Early Stage Kidney Failure in Cat

[hazelrunpack]

How long does it take to reverse the lipidosis? I'm assuming that as it subsides her appetite may improve?

She's such a good girl, letting her mom force feed her

[growler~GateKeeper]

The lipidosis will start to subside once she gets her enough food in her to stop relying on the liver for nutrients, that will happen faster once her appetite is back a bit, and her appetite will come back when the lipidosis has started to subside There's no real set timeline it all depends on how well her body responds to the frequent caloric intake

Once she gets consistant meals in her she feels better, so the next meal time she's feeling a bit hungry that's what I want & once she starts gaining a bit more weight back the lipidosis will disappear

It's lucky it's only mild at this point & I can turn it around before it gets to a point that would require more drastic approaches.

[hazelrunpack]

Well then, Ms Duffy, you keep being an and taking your meals for the day!

For once your vacation was well-timed by your boss. There are s looking out for you and Duffy!

[growler~GateKeeper]

It certainly is well timed right now.

The homeopath said today that the cancer remedies should help with her nausea/lack of appetite too The first remedy started today has listed that it also helps w/"gradual loss of weight from impaired nutrition"

[chico2]

Wow Duffy,what a wonderful very special kitty you are

[diandpat]

it is lucky you are home for a bit to get her back on track. Hope the cancer meds kick in quickly and wish you both all the best in the coming months!!!

[growler~GateKeeper]

Thanks Chico & diandpat

[growler~GateKeeper]

As an update to this thread on Duffy's fight with CRF & Lymphoma - Duffy was back in on the 10th April for a urine sample which did show the UTI had returned. The vet, homeopath and I decided to go with antibiotics again to fight the UTI and help with the sepsis (overall infection) she was fighting due to the lymphoma. The vet was still concerned about the chance of the UTI progressing upwards from the bladder into the kidneys as pyelonephritis, this time we went with ClavaSeptin the vet formula of Clavamox in pill form.

Duffy had a good couple of weeks on a combination of antibiotics and homeopathic remedies, still being force fed but otherwise doing well, until this past week where she got weaker and the tumor was visibly larger, as it metastasized in her colon, into her spleen and through her lymph nodes.

I brought Duffy in to the clinic on the 21st April to check her blood electrolyte levels as she had become much weaker especially in her back legs, her leg sliding out from under her while walking across the floor & on carpets when sitting and was starting to walk with a very very slight plantigrade posture (where the animal walks on the entire hocks not just the feet). Plantigrade posture is often seen as a symptom of muscle weakness, potassium deficiency, diabetes among other causes. I decided to run a full blood panel not just electrolytes, with the results due the following day. Her weight showed an increase to 4.8kg from 4.6kg a week & a half earlier, however it was evident this was due to the increase in tumor size, not from eating.

That afternoon & night Duffy was given pain remedies to cope with the pain/discomfort she was experiencing especially when being picked up or moved, she did perk up a bit as the remedy worked though she was still very tired and I was seeing signs that she was ready to go.

I made the decision early in the morning of 22nd April that it was time to let her go, she was ready & I accepted that it was what she needed. I called the homeopath on her cell phone a couple of hours before the clinic opened for advice on dosing for pain at that point as Duffy seemed a bit worse, and told her that it was time. I got a call from the clinic as soon as they opened and we discussed my decision and how I wanted things and a time that was suitable. Duffy had a nice afternoon snoozing in the sunshine and was peacefully let go at home. Duffy ~ 9 May 1991 - 22 April 2010



**I would like to point out that CRF and Lymphoma are not directed related, so if your cat has CRF they are not necessarily/automatically going to get cancer.**

Anyone who has questions or experiences they wish to share on Chronic Renal Failure in cats please do post them, I would like this thread to continue to help others who are dealing with this condition.

[Love4himies]

Growler, you have been in my thoughts since I heard about sweet Duffy. She couldn't have a better mom and without you, her life would have been years shorter.

Duffy

[MissPurryJess]

I just saw this - I know I'm not a regular on here, but you've been so sweet and helpful to me in the past, and I always remembered Duffy. I'm so so sorry to hear about Duffy. My babies and I are sending you our love.

[dogmelissa]

Originally Posted by growler

Canned:

Kidney cats do not require low protein, but high quality protein low phos food. Removing too much protein from the cats diet makes it less palatable therefore they often refuse to eat, plus cats are carnivores they need meat protein to keep their bodies functions to the fullest.

Fish should be avoided when possible especially tuna, but fed on occasion 1-2 per month is still okay. Cats often become addicted to fish and will eat nothing else and tuna especially creates an imbalance in vit e levels.


When looking at phos levels you want to convert to dry matter (meaning whats left if you remove all water) and find something as close to or lower than 1% phos dry matter.

One of my kitties was just diagnosed with renal failure last week. She also had a UTI, potential kidney infection, so I am hesitant to assume this is chronic but I'm also operating under the assumption that it is due to her age. Today she went to the vet for antibiotics (they did a culture to find out what would kill her infection,), subQ fluids and for me to get advice on hat to fee her. The vet *said* igh protein food but then handed me reduced protein food, so I'm a bit confused there. So that's my first question - her current/previous food was Horizon Legacy (dry) with 40% protein (good quality). Is this too high/low?
I understand about phosphorus and I have emailed the manufacturer to ask about it - no reply yet. However when I was out today buying food, before I realized the vet had said one thing but given me the opposite, I picked up some Go! Natural food with higher protein - I remembered about phosphorus and I am happy to report that the phosphorus levels are listed on the Go! Natural's bags. I got the fish formula - 50% protein & I think 1.2% phosphorus; its not on the website and I can't get to it right now. Assuming this is an 'as-fed' number, it will work out to less than 1% by dry matter, so is this good? I know you say fish is bad but I don't really understand why, and when we're talking about commercial food, how can that create any imbalances? At this point, I just need her to eat and know she likes fish food so that's what I got. Continuing with my thought above, is the protein level critical or is it just phosphorus? Is it better to have higher protein if the phosphorus is low? Or does it matter? I also got some Innova Evo - I don't know the phosphorus level but it is high protein (fish) too.
I also know that wet food is best, and this is where things get messy. All 3 of my girls eat from the same bowl, inside a modified dog kennel, to keep the boys out. There is no way that I can give one of them different food an I'm stubborn about it being dry food. Sierra (the crf kitty) gets 'supper' of soaked kibble with canned added so its not a problem to increase her water intake that way. So, is it ok for me to do this, in terms of water intake for her? I just can't do canned food for all of them and there is no way to only give it to her.

