Congenital Kidney Disease in Kitten

Hello all, I have a foster kitten who is approximately 6 months old and has been through a LOT in her very short life. She has had a swollen belly for the past 4 months and been to several vets (I'm her 2nd foster and have just had her for a couple of weeks). Apart from the swollen belly, she is very healthy, active, playful, has a healthy appetite, has good litter box habits, has never had an accident, and is very loving and friendly. The only "odd" thing is that she does drink quite a bit of water (I've estimated between 6 - 8 ounces a day).

With her swollen belly, naturally, her previous vets suspected worms and she was dewormed twice despite negative fecals. She was also on a round of Albon, and has been on 2 rounds of metronidazole (for suspected bacterial infection/giarda), with no change in her belly. She has very soft (sometimes loose) stools and she frequently poops VERY large amounts (like over a cup of poop!). Her belly fluctuates quite a bit in size based on her pooping, so it seems like IBS, or slow GI tract, something of that nature. She's had 2 ultrasounds (to make sure she wasn't pregnant firstly - but she was spayed in August (at 3 months)), and to check for fluid for possible FIP). The vets said they saw no abnormalities or fluid, and again suggested she just had a slow GI, so they recommended yogurt for the probiotics. Her previous foster tried mixing it with her food, but she would not eat it, and I became her foster shortly after that.

So, I took her to a new vet, they did another fecal, which was negative, and did additional bloodwork. The results came back that she may have kidney problems and has a phosphorus level of 10 (which is definitely high) and slightly elevated BUN. So they suspect congenital kidney disease/failure.  But they really don't have an explanation for the belly at this point because that's not a symptom of kidney disease/failure, so it appears she may have 2 underlying problems. My vet suggested putting her on wet food (she's been eating dry only up to this point). I was worried about that because it could make her stools softer, which could cause diarrhea. I started her on wet food last night and she gobbled it right up, and as I suspected, her poop was completely liquid last night. She also suggested probiotics (i.e., FortaFlora) to help with the diarrhea, so I'm going to add that to her wet food. She suggested doing this for a week and then following up. She would also like to get another ultrasound (possibly x-ray), and urinalysis after trying to manage her belly.

Long story, I know, but here are my questions:

1. I've looked around a lot for low phosphorus wet food and they're all for adult/mature cats. Will feeding her this cause further issues? Should I supplement it because she's a kitten?

2. Any other suggestions for the swollen belly/diarrhea? I just want to make sure she's comfortable.

3. Am I overreacting? She hasn't officially be diagnosed with kidney failure and is really perfectly healthy in every other way. Could the high phosphorus be something else?

4. Has anyone else had similar experiences with such a young cat?  Any recommendations?

Thank you all in advance!

Emily

Oh hun, what a sweetheart you are for caring for this kitty! :rub:

Wet food in and of itself does not cause diarrhea. But for a kitty with a sensitive stomach, a quick switch of any food does.

IF there are any issues with her kidneys, she needs a species-appropriate diet more than anything. And thankfully, if her issue is IBD, it will help this too.

A helpful site for you: http://www.ibdkitties.net

A species appropriate diet for a cat means:

A) wet food only (cats are descended from desert animals, and don't have much of a thirst drive. They are "designed" to get all the moisture they need from the food they eat. http://www.catinfo.org ).

B) A high protein, low carbohydrate diet (cats are obligate carnivores).

C) A food with a limited ingredient list - avoid veggies if possible (cats eat small mammals).


Commercial foods that will likely be best for her, if you can afford them are: Wellness Core Kitten (not the greatest ingredient list, but appropriate from a macronutrient standpoint), Nature's Variety Instinct (just pick out the peas and carrots, there aren't many and they're whole), and EVO (it's high fat, but cats handle fat well, and as a growing kitten, she'll use the energy).

Now - as to the probiotics.There really aren't enough probiotics in yogurt to make much of a difference, and fortiflora made our Chumley's digestive system go absolutely nuts. It works for some people's cats. But it's expensive for what it is, it's made with animal digest which is NOT healthy for kitties, and it's got no live cultures in it, just "fermentation" products. Better is a human acidophilus supplement. In the wild, cats naturally eat "probiotics" daily, because they eat the small intestines and colon of their prey. So I give my cats a probiotic daily, and will do so for life. I use Natural Factors acidophilus+bifidus (for my adult cats, I use the double strength (10 billion active cultures), once daily, and I buy it on Amazon. For a kitten, I would use a regular strength (5 billion active cultures - same as a child's dose) capsule daily. It can be sprinkled on their food or just mixed into it. FYI, this advice is from my holistic D.V.M. This REALLY helped Chumley's digestive system.

