary Medicine has more information on platelets.

Pet Place has some information about low platelets (no need to register to read the article, just click on Close at the bottom of the irritating pop-up).

 


Differences Between US and International Measurement Systems         Back to Page Index


 

The USA uses a different measurement system to the rest of the world, which uses the SI system (SystŔme Internationale). Although I am familiar with both systems, having lived in both the UK and the USA, Tanya's Feline CRF Support Group has primarily American members, so you will get more feedback when you join if you post your results in American values.

 

In order to do this, there is a handy converter on the Veterinary Information Network website. Remember to choose the feline measurements and to enter the SI (international) measurements for conversion to US equivalents, not the other way round. When converting urea from your international results, choose Urea Nitrogen from the dropdown menu - that is the nearest US equivalent. When converting creatinine, be sure to choose creatinine rather than creatine, which is also in the dropdown menu.

 

You can also use the Jay Clinical Services website, but you need to know a bit more about which values to choose. Most international values are in mmol/L and if you are trying to convert to US values, you will be converting to mg/dl. Creatinine is slightly different and the international value is in Ámol.

 

Sometimes the conversion site is down, but usually not for long. However, if you can't get it to work, here is a rough guide to the calculations:

 

Urea (BUN)


If you have a urea measurement in mmol/L, you multiply the international value by 2.8:

  • e.g. urea of 50 is a BUN of 140.

If you don't have a calculator, you can do it roughly by simply multiplying by 3:

  • e.g. urea of 50 is about BUN 150. Note this slightly overstates it.

If you have a urea measurement in mg/dl (often the case in Germany, Austria and Italy), you multiply the international value by 2.14:

  • e.g. urea of 65 is a BUN of 140.

If you don't have a calculator, you can do it roughly by simply multiplying by 2:

  • e.g. urea of 65 is about BUN 130. Note this slightly understates it.

Creatinine


You divide the international value by 88.36:

  • e.g if a cat has creatinine of 300, then it is 3.4 in US values.

If you don't have a calculator, you can just do it roughly by dividing by 100 and adding on about 10%:

  • e.g. if a cat has a creatinine of 300, dividing by 100 gives you 3, then add on 10%, which gives you 3.3. Note  this slightly understates it.

Phosphorus


You multiply the international value by 3.1:

  • e.g. phosphorus of 4 international is 12.4 in US values.

If you don't have a calculator, you can do it roughly by simply multiplying by 3:

  • e.g. phosphorus of 4 is about 12 in US values. Note this slightly understates it.

Potassium


This is the same in both systems, so no need to convert anything.

 

PCV/HCT


This is the same in both systems. However, sometimes in international values, it will be shown differently,e.g. 0.30% rather than 30%. If this happens, simply move the decimal place along two places.

 


Normal Ranges for Cats                                                                                      Back to Page Index


Why Ranges Differ Between Laboratories


Cornell University College of Veterinary Medicine provides some information on why reference ranges differ from laboratory to laboratory.

Lab Tests Online also explains more about this.

 

Normal Ranges for Blood and Urine Tests


These ranges are approximate - if those your vet provides are different, which is quite likely, you should be guided by them. These ranges are also not directly comparable; for example, the upper limit for urea/BUN is noticeably lower in the SI system.

 

This table contains ranges, but that does not necessarily mean that a result within these ranges is acceptable. For example, a CKD cat should aim for a phosphorus level no higher than 4 (US) or 1.3 (international), while most CKD cats do better if their potassium level is around 4.4.

 

Measurement

Normal Range (International) Normal Range (USA)
Urea (BUN) 3.5 - 8.0 mmol/L

9.8 - 35.0 mg/dl

Creatinine 40 - 180 Ámol/L

0.5 - 1.80 mg/dl

BUN:creatinine ratio 4 - 35

4 - 35

Potassium 3.5 - 5.5  mmol/L

3.5 - 5.5 mEq/l

Phosphorus 0.81 - 1.61  mmol/L

2.5 - 7.50 mg/dl

Calcium 2.0 - 2.8  mmol/L

 8.0 - 11.2 mg/dl

Phosphorus x Calcium less than 5

less than 70

Sodium 141 - 155  mmol/L

141 - 155 mEq/l

TCO2 17 - 23 mmol/L

17 - 23 mEq/l

Anion Gap 10 - 27

10 - 27

Packed Cell Volume 29 - 45%

29 - 45 %

RBC 5.5 - 9.9 

5.5 - 9.9

Reticulocytes 0.1 - 1.0

0.1 - 1.0

White Blood Cells 5000 - 18000

6 - 19

Neutrophils (segs)

