What can I expect from a cat with reduced kidney function?
June 8, 2010 12:52 PM   Subscribe

Cat with reduced kidney function -- what can I expect?

My poor cat is about 12 or 13 years old and we took him to the vet a couple months ago. He was peeing in really weird areas and drinking a lot. The vet did a blood test and said he had reduced kidney function. After adding another cat box, religiously cleaning both (though he rarely uses both) and making sure he has enough water, he seemed to quit with the random peeing.

Well, it's started up again. He's not really his old self. He doesn't purr as much. He seems uncomfortable. He's still eating and drinking adequately. He's always been a barfer but threw up about five times yesterday which is sort of out of the ordinary but not really.

Anyway, those of you who went though this kind of thing with your cat -- what can I expect? I'm starting to think about when is the right time to let him go but in many ways he's still doing well. But, then in other ways not. And, of course, the peeing in the house is especially untenable and I'm afraid it's clouding my judgment.

Calling the vet today to get more recommendations but just hoping I can get some other advice/stories to help me know what might be coming. This whole thing is just tearing me up.
posted by amanda to Pets & Animals (15 answers total) 6 users marked this as a favorite
Oh, man. I've gone through this a few times-- it never gets any easier-- and I feel for you and your cat. The sad truth is that, by and large, when a cat gets old and sick, it's usually kidney failure. It's just common that way.

As for what you can do for your guy, they do make special food for cats with renal issues, which you'll be able to get from your vet. When Rabbit's kidneys started to go, switching to the prescription food bought her a couple more good years. Also make sure he stays hydrated, with plenty of fresh water always available, and wet food is much better than dry.

Good luck.
posted by Faint of Butt at 1:03 PM on June 8, 2010

You may want to prepare youself for irrigating him. Which consists of introducing a measured amount of saline solution under the loose skin between his shoulder blades with a large caliber needle, several times a week. This will make him feel better, although he won't like getting it done, and it's a two-person job.

IANYV, but your vet may talk to you about this.
posted by Danf at 1:28 PM on June 8, 2010 [1 favorite]

I'm not a vet, but I did care for a cat through this. In our case, treatment was a combination of special food and subcutaneous (or if you're googling, sub-q) fluids.

Basically you're bypassing the kidneys and giving the cat fluids directly from a bag of saline solution with a plastic IV line and a needle that goes under the skin. This is a larger needle than one used for injecting drugs, and you don't need to hit a vein so it's something you can do yourself once the vet shows you how rather than needing to go in and have the nurse do it.

The sticking a needle into our cat part was pretty intimidating, but once we got ourselves to do it, it did extend our cat's life at what seemed a good level of quality for the biggest part of a year. He'd been losing weight rapidly because of dehydration, and not acting like himself, as you describe. The fluids really popped him back as far as seeming like himself, and he even put some weight back on. It doesn't last forever, but it did extend his life as I said, and I'm convinced gave him a much better quality of life as well.

As for getting stuck with a needle, our cat took it surprisingly well, but he was always kind of passive in stressful situations and your mileage may vary. And it wasn't as expensive or as stressful as taking him in to the vet every week or so and having them do it would have been.

As I said, this may never be applicable to your case, but it was the biggest thing to get my head around in caring for him, and some time to acclimate myself to the idea beforehand probably would have helped. Good luck with your cat and I wish you all the best. I know how difficult this can be.
posted by Naberius at 1:36 PM on June 8, 2010

Obviously YMMV, but with our cat with reduced kidney function, we were able to stretch out another 3 years of good times w/ a phosphate binder & potassium gel (Tamil-K?) each daily, and then when he hit the rough patches, ~100ml of subcuetaneous fluids daily for a couple of weeks. The sub-"Q" fluids really helped a lot. When he finally wouldn't bounce back from the usual regimen, one vet ordered ultrasounds on his kidneys, which just confirmed that they weren't working ("see those dark patches?"... so, IMO, don't waste the money), and another vet suggested darbepoetin, which requires constant blood tests, so along with the cost of the drug, becomes insanely expensive. Good luck. I miss Rex, but our little home treatment plan definitely kept him spry & affectionate for a few more years. Oh, we administered the sub-"Q" fluids ourselves at home. He didn't love it, but he tolerated it.
posted by Lukenlogs at 1:36 PM on June 8, 2010

Tanya's Feline CRF Information Centre is a pretty good source of information.
posted by coffeefilter at 1:37 PM on June 8, 2010

I just went through this with my beloved eighteen-year-old cat. She was in the end stage of kidney failure, but some cats can live for a long time with it--I wouldn't start thinking about putting your cat down just yet.

