Dear Dr. Hershey,
I have a 17-year-old kitty named Mollie. She was diagnosed with kidney disease about six months ago. She is doing OK, but sometimes she doesn’t eat very well and she is losing weight. I don’t think it’s time to put her to sleep, but I was wondering if there was something I could do to make her feel better
Kidney disease is a one of the most common ailments seen in our senior feline patients. Fortunately, most cases of kidney disease in cats are slow progressing, and with proper management the patient can have a good quality of life for the majority of the disease process.
The goal of managing kidney disease in our feline patients is to correct the imbalances that arise as the kidneys progressively lose function. If we are vigilant about monitoring, we can intervene when system failures occur, thus enhancing quality of life by decreasing the secondary complications that inevitably arise from kidney failure.
In order to understand how kidney disease is managed, it is important to understand the physiological changes that occur as the kidneys lose function.
The kidney’s primary responsibility is to act as the body’s filter. Through a complex mechanism, the kidneys are able to “test” the blood and excrete toxins and by-products of bodily function and preserve or excrete electrolytes, proteins and water for the body. A properly functioning kidney allows the body to balance out the excesses and shortages of what a patient eats, drinks and produces throughout the day.
If we are able to react and intervene with medications, special diets and supplements to the different stages of kidney failure, we can greatly enhance the quality of life of the patient while their kidneys are slowly fading.
The testing recommendations and treatments below are what I prefer for kitties with kidney disease, and are certainly subject to patient status and owner preference for intervention.
— X-ray of the abdomen to screen for kidney stones at the onset of kidney disease diagnosis. Kidney stones may make a patient prone to urinary tract infections, and uncommonly the stones will try to pass from the kidney to the bladder.
— Blood tests to assess BUN, creatinine, potassium, phosphorus, calcium and red blood cell counts every three to six months.
— Urine culture every three to six months.
— Blood pressure every three to six months.
— Urine analysis and urine protein levels every six to 12 months.
— Low protein diets: By feeding less protein the diet, less nitrogen and creatinine will be produced that the kidneys need to filter out. Many companies manufacture low protein diets. Hills, Royal Canine and Purina all have palatable, high quality low protein diets that are sold through veterinary clinics. If your cat doesn’t like the kidney diet initially, don’t get discouraged. Continue to leave small amounts of the kidney food out next to his normal diet every day, and most cats will eventually begin to eat it.
— Phosphate Binder: There are several types of phosphate binders; however, I typically prescribe aluminum hydroxide powder, which can be mixed with wet food.
— Potassium supplements: This too comes in many different forms, however, my favorite is a flavored gel that cats will often lick off of your finger, or you can wipe the gel on the paws for them to lick off themselves.
— Blood pressure medication: The most common first line blood pressure medication for cats is called amlodipine and comes in pill form. Cats typically take 1/4 of a 15mg tablet, so the pills are very small and can be administered in some canned food, or a special treat called a “pill pocket.”
— Anti-nausea medications and appetite stimulants: If your kitty is losing weight, vomiting, or noticeably not eating well, then we will often start the anti-nausea medication Cerenia and the appetite stimulant mirtazapine. Both are pills, and are administered on an every other day basis. (Typically opposite days from one another.)
— Antacids: My favorite antacid is omeprazole, commonly called Prilosec. Omeprazole capsules have tiny beads of medication in them. The beads can easily be disguised in wet food.
— Fluid therapy: We will commonly show owners how to administer fluids to their cats at home. The fluids are administered under the skin in the scruff area and are very well tolerated by most cats. The typically volume of fluid administered is 150ml (about 1.25 cups of liquid).
— EPO shots: 10 years ago, administering EPO shots when a patient got anemic was commonplace because the hormone was readily available to veterinarians. Now obtaining these hormone shots is a challenge. It is available through human pharmacies; however, it is usually only sold in multi-bottle packages, making it cost prohibitive for the feline patient who needs only very small volumes of the hormone.
Dr. Teresa Hershey is a veterinarian at Westgate Pet Clinic in Linden Hills. Email her your pet questions at firstname.lastname@example.org.