Old Kitty with Kidney Failure and Stomach Problems

Several years ago it was discovered that my now almost 18 year old cat was starting to have signs of kidney failure.  It was initially diagnosed through regular bloodwork, and at one point we had thought we thought we were going to lose her.  Lots of fluid shots over the course of a few weeks, and she was a whole new kitty.  When I moved into my own house I took her with me, learned more about cat diets, and started her on almost exclusively canned cat food in hopes to slow the progression of the disease.

Now, it seems as though she is in gastrointestinal distress.  A couple of months ago she started pooping out of the litter box, but I made some changes and thought we had handled the situation.  She's always been a cat that throws up hairballs and water on occasion, despite numerous attempts at changing her diet.  Lately she's been throwing up more often, and it's not just hair or water.  Around that time (a couple of days ago) her stools have become runny.  Apparently she had some sort of problem when I was in the shower earlier, and I found a fairly large spot of brownish very watery vomit next to a spot of equally runny diarrhea.  When I found it, she was sitting on the couch in the other room like there was no issue.  She's still eating and peeing in the box, and there haven't been any recent diet changes.

Could this be related to her kidney failure?  Or is it another issue entirely?  I don't think it's some sort of bug going around as I don't have any cats coming in or out, and my young cat is just fine.  Either way, what should I do about it other than take her to the vet? 

I don't want to make the awful decision to have her put down because of this if it progresses, but I fear the worst with older animals   I have noticed that for the past couple of weeks that she has seemed... kind of more droopy and sadder than usual.  She's still relatively active for an older cat, and there's nothing dramatically different about her.  She just doesn't seem to be like she has been.  Still loves to rub and snuggle all over me, and still hates every other person in existence.  Just... sadder.  It's been bothering me, and these issues now have me worried about her. 

Oh, and she will be going to the vet asap to see what they have to say.  I just wanted to see what other folks thought about her situation. 

When my Tabitha had kidney failure she would vomit from it.  We gave her medicine (Pepcid) to help control the stomach acid.  Kidney Failure cats produce excess stomach acid.  So definitely talk to your vet about that. 

cprcheetah said:

 
When my Tabitha had kidney failure she would vomit from it.  We gave her medicine (Pepcid) to help control the stomach acid.  Kidney Failure cats produce excess stomach acid.  So definitely talk to your vet about that. 

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Thanks... I'll discuss that with the vet.  We haven't had any out of the box issues since yesterday, but what has been left in the litter box is very runny indeed.

When was her most recent blood work? Where did they stage her CKD?

Increased stomach acid and anemia are common problems for CKD. It would be good to know her potassium levels too.

peaches08 said:

When was her most recent blood work? Where did they stage her CKD?

Increased stomach acid and anemia are common problems for CKD. It would be good to know her potassium levels too.

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We opted out of doing blood work at her last check up, which was in September if I remember correctly.  Now I kind of wish that I had, but just getting her to the vet is stressful enough for this little girl.  Let alone having blood work done- it's amazing how much of a monster a 4.5 pound elderly kitty with no front claws can be, and she comes home exhausted.  I don't know exactly what stage she was in when she last had bloodwork done a year ago, but on the most recent trip the vet said that the levels in her last exam were pretty high.  He said that he'd do it if I wanted, but that since nothing had changed with her recently then management of the disease would be the same.  Basically, it would have only gotten worse, but that her behavior and physical condition would direct the treatment more than the numbers would.

So should I request full blood work on this vet visit, with potassium levels included?  What other questions should I ask, and what else should I have the vet do with her? 

Definitely get some blood work. Potassium levels are on a standard CBC, as are factors for anemia. But knowing these numbers can tell us what's wrong and where to turn next.

Are you giving her subcutaneous fluids now? Better yet, other than canned food what does she get as far as treatments, water, type of litter, etc? I feel your pain on trying to learn as you go with CKD. My dear Grey (RIP) started eating her clumping litter (flushable clumping, thank goodness!) and I frantically took her to the vet thinking that I was going to have to consider surgery on an older cat. No surgery, but got the diagnosis of stage 4 CRF. Anyway, there are several members here who have battled CKD/CRF and hopefully they'll chime in soon. A great site for you to read right now is www.felinecrf.org. It's much harder to play catch up and learn than it is to go back and refresh one's memory during the course of a progressive disease.

peaches08 said:

Definitely get some blood work. Potassium levels are on a standard CBC, as are factors for anemia. But knowing these numbers can tell us what's wrong and where to turn next.

