Cat kidney failure - advice needed

Hi there,

I'm hoping I can find, I don't know, some reassurance I guess? Sorry for this being so long.

My dearest, sweetest Arlo was diagnosed with kidney failure on Monday. The vet gave him some fluids that day before we even got the test results back because he was dehydrated I guess. When his numbers came back the vet told me they "weren't horrible." I noticed an improvement in Arlo this Monday. He ate more and seemed a bit more alert.

The vet asked me to come in on Tuesday so we could start doing subcutaneous fluids on him. We went in, I learned what I had to do and we went home. Arlo ate a bit less this day but didn't really seem worse.

On Wednesday I game him his fluids and that seemed to go well. He only ate a few treats that my Mom gave him in the morning, but apparently he really enjoyed them. Later on in the day he hardly ate anything. Then in the late afternoon, early evening I noticed he would get this strange look on his face and his head was cocked a bit forward. This got worse through the evening. He also had some trouble walking. He would walk with what I now know is a stilted gait. He didn't eat or drink anything the rest of the evening. I took him upstairs with me and he had trouble getting comfortable. At one point he peed on the pillow he liked to sleep on on my bed. His chin seemed to be glued to his chest.

After doing some reading I thought maybe it was low potassium. We took him into the vet first thing this morning and I said the same to the vet and he didn't disagree. He gave Arlo one half of a 500mg potassium pill and sent me home with the rest with instructions to give half in the morning and half in the evening, for a total of one pill a day. Also he agreed that I should assist in his feeding, giving him at least an ounce of food today. We went home, I gave him his fluids then 1/2 an ounce of food.

Since then Arlo has peed in his cat bed and what looked like across the floor. He's still not lifting up his head and just seems uncomfortable. I just got off the phone with the vets office and...I don't know what to do. They just reiterated the same instructions and said he's peeing because of the kidney failure.

I guess what I want to know is given the circumstances is this normal? Is it possible for him to get better? I wish had gotten a copy of his numbers, but as I said the vet said they "weren't horrible." I remember one being 27 when the normal range was 29 to 40-something, but I don't remember what this was for. I haven't had much sleep since Monday and it is killing me seeing my baby sick. I don't want to lose him, but I don't want him to suffer and he's a shadow of his former self right now and I know he's not comfortable. I wish there was something more than basically fluids I could do. I've been trying to read on this, but I really don't know where to start. I feel pulled in a million directions.

Is there any hope for my baby? I'm crying right now even asking this question, but I...I just don't know what to do.

Thanks in advance for any advice you guys have!

I am so sorry, this is such difficult news to get about our babies.  Went through this a few years ago with 3 of my own and was able to get a wealth of information from Tanya's website...... http://www.felinecrf.org/.  I hope that you find some information that can help you out.  Hugs

i'd consider getting a second opinion, from a vet from a different vet practice. it's like with humans, many times we get a second opinion because we want to be sure of a diagnosis or if there's uncertainty in diagnosis/treatment/etc what one doctor didn't catch another doctor might be able to.

may i ask -- what type of fluids is your boy being given? sodium chloride, lactated ringers, etc. it should say on the bag of fluids.

it sounds like there could be something going on that is causing the symptoms your boy is experiencing since being started on sub-q fluids. this may or may not be related to the fluids, only a vet will be able to figure out exactly what is causing the stilted gait, incontinence, lack of appetite and not drinking water, and his chin seeming to be 'glued to his chest'.

what i personally would do if this were my cat (who has chronic kidney disease) is to make a trip to the emergency vet. these symptoms are very concerning, and for a cat who has chronic kidney disease i would not hesitate to get kitty in to be looked at asap. cats who don't eat or don't eat enough for as little as two days can develop fatty liver disease (hepatic lipidosis, which is extremely serious). the sub-q fluids being given may possibly prevent fatty liver from developing as quickly, but i would not count on that.

may i ask -- when you gave your boy fluids at home, when you set up the bag with the giving set/line and needle -- did you drain the line of air? did you open the flow valve and let the fluid run down and out of the line to clear the air out of it? i ask because this is a fairly common thing that can be forgotten.

kellie,

Thanks for that link! I've already discovered it. That's why I thought he had low potassium. I'm still trying to get through it.

mick,

Thank you for your help! This vet has very good reviews, that's why we chose him. At the same time I do feel a bit left hanging in the wind. Part of me really wants to, and may get a second opinion. The thing is that we are really in a bind because we're on a very limited budget so it's hard to go to another vet and start this process all over again when we've already spent almost $300 this week. I realize this may not seem like a lot to some, but this is a real hardship for us. And I realize that this is just the tip of the iceberg in the cost of his care, but to essentially have that money be thrown out the window is...makes me want to cry.