2500 - 12000

60 - 80

Neutrophils (bands) 100 - 300

0 - 3

Eosinophils 0 - 1500

0 - 5

Lymphocytes 1500 - 7000

17 - 32

Monocytes 0 - 850

0 -5

CK/CPK 88 - 300

88 - 300 U/L

Cholesterol 1.9 - 4.2 mmol/L 

65 - 200 mg/dl

Glucose 3.85 - 8.25 mmol/L

70- 150 mg/dl

Amylase 100-1500 /Ál

100-1500 U/L

ALT 10-130 /Ál

10-130 U/L

Albumin 25 - 40 g/L

2.5 - 4.0 g/dL

Globulin 23 - 53 g/L

2.3 - 5.3 g/dL

Total protein 5.5 - 8.1 g/dl

5.5 - 8.1 g/dL

Blood pressure Max: 145 (systolic)

Max: 145 (systolic)

USG 1.008 - 1.060

1.008 - 1.060

Osmolality 270 - 320

270-320

Temperature 38-39 C

101 - 102.5 F

 

Normal Temperature


 

Temperature 38-39 C

101 - 102.5 F

 

Pet Place explains how to take your cat's temperature (no need to register to read the articles, just click on Close at the bottom of the irritating pop-up).

 

Normal Heart and Respiration Rates


Surprisingly, there appears to be little agreement on what is normal in terms of pulse and respiration, as the following table shows.

 

Some people whose cats have heart problems learn how to use a pediatric stethoscope on their cats. Even if you don't do this (I never have), ask your vet for guidance on what is normal for your cat. If your cat appears to be having trouble breathing, particularly if s/he breathes with the mouth open, it is a medical emergency and you should seek veterinary help immediately.

 

Respirations are normally measured when the cat is asleep. They will always be more frequent when the cat is awake. Breathing in and out once counts as one breath.

 

Source

Pulse (beats per minute)

Respirations per minute

Merck Veterinary Manual 120 - 140  
Veterinary Drug Handbook 100 - 120 (old cats)  
The Cornell Book of Cats 160 - 240 20 - 30
The Pill Book Guide to Medication for Your Dog and Cat 160 - 180 20 - 40
Pet Place 160 - 220 20 - 30
University of Michigan 130 - 160 20 - 30
Colorado State University* 160 - 220 20 - 30

*This site also gives instructions on how to take the measurements

 


Veterinary Links Explaining Blood Tests                                                       Back to Page Index


To obtain more information on what the different measurements on your cat's bloodwork mean, try some of these websites:

 

Cornell University College of Veterinary Medicine ľ excellent detailed information on blood work, and urinalysis.

Washington State University - helpful information, and perhaps easier to understand than Cornell.

Animal Hospital of Rowlett discusses the tests usually contained in a geriatric panel.

Pet Education has some helpful sections:

Pet Place also has helpful information (no need to register to read the articles, just click on Close at the bottom of the irritating pop-up):

NationWide Laboratories is a UK website which gives a brief description of what the various items in bloodwork mean, together with approximate UK (international) ranges.

Small Animal Clinical Diagnosis by Laboratory Methods (2003) Willard MD & Tvedten H is a book which explains laboratory tests.  

 

 

Back to Page Index

This page last updated: 02 December 2013

Links on this page last checked: 04 April 2012

 

 

The group is hosted on yahoo!groups, part of yahoo. It has its own address separate from Tanya's website. You can either click here or copy and paste this link into your browser:

 

http://pets.groups.yahoo.com/group/tanyas-ckd-support/

 

If you are already familiar with yahoo!groups, just click on the link and apply to join (and don't forget to complete the short questionnaire you'll be sent), but if you'd like to know more about how the group works, read on.

