My cat has kidney disease

[Anonymous]

My sweet 13 year old cat had been acting funny over the last week. She disappeared into the basement for several days without coming out (she may have been eating/littering, but I couldn't tell) and then she emerged and seemed to be doing okay. But then had several episodes of vomiting. We noticed that there was less food consumed from the food bowls she's been sharing with her brother, but weren't sure how much she was taking in. I did notice she was having this odd reaction to water sources in that she wants to sleep in the tub/sink, and be there anytime we ran the water. She's had a similar episode in the past but our vet at the time couldn't figure out what was going on with her. She recovered quickly that time and I didn't give it much thought until last night. Yesterday we took her to our new vet (we've moved) and he knew right away.

She's still purring and able to get around around (although wobbly), but she doesn't seem to be eating or even drinking much. She's hypothermic and shaking much of the time and crawls out of any blankets we give her. She seemed to respond a little to the subq fluids, but continues to not eat. She's still urinating, but no BM. She's still dry heaving but nothing is coming up. She enjoys being petted though and seems to want to spend time with us and her brother (although he's not a very intuitive cat). She's unable to groom. She is able to go up and down the stairs okay.

She's beautiful still, even though she's lost some weight (she's always been on the low side). I wish we could afford to take her to the emergency vet for the IV fluids and boarding, but we are expecting baby number 2 and are already low on money and I honestly don't think it will prolong her life drastically.

DH is not ready to euthanize and I keep thinking about how she's bounced back in the past. I've read about giving subq fluids at home and I"m happy to do that, but my concern is that she's not eating and some sort of underlying pain. Are we doing the wrong thing by keeping her alive? Am I being too quick to jump to euthanasia? It's just that 2 weeks ago she seemed fine! She's always been low weight. Anyone have positive stories?

[Anonymous]

Aw, sorry, that is really sad. Poor kitty. Sounds like her quality of life is significantly diminished at this point.

Did the vet give you any hope that she might improve after a few weeks of subcutaneous fluids and extra external water sources (cat fountain, wet "kidney-friendly" food)? Did the vet give you the stage of kidney disease?

[Anonymous]

He didn't give us the stage, he didn't even do blood work, he said she had the classic signs and it wouldn't change his management. I appreciated the honesty. When I got home I researched it and he was right. He told us to come back today and he'd see how she did overnight. I do think she looks a tad better and she seems to attempt to lick water. But still very weak. I just want to make sure she's not in any pain. She's not having seizures, which comforts me.

[Anonymous]

I'm sorry you're kitty isn't doing well.

So what course of treatment is the vet recommending? Was it just the subq fluids and come back in the morning? I think a lot may depend on what the vet says today.

Its always hard knowing when its time to let go. Some people say you will know when its right -- but that isn't my experience. Be honest with your vet and don't be afraid to ask directly about euthanasia. I think vets don't usually want to bring it up even if they think it may be the right course of action. They wait for the pet owner to mention it first.

[Anonymous]

Are you doing the subcutaneous fluids at home or only at the vet's office? Any good vet will sell you a bag of fluids and an IV set up so that you can do them on a regular schedule. It is not expensive and not hard to do.

[Anonymous]

In the meantime can you try to get more fluids into her by syringe (the pet med kind, not the needle kind)? I did that for a few days once when my cat was dehydrated and having trouble urinating after surgery. It's obviously not a long term solution but might help a little.

[Anonymous]

No stage info from vet? No bloodwork? Did you refuse it?

You need to get to a new vet. Our cat is on blood pressure meds for kidney disease and has a low protein diet - very important for this. Stage 2 can last years if managed well. Our cat is blind due to complications from KD but manages well.

[Anonymous]

OP, one thing that sometimes helps kidney disease kitties is giving them extra potassium. You can google it, but our vet has us giving 1/2 a 50mg tablet of potassium gluconate every other day. The change in our guy was amazing.. the first day, we thought we were going to have to euthanize as he couldn’t hold his head up. That actually resolved within 24 hours, and his strength is improving daily (he’s only just been diagnosed with CKD at 18).

