The blood chemistry series of blood tests
measures various parameters in the blood.
This page
focuses on kidney parameters (BUN or urea, creatinine and SDMA), potassium and sodium, magnesium, proteins in the blood (albumin and globulin) and
other readings that are often out of range in CKD cats (cholesterol, ALT,
amylase, glucose and CK).
Measures of Kidney Function
There are a number of ways of measuring kidney function. The tests
most commonly used by vets are BUN or urea, creatinine and the newer
SDMA test.
The main work of the kidneys is performed by units
called nephrons, which filter the blood flowing into the kidneys. The measure of the nephrons’ function is called glomerular
filtration rate (GFR). There is more information about the glomerular
filtration rate here.
GFR can be helpful for the early detection of CKD. However, it is not easy to measure GFR, so it is highly unlikely that you will
ever be offered this test except occasionally at vet schools.
Once your cat
has CKD, it is likely that knowing your cat's GFR would only be of
limited use anyway.
Repeated measurements of renal function in
evaluating its decline in cats (2018)
Finch NC, Syme HM & Elliott J Journal of Feline Medicine and Surgery20(12) pp1144-1148 found "The within-individual variability data
suggest creatinine concentration to be the more useful marker for serial
monitoring of renal function in
azotaemic cats. In
contrast, in non-azotaemic cats, GFR is a more useful marker for serial
monitoring of renal function. The majority of cats with azotaemic CKD
did not have an appreciable decline in renal function during the study."
Blood Urea Nitrogen (BUN) or Urea
This is
one of the most commonly used measures of kidney function. It is known
as blood urea nitrogen or BUN in the USA. In the UK and some
other countries, BUN is not normally tested, instead you will see
urea listed on your cat's bloodwork.
During the
breakdown of dietary protein in the digestive process, ammonia is absorbed
in the gut. The liver then makes a substance called urea
from the ammonia. The urea, in the form of urea
nitrogen, is carried in the blood to the kidneys, which filter it out of the blood and excrete it
via urination.
Blood urea nitrogen is a measurement of the levels of nitrogen in the
blood that come from urea.
BUN rises in
CKD because the kidneys are no longer
able to excrete it efficiently.
Urea is not
a major toxin in itself, but it is used as a marker i.e. if BUN is high, then
certain toxins which cannot be easily measured will also be high. High
toxin levels from kidney disease are known as
uraemia. Although
BUN is not a major toxin, it is important to try to control high levels
because they can cause lack of appetite, nausea and vomiting.
Many vets who
run tests in-house in the USA cannot measure BUN levels over 130, so you
may see a reading of >130. If possible, it is better to know the exact
level, but don't worry if this is not available. With luck, it is going to
come down below 130 anyway following treatment.
Approximate normal levels
(precise ranges vary from laboratory to laboratory) for cats are in this
table.
Blood Urea Nitrogen (BUN) or Urea: Sudden
Increase
If BUN and
creatinine rise suddenly, your cat may have developed
acute kidney
injury or acute kidney disease
on top of CKD (ACKD).
There is often a particular cause, such as a
kidney infection or
hypertension.
Kidney
stones which cause blockages may also cause a sudden and high rise in both BUN and creatinine.
Blood Urea Nitrogen (BUN) or Urea: Other
Causes of Raised Levels
BUN levels can
rise for other reasons, e.g. dehydration, gastrointestinal bleeding or
congestive heart failure.
It is
also affected by both diet (since it is a by-product of the breakdown of
protein) and stress.
If BUN or urea
levels are high yet creatinine is normal or only a little elevated, it
may be because the cat is eating a high protein diet.
Effects of
dietary protein content on renal parameters in normal cats
(2011) Backlund B, Zoran DL, Nabity MB, Norby B & Bauer JE
Journal of
Feline Medicine and Surgery13(10) pp698-704 found that BUN
levels were significantly higher in healthy cats fed a high protein (46%)
diet compared to a low protein (26%) diet, though (since these were
healthy cats) they were still within normal range.
Cats with a
complication of diabetes called
ketoacidosis may also have elevated BUN or urea and creatinine levels,
particularly if potassium and phosphorus levels are normal.
Therefore BUN
or urea are not an entirely accurate indicator of kidney function, and you
should not assume that your cat has CKD based on the BUN or urea
measurement alone.
Blood Urea Nitrogen (BUN) or Urea: Low
Levels
BUN is not
normally low in CKD cats, but may be below normal in cats with liver disease or those who are suffering from starvation.
One of my cats, Harpsie, once
had low BUN levels when he was very sick with an infection (possibly in
his liver, though I suspect it was actually a kidney infection) and had
not eaten much whilst on IV at the vet's, resulting in rapid weight loss.
Creatinine
Creatinine is
another waste product excreted through the kidneys. It is generally
considered to be a more accurate measurement of underlying kidney function
than BUN or urea because it is less affected by diet, stress and dehydration.
