Female cat in early stages of CKD- please help!

Hi everyone - apologies in advance for the long thread, but I'm currently in a state of paranoia... 

So I have a 14 year old tortie named Fenella who has been the furry love of my life since she was about 9 hours old. She was relatively healthy up to age 10 and then started having issues like UTI and arthritis. The UTI has been resolved now and the arthritis is being treated through meds and Adequan injections. 

But a couple weeks ago she started vomiting and sudden loss of appetite, she wouldn't even eat her treats - and she started urinating constantly outside of the litter box! I had to syringe feed her and then she became constipated. I took her to the vet and she did a urinalysis and said that she was in the "early" stages of CKD. So I went home and did some research, and after finding out what it really was became really freaked out...

So the next day I asked my vet to do bloodwork and after the results came out she told me that Fenella was in stage 3 of CDK and had already lost 66% of her kidney function.  I felt TERRIBLE about this and was also a little mad at my vet as she had not diagnosed it sooner...   but I feel so guilty!

So for the past two weeks Fenella's just been really sick... she has nausea, is vomiting white foam and sometimes blood constantly and has an almost complete loss of appetite but is drinking water (sort of). I have to syringe feed her and sometimes she will go finish it on her own but normally she doesn't.... The vet diagnosed her with excess stomach acid issues. She gave me Famitodine as an excess stomach acid reducer... does this really work?? I'm just really worried at this point.. we're starting at 2.5 mg per day.

She's staying hydrated, but barely- we might have to resort to Sub Q fluids soon.   She has had several kidney stones in the past, all of which had been removed... could that have been a cause??

Right now she's sleeping, she's been acting REALLY lethargic, not playing, and I know it's not only her arthritis.

I feel absolutely terrible for not recgonizing this sooner and now that she's lost 2/3 of her kidney function I'm so lost. Can anybody please give me any advice or just answer these questions:

1. Why did the vet take so long to diagnose (when she was in Stage 3 already)?

2. She's been licking her lips really frequently... does anyone know why? (or is it just behavior?)

3. Will the Famitodine help with the stomach acid?

4. Do we have any hope at all? Or will she have to be put to sleep soon? I love my Fenella. She's like my sister, my baby, and even sometimes my mother and I couldn't imagine my home without her. I really don't want to lose her to this disease but I know it might happen.

Advice, support and vibes would all be greatly appreciated. I know all of you are wonderful and knowledgeable people who can help me through with this.

WinterCat

First of all, I'm so sorry all of this is going on. I've had 3 kitties who have had CKD and can imagine the stress and frustration you're going through right now. 

Please don't feel guilty/be angry at your vet for recognizing her CKD at Stage 3. Take a deep breath. It is actually normal for a cat to be diagnosed with CKD until he/she has lost 66% of his/her kidney function. 

Why? A cat's kidneys contain around 170,000-190,000 nephrons. This is actually more nephrons than are needed for normal function; plus, nephrons can increase their individual functions to an extent when other nephrons die. This is why people are able to donate a kidney and still manage perfectly well with the other kidney.

It works in a similar way  in a cat with kidney disease, i.e. as damaged nephrons die ("scar tissue"), other nephrons take over their work. Eventually, however, all the remaining nephrons will be working full time (i.e. there will be no "renal reserve" left). It is at this point, when around 66-75% of function has gone, that you will probably start to see symptoms in your cat, as the remaining nephrons start finding it harder to cope with the workload.

Also, cats are very good at hiding any signs of illnesses - so please do not feel guilty; it's perfectly normal to diagnose at this stage. And the percentages aren't as bad as you think.

Your vet has already diagnosed her with having excess stomach acid. This is one of the most common symptoms exhibited in CDK cats (especially in the early to intermediate stages). Vomiting white foam, vomiting water, lip licking, teeth grinding, hoarseness, drooling, yawning/yowling, and even playing excessively with her water bowl are signs and symptoms of having excess stomach acid. 

Don't worry about the Famotidine (also known as Pepcid AC). It is the most commonly used medication for CDK-related stomach acid problems and is a very  effective treatment for excess stomach acid (I have had direct experience with my 3 CDK cats - all were diagnosed with excess stomach acid issues and they were greatly helped by Famotidine meds). 

