3-year-old cat has chronic renal failure.. devastated and desperate.. please help

njbw

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Our cat, Rain, is a 3 year old Russian Blue Mix who we found outside back in 2014. When we rescued him he had snot and pus frozen to his face, so we took him to the local ER vet. After cleaning him up it was determined he was FeLV+ (feline leukemia). We immediately adopted him and setup a private space in our house for him, taking care of him and ensuring he was loved since we did not know how long he had left. He was otherwise completely healthy, just dirty.

Up until February 8 of this year Rain has been incredibly healthy. He was full of life, loved to play and cuddled with us constantly.. every night, without fail, he'd lay with my girlfriend and me and pur, love, and be our friend with all the energy in the world.

The only thing we noticed that was off with him was slightly bad breath, but we were told it was common for FeLV+ cats as they can develop some signs of periodontal disease quite easily.

However on February 8, we noticed he suddenly did not eat his dry food. He threw up once but that's it, and he was acting otherwise normally.. playing, sitting on our lap, etc.. We monitored him but he did not show any more signs of illness.

Over the next ten days he continued eating his wet food with no problem, but was picky with his dry.. ate very little of it and we started to notice he had less energy. We took him to the vet on February 18th after he suddenly stopped sitting with us and was sitting still looking depressed. His eyes developed a smelly brown discharge and we took him in immediately thinking it was an infection.

After a blood test it was determined his creatinine levels were 12.9 (his BUN number was high as well but I do not recall the exact number-- will update later). I understand 12.9 is highly into Stage 4 kidney failure, as any level above a 5 or 6 is considered Stage 4. Because he had virtually NONE of the symptoms of CKD until mid-February and had only vomited once a week prior, the vet assumed he was suffering from acute renal failure from ingesting a toxin.

He was admitted immediately and placed on an IV and given fluids. He had an ultrasound that showed his kidneys were "smaller than usual", and "bright". During his three-day hospitalizatoin, the vet rechecked his kidney levels and creatinine went from 12.9 at the time of admission to 11.9 the next morning. The following day, creatinine went to 11.2. On the last day, they went back up again to 12.4. Discouraged, the vet stated this was evident he was suffering from CHRONIC, not acute, kidney failure.

We are absolutely shocked and in disbelief. How could he be so healthy and show absolutely zero signs until February 8th, then just a week later have such high creatinine levels and continue to decline?

The day we brought him home, Tuesday 2/21, he had regained a pretty significant appetite and was acting normally just like his old self. He was vocal, walking around, and came on my lap / sat on my shoulder purring and headbutting me. However immediately the next day he stopped eating all food. No wet, no dry. He began just sitting on the window, idle, squinty-eyed and taking in the breeze. He did not come up to us when we came into his room, but just looked at us.

We have been administering Sub-Q fluids every day as prescribed by the vet. He has been given Omeprazole for acid reflux, Mirtazapine as an appetite stimulant, Zeniquin as an antibiotic (vet has since said to stop this as he has no signs of an infection) and Cerenia for anti-nausea. It has barely helped. After receiving his appetite stimulant, he shows some interest in food and takes about a 1Tbsp bite, but stops. He has been drinking a lot and drinks heavily after being given Omeprazole.

Today we got his values rechecked and his creatinine showed a 12.7. Virtually no improvement. We are devastated as the vet has suggested our options are (a) a feeding tube, or (b) euthanasia.

We are desperate for any help.. has anyone been through this? Any similar symptoms? I would imagine for his levels to be so incredibly high that he would have shown signs earlier than a week prior to the hospital admission. He went from being FULL of life, playing and eating a complete diet to being weak and refusing to eat anything ten days later.

Is there any hope for Vitamin B Complex in his case? We will not put him through a feeding tube as we want to make sure he does not suffer. Due to his FeLV and severe kidney state, surgery is too much of a risk.

I am hopeful someone has had a similar experience and can provide insight. Thanks so much.
 

Brian007

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Read this comprehensive guide to chronic kidney disease; it doesn't have to be a death sentence and can be successfully maintained:

http://felinecrf.org/index.htm

I'm sorry that you're all going through this right now, but hang on in there, and keep us posted 
 
 

white shadow

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During his three-day hospitalizatoin, the vet rechecked his kidney levels and creatinine went from 12.9 at the time of admission to 11.9 the next morning. The following day, creatinine went to 11.2. On the last day, they went back up again to 12.4. Discouraged, the vet stated this was evident he was suffering from CHRONIC, not acute, kidney failure.
It's well-known in the kidney-cat community that 3 days of intensive fluid and associated therapy is often insufficient to stabilize a cat with kidney 'failure'.

