Introduction
Kidney disease, also known as chronic kidney disease (CKD), refers to long-term kidney damage that can worsen over time. It is a common condition in older cats, estimated to affect more than 30% of geriatric cats over 15 years old.[1]
One large study found a prevalence of CKD between 1.6% to 20% in primary veterinary clinics, with higher rates in geriatric cats. Risk factors include age, with most cases occurring in cats over 10 years old. Kidney disease is more prevalent in male and purebred cats.[2]
Signs and Symptoms
Some of the most common signs and symptoms of kidney disease in cats include:
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Increased thirst and urination – Cats with kidney disease often drink more water and urinate more frequently as their kidneys struggle to concentrate urine. This symptom is often one of the first signs of kidney problems.
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Weight loss – Appetite changes and metabolic abnormalities can lead to weight loss in cats with kidney disease. This progressive weight loss is a hallmark sign of the disease.
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Poor appetite – Nausea, oral ulcers, metabolic changes, and toxin buildup can suppress appetite in kidney disease. Cats may eat less food, appear disinterested in food, or lose interest in favorite foods.
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Vomiting – Toxins that build up in the blood due to poor kidney filtration can cause nausea and vomiting. Vomiting may be intermittent or frequent.
Other signs can include lethargy, diarrhea, foul-smelling breath, mouth ulcers, and an unkempt coat. Severe kidney disease can lead to anemia, weakness, seizures, coma, and death. If kidney disease is suspected, prompt veterinary examination and testing is recommended.
Causes and Risk Factors
There are several potential causes and risk factors that can lead to kidney disease in cats:
Older cats are at higher risk – Kidney disease is more common in older cats, usually over the age of 10. As cats age, their kidneys naturally become less efficient at filtering waste from the blood. Older cats are also more likely to have underlying diseases that can damage the kidneys over time.
Underlying diseases like hyperthyroidism – Conditions like hyperthyroidism, high blood pressure, and diabetes can cause kidney damage if left untreated. Getting these diseases diagnosed and under control is important to prevent further kidney problems.
Toxins – Exposure to toxins like antifreeze, lilies, grapes/raisins, lead, or contaminated foods can directly damage a cat’s kidneys. Keeping cats away from toxic substances is critical.
Infections – Bacterial infections in the kidneys, like pyelonephritis, can scar kidney tissues. Feline leukemia virus (FeLV) can also infect and inflame the kidneys.
Cancer – Lymphoma, leukemia and other cancers sometimes arise in or spread to the kidneys, impairing their function. Catching and treating cancer early provides the best chance of preserving kidney health.
Getting regular veterinary care, screening for diseases, avoiding toxins, and monitoring cats’ kidney values can help prevent kidney disease through early detection and treatment of underlying causes.
Diagnosis
Diagnosing kidney disease in cats typically involves a combination of blood tests, urine tests, imaging, and sometimes biopsy [1]. Common diagnostic tests include:
Blood and urine tests
Veterinarians will run blood tests to check kidney values like BUN (blood urea nitrogen) and creatinine. Elevated levels indicate the kidneys are not properly filtering waste products from the blood. Doctors will also analyze urine samples for signs of improper kidney function, like excess protein. These tests help identify kidney disease and determine the stage based on levels of kidney function [2].
Imaging
X-rays and ultrasound allow veterinarians to visualize the kidneys and look for any anatomical changes, stones, cysts or masses that could be impacting function. Imaging helps identify underlying causes and inform treatment options [3].
Biopsy
In some cases, doctors may perform a kidney biopsy to examine kidney tissue under a microscope. This helps definitively diagnose the type and severity of kidney disease. Biopsies are not commonly performed unless the diagnosis is unclear from other testing.
Treatment
There are several main treatment options for cats with kidney disease:
Fluids: https://www.greatpetcare.com/cat-health/kidney-disease-in-cats/ Intravenous fluids help flush toxins from the body and prevent dehydration. This can be done at the veterinarian’s office or at home. Most cats tolerate subcutaneous fluid administration well.
Diet change: https://manypets.com/us/blog/kidney-disease-in-cats/ Prescription kidney diets restrict phosphorus and provide more omega-3 fatty acids. They are formulated to reduce strain on the kidneys.
Phosphate binders: These medications bind to excess phosphorus in the diet to reduce blood phosphate levels. High phosphorus can damage kidneys.
Blood pressure medication: Hypertension can develop secondary to kidney disease. Medications to control high blood pressure may be prescribed.
Antacids: Uremic cats can develop stomach ulcers, so antacids may be used.