 

I own and run the group, but I am ably assisted by two moderators, Anne V and Anne A. They help with membership queries, approve messages, and do lots of boring admin stuff behind the scenes to help the group run smoothly for the members.

 

The group has various sections, including a photos section and a realtime chat function but for most people the most important part of the group is its message section. Basically, a member who wants support, vet recommendations, or to hear how others are coping with a particular problem, sends a message to the rest of the group. Other members then respond if they can. All messages sent to the group are stored in a message archive which members can search if they wish.

 

The group is private, i.e. messages sent to it are only visible to members, so people are not posting to the internet at large. The names of group members are also private, so nobody will know you are a member unless you choose to send messages to the group.

 


Joining the Group                                                                                                                        Back to Page Index


 

There are two ways to join the group, via the group's website or via e-mail:

 

How to Join the Group via E-mail


Just send an e-mail to

tanyas-ckd-support-subscribe@yahoogroups.com

You should then receive an e-mail in response asking you to confirm that you definitely want to join the group. Just click Reply and send.

 

If you join the group via e-mail, you will be able to send and receive e-mails to the group, but you will not be able to access the group website and read the message archives or look at the photos. If you wish to do that, you will need to set up a yahoo! ID by visiting the group website.

 

How to Join the Group via the Web


You can visit the group's homepage and follow the instructions. If you do this, yahoo!groups will help you set up your yahoo! ID, which gives you access to the group message archive etc. A yahoo! ID is not the same thing as an e-mail address.

 

Here are the steps to follow. Don't worry, this all sounds far worse than it is! You should find that in practice it all works more smoothly than it sounds when you're trying to explain it in writing:

 

Existing yahoo! ID

  1. Go to the group website: http://pets.groups.yahoo.com/group/tanyas-ckd-support/

  2. Click on the Join this Group button and you'll be taken to a Sign In to Yahoo! page.

  3. Sign in and link Tanya's Support Group to your existing account.

  4. Choose the e-mail address you wish to use for the group (see below).

  5. There is a little box for you to tell me why you would like to join the group. You don't need to be inventive or fancy, it's not a competition, it's just an extra check by yahoo!groups to keep spammers out.

  6. Choose your message delivery options (see below).

  7. Scroll down and click on the blue Join button at the bottom right of the page.

New yahoo! ID

  1. Go to the group website: http://pets.groups.yahoo.com/group/tanyas-ckd-support/

  2. Click on the Join this Group button and you'll be taken to a Sign In to Yahoo! page.

  3. Scroll down a little and click on the Create New Account button.

  4. On the next page you can create your new account. Some people are somewhat inventive in their responses, but in such cases it is important to remember what responses have been given in case the information is needed later to access the account. I can't see any of this stuff, it's entirely private between you and yahoo!groups, so I cannot help in case of later queries. 

  5. Once the account is successfully set up, you'll be taken to a Congratulations! page.

  6. Before you click on the Continue button on the Congratulations! page, untick the box that makes yahoo! your homepage (unless that is what you want).

  7. Also click on the Edit Marketing Preferences link below the Continue button. This takes you to another page where they helpfully opt you in to everything, so go through and set it as you wish.

  8. Then on the same separate page click on Account Info at the top of the page. You will be asked for your password again and taken to the Account Info page. Click on Profile and opt out of the various choices as you wish. The key thing is, you do have choices here, you can make things as public or private as you wish.

  9. Now click on the Continue button on the original page. You will be taken back to the group page to choose your membership settings.

  10. Choose the e-mail address you wish to use for the group (see below).

  11. There is a little box for you to tell me why you would like to join the group. You don't need to be inventive or fancy, it's not a competition, it's just an extra check by yahoo!groups to keep spammers out.

  12. Choose your message delivery options (see below).

  13. Scroll down and click on the blue Join button at the bottom right of the page.


Membership Settings                                                                                          Back to Page Index


 

There are various choices you need to make regarding your membership of the group. The most important are which e-mail address to use, and which way you read messages sent to the group by group members.

 

Membership Settings: Your E-mail Address


You need to decide which e-mail address you wish to use for the group. If you have created a yahoo! ID, yahoo!groups will normally have also set up a free yahoo! e-mail account for you based on your new yahoo ID. You can use this e-mail address to access the group if you wish, but it's not essential, you can use any e-mail address you wish. Since yahoo! is now scanning messages for advertising purposes (similar to gmail), I would recommend not using yahoo! e-mail if possible (though it would probably be better than using your work address for private stuff).