My cat needed a potassium supplement. (Potassium loss can trigger a lot of weird and scary behavior, like seizure-like episodes.) I also tried some of the special food, but in the end I gave her whatever she would eat. She also felt better when she got her fluids (like Danf mentioned) and that isn't as scary as it sounds. Your vet will show you how to do it and have you practice with your cat; most cats get used to it and won't put up a fuss. My vet also recommended a 1/4 tablet of Pepcid AC to help with the vomiting.

Your cat will have good days and bad days--he'll seem tired and withdrawn, then be back to normal. I asked my vet if kidney failure was painful and she said it was more like having an upset stomach. I decided right away that I would do whatever I could (within reason) to keep my cat comfortable, but would need to make a decision when her quality of life started to decline. Some days I would be frustrated and overwhelmed, because it felt like I was forever cleaning up vomit and pee and chasing her down to administer fluids and medicine. And I dreaded having to make a decision about what to do. But when it came time to let her go--and I knew it was time, just like I'd always heard people say--it was almost a relief because I knew it was the right thing to do. So yes, you will feel scared and sad and frustrated, but it will be okay. Just give your cat lots of love and talk to your vet and take it one day at a time.
posted by janekate at 1:48 PM on June 8, 2010 [1 favorite]

Going through this with my cat right now. The special diet (in her case, Hill's Prescription Diet k/d), and a potassium supplement have been DRAMATICALLY effective in her case - she had almost no appetite, and little energy, and just these changes have been like flipping a switch for her. She's really back to her old self - how long this will last, I'm not sure, but for the last 2 months or so we've seen a dramatic improvement in her quality of life. We have the sub-q fluids handy, but haven't needed to use them after the first week or two after she was diagnosed - the diet and supplement have been enough, and sticking her just hasn't been necessary.
posted by deadmessenger at 2:27 PM on June 8, 2010

My kitty did very well on sub-q fluids for two years after her diagnosis. I was very nervous about sticking a needle into her, but turned out to have no problems doing it on my own... she would just sit on my lap and enjoy the snuggle for the few minutes it took. And it extended her life for quite a while -- she lasted to 18 years of age and didn't suffer from reduced quality of life until her last few days, when it became pretty evident that it was time for her to go.

She did have to go into the hospital for a week at one point, to have a more intensive treatment of fluids, but that was the worst of it.

Hopefully you and your cat will still have lots of time together... best wishes to you.
posted by OolooKitty at 2:33 PM on June 8, 2010

I went through this with a diabetic cat. Eventually his kidney function was so reduced that we did sub-q fluids for just about a year with him, it extended his life past even what the vet thought was likely with a very good quality of life. At first it was twice a week, getting closer together until it was eventually every day.

They taught us to do it, which was surprisingly easy, and my husband and I would sit with him for five or ten minutes every night giving him the fluid and praise and petting. The first couple times he was a little jumpy but after that he got used to it and felt so much better after the treatments that he didn't mind. The sub-q fluids kinda pool where you put them in, so sometimes he was a little lopsided/topheavy right afterwards, and we'd try to keep him quiet for a few minutes after his treatment to give them a chance to disperse into his system. Our other cat always wanted to groom the spot where the needle went in, probably because there was usually a bit of fluid there. (The vet said that was normal and okay.)

I am not good with needles, so the hardest part for me was learning to place the needle. Once I could do it I could manage it without having to think about it too much; right now I'm a little woozy because I'm thinking about it too much. :) To me, inserting it felt like popping a thick needle through a very taut, tightly-woven fabric in an embroidery hoop. At first it was always a two-person job for us but once we got the hang of it it was easy to do it as a one person job. (You can also hang the fluid bag to make it a one-person job instead of having one person hold the bag.)

