Does my cat have CKD / CRF / Kidney Disease? Worried sick. Please help!

Hi  all - I would like some advice and support from you all regarding my 15 year old male Turkish Angora. It seems like he may have kidney disease
based on a recent blood test. I have gone through Tanya's CKD website which I found had lots of information.  Unfortunately I am unable to join her
support group to ask more questions as it uses the bigtent website, which is not supported in my country.  If anyone has any more advice on any
support groups I could join please let me know... any help appreciated.  I know sometimes vets can be wrong and seem to adopt a trial and error
method, so would definitely like your opinions too. Sorry for the long post in advance.

We noticed for the past few months, he started pooping on the bed instead of the litterbox which we thought was mainly due to old age as he seemed
fine otherwise.  However, last week we noticed he was constipated for a few days so we took him into the vet and got a blood test done.  The vet
mentioned he may start to have kidney deterioration and prescribed him to eat prescription Royal Canin Renal Cat Food.  His creatinine is 269 umol/L
and based on Tanya's website, it seems like he is early Stage 3 (out of 4 stages!) kidney disease which makes me very sad. It seems he has also lost
2kg from 18 months ago (he is currently just about 4.xkg or 10 lbs).

To add to the worries, the vet found a Grade 2 low murmur in his heart by listening to the stethoscope. But he did another test from the blood from his blood test and confirmed he didn't have any sort of heart disease. He told us to monitor his resting breaths per minute to make sure it is under 30, and
we've noticed it is around ~20-23 so it seems like that is under control and we will continue to monitor. Regarding his constipation, the vet also
prescribed Cisapride 5mg and Bisacodyl for this week. Fingers crossed but it seems like he is no longer constipated and the medicine is helping him.

We haven't been able to collect his urine using the non-absorbent litter method from the vet yet , so no urine test done yet. Given he is still working on the constipation issues, we don't want to change up his litter just yet as he is very particular about how he wants certain things and we don't want
to add stress to him, given the vet visit last week. We may try it in a couple of weeks once things with his constipation has "stabilised" (fingers
crossed). Also, we haven't done any x-ray or ultrasound as that requires sedation, which we think is quite risky for a senior cat like him.

Some questions:
1) Do you guys agree he has Stage 2 CKD?  Seems his creatinine levels are high, but phosphorous is still OK. Though based on Tanya's website, seems like he has lost ~75% of kidney function because of the creatinine level  That sounds very scary to me!

2) Are sub-q fluids necessary at this stage? We would like to try to avoid this if possible. The vet did suggest it as his slightly high sodium level
meant he was probably dehydrated. However, this would be very difficult for us to administer this and we would like to avoid it.  He seems to be drinking water and we do add water to his already 100% wet diet. How much is enough water for a 10lb cat?

3) Is it fine to give him the Royal Canin prescription food?  We got him the cans only so 100% wet diet, we didn't ask for the kibble.  Previously
he was eating the "premium/natural" brands such as Wellness, Instinct etc. so at first I turned up my nose at the ingredients in the prescription food. However, I heard that prescription diets are the best to keep phosphorous levels low which is really key? He seems to be liking it and he is eating it.

4) The vet mentioned that he may need to take Cisapride long-term for his constipation. I asked him whether we can take him off it after this week, if we see improvement in his constipation, but the vet said it is likely if we stop the medication his constipation will come back. I am quite anxious about this given Cisapride was taken off the human market due to possible complications for the heart. Especially since my cat has a slight murmur. And I would want to avoid long-term medication unless absolutely necessary.

Thank you all for your help.  As he was just diagnosed, I am scrambling to get all the information I need to understand this more to ensure I can give
him the best quality of life. I am just freaking out about this given I never thought this would happen...

His blood test result below. The ones which exceed the reference intervals are in red:
GLU     9.87 mmol/L (Ref interval 3.94-8.83)
UREA    12.5 mmol/L (5.7-12.9)
CREA    269 umol/L (71-212)
PHOS    1.89 mmol/L (1.00-2.42)
CA      2.97 mmol/L (1.95-2.83)
TP      77 g/L (57-89)
ALB     32 g/L (23-39)
GLOB    45 g/L (28-51)
ALT     29 U/L (12-130)
ALKP    46 U/L (14-111)
TBIL    6 umol/L (0-15)
CHQL    4.95 mmol/L (1.68-5.81)
AMYL    853 U/L (500-1500)

NA      169 mmol/L (150-165)
K       4.8 mmol/L (3.5-5.8)
CI      117 mmol/L (112-129)

T4      42 nmol/L (normal)