 

If you do not want to use your free yahoo! e-mail address, click on Add e-mail address to add a different one. Be aware, if you don't add a new address here, yahoo! will use the yahoo! e-mail address as a default address. So if you don't receive the membership questionnaire, it may well be because it's gone to your new yahoo! e-mail address.

 

If you ever wish to change the e-mail address you are using for the group, you can do that here:

http://pets.groups.yahoo.com/group/tanyas-ckd-support/join

 

Membership Settings: Message Delivery


This sets up how you will access messages that are sent to the group.

 

This is a pretty active group. If you're looking after your CKD cat, you want support but you probably don't want a full inbox all the time. To help you manage this issue, you have three options for messages, and you can switch between them all as you wish:

  1. Individual E-mails

  2. Daily Digest

  3. Web Only (No e-mail)

Individual E-mails


This is the default setting. If you apply to join the group via e-mail, you will end up with this setting. If you apply to join the group via the group's webpage, if you don't choose one of the other settings, this is the one you will end up with.

 

This setting means that as soon as somebody sends a message to the group, it is sent directly to your inbox. It's a good choice if you might want to know immediately if somebody has responded to you, or if you would like to store some of the group messages for your reference. It's also good for being able to quickly delete messages which don't interest you.

 

The downside is that this is a busy group, averaging 50-100 group messages each day, so your inbox can quickly get full. One solution is to create a folder to use for group messages. All messages sent to the group have a tag in the subject line [tanya-crf] so you can filter all messages from the group to a new folder using this tag if you wish.

 

With both individual e-mail and message digest options, you can also choose the format of messages sent to you (Display Format), either Fully Featured (html, pretty colours etc.) or Traditional (plain text).

 

Message Digest


This means that you receive e-mails from the group, but yahoo!groups waits until there are about 25 messages available and sends them to you all in one go. With this option, you would therefore only receive 2-4 e-mails a day from the group, but it means you have to wait for responses (though you can still check on the group website for messages) and it can be more difficult to find what you are looking for within each digest.

 

With both individual e-mail and message digest options, you can also choose the format of messages sent to you (Display Format), either Fully Featured (html, pretty colours etc.) or Traditional (plain text).

 

Web Only (No Mail)


This means that you receive no messages at all from the group. This is a wise choice if you are using a work e-mail address, or if you cannot cope with the group's message volume. With this system you simply go to the group's website and read the messages that interest you there. Even if this is not your usual choice, it can be helpful to use this option if you are going on holiday.

 

So make your choices, then click the Join button at the bottom right of the page.

 


Important: Membership Questionnaire                                                           Back to Page Index


OK, so you've successfully applied to join the group. However, there is one more thing you need to do in order to join. I want to protect the group members from spammers, so whichever way you apply to join the group, you will receive a short questionnaire asking:

  1. Your first name

  2. The country where you live

  3. Your CKD cat's name and age

You need to respond to this before your membership will be approved.

 

Please don't worry about saying "the right thing." This is not a test to see if you are "good enough" for the group, everybody is welcome here, whoever they are or wherever they come from, as long as they want to help their cat. This questionnaire is basically just to reassure us that you are a real person applying to join rather than somebody trying to sell stuff and spam the group, but it also enables us to tailor our responses to your group messages e.g. if we moderators know where you live, we will not suggest treatments not available there.

 

Please note, only the two Annes and I can see your responses to these questions. The group will not know anything about you unless you choose to introduce yourself.

 

Once you respond to the questionnaire, your membership application should be approved very quickly (most people are approved within two hours or less).

 

Occasionally the questionnaire goes missing. You think we haven't sent it, and we think you haven't responded! If we haven't heard from you five days after you apply to join, we will send you a reminder. Unfortunately, we can only use the address you've used to sign up for the group, so if you've accidentally used your new yahoo e-mail address without realising it (see above), you won't see either the questionnaire or our reminder. If you don't hear from us, please simply write to us at tanyas-ckd-support-owner@yahoogroups.com and let us know. Please respond to the three questions in your response and we will either approve you (if your membership is pending) or send you a personal invitation to join the group (if your membership application has disappeared into a black hole).

