Pouncerstone

Kidney Disease - Management Suggestions

1. Proper Diagnosis And Treatment - It's critical that you find a veterinarian who will aggressively work towards properly diagnosing and treating your friend, if you feel that may not have been done. Getting your friend started on a good treatment plan developed by a doctor experienced with treating kidney disease is important.  An internist or perhaps even more so an internist who specializes in nephrology can be very helpful with this responsibility.

Finding a veterinarian that can help your cat may sometimes be particularly challenging in rural areas. Some vets in very rural areas may be more experienced in dealing with horses, etc. than domestic animals. It may be helpful to find an internist or a veterinarian in a city that has experience with kidney disease. One or two car trips (for exam(s), testing, etc.) may be well worth it if you can connect with a doctor that will work with your local veterinarian to set up a treatment plan. Then, your local vet will have a more experienced professional to consult with, as needed.

Another possible professional veterinary resource to consider is the telephone consultation services offered by Cornell University. Information on Cornell's services is provided in our Education And Resources page.

2. Find A Good Hospital - If you're looking for a new veterinarian, consider finding one who works at a larger, 24-hour facility. There you'll have the reassurance of a doctor being on staff at all hours. And if your kitty has to stay overnight, there will be appropriate medical personnel on hand to check on him. Just because a facility has the word "hospital" in its name does not mean it has medical staff present after hours, even though it may board animals and keep patients overnight. Ask your vet what the set up is at his or her facility so you can be sure you understand what care is available after hours. Get the name of an emergency facility nearby so you have it in advance in case you need it. Our experience here at Pouncerstone headquarters is that there is nothing worse than going through the yellow pages on a Sunday morning, hoping you'll find appropriate emergency care for your friend whose health may be in serious trouble.
3. Assume A Positive Attitude - Our pets easily pick up on our feelings. If we are upset, often they sense it. Be positive about your cat's condition, look at it as something to manage. You will be helping your cat. Even if your cat is in renal failure, there may be a lot you can do to help your cat have many good days, months and maybe even years.

Try to avoid thinking in terms "how much longer does my cat have left". When Pouncer was first diagnosed with kidney disease, this question was posed to a few of his doctors and none of them ever talked in terms of "time". Instead they talked about managing the condition and what can be done. We're most grateful for how this was handled because if one starts thinking in terms of how much time is left, there is the tendency to start treating the cat like a dying patient, rather than one who may very well have a lot more living to do.

When Pouncer had exploratory surgery and a kidney biopsy, his surgeon believed that Pouncer could be bordering on renal failure. The biopsy was done in 9/96 and Pouncer seems to have plans to be around for quite sometime yet. So sometimes it pays to think like a cat!

4. Three Most Common Tools - The three most commonly used tools in treating kidney disease are subcutaneous fluids (such as Lactated Ringers or Saline Solution), medication and prescription low protein diets.  Do some reading on your own and discuss different ideas with your veterinarian.

Through research and conversation you may find there's more that can be done to help your pet.  Or, on the other hand, you may learn why some treatment ideas aren't appropriate for your cat, although they may be right for others.  Don't assume that just because another cat is on a certain medication or on fluids that your cat should be on them also.  Talk with your veterinarian to understand the "whys".

A cat may need fluids if he is azotemic and cannot maintain hydration on his own. But then there are times when a fairly-well hydrated cat seems to feel better overall when on fluids, such as is the case with Taffy. Frequency of fluids administration varies, not all cats need or should have them on a daily basis. If you find too much in the way of fluids accumulating in the belly area and its been, for example, 24 hours since you gave the cat fluids, the amount may need to be reduced (or else the cat may need smaller amounts more than once a day).  Your veterinarian can make an appropriate determination.

Low protein diets - We have used both Hill's Science K/D (Kidney Disease) and Select Care Modified. It seems the consistency of K/D changes every few years and so a while back we changed to Select Care Modifed canned instead of K/D canned. Select Care Modified presently has a more moist consistency and Taffy enjoys that better. Pouncer remains on the low-protein diet and he's happy to eat either. Our cats also like Select Care Modified's dry cat food. The pieces are star-shaped and Miss Taffy prefers that over the round pieces as they seem easier for her to bite. And since she's in charge... We understand that Waltham's offers prescription diets, but we have not had the occasion to try them.