The fluids he is given is 200ml of .9% sodium chloride every day. He's about ten pounds. I agree with your opinion about the subq. The thing is he didn't eat much of anything on Sunday, that's why we brought him in on Monday. The fluids he got at the vets seemed to help on Monday, but since then his condition has deteriorated. I'm thinking maybe with all the fluids flushing out his system his potassium levels got low. He's so tired and feeling rotten I don't think he has much energy to get to the box - at least that what strikes me. Some people on another board thought maybe it was an infection, but he doesn't seem like that to me. He's had UTI's in the past and it's not like he has to go all the time. It's just when he does have to go, he goes right wherever he happens to be. Now, I'm not sure if it's a kidney infection since I'm not sure what that might look like. I suspected he might have an infection especially since he felt hot to me. The vet took his temp today and said it was normal. I didn't mention the word infection to him, and just ... I just didn't think I should mention it since his temp was normal and ... I was just at a loss. I mean, I can't believe that this guy is THAT incompetent. He's been in business here for over ten years! If he was this bad wouldn't there be bad reviews all over the place?!

Oh, and I did get a little over an ounce of food down him today along with the subQ's. But he's like a lump. It's more than obvious he's not doing well right now, and I've yet to see any improvement with the potassium supplement. He's had a full 500mg pill now after giving him the second half around 5pm.

And going to an emergency vet now? I was at the vet's office this morning. We don't have the money to keep going to different vets. What if the next one is just as bad as this one, not that I'm completely convinced he's bad yet. I'm beyond frustrated and heartsick.

And yep, I drained the line of air.

sgrbrn said:

 
kellie,

Thanks for that link! I've already discovered it. That's why I thought he had low potassium. I'm still trying to get through it.

mick,

Thank you for your help! This vet has very good reviews, that's why we chose him. At the same time I do feel a bit left hanging in the wind. Part of me really wants to, and may get a second opinion. The thing is that we are really in a bind because we're on a very limited budget so it's hard to go to another vet and start this process all over again when we've already spent almost $300 this week. I realize this may not seem like a lot to some, but this is a real hardship for us. And I realize that this is just the tip of the iceberg in the cost of his care, but to essentially have that money be thrown out the window is...makes me want to cry.

The fluids he is given is 200ml of .9% sodium chloride every day. He's about ten pounds. I agree with your opinion about the subq. The thing is he didn't eat much of anything on Sunday, that's why we brought him in on Monday. The fluids he got at the vets seemed to help on Monday, but since then his condition has deteriorated. I'm thinking maybe with all the fluids flushing out his system his potassium levels got low. He's so tired and feeling rotten I don't think he has much energy to get to the box - at least that what strikes me. Some people on another board thought maybe it was an infection, but he doesn't seem like that to me. He's had UTI's in the past and it's not like he has to go all the time. It's just when he does have to go, he goes right wherever he happens to be. Now, I'm not sure if it's a kidney infection since I'm not sure what that might look like. I suspected he might have an infection especially since he felt hot to me. The vet took his temp today and said it was normal. I didn't mention the word infection to him, and just ... I just didn't think I should mention it since his temp was normal and ... I was just at a loss. I mean, I can't believe that this guy is THAT incompetent. He's been in business here for over ten years! If he was this bad wouldn't there be bad reviews all over the place?!

Oh, and I did get a little over an ounce of food down him today along with the subQ's. But he's like a lump. It's more than obvious he's not doing well right now, and I've yet to see any improvement with the potassium supplement. He's had a full 500mg pill now after giving him the second half around 5pm.

And going to an emergency vet now? I was at the vet's office this morning. We don't have the money to keep going to different vets. What if the next one is just as bad as this one, not that I'm completely convinced he's bad yet. I'm beyond frustrated and heartsick.

And yep, I drained the line of air.

If anyone knows a good vet in the Brandon, FL area let me know.

 

In the meantime I will be getting the results from the office tomorrow (plus I'm supposed to call and give them an update on how he's doing - heartbreakingly the same at the moment.) I can't stand to see him this uncomfortable.

 

Thank you all so, so much again for your kind help!