RBC     7.92 x 10^12/L (6.54-12.20)
HCT     39.7% (30.3-52.3)
HGB     13.1 g/dL (9.8-16.2)
MCV     50.1 fL (35.9-53.1)
MCH     16.5 pg (11.8-17.3)
MCHC    33.0 g/dL (28.1-35.8)
RDW     20.6% (15.0-27.0)
% RET   0.3%
RET     21.4 K/uL (3.0-50.0)
WBC     11.36 x 10^9/L (2.87-17.02)
%NEU    58.2%
% LYM   34.8%
% MON   4.5%
%EOS    2.0%
%BAS    0.5%
NEU     6.61 x 10^9/L (1.48-10.29)
LYM     3.95 x 10^9/L (0.92-6.88)
MON     0.51 x 10^9/L (0.05-0.67)
EOS     0.23 x 10^9/L (0.17-1.57)
BAS     0.06 x 10^9/L (0.01-0.26)
PLT     283 K/uL (151-600)

Thank you for all your help and support.  I really appreciate it.

Sorry - I didn't realise I had posted this thread twice!  Must have accidentally clicked submit for the prior post.  I can't figure out how to delete the earlier repeated posting...

Couple quick notes since it has been hours and overnight in the most common US time zones:

1)  I'm not up on stages; my vet never spoke in stages with my CKD cat.  But the one thing to keep in mind is CKD is typically never diagnosed before about 2/3 of kidney function is gone.  That would be 67%.  Before that there's just typically no symptoms and even the blood test levels just don't register anything of much concern.  So while yes your kitty's numbers may indicate he has lost 75% of kidney function, that is not at all uncommon at first diagnosis of CKD.

2) If sub-q fluids was recommended, it's probably a good idea.  The biggest thing this does in non-technical observation is help a cat feel better longer. I don't know what makes you think it would be difficult, but I will tell you that I always thought it would be difficult, and I didn't think Amber would stand for it, but sub-q was one of the easiest things I did during her CKD time.  It turned out to be quite easy after the first couple times.

3) If he's eating the prescription food, I think that's great!  Still eating is a good sign, the prescription foods are low in phosphorous, etc.  I understand turning up your nose at the ingredients of that food vs what we think of as better quality ingredients in some other foods, but if you have him eating the canned renal diet and he is getting enough food to keep his weight up (that can be a big problem) then I would keep going with that.

4) I don't know anything about that med and it was never a part of my cat's regimen.  My cat did also have a heart problem and was ultimately diagnosed with congestive heart failure.  This is a tricky complication when trying to treat for CKD, because the fluid that will help the cat feel better from the kidney symptoms will also make the heart failure symptoms worse, with trouble breathing, etc.  Trouble breathing = no eating.  I don't know if your cat would be at risk for this or not.  Here in the US it is somewhat common to give normal non-prescription human laxative sold under the brand name Miralax.  (You may have run across this on Tanya's web site).  This sounds really odd but apparently the active ingredient is "Polyethylene glycol 3350" if you need to look for it.  I used to mix really tiny doses of this in the food just in case.

That's all I've got for now but maybe it helps a little.  I'm sure others will chime in with more info.  

Welcome to the forum, catpurr10 !

There is another specialized online support group - it is hosted by Yahoo.com - it has been running since 2000 and is almost as "popular" as "Tanya's". And, like Tanya's, it's a very busy group. I believe that Yahoo is almost universally accessible.

If I were unable to use BigTent, I would certainly join up with this other group. Most people with chronically ill cats realize that these specialized groups offer a higher level of expertise/info/support than more generalized feline discussion forums.

One piece of advice (from my own experience with these groups): get a brand new email address to use exclusively for this group (Yahoo email worked well for me). That way, it's very easy to track your posts and the replies you receive.

OK..........you'll find the group here: Chronic Renal Failure Cats - Yahoo Support Group

They also have a website: Feline CRF Information Center

Hope that helps !

Hi Unless i am blind I don't see any urinalysis done on your kitty.We need as well as all ckd groups need to know what your kitties urine specific gravity is.me3aning just how dilute your kitties urine is.how much water is being peed out in other words.The feline crf group at yahoo is excellent like other mentioned.over 14,000 members.very high volume sight.if you join pls post in big letters New member Need help Urgent!!If no response pls reply 2nd posting Pls help Ok?you already have their link as per the other member.Tanya's site is excellent to from the UK.We call her website helen's bible.Helen being the owner.I believe it takes some time to join ther though.Don't hesitate to join right away.i only go by Iris staging in kidney disease not what idexx says.You can google iris staging.I know when i got my first diagnosis i was frantic.Try to take a breath.Everything will be alright.these groups are absolutely wonderful and will help you.Lots of kitties all over the world have ckd many owners not even knowing about it.usual fluid start is when creatinine is in the 4's but don't quote me on it.Pls join.HTH C

https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info Or tanyas' at www.felinecrf.org

2bcat, White Shadow and MomofMaxwell- thank you all for your replies!