I don't know what the high phosphorus is, though it is discussed at Feline CRF: http://www.felinecrf.org/diagnosis_calcium_phosphorus_pth.htm#hyperphosphataemia

Now - the vet doesn't seem to be recommending phosphorus binders. The site indicates that the only low phosphorus foods are prescription foods - yet these are not appropriate for a kitten.

I would switch the food, use the moist high protein/low carb foods, use the probiotic - and recheck her bloodwork in a month or 6 weeks.

Vibes for you and this little foster baby!

But I think if you make these few changes, things might turn around for her. :heart2:

The vet hasn't recommended a prescription diet yet.  She wanted to see how she does with these adjustments.  If we can get her phosphorus lowered and her belly taken care of, we'll be in a better position to proceed. 

I had already found the feline CRF site and there is some great info on low phosphorus foods.  I had always assumed that dry food was better (I have 2 senior kitties both on prescription Royal Canin dry food and they love it and have seemed MUCH healthier since switching).  But, after reading all of the info, it makes sense.  A lot of the prescription low phosphorus foods are also lower in protein, which is vital to kittens, so I don't know how we'll handle that if we have to go that route (at least not yet).  You can get commercial brands that have relatively low phosphorus (not as low as prescription, but that's pretty drastic at this point).  She is thinner than her brother (everywhere except her belly obviously) and they both eat the same diet and amount of food, but she could certainly stand to gain some weight.  From everything I've read EVO and Organix sound like the best commercial brands that have a good balance of protein and lower phosphorus - I'm not too worried about the fat, because she is very active and she could stand to gain a little.  Hill's Science has quite a few too, but I've never been that impressed with their food to be honest.  I'll just get confirmation from the vet before choosing just to be safe.

She hasn't mentioned anything about phosphorus binders either.  It sounds like they're good, but not as good as low phosphorus foods and are usually used if the cats won't eat the prescription food or have appetite problems so you have to tempt them with other higher phosphorus foods.  My kitten doesn't seem to be too picky thus far (one benefit of a shelter kittie is that they eat just about anything!).

I had read some negative reviews of FortiFlora as well, so I may just go the route of human probiotics.  I've also read recommendations to give kittens fresh goat's milk (which I can get from my farmer's market), and interestingly is one of the main ingredients in most human supplements.  It's lower in lactose than cow's milk and cats can tolerate it better.  But I'm not sure if on it's own it has all of the necessary probiotics.  I'll ask my vet about that too.

I really hope we can get her "fixed" without having to poke and prod her any more than necessary.  I just want her to be happy and comfortable and she's been through so much already, and is just the sweetest kitten imaginable.

Thank you so much for the helpful info! I will let you know how she's doing after I get her settled on her diet.

I just remembered - egg white is a natural phosphorus binder. What you may want to do for your little foster baby is cook some egg whites, and mix a little raw yolk and cooked egg white into wet meals a couple of times a week. :nod: It's VERY nutritious, and may help fix her up via diet!

http://www.renalandurologynews.com/egg-whites-may-help-lower-phosphorus/article/111024/

FYI, Natural Factors has an acidophilus+bifidus supplement that's made with goat milk. I don't remember the other strains in there. FYI, if your vet recommended Fortiflora, personally I'm not betting your vet is... picky, let's call it, about what... struggling to find the words here... the healthiest alternatives are for your kitty.