Here are a couple of quick 'grabs' from the excellent resource referenced by Brian007:
 
I'm not in the business of vet-bashing, but this trend does give me pause for thought. No vet has a crystal ball. And CKD cats can look horribly ill when they are first diagnosed, particularly if they are dehydrated. I was dehydrated myself one time following surgery, and I definitely looked as bad as I felt. Note I say that I felt bad; but I was not in actual pain. CKD is not generally considered to be a painful disease (although end stage PKD, a genetic kidney disease, may be painful if some of the cysts rupture, but this is rare). Dehydration basically feels like a bad hangover, with a bad headache and a queasy stomach. CKD cats often have excess stomach acid, so that feels like stomach ache. They may be constipated, and may have anaemia which makes them feel weak. But none of these things is outright painful. And all of these things are treatable, in fact often relatively simple treatments can soon make a CKD cat feel and act much better.  

So I would say that in most cases, you should definitely try treatments, for a period of two weeks if not longer, before opting for euthanasia. And if your cat has high bloodwork levels, then one day on IV fluids is simply not long enough to decide whether a cat is going to turn the corner or not!

http://www.felinecrf.org/just_diagnosed.htm#euthanasia_recommended
 
If your cat is in crisis, the first thing to deal with is the dehydration. This will usually be treated via intravenous (IV) fluids (a drip), which requires hospitalisation for a few days. Personally, I would want to put any cat of mine with creatinine of over 6 on IV for 3-4 days (one day is not enough).  As the cat becomes rehydrated, s/he should gradually start feeling and acting a little better, though some cats do not do well as in-patients and will only turn the corner once they return home.

The cat may continue to exhibit a loss of appetite, so it is essential that sh/e eats, via assist feeding if necessary. Since cats with high BUN tend to have problems with excess stomach acid, ask the vet to treat this (the excess stomach acid) too.

http://www.felinecrf.org/just_diagnosed.htm#crashing_cat
If your Vet has offered/suggested a feeding tube, then medically, it's not "too much of a risk"....plain and simple. From a resource (cost) perspective, that may be another matter......here, my cats and I live within a necessary financial framework and certain decisions fall into that arena....that's life.

I hope you noted the "no pain" comment I highlighted in red in that first quote.......clear thinking is critical for you at this time, talk of 'pain and suffering' when it's non-existent,  is NOT helpful.

But.....feeding tubes save lives.....here's a reliable source for background information: http://catinfo.org/feeding-tubes-for-cats/

Within the last quote above, "assist feeding" was mentioned....one of the common methods is feeding by syringe. That is doable, but it requires that the cat be 'taught' and that requires patience. There's an excellent (again, reliable) site for info on this: http://assistfeed.com/

I would really urge you to join the specialized online community that is hosted by the author of the "Tanya's Comprehensive..." site. There, you'll get 24/7/365 personalized info, guidance and advice by other more experienced CRF caregivers - it has been a lifesaver for many kitties. Here you go: https://tanyackd.groups.io/g/support    Here's a FACT page about that group: http://www.felinecrf.org/tanyas_support_group.htm

(The Assist Feed owner also has a specialized online community.....a great help: https://groups.yahoo.com/neo/groups/Feline-Assisted-Feeding/info)

I recommend that you get new, separate email addys (Yahoo/GMail etc) for such groups - it helps organize & manage the info flow.

Just a final thought....it sure sounds to me as well like acute failure.

no time to edit - any boo-boos need to stand!

Keep us posted...but, go 'talk' to the experts !
 

mrsgreenjeens

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It sounds to me like ACUTE kidney failure also.  I've had three Chronic Kidney cats, and this is not something that goes from normal to creatinine level 12 overnight (that I've ever heard).  AND, sadly, ACUTE is definitely the worst of the two.  Could he have ingested a toxin...perhaps some poisonous flower or something similar?  Lillies are the most common houseplant/flower that can cause this.  Also, the dreaded antifreeze and I'm sure some other household chemicals. 

You said he is drinking a LOT....how about his uriniation?  Is he urinating a LOT also?  Cats with CKD will normally urinate lots because they are drinking a lot.  Cats with Acute kidney failure may not urinate much at all because of damage to the kidneys.  Could be another sign of which it is. 

 
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njbw

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Thank you Brian007, White Shadow and mrsgreenjeens.

We have researched extensively and have hit dead end after dead end. It seems nothing we try is working. Appetite stimulants (Mirtazapine) have no effect, antinausea (Cerenia) and Omeprazole are both not resulting in any difference in his inappetance.