Any help/suggestions and/or answers to my questions is much appreciated.
Thanks in advance,
Melissa

[sugarcatmom]

I'll leave most of your questions for growler to answer, but wanted to mention a couple things.

Originally Posted by dogmelissa

I know you say fish is bad but I don't really understand why,

Here is some info on that: http://www.littlebigcat.com/index.ph...ngerousforcats

Originally Posted by dogmelissa

I also got some Innova Evo - I don't know the phosphorus level but it is high protein (fish) too.

Stay away from the Evo. It's extremely high in phosphorus (396 mg per 100 kcal - you want to stay below 200-240 mg/100kcal, which is roughly 1% DM). http://binkyspage.tripod.com/dryfood.html The problem is, most of the high quality, grain-free kibbles are high in phosphorus. It's the nature of the beast.

Originally Posted by dogmelissa

There is no way that I can give one of them different food an I'm stubborn about it being dry food.

Remind me why that is again.

Originally Posted by dogmelissa

Sierra (the crf kitty) gets 'supper' of soaked kibble with canned added so its not a problem to increase her water intake that way. So, is it ok for me to do this, in terms of water intake for her?

It's not ok if this mixture sits out for more than 20 mins. There's a ton of bacteria in kibble that multiplies like crazy in a moist environment, as well as potential for mold toxins to become an issue.

[growler~GateKeeper]

Originally Posted by dogmelissa

One of my kitties was just diagnosed with renal failure last week. She also had a UTI, potential kidney infection, so I am hesitant to assume this is chronic but I'm also operating under the assumption that it is due to her age. Today she went to the vet for antibiotics (they did a culture to find out what would kill her infection,), subQ fluids and for me to get advice on hat to fee her.

Do you have a copy of the BUN, creatinine, phosphorus, calcuim, & USG plus anything else out of normal range from her test results?

Sierra will need to have her urine cultured again a few days prior to finishing the antibiotics and again 2 weeks after finishing. UTI can be hard to erradicate especially in CRF kitties. It may take a longer course of treatment than the standard 2 weeks, sometimes between 6-8 weeks.

A ultrasound is pretty much the only way to definately rule out a kidney infection, and if there is already renal failure noted I would recommend having one done. The UTI can travel fairly quickly up from the bladder into the kidneys & from there it is much harder to erradicate.

An ultrasound will also give your vet a clear "map" of the kidneys size & condition that will be good to refer to with any subsequent ultrasounds.

I am hesitant to assume this is chronic but I'm also operating under the assumption that it is due to her age.

Kidney failure is either acute or chronic.
- Acute renal failure (ARF) happens suddenly, severely with the cat crashing in need of several days of IV hospitalization & is most often due to antifreeze poisoning etc. Usually it is seen in young pets & if treated early & aggressively the pet may make a near-complete recovery with a higher incident of kidney related issues later in life.
- Chronic renal failure (CRF) is a gradual progressive deterioration of the kidneys that is terminal & happens with about 10% of cats over the age of 10. Most cats develop CRF as a result of aging, though some young cats may have a genetic predisposition or as a result of severe infection.

If the reason for the kidney failure is age it's chronic.

Originally Posted by dogmelissa

The vet *said* igh protein food but then handed me reduced protein food, so I'm a bit confused there. So that's my first question - her current/previous food was Horizon Legacy (dry) with 40% protein (good quality). Is this too high/low? I understand about phosphorus and I have emailed the manufacturer to ask about it - no reply yet.

I'm more concerned with the phosphorus content of the food, please post the value when they respond.

Protein should be of high quality actual muscle meat (chicken, turkey etc not chicken by product etc) so Horizon is good in that aspect & the protein level looks alright but the % phos still needs to be considered.

It is not recommended to restrict protein below 400 kcal http://www.vin.com/VINDBPub/SearchPB...00/PR00124.htm

Originally Posted by dogmelissa

However when I was out today buying food, before I realized the vet had said one thing but given me the opposite, I picked up some Go! Natural food with higher protein - I remembered about phosphorus and I am happy to report that the phosphorus levels are listed on the Go! Natural's bags. I got the fish formula - 50% protein & I think 1.2% phosphorus; its not on the website and I can't get to it right now. Assuming this is an 'as-fed' number, it will work out to less than 1% by dry matter, so is this good?

If 1.2% is as fed phos it works out to 1.3% dry matter that is too high.

100-moisture = dry matter; phos/dry matter * 100 = dry matter phosphorus

Go! Natural Trout Dry:
100-10 moisture (per website) = 90 dry matter; 1.2phos (per your bag)/90 = 0.013*100 = 1.33% dry matter phosphorus - too high

Originally Posted by dogmelissa

I know you say fish is bad but I don't really understand why, and when we're talking about commercial food, how can that create any imbalances? At this point, I just need her to eat and know she likes fish food so that's what I got.

As covered by scm

You may get to a point that you need to change foods to find one w/less phos than fish based, it is better to try to switch her to a non-fish food now rather than when she isn't feeling well. But yes she needs to eat in good healthy quantity, at some point it may come down to feeding whatever she will eat regardless of phos/protein level, just so she does.

Originally Posted by dogmelissa

Continuing with my thought above, is the protein level critical or is it just phosphorus? Is it better to have higher protein if the phosphorus is low? Or does it matter? I also got some Innova Evo - I don't know the phosphorus level but it is high protein (fish) too.

Phosphorus level is critical, protein less so as long as it is not restricted too low and it is quality protein.

Cat with protein levels restricted too far may start losing muscle mass & become weak, plus alot of the low protein foods aren't flavourful enough to be appetizing to many cats. If you offer a renal diet low in protein & phosphorus but the cat refuses to eat it - it does no good to the cat that won't eat it.

Originally Posted by dogmelissa

Sierra (the crf kitty) gets 'supper' of soaked kibble with canned added so its not a problem to increase her water intake that way. So, is it ok for me to do this, in terms of water intake for her? I just can't do canned food for all of them and there is no way to only give it to her.

If you are already giving her canned in her supper, why not increase the canned amount add some extra water & remove the dry from that meal? That way she is atleast getting 1 meal of just canned.

