My cat has stage 4 renal failure

My 8 year old Persian cat Smoky has always been playful and loving. Recently we noticed she was getting thinner and thinner. Every time we took her to the vet, he'd mumble something noncommittal about it. She has been on steroids for a while now due to a recurring ear infection. So the vet would merely treat her for that instead of paying attention to our queries about her weight loss. He is really uncommunicative and never tells us what he is giving her or what exactly the problem is. But he's the only vet in the city, so we don't have a choice. There was another vet we used to visit before this one, but he gave one of my cats wrong medication, and she died.

Smoky was really getting to be skin and bones when my mother noticed she wasn't moving away like she usually does when cars approach her on the road outside our compound. She would just remain sitting there. So my parents frantically took her to the vet and insisted he do some kind of blood test or something. We thought it was diabetes. The vet complies, and finally comes back saying her creatinine level is 14. He tells us there is no point giving her subcutaneous drip, because she's also anaemic, and this could be harmful to her. Instead he gives her some sort of iron injection and tells us to give her 1/6th of some tablet, whose name he isn't even forthcoming with. We keep asking him and he keeps mumbling something. It's really difficult when we can't even get angry with him because he's the only vet in town and he might just decide not to treat.

Anyway my mother finally decided to call a well known cat specialist in another state and he told her we HAVE to give smoky a subcutaneous IV drip everyday and also an antacid so that she doesn't develop stomach ulcers. My mother will obviously have to figure out how to administer this drip herself, as our vet has already refused to do it. The specialist said there is hardly any hope left, and that all we can do is try to give her the best standard of life and keep her comfortable and happy. If she starts vomiting, or showing evidence of suffering, we have to put her down. At the moment, smoky is very alert, responds to us when we call her, and is generally active and seems normal. Only she has become very thin.

I'm heartbroken because I grew up with smoky. And she is only 8 years old far too young to develop such a serious condition. Does anyone have any suggestions for how we can somehow get her through this? Do you think there is any hope at all? She is such a loving and intelligent cat. She's family.

I'm so sorry your having to go through this.

It's still early at the moment, so a lot of the members won't be on for a couple of hours, but keep checking in because some have been where you are now and hopefully give you some advice

Ihavethreecats said:

My 8 year old Persian cat Smoky has always been playful and loving. Recently we noticed she was getting thinner and thinner. Every time we took her to the vet, he'd mumble something noncommittal about it. She has been on steroids for a while now due to a recurring ear infection. So the vet would merely treat her for that instead of paying attention to our queries about her weight loss. He is really uncommunicative and never tells us what he is giving her or what exactly the problem is. But he's the only vet in the city, so we don't have a choice. There was another vet we used to visit before this one, but he gave one of my cats wrong medication, and she died.

Smoky was really getting to be skin and bones when my mother noticed she wasn't moving away like she usually does when cars approach her on the road outside our compound. She would just remain sitting there. So my parents frantically took her to the vet and insisted he do some kind of blood test or something. We thought it was diabetes. The vet complies, and finally comes back saying her creatinine level is 14. He tells us there is no point giving her subcutaneous drip, because she's also anaemic, and this could be harmful to her. Instead he gives her some sort of iron injection and tells us to give her 1/6th of some tablet, whose name he isn't even forthcoming with. We keep asking him and he keeps mumbling something. It's really difficult when we can't even get angry with him because he's the only vet in town and he might just decide not to treat.

Anyway my mother finally decided to call a well known cat specialist in another state and he told her we HAVE to give smoky a subcutaneous IV drip everyday and also an antacid so that she doesn't develop stomach ulcers. My mother will obviously have to figure out how to administer this drip herself, as our vet has already refused to do it. The specialist said there is hardly any hope left, and that all we can do is try to give her the best standard of life and keep her comfortable and happy. If she starts vomiting, or showing evidence of suffering, we have to put her down. At the moment, smoky is very alert, responds to us when we call her, and is generally active and seems normal. Only she has become very thin.

