My kitty is sick (kidney failure) and I need advice

Last friday, my little 13-year-old Russian Blue, Grace, wasn’t acting like herself, so I took her to the vet. They ran some tests and found out she was in severe kidney failure. They advised keeping her at the hospital and giving her fluids and antibiotics (for a UTI) along with heat support (her temp was very low) and we’d see how it goes. When we brought her in, her creatinine and BUN numbers were off the charts, and her red blood cell count was low.

A blood transfusion and fluids perked her up, and on Saturday and Sunday she seemed better–still weak, but more her bright-eyed self. When I picked her up yesterday morning to take her to the new vet (affiliated with the hospital, which was only open nights and weekends for emergencies) she even protested a bit about the car ride, which I thought was a good sign.

We visited her again last night and she seemed worse–lethargic again, trying to hide under her blankets, and not wanting to eat or drink. This morning I called and found out her red blood cell count is at 20% (down from 23% a couple days ago, and up from 15% when we brought her in), her BUN is still off the charts but now measurable, and her Creatinine is at 7.3 (down from 7.6 this weekend, and down from off-the-charts on Friday). She has some ulcers in her mouth now, which the vet said is consistent with kidney failure and might be contributing to her reluctance to eat. They’re going to do another blood test tonight to see where the numbers are.

We love this cat. She’s our baby. But now I’m starting to wonder if we’re not keeping going with the treatment for our sake instead of hers. The spouse is wondering if another transfusion might help–I plan to ask the vet when I go visit her today, but…even if it does, I wonder how long it will help. We have the money to pay for the treatments, but I don’t want to keep them up if all they get us is a short time with a cat who isn’t happy with her life.

So my question is, for those who’ve dealt with this before, what’s been your experience? This is chronic kidney failure, not acute (she didn’t get into any poison or anything–she’s a 100% indoor cat). It’s apparently been creeping up for a while, but cats are very good about not acting sick. Just a couple days before she got sick she seemed her usual happy, healthy self.

Should we help her keep fighting? Or is anything we do only likely to prolong the inevitable for a short time, and we should let her go?

Here’s our little blue diva in healthier days.

For my own animals I use the “desire to live” quotient: if they are still eating and interested in doing “normal” stuff, they still want to live and they should be allowed to. OTOH, if they won’t or can’t eat and/or won’t or can’t perform basic bodily functions, like poop, then their number has been called and they are waiting to die.

I’m so sorry.

I can’t make that call for you, none of us can, nor should we, but as hard as it is, and I’m not necessarily saying it’s now, but I know you will know when it’s time.

I had to make the choice. My cat was not eating. He’d got cancer of the jaw and had had 4 teeth removed; still he refused to eat. Turns out the tumour weakened his jaw so much that it broke.

It was incredibly hard, and my eyes tear up as I type, even 1.5 years later.

But you must do the best thing that you know will be in your cat’s best interest.

You need a professional medical opinion, or three, not some random advice. It may be that a special diet can fix your cat up, or it may not.

In the immediate term, sometimes sick animals need to be fed by hand. For a cat, it can be done using soft food and a syringe to squirt it into in the mouth.

Yeah, I get that. We’re getting professional medical opinions. But vets seem reluctant to make recommendations regarding when it’s “time,” so I was looking for stories from other folks who’ve had similar experiences.

Boy, I hate having to make those kind of decisions. Compare how she was to how she is. Are you are keeping her alive because you wish for the past, or are you thinking a cure can happen? If there is a reasonable chance at a painfree and happy life, I say go for it. If the rest of her life will be vet visits and invasive procedures I’d say let her go. IMHO.
ETA I’m wishing for the best for Grace.

If she’s on an antibiotic for the UTI, that’s also contributing to her reluctance to eat since they tend to make older kitties sick to their stomachs. It’s probably also why she seems like she’s feeling crappier. I would say please don’t make any decisions until she’s off the antibiotic for a few days. That she perked up after coming home is a good sign! Then the antibiotic side effects probably kicked in. Which one is she on? Orbax is well-tolerated by kidney kitties.

Sometimes it takes a while for the numbers to come down after they’ve been receiving IV fluids. It’s not like filling a gas tank; It’s more like wetting a sponge. It takes some time to get into the nooks and crannies. :slight_smile: Several days, at least. If you can afford the transfusion, I say go for it. It will help her anemia and she’ll feel better.

Here’s a phenomenal site:

And this is an extremely knowledgeable and helpful Facebook group run by a friend of mine and I think it will help you more than anyplace else:

CKD is a steep learning curve so try not to feel overwhelmed! You’ll get there. :slight_smile: Feel free to PM me if you want. The very best to you and Grace!

Helena330, thanks for the advice. Sounds like you’ve been there, and I appreciate it.

