Signs of Renal failure in cats. Increased thirst is often the first symptom
Kidney disease, in the form of chronic renal
failure (CRF), is a common problem in older cats. I have seen kidney failure in
cats as young as 4 years, but far more frequently in much older cats. The most
noticeable symptom is an increase in water consumption and urination
("drink-a-lot, pee-a-lot syndrome"). A blood test should be done if
you notice these symptoms, as there are several conditions that can cause this.
The increase in drinking and urinating in CRF is due to loss of the kidney's
ability to concentrate the urine. The kidneys have a very large reserve
capacity, and symptoms of kidney failure are not seen until approximately 75%
of kidney tissue is non-functional. In my experience, kidney failure is the
most common cause of death in older cats.
Diagnosing CRF
Laboratory tests are needed to definitively
diagnose CRF. A blood test alone is usually not sufficient; a urinalysis must
be taken at the same time the blood is drawn. Kidney disease is likely present
when the cat is “azotemic” AND the urine is not sufficiently concentrated.
“Azotemia” means that there is an increase in particular compounds in the blood;
specifically blood urea nitrogen– BUN–and/or creatinine. The measurement of
urine concentration is called Urine Specific Gravity (USG). If the cat’s USG is
less than 1.035 (1.030 in dogs) AND azotemia is present, then kidney function
is abnormal. BUN and/or creatinine may be high if the animal is dehydrated
(common in cats who eat a lot of dry food, or during hot weather or after a
stressful car ride). They may also be increased in animals on a high protein
diet. As long as the kidneys are able to concentrate the urine, small
elevations in BUN and/or creatinine are usually not a cause for alarm.
Causes of Chronic Renal Failure
Recent research suggests a link between
vaccination for feline distemper and immune-mediated inflammation of the
kidneys, which is thought to be the cause of CRF. Annual boosters for distemper
are completely unnecessary. Be sure to discuss all recommended vaccines with
your veterinarian. A cat with kidney disease or kidney failure should not be
vaccinated at all.
Long-term feeding of an all-dry-food diet is
also suspected as a factor in Chronic Renal Failure. Cats' kidneys are highly
efficient and adapted to life in the desert, where they would get most or all
of their water from eating their prey. Cats eating dry cat food take in only
half the water that cats on a canned or homemade diet get; this chronic
dehydration can cause stress on the kidneys over time. Dry diets also
predispose cats to lower urinary tract disease (FLUTD, LUTD, FUS, crystals,
stones, cystitis) because they force such a high degree of urine concentration.
Chronic or recurrent bladder disease may also
be a factor in the development of CRF.
Treatment of Chronic Renal Failure
Chronic kidney failure is progressive and
incurable. No conventional or alternative medical treatment can reverse its
course, since the disease involves the loss of kidney cells and replacement by
scar tissue. The rate of progression in any individual cat probably cannot be
slowed to any significant degree. When the process is advanced, the kidneys
become small and lumpy, and the amount of functional tissue is greatly limited.
The most significant problems caused by the loss of function are build-up of
blood toxins, and anemia. These can cause weight loss, lethargy, vomiting, loss
of appetite, weakness, and other signs of illness.
Some cats are able to maintain their body
weight and live relatively comfortable lives for months to years, while others
succumb to the disease more quickly. In conventional medicine, there are drugs
that can minimize anemia, and phosphate binders to prevent phosphorus
precipitates from further damaging the kidneys. However, these may not be
palatable, and may cause adverse reactions. They are also of little or no value
unless the cat is eating a restricted protein/low phosphorus diet exclusively.
It may also be important to supplement potassium in the food.
Diet for Kidney Failure in Cats:
The Protein Controversy
You may have heard that restricting protein is recommended for cats in kidney
failure. Although this has been the “standard” treatment for decades, as far as
cats are concerned, it has always been–and remains–very controversial.
Restricted protein does not prevent kidney failure in a healthy cat. Some
experts also suggest that protein has no effect on the ultimate progression of
renal disease. Research also shows that even very high protein diets do not
make renal failure worse in cats (although high protein does worsen the disease
in dogs and humans). (One pet food maker recently completed a study it claims
shows that its restricted-protein diet increases lifespan in CRF cats.
However, because the study has not yet been
published, it is impossible to evaluate the data, which is contradicted by
other research. The real culprit is actually phosphorus, which meat contains in
large amounts. Decreasing phosphorus intake (by restricting protein) can help
some cats feel better, so it may be worth a try in a symptomatic cat.
Some studies have suggested that excessive
restriction of protein may actually cause further damage to the kidneys and
other organs, because there is not enough protein for normal body maintenance
and repair. Experts say that these diets are not appropriate until the BUN
(Blood Urea Nitrogen) is at least double what it should be normally (about 60-80
mg/dl).