I'm heartbroken because I grew up with smoky. And she is only 8 years old far too young to develop such a serious condition. Does anyone have any suggestions for how we can somehow get her through this? Do you think there is any hope at all? She is such a loving and intelligent cat. She's family.

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I'm not really sure what you can do when your vet has problems with telling you what she actually is suffering from, and what his diagnosis or treatment plan is.

 It's great that your mom took the initiative and called another vet.

Is there anyway that this other vet could give your mom directions over the phone, on how to administer the sub-q fluids, since it is important for hydration.

Did you see this video here on how to syringe feed a cat who won't eat :http://www.thecatsite.com/t/227858/syringe-feeding-lucky-video-if-your-cat-is-not-eating

But if it is stage 4 then usually you can only do supportive care because the kidney's are shutting down. Just keeping her comfortable and looking at quality of life.  It all depends on what is causing the renal failure.  http://www.allfelinehospital.com/site/view/206525_chronickidneydisease.pml

I don't know enough about it, but this site might help http://www.felinecrf.org/is_there_any_hope.htm

Keep posting every few hours as @Rosiemac  said because someone who knows about renal failure will see it and reply.  

Thank you so much for your suggestions and advice. We just gave smoky a subcutaneous drip so as to be able to flush some of those toxins out. Hopefully. [emoji]128542[/emoji]

Ihavethreecats said:

Thank you so much for your suggestions and advice. We just gave smoky a subcutaneous drip so as to be able to flush some of those toxins out. Hopefully. [emoji]128542[/emoji]

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That's good.  So does this mean you know the cause of the renal failure in Smoky?

She had been having persistent ear infections since last year for which she was treated with anti biotics, steroid shots and ear drops. Our specialist vet tells us that 8 is quite a young age to develop renal failure and the frequent steroid injections could be a culprit

Ihavethreecats said:

She had been having persistent ear infections since last year for which she was treated with anti biotics, steroid shots and ear drops. Our specialist vet tells us that 8 is quite a young age to develop renal failure and the frequent steroid injections could be a culprit

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Yes, I thought 8 was young to get renal failure, so I thought maybe cancer or she ate something toxic.

I'm not sure but steroids are usually given to suppress the immune response and inflammation, so that the body can recover itself. Also as a pain reliever because it reduces inflammation.

I didn't know that frequent steroid injections can cause renal failure, but it makes some sense since the body does have to process the meds.  So I guess that the kidneys may have been getting overloaded.   I would have thought that it would hit the liver first, since the kidneys are usually like filters for toxins. you do get alot of water retention on steroids, though.

did she get tested for diabetes? or for felv and fiv?

I'm still hoping that some more knowledgeable TCS members will see your thread, in the afternoon, or evening and offer more helpful suggestions.

I just don't know enough about renal failure.

Is Smoky eating at all? and what does she eat?  Are her gums a yellow colour, or pink, or pale white?

I have a kidney cat, and the sub-q fluids, along with a diet low in phosphorus, added Vitamin B, added Omega 3s, Pepcid A/C for the upset stomach (or Slippery Elm Bark syrup) is about all I can think of right now.   There ARE some over the counter remedies you can try.  Lots of people swear by Azodyl, but it's the size of a horsepill, so unless you are good at pilling her, or hiding giant size pills in treats, it might be a waste of money.  Also, if you aren't in the U.S., it might be hard to get. 

This website http://www.felinecrf.org/index.htm, which was referenced above, is my "go to", when I have any questions like  "how much pepcid A/C", how do I make Slippery Elm Bark syrup", "where do I buy my needles for the sub-q fluids", etc.  They also have a food chart on which foods are lowest in phosphorus, but I like this one better, simply because this one is on alphabetical order by brand name of food, although it you aren't in the U.S., it may not help you  http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf (plus it's getting a little outdated, so some of the newer foods out there aren't on it).  Did your new Vet discuss foods with you?  Besides the fluids, foods are the next most important thing.  It's the phosphorus in foods that cause the high creatinine, and if you can't get your furry baby to eat foods low in phosphorus, then there are phosphorus binders you can give her.  The above website discusses those too.  And it discusses the anemia that so frequently accompanies kidney disease. 