He has lost some weight but we have begun assist-feeding him with Hills A/D and a feeding syringe. We have done this in the past while raising bottle babies with great success, and our vet agreed we should give it a try. We also tried a B12 injection yesterday which should be good for a week. So far, we see no effect from the B12 injection. We did notice his weight went up 0.22lb since we began assist-feeding. He doesn't seem to mind it as much, especially when we warm the food in a bowl of hot water while in the syringe. He actually finds it tasty, I think..

Immediately after feeding him he seems to allow us to put our heads on him without much aggitation. I believe he is thankful for the food and has not yet once thrown any of it up, and is keeping it down without any gagging or acid reflux that is apparent to us.

We inquired again about a feeding tube from a second vet this morning as a second opinion. He agreed that, like the first vet suggested, it would probably not get him anywhere in terms of long-term improvement and that it will likely be hospice care at this point. Given that his diagnosis is CKD, they have told us his underlying condition likely will not improve and that, while we may be getting food into him, his kidneys will continue to decline since they are not naturally regenerative.

We are continuing Sub-Q fluids every day, currently 75ml per day as prescribed by his initial vet. His weight at admission to the ER vet was 6.1lb (he has always been a smaller cat, even in adulthood). That weight when was he was of normal appearance. Today he was about 5.7lb, which is up from 5.5lb prior to when we started assist-feeding him.

Does that amount of Sub-Q fluid seem sufficient for his weight? He is drinking on his own, not extensively, but a decent amount. He does make trips to the water bowl and drinks.

I will look more into Tanya's site for info. Does it seem like we have missed a turn somewhere, or does it seem we are going in the right direction in terms of finding out his overall prognosis? Also, he does have a heart murmur. I have heard from others (not vets) that high blood pressure can cause issues with the blood flow to the kidneys, resulting in high creatinine and BUN levels. This can appear as CKD on tests, when the underlying issue is really just hypertension. Again, this was just heresay I read online-- any truth to that?

The final diagnosis from the initial ER vet was "Acute-on-chronic renal failure, or progression of extensting renal failure." So it sounds like they believe he had CKD, with an acute situation on top of it that made his symptoms suddenly show and his condition deteriorate. Still looking into what this exactly means..

@mrsgreenjeens-- have you ever heard of "acute-on-chronic" renal failure, with symptoms like these? We have zero flowers in our house, no lillies, no antifreeze or any other toxic substances that he could have gotten into. He urinates proportionately to how much he drinks, and I've notice only a slight increase in both. But nothing that stands out like wildfire. However his urinations are full and healthy, no blood, no straining or visible pain.

Thank you all again so much. We are trying to cope with this and not leave any stone unturned before making any decisions.

B&S
 
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njbw

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P.S. (doesn't look like there is a way to edit my post)...

The main two things we notice in him now are:

1. Personality loss and laziness, but I wouldn't call it "lethargy". He walks around, albeit seemingly weak, but still moves about.

2. Not eating on his own, other than what we are able to assist-feed him with in a syringe.
 

Brian007

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At the risk of always banging on about the medicinal benefits of catnip BUT give him catnip.  It reduces gas, indigestion, cramps, nausea, insomnia, and anorexia, amongst other things.    It is also psychologically beneficial in times of stress in cats.

 

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I can't urge you strongly enough to join Tanya's online group - for more knowledgeable insight, especially on the oddities of all he's presenting.

On this
 he does have a heart murmur. I have heard from others (not vets) that high blood pressure can cause issues with the blood flow to the kidneys, resulting in high creatinine and BUN levels. This can appear as CKD on tests, when the underlying issue is really just hypertension. Again, this was just heresay I read online-- any truth to that?
I have no idea.....I'm confident you'll get an answer from that group.

Has his BP been measured at all....if not, I believe it should have been - I'd get it done. Read up on it first in case you get flack: http://www.felinecrf.org/hypertension.htm#diagnosis

The amount of fluid to be given must also be evaluated in terms of any heart issue.....so, I won't go near that....again, the group would be my guide.

