Kidney Disease

i do the water by syringe trick to my younger female as i hardly ever notice when she drinks. i'll do the same to darwin when he gets out of "jail"

Don't forget about B12 injections, it's very important in a CRF kitty. sub q fluids as mentioned, B12, an all wet diet (not necessarily prescription). http://www.felinecrf.org/

daddyincr said:

perhaps i haven't explained everything clearly. i don't want darwin to be an inpatient. so i set up my bedroom as a mini clinic. my vet

came yesterday and put in the IV she set it for 250ml of ringers a day. basically the program is to flushout and detoxify his kidneys.

after that we'll see about the maintenance. my son in the states has had cats forever. i had him speak to his cat's vet, he said

this procedure is normal, but, usually done with the cat staying over, as mentioned previously i believe my home is cleaner

and he never has to be alone--i am taking time off from work until IV comes out. the first day he had @ 7 urine outputs first day. he's eating

great. strangely he cries when he sees me, and is quiet when i leave the room. i am his nurse. i check the flow of fluid, and clean out

his litter box as often as he urinates or eliminates. it's hard seeing him in this way, but i know it's for his health.
 

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I just find it confounding that the vet recommended doing this when the kidney values are not that high. Usually getting a "flush" of fluids via IV is used when they are close to a crash (kidney numbers are high), or have crashed--not at this stage of the game. Fluids are not without their problems--they increase the work the kidneys must do, for one. All Darwin would need at this stage is extra water (amount as stated previously) added to his food and syringed via mouth during the day to keep up with his hydration.

You'll probably not read this because I'm pretty sure you're not going to question your vet, but I'm going to post it anyway ...When to Use Sub-Q Fluids and info on IV fluids. Knowledge is power, so others can decide what they would do from reading this thread.

Excerpt below:

Although sub-Qs can be of great benefit to cats who need them, not all CKD cats need them immediately. As mentioned above, the purpose of sub-Qs is to keep the cat hydrated enough to avoid dehydration occurring. However, cats with early stage CKD can usually drink enough to offset their increased urination, and thus do not become dehydrated even without sub-Qs.                [MY NOTE: you can syringe and/or add extra water to their food!]

 

Processing sub-Qs in itself places an additional workload on the kidneys, plus it can flush out certain nutrients, reduce potassium levels and raise sodium levels. In Staged management of chronic kidney disease in dogs and cats (2009), a Presentation to the 34th World Small Animal Veterinary Association World Congress, Dr David Polzin states "Because recent evidence suggests excessive sodium intake may harm the kidneys, recommendations for long-term sodium administration in any form should be carefully considered."

 

Giving too many fluids or too soon may also increase the risk of overhydration. This is a particular risk for cats with heart problems. Therefore it is best not to begin fluids until the advantages are likely to outweigh the disadvantages i.e. when a cat would become dehydrated without them.

 

Dr Katherine James of the Veterinary Information Network believes that this tends to happen and that most CKD cats will benefit from subcutaneous therapy once creatinine levels are consistently over 3.5-4.0 US (300-350 international). This equates to high Stage 3 of the IRIS staging system. If your vet thinks your cat's CKD is less advanced than this, and your cat does not appear dehydrated, then it is probably safer to hold off on sub-Qs for the moment.

 

However, there are exceptions, and a small number of cats with creatinine below 3.5 US (300 international) may need sub-Qs. This tends to apply to cats whose creatinine is below 3.5 US (300 international) but who previously had a higher level, usually at diagnosis. So if, for example, your cat has creatinine of 6.0 US (550 international) at diagnosis, but this gradually falls to 3.5 US (300 international), s/he will still probably benefit from regular sub-Qs. Cats with pancreatitis are prone to dehydration and may need sub-Qs even if their creatinine level is lower than 3.5 US (300 international).

 

Also, any time more water is going out than is coming in, sub-Qs may be needed short-term. Thus, a CKD cat who is a bit below par because of vomiting or diarrhoea causing dehydration, or who stops eating or drinking, may benefit from sub-Qs as a one-off - my vet gave sub-Qs to my non-CKD cat when she had severe vomiting and diarrhoea for this reason.

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Any update on Darwin?

after 2 days his face and eyes looked more brilliant. we had to stop the iv after 2 days. each day the needle became displaced. instead

of the fluid going directly into vein, it went to muscles. body absorbed the fluid, but, not what doc wanted. in trying to reinsert the iv

day 3 we discovered from days one and two and various blood tests before we started, the veins were a little weak, so we took a 24hour break.

late yesterday afternoon we started again. all good on the outside, except of course darwin is not a happy boy being in a cage. i put the cage on

a table right next to my bed. i can pet him through the bars as i lie down. tomorrow @ 5pm we take out iv.

