Pouncerstone

Feline Kidney Disease

When one is first told that their cat has kidney disease or may be in renal failure, it may be frightening and saddening. If you're visiting our site because your cat has kidney problems, there may be a lot you and your veterinarian can do together to manage it, so plan on putting in a lot of effort to understand and get involved in your cat's treatment plan.

And put on your positive hat in case you're not wearing it yet! Depending upon individual case circumstances, your cat may have many years with you still. And remember that cats are very sensitive and can pick up on your feelings. If you treat your cat like someone who is dying, he may well sense that and that can impact how they feel and fight the situation.

In conjunction with helping your cat fight his kidney problems, it's important to keep in mind that our 4-pawed pals count on us to make health care decisions for them. We have to learn to be very observant in order to get them the treatment they need, when they need it. Get in the habit of keeping a log to record how your cat's doing, write down any new symptoms, his weight, etc. Work on developing sensitivity to take notice of your cat's behavior and appearance - suttle and gradual differences in your cat's coat or weight, for example, may indicate something is wrong. If you find your cat is unable to urinate, just sits or lies in the litter pan, is dragging his hind legs, is vomiting frequently or cannot hold down food or water, he or she may need immediate medical attention, since you may be dealing with a life-threatening, emergency situation. Do not waste time.

Be Forewarned

Anyone can write content and put it out on a web site. We found a lot of very negative, inaccurate and incomplete information on the Web when we first found out Pouncer had kidney problems. I figured he was going to die because most everything on the web pointed to a negative direction. Fortunately, the hospital that diagnosed him properly had doctors that like to use the word manage. "Manage the condition" is what they kept telling us. We caught on and followed their lead and started acting accordingly. We bought some veterinary textbooks on the topic so we could understand things better and ask informed questions. We armed ourselves with medical dictionaries to help us understand what we read. We have had regular D.V.M.s and a specialist that are well educated on the subject and that focus on treatment. We appreciate that in a way that words cannot express. So to give back and help others, we built the Pouncerstone web site.

On the Web, you will find a lot of sites that only reference kidney (renal) "failure". Some of these sites were built because they are dedicated to pets who have had CRF. Some of them are very good and present a lot of valuable information. But, keep in mind that there is a difference between kidney failure and kidney disease. A vet should know the difference, but from what we've heard from many who have contacted us, this is often not the case. If your vet doesn't know the difference or cannot explain it to you, frankly, you are probably not seeing someone who will be of much help to your cat. Find a vet that is educated and experienced on the topic, someone who has successfully managed a number of kidney cases. This is the type of doctor you want diagnosing and developing a treatment plan for your cat. Ask a lot of questions.

From our own experience, we learned that if a vet has little experience with treating and managing kidney disease, he or she may be too quick to suggest that your pet should be put to sleep. We quickly got our pets to a better health care facility for which we will eternally be grateful for the care they show for and provide to their patients. And a special thanks to two of our former vets (Drs. T and J) who have relocated and our current vet, Dr. B. All are truly doctors that work to save lives and who taught this human a lot about kidney disease and proper cat care.

So be prepared to spend some time getting educated properly and to be involved in managing your cat's kidney disease or kidney failure, whichever the case may be. Kidney disease may or may not progress to kidney failure. Read some books. Read about human kidney disease on human health web sites that are put together by those with medical expertise. Read information about feline kidney disease and failure on web sites put together by Colleges of Veterinary Medicine, for example. Go out and find your own credible sources on these subjects so you are in the best position possible to help your cat. Get busy! You'll feel better doing something and getting more involved.

Pouncer was our first cat to be diagnosed with chronic kidney disease.  His human quickly realized she needed to understand the role the kidney plays, if she wanted to be as helpful as possible. This understanding helps one feel more comfortable about the situation and responsibility of taking care of the cat. It helps you learn what questions to ask your vet. The more knowledgeable and comfortable you are with the topic, the more you will be able to help your cat and the better judge you will be regarding whether or not your cat is getting the proper attention from your vet. This is your responsibility, and an important one. No one else can do it for you. When we receive e-mails from people asking us to tell them what questions to ask their vet, we know they are missing the points we're trying to make here.