I'll offer a few thoughts about whether/not the stomach acid inhibitor is doing its job......because, with that, the Cerenia and the appetite stimulant......he really should be eating. There's a concern with using Omeprazole - it came out only last year - because, in humans, it was found to (itself) raise the risk of kidney failure. Here's what Helen (the author of the Tanya site) says about Omeprazole:
 So why don't I recommend starting with omeprazole rather than the histamine H2 antagonists, such as famotidine? Well, firstly, because I've seen the histamine H2 antagonists used for much longer, since 1999, and most people seem to find they are effective with few side effects. Secondly, in 2016 a human study, Proton pump inhibitor use and the risk of chronic kidney disease (2016) Lazarus B, Chen Y, Wilson FP, Sang Y, Chang AR, Coresh J & Grams ME Journal of the American Medical Association Internal Medicine 176(2) pp238-246, reviewed the use of PPIs in humans and found that "Proton pump inhibitor use is associated with a higher risk of incident CKD." In one study, the risk was 50% higher. I do not know whether IRIS will be revising its guidelines in light of this study.

http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#omeprazole

[my emphasis]
Given that, i would ask to stop the Omeprazole immediately and use a 'standard' antacid like Pepcid - famotidine. On the chance that this is why he hasn't turned around, I'd be tempted to then get him back on IV fluids for a few days with the new antacid on board. Is this the 'monkey wrench' in the works? I have no idea, but, I don't think it's impossible - and, there's nothing to lose at this point. (I'd bet the Vets are not aware of that study.)

But, I am only slightly familiar with the theory of all this.....the people in that group would be my go-to.

I really have to go. Maybe something there will help.

Keep up the a/d feedings.....yes, it's 'tasty' too, and that helps. Warming is always the best.
 
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njbw

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Thanks again all. Rain has never had an interest in catnip but we will give it a try. We'll buy some fresh catnip tonight and see if he reacts to it. I hope he eats it!

@White Shadow: Thanks again for your insight. I did join the group and am just waiting anxiously for my subscription to be approved so I can ask them. I do not recall ever hearing anything about his blood pressure but I will call the hospital tonight and see what it was, if they measured it (assuming they would have taken it).

We did not give him Omeprazole in the past 24 hours so we will lay off of it for now. Since we did not see any improvements with the prior doses we don't believe it will be of any help. And, as you described, maybe it is actually worsening things. I'll have to update on whether laying off this makes a difference.

I will inquire with our vet about famotidine (Pepcid) also. If we already have a prescription for Omeprazole, and he was just in the hospital last week, I'd hope they can prescribe it without issue. I have also heard it has a good track record with CKD cats. The appetite stimulants and Cerenia are making literally no difference. We gave him both about 3 hours ago (2:45pm ET this afternoon) with his syringe feeding, but nothing. It's now 6:17pm and he has not come out for food, or some fresh boiled chicken I put on a plate. He's just laying peacefully sleeping.

I will look more into having him put on IV fluids. He was incredibly "himself" when he got home from the vet right after being on IV fluids so I am so disheartened to see he has declined to such a depressing-looking shell of who he used to be :(

Thanks again.
 
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njbw

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Update: Rain is still not eating on his own, we are assist-feeding using Hills A/D and a feeding syringe. He is getting approx. 1 can per day. He began this around 6PM on 2/27. He hasn't had a bowel movement yet but I guess not much time has passed.

We are considering putting him on IV fluids and maybe trying Pepcid. I really think he has some acid buildup issues. He sits like he is slightly uncomfortable, and when he walked to his water bowl a few minutes ago he kind of took a few sips, sat, and just meowed once. It was a slightly different meow like he was uncomfortable. When we hold food in front of his face, he licks his lips once, looks away, and that's it.

We are really thinking maybe some IV fluids will help him and maybe some Pepcid.

I tried joining Tanya's group but is has been completely, utterly and overly annoying trying to post anything on there. Every single post, reply and update needs to be approved by their moderators before it's public, and the last two posts I made took hours to be approved.. one is still not approved. This is not really an option for me as time is of the essence. Their site is informative, but the group aspect is a complete disaster in terms of useability.

We will call the vet today to see how they feel about IV fluids and Pepcid. Any advice on IV at this point is appreciated.
 

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First, about Tanya's group......please stick with it....I've sent a note to someone I know 'there' in the hope of getting you 'cleared' and out of the moderation period....could you also do a post - just cut & paste the second-last paragraph in your last post above - and hopefully that can trigger the gatekeepers there.....it is a very busy place and the mods are really stretched and therefore things can appear to 'trickle' at times.....do bear with it, though....I WOULD !

A couple of things: instead of running things by the Vet(s), you can request that something be done....so, e.g., simply request a BP exam be done.....just say "I want to switch to PepcidAC and I want him put back on IV for a few days and to see/evaluate what change that may produce". So, just state your wants rather than suggest......these are relatively benign treatment issues. Say "I really need you to work with me..."

You might also share the Tanya site with the Vet - see the bottom of the homepage for "REVIEWS AND AWARDS" for Vet references.

BTW, it's PepcidAC, not plain Pepcid....and, it's available in injectible form which can be 'put' directly into him eliminating bitter pilling probs:
 
Famotidine Injectable

Some people prefer to use this because famotidine tastes very bitter in pill or oral suspension form. You can use the injectable either by injecting it directly into your cat, or if your cat is on sub-Qs, by adding it to the injection port of your IV line.

