Chronic Renal Failure (CRF) in cats

[CJ2008]

Good morning everyone...

My cat was diagnosed with CRF yesterday - 2/3 of his kidneys are not functioning.

I am really confused. At first I didn''t realize it was that big a deal but I am coming to realize it''s very serious.

He''s between 13-15 (I found him in the street when he was little so I don''t know his real age).

I know others here have dealt with this disease before and I am wondering if you could give me any advice, such as how to figure out what stage he''s at.

I really like my vet - I''ve used her since we moved here 2 years ago and love how she will take time answering whatever questions I may have. There''s something that''s bothering me though. When I reported that my cat seemed to be drinking a lot of water (I''m not sure how far back I first said this - I would need to look back on my paperwork), she suggested we do bloodwork - everything had come back normal, but there was some blood in the urine. She said that could happen for a few different reasons and suggested we do follow-up bloodwork in 3 months. So I did (right after we came back from our honeymoon end of June). Same results: everything was OK, but blood in the urine again. At which point she suggested an ultrasound, which he got yesterday.

From the very quick research I did, though, it seems that the bloodwork would NOT have been fine (i.e., some things would have been off so as to hint to CRF). Or am I wrong? Are there instances where the bloodwork could show up fine yet CRF be present?

I don''t know what to do - should I investigate (i.e., get a copy of the bloodwork and look at the values myself)? What would you do? Is there any worth investigating whether we "should" have caught this earlier?

My mind is going in all different directions. I hope your advice/perspective will help me focus on what''s important, whatever that may be.

 

[bee*]

Did she diagnose CRF just from the ultrasound? I''ve never come across a case in work where there was CRF with normal bloods. Usually there would be a problem with the Urea or Creatinine. There are special prescription diets like the hills k/d that cats seem to thrive on if they do have kidney damage. I''d probably get a second opinion if the kidney disease has been diagnosed purely from an u/s. Was urinalysis done also? If the urine is very dilute it can show that the kidneys aren''t working correctly.

 

[CJ2008]

The bloodwork DID show the urine to be very dilute - but because it was otherwise normal, she recommended we wait and do follow-up blood work in about 3 months. Second bloodwork showed the same thing: very dilute, with blood in the urine, but otherwise normal counts. That's when she recommended the ultrasound.

She put my cat on KD but he didn't like it too much...so I got him the Purina NF and he seems to like that. Plus she advised that I no longer feed him any dry food (partly due to the kidney problem, partly due to a tooth problem).

 

[bee*]

I would probably get a second opinion on it. The u/s can tell if the kidneys enlarged or smaller but the bloods are the main thing along with the urinalysis that we use to actually diagnose CRF. Were the urea and creatinine ok when the bloods were ran?

 

[Lorelei]

Date: 8/22/2008 1:45:40 PM
Author: bee*
I would probably get a second opinion on it. The u/s can tell if the kidneys enlarged or smaller but the bloods are the main thing along with the urinalysis that we use to actually diagnose CRF. Were the urea and creatinine ok when the bloods were ran?

Bee is right, get a second opinion. Also there are things that can be done to manage the progression of the disease in some cases, so hang in there.

 

[CJ2008]

Thanks, guys. I''ll ask the vet''s office to fax me over a copy of the results.

 

[bee*]

Let us know how you get on!

 

[Lorelei]

Date: 8/22/2008 2:14:25 PM
Author: bee*
Let us know how you get on!

 

[FireGoddess]

My 12 year old cat drinks a lot so I was concerned at her last checkup about kidney failure but her bloodwork and urine came out fine. I haven''t heard about cats having CRF and the bloodwork being completely normal...

 

[CJ2008]

FG - I am waiting for the vet to fax over the results, and will post the urea and creatinine levels.

Perhaps the bloodwork wasn't "completely normal" but whatever amount they were off, the vet obviously didn't think it pointed to CRF at the time...so I'm curious to see what the levels actually were. I hope they are within normal range or only slightly off - I would hate to think I could have caught this sooner.

ETA: another thing I forgot to mention is that last week they tested to see if there were any stones in his bladder or kidneys, and it was negative

 

[CJ2008]

I didn''t see anything called UREA - does it go by any other name?

3/18/08

Blood test

Total protein 8.9
Creatinine 2.1

7/15/08

Blood test

Total protein 8.1
Creatinine 2.3

Urinalysis

Blood 3+

Urine Culture

Negative

 

[bee*]

It can go under BUN also (blood, urea, nitrogen).