One of the major issues with kidney cats is that they simply don't feel like eating.  But, naturally, they need to eat.  And if you can get her to eat canned food, all the better.   She needs to eat a good quality canned food, and if possible even add water to it.  If she'll eat it, even add some egg whites to it, as this is wonderful protein for her and doesn't have phosphorus.  Don't give her egg yolks though, because those are loaded with phosphorus.  If she'll eat it, try adding in a little bit of coconut oil to her diet.  Start slow so she doesn't reject it.  This might help her put on some weight.  (and by slow, I mean less than one half a teaspoon per meal...if she likes it, then increase it.  My vet said ok to give up to one tablespoon per day) 

BTW, cats as young as just a few months have been known to get kidney disease.  Age really has nothing to do with it

I'm so sorry.  This actually makes me upset to even read.  My cat Thomas was in stage 3 renal failure when he was originally diagnosed.  He was given a special diet and couldn't have anything else.  He was able to survive nearly another 3 years and did pretty well up until his last 2 weeks.  I'm not sure how much diet will help at stage 4, but I wish you the best of luck.  Hang in there!

Thank you for your concern.I found the sites sent by themembers of this group very helpful and encouraging. I noticed that smoky was constipated today and gave her 5ml of duphulac. I have been giving her her sq fluids since the day before after watching a very good u tube video of how to go about it. She seems fine with it and is even quite content during the procedure. However I dont see any hump which signifies the build up of the fluid am I doing something wrong? She is eating canned food and finishes a small sachet of it each day. I give her an antacid morning and evening to make her comfortable..

Ihavethreecats said:

Thank you for your concern.I found the sites sent by themembers of this group very helpful and encouraging. I noticed that smoky was constipated today and gave her 5ml of duphulac. I have been giving her her sq fluids since the day before after watching a very good u tube video of how to go about it. She seems fine with it and is even quite content during the procedure. However I dont see any hump which signifies the build up of the fluid am I doing something wrong? She is eating canned food and finishes a small sachet of it each day. I give her an antacid morning and evening to make her comfortable..

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Ihavethreecats     I sometimes read over other TCS posts to get more pieces of info about certain things on Cat Health or Cat Nutrition.  Usually, I just type in a search for it, if I have a specific question. It shows loads of threads from other members, who have had these conditions, so I browse them.

In your case, you have gone even further, since you posted your own thread, but then to get members to answer, they first have to see it.  so I suggest addressing the two other members first, with a @mrsgreenjeens  and a @Skyefoxx  

Because of time differences in other countries, this question can take awhile to answer until the member come back online.  So another trick is to post the same question, in your thread, at about the same time that member was online last, or even when you may have noticed more busier times.

It seems to me that you are doing all you can in supportive care. I am actually learning a lot from this thread, but have no first hand experience with crf.

The eating of the wet canned food would also help with constipation, and I read that adding water, and mushing it up, also warming up the food may help the cat.

mrsgreenjeans already mentioned the adding water part and the low phosphorus foods.

sorry, if I just repeated things you may already know, because i only joined in january, so still new to this site, and some kind members told me some tips they used when posting.  I accidentally find the rest while reading.

While I've never done it myself, the vets had to do it with my cat.  I was warned he may have a lump of extra fluid there but he never developed one either.  So long as it appears that she is getting fluid I wouldn't be overly concerned.  It depends on how quickly she is getting the fluid and how quickly it is dispersed around her body.  The lump only signifies extra fluid buildup.  If it is draining slow enough to be absorbed or if it is getting dispersed quickly around her body, I would imagine that a lump would not form.