The problem with adding water or canned to dry is it needs to be consumed in a short amount of time, not snacked upon for more than 20-30 mins as scm mentions.

[dogmelissa]

Originally Posted by sugarcatmom

Here is some info on that: http://www.littlebigcat.com/index.ph...ngerousforcats

Thank you for that info. I still think it's a bit of a 'shock' opinion - especially the stuff about farmed salmon being fed colouring. And since none of my cats eat straight tuna (except as a very very rare treat), and especially with Sierra being sick, her being 'addicted' to food is a good thing and I'd take it if I could get it.

Originally Posted by sugarcatmom

Stay away from the Evo. It's extremely high in phosphorus (396 mg per 100 kcal - you want to stay below 200-240 mg/100kcal, which is roughly 1% DM). http://binkyspage.tripod.com/dryfood.html The problem is, most of the high quality, grain-free kibbles are high in phosphorus. It's the nature of the beast.

Good to know. I haven't opened the Evo, so I can take it back. She has basically been refusing all dry food for the most part so even the Go! Natural isn't going over that well. However, I've opened that one (obviously) so I have to finish it. I could give it to the others, I suppose. Not sure yet.

Originally Posted by sugarcatmom

Remind me why that is again.

To make a long story short, one of the girls refuses to eat canned food, all of them are nibblers, so the food sits out and canned food dries up (then they don't eat it at all and it gets thrown out), and I have a really hard time justifying spending $1.75 per tuna-sized-can of cat food; my tap water is much cheaper than the water in the canned cat food. Plus it's impossible to put canned food in the auto-feeder which is a requirement for a happy life with Taz.

Originally Posted by sugarcatmom

It's not ok if this mixture sits out for more than 20 mins. There's a ton of bacteria in kibble that multiplies like crazy in a moist environment, as well as potential for mold toxins to become an issue.

When Sierra was feeling well, she would finish her soaked kibble meal within 2-3 minutes of it being made so it wasn't an issue. Now is a whole different story and I'm not even offering her soaked kibble right now.

Will reply to Growler's post right away.
Melissa

[dogmelissa]

Originally Posted by growler

Do you have a copy of the BUN, creatinine, phosphorus, calcuim, & USG plus anything else out of normal range from her test results?

Sierra will need to have her urine cultured again a few days prior to finishing the antibiotics and again 2 weeks after finishing. UTI can be hard to erradicate especially in CRF kitties. It may take a longer course of treatment than the standard 2 weeks, sometimes between 6-8 weeks.

A ultrasound is pretty much the only way to definately rule out a kidney infection, and if there is already renal failure noted I would recommend having one done. The UTI can travel fairly quickly up from the bladder into the kidneys & from there it is much harder to erradicate.

An ultrasound will also give your vet a clear "map" of the kidneys size & condition that will be good to refer to with any subsequent ultrasounds.

I don't have a copy of her numbers, but I could ask for them today as we are going back to the vet. The vet called to check on her and I asked her if I need to get a repeat urinalysis done or something and she referred to herself as 'bad vet!' and then told me that she will do a 2nd injection of the antibiotics 2 weeks from the first and then a repeat culture one week after that. She didn't mention an ultrasound; I'm not going to ask because I don't want to offer them any more reasons to take my money but if there's still signs of infection next week then I'll consider it.

Originally Posted by growler

Kidney failure is either acute or chronic.
- Acute renal failure (ARF) happens suddenly, severely with the cat crashing in need of several days of IV hospitalization & is most often due to antifreeze poisoning etc. Usually it is seen in young pets & if treated early & aggressively the pet may make a near-complete recovery with a higher incident of kidney related issues later in life.
- Chronic renal failure (CRF) is a gradual progressive deterioration of the kidneys that is terminal & happens with about 10% of cats over the age of 10. Most cats develop CRF as a result of aging, though some young cats may have a genetic predisposition or as a result of severe infection.

If the reason for the kidney failure is age it's chronic.

Thank you for that explanation that makes a lot of sense. I'm not sure if the *reason* for the failure is age, but it doesn't really matter the cause, we're definitely looking at CRF.

Originally Posted by growler

I'm more concerned with the phosphorus content of the food, please post the value when they respond.

Protein should be of high quality actual muscle meat (chicken, turkey etc not chicken by product etc) so Horizon is good in that aspect & the protein level looks alright but the % phos still needs to be considered

It is not recommended to restrict protein below 400 kcal http://www.vin.com/VINDBPub/SearchPB...00/PR00124.htm.

I haven't heard from them, they have a local (to me) phone number so I'm going to try to find time to call this week.

Originally Posted by growler

If 1.2% is as fed phos it works out to 1.3% dry matter that is too high.

100-moisture = dry matter; phos/dry matter * 100 = dry matter phosphorus

Go! Natural Trout Dry:
100-10 moisture (per website) = 90 dry matter; 1.2phos (per your bag)/90 = 0.013*100 = 1.33% dry matter phosphorus - too high

At this point I'm not going to stress about 0.3% too much of anything. If we were looking at 1% or 5% then yeah that's a concern but right now I'm just concentrating on getting her to eat, and she's really not that interested in doing too much of that regardless of what I put in front of her.

Originally Posted by growler

You may get to a point that you need to change foods to find one w/less phos than fish based, it is better to try to switch her to a non-fish food now rather than when she isn't feeling well. But yes she needs to eat in good healthy quantity, at some point it may come down to feeding whatever she will eat regardless of phos/protein level, just so she does.

Phosphorus level is critical, protein less so as long as it is not restricted too low and it is quality protein.

Cat with protein levels restricted too far may start losing muscle mass & become weak, plus alot of the low protein foods aren't flavourful enough to be appetizing to many cats. If you offer a renal diet low in protein & phosphorus but the cat refuses to eat it - it does no good to the cat that won't eat it.

We're already dealing with her not feeling well plus having lost muscle mass. She's incredibly thin, like to the point where I can feel every vertebra in her spine and she can barely jump up on the couch on her own; she used to run laps through the house and bounce all the way to the top of the cat tree (7' above the floor). She's not feeling well, and incredibly skinny. Now is not the time to be messing with her food, IMO. The good news is that I bought a few varieties of canned food and she was fairly interested in the Wellness Chicken & Salmon variety - she ate more of that than any of the others I've offered, but still hardly any. She weighed 2.3kg when she got her antibiotic and the most food she's eaten in a day was less than half a can and a few kibbles. Smart girl though has fully refused to even consider any of the 'prescription' vet foods.