Furthermore, there is one big problem with
using the protein-restricted commercial diets: many cats don't like them, and
won't eat them. Obviously, it does little good to provide a special diet if the
cat is going to starve to death! Experts emphasize that it is much more
important to feed the cat what he likes and will eat, and maintain weight and
body condition, than to be overly concerned about protein content. (Please note
that if you add any other protein source to the diet, it will completely negate
any possible beneficial effect from the low-phosphorus renal diet. It is
useless to feed both a renal diet and a normal protein food or meat-based
treats at the same time.)
Let me say this again, because it is the
single most important thing to know about CRF: feed the cat anything she will
eat! IF THE CAT WON'T EAT IT, IT WON'T HELP THE CAT! Weight loss is your cat's
worst enemy in this disease; so let the cat eat what she wants!
Because water balance is so crucial, it is
best to feed a high-moisture diet to help keep the cat hydrated; do not feed
only dry food. Feeding mostly or only canned food, even though it is high in
phosphorus and protein, provides the moisture and calories that these cats
need, in a very palatable form that most cats will happily eat. You can also
get low-phosphorus renal diets in canned form. Dry cat food causes dehydration
even in healthy cats, and is not appropriate for CRF cats (unless, of
course, it's the only food he will eat!).
The best thing you can do is feed a
home-prepared diet; but only if the cat will eat it! If the cat has never eaten
homemade food, or does not have a hearty appetite, this is not a good time to
make this switch! There are several good books on home cooking for animals,
such as Dr. Pitcairn's Guide to Natural Health for Dogs and Cats, by
Richard Pitcairn, DVM, and Susan Pitcairn. (Rodale Press. ISBN 075962432.) They
discuss why a diet made from fresh, raw foods is important, and provide
recipes, including a special recipe specifically designed for animals with
kidney disease. Another excellent book is Home-Prepared Dog and Cat Diets:
the Healthful Alternative by Donald R. Strombeck, DVM. (Iowa State
University Press. ISBN 0813821495.) If you choose to use Dr. Strombeck's
recipes, I suggest substituting 1 capsule of taurine (250 mg) for the canned
clams, since clams do not contain enough taurine for proper maintenance.
Special Nutrition for Chronic Renal Failure
Several nutritional supplements may be
helpful for cats with kidney disease. Omega-3 fatty acids have been shown to be
beneficial in CRF. Antioxidants are also important. Both of these are contained
in the highly digestible algae, Biosuperfood.
A nutritional supplement called "Renafood" from Standard Process, is
a good renal detoxifier and helps to maximize kidney function in cats. Give one
or two a day. Most cats eat them readily if they are crushed into the food.
Call Standard Process at 1-800-558-8740 to find a distributor in your area.
Remember, though, that the basic diet is the most important factor in your
cat's health, and no supplement will make up for poor quality nutrition.
Supplemental Fluids
Your veterinarian can give your cat
subcutaneous fluids in the clinic, or teach you how to give them at home. This
is the least intrusive and most beneficial treatment you can give your cat.
Cats in chronic renal failure drink a lot of water, but they cannot drink
enough to compensate for the loss of water through the kidneys. Subcutaneous
fluids are an excellent way to help keep the toxins flushed out of the
bloodstream and make the cat feel much better. If the cat is sick or not
eating, it may be necessary to hospitalize it for a few days for intravenous
fluid therapy, followed by subcutaneous fluids at home as needed. A
semi-permanent "port" that can be inserted in the cat's skin has
taken much of the hassle out of this procedure; talk to your vet about having
this installed. It is best to have this procedure done by a veterinarian who
has lots of experience with these ports since there can be many complications.
Holistic Veterinary Care
While no treatment can create new kidney
cells when scar tissue has already formed, homeopathy, herbs, flower essences or acupuncture may be able to help your
cat feel better and live a better quality of life.
Other Resources
The Feline CRF Information
Center is an incredible website devoted to cats in renal failure.
You can find out just about everything there is to know about this disease
here, as well as explore a host of excellent links to other feline health
sites. You can also sign up for their email list, which can be a great resource
and support for guardians of CRF cats.
Pet Loss Support
Ultimately, fighting CRF is a losing battle, and may carry a great emotional
cost to the family.
Losing a beloved cat to CRF is just as traumatic as losing a human family member, but friends and
family don’t always understand. There are many resources to help you through the difficult times and
tough decisions you will have to make for your cat, and to support you afterward. Many of these are
listed on the Feline CRF pet loss support page.
Losing a beloved cat to CRF is just as traumatic as losing a human family member, but friends and
family don’t always understand. There are many resources to help you through the difficult times and
tough decisions you will have to make for your cat, and to support you afterward. Many of these are
listed on the Feline CRF pet loss support page.
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