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Kidney Failure in Cats

10/9/2015

2 Comments

 
This letter came in via the Litterbox, but lends itself more to a blog post, so here it is:
Dear Drs Jeff and Susie,

My domestic short hair feline, Sinjie who is about 12 yrs of age has been drinking more water within the last month and has had a couple of days where he's been lethargic with no appetite which lasted about a day and a half each time so we took him in for a check up after the second episode. He's been diagnosed with renal failure. We changed his food to a good quality protein by Instinct and every so often switched to Fancy Feast Classic entrees which is what we've mainly given him prior to his diagnosis. He was fine again after his visit though and seemed much better; had more energy and resumed his normal behavior. However late last night and all day today he hasn't eaten. He's drinking a bit when I hold the water cup for him. The Vet gave us a prescription for Sub-Q ringers which we refrained from giving him after his check up because he was eating and drinking as usual. I guess my question is, "Is there something more we can do for him to turn this around"? He is very loving and very precious to us. I can't bear the thought of him suffering. I'm so impressed by your commitment and above standard philosophy & practice that we hope you'll be able to point us in the right direction. Thank you for your knowledge and generous kind spirit. I realize how busy you must be and hope you'll be able to respond. 
Beth in Las Vegas
Hi Beth,
Thanks for your question.  Chronic renal failure is a common problem in older cats.  I'm sorry your Sinjie has been diagnosed with it, but there are a few more things you can do to improve the quality and length of his life.  Did your vet tell you what his phosphorus and potassium values were?  These can really affect how the cat feels and how active he is.  Phosphorus tends to rise with renal failure and potassium tends to drop.  There is a phosphate binder called Epakitin made by a company called Vetoquinol.  This is something you could sprinkle on his food and it prevents some of the phosphorus from being absorbed.  Potassium is a very small electrolyte and is one of the first things that starts to slip by the kidneys without being resorbed like it should in renal failure.  This you can supplement by adding potassium chloride to the food, sprinkling it on.  We carry our own brand at our clinic, but you can get it at some grocery stores as NuSalt or other brand of salt substitute for people on a salt-limited diet.  It is potassium chloride instead of sodium chloride, which is table salt.  This alone tends to make them feel better and improves strength.  Cats with renal failure also tend to do better on renal diets.  The one we recommend is Royal Canin's Modified Renal LP.  It comes in both canned and dry, but the canned gives them more moisture, which they need.  There is also another supplement made by Vetoquinol called Azodyl.  It is quite interesting in the way that it works.  It is basically a probiotic, but contains certain bacteria that bind to nitrogen in the intestines and prevent their absorption into the body.  One component of renal failure and something your vet probably noticed on the bloodwork is an elevated BUN, which stands for blood urea nitrogen.  By preventing the absorption of nitrogen in the first place (from the food) we can usually bring this number down somewhat.  Lastly, encourage water consumption and supplement with subcutaneous fluids as needed or if you notice less urine in the litter box, or if Sinjie starts to act a little puny.  You will do better with some fluid ahead of time, versus waiting until he gets dehydrated.  It is very easy for chronic renal failure cats to get dehydrated in the face of what seems to be normal drinking because their kidneys cannot concentrate urine like they are supposed to.  So they urinate large amounts of dilute urine, and lose most of what they are drinking.  I hope this information helps you and your kitty.  I guess there is one more option that I should mention.  UC Davis does perform kidney transplants in cats, there are certain criteria they must meet before being accepted into the program, and you will be bringing home a second cat, the kidney donor, if you go this route.  Also be prepared to bring your kitty's entire life savings account, because it is not a cheap procedure.
Good luck!
2 Comments