Are you giving her subcutaneous fluids now? Better yet, other than canned food what does she get as far as treatments, water, type of litter, etc? I feel your pain on trying to learn as you go with CKD. My dear Grey (RIP) started eating her clumping litter (flushable clumping, thank goodness!) and I frantically took her to the vet thinking that I was going to have to consider surgery on an older cat. No surgery, but got the diagnosis of stage 4 CRF. Anyway, there are several members here who have battled CKD/CRF and hopefully they'll chime in soon. A great site for you to read right now is www.felinecrf.org. It's much harder to play catch up and learn than it is to go back and refresh one's memory during the course of a progressive disease.

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Some may disagree with my stance on it, but I don't think that regular subcutaneous fluids are a good option for my cat.  She's not one that is easy to handle in the slightest, and at her age I don't want her to have to go through a battle every day for a shot to keep her feeling well.  I am mixing in water with her canned food every day, there are multiple water bowls in the area that she prowls (including one with flowing water), and we use fresh step clumping litter.  I haven't seen any signs that she is eating the litter. 

DuckDodgers said:

Some may disagree with my stance on it, but I don't think that regular subcutaneous fluids are a good option for my cat.  She's not one that is easy to handle in the slightest, and at her age I don't want her to have to go through a battle every day for a shot to keep her feeling well.  I am mixing in water with her canned food every day, there are multiple water bowls in the area that she prowls (including one with flowing water), and we use fresh step clumping litter.  I haven't seen any signs that she is eating the litter. 

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Grey was a wonderful patient. She was soooo easy to handle. Of my new cats, one is easy to handle, one might could be coaxed into treatments depending on what they are, and one I truly do not foresee her going along with any treatment. Not that I wouldn't give it a try, but she's just...her. so actually I do understand where you're coming from. As far as fluids subcutaneously, there are ways to make the process much better. There are some really sharp needles that hurt less available on the market now, and warming the fluids in a sink of hot water before administration really helps. Grey actually enjoyed fluids time and would roll over on her side or back during them! Anyway, food for thought but you know your cat best.

LDG wrote a great article on getting more water into your cat for this site. See, in CKD, cats can't reabsorb water in the kidneys like healthy cats do so water is really important for them. Adding water to her food is a great start!

Usually if a cat has developed anemia,that's when they will start to eat litter, or lick at anything that is clay...flower pots, brick, that type of thing. 

And usually, in my experience, when kidney cats throw up from too much stomach acid build up, or too much toxicity from their kidney's not filtering (thus the need for sub-q fluids), they will throw up froth, not what you have described.  Also, diarrhea, in and of itself, is not a side effect of kidney disease that I can find.  Usually kidney cats that end up with diarrhea get it from either a change of food, medication they are being given, or because they develop some other issue.

BTW, DuckDodgers, I'm completely in agreement with you on the bloodtests, etc. when you have a cat that you KNOW will fight you if you try to medicate or give fluids to.  My Sven passed away last year from kidney disease, and we rarely had his blood tested, because it really didn't matter what the results said.  We just treated the cat.  Whatever was happening to him, we would call his Vet and talk it over and go from there.  If he was throwing up a lot of froth, we would either try to give him Pepcid A/C dosages (as appropriate for a cat), and if we couldn't sneak them into treats, he wouldn't get them because he was impossible to pill.   Once those quit working alone, then we moved on to Sub-Q fluids.  We decided to try them and see how he reacted.  Luckily, he accepted them alright, so that helped him out for quite some time.  But now our girl has it, and DH and I both feel that she will NOT be so accommodating when it comes to getting fluids, since she absolutely HATES to be held down.  When the time comes that she may need them, don't get me wrong, we'll give it a try, but we won't force the issue.  If it's struggle every single time with her, then we won't do it.   We still took/take them in twice a year for exams, but don't get blood done every time. 

