CRF - Chronic Renal Failure:links and experiences with

pat

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Hi folks,
Because I do not know as much about ARF - Acute Renal Failure - perhaps we should have a seperate thread for that.

I want to put in one place, the resources I've used in dealing with CRF kitties for about 5 years now, and for us all to share additional links, and our experiences.

I know the first time I heard this diagnosis, with my beloved Patrick, I was heartsick. I knew little about what could be done and was SO not ready to have this special cat in my life, leave. He was 15. He lived to just under a month from his 19th birthday, with his CRF still in good control, but with other sudden health issues that we could not control.

I did some websearching and stumbled on two sites, one of which is my favorite and the one I recommend. Tanya's Site - www.felinecrf.org though written by someone who at the time was living in Europe, is filled with accurate information, kept up to date, and as a bonus lists supply sources in Europe (Britain only I think) as well as lists lab values both in as measured in the US as well as overseas.

It is an extensive site, it goes over diagnosis, what symptoms are seen, what they mean, what the lab results mean, treatments/medications, including studies done or ongoing, holistic approaches, related health issues and so much more.

I learned that dehydration is so key to address, increased stomach acid and nausea both affect crf kitties and their appetite (as does a too high phosphorous level..to be abbreviated as phos for the rest of this message), that crf kitties are prone to low potassium due to the high urine output that they have, so many require potassium supplementation, constipation is another frequent issue.

I lucked onto a wonderful support group, though I do believe there are lots of folks here experienced with this, and this forum is superbly supportive, sometimes the more info and the more support, the better. It feels so humbling when you realize you can't "fix" this for your cat.

But...you can often do so much to return a quality of life to them, and to extend their life considerably (to me considerably means at least a year).

I've seen a number of members on this support list whose cats, with treatment and their owners loving care, gain another 3-4 years, some 6-7, and some are at 10 years and still going! I know that Frankie and I are shooting for her to be a 10 year gal
or more


I found with Patrick, that what I believe made the most difference in how he did, was use of Calcitriol, a compounded medication that is a form of Vitamin D. Here is an article on it's use: http://www.marvistavet.com/html/body_calcitriol.html and I've used it with Frankie for over a year, Tyler for 2+ years now, and Tippy - recently diagnosed with Polycystic Kidney Disease (where to put it simply, cysts in the kidney - an inherited condition - pushes them into crf) - is also on this.

I firmly am a fan, if the cat is a candidate, in Calcitriol.

I also learned through experience with Tyler, how high bp can cause a detached retina and sudden bleeding into the eye. I am now a fan of a medication called Norvasc, as it got his bp down, and while he has only decreased vision left in the affected eye, it is clear, no blood remains visible, no further bleeding (though he did one more time when his bp spiked and he required an adjustment in his Norvasc dose).

I've learned that it is more important (imo) to get your cat eating then to insist on a prescription food the cat won't eat...that way leads to situations such as Hepatic Lipidosis...cats can not go without eating. No food=No cat.
I've learned that sometimes just assist-feeding for a day or two, was enough to jump start Patrick's appetite, and he'd begin eating again on his own.

I have come to agree with those that feel (in early crf) that paying attention to the phos content of the food (on a dry-matter analysis not an "as-fed" which is what the values are based on when printed on a cat food label) is more important than protein content. They will feel SO punky if their phos level is too high...so I used food lists that gave phos values, to choose foods with a phos content under 1% (per dry-matter analysis).

I use two lists - one is no longer very up to date, the katkarma lists:
http://webpages.charter.net/katkarma/dryfood.htm
http://webpages.charter.net/katkarma/canfood.htm
both have a link to a briefer more updated version.

Kept up to date, though compiled for those with cats who have diabetes, is jmpeerson's lists:
http://www.geocities.com/jmpeerson/canfood.html
http://www.geocities.com/jmpeerson/dryfood.html

These are wonderful as they are kept updated, and do list the phos and protein contents of a huge variety of dry/canned foods, prescription and non-prescription.

Okay...this is long enough. It's a start.
 
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sharky

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Thank you Pat and Yes MODS could this be a sticky



I could add alot but the ole brain is fried ..

Kandie and I have learned about CRF together .... It is not a death sentence... Kandie with diet and supplements ( holistic vet doesnt like heavy meds and so far none needed)

If your kitty is affected by this You need a VET you can talk to ....
 

pookie-poo

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Here is an Essay that I wrote for a cat forum that I used to own. It has many excellent links included at the end of the essay that are essential for learning about CRF and associated illnesses, and caring for CRF kitties.