Select Care Modified is typically sold at VCA Animal Hospitals, which also carries K/D. If you are interested in finding out if there is a VCA Hospital near you in case your own vet doesn't carry it or cannot order it, you can search for a VCA Hospital via their web site at Veterinary Centers of America, Inc. If the food is provided by a hospital other than your own, your vet will have to write you a prescription for the food which will have to be kept on file at the facility from which you go to purchase it.

As you know, each cat has their own preferences regarding food. And remember, any change in diet must be done gradually if it is to be done successfully.

5. Unusual Smelling Breath - If your smell an ammonia-type smell around your cat's neck area and mouth, it could be an indication that your cat is uremic (where there's an excess of both nitrogeneous waste and urea in the blood). When this was the case with Pouncer, we stepped up on the frequency of giving him Tagamet (another H2 receptor blocker) and also increased his fluids temporarily until this got under control.
6. Lack Of Appetite - There may be periods of time when your cat's appetite is lacking.  This may be due to a number of reasons, one of them due to not all waste products being filtered out by the kidneys, due to the disease.  When this is the case, the stomach lining may be irritated and Pepsid AC (a H2 receptor blocker which helps decrease the production of stomach acids) may be helpful.  This should only be given under your veterinarian's orders. Besides vomiting, another sign of stomach upset may be licking of the lips (indicating nausea). For longer-term lack of appetite situations, the prescription drug Percitan may be helpful.

When Pouncer first came home from the hospital after being very ill, the only food he would eat was Fancy Feast Cod, Sole & Shrimp. It had to be heated in the microwave (to remove the chill) and he would only eat it off of my fingers at first. Warming the food also seems to help release the aroma.  (Be sure to stir it after heating and check it to ensure it is not too warm).  Baby food is something else that cats like to eat and it may be appropriate to give them during those times when they won't eat much of anything. It too must be heated so it is lukewarm. (Cats in general have sensitive stomachs, even those not dealing with stomach problems.)

Stay away from baby foods that contain onion, onion powder or garlic, as they may cause Heinz Body Anemia in cats and other animals. See our Care Tips page for more on this topic.

7. Stimulating Appetite - Other things that may entice your cat to eat include adding tuna juice, clam juice or something like chicken broth. Another thing to keep in mind is that since some kidney patients feel better eating smaller, more frequent meals. Offering more frequent meals may be challenging if you run a multi-cat household that includes a big eater, such as Pouncer. Taffy needs frequent, small meals, and at  those times Pouncer either goes down to the basement for a while to work on  a project or else he sits in human's lap on the kitchen floor and waits until Taffy is done. Then he picks up a few extra pieces and he thinks he is getting a treat. Human's noticed than anytime she bends down over the kitchen floor, Pouncer comes closer and tries to sit in her lap due to his thinking that a treat will come afterwards!

When using canned food and you have leftovers, before storing the can in the refrigerator, add a thin layer of cold water to the can. This water serves two purposes: it keeps the leftover food a little fresher and some of the water can be poured onto dry food that may lack appeal. Taffy will sometimes sit in front of her bowl of dry food, just looking at it. This is her signal to human to spice things up a bit. Human pours a little of the juicy water from a can being stored in the refrigerator and Taffy then digs in to eat!

Another thing that may impact appetite is the administering of medicine around meal time or near the food bowl.  If your cat perceives pill swallowing as a negative experience, he may start to associate it with meal time and be less enthusiastic about stopping by for a meal.

8. Transition To Low Protein Diet - Once your cat's stomach is feeling better, start transitioning him over to the low protein diet. This should be done gradually by mixing in some of the low protein, prescription diet with the food he's been used to eating. Increase the proportion of low protein food in the mixture over time. In a few weeks you may have a cat whose fully made the transition!

