Am looking for any help on advanced kidney failure

I am new to this site and I would like to say as I read responses from members,  I am impressed with how knowledgeable and insightful many of your members are.

I have a Main Coon-ish rescue who has recently gone into kidney failure and while I understand what this means I guess I am hoping that there is something that my vet has not suggested or tried that might help give us some time. Has anyone had luck pulling their cat through a major kidney crisis for another year (or more) of life?

Some background on this cat. He was a street cat who started to show up in our yard. Our yard was walled off and protected with a lot of vegetation. It had good hiding spots for strays plus was good for bird hunting and we kept water out. He was extremely fearful so we could only get glimpses of him through the window. Over a period of weeks he started to show up in worse and worse shape. When we saw him hobbling around on three paws we decided to intervene. We had to trap him because he was aggressive. We took him into the vets, had him neutered, vaccinated and checked and found he was FIV positive. We brought him home, gave him his own room and did what we could for him. It took me three years but I finally was able to get him to start to interact with us. A friend of mine had a theory that he had a head injury and it took him time to recover. I think it took so long because I didn't know what I was doing. I sure someone with more experience would have made more progress is a fraction of time. Since then he has turned into my teddy bear, so to speak. Obviously, he doesn't tolerate strangers and loud noises or sudden movements. I always had to watch my body language when I walked up to him in the middle of the house. But he has a wonderful big purr and has became a great sofa and sleeping cat.

However, he also developed allergic stomatitis (sp?). So we had a FIV positive cat we had to put on predisolone and periodically  antibiotics. I had managed to get his stomatitis into remission and his mouth is doing quite well. But now he is in kidney failure. This came on suddenly. My vet says he may have had this for a long time and was able to compensate until he reached an age where he couldn't.  I always worry about street cats and kidneys because of contaminates  in water and food. But, I now realize this could have just as easily been caused by the predisolone.

He is at the vets now on IV fluids with antibiotics and B-12. The vet is hydrating him slowly because of potential heart damage from pushing too much fluid too fast. Once he is hydrated she wants to keep him on the IV longer to help flush his kidneys.  She has given him medication to help with nausea and another to stimulate his appetite, which has worked. She has added Tums to his food to help bind up his potassium (?). She says once we get other things stabilized we will need discuss his blood pressure. 

My thought is that we will be able to bring him home for a short period (like maybe a week), make life super special for him, say our good byes and then let him go. Am I being overly pessimistic? I understand to a certain extent it is all up to him. But has anyone had success pulling their cat through a crisis like this?

Cats CAN pull thru a crisis like this and live many more years.  Some do, and sadly, some don't.  It really is a case by case thing.  If your Vet is optimistic, then I would be too .  If she is saying once she gets things stabilized she wants to discuss his BP, then that sounds like she's expecting him to be around for awhile longer, IMHO.   And your Vet seems to know what she is  doing, ie the SLOW IV so as not to overload his heart, realizing high BP is likely with kidney failure, etc.  (a lot of Vets never even check their BP )

I had a  cat live for 3 years after being diagnosed with kidney disease .  We did sub-q fluids at home twice a week, give him Pepcid A/C twice a day (hidden in treats) for nausea, and let him eat whatever he wanted because we wanted to spoil him rotten and he didn't like the kidney foods available. 

If you haven't already seen this website, it's FULL of helpful information:  http://www.felinecrf.org/index.htm

Hi Fuzzycat - welcome to the forum!

First off, a recommendation for you, two things that I personally would do if I were faced with 'all' this. These come partly from personal experience with an immune comprimised cat and also from observation of other peoples' experiences.

There are specialized online groups for most chronic feline health conditions...communities of people who gather with one specific focus: managing their cats' health as it is impacted by that specific condition. These groups have been functioning for years and have a collective treatment and information base unequaled elsewhere. So, two groups, one focusing on kidney disease and the second, dedicated to FIV:

1. http://pets.groups.yahoo.com/group/FIVCats/?v=1&t=search&ch=web&pub=groups&sec=group&slk=2
2. http://pets.groups.yahoo.com/group/tanyas-crf-support/ There's a good coverage of how this group works here: http://www.felinecrf.org/tanyas_support_group.htm

If you do nothing else with these groups, at least join up and read the back and forth messages - that way you can decide whether/not you might find them helpful. I'd recommend getting two new Yahoo email addys - the groups use email as a platform - that will help you manage the respective information. (I'm suggesting the FIV group as well for a few reasons. Your cat won't be the only one to have kidney issues along with FIV - others' experience in dealing with dual diagnoses can be invaluable. In addition, there are proactive measures that can be taken with FIV itself - you'll learn about those, too.)

