The Pet Owner’s Guide to Cat Renal Failure

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Renal Failure in Cats: A Common Feline Health Dilemma

Things change!

You wonder, “Why is Kitty losing weight, drinking, and peeing all the time?” You think. Hmm!

Does Kitty have a serious health issue? If your cat suffers from renal failure, you are not alone.

Renal failure is the second most common cause of feline death in the United States. Kidney failure is another name for renal failure. In fact, pet food companies make millions of dollars selling special cat renal failure diets. Renal failure is big business.

The renal failure scenario portrays doom and gloom. Surprisingly, many cats afflicted with renal failure often live vibrant, productive lives. The key is early detection and the right treatment.

Since early detection is important, become familiar with renal failure's most common symptoms. First, let’s learn about the classifications and stages of renal failure, as it can be quite confusing. Renal failure has two broad classifications: chronic renal failure and acute renal failure.

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Chronic Renal Failure Overview

Chronic renal failure is not reversible, but it is manageable. Chronic renal failure is the progressive destruction of your cat’s kidneys. Chronic renal failure is most common in older cats. The disease progresses slowly, ultimately leading to death. The most common complication is blood pressure increase due to hyperthyroidism.

Acute Renal Failure Overview

Acute renal failure is more aggressive and occurs within hours or days of the initial onset. Aggressive treatment often reverses acute renal failure.

Common causes of acute renal failure are:

  • Eating toxins, such as lilies, raisins, grapes, radiator fluid
  • Consuming certain pain pills like ibuprofen
  • Extreme dehydration

Acute renal failure is an emergency. If your cat acts sick or possibly ingested any of the above substances, contact your veterinarian immediately.

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The 4 Stages of Cat Renal Failure

Cat renal failure consists of four stages, and treatment varies with each stage.

The stage of renal failure is independent of the classification of acute or chronic. Some experts describe five stages of renal failure according to the BUN and Creatinine values in the blood. However, PET | TAO’s co-founder and practicing veterinarian Dr. Marc Smith prefers to use the following four stages.

Stage #1: Early Kidney Insufficiency

Stage #1 Symptoms

Your cat’s kidney function is somewhere between 33% and 99%. Please note the body only requires 25% of kidney function to filter toxins.Thus, kidney failure is most often detected in the later stages.

Stage #1 Treatments

Increase water intake and supplement with electrolytes.

Stage #2: Late Stage Kidney Insufficiency

Stage #2 Symptoms

Your cat’s kidney function is between 25% and 33%. The kidneys are beginning to struggle during stage 2, but are still able to filter. Cats experience increased urination and subsequent excessive drinking.

Stage #2 Treatments

Diet modification and anti-nausea medication, such as Pepcid AC.

Stage #3: Early Kidney Failure

Stage #3 Symptoms

Your cat’s kidney function is now between 15% and 25%. We have entered the early stage of kidney failure. Your veterinarian will want to start aggressive treatments, including medication. The prognosis for renal failure at stage 3 is several months to four years.

Stage #3 Treatments

Give subcutaneous fluids (SQ fluids) and Stanozolol, which is an anabolic steroid.

Your veterinarian may also suggest medications and herbs to:

  • Stimulate the appetite.
  • Bind proteins in the intestine.
  • Reduce the stress on the cat’s kidney.
  • Increase red blood cells.

Acupuncture is a powerful tool to decrease nausea and stimulate red blood cell growth. TCVM veterinarians prescribe Eastern herbal blends to boost the immune system.

Stage #4: End Stage Kidney Failure

Stage #4 Symptoms

Your cat’s kidneys are now functioning less than 15%. Through aggressive treatments, a few more months of quality life are possible.

Stage #4 Treatments

Common recommendations include IV fluids, SQ fluids, phosphorus binders (decreases phosphorus levels) and a specialty diet. Kidney transplants are available at select veterinary facilities. The success rate of feline kidney transplants is 75%. Roughly 25% of cats die from kidney transplant rejection. Specialty diets play a major role in treating renal failure through all stages of the disease. Specialty diets slow the progression of kidney disease and reduce the incidence of acute crises.

It’s important to know: a diet appropriate for renal failure is more involved than simply decreasing protein.

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Digging Deeper into the Symptoms of Cat Renal Failure

Since renal failure is a common cause of feline death, being familiar with symptoms is very important. Early detection helps veterinarians develop treatment plans for cats with chronic renal failure. Treatment plans implemented early increase longevity and improve the cat's quality of life.

With acute kidney failure, knowing the symptoms can be a matter of life and death in as little as 72 hours. Let’s look at the differences between chronic and acute renal failure, symptoms related to both, and symptoms to expect as renal failure progresses toward the end stages.

Chronic Renal Failure in Cats

Chronic kidney disease in cats is the progressive deterioration of the kidneys. Kidney function decreases over time, reducing the cat’s ability to excrete waste via urine. Eventually, toxic waste accumulates in the blood.

While treatment doesn't cure chronic feline renal failure, treatment slows its progression, making symptoms more manageable. The body requires only 25% of kidney function to filter toxins.

Once your cat begins to show symptoms of the disease, he or she may be in stage two or three of renal failure.

