Chronic Renal failure

I have a 13 1/2 year old Cat that I've had since I was 9 years old and he was 3 months. A couple weeks before my birthday last September, he peed outside of his box. That is not normal for him at all. We took him to the vets thinking maybe he was diabetic, he was always a big guy around 20 pounds. Blood sugar cane back normal but his creatinine levels were around 3. We started sub q and supplements for kidney support along with a kidney friendly diet. He was doing good for about a month and then decided he didn't like the food anymore and started starving himself so we gave him his old food back. We were taking him in at least once a week to have his levels checked, and started him on steroids everyday about a month ago to keep him comfortable because his levels won't stop rising, he was about a 4.7 then. He also became anemic and we now give him a shot of epogen (sp?), his anemia levels went from 19 to 35. Last week I took him in for a check up, creatinine now at 7... His breath smells horrible, but he has no mouth sores. Today when meowed, it's very muffled and deep sounding, almost silent. He's 1/2 Siamese so he's always been a loud meower. He now has four different dry foods and 2 wet to choose from at all times but he doesn't seem interested in anything but the juice from the wet food. He is so skinny and his hair is wirery feeling. We even tried to give him fresh turkey tonight, he'll usually take your finger off to get it. He took about two bites and walked away. All he does is sleep now. I'm sorry for the long post but he is so much like my baby. Is there anything else that can really be done? Or am I just putting him through more than I should? What comes next symptoms wise or behavior? Thank you so much

I am hoping  @Donutte   can provide some advice.          

Thank you

Here's some information from "Nephrology and Urology of Small Animals"

Is he on anything for tummy issues, like Pepcid or anti-nausea meds? That can and will negatively affect appetite. How much are you giving for subqs? What about appetite stimulants, did your vet give any of those?

And when you say "supplements" what specifically are you referring to?

He hasn't been throwing up too much anymore, I think because he isn't eating much. He is very sensitive to any oral medication, the steroids he is on are the only oral meds he has ever been able to handle. If you try to give him any kind of pill, he immediately throws up. We are giving about 200 ml of sub q every other day, he gets dehydrated so quickly but can't seem to handle get 100 everyday. His supplement is epakitin, we've tried others but they make him sick. He is a very hard case. I forgot to mention he also has lymphoma in his kidneys...

Have you tried tuna? The meds I mentioned can be injected also, or compounded. Lymphoma definitely adds a twist to things. Wondering if he has acute renal failure.

And have you tried syringe feeding?

He is in end stage renal failure. He can't eat any seafood it makes him sick, I said he was a hard case. If we syringe feed him he fights like crazy and starts to drool and then runs away and throws up. He is no good with anything oral. We haven't tried anything to stimulate his appetite. I just don't know when it's fair anymore to him, I love him so much that I think I'm blinded to how bad he probably is. I think he is so sick of being poked with needles, and I don't blame him. He isn't anemic anymore, but I guess this medicine can only help for so long before the body starts working against it. Is crf painful? I know he is on steroids for the cancer, and to try and keep him comfortable. Thank you so much for responding.

chicago93 said:

He is in end stage renal failure. He can't eat any seafood it makes him sick, I said he was a hard case. If we syringe feed him he fights like crazy and starts to drool and then runs away and throws up. He is no good with anything oral. We haven't tried anything to stimulate his appetite. I just don't know when it's fair anymore to him, I love him so much that I think I'm blinded to how bad he probably is. I think he is so sick of being poked with needles, and I don't blame him. He isn't anemic anymore, but I guess this medicine can only help for so long before the body starts working against it. Is crf painful? I know he is on steroids for the cancer, and to try and keep him comfortable. Thank you so much for responding.

Click to expand...

What my vet told me is that when the toxins build up, and creatinine is pretty high here, but not the highest I've seen, is that they are not in pain, but they feel REALLY crappy, like they have a bad flu. Two days before my Lucky died, his creatinine was 12.5 and it was very noticeable how crappy he felt. when he got diagnosed two weeks before that, it was 8.3. He was just starting to show symptoms at that point. So every kitty is different, but in your case you have the added complication of the cancer, which I'm not familiar with. It really sounds, based just on how fast this is progressing, that he's in acute renal failure, and quite possibly due to the cancer. If that is the case, then there isn't anything you can do, not that I know of anyway.

The reason he's not eating is due to the fact that when the toxins build up as high as they have, they get hyperacidity and really bad nausea. That will make them not want to eat. there are ways of getting the meds into them other than pills. They can compound it into a liquid, or even inject it. That way you completely bypass the stomach route.

