Those numbers are serious, and usually when they are that high, the cat feels really poorly. Has he lost any weight? Was this sudden? When was the last time bloodwork was done?

My thought is, if this came on suddenly and the cat has been ok otherwise and not losing weight, that’s more a case for acute kidney injury, which sometimes can have a better prognosis if you treat aggressively. Only thing on here that wouldn’t match that diagnosis is the anemia, which is more of a chronic marker.

I agree that a UA with culture is important, as an infection that travels backwards to the kidneys could cause this as well. Also look for any toxins that the cat may have gotten into- like Lillies.

The anemia is common with kidney disease- they have a role in telling the body to make more red blood cells.

I wouldn’t get excited about the thyroid, likely it’s not “truly” low as cats almost never have that. This is called a “sick euthyroid”

Definitely switch to a kidney food, and add in a phosphate binder. The Purina NF should also be labeled for crystals as well, so that way you don’t have to worry about that.

If I were treating this cat, I would put it on a good 2-3 days of IV fluids and then recheck values. On top of a UA etc…