Acute Renal Failure, really need some advice.

My Marceline has Acute Renal Failure. She spent 5 days in the vets care having various tests and being on IV fluids. After tests had shown the reason was Lilly poisoning. Marcie has now been at home for the past 4 ddays. She had seemed okay the first couple of days but the last day or so she hasn't been herself, she can barely move without getting tired and had been twitching  / having spasms. What can I do to help? I just want to help her x

may i ask -- what prognosis did your vet give for your Marcie? also, has your vet recommended continuing with giving sub-q fluids, either at home or at the vet's?

okay, i just did some reading about acute renal failure. i have experience with chronic kidney disease (failure), but not acute kidney failure.

i would suggest calling your vet about these symptoms. my understanding is that the treatment for acute renal failure focuses on providing supportive care while allowing the cat's kidneys time to recover. there are quite a few 'levels' that your vet would be keeping an eye on -- like potassium. from what i read, it's very important to contact your vet should any further symptoms arise. it may be expected that at this point your Marcie tires easily and is having some twitching/spasms, but i would definitely call and check on this with your vet just to make sure.

with the twitching/spasms -- is it like her skin is twitching, under her fur? my snick does that when she's having nausea/gastro upset. how is your girl's appetite? is she vomiting at all in these past 4 days she's been home?

Jeffa----I have experience with acute renal failure. There are 4 stages and if your cat is

not at stage 4, there is hope. There is a new med called "Calcitriol and since we have

been administering it, our Sydney has stayed at stage 2 and he is eating and doing

very well. He also gets an appetite pill since kidney disease can cause appetite loss.

The appetite pill is called Mirtzapine.  Finally, we serve him mainly wet food because

kibble is very hard on the kidneys but he still does eat some kibble but no more vomiting!

Finally, all the wet food you feed your cat should not be fish-based nor should it contain

Carageenan.

A very good site for info is http://www.felinecrf.org/.  Hope this helps.

Thank you for the replies everyone. After being on the IV fluids, on the last day/night at the vets Marcie was on 2X the amount of IV fluids and she was still feeling the need to drink a lot. The vets suggested taking her off the fluids overnight and sending her home the next morning to see how she does. They said if she crashes fast then their has been too much damamge to her kidneys.
They never gave her any medicine to take home, just suggested high calorie wet food (as she has gotten very thin) and plenty of water.
She hasn't really been eating that much, she has a little nibble here and there, and she has not been drinking nearly enough water as I thought she would.
After I posted this Marcie had a little water and then she brought it back up.

What are the things to look out for stage 4?

Marcie also has a very strong odour coming from her.
Vets had said that they couldn't be sure how much damage had been done and she could be okay, but everything they said didn't sound that great. Although when they sent her home the note they left said "bring Marcie back when she begins to deteriorate". I'm really scared because they had made out that euthanasia would be the next step of she crashes. x

Jeffa.....here is a chart which will allow you to ask your vet specific questions, for example, "What are the Creatinine levels?" This is a very good indicator of how serious the problem is. However, if creatinine levels are too high, they can come down, which is a good thing if that is the case.

Bloodwork

Bloodwork tells vets quite a lot about how a cat's kidneys are functioning. BUN (urea) and creatinine are the two main measures of kidney function in bloodwork. Here is the IRIS staging system, with my estimate of the likely percentage of function lost:
*It is normal not to be able to detect CKD until at least 66% of function has been lost, because before that there are usually no symptoms, see below. Therefore for cats in Stage 1, bloodwork values are usually within the normal range, and kidney problems wouldonly be suspected if an anatomical or functional abnormality had been detected.

I chose the above chart because you asked how one knows what the stage of the kidney disease is. The Vet hopefully performed the above tests.

and therefore would be able to tell you the Creatinine levels which would allow you to determine what stage your Baby is at.

My heart and prayers are with you.

Joy

I sent you a chart which demonstrates the various stages of kidney disease, however, the fact that I posted a link means that my post to you first needs to be approved by the Admin of this board.

What I can tell you is this. As your Vet what Marce's Creatinine levels are at this time. The Vet can then tell you the stage of the Kidney disease.