There are two types of famotidine injectable. There is a 10mg/ml strength without preservative, which is available in 2ml vials. Because it contains no preservatives, this has a short shelf life (it is intended for single use in humans). There is also  a 10mg/ml strength available in a 20ml size vial. This contains a preservative and can be re-used, though it needs to be shipped chilled and should be kept in the fridge after you receive it. It is safe to take it out of the fridge about 30 minutes before using it so it can warm up a little before use.

Injectable famotidine is often out of stock so you may have to search for it.

Thriving Pets

Sell the 10mg/ml injectable form of famotidine in a 20ml size for US$29.95. If you want to give the usual famotidine dose of 2.5mg, you would give 0.25ml, thus the 20ml size contains 80 doses altogether. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$100. Shipping is free for orders over US$100 after the discount.

http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#famotidine
Make sure you continue the syringe feeding while he's off the antacid (and get the other going asap)....without food in the stomach there'll be a buildup of acid. It wouldn't hurt to increase the amount of food....that would mean more feedings (more often), not larger amounts.

You should be watching for stool too.......if he hasn't had a BM, he could be ~constipated. The a/d sometimes contributes here, even though it's liquid. (Human) Miralax is the easiest-to-use stool softener for these guys...here's info: http://www.felinecrf.org/constipation.htm#miralax

Sorry, gotta go.
 

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You asked me if I had ever heard of acute-on chronic renal failure, and I had not, but I did find this article on it:  http://veterinarymedicine.dvm360.com/differentiating-between-acute-and-chronic-kidney-disease.  It says that they "may require aggressive treatment in the hospital, but will have residual CKD..." 

As to the amount of fluid he is getting every day, with a heart murmur, I think 75 mls is probably the most he should get, because too much can be dangerous.  It's definitely a fine line when there are heart issues involved. Does he absorb the fluids well?  Does he get a fluid bubble everyday after you give him his sub-qs?  Does he appear dehydrated at all if you do the skin tenting test?  Of course, if you decide to go the IV route, it's a moot point as they can get much more into him yet monitor his heart at the same time to make sure everything is AOK. 

AND, yes, high BP can definitely cause kidney issues, at least in humans.  But what makes you think he has high BP?  Cats with chronic kidney disease often have high BP, but that's usually caused by ill functioning kidneys, not necessarily the other way around. (if that makes sense)  

I agree with White Shadow.  Talk to you Vet and tell them what you want and if then ask if they see any reason why you should not do it.  If they present a good reason why not, then then about it.  Come back here and talk to us if that seems reasonable.  BTW, we used the injectable famotudine with Callie.  Worked very well.  We just ordered hers thru a local compounding pharmacy.  There are MANY online compounding pharmacies...all they need is a prescription from your Vet, if that's the route you want to take. 

I wonder if that fact that he's FeLV positive has anything to do with this
 
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njbw

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Thanks for your replies. I will stick to Tanya's group, it is very informative but I am just overly frustrated altogether.

We have an appointment on Friday at 9am with an internal medicine specialist at the local vet where he was initially admitted. We will be persistent with our requests since I believe we know at this point that there is no time to waste. I'll ask for blood pressure to be taken since I want to know if it is a contributing factor.

We'll see if they have PepcidAC as well, even an injectable. We noticed Rain is sitting in meatloaf-style position.. with his abdomen raised a little bit off the surface of wherever he's sitting. It looks like obvious discomfort due to something. He also just strained trying to poop. He got into position, I could see his butt "clenching", but nothing came out. He walked away and seemed frustrated. I wonder if CONSTIPATION like you mentioned is causing a lot of his lack of appetite and weakness, plus his unbalanced walk.

I've read Miralax is potentially bad for CKD cats. Any truth to this that you know of?

@mrsgreenjeens: I agree, 75ml seems to be sufficient and he doesn't really seem dehydrated, just uncomfortable and maybe constipated (which could in theory be from dehydration, but his gums are a bit moist and his skin doesn't slowly snap back, which would indicate dehydration. It is relatively normal and goes back rather quickly when pulled.

We think he may have high BP because he has a heart murmur, and I have read heart murmurs can be caused by high blood pressure. Good point about it not being the root cause but I wonder if it could be making him feel crappy, if existent.

Every vet we talk to says FeLV should have no impact on CKD and would probably not be a root issue that led to CKD... However I highly doubt many vets have seen a 3-year-old FeLV+ cat with chronic kidney disease. It's rare enough for a cat who was born with FeLV to live three years, and when combining a 3-year-old cat who has been diagnosed with chronic kidney disease, I'm sure it's a stumper.

