Cat Chronic Renal Failure

Treatment Options

Chronic renal failure (CRF) can exists but be asymptomatic in cats for a very long time – even for years. Normally, by the time an owner notices symptoms of renal failure and a diagnosis is made, the condition is irreversible. Nevertheless, there are a number of supportive and management techniques that can help maintain the cat's quality of life. The goals of treating feline renal failure are to alleviate the signs of uremia (which is the nitrogenous waste build-up in circulation), delay progression of the disease and make the cat as comfortable as possible, for as long as possible.

Treatment Options for Cats with Chronic Renal Failure

The most effective initial treatment for cats in chronic renal failure is aggressive fluid therapy to address dehydration, anorexia and vomiting. Because the cat's kidneys are unable to fully perform their normal tasks, circulating waste products must be flushed out of circulation as frequently as possible. Over-hydration of the animal helps accomplish this. Fluid therapy is typically administered intravenously at first, which is an inpatient procedure. Once the cat is sufficiently rehydrated, fluids can be given by a subcutaneous route. Subcutaneous fluids are injected under the skin, normally in the scruff of the cat's neck between the shoulder blades. How frequently fluids are administered depends upon the extent of kidney damage (or, conversely, the extent of functional kidney tissue). Fortunately, most cat owners are able to administer subcutaneous fluids at home without difficulty, after brief instruction from their veterinarian.
Additional supportive care is important to manage cats with chronic renal failure. A strict "renal diet," commercially available now from several cat food manufacturers, will almost always be recommended by the veterinarian. Renal diets are typically low in protein, sodium and phosphorus. They are designed to reduce the amount of circulating metabolic waste products, in order to reduce stress on the cat's kidneys. The protein source should be of particularly high quality. Affected cats need adequate caloric intake to prevent weight loss. In fact, it usually is more important for a cat with CRF to maintain an appropriate body weight than it is to eat a diet with some special nutritional composition. Appetite stimulants may be necessary, because many cats do not tolerate dietary changes well, and they seem to find renal diets particularly unpalatable. Canned food may be a better option than dry food for cats with chronic renal failure, because of the greater water content. Cats with CRF should have unlimited access to fresh water at all times.
Oral or injectable medications are available to help control high blood pressure, address anemia and limit protein loss in the urine – all things that are beneficial to cats in chronic renal failure. If a cat is vomiting or has gastric (stomach) ulceration, the attending veterinarian can recommend a variety of over-the-counter and prescription medications to decrease gastric acidity and soothe the stomach lining. Vitamin and mineral supplementation may be recommended, including vitamin B, sodium bicarbonate, potassium gluconate, potassium citrate, vitamin D or calcitriol supplements, among others.
Blood transfusions may be necessary in cats with severe renal-related anemia. Human recombinant erythropoietin is available for use in cats to counteract anemia, as well.

Kidney transplants have become a legitimate option for owners of some cats with chronic renal failure. Survival after surgery is reportedly between 70% and 85%, with some cats living years post-operatively. Medication must be given long-term after a kidney transplant to try and prevent rejection of the donor organ. These drugs have a number of potential side effects, and their administration must be carefully managed. Kidney transplantation is only offered at a few veterinary teaching hospitals and specialty referral centers. The costs associated with the surgery typically exceed $5,000. However, transplantation is something for owners to discuss with their veterinarian if they are interested, particularly if their cat is only mildly to moderately ill and does not have underlying systemic illness. The most common method for identifying donors is to test shelter cats for compatibility. When a match is found, the shelter animal donates one kidney to the cat with CRF. The owner of that cat adopts the donor cat and agrees to provide it with a loving home for the rest of its life.
Regardless of the particular treatment protocol, cats with CRF should be monitored by their veterinarian on a regular basis to follow the progression of their disease.

Prognosis

The prognosis for cats with chronic renal failure is difficult to predict and depends upon a number of different factors, including how severely the kidneys have been damaged and the amount of normally functioning kidney tissue. Since this disease is incurable and progressive, the focus of management is on maintaining the best quality of life for the animal for as long as possible. Many cats diagnosed with CRF have happy months or even years of quality life ahead of them, if they are managed appropriately. Unfortunately, chronic renal failure is almost always ultimately fatal. The owner should have an honest discussion with their veterinarian about which treatment options are realistically available, and how to know when it is time to let the cat go peacefully.