2bcat - How long has your cat been diagnosed and what is his/her creatinine levels do you know? I totally did not realize that the fluid that makes the kidney disease better may make the heart disease worse so thank you so much for highlighting that and I will look out for that.

White Shadow - All these links are so helpful.
I will join these yahoo groups and really thank you all for the support and encouragement. It is a little scary at first and I keep telling myself that it isn't as bad as it sounds.

MomofMaxwell - Yes he only has had a blood test done. The vet said it would be very hard to get a urine sample so he gave us a non-absorbent litter to collect his urine at home. However given his constipation is only starting to get better now after the vet visit/diagnosis 1 week ago, I was thinking of holding off the urine test as I didn't want to mess with his litterbox and unwind the progress he's made with the constipation issue. However it seems like if I want to get more advice the next step is the urine test. Do you have any suggestions on what the best way to collect this is? I suppose I should use the non-absorbent litter in his box, perhaps in a week or 2 after he's "stabilized" from the vet visit and constipation issues.

catpurr10 said:

2bcat - How long has your cat been diagnosed and what is his/her creatinine levels do you know? I totally did not realize that the fluid that makes the kidney disease better may make the heart disease worse so thank you so much for highlighting that and I will look out for that.

Click to expand...

Unfortunately I can't tell you anything useful about the kidney levels.  I barely knew back then, and this was all a couple years ago.  I basically had a few months to get into this so there was not yet a routine in what I was looking for in levels.  Although I was prepared for many months or perhaps years of caring for Amber with CKD, she succumbed somewhat suddenly at home to a complication that we think was from the heart disease.  (I did not have anything done to learn for certain what the cause was.)  

Be careful in automatically equating the fluids to a possible problem in your case.  In my case, my cat very specifically was diagnosed with congestive heart failure, which involves fluid buildup in the chest.  Giving additional fluid subcutaneously, which is a very useful treatment in the CKD, must be done with caution when the cat has congestive heart failure.  But it's not to the degree that it should not be done at all.  Smaller doses of fluid could be the answer, along with continued additional medication related to any heart issue.

Now in your case, so far there is not a particular concern of heart issues.  You seem to think your vet ruled that out, which would be good.  But my recollection is that my vet had determined a heart murmur in Amber, and then after we started some fluid treatment and she didn't see a great response from it, we went back and he was able to hear and eventually get an x-ray that showed the fluid build up issue that indicated the congestive heart failure.

I hope that clarifies it a little.  I would still think you should consider doing the sub-q fluid as any cats I've heard of who have done well for many months or years are always on the fluid therapy.

Hi Catpurr.The hydrophic sand or beads sometimes they give you I did not have good luck with them.they didn't give you enough and Maxwell basically looked at them and said "Not" Then they tell you to lock your kitty into a crate with a litterbox at the rear with the sand in there.or lock them in a room with the stuff.i wasn't about to stress him out like that.i told the vet they should sell it in 10lb bags.I used what is called Kit4Cat i think it is called but only a teeny bag.it is reuseable but you really need enough IMO to cover the bottom of the litterbox.So I always had cysto done by the vet.needle in the bladder.i did one midstream freecatch with one kitty using an old plastic marg container I cut down with scissors to like 3/4" tall.i used a baby monitor near the toilet and the other upstairs.i heard digging & ran down there.It was a fluke scooting it under his very hair butt to obtain urine.Both Tanya's & the crf group at Yahoo will want to know your kitties USG.the reason I ask is kitties with ckd will have dilute urine.Meaning they are peeing out vital water that would have been used for other vital parts of the body.This loss in water causes dehydration.When a kitty is dehydrated the kidneys will pull water from the bowel before a more vital area thus drying out their stool.Creatinine also rises with a dehydrated kitty.You talk about constipation with your babe so that's why I wanted to know.Very true about fluids & heart conditions.i have seen as low a 50mls LRS cause major heart issues.oral water in canned meat can help.Yes my boy was on pumpkin daily as well as babyfood butternut squash.i froze it in ice cube trays (Small ones) from the dollar store & kept them in the freezer.I would only take out on a plate what I'd use in two days then chuck what was left & bring out new.he had Megacolon & fiber is almost taboo on that group.I also used babyfood chicken (No onions or garlic) also frozen in cubes and tid gave him like 1/8 tsp pumpkin & Bn squash with babyfood & added 1/8 tsp of Miralax.he loved the BF so that worked and he thought of it as a treat.He was also on 60 mls LRS subq fluid nightly for 6 yrs.never another enema after diagnosis.no rocks or diarrhea.I dealt with an Internist.you should talk to your vet about fluids and the heart.oral added to meat can help with constipation & pumpkin can too.just not too much as it will go the other way.Concrete.here is a friends book who dealt with constipation for yrs with her Sem a CKD kitty .

www.felineconstipation.org I'm presuming your vet cannot or doesn't prefer cysto for urine testing.Some vets are not good at it.they need to know what they are doing.but is the best way IMO.Sorry about the novel.HTH Hugs to your babe.C.Sorry about the typos.i am a mechanic not a typist.