You ask about treatments that your Vet has not suggested....what I will say is that, based on your account, you are very fortunate to have a Vet who appears to understand kidney disease (because she does seem to have a very good handle on the key issues and early treatments), she has not told you there is no hope and you should let him go (and many Vets take that approach), and she appears to be working with you and helping you understand........these are all excellent qualities in a Vet managing a chronic condition. You are certainly in good hands.

There are a few things that I'd find easier to respond to from within your post:

Has anyone had luck pulling their cat through a major kidney crisis for another year (or more) of life?

There are people on this forum and many people in the Yahoo group who have been able to successfully manage their cats' kidney disease for varying lengthy periods of time after the initial diagnosis...some for months, some for years. No one can predict the length of the journey. Every cat is  different. As guardians, each of us usually has a finite amount of resources. Initially, you have two choices: to venture down the treatment road and continually assess the circumstances as you go (cat's quality of life, costs - financial and social/emotional) - or decide instead that he has had a good life which is now near its end.

Some background on this cat....We brought him home, gave him his own room and did what we could for him. It took me three years but I finally was able to get him to start to interact with us. A friend of mine had a theory that he had a head injury and it took him time to recover. I think it took so long because I didn't know what I was doing. I sure someone with more experience would have made more progress is a fraction of time.

Again, each cat is unique. There are cats who have been 'brought inside' and who, after years, will retain their feral character and not interact - others bond immediately. You probably 'did just fine' and he needed that time...what you did is no mean feat - dare say, there are few people who would persist as you did.

So we had a FIV positive cat we had to put on predisolone.... But now he is in kidney failure. This came on suddenly. My vet says he may have had this for a long time and was able to compensate until he reached an age where he couldn't.

Kidney failure usually does appear suddenly. To understand this, you need to understand how kidneys 'work': how a youthful healthy kidney has millions of living cells (not all of which are needed at any given time); how, over time, kidney cells die and others 'step in' to take their place - until one day there are no more 'on reserve'; how, sometimes the kidneys are 'hit' by a toxic substance and 'fail' temporarily until, with treatment, function rebounds. In either case, it seems to happen suddenly. When the failure has been temporary, it is called "Acute", when, after a period of intensive treatment such as IV fluids, vitamins, appetite and nausea meds, there's no rebound to 100% function, the condition is then deemed "Chronic".  The foundation for all this is the fact that kidney cells do not regenerate - which is why the healthy body comes with lots of "spares".

 I now realize this could have just as easily been caused by the predisolone.

Frankly, this part I don't understand - I don't believe that, in cats, steroid use can cause to kidney disease (in fact, steroids are used as treatment in CKD)- perhaps I need to be corrected, though.

Once he is hydrated she wants to keep him on the IV longer to help flush his kidneys.

Hydration is a treatment that many people do themselves at home - there's lots of help available to learn about this...and, when you know the "tricks" (proper techniques) most cats actually enjoy the experience!

My thought is that we will be able to bring him home for a short period (like maybe a week), make life super special for him, say our good byes and then let him go. Am I being overly pessimistic?

Rather than suggest you're being pessimistic, let me go back to something I said earlier....you're at something of a split in the road here - you have two choices: you need to determine whether you will or you will not take the turnoff towards further treatment. If he has responded to your Vet's treatment and has improved, he may well continue at that level, perhaps improve further. (Remember, the cause of his sudden decline hasn't been determined - and, the degree of recovery is yet unknown.) Your Vet's input on her assessment will be important in making that decision - and, if it were I, I'd want the opinions of people in that kidney group.

I understand to a certain extent it is all up to him. But has anyone had success pulling their cat through a crisis like this?

Again, people have had success at maintaining a good quality of life in many cats after a kidney crisis. Eventually, once there are no "reserve" kidney cells left to call into action, then, as life goes on and further cells die, there will come a time when there are insufficient to provide the cat with that quality of life......how long that time may be is unpredictable.