Below we share the background of both Pouncer and Miss Taffy's experience with the disease, information on their treatment plans and how they are doing presently. Basic information on kidney disease is addressed. We hope you find this information to be helpful. Please keep that in mind that each cat's particular case and circumstances differ. We are not suggesting that our cats' treatment plans should be your cat's treatment plan. We present this information in an effort to be informative.

Never attempt to make changes to your cat's treatment plan on your own. Changes to treatment plans should only be made under the direction and guidance of a licensed veterinarian. But, you should never hesitate to ask your doctor a lot of questions and bring up other ideas that you've read about. Asking questions, reading and researching are important means of learning and understanding what is going on with your cat. We are grateful to our Dr. B for always answering all of this human's many questions and for making what some call "going the extra mile" her standard approach to patient care.

Pouncer's Experience With Kidney Disease

We came home from the hospital, armed with Lactated Ringers, I.V. Administration Sets to be used for subcutaneous fluids, prescription cat food so he could start a low-protein diet and medication.  After Pouncer's release from the hospital, it took 3-4 weeks for him to resemble his old self again.  During that time we often wondered if we'd see the old Pouncer again.  He did not want to eat and preferred to be alone most of the time.  He chose the enclosed back porch as his new room where he could have solitude. A bed was made for Pouncer in the garden window.  Footstools were put out there so he would only have to do gradual jumps to get to his bed in the window.  It was weeks before Pouncer could jump as high as he did previously.  Food, water and a litter pan were also moved out there so he would not have to walk far. And a heater on those cooler September nights.

Here we see Pouncer in his garden window bed. Pouncer regained his strength very slowly after coming home from the hospital.  It was weeks before he wanted to be around anyone - human or cat.  His stomach grumbled constantly from irritation of the stomach lining due to waste products.  He did not groom himself during that time, so his human did his grooming. After about two months, Pouncer's activity level was happily close to normal again.

Initial Treatment Plan - Pouncer's treatment plan in 1996 was established by an internist who specializes in nephrology. Some of the medications he was on initially were Cimetidine (Tagamet), a histamine blocker, and Amoxicillin, an antibiotic. Additionally I gave him Lactated Ringers Solution twice a day. A few weeks after he was initially diagnosed, follow-up blood work indicated he was anemic, so we gave him Epogen injections three times a week. His initial blood work didn't indicate a low hematocrit value and my understanding is that sometimes dehydration can mask the anemia.  This emphasizes the importance of follow-up blood work.

Pouncer was also put on Enacard, an ACE inhibitor.  ACE inhibitors differ from drugs such as Norvasc, which is a calcium channel blocker.  The purpose of Pouncer's taking Enacard is two-fold:   1) Pouncer also has glomerulopathy and the internist who developed his treatment plan believes Enacard may help with the glomerulopathy if administered over the long-term.   2) Cats may have intra-renal hypertension, which is different from systematic hypertension.  Intra-renal hypertension is hypertension within the kidney, which can be harmful. Unlike systematic high blood pressure, intra-renal hypertension cannot be measured.  Thus, if Pouncer has intra-renal hypertension, the Enacard may be helping  in that respect also.  Pouncer does not have systematic high blood pressure.

There's also a great deal of published information on how ACE inhibitors may play a role in slowing the progression of chronic kidney disease in humans. As cats' bodies and their kidneys are very similar, this is another reason why we want Pouncer to stay on the Enacard.

After about three months of treatment, Pouncer's BUN was down to 25 and his creatinine was 1.3, with 30 and 1.6 being the high end of the normal ranges, respectively.  Pouncer continued on the special diet, daily fluids and his medications for approximately 18 months when it was decided that we could try to wean him off most aspects of his treatment plan.  This was successfully done over the course of a few months.

Most Recent Treatment Plan - Pouncer's most recent treatment plan consists of the low-protein prescription diet and Enacard for his glomerulopathy and possible intra-renal hypertension.  He also takes Derm Caps, a dietary supplement that contains fatty acids.   This dietary supplement serves two purposes for Pouncer:   1) He recently developed allergies and Omega fatty acids may help relieve some of the itching.   2) Some research indicates Omega 3 fatty acids may slow the progression of kidney disease.  Studies in this area are new and minimal - let's just say that all the votes aren't in yet on their effectiveness with respect to kidney disease. Another thing we like about the Derm Caps is the marked improvements we see in a cat's coat after he's been taking Derm Caps daily for about a month. This has been our experience with Pouncer, Spice and Lucky as all their coats became softer and shinier.

