Chronic kidney disease (CKD) is a common cause of illness in older cats. Unlike some other organs such as liver, kidney damage can not be repaired. The signs of kidney disease are usually seen once at least 70-75% of renal tissue has been irreversibly damaged and, once established, the FIU is generally a progressive course. The rate of disease progression can vary greatly from one cat. There is no cure for CRF and people with this condition, dialysis followed by renal transplantation are the main options. None of these treatments are currently available in the UK, although it is possible to improve the quality of life of affected cats using a variety of medical treatments tailored to the needs of the individual. In recent years, many therapeutic advances have been made and there are now more options available to owners wishing to take care of their cats with CKD. Before discussing these treatments in detail, it is important to consider what is normal renal function and thus the range of problems that cats with CKD may have. In normal cats, the kidneys play many vital roles which are: Waste disposal, drugs and toxins from the body through urine Rules on the acidity of the body, electrolyte levels (calcium, phosphate, potassium, sodium and chloride) and water balance Production of hormones such as erythropoietin (needed to stimulate production of red blood cells by the bone marrow) and renin (important in controlling water balance and salt) Activation of vitamin D (important in controlling blood calcium and phosphate levels) Regulation of blood pressure signs of CRF develop when two-thirds to three quarters of renal function was lost. Cats with CKD are vulnerable to problems, including: The accumulation of degradation products of proteins (including urea and creatinine can be measured in blood samples) that is associated with clinical signs of illness (eg nausea, vomiting, loss of appetite) Dehydration Acidosis (acidic blood) Electrolyte abnormalities Anemia (due in part to lack of erythropoietin production) High blood pressure (systemic hypertension) Treasury cats often show nonspecific signs of ill health as a variable or poor appetite, weight loss, depression and illness. Increased thirst is observed in approximately one third of cats with CKD, although this clinical sign can also be seen with other conditions common among the cats and the elderly, such as hyperthyroidism and diabetes mellitus ("diabetes mellitus"). Treasury diagnosis therefore requires the collection of blood samples and urine for analysis. In most cases, the diagnosis is made after the identification of azotemia (accumulation of creatinine degradation products of proteins and urea in the blood) and loss of urine concentrating capacity (ie, urine is more dilute than it should be). Other tests may be needed in some cats to identify the cause of kidney disease. For example, an ultrasound of the kidneys is usually a simple technique for identification of polycystic kidney disease (PKD). Management of cats with CKD involves a range of care tailored to the needs of the individual. What is the ideal diet for cats with kidney problems? It is common to prescribe a specific treatment because food has been shown to improve the quality of life and survival of cats with CKD and may reduce the rate of disease progression. Renal diets are usually restricted levels of high quality protein that limits the amount of protein breakdown of wastes to the kidneys to excrete in difficulty. Phosphate levels are also limited because cats with CRF have a tendency to retain excessive amounts of it in the body that can contribute to their discomfort. systems failure have increased amounts of potassium and B vitamins including CRF cats are vulnerable to losing in their urine and an increase in the number of calories, which helps CRF cats with an appetite to maintain a normal body weight. Renal diets generally have lower levels of sodium in them which can help reduce the risk of developing hypertension. It is possible to prepare a home cooked food for cats with CKD and veterinary recipes are available for this purpose. Most homeowners are not elected to the protocols of home cooking because it takes a long time and is therefore not a practical option in most cases. Cats with CRF often have a poor appetite, which can be aggravated by offering special schemes which the kidney might not please the cat. In some cases, the use of appetite stimulants such as cyproheptidine antihistamine (trade name Periactin) or anabolic steroids may be helpful in stimulating appetite adequate. More recently, some veterinarians have been treating cats with persistent appetite by placing a feeding tube into the stomach. feeding tubes may be placed in the stomach by endoscopy and PEG tubes are called when it is done (percutaneous endoscopic gastrostomy tube placed). Although a period of anesthesia and acute postoperative hospitalization is necessary to place the tube, once in place they can be used for extended periods to administer food, fluids and medication for the cat. How can dehydration be prevented and treated? Cats with CKD are vulnerable to dehydration because they are unable to produce concentrated urine. Encouraging cats to drink and to maintain normal hydration is helpful, if possible, and moisture regimes are probably preferable. Offering flavored water can encourage cats to drink more (fish broth, for example) but it is important not to offer salted liquids because they may increase the risk of hypertension and other developmental problems. Many cats with CRF, however, prefers the diet of kidney dry and it can be hard to encourage consumption. In recent years, a treatment that has received much attention is the administration of fluids under the skin by the cat owner (subcutaneous fluid therapy). It is not currently a common recommendation in the United Kingdom, although many cat owners in the U.S. found that CRF is a simple and useful technique to help their cat. In severe cases, dehydration may require treatment with intravenous fluid therapy (cat is admitted to a veterinary clinic and placed on a drip). Give extra fluids at home can be useful in preventing this. In addition, adjuncts such as potassium can be added to fluids. Subcutaneous fluid therapy is usually put about 150 ml of fluid under the skin twice a week. The technique is well tolerated by most cats and owners include a report of a cat of 19 years at FIU, which was managed for 6 years using the subcutaneous fluid therapy in the management protocol. If necessary, the plan can be modified for smoother administration frequently. The owner will be trained in how to perform this technique by a veterinarian or a nurse - it is important that the fluid is given correctly in a sterile manner, so that infections do not occur at the injection site. Some cats do not tolerate this procedure and may not be suitable for all cats with CKD. How-electrolyte problems be treated and prevented? Electrolytes are salts present in the body that are necessary for normal cellular functions. The most common imbalances in cats involve CRF electrolyte potassium and phosphate. CRF cats are vulnerable to loss of potassium in