There should be a lump - even a small one. How much sub-q fluid are you supposed to be giving? I don't know how much fluid should be given to a cat with renal issues. When mine is dehydrated, I usually try for 100 ml (small cat and more would put too much stress her old heart. She also gets water added to her canned food.

Ihavethreecats said:

Thank you for your concern.I found the sites sent by themembers of this group very helpful and encouraging. I noticed that smoky was constipated today and gave her 5ml of duphulac. I have been giving her her sq fluids since the day before after watching a very good u tube video of how to go about it. She seems fine with it and is even quite content during the procedure. However I dont see any hump which signifies the build up of the fluid am I doing something wrong? She is eating canned food and finishes a small sachet of it each day. I give her an antacid morning and evening to make her comfortable..

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Constipation is VERY common in kidney cats .  My LAST kidney cat, may he rest in peace, was on a regimen of 1/4 teaspoon Miralax (also know as Peg-3350 in some countries) twice a day for over a year to help with that, and it worked miracles.  We just dissolved it in a little water, then mixed it right into his food.  It's completely tasteless and doesn't gel up like some of those things.  And it doesn't get sticky like Lactulose.

As to no lump with giving sub-q fluids...how much are you giving her?  Are you doing it every day?  Sometimes when we gave Sven his fluids, it would even show up in one of his front legs, but we were giving up to 200 mls at a time every 3 days or so.  Since Smokey is a Persian, she's got longer hair anyway, so I'm guessing it just may be a little harder to see if she's got a little fluid bump.  It would just be a soft bump that would slowly go away as the fluid is absorbed, but it isn't usually at the injection spot.  If you are only giving her around 50 ml each time, she may not be developing a "bump" anyway

So she isn't throwing up any "froth" that you notice?  That's a great sign The antacids must be working.  Sounds like things are coming along nicely.  Now you really need to concentrate on finding a food that is low in phosphorus.  Try to find something that is below 1% on that food chart.  If you have to, slowly mix the new food into her old food until she accepts it, or at least give her half and half.  Food and the fluids are the key the bringing down her creatinine levels. 

I give smoky 100 ml of sq per day. I mix the antacid tablet with lactulose and squirt it into her mouth. Since she doesn't protest too much about it I assume that it doesn't taste too bad. Yesterday after giving her her sq fluids I thought I felt a very tiny bump on the side of the injected site but I dont know if I was imagining that. I throw away the RL solution and iv set after each use. Can I use the remaining RL solution with a new needle? I haven't seen her throwing up yet. She ate quite well this morning. She prefers not to be in the house and jumps into her cage where she lies most of the day. Her eyes are bright and as before she replies to me with understanding Meow's when I talk to her. Two days ago she was passing clear fluid as urine but today I noticed that her urine was the usual normal colour. Isn't thata good sign? But after some time the urine was clear coloured again. Started adding a little coconut oil to her canned food today. Her appetite had picked up and she seems happier.

Ihavethreecats said:

I give smoky 100 ml of sq per day. I mix the antacid tablet with lactulose and squirt it into her mouth. Since she doesn't protest too much about it I assume that it doesn't taste too bad. Yesterday after giving her her sq fluids I thought I felt a very tiny bump on the side of the injected site but I dont know if I was imagining that. I throw away the RL solution and iv set after each use. Can I use the remaining RL solution with a new needle? I haven't seen her throwing up yet. She ate quite well this morning. She prefers not to be in the house and jumps into her cage where she lies most of the day. Her eyes are bright and as before she replies to me with understanding Meow's when I talk to her. Two days ago she was passing clear fluid as urine but today I noticed that her urine was the usual normal colour. Isn't thata good sign? But after some time the urine was clear coloured again. Started adding a little coconut oil to her canned food today. Her appetite had picked up and she seems happier.