Just to be clear - she already had one transfusion. We can afford another one, but I don’t want to go for it if it’s highly likely to just be a short-term solution.

She’s been on IV fluids since Friday afternoon. She was tolerating them well, but now she’s starting to gain weight and the vet thinks it’s because her kidneys aren’t dealing with the fluids as well now. She’s going to slow them down and see if that helps.

I will check out the sites you mentioned. Thanks again!

A friend had an older cat (23, not 13) with kidney issues; she fed him a ration of fresh turkey (bought daily at the butcher’s) every evening- these days there is probably special kidney food you can buy so you don’t have to prepare it yourself- and he was OK, happily playing, etc., for a very long time before finally succumbing to natural causes. So it may not be “time”, but you will probably have to watch the diet carefully.

I kept my kidney cat going for probably 1.5 years by giving him plenty of gushyfud, transitioning him to being indoor only (which pissed him off some) and learning how to give him sub-Q hydration several times a week. His decline was quite gentle–until it wasn’t, and I came home from a day trip to find him collapsed, weak, unable to do much of anything and obviously not feeling anything but terrible. I held him wrapped in a quilt on the couch all night long then took him in to the vet in the morning. I loved that cat.

Now that it’s an option, I’d probably register my info on Lap of Love, which is mobile euthanasia and hospice. You set it all up with what options you prefer, go on your way and when you decide it’s time you make one call to schedule the vet to come out. It’s very easy on the critter and on you too, the kitteh doesn’t have to endure another stressful vet trip, just a gentle letting go right there on your lap and the vet takes the body along for disposal if you don’t want to deal with that. It’s not cheap, but I’ll never do it any other way now that I know the advantages. Plus, the local Lap of Love vet is a friend of mine so that makes it even easier.

Best of luck with your kitteh.

Kidney failure is one of the major causes of death from “old age” in cats. It’s what ultimately caused me to make the decision to put down my last feline overlord. He didn’t do well under treatment. IIRC it was less than two months from the diagnosis to him effectively giving up. The real issue IMO is whether you can even get her back to where you can try to effectively manage the problem.

From a description of Chronic Kidney Disease at the Cornell School of Veterinary Medicine.

Early diagnosis and treatment sounds like a ship that’s sailed. The testing doesn’t sound good at this point. If you can get her back closer to stable there might still be a chance for long term management to be successful. Cats do love being unpredictable. The vet might not want to be seen as making a recommendation. They certainly are the one that can give you a better idea about the odds of getting past the current crisis to see whether long term care works for her.

These times suck. They are called the hard decisions for a reason.

Four days on fluids is a pretty good dose, so it’s not really a surprise that she’s not absorbing them well. I wish your vet would stop the fluids until she absorbs the excess. :slight_smile: She’s at risk of being over-hydrated. A lot of times general vets aren’t that well-versed in feline CKD. I don’t mean any insult to your vet. My general vet said the same thing and told me I taught HIM a few things. If you have the money, you may want to consult with an internist, but if you don’t want to do that, try to learn as much as you can so you can suggest things to your vet and make informed decisions.

The transfusion IS a short-term solution, but it’s a life-saving one. The less anemic she is, the better she’ll do. CKD kitties are frequently anemic. If she makes it through this, you’ll want to keep a close eye on her HCT. Either you’ll start out with medication to keep it stable and monitor the HCT as you go, or you’ll just monitor and give medication if it falls below a certain point. Either way, it takes some playing around. The problem with not giving it at first is that it takes about a week to kick in and by then the kitty might really be having trouble.

In any case, again, please don’t do anything until she’s off the antibiotic. :slight_smile: I’d also be curious to know how she’d do with Pepcid. Kidney kitties also tend to have stomach acid and the Pepcid really helps a lot of them. Had her appetite fallen off at all before this crash?

I really hope this is a hump and she will be ok for a while still with some management from you. On the kidney kitty group, we say to treat the cat, not the numbers. There are some high number kitties that do pretty well, and thirteen is young!

I posted this some years back:

And one of my first posts on this board is also about a cat, my beloved Mao.

Another cat, Heidi, I had put down shortly after I bought my house. She had health problems that I knew about when I adopted her and she went downhill quickly. She was suffering and unhappy and nothing was going to fix her, so I had to make The Decision a third time, hoping that her last 4 years with me were as good for her as they were for me. I don’t plan on not having cats, so it likely won’t be the last time I go thru this, either.

It’s never easy. It’s never fun to contemplate. But I have to remind myself that it’s part of the responsibilities I accepted when I agreed to shelter, feed, care for and love these critters because they can’t do it themselves. I never want any of my friends to suffer, no matter how many legs they have and unfortunately, it does fall to me make the call: I’m the human.