Constipation is common in cats with kidney disease. For my cat, giving sub-q fluids really helps to prevent constipation, so you might want to consider that as an alternative to the Cisapride. When she was constipated I also gave her canned pumpkin or babyfood squash - just a tiny bit mixed in her food once or twice a day, and that helped to resolve it, but it's really the fluids keeping her hydrated that prevents it from coming back.

My cat also has a mild heart murmur, and I was told to watch for symptoms of heart problems when giving her fluids, but also that it was not very likely. She's been getting fluids for nearly a year now and no sign of heart trouble.

2bCat / MomofMaxwell / momto3cats - Many thanks for all your replies!  I also had another quick chat with the vet today to update him on his constipation.  Also now it's been a week since his vet visit and he looks so much better, gained some weight and very alert which I believe is good news! I am feeling less worried now. Though my vet mentioned that cats with kidney disease, while their condition slowly deteriorates over time, sometimes their conditions can deteriorate rapidly if they suddenly do not eat/drink/urinate/look lethargic etc. and it becomes very risky if they don't get medical attention within 24 hours, so we will need to keep a close eye on him.

Regarding his constipation, he seems to be going quite regularly now, even twice a day yesterday too (his "regular habit" is once every other day).  He had loose stools 2 days ago, but now it seems it's back to normal (normal/soft/oily sorry if TMI). Spoke to vet and we have decided to stop the Cisapride for now and keep him on Bisacodyl for another 10 days and then assess.  He said it may be because he is on medication which is why his constipation has "healed", plus usually it takes 10 days for the constipation to regulate so we don't want to remove him off the meds completely.

He has good appetite and his diet consists of eating 1 can of Royal Canin Renal Wet Food a day.  He is also taking in approximately ~70 ml of distilled water a day which we force feed him via a syringe as he doesn't seem to drink water by himself after starting on a 100% wet diet.  I am not sure how much fluid is enough fluid for him (10 lb cat), but he doesn't seem dehydrated to me when I pinch the back of his neck.  I hope 70ml of distilled water + the wet food diet (77% moisture in a 195g can) isn't too much fluid for him (if there is such a thing), particularly if he has a heart murmur and potentially heart issues though we don't know for sure yet.  However, 2bCat/momto3cats, I think the heart problems are only compromised if you are talking about fluid build-up via sub-cutaneous fluids, not via regular drinking via the mouth right?

We are going back to the vet in 1 month to take another blood test to see if his kidney levels are better following the prescription diet.  We will try to do the cysto then to get a urine test which I believe would also give us a lot more information regarding the kidney disease.  I still haven't tried the non-absorbent litter to collect his urine and I think it will probably be a challenge as MomofMaxwell said. Will keep you all posted in 4-6 weeks! Thank you all!

Hey, sorry your kitty isn't doing well!

I would definitely recommend doing the subcutaneous fluids! It makes cats feel so much better and is amazing at helping the kidneys and fighting dehydration. It doesn't sound like your vet is worried about congestive heart failure, just the murmur, so as long as you're monitoring closely and he's getting regular check ups I think doing the fluids would be fine. Murmurs can also be temporary when caused by stress, so make sure your vet rechecks this at your next visit. Have a tech at the hospital give you a demonstration on administering the fluids and trust me, it gets easier with time. As for force feeding the water, I'd advise against it. Your cat may tolerate it now, but eventually it will become a battle. And I'd save that tactic for when you need to administer oral meds.

I agree with what another poster said. A urinalysis should really be done on your cat asap. Why couldn't your vet do a cystocentesis? It doesn't require sedation and is frequently done at most hospitals. It will also provide more accurate results than collecting a free catch sample at home.

Hope you get some answers soon and I hope your kitty starts feeling better! I'm glad he likes the rx renal food! Lots of cats don't, so you definitely got lucky there.

Hi CatLadyVetTech, thanks for responding!  We think sub-cutaneous fluids would be hard given our cat just lives with my elderly mom so it would be a struggle just for one person (we think).  Also, we think it would stress out our cat majorly.  However, given all the responses regarding sub-q fluids, we will see what the vet says at our next visit in 3 weeks.  I am just glad that my cat is still very active and very much himself.  We are still force-feeding him syringes of water each day, and it's not too bad as he is used to it.  He is also still eating the prescription food thankfully.

Our vet didn't do a cysto last time and just gave us the non-absorbent litter to collect urine at home.  Not sure if it was cus they were out of time.  I will definitely push for one next time so that we can get the full picture of his kidney problems.