Pouncer's doctor likes to see him for blood work to recheck the kidneys every three months and she also likes a urine sample brought in every 3-6 months. This is another tool to see how the kidneys are doing as the concentration level of the urine tells us a bit about the kidney function. The only thing unusual finding in Pouncer's urinalysis is periodic detection of traces of blood. Blood in the urine can be due to many reasons, one of them being glomerulopathy and a little blood leaking from the kidneys.  When blood is found in his urine, we try some antibiotics since we are uncertain of the exact cause.  Overall, Pouncer seems as healthy as a little pony and he dedicates a lot of time to grooming "his girls" and attending Pouncerstone staff meetings. His story and strength is the inspiration behind the founding of this web site. It's felt that Pouncer's kidney disease will not progress.

Pouncer's July, 2002 bloodwork showed his BUN level at 28, Creatinine at 1.4, Potassium at 4.3 and Hematocrit at 33. These were excellent numbers for a cat whose 1996 kidney biopsy results indicated he could have been bordering on end-stage renal failure. His urine was very concentrated showing the kidneys were doing a good job. Pouncer's case was proof that there may be hope for many other cats.

Around the beginning of November, 2002, Pouncer began showing symptoms that were identified to be associated with his breathing. Extensive testing, with the help of a Respiratory Specialist and Pouncer's regular doctor, indicated Pouncer had lung cancer, probably one of two types of lung cancer that are rarely seen. Although there was no known treatment for either of these two types of lung cancer, an oncologist recommended that we try a particular type of chemotherapy drug one time and most unfortunately the chemo treatment failed. It seems Pouncer's case was very advanced. Sadly, we had to let Pouncer go at the end of November, 2002 since by that time he could not breathe on his own without being in an oxygenated incubator at the hospital. We will always miss him and love him very much.

Taffy's Experience With Kidney Disease

Taffy's new doctor found this little patient to be in pretty good health for a 16-year old.  She remarked that Taffy looked more like a 7-year old.  Doctor found Taffy to have a very slight heart murmur which has required no treatment.  The main problem Taffy was having was vomiting a bit, with this occurring 2-3 times a week.  She was not vomiting food and this was happening mostly during the night when her stomach was emptier.   We started her on Pepsid AC and increased the frequency of giving Taffy hairball remedy, since hairballs were always a problem for her.  Both seem to be very helpful with reducing vomiting in Taffy's case. Her vomiting has reduced to only once or twice a month.

Initial Treatment Plan - Taffy was borderline with respect to needing subcutanous fluids at the time of diagnosis as she was not dehydrated. She was already on the special low-protein diet. Her blood pressure was normal. Taffy's potassium level later got towards the low-end of the normal range so she started on Tumil-K tablets. Tumil-K is Potassium Gluconate. Potassium Gluconate may be purchased as an over-the-counter mineral supplement from PlanetRx or most other drug stores. Our veterinarian recently gave us the okay to switch to the over-the-counter version. Do talk with your cat's doctor BEFORE doing this so you can ensure that you are providing the equivalent dosage if buying the over-the-counter mineral supplement, since too much potassium can be dangerous (and the amount of mgs. provided vary between the two pills). We find the cost of 595 mg. tablets of Potassium Gluconate, in a quantity of 100, to be about $3.00.

Taffy's subsequent blood work indicated her calcium was above the high end of the normal range. Initially it was 11.8 when first found to be above normal. Her ionized calcium level was checked and this was found to be above normal. (This has to be checked initially as it is the true indicator of calcium being above normal.) Taffy's doctor says that when the calcium level in the blood gets in the 14s it is in the danger zone, as calcium can build up in the kidneys and the cat can go into renal failure. We treated this at home by switching Taffy to Saline Solution from Lactated Ringers Solution (subcutaneously) and doing fluids daily. In a week her calcium level was down to 9.8, back in the normal range. Since then it's been down and up a bit, most recently at 10.9. We're satisfied with this number and so Taffy continues on the Saline Solution every other day, 100 mls., subcutaneously.