The sub-q fluids were a surprisingly inexpensive intervention, I thought, given the other things we'd been through with his diabetes, and they really drastically improved his quality of life once his kidneys were in very bad shape. I would definitely make the same decision again.
posted by Eyebrows McGee at 3:12 PM on June 8, 2010

I'm sorry you're going through this right now. My parents went through this with our sweet 18- year-old cat this past year. They did the fluid treatments, which certainly helped for awhile. They also got an additional litter box for upstairs so she wouldn't have to travel far to pee. My mom struggled a lot with how to know when it was time to let her go. She finally decided it was time when the cat seemed pretty disoriented and out of it and was spending more time hiding under the bed than out being active. It's always an incredibly hard decision to make. The vet (who is wonderful) kept telling my parents that it was up to them, they'd "just know" when it was time, and I think that that's the belief you have to hold onto. There is no exact right time. No matter what, you're doing only what you think is in the best interest of your beloved cat.
posted by tacoma1 at 3:54 PM on June 8, 2010

My cat is in the early stages of renal failure right now. Her water consumption and urination has increased, but her demeanor is sweet, as usual. The vet told me about the sub-q fluids, but I felt that constantly poking her with needles would be a good sign that her quality of life has diminished to the point that it is more humane to put her down. Reading the responses here makes me second guess that conclusion and now I'm not sure what I should do. Hopefully, I won't have to make that decision anytime soon.
posted by Jambi at 8:54 PM on June 8, 2010

I forgot to mention the Hills K/D wet food. We had Rex on that, too.
@Jambi: My S.O. used to prolong the Sub-Q administration process by dragging out the bag & needles, prepping w/ fresh needle, then hanging the bag, then getting a little cotton patch for pressure when we pulled the needle out, and all the while she'd be talking to Rex telling him everything is aaaaaaall right. I proposed a different method, gathering everything up first, hanging the bag last, not saying a word to the cat until I had him between my knees and the needle was going in. It took between 2-3 minutes for ~100ml to get under his skin, and those 2-3 minutes every day or two during rough spots we gave him an extra 1.5 million minutes (prolly a million of which were spent napping). It's worth a try.

Lastly, the expense was the shocking part of all of this. Forget ultrasounds, they just confirm what you already know, and it's not like you're going to get kitty a kidney transplant, so wy bother w/ US. Order your Sub-Q fluids & needles online, or show your vet what you're going to pay online and see if he can match. Also, in Rex's last few years, he was prescribed a few rounds of antibiotics, supposedly "just in case" he had a kidney infection. The few times they put him on antibiotics, they'd do a culture for infection, and it always came up negative, but we'd finish the course of antiobiotics anyway. Wait for culture results. Ruling out a kidney infection by treating it is, well, silly.

Rex was a classy cat.
posted by Lukenlogs at 11:49 PM on June 8, 2010

i just went through this with my 19 year old.

the k/d worked well. i used both dry and wet, giving him the wet whenever he asked for it (because he did). we tried sub-qs, but i almost passed out just watching the vet do it, so i opted to take him into the vet and have it done. they offered to sell me the bag of solution and then i'd only have to pay a minimal fee (like 10$ or something) every time i took him in. if he requires it every day, than that might not be an option. i refused to do it every day for his quality of life. maybe his life would have lasted longer, but he would have been far too miserable.

you'll know when it's really time to let go. i think it sounds like it's still early. keep having his blood work checked to see where he stands. i was told that they can't really tell you how much kidney function is left after a certain point, but they can have a good idea.

hang in there. spend as much time with your cat as you can. and EXPECT that he's got a long time left because he could. don't let anyone tell you now is the time to let go if you don't feel it is (one vet did try to tell me that shortly after diagnosis and i knew better). you will 100% know.
posted by itsacover at 6:06 AM on June 9, 2010

I agree with most of what everyone else has said - several of my family members have had cats with kidney problems, and they've done the special prescription food and subcutaneous fluids. We do sub-q fluids with our cat now, but because he won't eat or drink for a few days after his chemo, and I wanted to nth the comments that it's not as scary or difficult as it seems. The first couple of times, it was a 2-person job, but now I can do it myself with him on my lap and he just purrs through the whole thing. The key is hanging the fluid bag up so you don't have to hold it.

Best of luck with your cat and I hope you have lots of happy quality time with him.
posted by bedhead at 10:50 AM on June 9, 2010

Response by poster: Thanks for all your stories and information -- I had no idea. I got ahold of my vet and she informed that that the tests we did earlier indicated a "reduced kidney function." So, she wants to do *another* blood panel to see if it's further reduced and a urine test for crystals and/or an infection. I'd rather just get a round of antibiotics and see how he feels. For some reasons she thinks his urinating around the house might be "behavioral" but frankly I don't believe that.

I'm a little frustrated and not a little broke right now but I guess I'll pony up another $200 to find these things out so he can get some help. Or maybe I should see another vet. He really hates going to the vet and I can't get him blood panels every few months.

Anyway, at least I know what the options may be in the future from you all. This process is a little annoying but I guess I don't have a choice.

Thanks again.
posted by amanda at 3:38 PM on June 9, 2010

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