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If you'd like to get a sense of other peoples experiences, you'll find a number of them here: http://www.felinecrf.org/success_stories.htm Those stories will also give you a sense of how people are able to keep the balance in their cats' systems....that's what this is all about. When kidney function reduces, things are thrown out of whack....treatment is all about restoring the balance.

I see that you've been given a link to Tanya's website........that is an absolutely amazing resource - BUT, it can also be overwhelming. Remember, there's lots of supportive help and direction available from group members - that will 'simplify' and direct you to the specific treatment info you'll need. You should know that the woman who "wrote" that website is the same person who "owns" the Yahoo group - so, it's all connected.

If you decide to take the treatment highway, ask your Vet for printed copies of all the test results she has on file. These should include bloodwork and urine testing. You'll need those if people in that group are going to be able to assess just where your cat's 'at'.

Hope some of this helps.

BTW.....we need more than "my cat".......what's puss's name?

Thank  you so much for the input. I appreciate the links to other sites for additional support and the technical  information. All of this is very helpful.  Saturday morning when I went to visit him after about 12 hours of IV fluids he still looked bad. I had one of those, what am I doing moments - am I putting him through all of this for no reason? However, now he does seem to be improving to therapy. Knowing that it is possible for him to pull through makes me feel better about my decision to treat. My vet is repeating his blood work today to see if there has been any improvement in his numbers. That should give us more information. 

His name is Fuzzy. It was suppose to be Sebastion but my husband started to call him Fuzzy Britches and Fuzzy stuck. While very sweet and loving, he is easily confused so Fuzzy seems to fit in more ways than one. 

Fuzzycat said:

My vet is repeating his blood work today to see if there has been any improvement in his numbers. That should give us more information.

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You should know that it may take more than a couple/few days to see change in the numbers.....here's what the "Oracle" says:

I do not understand vets who take an arbitrary "if s/he's not better by tomorrow/within three days/whatever period the vet mentions, you have to put to sleep" approach. In the vast majority of cases, you need to treat your cat properly for at least two weeks before you can make an informed decision. Plus deciding on euthanasia is your decision, not the vet's, and you have to live with the feelings of guilt and loss which often follow. So do not be talked into euthanasia...if your cat's numbers do not improve after a day or two on IV fluids,  because in many cases there is room for hope; the cat just needs some time to stabilise with proper treatments tailored to his or her particular needs.

http://www.felinecrf.org/is_there_any_hope.htm

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Now.......that doesn't mean the cat needs to stay at the Vet's for two weeks, because much of what's done there, you can do at home.

he is easily confused so Fuzzy seems to fit in more ways than one.

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Good news - Fuzzy's numbers have improved significantly! My vet said he came in with the worse set of numbers she had ever seen. I think this completely surprised her. He definitely  has reduced kidney function and we will have to monitor him more closely. She will want us to bolis him several times a week for awhile but she was optimistic that we would be able to wean him off even that with time. Her thinking now is reduced function over time combined with an infection. We are keeping him on IV fluids for another 24 hours. He is very weak so I will have to figure out how to create a nest for him where he can keep tabs on me. 

Given the quote about it taking up to 2 weeks to see improvement,  there is good reason to hope. Yeah. 

Thank you - your support and knowledge has been very, very helpful. 

(My husband has been a basket case over this - I was seriously worried)

Yay...I am so glad he is significantly improving, and the YOU are feeling more optimistic .  Wonderful news!!!!!!!!!!!!!

Sending more positive healing vibes

Well, that certainly is the absolute, very best news!

Do you think your young Vet might be open to hearing that Fuzzy's outcome is not so uncommon? I'm wondering if you might even be able to 'broaden' her understanding of kidney disease and treatments by getting her to take a peek at Tanya's website.......you know, it is written by an English woman who is now living back in the UK, it has been recognized by The American Association of Feline Practitioners and has won many international awards including several recommendations by The Feline Advisory Bureau (UK) (which has just changed its name to "International Cat Care")  and most recently was recommended by the Newsletter of Cornell University College of Veterinary Medicine - all very principled organizations........all of that info is found on the bottom of the homepage http://www.felinecrf.org/

Let me tell you something else that becomes very readily apparent when one joins one of those specialized online groups I spoke about. Now, those groups draw people from all around the globe, so the quality Veterinary care described by group members varies wildly - yes, I said "wild"ly - but, from my own reading of peoples' experiences with kidney disease, British vets posed the most difficulty (in terms of resistance to new treatment modalities and their arrogance) (oooops, did I say that?) for members. Of course, that's something of a stereotype - but, stereotypes are developed from realities, too.