Good news! 

whollycat-- 250ml day for 4 days based on darwin's weight

daddyincr said:

whollycat-- 250ml day for 4 days based on darwin's weight

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That is twice the amount that has been recommended if reading the above shared info in the studies.

I am hoping that since your cat is fairly young and barely in kidney failure, that his body and kidneys will be able to handle this much fluid.

Yeah that's A LOT!!! I'd honestly call the vet and make sure because that's a crazy amount. Usually 50 mls per day or even every other day.

finnlacey said:

Yeah that's A LOT!!! I'd honestly call the vet and make sure because that's a crazy amount. Usually 50 mls per day or even every other day.

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Darwin is getting fluids via IV at home, rather than sub-q. 

What percent dehydrated did the vet say he was? Need this to calculate an approximate mL range of fluid that could be given via the IV.

Are you monitoring Darwin's weight? Monitoring his urine output to adjust the IV fluids accordingly? How about his heart rate? How about his lungs? Did the vet run any additional testing to see where his kidney values were at after the first or second day of IV fluids?

Was the vet going to slowly wean him off the IV fluids? I would talk to the vet about this if this hasn't been mentioned as discontinuing the IV fluids suddenly can cause major problems with kitty's system processes because more harm than good can come by making rapid changes in the kitty's sodium and fluid load by giving IV fluids. Renal failure kitties have lost homeostasis (the ability to maintain internal stability), and can not make rapid adjustments in salt and water balance.

Still shaking my head and at this whole thing because any vet that knows kitties with CRF/CKD knows that at the low kidney values (not in crisis mode) Darwin has, with most likely minimal dehydration (unless a lot of vomiting and/or diarrhea has been going on), is not the course of action to be taken--minimal sub-Q fluids would be.

Is there an update on Darwin?  I've been thinking about him.

got the blood tests back. creatinine 2.0.. at the top or just out of normal range. for now i have been instructed to

make sure he gets a lot of water and keep up the science diet k/d diet. we don't have any other option here in

costa rica as far as prescription diet goes.

  his third eyelid has gone back hiding (haha, thank goodness)

as always his outward behavior is normal. one thing i notice is he appears to have some sensitivity

in his eyes. like at times when he isn't sleeping the eyes are 1/2 shut. concerns me.

as an aside his baby sister (no relation biologically) has decided she will  eat no other food except

what darwin eats. she's a healthy young lady, but, just wants to eat the science diet k/d like

her big brother. if it didn't concern me it would be funny.

thanks for all the support i have been shown here at the cat forum.

finnlacey said:

Yeah that's A LOT!!! I'd honestly call the vet and make sure because that's a crazy amount. Usually 50 mls per day or even every other day.

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not sure if i explained myself clearly---that was over a 24 hour time. darwin will be 3 in october and his weight is 12 pounds.

That's still way too much fluids, that can damage the heart and lungs. I would still make sure about this. As for the little one eating what her brother does, I'd feed them separately. Not sure it's healthy for her to be eating special kidney food continuously without a reason. She needs more protein than that. 

Glad to hear Darwin is feeling better!

There's also some disagreement on whether a low protein diet is actually beneficial to CRF / kidney failure kitties.  Lots of info here on the forums recently discussing this topic.
 

Yeah, I'm actually not for giving a kitty a low protein diet myself. To me that just sets up a whole host of other issues. 

funny that all wet canned foods here have @ 8-10% protein. the dry food whether innova or k/d each has @ 28% protein.

so, i mix the dry with wet.

daddyincr said:

funny that all wet canned foods here have @ 8-10% protein. the dry food whether innova or k/d each has @ 28% protein.
so, i mix the dry with wet.

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Dry and wet percentages aren't compared like that. You have to convert them both to "dry matter basis" before you make the comparison.

To do this you find the moisture content of a food. Most canned foods are around 78% moisture. So say you have a canned food with 78% moisture, listing 10 % protein. You take the 10 % and divide it by the dry percentage, which is 22 % (100-78=22), which makes the canned food 45 % protein, which is a decent amount.

Dry foods are usually about 10% moisture (or less) If you are feeding a dry food with only 28% protein (which is way too low for a cat) and the dry percentage is 90% (100-10=90) the dry matter percentage for the dry food is 31 %.

So now you can compare them on a dry matter basis

canned 45% protein
dry 31% protein

The quality of the protein matters too. Canned food is more likely to have meat protein, which the cat can actually use, as opposed to protein from grains, which just get pooped out.

I am glad Darwin is good. btw, I really like the name Darwin