Feline renal failure
May 15, 2012 2:20 PM   Subscribe

Elderly cat with renal failure/retinal detachment and mild hyperthyroid. Looking for cat lovers who can help advise me on the road ahead.

My 19 year old male cat Bagheera has had renal failure for about 9 months, diagnosed after we noticed weight loss and extreme thirst. Nothing else in the chem panel was out of whack. Gave him special renal food, water on demand, and he's been OK.

In the past week he's looked thinner, more listless, and yesterday we noticed his eyes were dilated. The vet diagnosed bilateral detached retinas. . . he has no vision. This is a consequence of the high blood pressure cats (and people) get with renal failure. His BP was 203, which sounds high, if the values are anything like human BP values. We started him on amlodipine (Norvasc) 1/4 of a 2.5 mg pill once a day. It's about 50/50 that his retinas might re-attach, if we've begun the amlodipine soon enough after detachment. Blood tests also showed he's got mild hyperthyroid (4.3, where top normal is 4.0) but in this picture is probably helping his renal function.

I'm so sad to see this cat so ill, but I don't want to end his life prematurely just because he's ill. I don't want to cause harm, either. I'm afraid he'll fall down the stairs since he can't see. He actually nearly did this morning. He's also had a couple of urinary accidents in the past week, which he'd never had before. He seems to be falling apart before our eyes.

The vet said with conservative treatment, taking the amlodipine and with access to water freely he might live a few months. If the hyperthyroid worsens he may get congestive heart failure with trouble breating, but if not, the kidney function will eventually cause him to be more tired, emaciated, and finally so dehydrated that he'll slip into a coma and die.

I just don't know which way to go. We don't want to cause him pain or prolong a miserable, blind life just because we'd miss him. I'm looking for the experiences of other cat lovers to help inform our decision-making. Did your cat develop renal failure? How did you handle your cat's illness, and do you regret the decisions you made?
posted by citygirl to Pets & Animals (16 answers total) 3 users marked this as a favorite
It's time. This is not a good life for your beloved kitty. I'm sorry.
posted by runningwithscissors at 2:24 PM on May 15, 2012

You have done so many wonderful things for your cat. I would let him go. Sorry.
posted by OnTheLastCastle at 2:37 PM on May 15, 2012

My partner's cat experienced almost the same problems on the same timeframe, right down to the retinal detachment at about nine months after his renal failure diagnosis, resulting in blindness. It was agonizing trying to assess his day-to-day quality of life because even though he was clearly not well, he was eating and seeking out affection and using the litterbox. Finally it got to the point where he stopped doing those things, his abdomen swelled up, and it was clear that it was time. That didn't make it any less heartbreaking, but my partner at least felt some relief that his beloved companion wasn't suffering anymore and that he'd cared for him right until the very end. Loving your cat can mean helping them have a peaceful death.

As awful as making that decision was, we knew it was the right thing and we have no regrets. Our cat lived a long, happy life and will be remembered with love.
posted by hollisimo at 2:49 PM on May 15, 2012

I'm terribly, terribly sorry.

Are you giving him sub-cutaneous fluids? I ask because a lot of vets don't even bother to suggest it for home treatment, thinking that people will think it's "too much trouble." (It's not too much trouble.) And is he taking something for the hyperthyroid? My Tasha had that, and a cream that we rubbed on the inside of her ear daily worked very well. She stayed with me 22 wonderful years.

It may be time to let him go. But it may also be time to talk to your vet (or another vet) about what options you have. My heart goes out to you.
posted by cyndigo at 3:37 PM on May 15, 2012 [1 favorite]

Hi Citygirl, I'm a vet but not your vet, so this isn't medical advice.

What I usually use in my own pets as a metric is their observable behavior. Is Bagheera still eating, curling up on your lap for love and resting comfortably? For me, those are far more telling that a cbc and chemistry. Cats can do very well with no vision, but some cats will not adapt as well. I'm so sorry that Bagheera is ill, but glad he has a loving and kind hearted owner to care for him. And although you didn't ask, it sounds like you vet is on top of things. You'll both be in my thoughts.
posted by Nickel Pickle at 3:51 PM on May 15, 2012

Here's my response on a very recent, very similar thread.

I don't think you can rely on the similarity of your values and feelings to those of the people who just read your post and weigh in--your decision is far too personal for that, and you know much more than anyone on this thread ever could.
posted by yellowcandy at 4:30 PM on May 15, 2012

Response by poster: Thanks to everyone for the sympathetic responses. We're really struggling here and I appreciate the kind words.

Nickel Pickle, thanks especially for your comment. I don't know vets other than Bagheera's, and he hasn't had many issues until the renal failure, so I don't know her well. Bagheera is eating well, which is his norm. He just seems sort of disoriented in space, as though his inner gyroscope is not functioning well. And he sleeps a lot.

We've had him since my 21 year old son was 2, and it's very hard on him. He'd like to wait to see if Bagheera's vision improves. Somehow, though the vet says cats adjust, it seems particularly sad to have his vision taken away suddenly,and we would love Bagheera to regain a little of himself before he has to leave us for good. How's that for anthropomorphosis?
posted by citygirl at 5:19 PM on May 15, 2012

We just lost our eldest cat to renal failure last autumn. The thing I regret most is the extreme measures we were taking at the end. I don't regret trying earlier on after diagnosis, but the last round of hospitalization and IVs did no good at all, and shouldn't have happened.

