First, I want to say I am not a Veterinarian. I do not have any Veterinary training. I am just a geeky, over analytical cat owner who reads too much :)
This diary is a story about my recent journey with my 13.5 year old kitty Cleo and her diagnosis of both arthritis and early stage renal insufficiency. This diary isn't intended to provide Veterinary advice, but it will contain information about Cleo's diagnosis and treatment. Please do not change anything you are doing without talking to your Veterinarian. Also, I want this diary to be a place where everyone feels free to talk about their experiences whether related to kidney disease or another pet issue (cats or dogs!).
This journey started in mid-January. I noticed Cleo would sometimes hold her paw up when drinking water. I thought "Did she hurt her paw?" I then noticed a limp. I went to the Vet who did a "lameness exam." The Vet said it wasn't her paw but her elbow- she had decreased range of motion and bony changes to both elbows. The X-Ray confirmed mild to moderate arthritis in both elbows.
That experience made me realize Cleo is now considered a "geriatric" cat. In the past she never needed any Veterinary care besides routine dental cleanings. I never took her in for routine wellness exams. I began to wonder if I should now that she's older? Our pets age several years in one human year. - here's a pet age calculator.
Then Sara wrote her heartbreaking diary. I googled "cat kidney disease" and found this excellent website by an all cat Veterinary clinic. This paragraph under Stage II Late Stage renal insufficiency got to me:
About the only symptoms you may see in your cat in this stage are maybe a little more water intake, and a little more urine output. We may also start to see hypertension in cats at this point
In other words, if your cat is at this stage an owner may not notice it or may dismiss it as insignificant? After all, it says "a little more water intake" and "a little more urine output" not a lot. I think many pet owners including myself would not notice or would dismiss a modest increase.
This really convinced me there is benefit to routine wellness exams in an older pet. Why? Well, early detection usually has a better prognosis and is less expensive than responding to a crisis.
Also, the article points out that chronic kidney disease is a slowly progressive disease and doesn't show up in bloodwork until 2/3 to 3/4 of kidney function is lost. I also noticed that chronic kidney disease is divided into 4 stages, and to illustrate how gradual it progresses the time frame between stages can be several months or even years!!!
And chronic kidney disease is also a leading killer of older cats - link
I went back to the Vet for a follow up on the arthritis, and asked if I should have a routine wellness exam done including bloodwork. She thought that was a great idea...
Unfortunately, the blood work did raise questions about early renal insufficiency. The kidney related blood work was as follows:
Creatinine 2.9 (normal .8-2.4) HIGH
BUN 34 (normal 16-36)
Phosphorus- 3.4 (norm 3.1 to 7.5)
Calcium 10.8 (norm 7.8 to 11.3)
RBC 5.81 (norm 5-11)
HCT 30.3 (norm 25-45)
Glucose 129 (normal 71-159)
USG or Urine Specific Gravity 1.020 LESS THAN IDEAL
The Creatinine reading alone put Cleo in early Stage 3, but this was inconsistent with the rest of the blood work. For example, her BUN and electrolytes were all normal. The Vet said a cat's USG should be 1.035 or above, but 1.020 was not kidney failure which would be 1.008 to 1.012. I replied so would it be fair to say 1.035 or above is a green light, and 1.020 is a yellow light and 1.008-1.012 a red light? She thought this was a good analogy.
The Vet felt we needed to recheck the blood work before reaching any conclusion so that's what I did. I got very worried. Well, my kitty that nothing ever goes wrong with had two things go very wrong all in one month! Also, I have a needle phobia and I was reading all these articles about having to administer Sub Q fluids at home. I know the idea of having to give Sub Q fluids at home might not stress everyone, but it really would me. I didn't know what this would all involve or what it would all cost.
The recheck was as follows:
Creatinine 2.3 (norm .8-2.4) so now a high normal
BUN 41 HIGH (norm 16-36) so her Creatinine went down, but her BUN another key kidney enzyme went up and was now mildly elevated.
Phosphorus - 3.6 normal
Calcium 9.8 normal
Potassium 3.7 normal
Sodium 151 normal
RBC red blood cell 7.2 normal
HCT 34.0 normal
USG 1.017 (again below 1.035 but not kidney failure so in yellow light category).
The Creatinine came down some and was now a high normal, but there was now a mild elevation in her BUN (another very important kidney function enzyme). The USG was still not ideal. In light of these results, the Vet started Cleo on a "renal protective diet" which would be Hills Feline K/D. Also, I am to go back in 3 months for a follow up visit. She didn't say anything to me about giving Sub Q fluids at home. I assume this is because Cleo isn't anywhere close to that point.
The purpose of a renal protective diet is to reduce the workload on the kidneys and thus maximize the kidney function that remains. The food is lower in protein, phosphorous, and sodium. I guess just like a person with kidney disease shouldn't eat pepperoni pizza due to sodium Cleo shouldn't eat the cat version of pepperoni pizza! While some cats will not eat the renal foods, she is eating both the wet and dry K/D no problem at all. I figured she would because in her life she's never refused to eat any food.
Do the renal diets help? I found this on a web site Veterinary Partner:
A study of 50 cats with stable, naturally occurring renal failure were divided into two groups, one receiving a renal diet and the other receiving regular food. The cats on the renal diet survived over twice as long as the others.
Clearly there is tremendous benefit to the patient in switching to a therapeutic renal diet. Unfortunately, these diets tend to be more bland than what the pet may be used to and they are not always acceptable to the pet.
The Veterinary Partner website also addresses the question of when a cat should be started on a renal food. Evidently, Veterinarians aren't 100% in agreement here which happens in any profession:
This question has been controversial for a long time.....Now the International Renal Interest Society finally has guidelines. For cats, the diet should change when the creatinine reaches approximately 2.0 mg/dl (middle Stage II renal failure).
The Veterinary Partner site also has a paragraph on home cooked renal diets if anyone is interested.
I also notice that Stage 2 at Creatinine 1.6-2.8 overlaps with some higher normal values.
In reading, I learned there are people who don't believe in feeding the kidney diets at all. I've chosen not to follow that path.
The other key in treating chronic kidney disease is hydration. That's why I was told to feed some if not all wet food (wet food is 80% moisture), and if I feed dry to add water. The Vet also told me pet fountains can encourage a cat to drink more water. I'm under the impression if you can't adequately hydrate the cat via its food, adding water to food, pet fountains, and having multiple water dishes out then Sub Q fluids will be necessary?
I'm feeling hopeful! I am hopeful because I'm feeling I caught this early. I'm hoping the prescription diet will slow this down and that I will have many more happy years with Cleo! She still has a good quality of life despite the arthritis and early renal insufficiency.
In addition, I'm told if she's not herself it is probably the arthritis and not the kidneys. I get the impression the renal insufficiency is so early she doesn't feel sick.
As I said, I don't want this diary or any web site to be a substitute for Veterinary care or talking to your Veterinarian. This diary is about my journey. It is possible your journey with your pet should be different.
In closing, I want everyone to feel safe sharing their experiences and concerns here. Yes, people may have different opinions on what treatments or options are best. I just ask we all respect each other!
Finally, I know there are people out there who couldn't spend any money on Veterinary care. If they were in my shoes, they couldn't do anything about it. I want those people to feel free to participate here and tell their stories!
P.S. In the comments, Avilyn pointed out another great resource - Tanya's Comprehensive Guide to Feline Chronic Renal Failure. That resource can be found here
