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Acute & chronic kidney failure in cats

May 18, 2016

acute_renal_failure

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What is acute renal failure?

Acute renal failure (ARF) or acute kidney failure refers to the sudden failure of the kidneys to perform normal filtration duties. This is not the same as the much more common form of kidney failure, chronic renal failure (CRF). ARF leads to accumulation of toxins and other metabolic wastes in the bloodstream, dehydration, electrolyte imbalances and disturbances in the acid-base balance of the blood. ARF is potentially reversible if diagnosed early and treated aggressively. Older cats are at higher risk for developing ARF

What are the clinical signs of acute renal failure?

The clinical signs of ARF may include sudden anorexia, listlessness, vomiting (the vomited material may have blood in it), diarrhea that also may contain blood, a strange breath odor, and/or seizures. Some cats will urinate more frequently while others may not be producing any urine at all. There may be a recent history of ingestion of a toxin (especially antifreeze) or of recent trauma, surgery or illness. Many cats are in shock by the time they reach the veterinary hospital. The veterinarian will frequently find enlarged and painful kidneys during the physical examination.

What causes acute renal failure?

There are numerous causes of ARF. Some of the more common causes include:

  • Ureteral or urethral obstruction
  • Antifreeze poisoning (ethylene glycol toxicity)
  • Systemic shock
  • Heart failure
  • Hypotension or low blood pressure
  • Clotting disorders
  • Drugs such as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) or certain antibiotics
  • Insect or snake venom
  • Heavy metals such as lead, mercury, arsenic or thallium
  • Ingestion of toxic plants, especially lilies
  • Ingestion of rodenticides (rat poison)
  • Pyelonephritis or bacterial infection of the kidney
  • Feline Infectious Peritonitis

How is acute renal failure diagnosed?

Diagnosis is based on medical history, clinical signs, and the results of blood and urine tests. Other diagnostic tests may include abdominal radiographs, abdominal ultrasound, radiographic contrast or dye studies, fine-needle aspiration or surgical biopsy of the kidneys.

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What is the treatment for acute renal failure?

Treatment is focused on removing the circulating toxins as quickly as possible and restoring electrolyte balance. This is usually accomplished by administering intravenous fluids for twenty-four to ninety-six hours (1 to 4 days). Peritoneal dialysis and hemodialysis are rarely performed, but may be available in your area. If toxin exposure or a drug reaction is suspected, it is recommended that the stomach be emptied of its contents immediately, followed by administration of activated charcoal to prevent further absorption of toxins.

kidney_failure_-_acute-2

Nutritional support may be required in cats with persistent or uncontrollable vomiting. Your veterinarian will recommend an aggressive treatment plan to give your cat the best chance of recovering from ARF.

What is the prognosis for a cat diagnosed with acute renal failure?

The initial prognosis is guarded for all cases of ARF. If the cause is an infection, there is a better prognosis than if the cause is a toxic substance. The long-term prognosis for recovery depends on the amount of kidney damage that has occurred. The kidney has very little capacity to regenerate or “heal” itself, justifying the guarded prognosis. Your veterinarian will provide you with a more accurate prognosis based on your cat’s clinical signs and individual condition.

Kidney Failure – Chronic in Cats

What do my cat’s kidneys do?

The kidneys have many functions. They principally act to remove metabolic waste products from the blood stream, regulate the levels of certain essential nutrients such potassium and sodium, conserve water and produce urine.

What is chronic renal failure?

chronic_renal_failureThe kidneys have a large amount of spare capacity to perform their various functions so at least two-thirds (67% to 70%) of the kidneys must be dysfunctional before any clinical signs are seen. In many cases, this means that the damage to the kidneys has been occurring over a number of months or years (chronic) before failure is evident. Chronic renal failure (CRF) is mainly a problem in older cats. Only about 10% of the cases occur in cats less than three years old.

What are the clinical signs of chronic kidney failure?

Early signs of disease such as weight loss and poor coat quality are often dismissed as normal aging changes. In the initial stages of kidney failure, the kidneys cope with their inability to efficiently remove waste products by excreting them at a lower concentration over a larger volume (in other words, by producing a larger amount of more dilute urine). This is known as compensated renal failure. After approximately two-thirds of the kidney tissues have failed, there is a rapid rise in waste products in the bloodstream and an apparent sudden onset of severe disease.

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What are the causes of CRF?