 


Messages                                                                                                                                          Back to Page Index


 

Message Options: Sending Messages


You don't have to post, you can just lurk if you prefer.

 

If you wish to change the name that appears on messages you send to the group, Yahoo! explains how you can do that.

 

Starting a Thread


  1. You can simply send an e-mail to ask your question by sending it to tanyas-ckd-support@yahoogroups.com.

  2. You can go to the group website, click on Post Message in the sidebar on the left, and then write your message there.

Replying to an Existing Message


Messages sent in response to another message on the group also go directly to the group, not to the individual to whom you are replying. Therefore if you wish to respond to a message somebody else has sent, you can simply click reply on your e-mail programme. If you reply via the group website, you can click on the message in the group archives, then click reply which is top left above the message.

 

If you're changing the subject, or replying to a Digest (which have the subject line of Digest No. xxx), please change the subject line appropriately to something more meaningful. And please remove everything except that to which you are replying.

 

If you wish to reply privately to somebody, you will need to press reply, then delete the group e-mail address and paste their personal e-mail address into the To: line if you are using e-mail. If you are replying via the group website, you will see a little envelope over on the right under the person's name. If you click on that, your message will go to that person.

 

Message Content


You are welcome to discuss anything relating to care of your CKD cat. We do have a few guidelines we ask people to follow though:

  1. Please do not refer to vets or vet clinics by name for legal reasons. Just say "my vet" or "Dr J".

  2. Please do not ask for money or other donations.

  3. Since this is a very busy group, we ask that condolences are sent privately to the bereaved group member. Certain other messages should also be sent privately e.g. short "me too" messages, off topic posts etc.

  4. Please trim your posts.

Moderation of Messages


When you first join the group, your messages will be moderated for a short while. This means that they will not reach the group immediately, but will first be read and approved by one of the moderators. We do this to ensure that:

  1. you are not a spammer;

  2. you are keeping to other group guidelines (e.g. not naming your vet publicly);

  3. you are trimming your messages appropriately.

If you comply with the group guidelines sent to you when you join the group, you will be taken off moderation quickly. The main reason people stay on moderation is because they do not trim their posts. So please read up on this in the group guidelines. If you get stuck, just ask for help.

 


Leaving the Group                                                                                                Back to Page Index


 

Some people decide to leave the group. Their cat may have died, or they may find the message volume is too much, or they simply decide it's not the place for them. Leaving is fine, but if you're thinking of leaving simply because you cannot cope with message volume, please consider changing your message options first, such as by going no mail. This means your inbox will not be full, but you can still reach out for support quickly when you need it.

 

If you are leaving because your cat has died, please consider joining our sister group, Tanya's Feline Loss Support:

http://pets.groups.yahoo.com/group/tanyas-feline-loss/

 


Conclusion                                                                                                            Back to Page Index


I do hope you've decided to join Tanya's CKD Support Group! It can give you support, it can give you hope. It can make you smile too - where else would people share your thrill at hearing that your constipated cat has pooped? (Believe me, when you've been dealing with CKD for a while, things like this are real triumphs which can absolutely make your day).

 

I personally read every message sent to the group. I don't respond to every post (my priority is running this website) but I do keep an eye on things and post occasionally if I can add to what has already been said.

 


Group Quick Links                                                                                               Back to Page Index


Some of these only work if you are already a member of the group.

 

Weblinks


Group homepage:                                                 http://pets.groups.yahoo.com/group/tanyas-ckd-support/

Managing your membership options:                  http://pets.groups.yahoo.com/group/tanyas-ckd-support/join

Messages archive                                                 http://pets.groups.yahoo.com/group/tanyas-ckd-support/messages

 

E-mail Addresses


Sending a message to the group via e-mail:        tanyas-ckd-support@yahoogroups.com

Group owner e-mail address:                                 tanyas-ckd-support-owner@yahoogroups.com

Joining the group via e-mail:                                   tanyas-ckd-support-subscribe@yahoogroups.com

Leaving the group via e-mail:                                  tanyas-ckd-support-unsubscribe@yahoogroups.com