Feline Chronic Renal Failure
A Brief Overview



Feline Chronic Renal Failure (CRF) is often considered a disease of older cats. However, it can strike cats of any age. It is a condition where the kidneys gradually lose their ability to regulate electrolytes and filter the toxins from the blood. If your cat is 7 years or older, you should have your vet check for CRF. Acute renal failure (ARF) can often progress to CRF. ARF can be cause by exposure to toxins. Some examples of toxins that are known to cause ARF are ingestion of antifreeze and ingestion of any part of the lily plant family. If your cat has ingested either of these substances, it is imperative that you seek treatment immediately, as time is of the essence to prevent a fatal outcome.

Because cats are very good at hiding illness, and because the symptoms of CRF are subtle, most cats don't show signs of CRF until approximately 70% of kidney function is lost. The most common signs are increased thirst (polydipsia) and excessive urination (polyuria). As the condition progresses, the cat may experience loss of appetite, nausea and vomiting, weight loss, poor hair coat and lethargy. It is important to observe your cats' normal eating and elimination patterns to be able to notice changes when they begin to occur.

The tests that your vet will use to diagnose CRF are done via a blood draw. Your vet will take a small amount of blood and run a complete blood panel which should include BUN and creatinine, the two most accurate indications of renal function. BUN stands for Blood Urea Nitrogen, which is a waste product of protein metabolism. Creatinine is a more accurate indicator of kidney function. It is also a waste product of protein metabolism. Some of the other test levels relevant to CRF are: Potassium, Phosphorus, Sodium, Calcium, HCT (hematocrit) or PCV (packed cell volume), as well as a USG (urine specific gravity) which is done on a urine sample.

Cats are usually diagnosed with CRF by one of the two following scenarios. 1. Routine blood work shows elevated BUN and creatinine, and you have noticed few or no symptoms. 2. Your cat has 'crashed', i.e.: quit eating, vomiting frequently, lost excessive weight, etc. Many vets will recommend PTS when a cat has crashed. However, with appropriate treatment, many cats can overcome this initial hurdle and go on to live months or years with ongoing treatment. Remember though, that CRF is a chronic, progressive and fatal disease. There are treatments that can give you precious time with your cat, but there is no cure.

If a cat has crashed, several days of IV therapy at the vet's office can bring down BUN and creatinine from critical numbers. If your cat has stopped eating because of nausea, there are medications that can be given to address that problem. Assist feeding can prevent hepatic lipidosis and stimulate eating. Once the cat has been stabilized (or if your cat was diagnosed by blood work, with little or no symptoms), the vet will usually recommend sub-Q fluids. Your vet will teach you how to administer these at home. It will prevent dehydration and help your cat to flush the toxins from the body. Most vets recommend a prescription renal food that is low in protein and low in phosphorus to help reduce the work of the kidneys. The current opinion in this area is that low phosphorus is more important than low protein. High serum phosphorus levels have been shown to hasten the progression of the disease, so regulation of phosphorus intake in the food is imperative. If your cat refuses to eat the prescription foods, there are phosphorus binders that can be added to regular foods that can help to regulate the serum phosphorus levels.

I lost my soul mate kitty, Spooky, in April 2000, at the age of 17, to CRF. My sister lost her 18 year old kitty to CRF. My parents' 19 year old cat, Sam, was diagnosed when he was about 16 years old, and with treatment, is still going strong. My 7 year old, Cleo, was diagnosed at the age of 6 months, when my vet did pre-op blood work for her spay surgery. I didn't know about the treatments available when Spooky was diagnosed. I also didn't have a computer then to do research and inform myself. When Cleo was diagnosed, I decided I was going to fight this thing as best as I could. I have found many informational resources and support groups dedicated to people who care for cats with CRF. If your cat has been diagnosed with CRF, I highly recommend joining the Feline Chronic Renal Failure Support Group at Yahoo. It is a support group with nearly 8000 members. There is a wealth of information in the links and database of the group. The members are well informed, caring and compassionate. They give excellent advice and will help you learn about the disease so you can take the information to your vet and devise a plan of action. The following are links to sites that have been the most helpful to me when I was learning about feline chronic renal failure.

http://www.groups.yahoo.com/group/Feline-CRF-Support/
This is the support group that I recommend joining. It is free to join, but you must be a member to post messages and search the archives.

http://www.felinecrf.com/
This is an informational site which is geared toward people in the United States. The test units of measurement are in U.S. terms. This site explains CRF signs and symptoms, tests and test results, as well as treatments. There are also links and resources for foods and other information.

