Poor Appetite And Lethargy
Because the toxins that would normally pass in their pee build up in cats with kidney disease, they may feel nauseous and vomit, retch or go off their food. This can also makes them seem tired and generally not very happy, and you might notice bad breath.
Do be careful before you diagnose kidney disease, as these same symptoms could also be connected to other illnesses, so see your vet for a proper diagnosis and for advice on treatment of kidney disease.
Can Kidney Disease Be Reversed
Kidney disease can be managed and deterioration can be slowed down, but it cant necessarily be reversed.
Through proper management, you can certainly improve their kidney values and prolong their life, but you wont ever completely eradicate the disease.
The only situations in which you could reverse kidney failure is when the acute damage is due to infectious disease, urethral obstruction, toxin ingestion, or any other treatable situation.
If kidney damage is the result of an acute and treatable illness, then it is possible to reverse the damage with aggressive care.
A Mosaic Of Treatment
Dr. Vaden said about 2%-20% of all cats and 30% of cats over the age of 10 have chronic kidney disease. The recent advances in diagnostics and medical management mean veterinarians can now be treating some cats for extended periods.
When we look at that and were talking about treating some of these cats for three years or more, we really need to be very thoughtful in what we do and use an evidence-based approach to our treatment and diagnostics, she said.
Chronic kidney disease is usually diagnosed via imaging or by finding persistent azotemia or an increase in serum symmetric dimethylarginine concentration. The next step is staging according to the system from the International Renal Interest Society.
The IRIS stages, from 1-4, are based on serum creatinine and SDMA concentrations, the latter added recently. The staging system also offers substaging on the basis of severity of proteinuria and hypertension.
The staging becomes important because its a way to communicate where we are diagnostically, where we are therapeutically, where the animal is in regards to expected progression and symptomatology, Dr. Vaden said.
Dr. Vaden offered recommendations for controlling aspects of nutrition, proteinuria, hypertension, anemia, metabolic acidosis, renal secondary mineral disorders, hypokalemia, and gastrointestinal signs .
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Signs Your Cats Kidneys May Be Failing
- Frequent urinating. While you might think this is a sign your catâs kidneys are working well, it actually means they are no longer able to hold water. Urinating outside their litter box is another signal.
- Drinking a lot of water this means your cat is trying to replace the fluid they have lost through urinating.
- Bacterial infections of the bladder and kidney these develop more easily in the dilute urine produced by failing kidneys.
- Weakness and indifference
Dietary Treatment For Kidney Disease
In the early stages, CKD can often be successfully managed with a specialised kidney diet. These diets are balanced to help support the reduced kidney function. They have restricted nutrient levels of protein, as protein breakdown products have to be excreted via the kidneys and can cause further damage. They are often also lower in phosphate, which the kidneys can no longer excrete efficiently, and higher in potassium, which the kidneys can no longer retain.
How Veterinarians Diagnose Kidney Disease In Cats
Kidney disease is often diagnosed based on routine blood work and a urinalysis, looking specifically at such kidney markers as:
Blood urea nitrogen : is a by-product of protein metabolism. Higher values can often indicate kidney failure.
Creatinine : measures how well kidneys are filtering waste from blood.
Phosphorous: elevated phosphorous levels typically indicate kidney damage.
Electrolytes are often affected by the primary diseasebut also by secondary factors such as vomiting and a lack of appetite.
Calcium: elevated levels, though not as common, are often seen with kidney damage.
Red blood cell count: if low, it may indicate kidney failure.
White blood cell count: if high, it may indicate infection or inflammation.
Symmetric dimethylarginine : an additional test to help determine if kidney disease is present. It can be used for early detection of kidney disease.
Urine specific gravity: a marker of how diluted or concentrated the urine is. Usually, the higher the number, the more concentrated the urine and the greater the ability of the kidneys to conserve water.
Urine sediment: indicates the presence of protein, bacteria, white/red blood cells, kidney cells and casts. It is an indication of infection and/or kidney damage.
Your veterinarian will most likely recommend additional diagnostic testing, including:
Once diagnosed, kidney disease is then classified into four stages based on the severity of clinical signs and laboratory values:
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Advancing Chronic Kidney Disease In Cats
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How Does Kidney Failure Occur
Kidney failure occurs when at least two-thirds of each kidney is damaged. With this much damage, the kidneys cannot perform their essential functions.
Kidney failure can be acute or chronic.
Acute kidney failure occurs when the kidneys suddenly stop working. Some of the many causes of acute kidney failure are toxin ingestion and shock.
Chronic kidney failure, also called chronic kidney disease, develops over many years. It usually begins when cats are about six years old and becomes progressively worse as the nephrons slowly die. When more nephrons die than can be replaced, kidney failure becomes apparent.