Thanks again and I will let you all know if anything else comes up. Any more input is appreciated, especially about the apparent constipation. We are thinking of trying canned pure pumpkin during his assist-feeding as it appears to help. Any safe lax-products for CKD cats?
 

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Try some pumpkin for sure.  Just as an FYI, my last two kidney cats were both on Miralax for over a year each.  Of course, they were seniors, so we figured they weren't going to live years longer, but they did both live for 3 years after diagnosis.  Anyway, they were on about 1/8 teas. twice a day, like clockwork. WE just dissolved it in a tiny bit of water, then mixed it into a tiny bit of food.  Made sure they ate that before giving them any more food, since kidney cats also don't typically eat much.   If we missed a dose, instant constipation.  Constipation is very common in kidney cats. 
 

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We'll see if they have PepcidAC as well, even an injectable.............................

. We noticed Rain is sitting in meatloaf-style position.. ....

he also just strained trying to poop. He got into position, I could see his butt "clenching", but nothing came out. He walked away and seemed frustrated. I wonder if CONSTIPATION like you mentioned is causing a lot of his lack of appetite.............

I've read Miralax is potentially bad for CKD cats. Any truth to this that you know of?
 
However I highly doubt many vets have seen a 3-year-old FeLV+ cat with chronic kidney disease. It's rare enough for a cat who was born with FeLV to live three years, and when combining a 3-year-old cat who has been diagnosed with chronic kidney disease, I'm sure it's a stumper.
Thanks again and I will let you all know if anything else comes up. Any more input is appreciated, especially about the apparent constipation. We are thinking of trying canned pure pumpkin during his assist-feeding as it appears to help. Any safe lax-products for CKD cats?
Only time for quick points.....

Meatloaf position etc:
 
Sitting Hunched Up

Since cats with excess stomach acid have sore tummies, they may sit in a hunched up, uncomfortable position. In the worst case, this may indicate crashing, but only if you also see the symptoms described there.

http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#sitting_hunched_up
Without a doubt, that's constipation.......you can mix plain pumpkin into the a/d right away and add some extra water too. I'd be increasing the # of feedings as I said before. Miralax is perfectly safe - it's the gold-standard, in fact!
 Most people using it for their CKD cats seem to like it, finding it easy to give and effective, with no side effects.

http://www.felinecrf.org/constipation.htm#treatments
You need to act on this before it leads to impactation.....I'd be tempted to use some Miralax right away and also add in some pumpkin (provided he's had a BM within the last couple of days)....you see soft stool, stop the Miralax, the pumpkin will then regulate stool water content.

FWIW, FeLV kitties often live much longer than 3 years, so it may not be such a stumper.....unless someone can diagnose a direct connection in Rain, I'd not waste time focusing on it.

IF you're using any dry food/treats, ditch it (unless it's absolutely minimal treats)......if you want an alternative to a/d there's Iams Maximum Calorie (also Rx) - not all Vets carry Iams, so call around. It's also higher caloric content than Hill's: https://www.iams.com/cat-food/veterinary-formula-maximum-calorie-feline-canine

The injectible Pepcid.....see the link I gave you for an online supplier - you may need a Rx

On constipation, bookmark this for future reference - it's a must-read imo: http://felineconstipation.org/
 
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njbw

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Hi all, an update..

Rain is continuing to lose weight and looks so sick. He won't move and struggles to walk. He has barely any balance, no coordination, weak meows and we cannot stand to see him anymore like this knowing he may be better off at peace. For what it's worth, I was able to get most of the lab results and have posted them below. Please provide any advice as we have opted to euthanize tomorrow if our local vet has availability to perform it at home. We are losing hope and will not let Rain suffer.. We never were aware he had an issue at all. He was incredibly playful and energetic, and suddenly BAM.. Stage 4 kidney disease diagnosis with a prognosis of about 2 weeks to live and we are struck with disbelief.

I got the lab/test results from his admission (see below).

We just got back from an appointment where he got an enema. The doctor was concerned about his weight and gave him about 3 days to live. At admission at the ER vet on 2/18 he was 6.173lbs. A few days later during a recheck he was approximately 5.5lbs. Today he was 4.9lbs (4lb 15oz). At full weight he was about 6.5lbs so, like your cat, he is also on the smaller side. They did give Rain an enema and on the way home he passed two very small nugget-sized stools. They were very dry and fibrous, and kind of broke apart, so it does look like he is still dehydrated.