the urine that can cause a reduction in blood potassium (hypokalemia). hypokalemic cats can become very weak and lose their appetite. Although renal diets contain increased amounts of potassium in them, some cats with CKD may still develop low potassium levels in the blood. Extra potassium may be provided to these cats as a powder, tablet or liquid. CRF cats are vulnerable to the accumulation of phosphate which can make hyperphosphataemic (have high levels of phosphate in the blood). phosphate binders are oral drugs that bind to phosphate in the food and limit what is absorbed from the intestine of the cat. These drugs may be required in CRF cats whose blood phosphate levels remain high despite dietary therapy or cats who eat no statute of limitations. How systemic hypertension be treated and prevented? High blood pressure (hypertension) occurs in 20-30% of cats with CKD and may have serious consequences such as blindness. Monitoring blood pressure is important so that blood pressure can be identified and treated quickly to where it occurs. Most practices are now equipped to measure blood pressure in cats and is a technique that is simple, painless and only takes a few minutes to complete. In those cats requiring treatment, antihypertensive drugs (such as amlodipine or oral benazepril) may be prescribed. Most cats will need treatment once a day to maintain normal blood pressure. What other treatments may be needed? Additional treatments may be prescribed according to the needs of the cat are: Erythropoietin: Anemia is common in cats with CKD and one of the reasons is the reduced level of erythropoietin produced by the kidneys. Erythropoietin is a hormone that triggers the production of red blood cells by bone marrow and treatment of anemic CRF cats with human erythropoietin may be useful in reversing anemia. Unfortunately, this treatment can be costly and may not always have a lasting effect as the hormone of man is recognized as a foreign substance into the body of the cat that eventually produce antibodies against the drug will prevent a effectiveness. Another possible side effect of this treatment is the development or exacerbation of blood pressure to cats receiving this treatment should be monitored carefully. It is under research in two American universities to develop a feline erythropoietin would be much more useful and should not result in the production of antibodies by the cat. Iron supplementation: Some cats iron deficiency anemia FIU to measure iron status and given iron supplementation may be helpful. Iron is needed in the production of hemoglobin, the molecule that carries oxygen in red blood cells. Anti-sickness pills vomiting: cats with CKD may experience what is called a uremic gastritis (inflammation of the stomach due to retention of waste and excrete hormones that the kidneys normally). The anti-disease, including antacids and anti-vomiting can be very useful in treating this problem can help the cat feel much better. Prevention and treatment of acidosis: Cats with CKD are vulnerable to acidosis (ie, their blood is more acidic than it should be). This has many consequences that are all the cat feel worse. Where possible, cats with CKD should not be acidifying diet (these plans are often prescribed for cats with fewer problems such as urinary stones, cystitis and bladder) as this increases the probability of acidosis. The treatment of acidosis involves the use of drugs such as sodium bicarbonate. Calcitriol (vitamin D treatment). Although still somewhat controversial, many clinicians have used this treatment in selected patients with CRF and found it useful to maintain normal blood levels of calcium and phosphate. ACE (angiotensin converting enzyme angiotensin) inhibitors such as benazepril (Fortekor ®, Novartis): This treatment has recently been advocated based on research in people with CRF in which ACE inhibitors were found to increase survival time. Data from a recent clinical trial in cats with CKD has been suggested that cats receiving this treatment have a better quality of life (assessed by their owners), reducing the amount of protein they were losing in their urine and slightly increased survival time. Fortekor did not reduce the parameters used to assess renal function (urea in the blood for example, and creatinine levels). In the same trial, a specific subset of cats with CKD who were losing large amounts of protein in their urine showed an excellent response to treatment Fortekor ® (dramatically improved survival, appetite and gain weight). Unfortunately, this event accounts for CRF only a small proportion of all cats with CKD. ACE inhibitors also lower blood pressure and can be prescribed as antihypertensive treatment. Antibiotics: Recent studies have shown that up to 30% of cats with CKD suffer from bacterial cystitis at some point during their illness. In some cats the infection can spread to the kidneys further compromise renal function. In other cats, bacterial cystitis is a consequence of bacterial infection of the kidneys (pyelonephritis). Cats with CKD may be more vulnerable to developing bacterial infections of the urinary tract from the urine they produce is so diluted. Unfortunately, in many cases the bacterial infection causes no signs of cystitis (such as more frequent urination, difficulty urinating and urinating blood) that makes the diagnosis of this complication difficult. The diagnosis requires the collection of a urine sample that is assessed for signs of microscopic bacteria and inoculated into culture media for bacterial growth in a laboratory. A course of antibiotics, sometimes for weeks or months may be needed to successfully eliminate bacterial infections of the urinary tract. Other medications not discussed may be required in some cats with CKD and it is important to modify treatment according to the specific requirements of each cat. FAB site (http://www.fabcats.org/) contains useful information about kidney disease as well as the Web site was designed by an owner of a cat with CRF http://www.felinecrf . com / What is the prognosis for cats with CKD? The long-term outlook for cats with CKD is highly variable, ranging from a few weeks post-diagnosis years. Treasury is considered a progressive disease in most, if not all cats, although the rate of progression can vary considerably depending on the cause of disease and other individual factors. The prognosis is also affected by other issues, including whether the cat has other medical problems that affect its condition and the serious consequences of renal disease. For example, cats with anemia induced by CRF are often very poor long term it is difficult to treat effectively for long periods of time. Owner and the veterinary care of cats with Aid to assess disease severity and progression rate which ensures that all cats with receiving the treatment they need to help maintain good health. Care home with cats can be very rewarding and helpful to ensure that CKD patients have a better quality of life for as long as possible. "Caring for a cat with kidney failure" A comprehensive book by Dr Sarah Caney is available through its website as an eBook or printed form on request paperback.