Chronic kidney failure is much more common than acute kidney failure in cats, so well focus on chronic kidney failure.
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Prognosis For Cats With Kidney Failure
The prognosis for cats in acute kidney failure will depend on the underlying cause and the amount of damage to the kidneys. For example, kidney infection that is treated quickly often has a better prognosis than if a cat ingests or is exposed to a toxic substance.
The survival times for cats with chronic kidney disease depend, to a large extent, on the stage of kidney failure at the time of diagnosis. As the kidney failure stage increases, there is a consequent decline in survival rates.
Management Of Chronic Kidney Disease
CKD is irreversible but early detection and appropriate management can slow down progression of kidney disease in cats considerably. Basically we want to slow down further damage to the kidneys and treat the signs that have already occurred.
Although kidney transplants are available for cats in some countries, this is not a standard treatment option and would need to be discussed with your veterinarian. Usually this is only suitable for cats with very early disease before the onset of outward signs.
A Prescription Diet
What About Other Foods?
Despite diet being the best therapy, if your cat just wont eat it at all then it is more important for it to be eating something rather than the right thing. This is especially true in the later stages of the disease when weight loss and dehydration are a constant battle so at that point I feel any calories are good calories.
The Importance of Hydration
It is also really important to provide a continuous supply of fresh water since dehydration can occur so quickly and lead to kidney failure. The more they drink, the more the toxins are flushed out and the better they feel. Sometimes this can be assisted by giving fluids under the skin at home every few days. If dehydration is worsening, then this may require a couple of days in hospital on a drip. However it is also best to avoid stress whenever possible.
Image: Teresa Boardman via Flickr
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Below Is My Holistic Approach To Ckd In Cats:
- Diagnostics. When your cat reaches 7-8 years of age starting monitoring blood work regularly. Be sure your veterinarian is checking your kittys thyroid and kidney function. for cheat sheet of laboratory values that we monitor for kidney function. If your kittys lab work indicates any signs of kidney disease, begin monitoring every 3-6 months.
- Diet. Water is key here. Cats are notorious for poor water drinking! The more moisture you can put in your cats diet the better. Generally, a raw or canned diet will have the most moisture. Avoid dry food at all cost.
Protein content is a major source of debate between allopathic and integrative veterinarians. The idea behind protein restriction is that you stress the kidneys less and build up less toxins in the bloodstream. While this may be true, cats as a whole are much healthier on a high protein, low carbohydrate diet. For this reason, many integrative veterinarians recommend normal amounts of protein in the interest of the whole cat, not just kidney function.
I see both sides, and generally give my clients the option to feed either. For my cat, Sammy, I continue to feed a high protein diet.
Supplements. Let me start by saying, many cats wont take any supplements. So, I have listed in order of importance the ones I recommend for chronic kidney disease:
- Fish Oil. I use high doses of fish oil to help reduce inflammation and recommend Ultra EFA.
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Treatments For Kidney Disease In Cats Completely Natural
Kidney disease and failure in cats are very common and can be caused by a number of conditions. Healthy kidneys are very useful when it comes to eliminating waste from the blood, regulate calcium and hydration, and manage blood pressure. In chronic kidney failure in cats, nutrition is very important for a steady recovery in their health. Some symptoms of kidney failure are weakness, lack of appetite, depression, bad breath, weight loss, and many more.
In order to treat chronic kidney disease in cats, there are many nutritional requirements in order to optimize their kidney health. Robert suggests that your cat increases their intake of water. He mentions you could change their water several times a day, clean their bowl daily, and consider using running water to increase water interest. Limiting phosphorus in cats with kidney disease appears to really help delay the progression of the disease.
Robert recommends a therapeutic diet that is made for kidney disease for your car and that you add probiotics into their diet. It gets rid of wasteful toxins and helps reduce the workload on the kidneys. He also mentions checking their minerals and recommends antioxidants. Antioxidants help reverse any type of cell damage in the kidneys. Antioxidants come from any source of vitamin c or can come from any other high-quality multi-vitamin.
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Diagnostic Approach To Feline Cdk
In general, the diagnostic approach to patients once CKD has been identified and staged focuses on 3 areas :1. Characterizing the primary renal disease and/or complicating disease processes2. Characterizing the stability of renal disease and function3. Assessing patient problems associated with decreased renal function
Further definition of renal disease includes:
Quantitation of proteinuria Urine culture Urinary tract imaging with radiographs and ultrasound
Stability of renal function is assessed by serial monitoring of abnormalities identified during the initial characterization of renal disease. This monitoring should always include:
Serum biochemical profile Measurement of blood pressure
Monitoring may also include follow-up urine cultures and ultrasonography.
Further definition of renal disease is most important in earlier stages of CKD when correction of the underlying disease or disease complication has the greatest potential to improve or stabilize renal function.