Be aware that low protein diets contain less fiber. Thus, you cat may experience constipation, for example. We find that Vetasyl works well for this. It comes in capsule form or tablet form. Our experience with Taffy indicates the capsule form works better for her. We take very small empty gel caps and put the Vetasyl in them. Taffy favors that over having it sprinkled on her food.

9. Fast Your Cat Before Doing Blood Work - Generally your cat should fast before having blood work done to obtain results representative of  the "true picture" of how your cat is doing. Recent meals can raise the BUN level, among others. Talk with your vet to see how many hours of food fasting is appropriate. Also, keep in mind that slight fluctuations in blood work results may be normal - your vet can best explain interpretation of test results.
10. Medications Log - If you're administering fluids and pills to your cat, creating a Lotus or Excel spreadsheet and printing a copy out each week to fill in by hand helps bring some organization to the task.  If you don't have access to this computer software, write up a chart outline on a sheet of paper and make photocopies of the blank form.   This will provide you with a weekly log you can complete.  This beats writing things down on little pieces of paper that seem to disappear later!
11. Copies Of Blood Work - Keep current records on your cat's blood work results, particularly at least the major items such as BUN, creatinine, hematocrit, etc. Obtain a copy of any complete blood panels done on your cat. Keep them handy and up-to-date in a notebook that you can quickly grab to take with if you have to visit an emergency facility with no records on your pet.  You also may want to enter the major blood work items that are done on a regular basis into a spreadsheet.  Then you'll be able to see results over time at a glance on one page.
12. Home Care Day Sheets - If your cat is going through a tougher time, keep a log of notes on how he's feeling where you can write in what's working and not working. Comes in handy for future reference or during conversations with your vet.
13. Give Kitty Space - When your cat's not feeling well, give him space, but check on him regularly. Keep his doctor informed on how he's doing. Make his surroundings comfortable with food, water and a litter pan close by in a room at an appropriate temperature.
14. Educate Thyself On The Topic - Read as much as possible on the topic of kidney disease. This will help you better communicate with your cat's doctor and vice-versa. Arm yourself with a good medical dictionary and some books that help explain the disease and treatment. There's also plenty of information available on the internet. See Pouncerstone's Education And Resources and Suggested Reading pages.
15. Don't Jump To Incorrect Assumptions - Sometimes when our cats are diagnosed with a particular disease, we tend to assume other symptoms that occur are usually attributed to an already-diagnosed disease. Try to avoid making incorrect assumptions. Just because your cat may have kidney problems, it doesn't mean that their may not be an underlying, serious disorder that is promoting it. Below are a couple of examples that relate to the point we're trying to make here.

    Consider the symptom of weakness in the legs. I recently visited another pet care web site that listed some "Frequently Asked Questions". One question was about a pet "dragging its hind legs". The answer the site provided to this question said it could be a sign of potassium deficiency. This is true, but that's looking at it from a narrow perspective and only tying the symptom in with one condition: kidney disease. Dragging the hind legs could also be indicative of the heart not being able to pump enough blood to the hind leg area to allow for their proper movement. Seeing Pouncer drag his hind legs in 1996 was what made me realize that the doctor Pouncer saw the day before was way off with his assessment. So I quickly took him to the emergency room at another hospital. And there I was told his body temperature was 6 degrees below normal and that could mean that Pouncer is dying. As you know, Pouncer lived. And Pouncer never had a potassium deficiency. If I had assumed potassium deficiency was the source of the problem, I may not have taken him into the Emergency Room that day. And he probably would not be snoozing restfully in the next room as a write this. So remember to consider the big picture and move quickly to have things properly diagnosed when you see things that aren't right. And don't make assumptions about your pet's health from what you read on the web.

    As another example, consider the disease Feline Infectious Peritonitis (FIP). It has three forms: wet, dry and combinations of both. The dry form of the disease comes about more slowly than the wet. It can attack many areas of a cat's body: the cat may have anemia, may lose weight, have a fever, and may be depressed. The disease can attack the pancreas, the eyes, the nervous system, the liver, the kidneys, etc.

