Monday, January 12, 2015

Flooding the Litterbox: Chronic Kidney Disease and your cat


Before we re-write the book on Chronic Kidney Disease, please note that there are two extremely thorough and excellent resources for people with cats that have Chronic Kidney Disease (CKD) that we would like to recognize: 

Feline CRF (Chronic Renal Failure) Information Center
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

What is meant by the terms “Chronic Kidney Disease” and "Chronic Kidney Failure"?

The term "chronic kidney failure" suggests that the kidneys have stopped working and are, therefore, not making urine.  However, by definition, kidney disease is the inability of the kidneys to remove waste products from the blood.  This definition can occasionally create confusion because some will equate "kidney failure" with "failure to make urine".  Kidney disease is NOT the inability to make urine.  Ironically, most cats in kidney failure are actually producing large quantities of urine, but the body’s wastes are not being effectively eliminated. This is why many people avoid the term "kidney failure" and prefer "kidney disease". Because the kidneys are so efficient at their job and because cats are so adept at hiding their illnesses, it has been determined that a cat can lose up to 75% of normal kidney function before they begin to act sick. This is one reason that annual checkups with your veterinarian are so important!

There does come a point in CKD at which a cat's kidneys have been destroyed to the point where urine is no longer produced (anuria), but hopefully, the problem is recognized, discussed and treated before this is the case.

When is this likely to happen in my cat?

Commonly, chronic kidney disease is considered to be the result of aging - a “wearing out” process.  Most of the time, when chronic kidney disease is diagnosed, the cause is unknown. Biopsy of the chronic kidney usually results in a non-specific assessment called "chronic interstitial nephritis" - a hardening and inflammation of the filtration structures in the kidney. 

There are some known contributing factors to kidney disease:

  • Polycystic Kidney Disease:  an inherited disease seen in certain purebreds where one or more fluid-filled cysts start to gradually replace normal kidney tissue 
  • Kidney tumors: lymphoma is a common type of cancer seen in cats, and it can affect many different organs, including the kidneys. White Blood Cells called lymphocytes become affected and interfere with normal kidney structure
  • Infections: bacterial infection of the kidneys (known as 'pyelonephritis') may cause enough damage to the kidneys to cause CKD. Kidney infections are usually a complication of a long-standing, untreated urinary tract infection, but can occur more quickly in older cats with dilute urine, cats on immunosuppressive drugs, or cats with concurrent diseases such as diabetes or FIV.
  • Toxins: certain toxins and drugs can damage the kidneys - for example, cats that eat plants from the lily family, drink antifreeze or ingest pills from the pain-reliever family like acetominophen or ibuprofen
  • Glomerulonephritis: there are small filtration units in the kidneys called "glomeruli" that filter toxins from the bloodstream. These filters can become inflamed for a variety of reasons and if the inflammation is prolonged, this can lead to CKD
For most cats, the early signs occur at about 10-14 years of age. However, some cats may experience early onset kidney disease at 5-7 years or younger. About 20-50% of cats will be diagnosed with CKD at some time in their lives.

What changes are likely to occur in my cat?

The kidneys are the body's filters, removing toxins from the blood and excreting them in the urine. When aging causes the filtration process to become inefficient and ineffective, blood flow to the kidneys is increased in an attempt to increase filtration.  This results in the production of more urine.  To keep the cat from becoming dehydrated, due to increased fluid loss in the urine, thirst is increased so the cat drinks more water.  

Other job functions of the kidneys:
  • Maintaining hydration - the body's water balance
  • Maintaining balance of salts and electrolytes
  • Maintaining the acid balance of the body
  • Maintaining normal blood pressure
  • Producing hormones involved in calcium processing, red blood cell production, blood clotting and immune system health

Early signs of CKD:
  • increased water consumption (polydipsia)
  • increased urine production (polyuria) with or without litterbox avoidance
  • mild or gradual weight loss 

Signs of more advanced kidney disease include:
  • loss of appetite/severe or rapid weight loss
  • depression or lethargy
  • vomiting
  • diarrhea
  • poor coat
  • anemia
  • very bad breath (uremia)
  • occasionally, ulcers will be found in the mouth

Additionally, cats with kidney disease tend to have associated high blood pressure.

How is chronic kidney disease diagnosed?

The diagnosis of kidney disease is made by determining the level of two waste products in the blood:  blood urea nitrogen (BUN) and blood creatinine.  A urinalysis is also needed to complete the study of kidney function, with special attention paid to the "specific gravity" of the urine. Urine specific gravity is a measure of the "stuff" (such as proteins) in the urine that make it different than water. Since cats are descended from desert animals, they are very good at concentrating their urine - eliminating a lot of "stuff" and conserving a lot of water. Average specific gravity of cat urine is greater than 1.035, and may be as high as 1.060 if they eat a dry-food only diet. If the urine specific gravity drops below 1.035, it can be a red flag that indicates the cat is not concentrating urine well for some reason - for example: drinking more water than usual or losing kidney function. Comparing the BUN and creatinine levels in the blood to the urine specific gravity can be very informative to the veterinarian.