In your case, you probably want to have a serious heart-to-heart with your vet, as soon as possible. Tomorrow if they are open. Find out what his prognosis is, and are you working toward healing him, or just making him comfortable. And if it's the latter, you have to determine how good his quality of life still is. And as to how you do that, there's not an easy answer. I know someone posted a quality of life quiz type thing to help people determine if it's good or not. Since we can't just ask the cats unfortunately.

My personal opinion - he's in acute renal failure, which means it's hitting him hard, and will get significantly worse, very quickly. It's already progressed rather rapidly from the sounds of it. And if you have no way of getting food into him, that can cause him to have liver issues on top of this.

Thank you for your honesty. I was afraid to hear that it might be getting close to his time, but I didn't want to give up yet. I'll give my vet a call to discuss if we can doing anything else for him. I want to be fair to my kitty though too, he was such a proud guy when he was healthy. We always joked calling him a prince, he thought he was above everyone and everything. I don't think he has his pride anymore.

I can't speak for the cancer part. If it was just the renal failure, I'd say fight for it until you know for sure it's a losing battle. There's so much more that can be done in terms of managing the symptoms, which will help him to eat on his own. But if the cancer is what's possibly causing it to get so much worse, then it may not. I just don't know where that plays into this whole thing,  or if it does. It may be worth even having him be on IV fluids for a couple of days and treatment with Pepcid and anti-nausea meds. I don't think he's getting enough fluids (Lucky got them every day) either, which also plays a HUGE part in this. But that is a decision you'll have to have with your vet.

If it was me, I probably would be fighting still until I did know for sure that there was no hope. Once I know though... 

I just went back and re-read your original post. Was reading it on a phone before and missed the parts toward the end. You wanted to know what would happen next in terms of symptoms. With Lucky, he got to the point where he started eating less and less. Eventually just licking up the juice here and there. Then he'd try to bury it. He started getting cold and would burrow under my blankets which he had never done. He slept more often than not. 

Two days before he died, he started walking funny. I'm not sure how to describe it. Almost like he was walking on unsteady limbs, but it was not something I'd ever seen before. The next day he got so much worse. He just crashed. I knew that day I'd be putting him to sleep the next day, so I stopped the syringe feeding. He was losing his strength as you can imagine, and while he tried his hardest to go to the litter box, he would not have the strength to get out, so sat in there till he did. He lost bladder control three times that night, first time in his life. 

Not telling you this to influence your decision, but just tell you what my experience was. Your kitty's levels are not as high as Lucky's were, but I suspect he's very weak from not getting enough food or fluids.

I'm not going to give up until I know for sure that I have to. He is cold a lot so I bought him heated blankets and have them set to low, he loves them. We tried the sub q everyday but he started peeing outside his box, so our bet is having us do it every other day, they don't think his body can retain that much water anymore. They are also afraid of him getting fluid in his lungs if he gets too much. He practically lives at the vet, we always take him in to get his levels tested and to make sure he doesn't have any infections/uti. There is a lot of blood apparently in his irons when they test it, but they don't know why. He won't respond to antibiotics. Thank you for letting me know what your experience was.

chicago93 said:

I'm not going to give up until I know for sure that I have to. He is cold a lot so I bought him heated blankets and have them set to low, he loves them. We tried the sub q everyday but he started peeing outside his box, so our bet is having us do it every other day, they don't think his body can retain that much water anymore. They are also afraid of him getting fluid in his lungs if he gets too much. He practically lives at the vet, we always take him in to get his levels tested and to make sure he doesn't have any infections/uti. There is a lot of blood apparently in his irons when they test it, but they don't know why. He won't respond to antibiotics. Thank you for letting me know what your experience was.

Click to expand...

Sorry I meant to say he has blood in his urine not irons.

chicago93 said:

Sorry I meant to say he has blood in his urine not irons.

Click to expand...

There can be so many reasons for that. Have they done scans of his bladder to make sure there are no masses there? My Sara perpetually has blood in ther urine. We're suspecting cystitis, but for the most part it's not bothering her. We've run more tests than we can count for it. My vet and I decided  not bothering her, we won't worry about it. Her flare-ups are obvious so we can tell when it's bothering her or not, and she's been good for months now.

My question for you - have you asked the vet about doing a smaller amount of subqs on his off days? Instead of doing 100 maybe you can do 50? Because ANYTHING is better than nothing. I can tell you right now - there's no such thing as living in an idyllic world with a kidney cat. Yeah, it would be great to give them the prescribed amount all the time, but Lucky could only tolerate 200ml two days in a row. If I did it a third day, he got sluggish. We had to play around with it. Oh, that's not counting all the times the needle popped out and I promised him I wouldn't poke him more than once a day. I broke that promise one time only, and that was because he needed more fluids in him so I could give him his anti-nausea injection. He wasn't good with pills around this time either, btw.