Pre-anesthetic Bloodwork

10/30/2012

1 Comment

 
When you go to the doctor (especially after a certain age) what is one thing it seems they always want to do?  Bloodwork.  Before any procedure, if you aren't feeling well, and sometimes just because it has been a year.  Well, your pets are no different.  Labwork helps us identify anything that may be out of the ordinary on the INside of your pet.  We can check liver function, kidney function, electrolyte balance, protein levels, number of red blood cells and white blood cells, just to name a few.  What we especially like to know, is if there is anything we need to know BEFORE we anesthetize your pet for any procedure.  We offer bloodwork in our clinic, and can usually have the results in about 30 minutes.  We can do this the morning of surgery or dental cleaning, and have the results before we even sedate your dog or cat.  This helps us know if anything in our protocols should be changed, or maybe even cancelled due to abnormalities in your pet's internal systems.  I can think of 2 specific incidences where there was a vastly different outcome because of knowing lab results prior to anesthesia.
    The first was about 14 years ago while practicing in Arizona.  The clinic had a young white purebred puppy come in to be neutered.  He was anesthetized and his surgery seemed to go fine.  He was sent home that afternoon still a little groggy.  The owners called the next day and he was not feeling well and was vomiting.  They were told it was likely the anesthesia making him naseous and to keep an eye on him.  The next day was no better, and he returned to the clinic.  He was treated with fluids to help rehydrate him, and sent home.  Finally a few days later he seemed to be feeling better.  One month down the road he ate something he shouldn't have, and vomiting had to be induced.  At the time, salt was recommended, and he vomited up the offending candy.  For the next several days he vomited off and on and felt terrible.  Finally he seemed to turn the corner and improve.  Two weeks later the owners brought him back to the clinic because he was laying around all the time and drinking and peeing a lot.  Bloodwork was done then, and that 7 month old puppy was in kidney failure!!  He lived about one more month and then had to be euthanized.
    The second case was just a couple months ago.  A young female mixed breed dog came in to be spayed.  We did some pre-anesthetic labwork and found very elevated liver enzymes.  This little dog's liver was working too hard and had something wrong with it.  Instead of going ahead with the spay, we performed some additional bloodwork that we sent into the lab.  She went home just as happy and perky as when she came in, and all we did that day was draw blood. 
    The biggest difference between these two cases was the labwork that was or was not done before the surgery.   In the first case, we went ahead with anesthesia which compromised the already ailing kidneys and in all liklihood hastened the progression of his kidney failure.  The second case has yet to play out to the end, but by knowing what was going on inside, we avoided doing any harm to the puppy.  Pre-anesthetic labwork is an amazing and valuable tool to the pet, the owner, and the veterinarian.  That is why we recommend it with any surgery.
1 Comment

Dental Disease

2/1/2012

4 Comments

 
Dental disease is a significant problem in our companion animals.  It can take a subtle toll on your pets energy and well-being, or be a silent killer.  Tartar develops on teeth after a certain amount of time with no brushing or other abrasive activity in the mouth.  Brushing your pets teeth helps, as do certain types of food designed to hold together and scrape the teeth as they are chewed versus breaking apart easily.  Chewing on certain types of chewies can do the same thing to dog's teeth.  When tartar is present on the teeth, there are bacteria that live in the tartar.  The combination of the tartar and bacteria irritate the animal's gums, and form pockets under the gum tissue.  Irritated gums tend to be red and inflamed, and this allows bacteria to get into the blood stream.  Bacteria from the mouth that travel in the blood stream will seed out on heart valves, in the kidneys, and in the liver.  In each of these locations the bacteria cause significant problems.  On the heart valves little colonies of bacteria grow into larger colonies, until they interfere with the heart valve closing properly.  This causes valvular insufficiency, which leads to secondary heart disease.  Heart disease is one of the leading causes of death in dogs.  Bacteria that land in the kidneys cause parts of the kidney to die off, thus reducing the amount of normally functioning cells.  This results in impaired renal (kidney) function, which can then lead to kidney failure.  Kidney disease and failure is the leading cause of death in older cats.  Bacteria that make it to the liver can cause small abscesses and adversely effect the way the liver is able to handle other stresses and do it's everyday jobs like removing toxins from the bloodstream.  So an animal's mouth can be a great indicator of overall health, and also show us where there is room to make improvements.  Teeth cleaning is something routine in our lives, and should be done for our pets as well to help maintain overall health.
Read more...
Picture
Teeth with tartar build up before cleaning
Picture
Same teeth following cleaning
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