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i understand, unexpected vet expenses are hard plus they add up very quickly.

i'm not saying that your vet is incompetent. there's nothing you've said that points in that direction at this point. when you called the vet's and they 'just reiterated the same instructions and said he's peeing because of the kidney failure', was that the actual vet who said that? or was it a vet tech or receptionist or similar?

i think it might be possible for the fluids to be flushing out the potassium. i think it's also a possibility that your boy has an infection. it's quite common for cats with chronic kidney disease to develop urinary tract infections (UTI's) because the fluids they get on a regular basis dilute their urine so much. i think it could easily be possible that it's an infection that's made it's way up into the kidneys. these are all things i'd discuss with your vet.

urinary tract infections can have some symptoms that aren't what we'd expect. i know my snick usually has dribbling of urine and/or some slight loss of control (has a little urinating, usually when she's sleeping) as her first symptoms of a UTI starting.

200 ml fluids every day is a lot of fluid. i'm not saying it's too much, and i'm sure your vet has good reasons for that amount. but it might be worth asking (in a diplomatic, respectful way) if (that you mentioned to him before) it could be the fluids flushing out potassium or if it might be that your boy's body isn't able to handle the 200 ml fluids daily.

when cats have these kind of serious illnesses that require longer term treatment, it's really good to develop a good 'rapport' or partnership kind of thing with the vet. the goal being that we work together with our vet in caring for our cat. this is the time for us to write down our questions to bring with us to vet appointments and discuss things with our vet. no question is 'stupid' or such at this time. we ask questions as we have them, and sometimes we may ask our vet to run some blood work or test for other things.

It can be tough at times, that is for sure.  I definitely felt pulled in so many ways and so drained after a while.  Looking back I am still unsure of some of the choices we made, but it seems that is pretty normal.

Some of us have had experience caring for CKD cats, but sometimes I hesitate to compare too much because every case can be a little different.  It's really hard when what we have heard is that it's earlier stages of the disease but our cats are very obviously not feeling very well, which seems to be the case here.  I went through a fair bit of that with Amber, who turned out to have additional complication of congestive heart failure.

In my experience, peeing outside the box was not normal.  Amber used her litter box faithfully to the end, so this to me is potentially indication of some additional complication Arlo may be having.  That is perhaps the most concerning thing about the current vet.  I mean, I don't have a vet background, and I don't have multiple cats worth of experience with CKD.  But it just strikes me as odd given my one experience, that urinating outside of the box would be dismissed.  But, maybe that is just one of those things that's different for each cat, or different for male/female.  This page on the Tanya's site (scroll down near the bottom) has small sections on incontinence and inappropriate urination:  http://felinecrf.org/symptoms_regulation_body_fluid.htm  It seems that sometimes CKD cats can just be caught too far away from the box, but in other cases it can be a symptom of a UTI, kidney infection or other possibilities.  You are giving  really large doses of fluid so maybe he really was just caught short.  

It does seem like an extra large fluid dose.  My vet also seemed inclined to large doses (suggested was around 150ml), but we did them less frequently (every 3 days), and in the end I am still annoyed I didn't push back more on the fluid dosing because the fluid was adversely affecting the heart failure.  (We believe she died somewhat suddenly from the heart complication; she was not that far progressed with kidney issues.)

The not eating was always the most stressful part for me.  In Amber's case it's because she would have breathing problems related to the heart condition.  Breathing issues are not something you mentioned but they would be something to watch out for because it is one of the things that would make Arlo feel worse after the sub-q fluid dose (most cats should feel better after fluid) and would also make him not eat.  Not eating is a concern because cats can begin to have complications from this after as soon as 2-3 days not eating.  My vet was not especially concerned at past 48 hours, but I was and many others note that 2 days is long enough that it's time to take action.  During my bout with this early , Amber ate at somewhere just before 72 hours or 3 days.  It was what happened right after her first dose of fluid, if I remember right, so there is potentially some concern here.

I understand that costs can add up.  Luckily the fluid costs for doing that at home really can be minimal, but this initial period of getting things stabilized can mean several vet visits and tests.  To me, though, I'd want to be sure of what is going on, however much that is possible, because they have told you that the numbers "weren't horrible".  (BTW, should be no problem to get a copy of the lab results, just call in and ask them to email or make a copy for you to pick up or whatever.)  A cat who is diagnosed with CKD in early stage should in most cases be able to live for some months or even a few years with decent quality of life.  Right now in these few days Arlo is not showing that.  Incontinence and not eating indicate something not quite right as far as I'm concerned, whether it is an infection or even simply too much fluid.  As noted above with this ongoing condition you'll need to be able to discuss such things with the vet, and you may find in these moments that some vets are better than others with this.  One reason I never ended up getting a second vet opinion it that my vet would spend plenty of time with me on the phone talking through things if it was necessary.  I felt like I could bring up things to a reasonable degree, like amount of fluid, a med she should have, etc.

