Anyone know anything about cats with kidney problems?

Kidsandliz went on a bit of a rant said
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My 17 year old cat (littermate to my cat that died 9/15) has hyperthyroid and late stage 3 kidney disease (and diabetes that continues to be in remission). Two weeks ago we upped his thyroid med because he was losing weight, throwing up (common symptoms of this) his T4 was high… Giving him an anti nausea seemed to help. Then yesterday he suddenly no longer wanted to eat, use the dirt box, was constipated (likely due to eating less food than he should have been and dehydration due to the vomiting) listless on the chair with the pet heating pad rather than on my bed, on the cat tree… He was dehydrated so I gave him sub Q fluids, cerinia (anti nausea you can use for 3 days in a row only), and started syringe feeding him which he did not fight so clearly he was hungry under the nausea.

Almost took him to the emergency vet (connected to a vet school) but they wanted $300 to walk in the door and do basic lab tests (my vet charges $158 for that). I finally decided I can’t afford to take him as I already have a significant amount of money on my credit card with vet bills. Lucky for me he started to improve (otherwise I’d be dealing with a lot of guilt) - lifting his head when I talked to him, started using the dirt box again rather than pee as he lay there (and dribble out dollops of creamy poop which has also stopped). So I finally decided not to sell my kid in order to take my cat to the vet.

Had an apt with my vet (this is not the one that essentially killed his littermate 2 months ago, I now live in a different state) late morning. He took one look at how thin he was and how listless and said I needed to put him down now. I didn’t even think to ask if we could draw blood levels on kidney function and thyroid, I was so upset. I figured since it takes time for a cat to gain weight after you increase the thyroid med this is why he was still so skinny (been though this before and when the med is upped they slowly gain weight); that he was dehydrated a bit and an IV might be useful… was not expecting this.

So I took him home and told him I needed some time to say good by, my kid needed to see him (she considers him her cat, not so much so his sister), and I needed to adjust to this.

Those of you who have had cats with kidney issues (his creatinine was barely over normal last time and his BUN was about double what it should be) is there any way you can tell they are having a kidney crash rather than are near the end of their life? I don’t want to put him down prematurely but I also don’t want him to suffer. His sibling went through 3 bouts of not eating, constipation, losing weight (she was also hyperthyroid) and several week of syringe feeding pulled her out of it twice, the third time she died due to the vet not giving her an IV - she was enough dehydrated he had trouble drawing blood (there is an older thread about her).

Right now he is not fighting being syringe fed nor having water squirted into his mouth (I also am doing subQ fluids), but when I tempt him with treats he loves he sniffs them and ignores them. He walks to the water and mostly looks at it, drinking just a bit.

I am thinking of diplomatically asking him to draw at least kidney function and thyroid levels to see where they are before I decide to put him down. What other things should I ask to include (I am hoping to avoid a full blood panel due to the expense and just do what is needed now - I am sure the vet will tell me, but I’d like to independently know as I have only been to him since I moved back so don’t know him very well).

Any advice appreciated on the vet issue and how to tell with a cat with kidney disease the difference between it’s time to put him down vs nurse him through a crisis. I’ve cried buckets over him yesterday and today but I also know when it’s time it is cruel to not let him go.

Thanks.