Does My Cat Really Have CRF?

CatChannel veterinary expert Arnold Plotnick, DVM, offers advice for a cat owner whose cat was diagnosed with chronic renal failure.

By Arnold Plotnick, DVM | Posted: July 1, 2011, 3 a.m. EDT

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Q: My 10-year-old cat, Max, was recently diagnosed with chronic renal failure (CRF). His blood urea nitrogen (BUN) is 41 mg/dL, his creatinine is 2.9 mg/dL, and his phosphorus 3.4 mg/dL.

My cat's symptoms included vomiting and increased urination. After the diagnosis we immediately started subcutaneous fluids 2x per week and diet alteration. Our vet put him on Hills k/d, however, this is causing extreme diarrhea/straining. Is there a good formula for this situation? My cat is in relatively good health otherwise, drinking well, eating well and still active.

What is the prognosis/life span he can now live with the above treatment? When do we stop the treatment? I do have a vet I trust but an opinion and any suggestions from someone with your knowledge would be very helpful.

A: First of all, make sure that your cat really has CRF. The kidney toxins (BUN and creatinine) are very mildly elevated, and the phosphorus isn’t elevated at all. Numbers like this can be seen in cats with mild dehydration rather than CRF. The way to really tell is to look at the cat's urine. If the urine is concentrated, your cat’s kidneys  are fine. If the urine is dilute, then yes, your cat does have mild CRF.
Your vet should check your cat’s urine protein level by running a urine test called a urine protein-creatinine ratio.  Some cats with CRF will have elevated levels of protein in their urine. If the level is normal, then that’s one less thing to worry about. If the level is high, putting your cat on the proper medication can improve the prognosis. 

Your vet should also measure your cat’s blood pressure. Twenty percent of cats with CRF will have high blood pressure, and this can accelerate the rate of progression of the CRF. If your cat does have high  blood pressure, putting your cat on the appropriate medication improves the prognosis. 

The most important thing you can do for your cat is to feed a restricted protein, low-phosphorus diet. Hill’s K/D is an excellent diet, however, if your cat won’t tolerate this diet, there are other diets designed for this purpose. The Iams Company, Purina and Royal Canin all make prescription renal diets. You probably don’t need to give subcutaneous fluids. Giving fluids does not improve kidney function. The fluids lower the kidney parameters and maintain hydration. If your cat is eating and drinking well on his own, you don’t need to give additional fluids. At the rate you’re giving them (twice weekly), they are probably not making much of a difference.  When cats truly require subcutaneous fluids, they usually require them daily or every other day. 

The prognosis for CRF varies from cat to cat. In most cats, renal disease progresses slowly. In others, it progresses rapidly. The best thing you can do is to feed a prescription renal diet, control the blood pressure, maintain a low urine protein level, and have his blood checked regularly.  If things become unbalanced, for example, if the potassium levels gets too low, or the phosphorus level gets too high, your veterinarian can intervene to get things back in balance, and this will improve the prognosis overall.  Good luck!
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Does My Cat Really Have CRF?

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