Originally Posted by growler

If you are already giving her canned in her supper, why not increase the canned amount add some extra water & remove the dry from that meal? That way she is atleast getting 1 meal of just canned.

The problem with adding water or canned to dry is it needs to be consumed in a short amount of time, not snacked upon for more than 20-30 mins as scm mentions.

Again, right now the concern is just getting her to eat. Up until she got really sick, her 'supper' was really just a snack and did have more canned & water than kibble anyways. And as I mentioned in response to scm, she would eat it all within a few minutes so the time factor wasn't an issue. Now just getting her to eat anything is a small miracle.

And on that note, since she refused her breakfast this morning, I'm going to go offer it to her again. She goes to the vet for a re-injection of antibiotics at 3:20pm today and I think she's also going to come home with instructions for me to give her sub-Q fluids which I'm not excited about. I know how to do it because I worked at the local Humane Society for 3 years, but I've never done it to a cat in my care and I'm not looking forward to it - but I know it's probably necessary.

Thanks for everything so far.
Melissa

[growler~GateKeeper]

dogmelissa Not every UTI will turn into a kidney infection, but there is a higher potential for it to happen in a CRF kitty. Sierra's doesn't progress that far.

I would say at this point give her whatever she will eat, if she's feeling that poorly give her anything to get her tempted to eat. You could try a little parmesan cheese sprinkled on her food, or some treats like PureBites Freeze Dried Treats, or a tiny dab of melted butter, a teensy pinch of catnip, shredded bits of deli meat etc just enough of something to peak her interest.

You can always discuss Phosphorus binders with the vet if Sierra has high blood phosphorus levels & will not eat something with a lower phos range.

Force feeding might also be an avenue that might need to be looked at.

2.3kg? man that's tiny she sure doesn't have any room to loose. Can you put boxes/stools infront of the couch/bed/fave places to give her "steps" to get up to where she is comfortable? For Duffy I had a sturdy cardboard box & a rubbermaid tote beside the bed so she didn't have to jump up, just step up & then up to the bed.

Are you able to place a phone book or such of a similar thickness under the food/water dishes? I found that helped a lot in reducing nausea, also makes it easier on the neck reaching the bowl.

Sierrra is likely also feeling pretty low because of the infection for kicking that asap

It sounds like fluids would be very beneficial to start soon, the increased hydration makes them feel better, plus it flushes out more toxins from the body which will make them feel better as well. Giving sub q fluids to your own cat is honestly not as bad as it seems at first. Some good tips on it here: http://www.weirdstuffwemake.com/weir.../catjuice.html

[sugarcatmom]

Originally Posted by dogmelissa

I still think it's a bit of a 'shock' opinion - especially the stuff about farmed salmon being fed colouring.

Might want to research that a bit more before dismissing it:
http://www.nytimes.com/2003/05/28/di...less-rosy.html
http://www.seattlepi.com/opinion/123199_dye23.html
http://www.cbc.ca/news/story/2003/05...ng_030501.html
http://www.thefreelibrary.com/Salmon...rs.-a087749668

.....consumers learned about another difference, when the class-action lawsuit in Washington called attention to the little-known fact that farmed salmon are not naturally salmon pink or red, and that if they were not fed artificial colors they would range from gray or khaki to pale yellow or pale pink. Wild salmon turn pink from the krill and shrimp they eat. (Farmed salmon eat a fishmeal diet.) The lawsuit accused three supermarket chains of violating Food and Drug Administration regulations by not telling shoppers that farmed salmon were artificially colored, thus leading them to think they were buying wild fish. ....

Hoffmann-La Roche, one company that makes the dyes, canthaxanthin and the more expensive astaxanthin, from petrochemicals, offers salmon farmers the SalmoFan, a sort of paint wheel with assorted shades of pink, to help them create the color they think their customers want. ...

[OtisIsMyCat]

I am now joining this thread as the owner of a newly diagnosed CRF cat, one week ago today. My 11 year old Marshall.

I had this long, thoughtful post typed out but for some reason when I hit submit, it redirected me to the log in page again and I lost everything.

Anyway I will ask this one important question I did have in my reply and will type out the rest of my post later on today.

One quick question re: food.

I don't like how the Hill's K/D diet has fillers like glucose, corn gluten meal, corn syrup, pork by-products, etc.

I've been trying to find a good quality cat food that complements a cat in renal failure. I was previously feeding both my cats Evo Chickey & Turkey wet but see that it has too high of a phosphorus level for a cat in renal failure.

So... I have a quick question... how is 0.2% for a phosphorus level? Unfortunately the K/D wet is by far the lowest on all the lists but I don't like their overall ingredients. So I'm trying to find a safe alternative.

Also, is it true that it's actually the phosphorus that is damaging to CRF cats? And, not necessarily the protein itself?

THANKS!!

[sugarcatmom]

Originally Posted by OtisIsMyCat

I am now joining this thread as the owner of a newly diagnosed CRF cat, one week ago today. My 11 year old Marshall.

Sorry to hear about Marshall's diagnosis. Do you have a copy of his lab results (urine specific gravity, creatinine, BUN, phosphorus, calcium, etc?)

Originally Posted by OtisIsMyCat

So... I have a quick question... how is 0.2% for a phosphorus level?

Which food is it that has 0.20%? Are you referring to the Wysong Chicken Au Jus from this list?: http://webpages.charter.net/katkarma/canned.htm I think there's some question about the accuracy of that value, but the bigger issue is that the Wysong Au Jus foods aren't a complete diet. They need to be supplemented with extra nutrients if you plan to feed it regularly.

The general goal when feeding kidney cats is to look for foods with 1% phosphorus or less (or roughly less than 200mg/100Kcal, as indicated on this chart: http://binkyspage.tripod.com/CanFoodNew.html) Keep in mind that phosphorus is an essential nutrient and cats, even those with compromised kidneys, still need SOME. Just not too much.

Originally Posted by OtisIsMyCat

Unfortunately the K/D wet is by far the lowest on all the lists but I don't like their overall ingredients. So I'm trying to find a safe alternative.

There is no good reason to feed K/D, and many reasons not to. Good to hear that you're looking form something better .

Originally Posted by OtisIsMyCat

Also, is it true that it's actually the phosphorus that is damaging to CRF cats? And, not necessarily the protein itself?

