Vancouver Feline Hospital - Cat Veterinary Clinic

Treatment centres around diluting these toxins and getting them out of the body. The first step is rehydration, and maintaining daily hydration - encouraging water intake, SQ fluids as needed.

In human medicine, patients are placed on a low protein, low phosphorous diet. Veterinarians extrapolated this concept to cats, but recent studies are showing that protein restriction in our pet carnivores may not be beneficial in early or mid-stage chronic renal disease. Protein restriction is beneficial in end-stage uremic disease - but at this point we are often more concerned with quality of life. Protein malnutrition occurs very quickly in cats, especially if they wont eat because of nausea. Renal diets may have less benefit in feline medicine than originally thought. So initially, whatever kitty eats is fine, so long as kitty eats and maintains body weight . This is a core concept!

Most cats survive many years with only SQ fluid support. Closer to end-stage, dialysis becomes an important concept. It is rare for a cat to undergo renal dialysis, and mostly veterinarians rely on the second-best - an IV diuresis procedure which means your cat would be in hospital on IV fluids for three to four days, every so often. Some cats undergo a crisis such as concurrent kidney infection and do very well after IV diuresis. Prognosis is only possible after the diuresis and we can build an idea of how well those kidneys are coping.

Many cats suffer from the renal gastritis. Very low levels of toxin build-up can cause this. Start treating this early and do everything to prevent this discomfort - because not eating can do more harm than the CRI to the cat. Basis of treatment is SQ fluids, then drugs like famotidine to prevent gastric acid secretion, metoclopramide to prevent central nausea and vomiting, odansetron and others. Sulcrate will coat and protect the gastric lining. Bland nutritious diets help - plain boiled chicken on "off" days, nutritionally balanced commercial diets for allergic cats or diabetics with gastritis - avoid fibre diets or calorie restricted senior diets as these will make constipation, dehydration and protein malnutrition worse.

Simulating Red Blood cell production.

The kidneys produce a hormone called erythropoitin ***weblink to hormones good bad ugly ?* *** which stimulates the bone marrow to produce red blood cells. Red blood cells carry oxygen, vital for energy metabolism and life support, to the tissues. Red blood cells live about 100 days, and are constantly renewed. Without enough red blood cells, your cat will feel weak and energyless. This is noticeable as sleeping more, lethargy, less playful, sometimes urinating or pooping outside of the box, antisocial behaviour, poor grooming. They eat less (it is tiring to eat).

Haematocrit (Hct or PCV) is a measure of red blood cell amount.

At a Hct below 25%, we start supplementing erythropoitin .* ***weblink to procedure**** The increase in red blood cells can significantly improve quality of life for the cat.

Conserving potassium

Potassium is an electrolyte which must be delicately balanced within the body's cells for muscle function. The heart is a muscle and is affected by potassium levels. Potassium is eaten - that is, your cat gets it from the food. The kidneys have to prevent potassium from being excreted in the urine. So in a cat that isn't eating enough, potassium loss can be critical. In CRI, the kidneys are not able to conserve the potassium as efficiently, and because of renal gastritis, the cat doesn't want to eat, or is vomiting. Low potassium levels are noticeable by weakness, walking with dropped hocks, head hung low, lethargy.

Serum (blood) potassium levels can give an indication of lack of total body potassium levels. Normal blood levels may mask a lack of potassium in the cells, which is the critical parameter, but we have no way of measuring that yet. The veterinarian may suggest supplementing dietary potassium even with normal blood values, based on clinical signs.

Potassium gluconate can be added to your cats food. Some cats will refuse food with anything added, in which case you may have to give a syrup or tablet daily. It is possible but not desirable to add potassium to the SQ fluids, because this will change the solution and cause it to sting. It is also easy to overdose potassium (fatal) if giving it SQ but impossible to overdose if giving it by mouth.