 

[CJ2008]

Hi bee*

3/18/08 BUN 42 and the vet wrote on the page margin "gingivitis"
7/15/08 BUN 34

 

[tradergirl]

I have had both cats and dogs with CRF and have managed each of them. Some live longer than others. Right now, I have a 20 year old cat who i have been managing for 2 year with it.

This is an invaluable site. I have been reading it since 1998. It has all the information you will ever need.

www.felinecrf.com

You can get the subcutaneous fluids (lactated ringers or noromosol for $2-3 a bag at any number of online medical supply companies).

HTH

BTW: your lab numbers aren't that bad. BUN of 42 is barely above normal. The creatnine is a bit high but manageable. "Urea" is the BUN as in "blood urea nitrogen"

 

[CJ2008]

Thanks, tradergirl...

I had found that site when I was doing research - I have to go back and read more in depth now that I''m starting to understand what I''m dealing with.

Yes - when I looked at the tests, his levels for what WAS NOT in range were off by very little. So I feel great that we caught this by being persistent and going further...so glad I did the ultrasound.

I notice a decrease in his appetite and his water intake though - so I''m not thrilled about that. At first I was happy he was drinking less water due to the new food...but now I''m worried about the other side of it - not drinking plus his kidneys not working. So I''m going to keep an eye on his water intake and call the vet if it remains low like this.

 

[bee*]

His levels aren''t too high so it''s great that you caught it quickly. Is he peeing ok?

 

[CJ2008]

bee, thank you so much for checking back in.

He seems to be peeing fine, by what I can see in the litterbox.

It just almost seems like his habits have changed all of the sudden. He used to wait impatiently for his food in the morning, following me as I was putting it down. Now he hardly cares when I put it down for him - he''ll eventually get to it and eat, but it''s different, he just doesn''t seem to care as much.

By the time 24 hours rolls around I say he''s had in total half a can of the NF - maybe a little less. Now this can is 5.5 oz, compared to the the can of Fancy Feast he used to eat per day, which is only 3 oz. But when I was feeding him FF he also had dry food in a bowl for whenever he wanted. Now, because of his teeth, I''ve taken the dry food away, so that adds up to the less amount he''s eating. Today I''m going to put out 1/4 of the can in the AM, 1/4 in the PM and 1/4 at night to see if that helps (more fresh).

He''s drinking much less water, too. In 24 hours he''s drinking about 1/4 of a cup a day - perhaps that''s normal - but before this, he was usually drinking the full bowl dry (the full bowl holds 1 1/4 cups).

 

[bee*]

If he''s only having wet food from a can, they do tend to drink less anyway than if they were having dried food, so that could explain his drinking less. It''s also a good sign though as normally with CRF they seem to drink quite a bit. Is he having anything for his gingivitis? It could just be hurting him to eat.

 

[CJ2008]

Right...I was expecting him to drink a little less.

I don''t think it''s hurting him to eat. I know how much he loves Greenies so today I took two and crushed them up like dust into his food - and he''s eating more! So I think it''s a case of him not loving the NF. The same thing happened with the KD - the first day he ate it fine but he gradually stopped eating it. So I''ll double check with my vet to make it''s OK crush a couple of Greenies into his food.

The vet thinks the best thing would be to remove his teeth because she thinks he might be in some pain because of them (although as I told you I don''t see that - as a matter of fact if I give him a Greenie he will eat it) He had most of his teeth removed a while back so he has very few teeth left. But because of the CRF she thinks that unless I see him having pain where he''s not eating or having trouble eating it would be best to leave it alone. She thinks that the amount of time he would need to be under for the procedure could throw him over the edge kidney-wise.

I asked her what we could do in the meantime to help him, and that''s when she recommended no more dry food...she also thinks that brushing his teeth would be painful for him at this point too. If you know of anything I can do for him let me know.

And thanks again bee - I so much appreciate your time.

 

[bee*]

I think that you''re doing everything right. It would be good if you could get him on some of the kidney food, but if he hates it, the most important thing is just to get him to eat, no matter what it is. If he''s happy and not in pain with his teeth, I''d leave it be. You don''t really want to put him under the stress of having an anaesthetic when it''s not needed. I''d probably recommend having some routine bloods every month/two months and that way you can monitor him and his condition.

 

[CJ2008]

I think he is fairly happy - we''re still playing hide and seek every day.

I''ll leave his teeth alone for now, and like you said, monitor his condition via bloodwork.

Thanks so much, bee.