The vet today said the antibiotic will probably not do anything. He was explaining that, sure, we can put him on IV fluids. But the second they come off, he will be feeling sky-high for about a day. Then, as his kidneys simply fail to work, toxins will build up in his bloodstream and cause him to feel miserable again.

The vet today also seemed to think a phosphorous binder was useless at this stage of the game. He said that since it is apparent his kidney values did not improve during three days on IV fluids, and that since giving him Sub-Q fluids each day, that should have been enough to bring his levels down if he were going to be able to remain in a liveable state.

Lab/test results below from the *INITIAL* ER vet visit when Rain was admitted:

===== INITIAL ER VET VISIT WHEN HE WAS ADMITTED =====

Physical Examination:

S(ubjective): QAR, hydration 7% dehydrated, BCS 4/9, pain score 0/4

O(bjective):

Weight: 2.8kg

TPR: [temp]100.2F,
 

white shadow

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Well........the best/most I can do is to lay out what I, myself, would do. You will choose whatever is right for all of you.

First, I'm hearing that "suffering" again.....let me repeat, humans "suffer", cats do not, they just deal with immediate reality......the only actual pain I'm possibly hearing about could come from the (beyond) constipation he has - and I've covered any actual pain below.

I would have him put back on IV (for several days) and have him given PepcidAC with Cerenia and the appetite stimulant.

If the stool he produced post-enema was so hard as you describe, I strongly suspect there's more where it came from, so likely further enemas are needed. Because of the impactation, there may be actual pain, I would have him given an opioid pain med Buprenorphine - no other

I would continue to assist-feed the a/d, now adding 1/8 tsp Miralax and feeding as posted earlier.

.........

In one post, you wrote about kidneys not being regenerative. Correct. BUT - are you aware that the kidneys 'come' with 'spare parts'.......the filtering parts of the kidneys are called nephrons. Cats (and humans) 'come' with many, many more nephrons than are needed for day-to-day business. The 'extras' that are not needed 'wait in the wings' and will come on board, come 'to duty' if and when they're needed to replace nephrons that die off or are damaged/destroyed by some toxic agent/or the like. Often, it takes a period of time for this 'change over' to occur - it isn't instant! (on another forum and in another case, it took six months before the blood chemistry showed almost normal kidney function!).

Here's Tanya's explanation:
 
The Role of Nephrons

The main work of the kidneys is performed by units called nephrons, which filter the blood flowing into the kidneys. The measure of the nephrons’ function is called glomerular filtration rate (GFR).

Khan Academy has a clear video showing how the nephrons work.

http://Why CKD Cannot Normally Be Detected at an Early Stage

A cat’s kidneys contain around 170,000 - 190,000 nephrons. This is actually many more nephrons than are needed for normal function; plus nephrons can increase their individual function to some extent when other nephrons die. This is why people can donate a kidney and still manage perfectly well with one kidney. In the case of a kidney transplant, if you remove one kidney from the donor, the donor's GFR (glomerular filtration rate, a measure of kidney function) will immediately fall to half of what it was, but will then gradually improve as the remaining nephrons increase their function to compensate for the loss of one kidney. Eventually the nephrons in the remaining kidney will reach almost the same level of function as two kidneys.

It works in a similar way in a cat with kidney disease, i.e. as damaged nephrons die (they are often described as "scar tissue"), other nephrons take over their work. Eventually, however, all the remaining nephrons will be working fulltime (i.e. there will be no "renal reserve" left). It is at this point, when around 66-75% of function has gone, that you will probably start to see symptoms in your cat, as the remaining nephrons start finding it harder to cope with the workload.

This is also why it is actually normal for CKD not to be diagnosed until at least 66% of function has been lost. So please do not feel guilty for not noticing sooner - there was probably nothing for you to notice, plus cats are very good at hiding signs of illness. CKD is not normally painful, so this makes it easier for the cat to hide what is happening.

http://www.felinecrf.org/what_happens_in_ckd.htm
So...........I believe it's likely (because he's a very young cat at 3) he will still have that nephron reserve. That's why I would get him stabilized via a return to IV (like the doc said) but not cut that short, then have him at home with careful monitoring of his input and output.

.....

There's a short page on Tanya's site I encourage you to read....no, I'll give it to you here:
 
http:// Cat in Crisis: Probably Receiving Intravenous Fluids (IV)                              Back to Page Index

Since it is so hard to diagnose CKD early (see What Happens in CKD? to understand why), your cat may be in crisis at diagnosis. Please do not be too despondent if this is the case, particularly if your cat has crashed (see Symptoms) and is on a drip, as happened to Thomas. Many cats have horrendous bloodwork at diagnosis, or may experience a sudden crisis after having CKD for a while, which is often a reflection of severe dehydration. The true bloodwork values will not be apparent until your cat is rehydrated and stabilised, either via sub-Qs for less critical cases or via IV for more severe ones. If your cat has an infection, you need to get it under control before you can tell how severe things really are; hypertension may also make bloodwork look worse than it will once the hypertension is under control.