Have you tried giving treats for him to eat? I know it sounds silly but I know how it is being at that "feed them whatever they'll eat" point. Baby food (without onions and garlic of course), treats, anything that won't cause him issues due to the cancer is pretty much a go. He probably won't eat though if his tummy is bothering him, so hopefully you can talk with your vet today. I ask about treats though because I decided to offer Lucky Temptations when giving them to my other cats. I didn't expect him to eat them, but then he gobbled them up!

When we give him 200 ml every other day, he still has a lump on his back on his off days. It takes him awhile to absorb it. I can talk to his vet about doing it everyday, but his epogen that he gets can't be given to him on a day he gets his sub q. I guess it'll dilute the epogen, and he will become hypoxic again.

I actually just found a treat last night that I bought at the pet store. He seems to like it, and I got him to eat almost a handful last night. I think they are called irresistibles but I'll try temptations too. He likes soft treats. I know it isn't healthy, but I agree anything at this point is better than nothing.

He's had multiple X-rays to see why he could have so much blood in his urine. Nothing came from them. They looked for cysts, masses, infections, nothing. My only guess is that it has something to possibly do with the cancer. When he was 3 he has crystals get stuck all the time, so he has a surgery to make his uretha larger. X-rays showed no crystals either, not that they could get stuck anymore if he did have one. He pees a lot too.

I'm going to call our vet and ask about anti nausea medicine.

Not sure what epogen is, but whatever it is, you definitely don't want to make the kitty hypoxic.

I would ask the vet about both Pepcid and anti-nausea, since it's a combination of the two issues that can cause inappetance.

He pees a lot both as a result of the kidney disease, and the subqs. you probably notice a lot more on the days he gets the subqs. Lucky was peeing huge saucer-sized patties after he started the subqs. It actually wasn't until after he was gone that I realized half of what was in the litter box was coming from him.

Poor baby, it just sounds like he's had a lot of problems his whole life. The one question I haven't asked - is the cancer terminal?

And btw, he's an absolutely gorgeous kitty. I've always loved Siamese cats, and you can definitely see it in him.

Thank you, he's always been a unique looking cat.

Epogen is a human medicine that is supposed to help the body produce red blood cell, it seems to be working.

Our normal vet, who has turned into Skylar's (cat) specialist wasn't in today. He is the one who has contacted many specialists on Sky's condition. The vet isn't open on Sunday. He should be back on Monday, I'll call him then. He knows what would be best to give him to help him with his nausea.

Sadly his cancer is terminal. The steroids are supposed to help with any discomfort, but nothing has had an impact on the cancer.

I think he might be crashing right now... I gave him his sub q earlier today and he ate a pretty good amount of treats (handful) and some wet food juice, but he really isn't doing good. He's hiding, which he never does, and he is staring blankly at the wall. Right now he is in the "meatloaf" position I believe, according to a website I saw, that isn't good. We have him on a heating pad and I'm about to listen to his lungs/heart (I'm an Emt). If I need to get him to the ER I will.

What happens when they crash? He never really has before. And I'm not completely sure he is.

chicago93 said:

Thank you, he's always been a unique looking cat.

Epogen is a human medicine that is supposed to help the body produce red blood cell, it seems to be working.

Our normal vet, who has turned into Skylar's (cat) specialist wasn't in today. He is the one who has contacted many specialists on Sky's condition. The vet isn't open on Sunday. He should be back on Monday, I'll call him then. He knows what would be best to give him to help him with his nausea.

Sadly his cancer is terminal. The steroids are supposed to help with any discomfort, but nothing has had an impact on the cancer.

I think he might be crashing right now... I gave him his sub q earlier today and he ate a pretty good amount of treats (handful) and some wet food juice, but he really isn't doing good. He's hiding, which he never does, and he is staring blankly at the wall. Right now he is in the "meatloaf" position I believe, according to a website I saw, that isn't good. We have him on a heating pad and I'm about to listen to his lungs/heart (I'm an Emt). If I need to get him to the ER I will.

What happens when they crash? He never really has before. And I'm not completely sure he is.

Click to expand...

He had 200 ml of sub q around 9 this morning and has had a bowl of water and some water from his filtered bowl. His skin is still snapping back and his mouth looks good and moist, so I don't think he is dehydrated.