Feline Kidney DiseaseFeline kidney disease is a disturbingly common condition among older cats. We don't necessarily always know what the cause is either. Some identifiable causes are listed below. Most often though, the cause of feline renal failure is unknown.
Feline kidney disease or feline chronic renal failure is usually a disease of geriatric cats. It tends to progress (worsen) over time, as a slow degeneration and loss of both kidney tissue and kidney function. The rate of progression will vary - kitties with cancer in their kidneys fail much more rapidly than those with a treatable kidney infection, or even those where the cause of the failure is undiagnosed. Without treatment, a kitty with renal cancer may only live for another 2-3 weeks, and with treatment they sometimes only live comfortably for another few months. Compare this with typical "old age" related feline kidney disease, where the cat may live several more years with monitoring and aggressive supportive care from their owner. And, if the cat has been diagnosed with a kidney infection, called pyelonephritis, and you have caught the problem early on, then that cats prognosis is better than either of the others, because a real way to fix the problem exists. Some breeds of cats are more prone to developing feline kidney disease, due to the presence of congenital (familial, or born with it) diseases. Polycystic kidney disease in Persians, and amyloidosis in Abyssinians are two common examples.
Diagnosis of feline kidney disease is fairly easy - a blood and urine test will give your vet the answers to this question. Diagnosing the cause is, unfortunately, much less easy. Bladder infections can sometimes travel up the pipeline to the kidneys, and lead to a kidney infection. If a bladder infection, called cystitis, was found at the time your cat was diagnosed with feline kidney disease, then a urine culture and sensitivity can be done to find out what bacteria is causing the infection, and what antibiotic will kill it. BUT, a bladder infection does not mean that the cause of the kidney failure HAS to be a kidney infection (pyelonephritis). Kitties with "old age" chronic renal failure are also prone to having bladder infections, unrelated to kidney infection. An abdominal ultrasound (ultrasound of the belly) is a good way to get a look at the entire urinary system. With this, kidney or bladder stones, masses (which are often cancer), and changes in kidney texture can be seen, giving you and your vet a better idea of what is happening in there. A true diagnosis will often come down to gettinga kidney biopsy - this is NOT a simple or a risk-free procedure, and you should discuss with your vet all of the risks and benefits if you are considering having this done. For instance, if there is a mass or are masses in your cats kidneys, then are there also masses present somewhere else in the abdomen, that might be a safer place to biopsy? Will the biopsy change how you will treat that cat? Definitely think and discuss before you have this procedure done!
Before we start talking about feline kidney disease treatment options, I want to explain to you everything that the kidneys do in a living system, so that you can see why you are treating as you are. The kidneys very first and main duty is to conserve water. As urine is passing through the duct work of your kidneys, all of the water that can possibly be recovered is recovered. You may have noticed that a healthy cats urine is small volume, and often very dark yellow in color, and probably has a strong odor. This cats urine has been concentrated - a lot of the water has been removed and saved by the cat. Now notice the cat with feline kidney disease. Their urine is a much larger volume, is a pale yellow to almost clear color, and probably doesn't have much of an odor. The urine has not had any or much extra water removed from it, which means that the cat is losing all of that extra water. This inability to hang on to water is the first sign of feline kidney disease, as well as many other diseases (see the symptoms section). Owners see this as drinking a lot and peeing a lot, in veterinary jargon called polydypsia and polyuria. This inability to hang on to water also causes the first medical problem - dehydration. Please understand, even though your cat seems to be drinking A LOT of water, this does not mean they are adequately hydrated. They are losing massive amounts of water in their urine, and can no longer replace it with drinking. The kidneys are also responsible for electrolyte balancing of the blood. This is done through both a passive filtering and an active recovery system. As the renal disease progresses, the cat will be unable to recover the filtered electrolyte called potassium, and so will lose potassium. They will also be unable to excrete the excess electrolyte phosphorous, which will then accumulate in the blood. This is a problem. If you don't have enough potassium in your blood, then your muscles become weak and you can't get around like you should. If you have too much phosphorous in your blood, then your body compensates by leaching the calcium out of your bones. This causes very weak bones that break quite easily (this kind of high phosphorous and bone weakness is called secondary hyperparathyroidism). The kidneys actively excrete toxic waste products. A lot of the waste of energy metabolism is in the form of nitrogen waste. This type of waste is removed by the kidneys into the urine. Kidneys also make a hormone, called erythropoeitin, that they release into the blood. This hormone travels to the bone marrow, where it tells that system to make more red blood cells. Feline kidney disease patients make less of this hormone. Because of this, they are also often anemic - they don't have enough red blood cells. The red blood cells, of course, carry oxygen to all of your cells, and is needed for energy production. Not enough red blood cells then leads to weakness or tiredness.
I bet you never new your kidneys did so much, huh?
The treatment for feline kidney disease will be two pronged. If you have a specific diagnosis with a specific way to treat the problem, then you will use that. For example, your vet will use antibiotics for pyelonephritis, and will use or refer you to someone who can use chemotherapy for kidney cancer, if you wish. In addition to this specific treatment, and for all undiagnosed feline chronic renal failure cases, general supportive care is begun. This is where the owners ability to care for their cat can make a huge difference. The treatment for "old age" feline kidney disease attempts to address all of the things the kidneys can no longer do. Unfortunately, none of the treatments "fixes" the problem - there is no cure for chronic renal failure, only supportive therapies. The first two items listed are the basic mainstays of treatment. The remainder are begun on a case-by-case basis, as you and your vet monitor your cats progression over time.
