The household cat, Merconutter, is getting on in years. Age 17, I believe. And while I’ve never been particularly attached to this roving ball of allergens, both elfbabe and Eowyn the Mercotan seem to have formed significant bonds of affection (unreciprocated, if evaluated with cold logic) for the beast. Therefore, when the cat began to york up its food regularly, vet bills were incurred, kitty serum BUN and creatinine levels were assayed, and special failing kidney kitty cat food was procured. When this still did not solve all problems of feline upchucking, the vet recommended every other day subdermal infusions of 50-100 cc of lactated ringers. Which has worked rather nicely.
Now in my human medical practice, noting that someone had kidneys which were failing, and giving them more fluids via the infusion route would open me up to charges of non-standard medical care, if not worse things. Acute and chronic fluid overload and electrolyte imbalances would be real issues.
Yet in the kitty world, this seems a peachy solution. My question to the Vet (and other animal medicine type) dopers here is: Why is this? What is going on in the realm of renal function/electrolyte metabolism that makes this work?
There are links at the bottom of the page for further resourses that may get into the medical details more, and there is a frame set at the bottom of the page with an eMail link. The doctor will answer questions via eMail.
Even in people, a rising BUN and creatinine and/or low urine output might be due to something as simple as dehydration, in which case more fluid would work nicely. In people with low urine output due to acute kidney failure, a bolus of fluid and Lasix might be given to induce them to pee and avoid a suprapubic catheter. Your kitty’s kidneys may be kind of komplex – did the vet give you a diagnosis, or tell you if the failure was prerenal, postrenal, etc.?
Well, that’s the odd thing. Kitty was not barfing so much as to get dehydrated, and peed well and often, and drank frequently. So the picture was not one of ARF or inadequate vascular volume. More just intermittent vomiting. He really looks like some of my pre-dialysis renal failure patients, knocking back bottle after bottle of soda, pissing, yowling a lot, and puking on occasion. And shedding.
And I never got to speak with the vet directly, but am gleaning the info from the Mrs. who didn’t inquire as to the source of the azotemia.
So perhaps the treatment is just empiric, and given the complexities of kitty dialysis, probably the best treatment the cat’s gonna get. And yes, if I really want to know what’s going on, I’ll probably have to talk to the vet myself.
I’m not really sure of the mechanics of it all, but that’s standard treatment for kidney failure kitties. My understanding is that with the kidneys not working efficiently, it takes more fluid to get all the stuff that needs filtering out of there. It’s hard to keep kidney cats drinking a normal volume of water, much less an increased amount. (I know your cat is drinking frequently, but it’s not unusual for them to only drink tiny amounts at each visit to the water bowl. How often you have to refill the bowl is a better indicator than how often he’s drinking from it.)And if you’re peeing out more than you’re taking in, you’re eventually going to get dehydrated, puking or no. The SQ boluses aren’t so much a matter of fluid overload as a matter of fluid replacement.
It’s also not unusual for renal cats to have reduced appetite, especially as the kidney failure progresses and they start to feel worse. At that point, you can try switching him to the canned version of the prescription food. If he still won’t eat, try heating it up. If he still won’t eat, try putting it in the blender with a bit of water to make a slurry. Sometimes they’ll drink that. If he still won’t eat on his own, you can try syringe feeding him. Sometimes once you get them started they’ll eat on their own. Alternatively, you can try a bit of tuna or chicken, or baby food. Our anorexic patients seem specially fond of the lamb flavor. I’d try to keep him on the prescription food as much as possible, though.
Of the clients at my previous job absolutely swears by a product called Catsip for renal cats. It’s some kind of non-dairy milk substitute marketed for kitties (it sounds suspiciously like overpriced soy milk to me, but I don’t know that for sure). Her cats would guzzle that when they wouldn’t even look at the water dish, so that might be an option for helping keep your kitty hydrated.
Chronic Renal Failure (CRF) is a very common thing to find in older cats. All organisms die of/with something and in cats the kidneys seem to be a weak link. Diuresis is typically not an option due to cost, and transplantation is an option only for those willing to go to extremes (travel + cost).
I can send you some material pertaining to feline polyuric chronic renal failure if you would like. I have seen my own patients do well for years with three times/week subcutaneous fluid administration. As long as the cat is eating there is seldom a problem with electrolytes, and I would assume your veterinarian feels the cat’s cardiac situation is good enough to handle the extra preload.
Most cats eventually resent an 18 gauge needle poking them every few days, and a 20 or 22 gauge usually takes too long. A cool alternative is the implantation of a delivery system that allows pain free sub-q administration via a small port. I could send you details if you like.
Feel free to email me at vetbridge(at)unforgettable(dot)com.
Another option to help increase oral fluid intake in cats is the drinking fountain type device marketed for cats. A small pump creates a splashing fountain effect.
If you do talk to him/her, try to find out the phosphorus value, as it is an important prognostic indicator. Also, if the cat’s hematocrit is lower than 30%, you might wanna consider erythropoeitin injections as a way of increasing quality of life.
Thanks for the input, CCL and Vetbridge. The beast doesn’t seem to mind the needle at all, really. And has done quite well since getting regular infusions.
Hm. For a cat who makes me sneeze and who only ever brought me one present: rodent guts. If his quality of life declines, I will consider it. But only if his quality of life is worse than mine. Sleep 20 hours a day, jump around like an idiot, eat some. Pass gas. The damn cat is already living my dream retirement!
UK vets have taken to prescribing ACE inhibitors for cats in kidney failure. You may want to look into this. My late cat Alex was treated in this way from April to October of last year. He rallied considerably at first, even gaining a little weight and certainly being a lot happier. Sadly it didn’t last but I would say that the drug gained him the summer.
This is not without some controversy. While most cats with CRF are hypertensive, only a minority end up with clinical consequences. Personally, I save ACE inhibitors until they are needed, which is seldom.
I thought it might be controversial as the research I did at the time indicated that this treatment was being used by UK vets and not by US vets. So far as I could make out this treatment is being used in the UK on the grounds that it works as much as anything else (do we have a UK vet on the boards?).
And Elfbabe keep up with the cuddling and stroking, that works too.
We went through this last year at this time, except it was at the end of our 19 yo cat’s life. It was not easy, and I find myself wondering if I/we waited too long. We did try the peritoneal dialysis bit for a few days about 18 months before the end, but at that time our cat was still pretty comfortable and didn’t like the needle at all. But the vomiting and god-awful howling were hard to take. Regardless of one’s feelings, pets are a part of the family, and I found that a lot of the issues we struggled with were similar to ones I’ve been involved with clinically. I need to remember the phosphorus levels if we ever face this again. I wasn’taware of them being part of the renal prognostic tests.
I wish. I know a few vets in the U.K. and they are great people. They do, however, sometimes use the term “pussy” to refer to a cat which just does not fly in the US.