Cats NEED protein. If they don't get enough, they start to use their own muscles for a protein source, which is one reason you see so much muscle wasting in kidney cats. Unfortunately there was some lame study done on rats around 50 yrs ago where rats with renal failure did better on a reduced protein diet, and it's been held up as the standard to follow for dogs and cats ever since. HELLO???? Cats are not rats. This myth needs to be put to rest. But Hill's and their cohorts make too much money selling their "prescription" diets, and so it goes......

Depending on what Marshall's lab results are, you would probably be fine with feeding a good quality wet food like Wellness Chicken or Turkey, or Innova Evo 95% Venison or Beef.

[OtisIsMyCat]

Thanks sugarcatmom!

Here's what I know of Marshall's initial diagnosis. I only obtained his BUN and creatinine. That first 48 hours were such a blur I never thought to get anymore results further than those two.

Upon diagnosis his BUN was at 70, creatinine was at 1500. After 24 hours of IV those figures went down to 55 and 1100 respectively. After 48 hours of IV they were down to 33 and 690.

It was a shock for me because I thought I was bringing Marshall in for a mouth infection as his breath smelled like a rotting carcass and he had strings of bloody drool dangling off his lips. Those symptoms came on in about 24 hours. I guess I figured bad breath + blood = Gingivitis? Broken tooth and infection? He hadn't lost any weight, still purred, cuddled, talked to me.

Turns out nearly his entire mouth was in ulceration as a result of the high levels of toxins that had built up in his body from his deteriorating kidneys.

Even the vet was surprised because she told me that when a cat comes in with levels that high (I believe she said his kidney function was 5-7%) they are emaciated, in muscular atrophy, and half-dead. But then there was Marshall, prancing round and demanding attention and cuddles.

He's strong, my boy. ha.

The cat food I'm referring to is "Felidae" Chicken & Rice. The exact product is HERE. If you scroll a bit you'll see the guaranteed analysis as well.

I only bought two cans of Felidae but haven't opened them yet because I have several K/D wets left. I also didn't want to feed him anything different until those with more knowledge on the subject can advise me. I don't think I can approach my vet because I highly doubt she'd endorse this brand as opposed to K/D.

Another option I found was HALO brand - the one supported by Ellen Degeneres. Their protein levels for wet can be as low as 4.2% depending on the flavour. There is no phosphorus level indicated though and I have emailed them but no response, yet.

It's been exactly a week since I brought Marsh home from his 48 hour stay at the vet. He appears to be doing incredibly well but I hesitate because that's how he seemed last time! He has no traces of bad breath though, has a fantastic appetite and drinking water all the time on his own (I've got fresh bowls in all his hang-outs around my apt.) + the sub-q therapy I've been doing every 2nd day.

Next Wed I bring him in for his follow-up checkup and blood analysis.

Thanks again for getting back to me! This has been quite the ordeal, in fact, I think I'm still recovering from it!

[sugarcatmom]

Originally Posted by OtisIsMyCat

Upon diagnosis his BUN was at 70, creatinine was at 1500. After 24 hours of IV those figures went down to 55 and 1100 respectively. After 48 hours of IV they were down to 33 and 690.

Oh wow. Glad that Marshall pulled through, and my fingers are crossed that he continues to recover. Did he have any other symptoms prior to the bad breath, like increased drinking and urination? He's pretty young to be in such an advanced stage of renal failure from natural causes. Is there any possibility that he ingested something toxic?

Originally Posted by OtisIsMyCat

Turns out nearly his entire mouth was in ulceration as a result of the high levels of toxins that had built up in his body from his deteriorating kidneys.

If there were no prior CRF symptoms, I really have to wonder whether the mouth ulcers were actually caused by something he ate, and his current state of renal failure is a symptom of that, not the other way around.

Originally Posted by OtisIsMyCat

Even the vet was surprised because she told me that when a cat comes in with levels that high (I believe she said his kidney function was 5-7%) they are emaciated, in muscular atrophy, and half-dead.

Exactly! More reason to think this isn't a case of CRF, but ARF (Acute Renal Failure - brought on suddenly by something external). Did the vet bring up this possibility at all?

Originally Posted by OtisIsMyCat

The cat food I'm referring to is "Felidae" Chicken & Rice. The exact product is HERE. If you scroll a bit you'll see the guaranteed analysis as well.

Ah okay. You're looking at the Guaranteed Analysis, which isn't too terribly useful. What you want is Dry Matter, and you can find that if you click the "Detailed Nutrient Analysis" just below it. It takes the "As Fed" values, which are more accurate than the Guaranteed Analysis, and removes the moisture content, making it easier to compare to other foods. So the true phosphorus content of the Felidae is 1.16%. Not too bad. Since Marshall already likes regular Innova EVO (the one that's too high in phosphorus - Turkey and Chicken), perhaps he'd be okay with the Innova 95% Venison, which is even lower than the Felidae. Do you think he'd go for a raw diet? Nature's Variety makes pre-made frozen raw that is also low in phosphorus ("Chicken and Turkey" and "Beef" flavours in particular).

Phosphorus binders are another option to consider, particularly if Marshall's blood phosphorus is above normal, or even at the high end of normal.

Originally Posted by OtisIsMyCat

the sub-q therapy I've been doing every 2nd day.

What's the volume of fluids that he gets per session? You might want to consider giving smaller amounts more frequently to provide more even hydration.

Originally Posted by OtisIsMyCat

This has been quite the ordeal, in fact, I think I'm still recovering from it!

No doubt! Scary stuff indeed. You're doing great though . Give Marshall some good chin rubs and bum pats for me and tell him to keep prancing and cuddling.

Here are a couple more links with good info that you might be interested in:

http://www.felineoutreach.org/Education/Kidney.html
http://www.holisticat.com/crf/Diet-w...in-issues.html

[OtisIsMyCat]

RE: Bad Breath. He's had bad breath for the last several years. And, just before I moved to Vancouver from Ottawa I took Marshall and Otis to the vet to make sure they were healthy for travel in the plane. Turns out Marshall needed to get three teeth pulled and he would have been 8 then. So I guess I always attributed his bad breath as something more to do with his specific physiological make-up. But, now I'm wondering if it was just gradual kidney disease? Although the vet in Ottawa did a blood analysis before putting him under for his teeth extraction, and those results have since been faxed to the vet here and nothing in his kidneys stood out, although his liver enzymes were a little bit off. Otis is the same age and you can't ever smell his breath. When his mouth was in that state, that was the first time I ever noticed that carcass-type of smell.