Although BUN and creatinine levels reflect kidney failure, they do not predict it.  A cat with marginal kidney function may have normal blood tests.  If that cat is stressed with major illness or surgery, the kidneys may fail, sending the blood test levels quickly into the abnormal range. Additionally, other factors can affect the body's BUN and creatinine levels, such as kidney infection, hyperthyroid disease, muscle loss, and anorexia (lack of food intake).

Since this is basically just a wearing out process, can it be treated with anything other than a kidney transplant?

Yes, it can. We must recognize that your cat’s kidneys have reached this point due to aging, so they will never be normal again, but many cats still have enough functional kidney tissue so treatment can be very rewarding.

Treatment generally has two phases.  If your cat has reach a crisis, the first phase is to “restart” the kidneys.  The cat is hospitalized and large quantities of intravenous fluids are given to “flush out” the kidneys.  This flushing process, called diuresis, helps to stimulate the kidney cells to function again.  If enough functional kidney cells remain, they may be able to adequately meet the body’s needs for waste removal.  Fluid therapy includes replacement of various electrolytes, especially potassium.  Other important aspects of initial treatment include proper nutrition and drugs to control vomiting and diarrhea.

There are some exciting new developments in diagnosis and treatment of feline chronic kidney disease that will hopefully be very beneficial when they become available outside of university research settings.

A newly discovered biomarker of kidney disease may provide earlier detection and allow for closer monitoring and better, earlier treatments.

Stem cell therapy has been showing some promise in treating feline kidney disease, too. The stem cells for this therapy are cultivated from the fat of young, healthy cats; donor animals are not harmed.

What can I expect from this phase of treatment?

There are three possible outcomes from the first phase of treatment:

1) The kidneys will resume functioning and continue to function for a few weeks to a few years. 
2) The kidneys will resume functioning during treatment but fail again as soon as treatment stops. 
3) Kidney function will not return. 

Unfortunately, there are no reliable tests that will predict the outcome. The best your veterinarian can
do is assess the response of the cat's blood values and attitude while hospitalized and draw on their experience as to whether they recommend continued treatment, and if so, how aggressive that treatment needs to be to keep your cat healthy. A close relationship with your veterinarian will help them design a continuing treatment plan to keep your cat feeling healthy for as long as possible. That plan will need to be continually adjusted based on your cat's progress.

 If the first phase of treatment is successful, what happens next?

The second phase of treatment is to keep the kidneys functioning as long as possible. This is accomplished with one or more of the following, depending on the situation:

1. A high quality diet.  This helps to keep the blood tests as close to normal as possible, which usually makes your cat feel better.  We can recommend a commercially prepared food that has the quantity and quality of protein needed by your cat.

2. Potassium supplementation.  Potassium is lost in the urine when urine production becomes excessive.  A potassium supplement will replace that loss.  Low potassium levels have been shown to further reduce kidney function.  This is the second reason that a potassium supplement is recommended.  Monitoring of your cat’s potassium will guide our decision to supplement.

3. A phosphate binder.  One of the secondary things that occurs in kidney failure is an elevation of the blood’s level of phosphorus.  This also contributes to lethargy and poor appetite.  Certain drugs will bind excess phosphates in the intestinal tract so they are not absorbed, resulting in lower blood levels of phosphorus.  Phosphate binders are helpful only when feeding a phosphate restricted diet, as there is far too much phosphate in a  “normal diet” for these binders to be of benefit.

4. Fluids given at home.  Once your cat is stabilized, fluids can be given under the skin (subcutaneously). This serves to continually “restart” the kidneys as their function begins to fail again.  This is done once daily to once weekly, depending on the degree of kidney disease.  Although this might not sound like something you can do, you will be surprised at how easily the technique can be learned and how well most cats will tolerate it.

5. A drug to regulate the parathyroid gland and calcium levels.  Calcium and phosphorus must remain at about a 2:1 ratio in the blood.  The increase in blood phosphorus level, as mentioned above, stimulates the parathyroid gland to increase the blood calcium level by removing it from bones.  This can be helpful for the sake of the normalizing calcium:phosphorus ratio, but it can make the bones brittle and easily broken.  Calcitriol  can be used to reduce the function of the parathyroid gland and to increase calcium absorption from the intestinal tract.