It's so hard to let go, and I'm so sorry.
posted by skybluepink at 5:38 PM on May 15, 2012

Just recently, my oldest cat (16 YO) was diagnosed with both kidney disease (renal failure) and hyperthyroidism. So far, he's responding well to treatment to both; felimazole for the hyperT and calcitriol for the symptoms of kidney disease (many of which are apparently from the parathyroid going awry from the KD). I'd encourage you to explore these options with your vet, or find a vet with experience with calcitriol; my cat vet is having amazing success with it in many cats with KD. If these treatments are not options for any reason, Nickel Pickle's helpful advice above for quality of life is spot on.

Sudden onset blindness would cause falls on stairs and falls can make the renal detachment worse or fail to heal; might you keep him off the stairs until he adjusts and you have a chance to do some training? That's what I did with my almost blind dog, and it worked, and at least cats are lower built and closer to the floor so falls aren't quite so bad.

I am sorry you're facing this, but your cat is fortunate to have you on his side. And we do the best we can when we face something like this with them. I hope you have many more good days together.
posted by vers at 5:55 PM on May 15, 2012

Sudden onset blindness would cause falls on stairs and falls can make the renal detachment worse

Retinal, not renal above. Sorry.
posted by vers at 6:42 PM on May 15, 2012

I am so sorry that you are dealing with such a difficult situation.

I am very confused about what you mean by "water on demand". Your kitty needs to have access to fresh water continuously. Having access to water 24/7 is absolutely critical, especially with the increased thirst that accompanies chronic real failure. Is he having difficulty finding his water dish now because of the vision loss?
posted by OsoMeaty at 7:45 PM on May 15, 2012

Response by poster: OsoMeaty, yes, he has trouble finding his water. We've got heavy cups he won't turn over in several spots now. He used to occasionally perch on the rim of the toilet, but now he wouldn't be able to judge the jump. He does like to drink from the bathroom tap, so we're making sure we run it for him if he comes in. He has a step to jump on, but I can't leave the tap running all day just in case, but I put a cup on the bathroom counter, too.

cyndigo, I doubt we'd go with the sub-Q fluids since this is actually a terminal condition. Renal failure will eventually cause his death, but I really don't want him to suffer from thrist. Actually, if it's anything like human renal failure, it's not a terrible way to die. There's oblivious coma at the end, but I definitely want to intervene before that. I think we're looking for a few weeks where he seems to be affectionate and happy so we humans can say goodbye, but not at Bagheera's expense.

We would probably be much more aggressive if he were a younger kitty, but at this point it's really about comfort care. Thank you all again for sharing your experiences and your advice.
posted by citygirl at 5:52 AM on May 16, 2012

I have lost two of my three cats over the last 7 months. One was 9 and the other was 13. I know what it is like. If it were me, I would take a day to spend as much time as you could with him and then let him go. It is time. I am very sorry.
posted by Silvertree at 7:55 AM on May 16, 2012

It sounds like you have given Bagheera a really wonderful 19 years. If you choose not to euthanize him I would tell your vet, “We’ve decided to let him pass on his own, but we want to keep him as comfort as possible. How can we do this?” I think the sub-q fluids would help with that, but if that’s not something you’re comfortable doing that’s obviously okay. Personally I would opt for intervening with the natural process and euthanize him. But he is your kitty and this is such a personal decision that can only be made by you and your family. Whatever you decide to do, you have done right by Bagheera by loving him for so many years.

I have a couple of websites to recommend that are aimed at helping cat owners navigate chronic renal failure;

CRF Information Center
Tanya's Comprehensive Guide to CRF

I will be thinking of Bagheera and your family and am wishing you all the best.
posted by OsoMeaty at 8:28 AM on May 16, 2012

We lost a cat due to CRF and struggled with many of the same questions you are facing. Our vet insisted that we would know when the time was right because the cat would withdraw from us, not seek affection and we would notice and correctly interpret his behavior. Although we were inordinately concerned we would not be able to recognize that moment, we actually did realize when he was no longer seeming to be comfortable and in hindsight I think we made a good decision.

Although we knew that our cat's renal issues were the beginning of the end and that there was really no hope for a cure, we opted for the SubQ route and were very happy that we did. The difference in his comfort was readily apparent and profoundly dramatic.
posted by Lame_username at 9:53 AM on May 16, 2012

I lost 4 cats to CRF in 4 years. 2 of them went very quickly, and two of them lasted a while. The two that lasted a while, I did subQ fluids with. The difference in their health was immediate and dramatic, for the better. It was not something that I at all regret doing. I thought at first that it would be stressful for me or the kitties, but it ended up being a quiet, snuggly time for us in the evenings with lots of petting and purring and staring into each others eyes and blinking. I would not discount it, if it is an option.
posted by Addlepated at 11:33 AM on May 16, 2012 [3 favorites]

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