On the day I started to notice smell and discharge from his mouth he was drinking a lot more than usual.

I too have wondered about acute. When I first brought him in and she realised how quickly the symptoms had come on she asked me about him ingesting something toxic. I wracked my brain and couldn't think of anything. Marshall's unique in that he has no "hips." The tips of his femurs were removed when he was a year old after he developed Legg-Perthes disease. So a) he can't jump up on anything to even access my plants and 2) I don't have any toxic plants in my apartment.

I live on the ground level of a two-story home I share with my landlady upstairs. She's got a fenced off front-yard garden that I let the cats roam around in. They're always attracted to the same leafy plants, or the grass shoots, and I've been living here for three years. If it was something outside, Otis should have been affected too, no? And why now?

Although, there is one specific instance I can recall which I think about often and am wracked with guilt. I use Nair on my legs and will often walk around my apt doing things while I wait for it to set. Marshall had brushed his tail along my legs about 3 days prior and did get some Nair on his tail. I wiped it off but I worry it wasn't enough. What if that's what it was? What if he was cleaning himself and became poisoned from the Nair because I didn't get all of it? That's about the only toxic thing I can possibly think of - and probably the only toxic chemical I have in my place! Even my cleaning and beauty products are non-toxic, all-natural.



Maybe it was ARF but I think the level of deterioration his kidneys endured is past the point of repair. I do believe though that usually at initial diagnosis, if the cat is really in a crash, the kidney functioning will be extra low because at that point they are so dehydrated that the percentage can be much worse than after they are stabilized. After I get the results from his Wed blood test I will ask the vet what his kidneys are functioning at.

Re: Food. I did some more searching through this forum and found some strange reviews on Felidae, some with people finding bone and cartilage matter in the food? Gah!

I'm going to look into the Evo Venison or Beef. I hate keeping him on this K/D garbage. Especially since I know the primary reason that food is even endorsed by the clinic is because some rep went there and made a good sell.
It's full of junk and $56 for a case of 24 mini cans? What a rip.

I wonder when retail pet foods will make a food specifically for kidney issues in cats. Rather than just via the vet. They have food for weight, shedding, diabetes, I've even seen food specific to the breed! It would make my life so much easier.

I haven't looked into Nature's Variety, but I will.

RE: sub-Q. The vet prescribed 150 ml every 2 days. We've been doing really well on them. He doesn't seem to care as long as I'm tickling his face and his ears and he just purrs away in ecstasy. But today he got startled for some reason and wriggled sharply away from me. I had to let the needle go before he did himself harm as his upper body strength is powerful (with no hips in the back he compensates by climbing and pulling himself up rather than jumping). So, he only got 50 ml today, but I may try again later. It was funny though because after getting free he just ran straight to one of his water bowls and lapped water on his own. He's very independent apparently.

Thanks for those links as well. I'll check them out. I'm going to try to pay more attention to the 'Detailed Nutrient Analysis' vs the Guaranteed now as well.

Marshy... for bragging rights. ha

[growler~GateKeeper]

Originally Posted by OtisIsMyCat

I am now joining this thread as the owner of a newly diagnosed CRF cat, one week ago today. My 11 year old Marshall.

Hi OtisIsMyCat, welcome to the forum & the CRF cat club

Originally Posted by OtisIsMyCat

So... I have a quick question... how is 0.2% for a phosphorus level? Unfortunately the K/D wet is by far the lowest on all the lists but I don't like their overall ingredients. So I'm trying to find a safe alternative.

Also, is it true that it's actually the phosphorus that is damaging to CRF cats? And, not necessarily the protein itself?

THANKS!!

When looking at the phosphorus levels on the can/site it needs to be converted to dry matter basis, as the formula below shows, the moisture content of the food is crucial as well as the phos:

100-moisture = dry matter; phos/dry matter * 100 = dry matter phosphorus

As an example Evo 95% Vension: 100-69.8 = 30.2; 0.62/30.2 * 100 = 2.05% dry matter phosphorus = way too high

As an example Evo 95% Chicken & Turkey: 100-73.9 = 26.1; 0.23/26.1 * 100 = 0.88% dry matter phosphorus = Good value

Phosphorus

http://www.felinecrf.org/just_diagnosed.htm#phosphorus
Phosphorus and calcium are minerals which are important for nerve function, muscle contraction and bone formation. A healthy body has a natural balance between levels of phosphorus and calcium.

CRF kidneys can no longer excrete phosphorus properly so levels of phosphorus rise (hyperphosphataemia), which can then adversely affect the cat's calcium levels, with potentially serious consequences (see secondary hyperparathyroidism).

Not only that, but high phosphorus levels may make the CRF progress faster and can make a cat feel lousy. So controlling phosphorus levels is one of the most important steps in managing CRF and helping your cat feel better.

Protein

http://www.felinecrf.org/nutritional...ts.htm#protein
A healthy cat needs around 30% of its calorie intake to be protein, and since cats are obligate carnivores (which means that they need to eat meat in order to survive), virtually all of that must be animal protein. Protein contains essential amino acids which are necessary for maintaining muscle, but it also creates a large amount of waste, which is processed by the kidneys in the form of urea (BUN). Since urea/BUN levels tend to rise in a CRF cat because the kidneys are working less effectively, many vets recommend a diet low in protein so as to minimise the levels of urea/BUN which are produced.

However, there is a lot of controversy about how useful low protein diets are for CRF cats, and when they should be introduced. Many vets recommend a low protein diet immediately; but this is not necessarily a good move. Cats need a relatively high amount of protein in their diets, compared to say, dogs or humans; and if protein is reduced too early, it can cause weight loss, raised liver enzymes, and may in some cases contribute to the development of anaemia. This is particularly true of those CRF cats who leak protein in their urine (proteinuria), leading to low protein levels in the blood. Having said that, the low protein prescription diets claim to have sufficient protein for cats at all stages of CRF.

Low protein diets are also of concern for cats with metabolic acidosis, because studies of rats and humans with renal failure show that "acidosis may limit the ability of patients to adapt to dietary protein restrictions" (Nutrition and renal function in cats and dogs: acid-base, electrolytes and renal failure (1999) Polzin DJ, Osbourne CA, James K Supplement to Compendium on Continuing Education for the Practising Veterinarian 21 11(K)).