I’m so sorry, Infovore.
I went through this with Whitey the Wonder Cat, and though I spent a lot of money and put him through a lot of discomfort, of course he couldn’t be cured. I said at the time that I would never do it again.
Years later, my cat Lloyd developed the same problem, and I did hold on for a little while, but only in preparation to say goodbye. I think it was better that way.

I’ve never had good luck with failed cat kidneys, but given the other anecdotes that it’s not necessarily hopeless, I won’t spread doom and gloom here. But it IS amazing how much your typical vet doesn’t know about cats. I got an ER vet to get candid when my rescue panther was being unusually lethargic. “Fever of unknown origin” he said. “So…you don’t know what’s wrong with him then, do you.” “Well, not a clue, really. He’s got a tiny fever, but is otherwise chemically normal. Cats are like aliens in little fur suits–they just don’t make a lot of sense biologically, sometimes.” Really the best cat vet I ever met was an ancient dude who worked out of a mobile home in rural Georgia. He could recite the science behind what was happening, expensive options for fixing the critter, cheap options that were nearly as good, etc. Most of all, he knew how to interact with and handle a cat. Still blows my mind how many vets will greet and touch a cat as if it were just a small dog.

We put down our cat within a month of getting the kidney failure diagnosis - which we got because he was no longer regularly using the litterbox, and was obviously in pain.
An altered diet didn’t do much, and let’s face it, this is chronic kidney failure – by the time the symptoms show up, 90%+ of the kidneys are gone.

You could also look for a cat vet specifically, who should have additional training and certification for cats.

Many, many vets are unhelpful when it comes to end of life recommendations for cats. I recently spent 2 years or more dealing with this with my elderly dog. I’d take him into the vet for a quality of life examination, and the vet would cheerfully list all of the treatments we could try. In retrospect, I put him through more pain and low quality of life than I should have.

Regarding your cat, based on my experience I suspect you have missed the window to make a difference in her condition. This is only my own experience. SmartAleq obviously has done more with this condition than I have.

Your cat is clearly miserable now. You need to make a determination as to whether this is acute health crisis she can get past, or whether you are prolonging the inevitable. No one feels good during an acute crisis, so it’s hard to measure things. I would make sure you understand each treatment that has been undertaken, and find out what result is hoped for each one. Are you seeing any forward progress towards those metrics? Second, ask what the long term treatment is for her if she does get through this. Usually it’s fluids at home, which you will have to administer. This isn’t hard to learn, but your cat will have to sit still with you, with a needle in her skin, while the fluids drain down. Ask yourself if your cat will tolerate this. (I had one cat that would, and one cat that would not.) Third, ask the vet what life expectation is. Some cats will go on for a long time with supportive treatment, such as fluids at home, a new diet and so on. Some cats you’re really just buying days or weeks. Ask yourself if the answer you get, in terms of the care you will have to do at home and her quality of life, results in something that is worth it.

Ultimately, everything comes down to her quality of life. Don’t use this time in hospital as your yard stick. Find out what you can expect afterwards, and then ask yourself, knowing your cat, whether she will have enough quality of life to make the additional time worthwhile.

I will tell you what everyone was reluctant to tell me: based on what you are saying, I think it’s time to let her go. She can’t eat, she is hiding, she is in pain. Unless something major has come along, the long term treatment options are poor. (I want to acknowledge that yes, some cats do well for months or even years.) This is my opinion only, based on having many cats, and losing 4 to kidney disease.

I’m sorry this is happening. My best wishes to your family.

my stretch the super d duper hit this earlier this year. he was off his food Friday night and I made appt. for him on Monday. the whole weekend I wondered if he would make it to Monday. he just was laying in the bathroom either the sink or by the toilet. the other 2 cats left him alone. he only wanted to eat fancy feast broth. Monday’s appt showed liver and bladder troubles, and the blood test , kidney failure. he rallied a bit at the vets, and ate food and treats while we were awaiting the results.

as I was deciding which option to go with, I found myself using “I” and “me” instead of stretch and him. then I remembered that one person here, had in a “what to do” thread, said: “I don’t regret making the decision, I regret not making it sooner”. that helped me decide that stretch was at a good point. he had a nice meal, treats, and was with people who knew him. he ate treats right up to the end. such a good boy.

When I lived in Seattle, I had a great house call vet. One of the things he did a lot of was in-home euthanasia. My wife and I were struggling with one of these decisions once and I think I was trying to get him to make a definitive ‘time/not time’ statement. He wouldn’t, but he said something that helped. I asked him in his opinion, how often people made the euthanasia decision too soon. I don’t remember all of his reply, but it started with, “Never…”

At the risk of repeating myself, no, you really, really don’t, even if you play a doctor on TV. You do need to make a determination whether any given vet is a quack, though, which is why I recommended getting a second or third opinion; with reliable lab work and medical advice you can make an informed decision regarding treatment options. Same thing if you yourself were diagnosed with a blown kidney.