Cats with severe anaemia (PCV or HCT below 20%) often appear extremely ill, but usually feel and look dramatically better once the anaemia is under control.

Some cats with very high numbers will actually be suffering from acute kidney injury (AKI) rather than CKD, and whilst AKI is difficult to treat, if treatment is successful the cat may actually make a complete recovery.

There are a variety of possible outcomes for a cat who has crashed and is on IV with extremely high bloodwork values:

  • the cat's numbers improve on IV and the cat looks and acts better, and continues to do well at home;

  • the cat's numbers do not improve on IV, but the cat nevertheless acts better, and the numbers gradually reduce at home (usually with sub-Q therapy);

  • the cat's numbers do not improve on IV or with sub-Qs, but the cat acts better and continues to do well at home despite the high numbers;

  • the cat's numbers do not improve on IV, and the cat continues to act ill once s/he is home, and is put to sleep;

  • the cat's numbers do or do not improve on IV, but the cat crashes again once at home. 
Obviously I cannot predict to which category your cat might belong, but it is usually worth trying treatments, particularly if your cat has a kidney infection, where the numbers may improve once the infection is under control.

I am growing increasingly concerned recently about the number of vets who offer just one day on IV, tell the person their cat's numbers have not improved after that short stint, and recommend euthanasia. In most cases this is inappropriate in my opinion. Yes, not every CKD cat can be saved; but euthanasia is an irrevocable decision so you need to be very sure, and for most people that means giving their cat every chance. Dr S DiBartola says "Don't pass judgement on a lethargic dehydrated cat with markedly abnormal laboratory results. 2 to 3 days of conscientious intravenous fluid therapy can produce remarkable results."

For a severely ill cat, one or two days on IV are simply not going to be long enough. Thomas was on IV for four solid days and nights, and only began to eat a little on day 3. Also, Thomas's numbers did not improve at all on IV fluids. He had urea of 89 (BUN: 241) at diagnosis, and it was the same after four days and nights of IV. Some cats will actually have numbers which worsen while on IV fluids. Try not to panic! Your cat did not get this sick overnight, and s/he won't necessarily get better in only 2-3 days. In Thomas's case, my vet suspected he would fall into category 5 of my possible scenarios above, but in fact he was in the second category. He was acting a little better by the end of the four days on IV fluids, and with home treatments over a few weeks we eventually reduced his numbers to urea 27 (BUN: 76) and creatinine 316 (US: 3.57), where they stabilised for some months. 

So even if you are dealing with category 4, I would recommend that you make sure that your cat is given a reasonable stint on IV, and is given a reasonable chance of success at home, especially if anaemia is present. Being at the vet's is very stressful for most cats, and they often need a few days at home convalescing before they begin to act better.

http://www.felinecrf.org/is_there_any_hope.htm
This "3 days to live" prognostication is undoubtedly without any treatment.....otherwise, know that, as good as (some) Vets are, none have crystal balls !

And, so far as the other '3-day on IV being enough'.......I would simply say that it simply isn't enough in many cases......and that Helen (Tanya) and the people she has worked with have personally witnessed that. It's 'simply' a lack of experience with a deficit in education/training that results in statements like that.

Back to the top of my page, those are my thoughts, what I would do and why. I am NOT trying to direct your own personal decision.

And, again, whatever decision you make will be the right one.
 

mrsgreenjeens

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What is Rain's status now?  I'm so sorry I've been unavailable now for the past almost two weeks and am still not online often due to my mother's passing.  I will check as often as I can.
 

cindycrna

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OP, I'm so sorry. Did you have to put your sweet kitty to sleep? We just put our 7 month old to sleep because of FIP.
 

howmany

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I had a younge cat go into kidney failure verty quickly they Vet thought one day was normal and but said they would try 2 we pushed for more on day four nothing had changed# wise and if we took him home he would only become crazy thirsty and week again.
It was a terrible experience because he seemed so happy with the iv we feed and cuddle and said our good bye. It sucks!
Iknow that Vet mange cats with ckd with weekly fliuds, but that was not our option.
We have an felv + cat right now and he is unable to fight off even a uri but as we have been watching him more closely with his weight loss ect. He has started to show sighs of kidney problems, one is swollen. Is it possible that the ckd isa symptom of the Fevl rather than an aside.
 
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