It is not yet certain whether acidosis also affects cats in this way, but it seems reasonable to suspect that it does, given the cat's relatively high requirement for protein.

Wellness has Turkey, Chicken and Beef & Chicken which have good numbers all under 1.2% dm phos

Originally Posted by OtisIsMyCat

Here's what I know of Marshall's initial diagnosis. I only obtained his BUN and creatinine. That first 48 hours were such a blur I never thought to get anymore results further than those two.

Upon diagnosis his BUN was at 70, creatinine was at 1500. After 24 hours of IV those figures went down to 55 and 1100 respectively. After 48 hours of IV they were down to 33 and 690.

Ouch. It sounds like initially it was acute renal failure that has, due to the high levels, lead into chronic renal failure.

http://www.felinecrf.org/links_and_r..._renal_failure

With ARF even though the situation is critical at first, the cat will not always present all usual symptoms, you might just see reduced urination, increased drinking symptoms that can look like other things.

Originally Posted by OtisIsMyCat

Turns out nearly his entire mouth was in ulceration as a result of the high levels of toxins that had built up in his body from his deteriorating kidneys.

Could be the excess blood toxins, could also be a result of infection or external ingested toxic substances.

Originally Posted by OtisIsMyCat

The cat food I'm referring to is "Felidae" Chicken & Rice. The exact product is HERE. If you scroll a bit you'll see the guaranteed analysis as well.

I only bought two cans of Felidae but haven't opened them yet because I have several K/D wets left. I also didn't want to feed him anything different until those with more knowledge on the subject can advise me. I don't think I can approach my vet because I highly doubt she'd endorse this brand as opposed to K/D.

Another option I found was HALO brand - the one supported by Ellen Degeneres. Their protein levels for wet can be as low as 4.2% depending on the flavour. There is no phosphorus level indicated though and I have emailed them but no response, yet.

The numbers for that variety of Felidae is okay dm 1.16%, for the Halo I need to see the phos numbers to tell.

Originally Posted by OtisIsMyCat

Next Wed I bring him in for his follow-up checkup and blood analysis.

Ask for a copy of the full blood & urine results

Originally Posted by OtisIsMyCat

If it was something outside, Otis should have been affected too, no? And why now?

Not necessarily. If they are allowed free roam outside & not just out supervised on a harness they could've been anywhere in your neighbourhood or the next. One may have wandered away from the other.

Lilies are especially nephrotoxic but popular & pretty lots of people putting in gardens. Someone working on their car spills antifreeze - it is very sweet tasting which is attractive to cats. Most people think antifreeze poisoning will only occur in winter but some people do change out antifreeze when they do regular maintance or have a leak. I have heard of some free standing basketball hoops recommending to fill the base with antifreeze so it won't freeze & also for ballist

Originally Posted by OtisIsMyCat

I do believe though that usually at initial diagnosis, if the cat is really in a crash, the kidney functioning will be extra low because at that point they are so dehydrated that the percentage can be much worse than after they are stabilized. After I get the results from his Wed blood test I will ask the vet what his kidneys are functioning at.

This may be true, same with the blood values, once the IV fluids have flushed much of the toxins out & starts to correct the imbalance the numbers will revert to pre crisis numbers - though it will not necessarily be close to/or in normal range.

Originally Posted by OtisIsMyCat

I'm going to look into the Evo Venison or Beef. I hate keeping him on this K/D garbage. Especially since I know the primary reason that food is even endorsed by the clinic is because some rep went there and made a good sell.

Evo only if 95% varities but not vension or duck - those two are way too high. Beef is 1.23% dm I would feed this occasionally but not as a staple, 95% Turkey & Chicken is good at 0.88%.

Originally Posted by OtisIsMyCat

It was funny though because after getting free he just ran straight to one of his water bowls and lapped water on his own. He's very independent apparently.

............

Marshy... for bragging rights. ha

I found that as well, my grrl would head right for the water dish after her fluids

So cute

[sugarcatmom]

Originally Posted by growler

As an example Evo 95% Vension: 100-69.8 = 30.2; 0.62/30.2 * 100 = 2.05% dry matter phosphorus = way too high

Hmm, interesting. According to J&B's chart, the phosphorus level is 146mg/100Kcal, which is really quite excellent, and venison tends to be naturally lower in phosphorus than most other types of meat. I'm wondering if that 0.62% isn't a Dry Matter value already?

ETA: Here's a little list put out by a vet listing some of the lower phosphorus foods for CRF kitties: http://sites.google.com/site/felineh...kidney-disease

[growler~GateKeeper]

Straight from the Evo website Nutrient Analysis page: http://www.evopet.com/products/defau...nel=na&id=1665

Unless they've changed the formula or just made an error on the site but the way it stands right now from their offical site I wouldn't recommend this flavour.

[driver8]

What an interesting thread - good to know this is a common enough problem to make a sticky thread.

My Lucy is about to turn 14. For the past two yearly check-ups, she has lost weight each time, and this time she had lost enough to start doing investigations. She throws up a fair bit, but she's always had hairball problems so we assumed that's what it was, but maybe it was the renal failure symptoms. Her liver function was normal, but her creatininine was elevated, thyroid normal, no diabetes. The vet said it was "mild to moderate" chronic renal failure.

She's always been a petite cat, and she is tiny but not emaciated. She has lots of energy still. Runs around the house, rolls on the carpet to get attention from guests, etc. Because she's had dry food most of her life, we're trying the dry food first - Renal LP from Royal Canin. She seems to like it so far, and hasn't thrown up at all since we started introducing it. She drinks tons of water on her own, so I'm not worried about dehydration so far.

For me, it's a quality of life thing and as long as she is happy and energetic and not in discomfort, I'm happy. But it's sad to know there is a tangible sign that she is becoming and older, more frail cat.

[sugarcatmom]

Originally Posted by growler

Unless they've changed the formula or just made an error on the site but the way it stands right now from their offical site I wouldn't recommend this flavour.

I sent Natura an email for clarification on this, because I know this food is frequently recommended for CRF kitties on other sites. I'll let you know what they say.

[sugarcatmom]

Originally Posted by driver8

Her liver function was normal, but her creatininine was elevated, thyroid normal, no diabetes. The vet said it was "mild to moderate" chronic renal failure.

Do you have any other lab values, such as BUN, phosphorus, calcium, potassium, etc, and the urinalysis results (particularly the urine specific gravity)?