If youre not sure about if your cat is eating, that’s a bigger issue. Separate the two casts if y8u have to. There are “lickable treats” you can get now, which are in essence the gravy part of wet food. It may help stimulate your cat’s appetite back. I’m not sure if you know, but not eating with cats become a cyclical problem as it causes liver and muscle wasting, which further depresses their appetite. Get calories in, even if it’s not a therapeutic renal diet (lower protein, low phosphorus) if you can.

[Anonymous]

Thanks everyone for the kind comments and suggestions. I did end up refusing the bloodwork as the vet seemed really confident and also her symptoms seemed to match the end of life for kitties with kidney disease. It's just a little strange that it seemed to have really presented itself in the last few weeks (she had had an episode several years ago that another vet never diagnosed- but she recovered within a day or two and so I didn't pursue it).

We feel a lot of guilt for not recognizing it faster (we noticed less food missing and her seeking water, but couldn't pinpoint if one cat were just eating a little less or they didn't like the food). Maybe I will ask for the blood work to be taken. Right now we're just keeping kitty in the bathroom with the space heater at night (she was really hypothermic on the first vet visit). She's licking at water/milk, but doesn't seem to take much in. I'll ask about the home subq fluids and potassium. Anything to make her at least feel better. She just is keeping her head low and is staggering quite a bit.

I did notice that she's vomiting again - which I assume is bad. she had some snot yesterday and she is peeing, so either she's just draining of the subq fluids from the vet or maybe she is drinking something?

I will also point blank ask about euthanasia. I asked yesterday about how much longer she can go without food and the doc said only a couple more days. I just had to let that sink in a bit.

Ugh, I hate this for my sweet kitty.

[Anonymous]

I am so sorry about you baby OP. I went through this with my cat about a year and a half ago. He showed no signs until both kidneys were shutting down. We went into the vet on Wednesday when he seemed lethargic and they did some tests that showed kidney disease. On Friday he curled up in the corner and stopped eating and drinking, I admitted him to the animal hospital and we put him down Saturday. It was horrible at the time, but at the same time he never really suffered. They got him on pain meds and they gave him euthanasia while I held him in my lap with his favorite blanket and toy. I'm thinking of you and your kitty.

[Anonymous]

Op, sorry to hear your cat is going through this. I know you refused blood work and your vet seems to think your cat is close to end stage but please know that this can be a manageable disease. My cat was diagnosed with kd 5 years ago and has been stage III for the past couple years. I had no idea there was anything wrong until one day he refused to eat and was throwing up and very lethargic. I also thought he was in his end stages and took him to the ER and multiple vets. If your cat is still throwing up and refusing to eat it's worth it to ask your vet to prescribe anti nausea medicine. Also, the vet recommended we give our cat a quarter tablet of Pepcid AC. We ended up giving him the anti nausea, Pepcid ad and mirtazapine (an appetite stimulant) and it worked wonders. The key is to get him eating again. Once he started eating again he bounced back quickly. we administer subq fluids 2x a week and he is otherwise a normal cat.

[Anonymous]

Op again, this is a great resource for kd cats http://www.felinecrf.org/

[Anonymous]

My cat was diagnosed earlier this year. I give her the sub-fluids daily, along with a quarter Pepcid for nausea. Ask your vet about doing the fluids at home. It's not expensive at all and easy to do, and really makes the cat feel better.

[Anonymous]

Oh, OP, I'm sorry. It's tough, and it's possible to keep them going for a while with fluids/meds, but it sounds like perhaps the disease has progressed pretty far.
Also it depends a lot on how your cat tolerates the fluids and pills.

It is true that at-home fluids are pretty easy, scary as it sounds.

Regardless of how things go, you're doing the right thing to keep her comfy.