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Her appetite picking up is good news.  Good going Smoky!  That's an improvement, @Ihavethreecats  .(just bumping this, so more see it)

Ihavethreecats said:

I give smoky 100 ml of sq per day. I mix the antacid tablet with lactulose and squirt it into her mouth. Since she doesn't protest too much about it I assume that it doesn't taste too bad. Yesterday after giving her her sq fluids I thought I felt a very tiny bump on the side of the injected site but I dont know if I was imagining that. I throw away the RL solution and iv set after each use. Can I use the remaining RL solution with a new needle? I haven't seen her throwing up yet. She ate quite well this morning. She prefers not to be in the house and jumps into her cage where she lies most of the day. Her eyes are bright and as before she replies to me with understanding Meow's when I talk to her. Two days ago she was passing clear fluid as urine but today I noticed that her urine was the usual normal colour. Isn't thata good sign? But after some time the urine was clear coloured again. Started adding a little coconut oil to her canned food today. Her appetite had picked up and she seems happier.

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Wow!  You have a very compliant kitty   I'm not sure what  antacid you are giving her, but Pepcid A/C, and even famotidine (the main ingredient in Pepcid) compounded into fish flavor supposedly is bitter, so either your cat has lost her taste, or she is just a very good kitty about taking her mads .  And with the Lactulose too!  Again I say...Wow!  BTW, if you don't want to hassle with the Lactulose, Miralax, or any generic of it, IMHO), works just as well, if not better, and doesn't cost an arm and a leg, mainly because one bottle of it will last you for years

OK, not sure what the RL solution is that you are using, I always used Lactatated Ringers that came in a 1000ml bag, so would put the IV set-up into the bag and just put a new needle on each time and re-use the same IV set-up over and over until the bag was done.  Actually, our Vet advised we could even re use the IV set up in another bag as long as we didn't cross contaminate it, but I wasn't comfortable with that unless I was running short on IV set-ups.  I think I ordered them 25 at a time, though, for something like $1.10 each via the internet, so it wasn't a big deal to use 1 every 2 weeks or so.  What kind of needles are you using.   I suggest Terumo 19G.  Once we started using those, the fluids started flowing much quicker and also the needle went in easier.  It's something about the way they are made.  Anyway, I also warmed up the bag of solution everytime before giving them, just in a large bowl of hot water, so in answer to your question, yes, it's ok to reuse the solution, but guess I need to preface that with "it depends on whether or not it's non-contaminated".  Does that make sense?  Is this a solution that you purchase.  We always had to get it be prescription.  Oh, and you know you can move the injection site around, right?  Just anywhere in her scruff is fine.  Otherwise if you do it in exactly the same spot every day it will tend to get sore.  You may feel a tiny bump, but that's probably not a water bump.  A water bump is kind of like a water balloon, only smaller.  Since you are giving this just under the skin, it will literally jiggle as they walk.  We used to give Sven his on the table, then when he jumped down if his was big, I always told him be careful not to burst his water balloon

As to the color of her urine, the clear urine means she's getting plenty of liquid.  Possibly too much if it's totally clear, just like water.  You might want to check with your  net Vet on that and see if he wants you to cut back on the Sub qs if that's the case.  

Great job on her eating well and seeming to be happier.  Have you managed to get any Vitamin B or Omega 3's in her yet?  You can buy Omega 3 oil on-line, and I know you can give them Vit. B shots, but probably can give Vit B supplements too, since she's such a cooperative eater. 

Keep up the good work!!!!!!!  Smokey is so lucky to have you around

@mrsgreenjeens: - Actually , i started Smoky on Duphulac after reading the link that you sent me. But when i told my specialist vet about it ( i consult him over the phone as he is not in my city ), he told me not to give Duphuloac as it can dehydrate her further!!! So i have discontinued that. At present , i am not giving her any vitamins or iron. My local vet had given her a shot of inferon ( iron ) , but the specialist vet told me that that was not of any use. HELP!!!