Originally Posted by driver8

Because she's had dry food most of her life, we're trying the dry food first - Renal LP from Royal Canin. She seems to like it so far, and hasn't thrown up at all since we started introducing it.

What was Lucy eating before being put on the Renal LP?

Any way you can try offering her some quality (ie non-prescription) wet food? It would be so much better for Lucy if you could transition her off of all dry food, which is problematic for even healthy cats. More so for those suffering a chronic illness. You might want to check out this link if you haven't already, particularly the section on health problems caused by dry food, and the part with tips for transitioning kibble addicts over to wet food: www.catinfo.org

Here are the ingredients for Renal LP dry:

Pork Meal, Corn, Chicken Fat, Rice, Wheat, Corn Gluten Meal, Powdered Cellulose, Natural Flavour, Wheat Gluten, Chicory Pulp, Fish Oil, ....

Tons of grains (corn, rice, wheat), fillers (chicory pulp and powdered cellulose - aka sawdust), and a poor quality meat source (pork meal). A much better idea would be to feed one of the lower phosphorus canned foods like Wellness Turkey. To compare, here are the main Wellness ingredients:

Turkey, Chicken Liver, Chicken, Chicken Broth, Carrots, Natural Chicken Flavor, .....

See the difference? Plus it's 78% moisture, compared to the 10% or less moisture in the Renal LP. Water is a crucial ingredient in cat food, and for those cats with renal insufficiency, it's an essential aspect of their treatment.

Originally Posted by driver8

She drinks tons of water on her own, so I'm not worried about dehydration so far.

That can be deceiving. The reason that she's drinking so much water is because dehydration is already a factor. She's trying to catch up to all of the peeing she's doing since her kidneys aren't able to retain as much moisture as they should. I have a cat with diabetes, and prior to him getting regulated on insulin injections, he would camp out at the water bowl drinking several cups of water a day. How could he possibly have been dehydrated with all that water consumption? In order to get rid of all the glucose building up in his blood stream, he was peeing it out faster than he could replenish it. Very similar with CRF kitties.

Originally Posted by driver8

But it's sad to know there is a tangible sign that she is becoming and older, more frail cat.

Many cats can live for years with compromised kidneys, so even though you may have to modify some things in Lucy's life, take heart in that this isn't necessarily a death sentence. Just love her and appreciate each day with her, as we all should with our beloved furry friends.

[driver8]

I tried to transition my cats to wet food once before, on the advice of one vet I had seen. this was when we had three cats. They had been eating the dry Iams multi-cat, and when we mixed wet food in, they had a really hard time. They were always hungry, seemed much more anxious about food, were almost frantic. It was rediculous. This was giving the recommended amounts, still mixed with the dry food a bit. So we eased them back to the dry food and all was well.

I know that water in food is important, and probably easier on my cat than drinking water so much from her bowl. . But I read the labels on the canned foods, and they all have less protein content than the dry foods, and I wonder if that was why my cats were so hungry when we tried to transition. I'm going to go to pet valu this week and see what they have that I can try - I want to do the right thing for my cat and her diet, but it all depends what she will accept. Now that we only have one cat, the transition might be easier to make.

My mom's cat was 18 when she died, had CRF, hyperthyroid, and recovered from a bad bout of pancreatitis. She would never eat ANY of the special foods for renal, etc... she would only eat the cheap crap (wet) from super-valu. So that's what she ate... (She had quite a personality, that cat, and would tell you in no uncertain terms if things did not meet standards. )

Lucy isn't ravenously thirsty, so I will try and gently ease some changes in but not stress it too much if it distresses her. Older people don't often like the diet changes prescribed for them either, and at some point you've got to decide how much to push and when to leave it alone. So I'm going to do some investigating and definitely will try wet food. But my past experience made me a bit wary. I know it's different when cats are on wet food from the beginning, and with the next cat we get, that will likely be the case.

I didn't ask the numbers of her lab values, I don't want to get too focused on numbers. (Treat the patient, not the numbers) She still has lots of energy, etc, so I'm not too worried yet. I know that with CRI, diet is only a small part of it, and that the disease will still progress anyway. I'm pretty confident that she has a lot of living left to do.

[sugarcatmom]

Originally Posted by driver8

They had been eating the dry Iams multi-cat, and when we mixed wet food in, they had a really hard time.

Were you actually mixing canned and dry together in the same bowl? That might have been part of the problem. Some cats, mine being one of them, hate the combo of textures. Putting out just the wet food alone would be preferable.

Originally Posted by driver8

But I read the labels on the canned foods, and they all have less protein content than the dry foods,

Most canned foods are actually higher in protein than dry food. You have to subtract the moisture content in order to compare the nutrient analysis of wet vs dry. Some info for you on that: http://www.catinfo.org/commercialcan...tter,_Calories

Originally Posted by driver8

she would only eat the cheap crap (wet) from super-valu.

The fact that it was wet was probably a big factor in her longevity. I've always maintained that it's better to feed cats the cheapest canned food than the most expensive dry food.

Originally Posted by driver8

Older people don't often like the diet changes prescribed for them either, and at some point you've got to decide how much to push and when to leave it alone.

Exactly, which is why it's important when transitioning cats to a better diet to use techniques that are gentle and don't cause stress for us or them. This isn't a race. Just be patient and persistent, and I guarantee that even the most hard-core kibble addict can eventually be converted. If I did it with my boy (and it took months), anyone can do it.

Originally Posted by driver8

I didn't ask the numbers of her lab values, I don't want to get too focused on numbers. (Treat the patient, not the numbers)

I totally understand that. But it's also a good idea to have a sense of what's going on, so you can make some adjustments along the way if necessary. Such as when to implement other treatments or supplements like probiotics, phosphorus binders, Calictriol, subQ fluids, potassium, omega3's etc. There is lots that we can do to help renal kitties be more comfortable and augment their health. Not all vets are current with these treatments and way too many of them just shove a bag of prescription kibble at their clients and call it a day.

Originally Posted by driver8

I know that with CRI, diet is only a small part of it, and that the disease will still progress anyway.

I don't entirely agree with that, I think diet is a fairly big factor. Even to the point that it actually causes many cases of kidney disease in our cats.

Originally Posted by driver8

I'm pretty confident that she has a lot of living left to do.

Excellent attitude! Staying positive can have a very real impact on cats, who are quite sensitive to the moods of their caretakers.