I personally wouldn't make a trip to the emergency vet for what is going on now (not that this is a wrong suggestion, just throwing that out there as a difference of opinion) but I would be following up more with the regular vet today and, if they weren't seeming responsive, potentially getting a second opinion from another vet.  If he's continuing to show instances of peeing outside the litter box and having no interest in food, these are things to focus on.  There should be some explanation for this other than just "it's the kidney disease".  Assisting the feeding at 1oz of food is fine if he's picking up eating on his own again, but that's not going to be enough if that is all the intake he is getting.

It's a lot to have dumped on you all at once, for sure.  Hang in there.

My vet also recommended a large amount of fluids for my cat at first - 150 ml at a time for my 5 lb cat, because she was very dehydrated. After a few doses she became very weak, seemed "floppy", couldn't lift her head or walk properly. I had the same thought you did, that the fluids were flushing potassium out of her body, so I skipped a day, and then reduced the amount to 50 ml per day (I read a lot of things that all pointed to 10 ml per lb per day as the standard dosage). She recovered pretty quickly at that point. I don't know whether the same thing is going on with your boy, but if he's urinating wherever he is it could be because he feels too weak to get to the box.

Whew! First I'd just like to thank you all for your kind words of encouragement and advice.

Thankfully Arlo has returned to using his litter box - at least at home. He peed in his carrier today on the way to a new vet - he probably couldn't hold it any longer, poor guy.

And yes, we went to a different vet today. Initially this morning I called our old vet's office to update him as to whether Arlo's condition improved - not much, but at least he's peeing in the box now. The thing that freaked me out is that this time the girl on the phone told me that the vet told her that his, "kidneys were shot," which was why he peed. This totally contradicted his words to me about Arlo's numbers not being, "horrible."

So I looked around and found what I think to be such a major improvement in care. We were able to get in this afternoon. I got the test results from the first vet and brought them with. While we were driving to the new vet's office I read them and became even more upset. There's not much on there that I could completely understand at the time, but to see:

Potassium 2.7(LOW)

This got me so upset! These were his numbers on Monday! And he had me giving my poor little guy 200ml a day with NO SUPPLEMENT. It took his condition deteriorating and my own detective work to figure out what that vet should have taken care of on Monday! I can not tell you how upset I am at this vet. I'm astonished that this man has been in business for as long as he has.

The new vet took Arlo's temperature, weighed him, and listened to his heart - something which the first vet did none of until I mentioned he felt hot on the third trip there and then it was only a temp check. I typed up a sheet of everything that has gone on over the last few days (I'm forgetful. Even typing it out I still forgot to add that he has some arthritis.) and gave him the test results. He said that his current condition - the head drooping, the walking funny - was textbook low potassium. He said that having low potassium makes the muscles weak which is why it's so hard for him to keep his head up. He said that this may be part of the reason he didn't make it to the litter box earlier. But just to play it safe he gave Arlo a prescription for an antibiotic just in case an infection was at play. He didn't feel comfortable trying to get urine from him at this time since he just peed in the carrier and he wanted to address any problems ASAP.

He told me the Rolls Royce standard of care would be to have him hospitalized with a potassium IV drip, but it would cost thousands since it would be over the weekend and he'd need to be transported to an emergency clinic tonight after hours. We obviously can't afford to do that.

He asked me what kind of supplement the previous vet gave me to give Arlo and I said it was a big, flat pill that could be broken up into four pieces and was a cream color with brown specks. He said that pills weren't very good because the cats GI is short and won't have much time to absorb the supplement. He gave us a potassium gel, Renal K, that should be absorbed more quickly. Let me tell you, the gel is so much easier to give him than those freaking pills! I'm to give him a half teaspoon twice a day and 100ml of fluids. I asked him about some other suggestions I received elsewhere on some boards and while he thought it was really too early to tell if he needed an anti-nausea medication (he wants the potassium controlled first) the Pepcid AC would be a good idea. He said to give him 1/4 of a 10mg pill once daily.

He explained that he has a chance, but nothing is guaranteed even with the Rolls Royce care.

I could kick myself for not getting a copy of his numbers right away. I would have checked on that potassium right away. I'm actually not a very trusting person, especially when it comes to the medical profession, but for whatever reason I thought how could he be that incompetent. I mean, how can you not see and address what is in black and white?! I'm trying to stay calm, but whenever I see how much he's uncomfortable, how weak he is....I hate to see him in this condition, especially when I think it could have been avoided, or at lease alleviated much more quickly had I known about it!