Smoky seems better now and i may be imagining it, but i feel that she has actually gained a bit more weight. Yesterday, she hardly ate any food, but today, when i hand fed her, she was quite happy to eat. ( not as much as i would like her to eat, but quite enough i think ). The amazing thing about my lovely, intelligent Smoky is that when its time to give her her SQ fluids, she actually comes into the house, goes up straight to the room where the iv is set up and sits down meekly and undergoes the procedure without a fuss. 

I seriously have no idea why i was told not  to reuse the iv fluid. Over here, we can get Ringer's lactate solution without a prescription.....And i think its your video that i saw on U Tube which helped me started on giving Smoky her SQ fluid with no professional help whatsoever. I remember that the cat's name in that video was Sven and he had quite a big lump on his scruff after the procedure. Sadly, i am not able to see that in Smoky, but she does have a lump which i can feel after giving her sq fluids. Thank you once again for all your help and support. Wish i could post a photo of Smoky here. She is such a darling cat!

Hmmm. well, Duphulac and Miralax are definitely NOT the same thing.  So, is she doing ok in the constipation without any help?  Perhaps with the daily sq fluids she's getting enough fluid in her NOT to "dry out" in her intestines.  Anyway, our Vet felt Miralax (or the generic) out weighed the alternative of having constipation.

As to the iron shot, I have read that anemic cats do need iron, and Vitamin B, so like humans, if you can get her to eat red meat, and liver, that would be good (but not spinach ).  Cats usually love chicken liver, just don't make an entire meal of it, because it might make her sick.  Mine eat raw, and even at that, they cannot eat just liver by itself.  No reason why you cannot cook some liver and give it to her a little at a time, mixed into her food.  Who know, it might make her eat more .  

OK, so you have Ringers Lactate Solution.  Is it in a 1000ml bag?  If so, that's what I used.  I would insert an IV set-up into the bag, insert a needle, insert in  Sven, run some fluids, close off the drip with the roller thing, detach from Sven, toss the needle (safely), store the bag and IV-set-up in a grocery bag until next time)  As I think I mentioned, one bag would last between 1 - 2 weeks.  Did you buy the solution at a pharmacy?  Maybe you could ask the people wherever you bought it if it's okay to leave the IV set-up attached to it and reuse it as long as you use a fresh needle each time. 

I still wouldn't worry about not having a water bump.  Sometimes Sven had one, and sometimes he didn't.  Are you wondering if you're not doing it right?  You're putting it right under his skin, right?  I think if you weren't, Smokey would be hollering pretty loud and being really uncomfortable.  She's long haired, isn't she?  I'll bet she has one and you just can't see it.  It may be around on her chest, or her stomach...could be anywhere.  And it's not THAT big .  After all, 100 ml isn't that much.  When it would go into Svennie's foot, it just looked like he had a swollen foot for awhile, and that was with 100ml.  (BTW, it wasn't my video you saw, because I never made one )   You must be doing something right though, if Smokey comes to you willingly.  She must know you are helping her, and must feel better afterwards

Oh, I just though of more things you could try to get her to eat.  Sven used to love (and ALL my cats still love) 100% freeze-dried pure meats like PureBites or Wholelife.  They sell them at most Natural Pet Stores, and Amazon, etc.  I buy the dog sized bags.  I have them in chicken, turkey, beef, salmon,cod, beef liver, chicken liver and I forget what other flavor.  I just break them into bite size pieces, and sometimes crush them and use them for toppers on their food if they are being picky.  

Thank you so much. 

Very disheartened because she didn't eat anything at all today. 

The IV is in 500 ml bottles, and I have started reusing it. The vet says that there is no point in giving iron because anyway, the kidney has stopped helping in the production of iron. 

I gave her a little Dupholac in the morning because she's constipated and I thought that might be the reason she isn't eating. But she still hasn't eaten anything much tonight. She stumbles a little now when she jumps and runs. Just a little though- now and then. She prefers to sit in our garden all day just quietly by herself, looking at the trees and the birds. It breaks my heart.

The vet said Miralax is good but it isn't available in our part of the world.

I'm just so sad and depressed. I don't know if she can continue much longer.