Kidney disease in cats

Kidney disease is most common in middle-aged and older cats

The most common causes of premature disease and sometimes death in cats are cancer and kidney failure. With regard to kidney disease, our discreet felines often exhibit only very subtle if any signs of early kidney problems, making early diagnosis sometimes difficult. While kidney disease can occur in a cat at any age, it’s most common in middle-aged and older cats. Causes of acute kidney failure most commonly include acute infections, toxic exposure and certain drugs such as the use of nonsteroidal anti-inflammatory drugs such as aspirin, Tylenol (which can kill a cat), and even on occasion prescription Metacam.

These cats typically present acutely ill with recent history of drug exposure. The more common diagnosis of chronic kidney disease certainly presents a more difficult diagnostic challenge. While infections, reactions to drugs, chemicals and/or vaccinations can be involved, in the vast majority of cases, conventional veterinarians rarely find out the cause of chronic kidney failure, often leaving us with palliative management at attempting to preserve kidney function and slow down kidney decline. However, once elevations in blood creatinine and BUN (blood urea nitrogen) occur in cats with chronic renal failure, greater than 80% of kidney function has been irreversibly destroyed when the disease is often first detected, which makes long term management much more difficult.

The diagnosis of chronic kidney failure in cats is based on a combination of blood work, urine analysis, and potentially urine culture and ultrasound done at the veterinary office.  Once diagnosed, attempts are made to slow down kidney decline and metabolic complications. Secondary urinary infections are treated with antibiotics. High blood pressure is treated with drugs like Amlodipine. Low protein and low phosphorus diets are fed to ease workload on the kidneys, preferably homemade, but there are commercially available diets as well. Some veterinarians will prescribe appetite stimulants and anti-nausea drugs such as Cyproheptadine, Pepcid AC, Metoclopromide, and Mirtazapine. Because elevations of blood phosphorus occur, many veterinarians will prescribe phosphate binders such as Epakitin to be given at mealtimes. There has been some excellent clinical responses of cats with kidney disease to the probiotic Azodyl, as well which seems to draw the toxins of kidney failure right out of the blood into the digestive tract.

Many cats with chronic kidney disease benefit from receiving subcutaneous fluids under the skin at home several times weekly, which can be easily taught to the pet owner by the veterinarian or veterinary technician. Rarely, some animal guardians will see if their pet is a candidate for kidney transplant. Limitations here include limited facilities across the country that provide this service, VERY high cost, as well as risk of donor kidney organ rejection in the sick patient. Holistic veterinarians will often prescribe nutritional supplements, herbs and/or homeopathic remedies in helping the feline cope with this very difficult disease. The best thing guardians can do is be aware of the early signs of kidney disease in cats. These include:

  • Increased thirst/urination
  • Subtle weight loss
  • Nausea, vomiting
  • Drooling from oral ulcers
  • Loss of appetite

With routine annual to semiannual exams, blood work/urine analyses and blood pressure measurements, kidney disease in cats can be detected early. And with early detection the disease can often be better managed for an improved and enhanced quality of life for your cat.

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  1. Hi Dr. Dym,
    Have you ever read this article about the controversy of protein restriction?:

    Protein restriction with kidney disease is controversial and may not always be beneficial, especially with cats. Reducing phosphorus (with binders), which can be found in higher levels in meat, can be helpful to cats with CRF. There are vets now who are questioning this whole “low protein” dietary approach to cats with kidney disease. Protein deficiencies can create more problems. Cats, especially, need protein to thrive, and during illness it’s needed for repair and recovery. I am speaking to cats here (my interest) – though the article I linked also points to issues with using low protein with dogs. This whole focus on low protein also seems to have made some people mistakenly assume that higher protein diets contribute to the development kidney disfunction/disease. Also wet food is always important for cats with kidney concerns and in general. 🙂

    Just some thoughts I wanted to share. I enjoy reading your well-written articles.

  2. Dr. Michael Dym, VMD veterinarianJune 11, 2011 at 3:14 pm

    You are very welcome. Spread the word about these blogs.

  3. How do you know if a cat has primary hypertension when no other diseases are present and a cat is afraid even at home if a stranger comes over? How do you prevent hypotension if you attempt to treat for hypertension and the cat actually has white coat syndrome?

  4. Dr. Michael Dym, VMD veterinarianAugust 13, 2012 at 12:11 pm

    Hypotension is usualla not a clinical problem in veterinary practice. Primary hypertension is diagnosed when other causes of hypertension i.e hyperthyroid, kidney disease, etc are not present as determined by a blood workup.

  5. Kidney and hyper-t ruled out. Worried will become hypo if left on amlodipine but worried that might have stroke or go blind if he is hypertensive. How do you get true reading in a very shy cat?

  6. Dr. Michael Dym, VMD veterinarianAugust 14, 2012 at 6:51 pm

    Hard to get accurate reading in some cases. I dont think low blood pressure will be problem on amlodipine in most cases.

  7. My cat has had crf for over a year and a half, My vet told me there was nothing I could do. I went to only natural pet products and got a detoxifier 3 drops in his mouth a day helped with him peeing alot and kept him from loosing all his water all the time, I also have him on a capfull of baby pedialite mixed with his food. He eats great and looks alot better a year and a half later maybe it might help yours. No treats (never) it was not good for my cat I also use wet purina one urineary track food chicken and tuna. Mixed with the capfull of the pedialite.. Hope this helps you also

  8. Dr. Michael Dym, VMD veterinarianJanuary 21, 2013 at 1:30 pm

    HI Sandra. Thanks for sharing your wonderful success story.

  9. If you can afford it, a mobile vet who comes to your home may be the answer. They don’t wear white coats and it is in a familiar environment. My vet charges $30 to come to my residence.

  10. Dr. Michael Dym, VMD veterinarianMay 20, 2013 at 11:26 pm

    House calls are indeed much less stressful on feline companions

  11. Now the creatinine has gone from 1.6 last June to 1.8 in Feb. to 2.0, The USG is 1.047 but +2 protein. One vet says no need for urine/creatinine ratio test due to high USG. I am worried.

  12. Dr. Michael Dym, VMD veterinarianMay 23, 2013 at 11:11 pm

    I would put cat on a preferably a home made raw meat based diet as described in books The Natural Cat By Anitra Frazier, or Dr Pitcairns guide to natural health for dogs and cats by Richard PItcairn, dvm, phd where there are kidney diet recipes. I would also use kidney supplements like feline renal support from company called Standard process which you can find on line. Also consider working with a holistic vet to improve overall health

  13. Does 800 pets meds have subcutaneous fluids?

  14. Dr. Michael Dym, VMD veterinarianAugust 12, 2013 at 11:26 pm

    I would check with 1800petmeds pharmacist Eddy

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