Tuesday, August 2, 2022

Kidney Failure In Cats Final Stages

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Creating Brighter Futures For Cats With Chronic Kidney Disease

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Katie Burns

Cats with chronic kidney disease can now live longer, better lives than ever before.

Its been a very exciting time over the last decade or so in that weve really enhanced our abilities to diagnose and detect chronic kidney disease, said Dr. Shelly L. Vaden, a professor of internal medicine at North Carolina State University College of Veterinary Medicine. Weve also made many improvements in medical management.

Dr. Vaden was speaking during the New Therapeutic Approaches to Chronic Care Symposium at the AVMA Virtual Convention 2020 this past August. Another convention presentation focused on RenalTech, a new tool from Antech Diagnostics that uses artificial intelligence to predict which cats will develop chronic kidney disease in the next two years.

During an October 2020 webinar from Morris Animal Foundation, Dr. Jessica Quimby, an associate professor of small animal internal medicine at The Ohio State University College of Veterinary Medicine, spoke about trying to develop a deeper understanding of CKD in cats while still improving on practical aspects of treatment.

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 .

How Does Crf Affect My Cat

Because the kidneys perform a variety of different functions, the clinical signs of renal failure can be somewhat variable. The most common changes seen are weight loss, poor hair quality, halitosis , variable appetite which may be associated with mouth ulcers, lethargy, and depression. Less common signs include increased drinking or urinating, vomiting, diarrhea, and anemia.

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Kidney Disease In Cats: When To Euthanize

Cats kidneys are a very vital organ of their body. Cats of any age can develop chronic kidney failure but it is usually more common in senior cats. Kidneys usually slowly lose function over a period of a couple months to a year.

Kidney problems often occur so gradually that by the time the symptoms become obvious in cats, it is already too late to treat the disease effectively.

Symptoms Of End Stage Renal Disease In Cats

Kidney Failure In Cats Final Stages

A cat in end stage renal disease is in poor condition, and her welfare should be uppermost in the pet parent’s mind. VCA Hospitals notes the nature of the illness means the cat is often painfully thin, with little or no muscle mass, and she has a dull, starry coat. In addition:

  • High toxin levels in the blood cause her to have bad breath.
  • The stomach lining becomes inflamed which causes nausea resulting in a poor appetite and vomiting.
  • In an attempt to flush toxins from the blood, the cat is usually very thirsty and produces lots of urine. The end is often close when the cat stops drinking or producing urine.
  • Dehydration produces a lack of elasticity in the skin. The classic sign is skin tenting. To detect dehydration lift the skin over the cat’s shoulder and let go. The skin should instantly ping back into place, but dehydrated skin takes a second or more to fall back into place, or worse still stays in a peak.
“My 17 year old cat Smokey-Jo is currently going through this. Within 2 days she has stopped eating, barely drinks any water and hasn’t gone to the bathroom in 2 days. Now she can hardly stand up.” — Reader comment from Russ

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Signs To Watch Out For

While cats with chronic kidney disease can live for years while undergoing treatment, there may come a point where their kidneys have become too damaged to keep them stable. When this happens, you might observe a few symptoms that are different from the minor ones your cat was displaying before.

  • Loss of appetite: The first sign cat owners usually notice is a complete loss of appetite. Cats with end-stage kidney failure often lose interest in eating any food you give themeven treats and their favorite wet food. They completely avoid their food bowls and wont drink from the water dish. Cats who dont get enough fluids from wet food and fresh water will become severely dehydrated, causing skin tenting and infrequent urination.
  • Weight loss: A loss of appetite is closely followed by severe weight loss and muscle wasting. Cats with end-stage kidney failure lose weight despite their lack of exercise. Unlike the other possible symptoms, weight loss usually develops over a long period of time and might go unnoticed at first. However, by the final stage of kidney disease, your cat may appear extremely thin and unhealthy.
  • Stage : Cats Kidneys Are Now Functioning At Less Than 15%

    With creatine levels above 5, stage 4 kidney disease in cats can be scary.

    Treatments from stage 1 through 3 will continue.

    Anemia will likely be a problem at this point, so your vet will want to treat that with medications.

    Making your pet comfortable will be a top priority now.

    Acute renal failure or any sudden worsening of symptoms could require extended hospitalization for your cat.

