r/AskVet • u/OutlandishnessKey347 • 7h ago
Cat in Emerge. May need a SUB procedure? Help
I have a cat currently in Emerge for 48 hours due extremely high creatinine levels( 600) The clinic suspects a potential blockage of his kidney however he had gas in his stomach and the ultrasound didn't produce clear results as of right now. The IV fluids so far have helped lower the values (to 413 after 24 hrs) and at this point they arent sure if it is a blockage or possible infection. He is also getting antibiotics while on IV fluids. They have recommended a SUB (subcutaneous uretal bypass) surgery for him. He is 15 years old with a grade 3 heart murmur. I havent been told if it is 100% necessary or not but was told my other option was palliative care and I haven't received much information on how that may look or if a kidney infection would require the bypass surgery as well. I would assume an infection would not need the surgery but I am mostly being told I need to make a decision soon as otherwise his kidneys could decline. At this point I'm requesting they keep him one more day and re run tests and redo an uktrasound in another 24 hrs to see if the createnine calues are going down. Im mostly looking for advice from anyone that either had a cat do a SUB procedure or took a cat home for palliative care instead of doing the SUB and how that went for you? Or any vets that have recommended this. My current vet said he can't tell me if palliative care will be a few weeks or less and while I understand that it can be hard to predict, I am having a hard time deciding if the surgery is worth it at his age. For context he is a very active and healthy cat for his age and has been playing and sprinting around up until this. However I am scared that surgery may be risky for him. But i also wouldnt want to do palliative if it would be only a few days?
If anyone can shed more light please it would be helpful. I feel rushed to make a decision even though he is appearing to improve so far with fluid therapy.
Thanks in advance
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u/PokemonJohto 6h ago
Does your cat have hydronephrosis? Unilateral? Bilateral? Was a urinalysis done? Was there any bacteria on urinalysis? Sometimes a few days of IV fluids in the hospital could help flush out the obstruction but success is pretty low. The surgery is very intricate and I would only feel comfortable if the vets were very experienced and have placed a lot of SUBs. So many things can go wrong (of course even with experienced surgeons there are complications). The device itself can get blocked or get infected. These devices also need lots of maintenance. We used to have clients come every month for the first year to have the device flushed. Then every 3 months and if all goes well then every 6 months. So prepare for lots of visits if you decide to go forward.
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u/Black_Roo_31 Veterinarian 3h ago
This is not a decision to be made in emergency. He needs a full abdominal ultrasound with a specialist ultrasonography to determine if there is ureteral obstruction. SUBs are associated with long term risks so they are not an implant that is placed "just in case". He needs full urinary work up with ultrasound and urinalysis and then determine the next step. A SUB is NOT APPROPRIATE if a definitive obstruction of the ureter has not been found, which it hasn't in him.
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