Characterization of the disease stability is most important in earlier stages of CKD, when appropriate treatment has the greatest potential to stabilize renal function.
Characterization of patient problems becomes more important in later stages of CKD, when clinical signs tend to be more severe. In this case, diagnostic efforts should be directed at patient problems, including anorexia, vomiting, dehydration, acidosis, potassium depletion, and anemia.
What Treatments Are Available
The treatment of CRF depends on the results of blood tests, and specific treatments are aimed at resolving specific abnormalities. The majority of cats are effectively managed with diet change including supplementation and one or two other treatments. Your veterinarian will work with you to determine the best treatment for your cat.
“Different treatments are available and the majority of cats are effectively managed with diet change including supplementation and one or two other treatments.”
- Special diets – feeding low protein and low phosphorus diets help lower the level of waste products in the bloodstream. These can be prepared at home or are available ready prepared from your veterinary practice.
- Phosphate binders – despite low phosphate in the diet, blood phosphorus levels remain above normal in some cats. Reducing blood phosphorus can have a major effect on improving your cat’s well being and slowing disease progression. Oral phosphate binders such as aluminum hydroxide help to lower the amount of phosphorus absorbed through the gut wall.
- Antibiotics – many cats seem to respond well to antibiotics though the reason for this is not always clear. Cats with CRF develop bladder infections more frequently and routine urine cultures are recommended for many patients.
- Vitamins B and C – when the failing kidneys are unable to concentrate the urine, these water-soluble vitamins are lost and affected cats need daily supplementation.
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Primary Causes Of Chronic Kidney Disease In Cats
CKD appears when there is long-standing, irreparable damage to the cat’s kidneys that hinders their ability to function and eliminate waste products from the blood. Nevertheless, in most instances, the exact cause of CKD remains unknown.
Biopsies from affected kidneys regularly show a mixture of fibrosis and inflammation entitled “chronic interstitial nephritis.” Still, chronic interstitial nephritis is a non-specific end-stage change and doesn’t suggest anything about the CKD’s underlying cause.
And even though most CKD cases have an unknown underlying cause, particular causes of CKD are well recognized. The primary ones include:
- The polycystic kidney disease, also known as PKD, is an inherited kidney disease mostly found in Persian and related cats where multiple fluid-filled cysts gradually replace normal kidney tissue
- Different types of kidney tumors
- Various infections – for example, a bacterial infection of the kidneys may lead to kidney damage and cause CKD
- Certain drugs and toxins can irreplaceably damage the kidneys
- The inflammation of the glomeruli may lead to CKD.
If the underlying cause for the CKD can be identified, there’s a good chance that the condition may be treatable, and the progression of the disease can be halted.
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What Are The Causes Of Crf
CRF is the end stage of a number of different disease processes rather than a specific disease in its own right. Diseases or conditions that can eventually lead to CRF include:
1. Congenital malformations of the kidneys – such as polycystic kidney disease in long haired cats
2. Pyelonephritis – bacterial kidney infections
3. Glomerulonephritis – inflammation and damage to the kidney’s filtration membrane
4. Neoplasia – various tumors of the kidney, most commonly lymphosarcoma
5. Amyloidosis – this is the build-up of an unusual protein in the kidney that prevents the kidney from functioning normally
6. Viral infections such as feline leukemia virus or feline infectious peritonitis virus
7. Kidney stones or ureteral stones
What Are The Clinical Signs Of Kidney Failure
Excessive thirst and urination are among the most recognizable symptoms of kidney failure in cats.
Even when the kidneys are failing enough to cause clinical signs, kidney failure may not be the obvious diagnosis. Kidney failures clinical signs are non-specific, meaning that they dont indicate a particular disease.
The clinical signs gradually worsen as kidney failure progresses.
How Is Kidney Disease Diagnosed In Cats
None of the signs are specific for chronic kidney disease in cats, so we will need to carry out a number of tests to find out what is causing them.
Initially, your cat will need a thorough clinical examination in a free consultation with one of our vets. In addition to the presence of the signs above, we may be able to feel that your cats kidneys are enlarged, painful or shrunken.
There will often be an increase in kidney values on blood tests. These include Urea, Creatinine, Phosphate and electrolyte imbalances. In addition, a newer, more sensitive marker SDMA is helping us to detect the condition at an earlier stage. Even so, we are unable to detect kidney failure until 66% or more of the kidneys are not working normally.
Before your appointment with the vet, we will ask for you to collect, or hospitalise your cat to obtain, a urine sample. Cats with kidney failure will usually have protein in their urine and sometimes blood or cells dependent on the cause.
If your cat is compliant, we will advise blood pressure testing. Blood pressure is often high due to excessive salt retention by the kidneys. We may also suggest X-rays or an ultrasound scan to check for conditions such as polycystic kidneys, kidney stones or tumours.