[Anonymous]

Hi, I have had great success keeping my cat alive and happy with kidney disease for the past year. (My cat is now 16 1/2. He began declining rapidly over last year's Thanksgiving holiday. I never dreamed he would make it to January. And here we are in November and he has been stable ever since his crisis last November!)

As others have said, the key to long-term management of kidney disease in cats is:

* subcutaneous fluids:
We have been giving 150 ml nearly every day. After several months, the vet said we could try cutting back to alternate days, but I didn't want to risk it. This means that my cat pees a LOT because of all the extra fluid. But the extra fluids help to keep flushing toxins out of his system and keep him hydrated. With kidney disease, the cat loses the ability to make concentrated urine. So they become dehydrated very easily. That is why your cat was staying near your water supply. We also found it helpful to set up one of those pet water fountains; our cat seems to love drinking from it.

* nausea management and appetite stimulation:
Pepcid: At first we used the expensive veterinarian-prescribed anti-nausea medicine, but when that first batch ran out, we switched to 1/4 tablet of Pepcid AC once a day. Now after a year, my cat has lost a bit of the weight he had regained, and he seems to be throwing up occasionally again, so the vet suggested we try increasing the 1/4 tablet Pepcid to twice a day.

appetite stimulant: We give a very tiny dose on alternate days (or sometimes every third day), because the vet explained that the pet needs time for it to clear out of his system. For some reason, it costs much more for 7.5 mg tablets than 15 mg tablet. The vet prescribed 1/4 of a 7.5 mg tablet per dose (once every 2 or 3 days), but instead, we found a much less expensive source for 15 mg tablets. That means we have to somehow cut them into 1/8 tablets! I have to get very clever with my pill cutter, and we end up sometimes with slightly larger or tinier bits.

My cat sometimes "cheeks" pills and later spits them out, but my neighbor is great with giving pills and I've learned from her. It helps to tuck the cat under my arm while he is sitting on a couch or even on the counter, and then stroke his chin with my other hand so he lifts his head way up to enjoy the stroking, and when he does that, he can't clench his teeth together, and also his throat is wide open and straight, so while his mouth is straight up and he is relaxed, I suddenly press on the sides of his mouth so it opens, and then I toss the pill (or both pills if it's one of those days) back as far as I can to the back of his mouth, and I keep stroking his chin and wait for him to swallow. If he starts using his tongue a lot, I think he's moving a pill around, so I check inside his mouth and also between his teeth and cheeks to make sure he didn't hide it.

After Thanksgiving last year, my poor cat was so sick he could barely walk (staggering). His kidney function numbers were so bad the vet was amazed. (Like, a normal level is under 2 or something like that, and my cat's number was 13. The other measure was similarly awful. The vet surmised he had a kidney infection along with kidney disease. So he was put on antibiotics, too.) A couple of days of IV fluids while boarding at the vet barely helped at all. But what with that and anti-nausea meds and antibiotics and tempting wet food, at least he started eating again.

What really helped get his numbers down, though, was the consistent subcutaneous fluids given at home. The sky-high number was down to 6 within a few weeks, and in the 4 range a month after that, and entered the 3 range after some months, where it has remained.

I urge you not to write off your cat! Our cat has had an extra year of a very happy life and is still going strong. I have no idea how much time he has left, because he has a heart murmur too (being an old cat), and the extra fluids might make extra work for his heart, but at least for now, he is doing great; he's had the strength to leap up on the counter starting several weeks after we began treating his KD; his purrs and curiosity and love of the great outdoors let us know he is enjoying life. Last November he was clearly feeling miserable. But he rebounded quickly.

If you do start giving subcutaneous fluids, start out with stuff from the vet but then call around to local pharmacies and check online pet supply sources, because our vet's fluids were quite pricey compared to other sources we have found. But our local source went out of business and I'm paying about twice as much to get the fluids online. I'd love to know a good recommendation and price for the fluids, from anyone who has been through this. Thanks!

Good luck OP - hope your cat responds as well as ours did!