High calcium in the blood may be a sign of some types of cancer, parathyroid disease or later-stage kidney disease. A special parathyroid panel can be done at Michigan State University by your vet taking a sample locally and getting the blood up there very promptly (while the sample is at the right temperature). This panel is much more detailed than what can be done by most hospitals. This was done for Taffy and the findings showed no indication of thyroid disease. Thus, her high calcium level is not due to a thyroid disorder. Her kidneys aren't that bad to justify the higher calcium levels. X-rays rule out some obvious cancers, but x-rays can't detect all. We're not sure what exactly is causing it; it may just be a senior health care issue. But Taffy seems to feel pretty good and keeps a busy schedule. Her present treatment plan is comprised of Pepsid AC, Potassium Gluconate, Saline Solution fluids given subcutaneously and the low-protein, prescription diet. She also started taking Norvasc in early 2001, when a routine blood pressure check indicated she had developed high blood pressure. We have found Norvasc to be most effective in the treatment of high blood pressure.

Taffy's urine has been very dilute for some time, but this comes as no surprise. She probably urinates about 4 times daily. But she seems to do very well outwardly. We think the subcutaneous fluids help her feel perky. She weighs in a at about 6 lbs., 2 oz. Her June, 2001 BUN and creatinine were 40 and 2.7, respectively, with 36 and 2.4 being the high end of the normal ranges per the lab that analyzed the blood. With the help of the fluids, her values hover not too far from high end of the normal range. It would have been a very poor choice for us to have put her to sleep in 1996 without even trying any treatment. Acheiving results can take time and adjustments sometimes need to be made in the treatment plans, but the results are rather positive and obvious with Taffy. It's certainly well worth the extra two hours per week or so that it takes to give her medications and do her fluids to see this little bundle of unconditional love still steamrolling around.

Taffy Update - Taffy started taking Anipryl in April, 2000 since symptoms she was showing (and after having ruled out other medical bases for them), were indicative of old-age cognitive disorder. Her symptoms were excessive calling, screaming when she goes off alone by herself and getting lost in corners. We found medical basis indicating she's in any physical pain, so we decided to try Anipryl. We saw very good improvement with this drug and later started using the recently-available generic equivalent (Selegeline). The results we saw with this drug seemed to "plateau out" after about a year, which sometimes happens in these cases. But, Taffy would still be up, dressed and out on the enclosed porch by 6:30 A.M. and still thought she should be staying out there till 2 in the morning (always the rebel).

Taffy's main challenge during the past few years was her deteriorating vision, in the one eye that she still had. During the spring of 2002, life was getting more difficult for Taffy in terms of getting around the house comfortably without walking head on into things. Due to concerns about her comfort and not wanting her to injure herself accidentally, we decided to let Taffy go in the spring of 2002. Take heart, we feel Taffy is in a safe place now and had a very complete life. And she's with her best catfriend, Boone, now. Taffy's kidneys were still doing well as her life came to a close. If it weren't for Taffy's vision problems, I'm sure she'd still be with us.

We provide the above information to share Pouncer and Taffy's historical treatment plans and how they've progressed over time. Do not interpret this information as what may be helpful for your cat. Drugs that were used several years ago may not necessarily be appropriate or be the drugs of choice now.

NEVER give your pet any over-the-counter or prescription drug unless it has been prescribed by your veterinarian.

If you have questions on the information provided or something you'd like to share, please send us an e-mail. But, if you are in need of advice on your cat's health or treatment plan, you need to be consulting with a licensed veterinary medical professional and again, that is not us. Pouncerstone does not provide such services and we cannot provide any opinions on your cat's situation. E-mail requests of this nature only waste valuable time that your pet may not have to spare. We review mail once each week.

petmail@POUNCERSTONE.COM

If you are looking for someone with whom you or your vet can consult, you may want to consider Cornell University's Feline Consultation Services. We have consulted with them on more than one situation where we wanted additional advice and input. Our vet's attitude is: "You can never talk to too many people." You or your vet can talk with Cornell. We have links to their web site on our Education And Resources and our Other Pet Sites pages.

Copyright © 1999 - 2005 S.M. Kieta