For diet-related stuff, it's really best to find a vet (someone trained as a D.V.M.) that also has training in nutrition. Most traditional vets - unless they have a specific interest in species-appropriate diets - really know very little outside of what they learn from Hill's or Royal Canin - who obviously have an agenda. If you're in the States, you can search to see if there's a holistic vet in your area here: http://www.ahvma.org

Just to give an update, there is no change in her belly after being on probiotics for 2 weeks. Her poop seems to have improved a bit (she has not had diarrhea since the first day of switching to wet food). And her appetite is great. She's stopped drinking excessive amounts of water (so I'm guessing that was due to the dry food only diet). But, her belly is still really big. It's not hard at all, it just feels bloated. One day last week when I was picking her up, it sounded almost like letting the air out of a balloon. I guess it was just the way I picked her up and hit a certain spot. But anyhow, a lot of gas came out. She did not seem in any discomfort at all, and I've noticed she has had gas several times when I've been around. She poops/pees regularly and never seems to strain or be in any discomfort.  And, I have checked her poop for blood/mucus and found nothing, it's just regular brown poop (pretty much the color of her food) and it looks just like her brother's. Any other ideas of what could be causing the swollen belly and gas? 

Thanks!

Emily

What food are you feeding her? We'd need to look at the ingredients. It's what goes in her that causes the gas....

Well, she was rescued from a shelter in August and her first foster had been feeding her Iam's kitten dry food.  Her belly was already swollen/bloated when she was rescued (and everyone assumed parasite/worms, so she had treatment).  So after all of her treatments and negative fecals, she still has the swollen belly accompanied with gas, soft (sometimes loose) stools.  She's had ultrasounds to rule out FIP and the vet said it just looked like air/feces in her bowels, they did not see any blockages.   

I became her foster about 3 weeks ago and was also feeding her Iam's kitten dry food until my vet found her phosphorus and BUN to be high.  She suggested I switch her to a canned low phosphorus food. She has not yet recommended a prescription diet, she wanted to see how this goes.  The swollen belly is not typical of renal problems, so I think it's unrelated. 

In any event, I found an organic canned food that is ok for kittens (Organix - organic turkey and organic spinach - I verified the nutrition info with the vet before starting her on this).  She did have diarhea for the first day (I started by mixing it with her dry food), but that went away once she got used to the food.  This was exactly 2 weeks ago.  Then I started her on a probiotic (also at the recommendation of the vet - I do not give her FortiFlora, but a human probiotic (actually the Natural Factors one you suggested - after I verified with the vet)).  I started her on that about 2 days after starting her on the wet food just to give her system time to adjust (and in the event one caused/resolved problems).

Here are the ingredients for the food:

ORGANIC TURKEY, WATER SUFFICIENT FOR PROCESSING, ORGANIC CHICKEN, ORGANIC CHICKEN LIVER, ORGANIC BROWN RICE, ORGANIC SPINACH, ORGANIC GUAR GUM, SALT, CALCIUM SULFATE, ORGANIC FLAXSEED MEAL, TRICALCIUM PHOSPHATE, POTASSIUM CHLORIDE, MINERALS (IRON AMINO ACID CHELATE, ZINC AMINO ACID CHELATE, COBALT AMINO ACID CHELATE, COPPER AMINO ACID CHELATE, MANGANESE AMINO ACID CHELATE, SODIUM SELENITE, POTASSIUM IODIDE), VITAMINS (VITAMIN E, A, D3, B12 SUPPLEMENTS, THIAMINe MONONITRATE, NIACIN, d-CALCIUM PANTOTHENATE, PYRIDOXINE HYDROCHLORIDE, RIBOFLAVIN SUPPLEMENT, FOLIC ACID, BIOTIN), TAURINE, CHOLINE CHLORIDE.

So, I'm wondering at this point if it could be food allergy or IBS.  This looks pretty clean to me - do you see anything worrying?  She has another appointment with the vet tomorrow to follow up and get her vaccines/boosters.

Thanks so much for your time!

Emily

Well, for a sensitive kitty, there's actually a number of things in there that could be causing the gassy problem: the brown rice, the spinach, the guar gum (a likely culprit). And I really don't like feeding cats any food with spinach in it. Here's a quick overview of other issues with rice, and the issue with spinach: http://www.ibdkitties.net/Food.html

But if I had to guess, I'd figure the guar gum and/or the rice is the problem. Cats with digestive issues tend to do best with no grains, limited ingredient lists, high protein, low carb foods (not all grain free foods are low carb). I know that high protein thing is of concern for your kitty, but as I mentioned in an earlier post, cooked egg white can be substituted for some of her food, it's a natural phosphorus binder.

I had no idea spinach was that bad. It's in a LOT of natural cat foods! I just picked that one because it was very low in phosphorus and natural. She likes dry food too, which is generally higher in protein, but also much higher in phosphorus. And with kidney problems, the vet recommended wet. So now I have to find a low carb and low phosphorus food. Argh! I'll avoid the guar gum too.