Anyway, I know that your young Vet would benefit from it in more ways than one (maybe even to use it as a reference?) - and, that would certainly make for many other cats' benefiting.......
With quips like that, I think your husband's "basket-case-edness" is in good hands!

Keep us posted

My vet may be open to check out some of the sites. She told me this was the first time she had seen a full blown nictitating membrane in a cat (I forget the name of the syndrome). She had checked her books and they said intestinal problems. I think she was worried that there may be something else wrong with Fuzzy that she hadn't found yet. I told her about my search and how on this form several people mentioned dehydration. It turned out to be dehydration and kidney disease for another cat mom, exactly like Fuzzy. My vet seemed interested. She seemed more open to some of my questions. 

He comes home today. Yeah
With quips like that, I think your husband's "basket-case-edness" is in good hands!

 I was referring to my husband. He is driving me nuts!

Quote:

Fuzzycat said:

My vet may be open to check out some of the sites.

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Sorry...not meaning to quibble nor to be deliberately anal.....but....it's the one site I was suggesting: Tanya's

I understand. I was just encouraged that she didn't scoff at the idea of going to a (as in any) cat web site. She is a little cranky with me so I will work on her slowly. I always have difficulties getting into this vet. Sometimes, they will try to schedule you out a week, which when you have a sick pet seems outrageous. This time I called them on this policy because Fuzzy had gone down hill rapidly from the time I made the appointment to when I got him in. She tried to say maybe I had just had bad luck etc. I pushed back, this was not about me. I will give her time to get over that.

Anyway, Fuzzy is home. He is much happier. He is weak but not as weak as I expected. So, all we can do now is hope for the best. The bill was a little scary. Getting him to eat may be a challenge. I expected that. 

Hi all,

I know it has been awhile since I last posted. It has taken me this long to figure out how to post a photo and I had it in my head I needed to include a photo of Fuzzy.

So, today Fuzzy is doing OK. He gets fluids every other day. He eats well and is maintaining weight - although not putting any back on as my vet had hoped.

The information shared from members of this site was invaluable to helping me make an informed decision, which is all that we can hope for. Fuzzy was literally pulled back from deaths doorstep and I honestly believe this is due to the help and support I received from this site which allowed me to  push my vet. She did give Fuzzy excellent care. I can't even complain about the bill considering what was done.

Fuzzy in not very photogenic. He doesn't pose like other cats so it is difficult to get a good shot of him. We pulled him off the streets some 7 years ago. He was aggressive and could not be handled. It took me three years to get him to where he could be held. Today, while still quite shy, he is a major cuddle kitty with a HUGE purr. I never thought he would turn around to the extent that he has.

Awwww!  Look at that big cuddle bug .  He's a cutie pie   And I'm so glad to hear he's doing AOK.  For a kidney cat to even maintain his weight is an accomplishment, so you should feel good about that

So what is he eating?  Are you adding anything to his food, like fish oil or any type of extra nutrients?

My own kidney cat HATES any kind of fish oil that I've tried so far, so I'm thinking about buying some green lipped mussel POWDER.  Maybe it's more of a texture thing with her .  And I DO give her some freeze dried raw treats that have green lipped mussels in them, which she loves, so hopefully I can sneak the powder in her food, alongside her probiotics and digestive enzymes.  I'm also thinking about adding some PREbiotics.  Pretty soon there will be more additives than food.  Wonder if she'll notice  

At the moment I am only adding lysine to his food, but I wanted to start to research what else I could do. He eats really well, so I probably could get away with adding to his food. My vet simply said let him eat anything he wants that is canned, but now that he seems pretty stable I am wondering  if there isn't more I could do to help him out nutritionally.

