Feline Kidney Disease

Feline kidney disease is common in elderly cats, yet I’d never heard of it until I had elderly cats (elderly is often defined as 10  to 12 years and older). In January 2014, my beloved Alegria died of kidney disease at age 18. And now my sweet Sarafina has just been diagnosed. She’s ten.

On Monday, my husband and I dropped Sarafina at the vet’s for a dental cleaning and exam. The doctor called about two hours later; odd, since she was supposed to be there all day.

“We did her blood work before anesthesia,” Dr. Cody explained, “and her kidney levels are very high. She has kidney disease.”

My stomach dropped. Dr. Cody is new to the practice; he didn’t know about Allie. “Our other cat died of that earlier this year,” I said softly.

“Oh, I’m so sorry,” he said, and then went on to tell me more about Sarafina. Her kidney levels (creatinine is what’s measured) were double what they were a year ago, higher than Allie’s had ever been; her potassium was low; she’d lost three pounds in seven months (nearly 30% of her body weight). She would stay for the rest of the day to receive more fluids.

I asked the doctor if there was something in the environment; meaning, of course, what could I have done differently. While it’s possible a rare toxin caused kidney disease in both cats, it’s highly unlikely, he said. Kidney disease is just really common in elderly cats. And I have/had elderly cats.

The ASPCA explains:

Kidney disease is most prevalent in older cats, but can occur in cats of any age. Cats can be born with abnormal kidneys that never function properly. Some breeds, like Persians, are predisposed to such hereditary kidney problems.

Additionally, outdoor cats run the risk of acute problems because they have more chance of exposure to toxins that can cause kidney failure, namely antifreeze.

Yet one more reason to keep cats indoors.

Dr. Arnold Plotnick writes that:

Chronic renal failure (CRF) is a common cause of illness in cats, especially in older cats, and the incidence of CRF is increasing. In 1990, there were 45 cases of CRF for every 1000 cats admitted to veterinary teaching hospitals. In 2000, the number increased to 96 cases per 1000 cats.

A more recent study suggests 1 in 12 cats will develop kidney disease. The American Assoication of Feline Practitioners estimates 49% of cats older than 15 will have kidney disease. Prognosis ranges from 6 months to 3 years, depending on the severity of the disease when it’s found. Alegria lived for about a year and a half after diagnosis.

The most difficult aspect to face is that there’s no cure. Kidney disease is ultimately fatal. All an owner can do is try to make the cat comfortable. Sarafina, for example, had always been obese. Now, after losing so much weight, she can eat whatever she wants: that she eat is the more important thing.

Kidneys regulate waste; we all remember that from high school biology. Part of that process is removing excess salt; low or non-functioning kidneys leads to more salt which leads to higher blood pressure. Additionally, kidneys process vitamin D and calcium.

How to prevent it? To prevent acute (abrupt) kidney failure, keep cats away from toxins such as antifreeze and lilies, and keep an eye on kitty if there is shock or an infection. There’s no prevention for chronic (long-term) kidney failure. Chronic kidney failure could be the result of past injuries… or genetics… or something else. Long-haired breeds seem to be more susceptible; Allie and Sarafina are far from pure-bred, but they’re both fluffy kitties. There might be a link between periodontal disease and kidney disease as well, but so far the findings aren’t clear. Sarafina has had problems with her teeth in the past, so perhaps that is a contributing factor in her case.

There’s rarely just one “aha!” symptom; usually it’s a collection confirmed by blood and urine tests. Alegria displayed several classic symptoms (vomiting clear liquid, patchy fur) that I didn’t pick up on because I didn’t know. Sarafina, I see now, had a few symptoms that I could easily chalk up to other causes. To wit:

• Sarafina had stopped eating her dry food. Since she still ate wet food and crunchy treats, I assumed the issue was the food (had it gone stale?). But lack of appetite is one symptom.
• Her breath smelled bad. To put it delicately, Sarafina has always been a smelly cat. And her breath didn’t smell like ammonia, as Allie’s had. It just smelled gross, like cat food. But bad breath and body odor are another symptom.
• I could tell she had lost weight, but I didn’t realize it was so much. Add to that, she’s been obese and we’ve been trying to get her to lose weight.
• I realized I hadn’t seen her drink much water.
• Other symptoms include drinking and urinating excessively… or not drinking and not urinating.

Treatment ranges from a change in diet (to a lower protein diet), medication (especially for related problems like high blood pressure), subcutaneous fluids, and even dialysis. We changed Alegria’s diet but didn’t do much else given her already advanced age. Since Sarafina is only ten, and has been in very good health until now, we will probably pursue more aggressive options. Her creatinine levels are at 4.1%, which is right on the edge of “with treatment, can live happily for several more years.”

Sarafina is home now. She is busy exploring the house, making sure we didn’t change anything while she was gone. She’s had wet food and treats and new toys. Her main concern is getting her bandage off (from the IV). She’ll see the vet again in a few days. We hope, of course, the fluids, medication, and diet will have made a difference.