CRF is the end stage of a number of different disease processes rather than a specific disease in its own right. Diseases or conditions that can eventually lead to CRF include:

  1. Congenital malformations of the kidneys – such as polycystic kidney disease in long haired cats
  2. Pyelonephritis – bacterial kidney infections
  3. Glomerulonephritis – inflammation and damage to the kidney’s filtration membrane
  4. Neoplasia – various tumors of the kidney, most commonly lymphosarcoma
  5. Amyloidosis – this is the build-up of an unusual protein in the kidney that prevents the kidney from functioning normally
  6. Viral infections such as feline leukemia virus (FeLV) or feline infectious peritonitis virus (FIP)
  7. Kidney stones or ureteral stones

How is the disease diagnosed?

blood_test

Renal disease is usually diagnosed by looking at the level of two biochemical byproducts in the bloodstream, blood urea nitrogen

(BUN) and creatinine, in conjunction with the urine specific gravity (USpG). Microalbuminuria (or the presence of small protein molecules in the urine) is another indicator of CRF. Tests to measure the blood levels of other substances such as proteins, potassium, phosphorus and calcium as well as the red and white blood cell counts are important in order to determine the extent of failure and the best course of treatment.

Could the renal failure have been diagnosed earlier?

Unfortunately, the early diagnosis of chronic renal failure is very difficult. Neither clinical signs of renal failure nor rises in BUN and creatinine are evident until significant loss of kidney function has occurred. In earlier stages of disease, there are no clinical signs to indicate that renal function tests, which can pick up early renal damage, are required. Therefore, we recommend that all senior pets have at least a urinalysis performed every six to twelve months to diagnose kidney disease at it earliest detectable stage. A low urine specific gravity or an increase in protein levels in the urine may indicate that the kidneys are not functioning optimally.

How does CRF affect my cat?

Because the kidneys perform a variety of different functions, the clinical signs of renal failure can be somewhat variable. The most common changes seen are weight loss, poor hair quality, halitosis (bad breath), variable appetite which may be associated with mouth ulcers, lethargy and depression. Less common signs include increased drinking or urinating, vomiting, diarrhea, and anemia.

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What treatments are available?

The treatment of CRF depends on the results of blood tests, and specific treatments are aimed at resolving specific abnormalities. Don’t worry if the list below seems so long that you will never be able to administer all of the medications. The majority of cats are effectively managed with diet change including supplementation and one or two other treatments.

  • Special diets – feeding low protein and low phosphorus diets help lower the level of waste products in the bloodstream. These can be prepared at home or are available ready prepared from your veterinary practice.
  • Phosphate binders – despite low phosphate in the diet, blood phosphorus levels remain above normal in some cats. Reducing blood phosphorus can have a major effect on improving your cat’s well being and slowing disease progression. Oral phosphate binders such as aluminum hydroxide help to lower the amount of phosphorus absorbed through the gut wall.
  • Antibiotics – many cats seem to respond well to antibiotics though the reason for this is not always clear. Cats with CRF develop bladder infections more frequently and routine urine cultures are recommended for many patients.
  • Potassium supplementation – cats in renal failure tend to lose too much potassium in the urine. This leads to muscle weakness, stiffness and poor hair quality. Low potassium levels may also contribute to the worsening of the kidney failure.
  • Vitamins B and C – when the failing kidneys are unable to concentrate the urine, these water-soluble vitamins are lost and affected cats need daily supplementation.
  • Anti-emetics – for those cats that are experiencing vomiting, the use of anti-emetics (anti-vomiting mediations) reduces nausea, thereby improving appetite.
  • Blood-pressure lowering drugs – significant numbers of cats with kidney failure have high blood pressure, which can lead to further damage to the kidneys. In some cases, lowering their blood pressure may be necessary.
  • Treatment of anemia – the kidneys initiate the production of red blood cell in the bone marrow. Many cats with CRF are anemic due to a lack of stimulation of the bone marrow. Newer drugs have been developed to help stimulate bone marrow production and may be prescribed for your cat.

What is the cost of treatment?

Treatment costs will vary with each individual case. In the majority of cases, long-term management is relatively inexpensive.

How long can I expect my cat to live?

Unfortunately, once the kidneys are damaged, they have very limited ability to recover. However, with proper management, most CRF cases progress very slowly. With treatment, your cat may have several years of good quality, active life ahead.

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Ernest Ward, DVM
© Copyright 2009 Lifelearn Inc. Used and/or modified with permission under license.

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