I know Merrick has some good grain free options that my other kitties have tried. I just don't see the phosphorus amounts for those. Wysong makes a couple too (95% meat/organs) that are definitely low phosphorus but they are SO hard to find (literally back ordered on every website)!

I have tried the egg yet, so I may do that too. The good thing is, she's not picky at all! Hopefully the vet will have some good news tomorrow. I hope her blood work looks better!

Thanks again!

Oh - this list is a great starting point! http://www.catinfo.org/docs/Food Chart Public 9-22-12.pdf (This is the article that goes with it: http://www.catinfo.org/?link=cannedfoods ). Hope this helps!

Eek - the Merrick Before Grains ones are pretty high in phosphorus. There are quite a few other non-prescription ones that are low, I'll just need to check their ingredients. Guess I know what I'll be doing this weekend!

Ok, I cannot find a food that is grain free that has no guar gum. After looking more at Wysong Au Ju, I don't think it's an option since they don't meet nutritional requirements (if thats the sole food source). Of all of the ones I have the phosphorus info on, it looks like EVO chicken & turkey may be the best bet. It is grain free, has low carbs, relatively low phosphorus (.88 % DM) and the fewest ingredients I've found:

Chicken, Chicken Broth, Turkey, Natural Flavors, Carrageenan, Minerals, Guar Gum, Vitamins, Choline Chloride, Herring Oil, Salt, Potassium Chloride, Sodium, Ascorbate, Taurine, Sunflower Oil, Sodium Phosphate, Beta Carotene

The only thing questionable is see carrageenan. My other cats have never tried EVO, but I've always heard good things and it has good reviews. Thoughts?

The other option I saw was Honest Kitchen, but that does have spinach (as well as cranberries) and I don't know the phosphorus content...

emilyatl said:

I had no idea spinach was that bad. It's in a LOT of natural cat foods!

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Surely a rally natural cat food would be made from small rodents and the odd bird?

I did, very recently.... My cat was born with a congenitus disease in her kidneys, she would have crisis every three months, vomiting, diarrhea, stop eating and drinking....... she used to drink so much water, which is another simpthom..... from the sink, I took her to the veterian a thousand times, during the past year.... they never thought she had a kidney condition because she was not even a year old.... this christmas she had a new crisis.... they never told me about potasium, since the most important parameter to really know which are their kidney conditions is creatinina and urea.... and perhaps an eco....if i had discovered before that last crisis all of this things, she could still be alive today.... it lasted 7 days... and died the 8 of january of 2014. She was only one year and 17 days old.... i read so much about all that stuff.. during those 7 days..... dyalisis, the two different types, food change, everything.... If I was you I would have your cat make all the exams so you know exactly whats the percentage of kidney damage.... so you can act in consequence, valorating life quality of your cat, and economic issues... I read that by changing the diet they can live for many years if your cats condition is not severe... but still if you dont know exactly you wont solve the problem.... if you already know something about it.... search, search, test, and be sure what your cat has.... I wish someone had discovered my cats sickness on time...

taiga said:

 
I did, very recently.... My cat was born with a congenitus disease in her kidneys, she would have crisis every three months, vomiting, diarrhea, stop eating and drinking....... she used to drink so much water, which is another simpthom..... from the sink, I took her to the veterian a thousand times, during the past year.... they never thought she had a kidney condition because she was not even a year old.... this christmas she had a new crisis.... they never told me about potasium, since the most important parameter to really know which are their kidney conditions is creatinina and urea.... and perhaps an eco....if i had discovered before that last crisis all of this things, she could still be alive today.... it lasted 7 days... and died the 8 of january of 2014. She was only one year and 17 days old.... i read so much about all that stuff.. during those 7 days..... dyalisis, the two different types, food change, everything.... If I was you I would have your cat make all the exams so you know exactly whats the percentage of kidney damage.... so you can act in consequence, valorating life quality of your cat, and economic issues... I read that by changing the diet they can live for many years if your cats condition is not severe... but still if you dont know exactly you wont solve the problem.... if you already know something about it.... search, search, test, and be sure what your cat has.... I wish someone had discovered my cats sickness on time...

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I'm so sorry   SO young