http://www.felinecrf.org/
This is a great informational site also. It is geared toward people in the U.K. and Europe with the test information given in European units of measure. The food links are for foods available in Europe. The information about related diseases, treatments, and 'How To' section are very informative.

http://www.weirdstuffwemake.com/weir.../catjuice.html
Excellent step-by-step instructions (with pictures) on how to administer sub-Q fluids.

http://members.verizon.net/~vze2r6qt/supplies/
This is a site set up by a member of the CRF Support Group. This site has valuable information about different medications used in the treatment of CRF, as well as internet vendor links where you can purchase the supplies in bulk (which can result in significant savings over time!)

http://webpages.charter.net/katkarma/canfood.htm
Canned food comparison chart. Foods are listed by protein and phosphorus content to help you choose the lowest phosphorus food that your cat will eat.

http://webpages.charter.net/katkarma/dryfood.htm
Dry food comparison chart.

Some other support groups related to CRF:

http://groups.yahoo.com/group/Feline...us-Management/ Dedicated to phosphorus management. They also discuss assist feeding on this list.

http://groups.yahoo.com/group/Feline_Anemia/ Dedicated to discussing treatment related to feline anemia. Anemia is a common symptom of CRF. Transfusions, as well as medicines such as Epogen, Procrit, Aransept, Winstrol, and other drugs used to increase red blood cell production are discussed.

http://groups.yahoo.com/group/Calcitriol/ Calcitriol is a treatment used to prevent hyperparathyroidism which can be caused by CRF. Calcitriol is the active form of vitamin D. It's use prevents soft tissue calcification secondary to renal failure.

http://groups.yahoo.com/group/feline-hyperT CRF and hyperthyroidism are two diseases which seem to go together frequently. I've added this link since many cats who undergo treatment for hyperthyroid tend to develop CRF.

Author: Pookie-poo

Edit: Samson was helped to cross the Rainbow Bridge on 12/23/06, at the ripe old age of 19 years and 4 months.
 

xocats

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I am so grateful that you started this thread Pat.
As you know, Sadie was diagnosed just yesterday with early CRF.

I am just beginning to understand how much I have to learn about this complicated subject.

Mods.....please make this thread a sticky.

Edit....
I have been reading information about CRF and the bottom line is that I feel overwhelmed and don't know where to begin.
I had to stop feeding my kitties their wet food because of the recall.
They still have their Nutro dry, which I want to change but that must be done gradually.
Sadie has small urine crystals.
I can see that dealing with CRF will be a balancing act...
a combination of art and science supported by a foundation of patience & love.
I hope that I have what it take to help Sadie.
 
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pat

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Originally Posted by xocats

I have been reading information about CRF and the bottom line is that I feel overwhelmed and don't know where to begin.

I can see that dealing with CRF will be a balancing act...
a combination of art and science supported by a foundation of patience & love.
I hope that I have what it take to help Sadie.
Lei,

That is a good description, it is a balancing act, but in the middle of it all, are the kitty kisses and snuggles after a good afternoon when the sun is streaming in and they are feeling good. Each moment is precious. We already know that, but this disease really forces you to live in the moment. I wish you years of extra moments with your sweetie.
 

sillyjilly

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Thank you both Pat and Pookie-Poo on so much information.
I have not had a cat with ARF or CRF nor any issues with Kitters but it is so nice knowing so of the info JIC and also what to look for. This is definatly going to be subscribed for me so I can access it back easily if needed!
 

xocats

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Originally Posted by Pat & Alix

Lei,

That is a good description, it is a balancing act, but in the middle of it all, are the kitty kisses and snuggles after a good afternoon when the sun is streaming in and they are feeling good. Each moment is precious. We already know that, but this disease really forces you to live in the moment. I wish you years of extra moments with your sweetie.
You raised my spirits Pat.
 
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pat

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Bumping this up.
 

xocats

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I took Sadie for more blood labs and a UA today.
The news is very hopeful....

She has started concentrating her urine...

specific gravity was 1.050

up from 1.023 last Saturday.
PH 7 up from 6.

Blood
BUN 38...up from 30
but the vet said she was dehydrated as really stressed out...poor little girl.

Creatinine / 2.5---
still above normal high but down from 2.8.

I made chicken broth from poached chicken thighs and will try to get her to drink more water.
I am thrilled that her numbers are improving.
 
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pat

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Go Sadie cat! That is nice news to hear! (who ever knew urine concentration could be such a topic of interest?
)
 

xocats

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Let's all do the Urine Concentration dance.