    We are not telling this to scare you or to suggest your cat has FIP, but rather we are telling you this to make a point: many other diseases or disorders can cause problems that impact the kidneys. These other diseases can sometimes be very hard to diagnose because symptoms may vary among cats with the same disease and the symptoms are also a lot like those seen in a variety of other diseases. This is why it is important for you and your vet to always look at the big picture and keep your minds open. Ask a lot of questions that prompt your doctor to consider other perspectives. It isn't easy. But this does reiterates the importance of trying to educate yourself well as a pet owner, being observant, communicating with your doctor and having a doctor that thoroughly diagnoses his or her patients.

16. Fluids Setup - Don't let your cat see you do the setting up of subcutaneous fluids. They'll soon associate their role as the patient in the process and may head in the opposite direction. Set things up quietly while they are out of the room. Make them comfortable on a pillow or blanket while administering fluids. Perhaps warm the bag of fluids a bit by letting it sit under a short lamp (but not too close!) to warm it so it's closer to your cat's body temperature.  Some like to put the bag of fluids in a pot of already warmed water, being careful that things such as the IV line are staying clean during the process.  So if you notice your cat shivering while he is getting fluids, warming them can take the chill out.  Afterwards, give you 4-pawed friend a treat!

If you use a Vented IV Administration Set and use bags rather than the plastic bottles, be careful not to pump too much air into the bag as it could explode. Be sure there's always a little play in the bag and that it's not completely filled with air and fluid. You'll get more comfortable doing this over time. Also, don't pump air in the bag too far in advance of sitting down with your cats to do fluids: additional air can build up in the bag, causing it to burst.

It's helpful to take a soft-tip, permanent marker and draw horizontal lines on the bag of fluids to represent the intended amount of dosage.  You may notice that when the bag is filled with air, it's shape changes somewhat.  Therefore the lines put on the bag by the manufacturer may not represent 100 mls. each time, for example.

If you administer subcutaneous fluids over a period of time, eventually scar tissue may develop if you're always putting the needle in the same area. (So it may not be that there's something wrong with the needle if you find they aren't going in easily.) Rotate the area of needle injection (discuss with your vet the appropriate areas in which to put the needle) when you give fluids to help ensure minimal development of scar tissue.

17. Weigh Your Cat Regularly - Often kidney patients are lighter in weight, due to appetite problems or their size in the first place. Weigh them regularly and keep track of it. Unfortunately once cats get in their teens, they normally seem to lose about a pound per year. Keeping a close eye on your cat's weight can help you and your vet better manage it. Talk to your vet about any differences in weight that you notice. Make sure that your cat is weighed everytime he goes to the vet. Get a baby scale so you can accurately weigh your cat at home. And if your cat is losing weight, don't just assume it's because of his kidney disease. It could be completely unrelated. Weight is very important to watch in a cat. If a cat loses more than one pound a month, he can get an excessive accumulation of fat within the liver (Lipidosis), which can be fatal. This is one reason why you should never put your cat on a diet without your vet's consent and without proper weight monitoring.
18. Vitamins And Supplements - A low, protein prescription diet food typically contains and the vitamins your cat needs.  Be very cautious of giving your cats any vitamin supplements since vitamin and mineral metabolism is disrupted when there is kidney disease.  Always talk with your vet about specifics on the particular supplement before giving any supplemental vitamins or minerals. Even multi-vitamin supplements may do harm since they may contain things like magnesium or phosphorus.  Remember that it's the kidney's job to filter out things that are in excess and we must be careful to not create more work for them (although our intentions may be good).

D I S C L A I M E R: This information is offered for informational purposes only. No information or materials posted herein are intended to constitute medical advice. Materials in this WEB site were not developed by a licensed medical professional. This site is not intended to be either: medical advice, medical opinion or a substitute for obtaining professional medical advice from a licensed veterinarian. This site assumes no responsibility for the accuracy of materials found in other WEB sites referenced herein. This site assumes no liability for the use or interpretation of information contained herein.

Copyright © 1999-2002 S.M. Kieta