Cornell University offers a very excellent video demonstration of how to give your cat SQ fluids. 2. Nutritional Support. This is also extremely important. Feline kidney disease patients need a high energy diet that is easily and nearly completely digestible. Their appetites are usually poor, so calories are important. And, the more digestible the food is, the less waste products are produced, and the fewer the toxins that build up in the blood. This in turn helps the cat to feel better, which improves their appetite - one of those rare upward spirals! Renal diets are also restricted in phosphorous, which we know tends to accumulate to toxic levels in cats with feline kidney disease. I have never seen an over the counter (pet store or grocery store) diet that I consider appropriate for feline kidney disease patients. Prescription diets are the best, through your vet. If the cat absolutely won't eat the kidney diet, then it is OK to feed over the counter foods so that we continue to get calories and nutrition into the cat. You should try VERY HARD though to get them to eat a kidney diet - there are multiple brands available all with different tastes and textures. Keep trying and see if you can find one your cat likes!
Look to the right for the tools you need to help your pet! There are several supplements that have been developed for these cats. Azodyl is designed to help reduce the toxins in the blood, that the kidneys are less able to remove. Epakitin is designed to decrease the amount of phosphorous that is taken up from the GI tract. This supplement would be more important for those cats that will not eat the prescription kidney diets. Also under nutritional support comes vitamin supplementation. Remember, feline kidney disease patients are losing a lot of water through their urine. Water soluble vitamins are also lost as the water is lost. Supplementing B vitamins especially will help the cat to feel better. And, if a supplement has iron in it, this can give the body extra material to help build more red blood cells, which they also usually need. 3. Control Blood Pressure. As we learned above, cats with feline kidney disease often develop high blood pressure. This needs to be monitored by your veterinarian, and appropriate medications need to be started when needed. The negative health consequences of hypertension are not to be dismissed - treat this condition! 4. Electrolyte Support. As the condition progresses - remember, we can't cure it, only treat it - routine monitoring bloodwork will often show the electrolyte imbalances we discussed. They are both relatively easy to treat from a medical perspective, but can be difficult in real life. There is a potassium supplement available for those cats with low potassium. And, a phosphate binder can be used in the food to prevent phosphorous from being absorbed in the intestinal tract, so helping to keep phosphorous low. Sounds easy, but both of these treatments are oral. And we have to use them in a cat who likely doesn't have the best appetite. They will help though, so get creative! Heat their favorite canned food and hide the stuff in there. Maybe cook a special gravy and use that to mix the supplements in, and poor over dry food. It will be trial and error to figure out what will work for each individual cat! Keep trying! 5. Erythropoeitin. This, remember, is the hormone that the kidney is supposed to be making to tell the bone marrow to make red blood cells. The kidneys don't make it so well when they are ill, but it can be given to the cat as an injection. It is expensive, and eventually the cat will make antibodies to it (like a vaccine) and destroy it, so it will eventually stop working. But, it is available and is used successfully by some. 6. Kidney Transplant. Yes, kidney transplants are indeed available for cats. BUT, it is not a simple carefree type of procedure. The main points to know about feline renal transplantation are: * It is quite expensive. The estimates that I saw ranged from $7,000 to $15,000 dollars. This is for the procedure only - you should also plan to spend up to $200/month afterwards on continuing care and support. *The cat receiving the transplant must be in otherwise very good health. No other medical conditions should be present. *The cat giving the transplanted kidney must be in otherwise good health. No other medical conditions should be present. *The recipient cat will be on medications for the rest of its life. You must be able to medicate this cat! *Both donor and recipient cats must not be "fractious". They must be easily handle-able by the veterinary care team! *You should plan to adopt and provide a good home for your donor cat. This is the least that you can do for them, since you were unable to ask their permission before you took one of their kidneys..... For a listing of facilities that are currently offering feline kidney transplants, go to
Feline Kidney Transplant Facilities.
The information presented here is not meant to replace the advice of your own veterinarian! A valid veterinary-client-patient relationship (created when you take your pet to see your vet) is essential to providing excellent individual pet care. If your pet is ill, call or go to your vet or an emergency veterinary hospital!
Go back to Cat Health Problems from Feline Kidney Disease.
Last updated 01/25/12. |
1. Hydration Support. Learning to do subcutaneous (under the skin) fluid administration (abbreviated SQ fluids),at home can help these cats immensely. If your cat is VERY ill, ie vomiting, not eating, and/or smells really bad, then hospitalization with intravenous (in the vein) fluid therapy would be a part of an aggressive treatment plan. The fluids do several things - they directly address dehydration, they help improve circulation to the whole body, and they help flush out those toxins that the kidneys are supposed to be getting rid of.
Feline Kidney Disease Supplements
Buy Azodyl, a supplement to help lower toxins that can accumulate in kidney disease.
Buy Epakitin, Small Size. A supplement to help decrease phosphorous absorption from the GI tract.
Buy PetTinic, a liquid supplement source of both iron and B vitamins.