Unfortunately, Pepcid AC has been discontinued in the UK and instead replaced by Pepcid Two. Pepcid Two contains magnesium and calcium in addition to famotidine, so it is not suitable for CDK cats. 

2.5 mg Famotidine per day sounds like a good dosage amount for the intermediate dose - normally, the average starting dose is 2.5 mg per other day. Maybe confirm with your vet that this is the best starting dosage for Fenella.

In response to your question about if you and Fenella have hope, I would say YES.   Whilst I can't promise that your cat will pull through a crisis or survive for years, I can tell you firstly, the numbers do not tell the whole story; and secondly, that not being proactive is definitely going to reduce his or her chances.

Just as I cannot promise Fenella will be a success story, nor can your vet know for sure that she won't be. None of us has a crystal ball (though if your vet does happen to have one, please find out where I can get one too because I could really use one ). Vets have some idea of the prognosis based on your cat's test results and their previous experience, but there are so many other factors, such as the cat's attitude and tolerance levels (my Thomas ate like a horse with creatinine over 7 or 650 international), how proactive the vet is, which treatments are used and of course the caregiver's efforts. The only ones of these which we can control are the latter two (and possibly which vet you use, though that also depends upon where you live), so I recommend focusing on these and then, whatever happens, you know you've done your best. 

If you have any other questions, please feel free to ask, and please keep us updated on little Fenella!

@CKDKitties  Firstly I'd like to thank you so much for your quick and detailed response.   (And sorry about any typos in my first post- I was really freaked out!)

I'm still worried though. She's eating a little now, but I am not sure what exactly to feed her... I know that if they don't eat for a certain amount of time they get a disease and can even die. do you have any diet suggestions?

Thank you so much again!! You are an angel!! 

You're so welcome! 

To be honest, the best food for a CKD cat is a food that Fenella will eat. You can source the most organic, wholesome food on the planet, but if your cat would rather starve than eat it, it is of no use whatsoever. To me (everyone has different opinions about this), it is more important (firstly) that a cat eats than that a cat eats certain foods. 

When it comes to food:

• Please, feed a food that she will eat! Cats eat to live rather than live to eat. 
  
   Getting food into Fenella's system is more important (IMO) than letting her starve to death because she is "only supposed to eat _____ diet" or something along those lines.
• In the earlier stages of CKD, I would have advised you to feed a high-quality protein food (since there can be harmful side effects to having a low protein intake in the early stages)- however, in the later stages of CKD, it will help if you restrict protein intake as it progresses. Once BUN (Blood Urea Nitrogen) levels are above 60, you start seeing the symptoms such as vomiting and nausea (which you are seeing in Fenella). This is when it is advised to drop protein intake gradually. The usual goal is around 25-30% protein on a Dry Matter Analysis (DMA) basis. The easiest way to do this is to feed a renal prescription diet  (have a low protein level of around 25-30%).
• Please keep phosphorus levels low in Fenella's diet. The kidneys of a CKD cat can no longer efficiently excrete excess phosphorus, so it is crucial that you keep the amount low. If the amount of phosphorus in their blood gets too high, this leads to hyperphosphataemia. High phosphorus levels will also make the CKD progress faster. But do not drop the phosphorus levels too low, as this can cause extreme lethargy and even seizures.
• Wet food is a must!  This helps with potential problems (i.e. dehydration) that will worsen the CKD. If Fenella is accustomed to dry food, don't worry - you may be able to gradually switch her over to wet food.

Your vet will most likely prescribe you with a prescription diet (if she hasn't already). 

CKD prescription diets are intended to help cats cope better with the CKD and ideally prolong their lives. Everybody knows that these foods are low in protein, but there is more to them than that. These foods differ from other cat foods in that they:

• 
  are relatively low in protein but the protein they contain is high quality protein;
• 
  are relatively low in phosphorus;
• have added potassium. This is usually in the form of potassium citrate because this can help with metabolic acidosis;
• 
  are lower in sodium;
• 
  contain higher levels of B vitamins;
• 
  contain increased levels of essential fatty acids
• 
  usually contain additional fibre.

So remember your new mantra: Fenella must eat! 

If you need more information, you can always visit my website - just look up "Tanya's Comprehensive Guide to Feline Chronic Kidney Disease". Feel free to ask any more questions and please keep us updated.

Lots of vibes coming Fenella's way.