6. A drug to stimulate the bone marrow to produce new red blood cells.  The kidneys produce erythropoietin, a hormone that stimulates the bone marrow to make red blood cells.  Therefore, many cats in kidney failure have a low red blood cell count, anemia.  Epogen, a synthetic form of erythropoietin, will correct the anemia in most cats.  Unfortunately for some cats, the drug cannot be used long term because the immune system recognizes the drug as "foreign" and will make antibodies (immune proteins) against it.

How long can I expect my cat to live?

The prognosis is quite variable depending on response to the initial stage of treatment and your ability to perform the follow-up care.   However, we encourage treatment in most situations because many cats will respond and have good quality life for up to 4 years. 


  1. Dr Itua cure my HIV, I have been a ARV Consumption for 10 years. i have been in pains until i came across Dr Itua on blogs site.I emailed him about my details of my HIV and my location i explained every thing to him and he told me that there is nothing to be scared of that he will cured me, he gave me guarantee,He ask me to pay for items fees so when i'm cured I will show gratitude I did and giving testimony of his healing herbs is what I'm going to do for the rest of you out there having HIV and other disease can see the good work of Dr Itua.I received his herbal medicine through EMS Courier service who delivered to my post office within 5 working days.Dr Itua is an honest man and I appreciate him for his good work.My GrandMa called him to appreciate him and rest of my friends did too,Is a joy to me that I'm free of taking Pills and having that fat belle is a will understand what i'm talking about if you have same problem I was having then not now though.I'm free and healthy Big Thanks To Dr Itua Herbal Center.I have his calendar too that he recently sent me,He Cure all kind disease Like,Cancer,Weak Erection,Wart Remover,Hpv,Herpes,Alzheimer’s disease,Bechet’s disease,Crohn’s disease
    ,Cushing’s disease,Heart failure,Multiple Sclerosis,Hypertension,Fibromyalgia,Hiv,Hepatitis B,Liver/Kidney Inflamatory,Epilepsy,Blood Cancer,Prostate Cancer,Colo-Rectal Cancer,Brain Cancer,Lung Cancer,Infertility,Parkinson's disease,Schizophrenia,Lung Cancer,Breast Cancer,Colo-Rectal Cancer,Blood Cancer,Prostate Cancer,siva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic small-round-cell tumor Diabetes ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,measles, tetanus, whooping cough, tuberculosis, polio and diphtheriaAmyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
    Syndrome Fibrodysplasia Ossificans ProgresSclerosis,Seizures,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpe ,Copd,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
    Dementia.Fibroid,Diabetes,Dercum,Copd ,and also Bring back Ex Lover Back..Here his Contact Or Whats_app Number +2348149277967

  2. Thanks for sharing such beautiful information with us. I hope you will share some more information about kidney. Please keep sharing.
    Health Is A Life

  3. I am so happy, i never believe i will be this happy again in life, I was working as an air-hoster ( cabby crew ) for 3years but early this year, i loose my job because of this deadly disease called Herpes virus (HSV), I never felt sick or have any symptom, till all workers were ask to bring their doctors report, that was how i got tested and i found out that am HSV positive that make me loose my job, because it was consider as an STD and is incurable disease, i was so depress was thinking of committing suicide, till i explain to a friend of mine, who always said to me a problem share is a problem solved, that was how she directed me to Dr Isibor, that was how i contacted him and get the medication from this doctor and i got cured for real, I just went back to my work and they also carry out the test to be real sure and i was negative. Please contact this doctor if you are herpes positive  diseases his email is: 
    or his WhatApp contact +2348110493039

  4. Herpes Cure Testimony
    I was diagnose with Genital Herpes for the past 2 years and I have been searching for cure. I have several outbreaks on my back and it really affected me morally, I read a testimony on this platform of a lady from Nevada who was cured from Diabetes with doctor Nelson Saliu Herbal medicine including the doctor official email address. I contacted the doctor through his email, after much discussion and few questions he prepared the Herbal medicine and asked for my address which I received the Herbal medicine 3 days later and with his prescription I drank the Herbal medicine for 21 days. After concluding the herbal medicine I went for test and my IgG result was confirmed Negative with no trace of the virus on my blood. Contact doctor Nelson and be cured his email; or send him a whatsapp text +2348111067336
    He has Herbal cure for Diabetes, Hepatitis, Heart diseases.
    Hypertension, Alzheimer's disease, cancer, Strokes and Liver disease.