Oh, and the new vet sent me home with some KD food. He said that most cats don't particularly enjoy it, but since I'm assisting in Arlo's feeding already it would be a good thing at this point since there's a phosphorous binder in it already which should help his kidneys. We're just trying to get him through this low potassium crisis.

So if all of you could say a prayer, light a candle, or whatever for my sweet boy to make it through and turn the page on this horrible experience I'd greatly appreciate it.

Thank you all so much again for your help!

sgrbrn said:

 
Whew! First I'd just like to thank you all for your kind words of encouragement and advice.

Thankfully Arlo has returned to using his litter box - at least at home. He peed in his carrier today on the way to a new vet - he probably couldn't hold it any longer, poor guy.

And yes, we went to a different vet today. Initially this morning I called our old vet's office to update him as to whether Arlo's condition improved - not much, but at least he's peeing in the box now. The thing that freaked me out is that this time the girl on the phone told me that the vet told her that his, "kidneys were shot," which was why he peed. This totally contradicted his words to me about Arlo's numbers not being, "horrible."

So I looked around and found what I think to be such a major improvement in care. We were able to get in this afternoon. I got the test results from the first vet and brought them with. While we were driving to the new vet's office I read them and became even more upset. There's not much on there that I could completely understand at the time, but to see:

Potassium 2.7(LOW)

This got me so upset! These were his numbers on Monday! And he had me giving my poor little guy 200ml a day with NO SUPPLEMENT. It took his condition deteriorating and my own detective work to figure out what that vet should have taken care of on Monday! I can not tell you how upset I am at this vet. I'm astonished that this man has been in business for as long as he has.

The new vet took Arlo's temperature, weighed him, and listened to his heart - something which the first vet did none of until I mentioned he felt hot on the third trip there and then it was only a temp check. I typed up a sheet of everything that has gone on over the last few days (I'm forgetful. Even typing it out I still forgot to add that he has some arthritis.) and gave him the test results. He said that his current condition - the head drooping, the walking funny - was textbook low potassium. He said that having low potassium makes the muscles weak which is why it's so hard for him to keep his head up. He said that this may be part of the reason he didn't make it to the litter box earlier. But just to play it safe he gave Arlo a prescription for an antibiotic just in case an infection was at play. He didn't feel comfortable trying to get urine from him at this time since he just peed in the carrier and he wanted to address any problems ASAP.

He told me the Rolls Royce standard of care would be to have him hospitalized with a potassium IV drip, but it would cost thousands since it would be over the weekend and he'd need to be transported to an emergency clinic tonight after hours. We obviously can't afford to do that.

He asked me what kind of supplement the previous vet gave me to give Arlo and I said it was a big, flat pill that could be broken up into four pieces and was a cream color with brown specks. He said that pills weren't very good because the cats GI is short and won't have much time to absorb the supplement. He gave us a potassium gel, Renal K, that should be absorbed more quickly. Let me tell you, the gel is so much easier to give him than those freaking pills! I'm to give him a half teaspoon twice a day and 100ml of fluids. I asked him about some other suggestions I received elsewhere on some boards and while he thought it was really too early to tell if he needed an anti-nausea medication (he wants the potassium controlled first) the Pepcid AC would be a good idea. He said to give him 1/4 of a 10mg pill once daily.

He explained that he has a chance, but nothing is guaranteed even with the Rolls Royce care.

I could kick myself for not getting a copy of his numbers right away. I would have checked on that potassium right away. I'm actually not a very trusting person, especially when it comes to the medical profession, but for whatever reason I thought how could he be that incompetent. I mean, how can you not see and address what is in black and white?! I'm trying to stay calm, but whenever I see how much he's uncomfortable, how weak he is....I hate to see him in this condition, especially when I think it could have been avoided, or at lease alleviated much more quickly had I known about it!

Oh, and the new vet sent me home with some KD food. He said that most cats don't particularly enjoy it, but since I'm assisting in Arlo's feeding already it would be a good thing at this point since there's a phosphorous binder in it already which should help his kidneys. We're just trying to get him through this low potassium crisis.

So if all of you could say a prayer, light a candle, or whatever for my sweet boy to make it through and turn the page on this horrible experience I'd greatly appreciate it.

Thank you all so much again for your help!

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@sgrbrn -- it sounds like you and your arlo have found a good vet. may i ask -- how old is your arlo? my snick was 11 years old when she was diagnosed with the 'beginnings of kidney issues'. snick's CKD diagnosis came within the next two years, but we'd already started sub-q's (100ml, twice each week) when she was diagnosed with 'the beginnings...'. snick and i are sending  that your arlo stabilizes soon and settles into a comfortable routine of treatment.