With my cat who was just diagnosed with diabetes I have found a website called catinfo.org. I am assuming you already know all about it. I have downloaded the breakdown of different canned foods so it occurred to me while I was looking for high protein, low carb foods for my diabetic cats I should be looking for low protein, high fat, low carb foods for Fuzzy. I was also beginning to look into digestive enzymes.

What does the fish oil do?

Thanks,

Fuzzycat
 

Well, fish oil does have calories, plus it's just a great source of Omega 3's, which help with general inflammation, which causes all kinds of ill health, it's great for the joints, boosts the immune system, etc.  Krill Oil is actually the best IMHO, and that's what my hubby and I take, plus ONE cat loves it, but the other two don't like it so much, so I have another one on Salmon Oil, and Callie, my kidney cat can tolerate up to .1 ml anchovy oil, but she'd prefer if I didn't add it to her food. 

Yes, I refer to that food chart at catinfo.org ALL the time.  It's saved as a favorite.  My feeling, and now my Vets' is that we should be feeding not only high fat, but a good quality high protein for the kidney cats.  That's how we can keep them from losing muscle mass.  So when I say high quality, I mean no by products in the ingredients, that sort of things.  When you look at certain of the  canned Friskies on the chart, they actually look great...high protein, high fat, low carbs and low phos.  But then when you look at the ingredients, and they aren't so good (at least for kidney cats and for them to easily digest).  But depending on which food you are going with, you just might be able to feed the same food to both a kidney cat and a diabetic cat.  Right now I'm going with BG 96% Beef, Wellness Chicken, or Beef, Pinnacle, and Merrick Cowboy Cookout.  This is what Callie will eat.  By Nature Organic is what I WISH she would eat, but she doesn't like it.  I just bought a case of it which is sitting on my kitchen counter collecting dust.  (need any?)  So far it is by far the best looking food for kidney cats that I have seen. 

Oh, BTW, I think digestive enzymes are great for any cat trying to gain weight, because it helps them assimilate ALL the food they take in.  (that's my impression anyway)  Mine were already on them because when I started feeding them raw I felt it was good to give them to them so they could transition easily with no upset tummies.  It must have worked, because we had no problems in that area. 

mrsgreenjeens said:

Cats CAN pull thru a crisis like this and live many more years.  Some do, and sadly, some don't.  It really is a case by case thing.  If your Vet is optimistic, then I would be too

.  If she is saying once she gets things stabilized she wants to discuss his BP, then that sounds like she's expecting him to be around for awhile longer, IMHO.   And your Vet seems to know what she is  doing, ie the SLOW IV so as not to overload his heart, realizing high BP is likely with kidney failure, etc.  (a lot of Vets never even check their BP

)

I had a  cat live for 3 years after being diagnosed with kidney disease

.  We did sub-q fluids at home twice a week, give him Pepcid A/C twice a day (hidden in treats) for nausea, and let him eat whatever he wanted because we wanted to spoil him rotten and he didn't like the kidney foods available. 

If you haven't already seen this website, it's FULL of helpful information:  http://www.felinecrf.org/index.htm

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My beloved kitty was diagnosed with kidney disease at age 15 and lived to be 17-1/2.  We didn't do anything differently at first, just let her eat whatever she wanted to.  The last few months we did sub-q fluids with her.  

Such good news that Fuzzy has stabilized--I hope you have some good years left with him!! 

I have had five cats who eventually succumbed to kidney disease.  The first thing to string kitty along is getting good at giving Ringer's drips at home and estimating how long it takes him to absorb what you give. It is sort of a balancing act of not giving too much fluids (taxes the kidneys and lungs fill up with water) or too little (toxin levels go up).  You can see how you are doing with the Ringer's drips by getting bloodworks done periodically.  The numbers you are looking at on the CBC for toxin overload are UREA and BUN.  These usually improve alot with home drips. You can get a visual sense of when the cat is over-hydrated by a barrel-like look.  Under-hydrated and they are nauseous.

The kidneys also keep certain minerals in balance and generate a hormone to the bone marrow to regenerate red blood cells (HCT on a bloodwork panel).  A common mineral imbalance in CRF is phosphorus too high and potassium too low..  These two minerals will also be identified on a bloodwork panel.    Ask to have copies of all the bloodworks to have and refer to.