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    Feline Kidney Disease Stages

    The International Renal Interest Society divides renal disease into different stages. These range from mild, early disease to end stage. According to these IRIS guidelines a cat is technically in end stage failure when they have less than 10 percent of normal renal function. Markers of kidney function which predict when she has entered end stage include:

    • Extremely high blood creatinine levels
    • Excessive amounts of protein in the urine
    • Very weak urine
    • High blood pressure
    • Anemia

    However, as Prof. Johnathan Elliott advises, test results are only ever a guide to the cat’s health and it’s important to treat the cat rather than the numbers. For example, some cats have shocking blood results but are relatively well, while others have OK results on paper, but are very sick in reality.

    What Is Kidney Disease In Cats

    Stages Of Kidney Disease In Catsð?±Symptoms of Kidney Failure in Cats

    Kidneys have the important job of eliminating protein waste, producing urine, and balancing the salts, acids, and water in your cats body.

    They contribute to healthy blood pressure, make hormones, and are responsible for signaling bone marrow to create more red blood cells.

    Kidney disease can interrupt any of these processes to catastrophic effects.

    Kidney disease is also known as:

    • Renal disease
    • Kidney failure

    Its a frighteningly common problem for senior cats and even some younger felines.

    Renal disease can either be congenital, which means it existed at birth, or it could be developmental, which means it developed over time.

    For congenital and developmental, early diagnosis greatly increases the effectiveness of treatment and your cats quality of life.

    Though it can be hard to detect, astute pet parents and veterinarians may be able to see the signs before its too late.

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    Helping Your Cat With Kidney Disease

    You love your cat and it breaks your heart to see her so sick. By all means, do everything possible to comfort her, but know sometimes it is kinder to say goodbye than battle on. Euthanasia is hard for an owner, but know you are putting the cat’s best interests first and preventing suffering. Ultimately, saying goodbye is a brave decision made from a sense of self-sacrifice. It is not what you want, but what the cat needs, that is of paramount importance in the end.

    Unproven Treatments For Kidney Disease In Cats

    Its scary when your beloved companion is diagnosed with kidney disease.

    The thought of losing your best friend may push you to investigate unproven treatments.

    While nobody can blame you for exploring every available avenue, you should never treat your cat for renal failure without the supervision of your veterinary team.

    With that said, some controversial and complex therapies can be discussed with your vet.

    They include hemodialysis, which removes toxic waste products from the bloodstream, and kidney transplantation.

    Or I came across this site that delved into the area of holistic healing using the EFT Tapping Method.

    It may sound a bit woo-woo or just plain unbelievable but keep an open mind.

    Not all vets are right.

    Not all vets know holistic ways of healing.

    Not all vets know everything.

    When you feel totally helpless and your cat is suffering, you WILL try anything to make them better.

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    Can Heart Failure Be Cured

    Now in most cases the changes are irreversible, especially when they’re picked up late.

    If it’s early then it may at least be partly reversible if there is an underlying cause. So I guess the classic example of this would be a taurine deficiency, which we don’t really worry about so much anymore because cat foods have extra taurine added to them because we know about this link. This was a problem I believe in the 1980s or earlier when we weren’t aware that taurine was linked to heart health.

    The other example where heart failure may be reversible in cats is an overactive thyroid or hyperthyroidism. Hyperthyroidism can cause heart disease, amongst other things, and if we’re picking up this disease in the early stages and were then reversing that overactive thyroid, or that increased levels of thyroid hormone in the blood, then we could potentially reverse some of those changes within the heart.

    Symptoms Of Kidney Failure In Cats

    Navigating Kidney Failure in Cats Final Stages

    If your cats kidneys arent removing waste from his or her body, you may notice that your cat is drinking more water and attempting to urinate more. Because the toxins build up in the cat’s body, they may feel nauseous and stop eating their food. In general, your cat will appear to be lethargic and not very happy.

    General symptoms of kidney failure in cats can include:

    • Dehydration
    • Depression
    • Bad breath

    If your cat is suffering from acute kidney failure you may also notice an arched back or stiff-legged gait, symptoms that your cats kidneys are causing pain.

    Chronic kidney failure gradually progresses over years, and the signs may not be noticeable. By the time you do see symptoms, the disease may already be leading to total kidney failure.

    While there is no cure for chronic kidney disease, if its detected and treated early your cats longevity and quality of life can be improved.

    Symptoms of End Stage Kidney Failure in Cats

    Symptoms of end stage kidney failure in cats include dull sunken eyes, inability to walk, body odour, incontinence in bladder or bowels, refusal to eat or drink, seizures, confusion, pacing and restlessness, withdrawing, hiding and running away.