My daughter had a kidney transplant, my husband has the use of one kidney and we lost our cat Koko last NOvember to kidney disease.  It is from all this that I learned about kidney disease. Ask me anything you like and I will do my best to answer but first call your vet and ask him what Marce's Creatinine levels were.  It's important that she eats, even if you have to try and feed her baby food with your finger----Junior chicken baby food--it may cause loose stools but at least you'd be getting some food down her if you can.

Best to you and Marce.

Keep in mind that Acute Renal Failure from poisoning is not exactly the same as the slow onset chronic kidney disease we often see in older cats and tend to be more familiar with.  Depending upon how severe and how quickly treatment is sought, some cats can come back from the acute injury, although then they may be left with the lower kidney function associated with CKD.

There is a page on the felinecrf.org about Acute Kidney Injury (as it is now technically termed): http://www.felinecrf.org/acute_kidney_injury.htm  Note that the stages of the Acute with the accompanying creatinine levels are different than the chart posted above.  There is a chart of 5 stages on that page.

I don't have any personal experience with acute kidney problems, but apparently the 5 days of IV fluid support in the hospital is the right sort of idea, and you hope for her to regain some kidney function with that support.  Sometimes the cat is left with the chronic kidney issues after this kind of event because they don't regain enough kidney function to be "normal".  If that is the case here you might be looking to continue more fluid support (sub-q fluid which you could give at home once you learn how, it's pretty easy) and some meds to help the stomach upset or accompanying symptoms that it sounds like she might have.  And she needs to eat!  Eat something, anything, and you might have to help her with that by feeding with syringe or similar.

Personally, having cared for a couple of older cats with chronic kidney disease and eventually learning more about it, I would not yet accept euthanasia as the next step without spending some further time seeing if she can be stabilized at a low but still functioning kidney level, which she may be able to live with for some time.  I don't want to give false hope, because I don't know how severe her acute issue was, but like other cats who are diagnosed with the chronic disease, she could be able to live months or years with lower but stabilized kidney function.  It varies from cat to cat.  Note that this would likely require the ongoing sub-q fluids and you're going to have to get some nutrition into her somehow. If prognosis is otherwise good but she won't eat, a feeding tube can be considered (but it is costly so you probably want to know that in other ways she will be okay for a while before committing to something like that).

Unfortunately some cats do not make it back from an acute kidney issue, but the fact that Marcie made it through the 5 days in the hospital to me seems like a positive sign, even if she's not really doing that well at home just yet.  Maybe another check of the kidney levels would be in order, not sure.  She needs to get food somehow, and some nausea/stomach upset/etc is common with kidney issues.  If the vet wants to jump ahead to giving up, I don't think i would accept it without at least a second opinion, if you are in a position to get one from another vet.  I'm sorry you're going through this with your kitty.  Hang in there.

Thank you for all the replies. I was going to comment back once the vet got back to me with Marcies Creatinine levels. The Urea levels were the worry as they were still very high. Things took an unexpected turn for the worse, without going into detail as this is heartbreaking. Marcie hadn't moved all day. She really didnt look okay all. When I encouraged her to drink, move etc she couldn't stand up. I could see she was dying. I couldn't let her go through that. Marcie had to be put to sleep, I held and cuddled her all the way through. We are all absolutely heartbroken

I'm so sorry for your loss. My heart breaks for you. ((Hugs))

So sorry for your loss. My heart also breaks for you. She's not suffering now thankfully. Prayers for you.

i'm so sorry for your loss. i'm sure that my mickey was among the cats waiting to greet your marcie as she crossed the Rainbow Bridge.

I am also so very sorry for your loss. 

I'm really sorry for your loss. She is resting in peace now. 

Thank you all x

Oh no, I'm so sorry. My condolences.

On behalf of the TCS Team, we offer our condolences on the passing of your kitty.  The thread will be locked now as a sign of respect for your loss.  We invite you to post a tribute to Marcie in our Crossing the Bridge forum if you wish:  http://www.thecatsite.com/f/19/crossing-the-bridge