Symptoms of Chronic Renal Failure in Cats:

  • Increased thirst due to frequency of urination (most common symptom)
  • Anemia
  • Apathy and sluggishness
  • Bloody or cloudy urine
  • Change in water consumption
  • Dehydration
  • Discoloration of the gums and tongue
  • Dry hair coat
  • Bad breath with an ammonia-like odor
  • Loss of appetite and weight
  • Mouth ulcers
  • Stumbling, acting drunk
  • Urinating outside the box
  • Vomiting
  • Weakness

Acute Renal Failure in Cats

The most important thing to know about acute renal failure is it is a life-threatening emergency. Unlike chronic kidney failure, acute kidney failure in cats is not progressive.

Instead, it is the sudden failure of the kidneys to perform their function of filtration, allowing toxins to flood the body.

Common causes of acute renal failure are:

  • Eating toxins
  • Dehydration
  • Insect or snake venom
  • Trauma
  • Blood clots
  • Heatstroke
  • Infection
  • Certain medications
  • Systemic shock

If your cat suffers possible exposure to any of the toxins or poisons listed above, see your veterinarian immediately. While acute kidney failure can be reversible, success depends on immediate treatment.

Symptoms of Acute Renal Failure in Cats

The symptoms of acute renal failure in cats are the same as the symptoms of chronic renal failure. The difference is, symptoms appear fast and severe. For example, a cat in chronic renal failure may start vomiting on a more regular basis. But, a cat in acute renal failure will vomit several times within an hour.

End Stage Renal Failure

When your cat reaches the end stage of renal failure, it is time to decide when and if you plan to euthanize. During the end stage of kidney disease, your cat still benefits from treatment. If you have the resources available, aggressively treat your cat with subcutaneous fluids, IV fluids, herbal supplements, and appetite stimulants. Some cats may appear to be on their way out but survive a few more months with treatment.

Symptoms of End Stage of Renal Failure:

  • Wasting
  • Dull coat
  • Extreme nausea
  • Not eating
  • Constant infections
  • Decreased immunity
  • Extreme dehydration
  • Incontinence

In all cases, cat renal failure requires treatment. Even something as simple as a specialty diet helps a cat diagnosed with kidney disease. If you notice strange behavior in your cat like the symptoms listed above, take your cat to your vet for an exam.

With a prompt diagnosis, your vet can create unique treatment plan fitting your cat’s needs, stays within your budget, and increase the quality and length of your cat’s life.

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5 Treatments for Your Cat’s End Stage Renal Failure

Many cats present to the veterinarian in end-stage renal disease. Because chronic renal failure is a progressive disease, the outcome is, ultimately, death. The following five treatments are necessary to manage end-stage renal failure.

1. Subcutaneous Fluid Administration

As renal insufficiency progresses, oral fluid intake cannot keep pace with fluid losses. Intermittent subcutaneous fluid administration replenishes lost fluids. The recommended dose is 100-150 ml balanced electrolyte solution once daily. Sometimes, 200 ml every other day is more manageable.

Fluid dose varies with the cat's symptoms and individual situation. Most pet parents are able to administer SQ fluids with a drip set and fluid bag with a large bore needle (18 or 20 gauge).

2. Controlling Anorexia/Nausea/Vomiting

Increased stomach acid accumulation due to reduced clearance leads to gastric hyperacidity, gastric irritation, and stomach ulcersMedications like cimetidine, ranitidine, or famotidine reduce gastric acid secretion and improve appetite.

Veterinarians recommend Sucralfate for those patients with significant evidence of gastric ulceration.

Metoclopramide helps patients with signs of nausea (vomiting, lip-smacking, ptyalism). You should give Metoclopramide 60 minutes before feeding for best results.

3. Controlling Elevated Phosphorous

Eventually, renal function fails to the point dietary restriction alone won’t manage serum phosphorus levels. Supplementing with aluminum hydroxide in tablet form helps. Give phosphate binders before meals for the greatest beneficial effect.

4. Improving Anemia

Anemia develops in later renal failure stages due to decreased erythropoietin production by failing kidneys. Human recombinant erythropoietin (EPO) increases red cell mass in cats. However, most cats treated with EPO eventually develop antibodies against it, resulting in treatment discontinuation. Wait until as late in the course of the disease as possible before using EPO.

5. Frequent Reassessment

Cats with end-stage renal disease need to be re-evaluated regularly. Pay close attention to your cat's body weight. Subtle weight loss often indicates deterioration of renal function. Or, your cat may have a new concurrent problem like hyperthyroidism or IBD.

Oral cavity health is very important. Have your cat's teeth cleaned as needed. Hypertension may already be present. Or, hypertension can develop at any point during the progression of renal disease. Have your cat's blood pressure checked at each follow-up visit.

You can successfully manage feline renal disease for years if you catch it early and manage it properly.

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Action Items

Complete the following action items, and you'll be well on your way down the path to better health for your pet!

  1. Learn more about cat renal failure and how to choose the right diet in our free ebook by downloading: "Help! My Cat Has Renal Failure: How Kitty Can Still Live a Healthy, Happy Life."
  2. Switch to wet food. Note: Sometimes low protein diets fed before your cat has symptoms of low specific gravity and high BUN and Creatinine levels can be harmful. Check with your vet before feeding a low protein diet.
  3. Add water to your cat's food, even if you are feeding wet food. Extra fluids are very important to help flush toxins out of the body. 
  4. Always consult with your veterinarian before making changes to your cat's diet and exercise routine.

Free Ebook: Help! My Cat Has Renal Failure: How Kitty Can Still Live a Healthy, Happy Life