    Though more than one of these symptoms will be present, you may not see all of them in your cat. With kidney failure, there are no easy answers, as different symptoms may be present at different times.

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    How Is The Disease Diagnosed

    Renal disease is usually diagnosed by looking at the level of two biochemical byproducts in the bloodstream, blood urea nitrogen and creatinine, in conjunction with the urine specific gravity . Microalbuminuria is another indicator of CRF. Tests to measure the blood levels of other substances such as proteins, potassium, phosphorus, and calcium, as well as the red and white blood cell counts are important in order to determine the extent of kidney failure and the best course of treatment.

    Nursing The Cat In End Stage Kidney Failure

    Nursing is an essential part of caring for a seriously ill cat. You should keep the cat indoors for her own protection. Bed the cat down on a comfortable padded surface, such as Vetbed or a puppy pad on top of blankets. Check the cat regularly in case she has soiled and is lying in urine. If she is not moving around, encourage her to change position when awake to reduce the risk of bedsores. She may feel the cold easily, so ensure the room is warm or provide a heat mat.

    The cat will not want to walk far so place a litter box, food, and water within easy reach. Most sick cats feel better for a gentle brush and having their eyes, nose, and mouth wiped clean with damp cotton wool. Let her rest but also provide quiet companionship and fuss when she is awake.

    “Today I made the decision to put my Mister down. It wasn’t fair to him to prolong the inevitable. The vet was amazing and I held him through the entire process. I have a huge gaping hole in heart but I know that I did the right thing.” — Reader comment from Sherry Purdue

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    Symptoms Of The Final Stages Of Kidney Failure In Cats

    The most common symptoms:

    • Low potassium levels, high phosphorus levels, and very high urea and creatinine levels

    Cats experience many of the above symptoms throughout each progressive stage of kidney failure.

    As cats get closer to death the symptoms become much more severe.

    Kidney disease escalates through four stages, and symptoms escalate as well.

    Watching your beloved pet suffer more and more may become intolerable.

    However, symptoms alone are not a direct indication your cat needs euthanasia.

    A cat can appear to be moments from death, and with the right treatment, able to regain most of its health.

    If you are able, exhaust all options, such as extended IVs and sub-Qs.

    Your veterinarian can assess the effectiveness of the prescribed treatments by doing additional blood work.

    When treatment fails to improve the blood work of your cat, it is time to start preparing for the end.

    Bad Breath And Body Odor

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    Most cats with chronic kidney disease have bad breath that smells like ammonia. This gets worse as the condition advances. While its possible to treat bad breath, it will only get worse and worse as toxin levels in the cats body increase.

    If your cat is not suffering from kidney disease then bad breath can be a sign of dental problems, dehydration, or other health complications.

    The accumulation of waste and toxins in the body eventually leads to body odor. It is, however, good to keep in mind that body odor can also be caused by dehydration or diabetic ketoacidosis. Make sure to seek veterinary assistance to be absolutely sure.

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    How Your Cat Feels In End Stage Kidney Failure

    The cat in end stage renal disease feels nauseated and weak. She refuses food and may be very thirsty or stop drinking altogether. She will also be thin, and the anemia means she lacks energy even to do simple things like groom. Sadly, a mistake often made by owners is to think a purring cat is happy. A sick cat purrs to comfort herself so the hard decision to say goodbye should not be postponed because the cat is still purring and presumed content.

    End Stage Of Kidney Disease

    At the end of your pet’s bout with kidney disease, he’ll likely have lost a great deal of his kidney function. His body will no longer be able to adequately process the toxins that it typically would have been able to. Unfortunately, the prognosis at the end stage of kidney function is very poor it is typically only a matter of stabilizing yourcat’s system to allow him to die in a peaceful and comfortable manner.

    End stage kidney disease is represented with a few distinctive symptoms. In addition to the various other symptoms that will accompany decreased kidney function throughout the earlier stages of the disease , watch out for these end stage kidney disease symptoms:

    • Seizures

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    The Dangers Of Chronic Kidney Disease In Cats

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    Treating Heart Failure In Cats

    Kidney Failure In Cats Final Stages

    Now, as far as treatment goes, I always struggle with treating cats with heart failure because there’s not much good quality evidence that shows very much of what we do makes a really significant difference.

    It could just be because we are often only treating cats with heart failure late in the disease process, when too much damage has already been done.

    Often it can be very frustrating to treat, we’re not getting the same response that we do in dogs with heart failure for example. But there are a few things that we can use, we do use and that I feel probably do make a difference.

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