  5. I have been suffering from (HERPES SIMPLEX VIRUS) disease for the past four years and had constant pain. During the first year, I had faith in God that i would be healed someday.This disease started circulating all over my body and i have been taking treatment from my doctor, few weeks ago i came on search on the internet if i could get any information concerning the prevention of this disease, on my search i saw a testimony of someone who has been healed from Herpes Simplex Virus by this by Dr voodoo and she also gave the email address of this man and advise anyone to contact him for any kind of problem that he would be of help, so i wrote to Dr voodoo telling him about my (Herpes Virus) he told me not to worry that i was going to be cured!! Though i never believed it,, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over me as the Dr voodoo assured me, after some time i went to my doctor for test and it confirmed that i have be finally healed behold it was TRUE, So friends if anyone have such problem and need help contact Dr voodoo on his email: Add Dr voodoo on whatsApp +2348140120719

  6. Hello Everyone out there,I am here to give my testimony about a Herbalist doctor who helped me . I was infected with HERPES SIMPLEX VIRUS in 2012, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution out so that my body can be okay. One day I was in  the river side thinking where I can go to get a solution. so a lady walked to me telling me why am I so sad and i open up all to her telling her my problem, she told me that she can help me out, she introduce me to a doctor who uses herbal medication to cure HERPES SIMPLEX VIRUS and gave me his email, so i mail him. He told me all the things I need to do and also give me instructions to take, which I followed properly. Before I knew what is happening after two weeks the HERPES SIMPLEX VIRUS that was in my body got vanished . so if you are also heart broken and also need a help, you can also email him at {}
    or whatsapp him number: +2349038382931.Contact him today and you will have a testimony…Good luck!

  7. Hello Everyone out there,I am here to give my testimony about a Herbalist doctor who helped me . I was infected with HERPES SIMPLEX VIRUS in 2012, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution out so that my body can be okay. One day I was in  the river side thinking where I can go to get a solution. so a lady walked to me telling me why am I so sad and i open up all to her telling her my problem, she told me that she can help me out, she introduce me to a doctor who uses herbal medication to cure HERPES SIMPLEX VIRUS and gave me his email, so i mail him. He told me all the things I need to do and also give me instructions to take, which I followed properly. Before I knew what is happening after two weeks the HERPES SIMPLEX VIRUS that was in my body got vanished . so if you are also heart broken and also need a help, you can also email him at {}
    or whatsapp him number: +2349038382931.Contact him today and you will have a testimony…Good luck!

  8. I want to use this medium to thank Dr Noah, you all should thank him for me. I started having some symptoms, warts started coming in so I went to see my doctor. He carried the test and he said I have (Herpes) so went to another hospital for another test. My doctor prescribed some tubes  and cream which I started using, I use it for a while and I couldn't trace the infection and after a while it came back so I had no choice than to do research on some natural remedies there I saw a post about Dr Noah powerful herbs, I contacted him and purchase the medicine from him which I used for 2 weeks. On the 10th days of using it I couldn't have any trace of if I was not amazed hoping it will come back so that lead to my doctor for confirmation to my greatest surprise the result comes out negative, I was still a bit shocked I want for a month and still no trace then I called Dr Noah to appreciate his work in my life and I promise not to keep it to myself.
    Here's his basic information. Go get in touch with him:, call +1 310 982-4670 and do get your healing. Website

  9. I'm giving a testimony on how me and my fiance became a vampire. This was how I and my fiance became Vampire, I was browsing the internet searching on how i could be transformed. When i came across the email of a man named Lord Mark. who was a VAMPIRE so I told him that I and my fiance has always dreamed of becoming a VAMPIRES so he asked me my name, country, State, address, photo, etc. and asked me to contact the market of spells for the Hindu materials required for our transformation. So I did and he said that a vampire will be assigned to guide us and direct us on how the items are to be used. After five days I and my fiance was totally a vampire. if you are interested in becoming a vampire, contact him for more information on how you could also be transformed. Email:

  10. I’m here to testify about what Dr. Omola did for me. I have been suffering from (GENITAL HERPES VIRUS) disease for the past 3 years and had constant pain and inching, especially in my private part. During the first year, I had faith in God that i would be cured someday.This disease started circulating all over my body and I have been taking treatment from my doctor, few weeks ago I came across a testimony of Mary on the internet testifying about a Man called Dr. Omola on how he cured her from 5 years HSV 2. And she also gave the email address of this man, advise anybody to contact him for help on any kind of diseases that he would be of help, so I emailed him telling him about my (HSV 2) he told me not to worry that I was going to be cured!! Well, I never doubted him I have faith he can cure me too,, Dr. Omola prepared and sent me Healing Oil, Soap, roots and herbs which I took. In the first one week, I started experiencing changes all over me, after four weeks of using his Roots/ Herbs, Oil and Soap, I was totally cured. no more inching , pain on me anymore as Dr. Omola assured me. After some time I went to my doctor to do another test behold the result came out negative. So friends my advise is if you have such disease or know anyone who suffers from it or any other disease like HPV, HBV, ALS, HBP, CANCER etc. you can contact Dr. Omola for help via or whatsapp +2348118116254.

  11. Remarkable article, it is particularly useful! I quietly began in this, and I'm becoming more acquainted with it better! Delights, keep doing more and extra impressive!Water Filter UAE