An accepted practice is to give potassium supplements by mouth and stir phosphorus binders into his food to blot up available phorphorus in whatever he is used to eating.  Science Diet K/D already has these two minerals reversed (high potassium, low phorphorus), but a lot of cats don't like it.  Also low sodium.

Tanya has a discertation on phosphorus binders: http://felinecrf.org/phosphorus.htm

Looking back, I found that I could get pretty good at controlling the toxins part of the equation with learning how to deliver frequency and fluid amount of Ringer's drips, and with a little practice on monitoring the phosphorus and potassium in bloodworks - keep that in balance, but the evantual loss of the hormone to regenerate red bloods cells led to anemia where the cat gets progressively weaker.  Looking back, I would have to say that it was the anemia which eventually got them all.  There are some experimental practices of giving the missing blood-making hormones by injection, but red blood cells take about six weeks to mature if I remember, so even if the cat responds to the hormone injections you have to start pretty early with them.

In all, they sort of just wither away. 

Thank you for the good information. I was tentatively planning on getting him in for repeat blood work this week anyway. I think I have the hydration part down, but this is the first I have heard about the phosphorous and potassium levels. I will also try Krill oil and research further the digestive enzymes.

I was looking at Soulistic foods and the Weruva foods for my diabetic cat. I know I can buy the Weruva locally. I was concerned that the protein level was too high for Fuzzy. I have tried the Wellness before and they didn't love it, but maybe that would be a good choice for Fuzzy.

I vaguely remember my vet mentioned blood doping - essentially what Lance Armstrong did. I wonder if this something being tried for the anemia? Sounds expensive.

I don't have any illusions that the prognosis for Fuzzy is grave, but if I can get another good year or possibly two of a happy and comfortable cat, then I am happy. He has had a longer life then he would have if he had stayed on the streets. He was getting his butt beat up by other cats and he was half starved. The only reason he wasn't put down when we first took him into the vets for tests, shots and neutering was the vet was unable to contact us at work when she discovered he was FIV positive, (he was still under anesthesia and her plan was to simply not wake him up). Back then we couldn't handle him,  he had to be dumped into an aquarium and gassed to sleep.

Fuzzycat

Well, as far as the low potassium and high phosphorus goes, it is true and these numbers can get out of whack, but that's why you are looking for food on that food chart that is low in phos.   If you can get him to eat food that is low enough, you may never need to use phosphorus binders.  We never needed them with our Sven.  And as far as low potassium goes, there are signs to look for that might mean his potassium is getting low, which are outlined on Tanya's website, one of them being they hang their heads down, if I'm remembering correctly.

But as far as the anemia goes, that's not necessariiy a given.  My Svennie never had that issue.  I think that may be a side effect of the dreaded LOW PROTEIN diet, which is now being re-thought.  Personally, I think that's bad all the way around.  That's one reason why kidney cats just waste away.  How can an obligate carnivore be expected to survive on a low protein diet?  That's why I said I look for good quality high protein (no by-products), high fat, low carb, low phos canned food, or better yet raw.  I actually add egg whites to my Callie's food because they are full of protein yet contain very little phos and NO carbs.  She eats them raw, but I buy the pasteurized ones in the carton to add to her food.  I would rather she eat them cooked, but she refuses, the little diva.   Funny, she won't eat raw meat anymore, but she want's her egg raw .  BTW, all of what Callie eats (including raw meat when she'll eat it, is with my Vet's approval )  She (the Vet), just came back from a seminar on kidney treatment, and apparently nutrition was a hot topic.  High protein was being discussed as maybe a GOOD THING!!!!!  Imagine that

Oh, Fuzzy, as far as Soulistic and Weruva go, the only problem with them is that don't have a very high fat content.  Callie eats Weruva one meal per week, just because she loves it so, but that's it because it so very low in fat and calories, and she needs to maintain her weight, if not gain.   BUT, on the other hand, if that's what your guy loves, then that's what he should eat, IMHO.  I say let them be happy at this point in their lives. 

Thank you! This is very helpful. That one website is excellent and I will go back over it. Right now is looks happy and is eating like a hog. So, I think my first step is to repeat his blood work and see where his numbers are and then figure it out from there.