Feline Chronic Renal Failure

by Mewsette

Feline Chronic Renal Failure, or CRF, is more commonly called kidney disease. It is said to be the second leading cause of death in cats (after accidents!) and the number one cause in older cats, but it can strike a cat of any age.

Our kidneys have many important functions that are critical to our health, but in CRF they are no longer functioning well. With this disease, the kidneys cannot eliminate wastes the way they need to, and a buildup of toxicity develops which is eventually fatal. There is no cure for CRF because once kidney function is lost, it cannot be restored.

That's why it's very important to have bloodwork done by the vet at our annual checkups when we get older. High levels of BUN (Blood Urea Nitrogen) and Creatinine in the blood are the main indicators of kidney disease. Outward signs of kidney problems are usually not seen until the disease is very advanced. By the time CRF is diagnosed, a cat may have lost 75% or more of kidney function. It is not even possible to diagnose until a lot of kidney function is lost. Many cats are not yet critical at this stage. The disease may progress slowly in some cats, and quickly in others, especially very old cats.

  Symptoms

Signs of kidney disease or failure include: greatly increased water drinking and urinating, loss of appetite and nausea, sudden weight loss, vomiting, especially clear foam and immediately after using the litter box, urinating outside the box, flaky dandruff in the coat; chronic constipation; hunching over the water bowl; a stiff gait or stumbling and lack of coordination; urea odor on the breath, lethargy, weakness, anemia and dehydration. Most of these things can indicate other diseases or problems as well. That's another reason bloodwork is so important.

Cats with CRF can no longer concentrate the urine, so it is very dilute, light in color and odor, and produced in huge amounts. The cat drinks more, trying to compensate for all that water loss, but may still become dehydrated. If you gently pinch up the skin and fur at the scruff of the neck, and it does not fall right back down, the cat is dehydrated.

Causes

We don't really know what causes kidney disease, but these are some probable causes indicated in the epidemic of it that we are seeing in cats these days:

A lifetime of a poor diet, overprocessed, low quality, and chemical additives in our food; exposure to toxins, such as chemicals in household cleaners, air sprays, formaldehyde in carpets, and toxic pesticides; genetically weak kidneys; and simply deterioration from aging. There are many possible contributing factors and no real agreement on what those factors are.  

Treatment and management

Treatment for CRF is meant to retain the remaining function of the kidneys as long as possible. Good management can slow the progression of the disease, greatly increase the cat's comfort and quality of life, and even prolong life. It is very important at this time to have a vet who is knowledgeable in the management of CRF, even if it means changing vets. And the more your human learns about CRF, the better she can help.

Most vets recommend prescription food which is low in protein. The thinking behind this is that the kidneys work harder to process protein than other parts of the food. Cats have a greater need for protein than other animals do, and some feel that the quality of the protein is more important. The diet needs to be very low in phosphorus, because high levels of phosphorus damage the kidneys further. It is best to read the labels of prescription food carefully, just like any other, to see what's in it that may add to the toxins the cat cannot handle. There are many brands of reduced protein and low phosphorus food available, both prescription and not.

A CRF cat is usually deficient in potassium, which can make her feel more sick and weak. If the blood potassium tests low, a supplement may be given every day, in gel or tablet form. This must be a veterinary supplement, not a human one, and be the correct type of potassium. You should get it from the vet. Antacids in very small doses may help if the cat is too nauseous to eat. Phosphate binders help carry the phosphorus in the food out of the body so it doesn't do as much damage. Sometimes when the cat won't eat because she can't smell her food, a veterinary antihistamine is prescribed. No drug is without risk, and all of these should be discussed with the vet.

If the cat becomes dehydrated, subcutaneous fluid treatments may be needed. This is fluids run under the skin with a needle, to bring the cat's fluids up to a safer level and help eliminate toxins. These fluids may need to be given every day, and the vet will show the cat's human how to do this at home.

Your vet should also test for hypertension. A high percentage of CRF cats develop hypertension, leading to further risks, but this can often be controlled with medication.

It's very important to have plenty of fresh water, and to keep the cat eating, if not the best thing, eating at least something. Brush her often to get the flakes out of her coat (which are toxins released through the skin). Keep her warm and comfortable. The cat will have good days and bad days while battling this disease, but good management can give her more good days than bad for a long time. And she's worth it.