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9539 Liberty Road, Frederick, MD 21701
Phone: 301-898-4009 ~ Fax: 240-668-3664 clientcenter@frederickcatvet.com Gentle, complete veterinary care for the felines in your family |
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Chronic Kidney (Renal) Disease is one of the most common problems in senior cats. Fortunately, there are several easy things you can do at home to keep them happy and comfortable without this disease affecting their quality of life.
The kidneys are a very sophisticated pair of organs in the abdomen that function to conserve fluid, regulate electrolyte levels, excrete waste product (BUN and creatinine) into the urine, assist in blood pressure regulation and stimulate the bone marrow to produce more red blood cells. For reasons not completely understood, most kidneys in cats slowly become smaller due to a chronic inflammatory process. It is not a painful process, but one that can lead to a number of problems as it may impair some or all of the aforementioned functions. It is not a reversible disease, but much can be done to slow the progression. The disease course can vary greatly and, while some succumb in a matter of months, it is not unusual for cats to live 3-7 years with this disease.
We diagnose this disease, also called chronic kidney failure, by evaluating a serum chemistry and complete blood count, in conjunction with a complete urinalysis. In an early diagnosis, labwork abnormalities may be detected prior to your cat showing any clinical signs.
The most common signs of chronic kidney disease are:
Based on your cat's physical examination and labwork, we will tailor a program for your cat's specific needs. The following are the most common components of this treatment plan:
Dietary management: The goals are giving a high-quality diet with increased fiber levels (can be supplemented with psyllium) and avoiding overfeeding so that there is not excess waste that the body needs to handle. A good daily amount is 200 calories (kcal) to maintain a lean frame (the low side of normal is better than the high side of normal for body mass). For most cats with kidney disease, too little protein is a greater problem than too much protein, so "prescription diets" are usually not necessary, and in some cases can be counterproductive.
Increased water intake: These cats are already drinking more to make up for the excess they have lost into the urine, but they may have difficulty keeping pace. It is typical for their intake requirements to increase two to fourfold compared to when they where younger and had normally functioning kidneys. Eating canned food automatically supplies them with extra water, and should be fed if there is a variety your cat will eat. Adding water to the canned food may help, but the palatability may go down, so a small amount works better. A circulating water fountain will often stimulate cats to drink more, as they are enticed by fresh, running water. Fresh water bowls, in many easily accessible locations, can stimulate extra drinking as well. These should be changed daily.
Daily multi-vitamin: Many vitamins, especially the B-vitamins, are water-soluble and are lost in greater quantities in cats that urinate excessively. Cats with this disease are also prone to low potassium levels. A palatable feline-specific multi-vitamin like Felo-Form, which can be crumbled and mixed with food, can be very helpful.
Daily massage and combing: Many older cats are less active and prone to reduced muscle and bone mass as a result. Gentle massage with your fingertips on the head, neck and along the back is very soothing and stimulates blood flow to these areas. This, in turn, can make them much more comfortable and boost the appetite. Using a metal fine-toothed comb very gently has a similar effect and also helps to groom areas that may be more neglected. Grooming is decreased in cats that have subtle dehydration because they may have a drier mouth. Rather than a full bath, try using baby wipes with the comb. These usually have aloe and vitamin E and are alcohol-free and are excellent at providing coat moisture that is OK for your cat to lick off.
Fiber: Fiber is another treatment that is often helpful for most older cats for its beneficial effects throughout the intestinal system. With kidney disease, it has the additional benefit of reducing stomach acid to reduce vomiting. It can also bind some nitrogenous waste products in the colon so it assists the kidneys in this way.
Pepcid AC: The kidneys are indirectly responsible for controlling levels of stomach acid. Cats with chronic kidney disease are more likely to have elevated acid levels making them more prone to vomiting. A daily dose of a 1/4 of a 10 mg tablet of Pepcid AC (or generic, famotidine) can control this. Some cats feel nauseous without vomiting, which causes a decrease in appetite. This medication can then trigger a return to normal appetite. We can order it in a transdermal gel (applied to the ear) if giving an oral medication is too difficult.
Blood pressure management: Cats with renal disease are vulnerable to systemic hypertension, so it is important to have this checked. If the blood pressure is too high, a daily medication quickly gets this to a normal level.
Subcutaneous fluid administration (often called Sub-Q fluids): As the disease progresses, the chance of dehydration and loss of appetite increase. An electrolyte solution is easily administered underneath the skin to correct imbalances. This procedure can be done at Frederick Cat Vet or at home, usually 1-3 times per week.
Appetite stimulant: Mirtazapine can control nausea and stimulate appetite if it has not improved as a result of any of the above treatments.
Cosequin and Meloxicam These medications control joint inflammation (meloxicam) and restore joint cartilage (Cosequin). There is no connection between kidney disease and joint disease other than the increased chance of occurrence in older cats. Cats receiving this medication are more active, which in turn, is very beneficial for good blood supply throughout the body. Meloxicam (brand name is Metacam) is controversial for this use because too much of this NSAID can harm the kidneys. At the proper tiny dose (typically one drop daily) is beneficial without building up to toxic levels. Because of improved comfort and activity which enhances circulation, we have seen some cats improve their kidney values while receiving Metacam.
Other medications including phosphate binders to reduce the bloodstream phosphorus level and erythropoietin to stimulate red cell production in very anemic cats are occasionally used in more severe cases.
Hearing the phrase Chronic kidney failure sounds worse than it usually is. It may become a terminal disease for your cat, but if treated early, the progression to this point can be a very gradual process during which your cat can be generally comfortable. We will want to repeat labwork regularly, i.e. check your cat's numbers to help us choose different treatment options, and get a forecast of what can be expected. Your interaction and observation at home will tell you more about how your cat is doing with the treatment plan each and every day. Continue to stimulate your cat with different toys and games. Opening the windows to give them fresh air whenever possible is very helpful as well. Just because your cat has this specific disease does not mean it should affect your daily routine together.
-Mike Karg, DVM
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