This is a whole new vocabulary for me.
 

techiegirl

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FLUIDS FLUIDS FLUIDS FLUIDS


The most important thing for CRF cats IMHO is fluid therapy!! More about that later.


Great idea for a thread! Many of the links already posted have been such great resources and support for me.

My Phoebe was diagnosed with early CRF when they did the pre-surgery bloodwork for a tooth extraction 2 years ago. My vet at the time said to just keep an eye on her and redo bloodwork. So we redid it in 3 months and the Creatinine and BUN were higher - redid it again in 6 months and it was higher still. My vet never recommended anything except put her on an Rx renal diet.

Phoebe also has asthma, and my vet was not real helpful with that either. So a year ago, I went to my friend's vet for a second opinion on her asthma. Well the new vet was like, "yeah she's got asthma, but that's secondary - she's in kidney failure!" She said, "I keep repeating that she is 'in kidney failure' because I want you to understand how serious this is; most cats with her values are hospitalized on IV fluids!" I was like


I asked her why my other vet had never suggested anything and she said that some vets are just not very proactive with kidney cats. That really made me mad! Needless to say, I switched to the new vet! They are very aggressive with treatment, and I know it has kept her alive and happy.


So, we immediately started her on fluids - 150mL once a day. That was an emotional battle in the beginning -you think you are hurting them, but you have to realize that you are doing it so they will feel better and live. Someone told me to remember: You are doing it FOR them, not TO them.

And now it is easy - I give her fluids every day and she is used to it - in fact, she runs to the kitchen and jumps up on the counter to get them!
And I give fluids to all the kidney cats at the cat retirement home I work at, and also help friends with their CRF cat's fluids.
There were many tears in the beginning, but I will tell you that if I can do it, anyone can!


Since then, we have added:
1) Famotidine - 2.5mg once a day (added this about 9 months ago to help with stomach acid common in kidney cats)
2) Norvasc - 1/4 of a 2.5mg tablet, once a day (reduces high blood pressure)
3) Benazepril - 1/4 of a 5mg tablet, once a day (reduces blood pressure in the kidneys themselves, by dilating the blood vessels thereby increasing blood flow to the kidneys.)

Just started the Norvasc and Benazepril about 2 months ago and that is going well, and her BP is within normal range now.

And she takes her inhaler (AeroKat) - FlowVent, 2 puffs 2x/day and Albuterol as needed.
And she just started Atopica for her allergies - hoping to wean her off the inhaler.

She is doing very well - she actually has gained weight recently! LOL
I know there will come a time when she starts to decline - I have seen it in many cats. But for now, she is doing just great!
 

xocats

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Phoebe is fortunate that you searched for a vet who understood CRF and how to treat it.

Anyone who has a possible CRF kitty should be pro-active in finding a vet who understands this complicated disease.
Thanks for sharing Phoebe's story...

Keep us updated.
 

minxie

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Thanks for that information. Its good for all of us to know. My dear Gizmo had to be put down due to renal failure
 

xocats

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How sad to lose a kitty to CRF.

I clicked Gizmo's picture link.
What a beautiful kitty.

I hope that you will keep an eye on this thread and share what you learned about this all to common disease with us.
Gizmo
 

techiegirl

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oh, also, regarding meds and supplies. I buy most everything at Costco - much cheaper!

My vet charges $30 for one bag of Lactated Ringers Solution, one IV admin set and 8-10 needles. At 150mL/day I go through a little more than one bag per week.

I get a case (12 bags) of LRS from Costco for $25, I buy the needles ($8 for box of 100) and IV admin sets ($22 for 12) from my vet. So for around $80 I am set for 2 1/2 months for the same price as 2 1/2 weeks of supplies form my vet.

I also have all her other prescriptions called in to Costco and it saves me tons!

There are several online suppliers as well - the one I have heard is good is Bricor - http://www.bricomedicalsupplies.com/CRFpage.html But shipping is a lot. Still cheaper than a vet but doesn't beat the ole Costco pharmacy!



On a side note, Phoebe is quite the celebrity at the Costco pharmacy. They are always amazed how a cat can use an inhaler. So they always ask about her and ask for pics. haha And they were all sad when Sebastian passed away last year from hypertrophic cardiomyopathy, cuz he got all of his heart meds there.
 

sharky

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* note FYI you dont have to be a Costco memeber to get RX stuff there
 

techiegirl

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Originally Posted by sharky

* note FYI you dont have to be a Costco memeber to get RX stuff there
ooo! Very good point! I had heard that, but since I am a member I forgot. Do non-members get the same price though?
 
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