Nutrition
Cats with kidney disease often need to follow a special diet that is lower in phosphorus and protein than regular cat food. This helps reduce strain on the kidneys and slow the progression of the disease. Vets typically recommend switching to a low phosphorus, low protein prescription kidney diet. These prescription foods are formulated to contain reduced levels of these nutrients while still providing complete and balanced nutrition.
Feeding canned food is preferable over dry for cats with kidney issues because the extra water helps increase hydration. Canned food typically has lower protein and phosphorus levels as well. Look for a canned kidney diet approved by your vet.
Supplements may also be recommended. For example, potassium citrate supplements can help maintain healthy potassium levels. Some cats benefit from antacids like famotidine to reduce gastric ulcers. Always check with your vet before giving supplements.
With the right nutritional management, many cats with kidney disease can still enjoy a good quality of life. Monitoring labwork helps ensure their special diet is keeping phosphorus and waste products at an acceptable level. Work closely with your vet to find the right food regimen for your cat’s needs.
Sources:
https://www.greatpetcare.com/cat-nutrition/best-cat-food-for-kidney-disease/
https://www.catster.com/guides/best-cat-food-for-kidney-disease/
At-home Care
There are several things you can do at home to help a cat with kidney disease live more comfortably:
Provide easy access to water. Cats with kidney disease need to stay hydrated, so provide multiple bowls of fresh water around the house. Consider getting a cat fountain to encourage drinking. You can also add tuna juice or low-sodium broth to the water to make it more enticing.
Maintain litter box hygiene. Cats with kidney issues may have accidents or difficulty using the litter box. Scoop waste daily and completely replace litter weekly. Use low-dust, unscented litter. Place litter boxes in easy to access areas.
Offer comfortable bedding. Kidney disease can cause bone and joint pain. Provide soft, warm beds in quiet areas of the house. Wash bedding frequently as sick cats may miss the litter box. Use waterproof and washable beds when possible.
Check with your veterinarian for any other at-home recommendations to keep your cat comfortable. Providing extra care and meeting your cat’s needs is important for their quality of life.
Quality of Life
Monitoring a cat with kidney disease for signs of pain or discomfort is important for maintaining quality of life. Changes in behavior like decreased activity, vocalizing, agitation, or hiding may indicate your cat is uncomfortable. Your veterinarian can prescribe pain medication as needed. Keeping your cat’s environment clean, comfortable, and low-stress can also help.
Maintaining your cat’s appetite and weight is vital. Kidney disease can cause nausea and changes in taste which may lead to food aversion. Offering smelly, appetite-stimulating foods like tuna, clam juice, or heated baby food can entice your cat to eat. Supplements like mirtazapine may increase appetite. Multiple small meals and different food textures can also help. Track your cat’s weight and report significant changes to your vet. Getting calories however you can is most important.
Prognosis
The prognosis for cats with kidney disease depends greatly on whether they receive treatment or not. Without treatment, cats with kidney failure typically only live for a few weeks to months after diagnosis. However, with proper treatment and management, cats can live comfortably with chronic kidney disease for months to years.
While kidney disease is a progressive condition that cannot be cured, treatment aims to slow its advancement and manage symptoms. With medications, diet changes, intravenous fluids, and at-home care, many cats go on to live happy lives for years after their diagnosis. According to one study, the median survival time for cats with chronic kidney disease receiving standard treatment was over 2 years.
However, the prognosis depends on the stage and progression of the disease. Cats diagnosed earlier, before the disease has progressed too far, tend to respond better to treatment and live longer. Regular vet checkups and bloodwork allow early detection and intervention. Working closely with your vet is key to successfully managing this chronic condition and maintaining your cat’s quality of life.
Source: JustAnswer
When to Say Goodbye
As kidney disease progresses, your cat’s quality of life will deteriorate. It’s important to watch for signs that your cat is suffering or in significant pain. According to PetMD, common signs a cat is nearing end-of-life include [1]:
- No interest in food or water
- Difficulty standing or walking
- Lethargy and lack of interest in surroundings
- Vomiting or diarrhea that does not respond to treatment
- Significant weight loss and muscle wasting
As a pet owner, you know your cat best. If your cat seems to have lost joy and comfort in day-to-day living, it may be time to consult your veterinarian about end-of-life care. Your vet can help assess your cat’s pain levels and quality of life. They can also guide you in making the difficult decision around euthanasia. According to Emergency Vets USA, signs it may be time for euthanasia include [2]:
- Your cat is in constant pain that cannot be managed with medication
- Kidney values rapidly deteriorating despite medical treatment
- Your cat has lost significant weight and muscle mass
- Persistent vomiting, diarrhea or anorexia
While a very difficult decision, euthanasia can be the final act of love and kindness we give our pets. Your vet can help you determine the right time to say goodbye based on your cat’s condition and quality of life.