Do you have your old girl on probiotics?  Since she appears to be having a GI issue, if you can figure out what's wrong, you might start her on them.  We have ALL of ours in them, and I think they really help.  We haven't had any issues (other than our kidney cat throwing up froth once in awhile) since they started on them.  We give them the same ones WE take.  Just open up a capsule and mix into their food

for your old girl.  Hopefully this IS just a bug that she caught and will be able to throw off soon

Thanks... I guess I'll go in to get bloodwork done, and have them thoroughly examine her for any other issues.  As of late any vomit that she's been throwing up has actually been a little more frothy and clear than usual... up until yesterday's stuff.  I wish I had been around to see what was going on... but apparently that incident happened in the half hour I was up in the shower.  Guess I wouldn't have been able to do anything about it anyway. 

Well, I took her in today and the vet didn't find anything out of the ordinary from the physical exam except for a likely enlarged thyroid gland.  He gave her a fluid shot, took some blood, and gave me some probiotics and metronidazole pills to give her for the diarrhea. 

The bloodwork should be back Wednesday at the latest, and at that we'll discuss what else to do.  He suspects that she has developed hyperthyroidism, but that managing it can be difficult in cats with kidney problems.  That because hyperthyroidism causes an increase in appetite when he's tried to use medicine to treat the thyroid problems the cat will stop eating and crash.  Either way, we'll see what happens when the blood work comes in.  He didn't say not to treat the thyroid, just said that there are concerns associated with the treatment.

Thoughts, especially on the kidney disease vs hyperthyroid treatment?  I certainly don't want to deny her necessary treatment, but I don't want to make her situation worse in an attempt to help her.  She's pretty thin at 4.5 lbs, but is naturally a very small cat and has held onto that weight since her last visit. 

Thyroid issues with kidney cats is NOT uncommon and IS treatable.  What you say the Vet said does not really make sense to me   Here is a link from a very good site on kidney disease, and I have linked to the page that discussed Thyroid issues.  Be sure to read the entire page, which discusses foods, symptoms, treatments, etc.

It's good to be armed with information before your next discussion with your Vet.

How's she doing today.  Did the meds help with her vomiting and diarrhea? 

mrsgreenjeens said:

Thyroid issues with kidney cats is NOT uncommon and IS treatable.  What you say the Vet said does not really make sense to me :dk:   Here is a link from a very good site on kidney disease, and I have linked to the page that discussed Thyroid issues.  Be sure to read the entire page, which discusses foods, symptoms, treatments, etc.

It's good to be armed with information before your next discussion with your Vet.

How's she doing today.  Did the meds help with her vomiting and diarrhea? 

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Methimazole can unmask/exacerbate renal disease. However, the key is to start low and slow. It can certainly be done and both issues are too important to let go.

peaches08 said:

 

mrsgreenjeens said:

Thyroid issues with kidney cats is NOT uncommon and IS treatable.  What you say the Vet said does not really make sense to me

  Here is a link from a very good site on kidney disease, and I have linked to the page that discussed Thyroid issues.  Be sure to read the entire page, which discusses foods, symptoms, treatments, etc.

It's good to be armed with information before your next discussion with your Vet.

How's she doing today.  Did the meds help with her vomiting and diarrhea? 

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Methimazole can unmask/exacerbate renal disease. However, the key is to start low and slow. It can certainly be done and both issues are too important to let go.

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Exactly!   That's what it says in that link that I .....oops, I see I didn't attach the link   Here it is:  http://www.felinecrf.org/hyperthyroidism.htm  Anyway, that's why I wanted you to be familiar with this information before you go back to the Vet!  You CAN treat kidney disease and Hyperthyroidism together as long as you do it correctly.  That includes food, so be sure to read up on that too.

mrsgreenjeens said:

 
Thyroid issues with kidney cats is NOT uncommon and IS treatable.  What you say the Vet said does not really make sense to me

  Here is a link from a very good site on kidney disease, and I have linked to the page that discussed Thyroid issues.  Be sure to read the entire page, which discusses foods, symptoms, treatments, etc.

It's good to be armed with information before your next discussion with your Vet.

How's she doing today.  Did the meds help with her vomiting and diarrhea? 

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He didn't say that it wasn't treatable... just that you need to be careful in what path you take.  It made sense to me according to the link!

Ugh, now I'm irritated.  The vet called me at about 4.30 to say that he had the bloodwork.  I called back five minutes later, and the receptionist said that he's in an appointment so he'll call me when he gets done.  Never hear back, so I call at almost 6 when they close and he already left.

I hate hate hate having to play phone tag with people.  HATE.  It just makes the situation even more upsetting. 

Phone tag is the worst!

I hope you can get some answers as to which path to take soon.