In CKD cats, both BUN/urea and creatinine will be
elevated to some degree depending upon the severity of the disease; but if
BUN/urea levels are high yet creatinine is only a little elevated, it
usually means that the cat is dehydrated, has gastrointestinal bleeding,
or is eating a high protein diet. Cats eating a raw or homemade diet
tend to have higher creatinine levels.
Creatinine is
not a linear measurement. This means that an increase in creatinine from,
say, US 2
mg/dl
to 3
mg/dl, indicates more loss of function than an increase from US 5
mg/dl
to 6
mg/dl. Thus, whilst your cat might have a relatively high creatinine of,
say US 5
mg/dl, if it increases to US 6
mg/dl, then whilst you are right to be
concerned, it does not automatically indicate a massive worsening of your
cat's condition. If your cat's levels jump a lot suddenly, consider the
possibility of an infection (see
Is
There Any Hope?)
See the
How Bad Is
It? page for more information on how creatinine is used to confirm and
stage CKD in cats. In all cases, two readings in a stable cat (who is not
dehydrated — this can make the numbers look a lot higher than they really
are), ideally
after fasting (though that is not always the best choice for a CKD cat), are required
before making a firm diagnosis of CKD. In practice, most vets will make
the diagnosis based on bloodwork taken once during your initial visit.
Creatinine levels are one factor in the new RenalTech test, see
Early
Detection.
See
below for
information about low creatinine levels in end stage CKD.
Approximate normal levels (precise ranges vary from
laboratory to laboratory) for cats are in this
table.
Creatinine
and Muscle
Although
creatinine is an accurate measure of kidney function, the cat's size is a
factor. Creatinine is a
by-product of muscle. Therefore small, dainty cats or kittens would be expected to
have lower levels of creatinine than large, muscular cats.
Effects of
dietary protein content on renal parameters in normal cats (2011) Backlund B, Zoran DL, Nabity MB, Norby B & Bauer JE
Journal of
Feline Medicine and Surgery13(10) pp698-704 found that the
cats in this study were muscular, and that if only one creatinine reading
had been taken, many of these cats would probably have been deemed to be
in IRIS stage 2, even though their
USG indicated that they were not in
CKD.
Cats who lose a
lot of muscle may have reduced creatinine levels, because they cannot
produce as much creatinine.
Overview of the urinary system
(2016)
Sanderson SL Merck Veterinary Manual states "Serum
creatinine levels can be falsely decreased in patients with severe muscle
wasting."
Feeding cats with different nutritional needs: a
dilemma in the multicat household (2012) Scherk M
Presentation to the 73rd SCIVAC International Congress 2012 says "As
an obligate carnivore, if a cat doesn’t get enough dietary protein to meet
metabolic requirements, he must draw on endogenous (stored) protein
sources to meet those needs. Over months cats can down regulate their
protein needs and switch to use other pathways, but in the short and
intermediate term, muscle will be catabolized. The resulting muscle
wasting and decreased mass reduces the serum level of creatinine (Cr)
measured."
So if your cat's creatinine level falls but your cat has lost a lot of
weight and muscle, this might be the cause rather than improved kidney
function.
Creatinine: Sudden Increase
If BUN and
creatinine rise suddenly, your cat may have developed
acute kidney
injury or acute kidney disease
on top of CKD (ACKD).
There is often a particular cause, such as a
kidney infection or
hypertension.
Kidney
stones which cause blockages may also cause a sudden and high rise in both BUN and creatinine.
Other
Reasons for Raised Creatinine
Cats with a
complication of diabetes called
ketoacidosis
may have elevated
BUN and creatinine levels, particularly if potassium and
phosphorus are normal.
Cats with
pancreatitis also
sometimes have elevated creatinine levels. If your cat has a relatively low
creatinine level (around 2 mg/dl US or 175 µmol/L international) yet seems lethargic and far more ill than that mild
level of kidney disease would suggest, I would consider pancreatitis.
Cats given medications in the
ACE
inhibitor family (e.g. Fortekor) or
ARBs family
(e.g. Semintra) may exhibit an increase in creatinine levels within a week
or two of beginning the medication. This is often, but not always,
temporary. See
Proteinuria for more information.
Because
creatinine is a by-product of muscle, large, muscular male cats may
naturally have high normal levels of creatinine (see
above).
(2002) Gunn-Moore DA, Dodkin
SJ & Sparkes AH Journal of Feline Medicine and Surgery 4(3)
pp165-6 says that up to 80% of Birman kittens under six
months of age seem to have high levels of creatinine and BUN. As adults,
this incidence reduces, but is still high, at 35%. However,
these cats do not appear to develop full-blown CKD at a young age as one
might expect. Monitoring them regularly would nevertheless be wise.
Reasons for Low Creatinine
(Especially if BUN and Phosphorus are High)
Since creatinine is a by-product of muscle, cats who lose a lot of
weight/muscle may have reduced creatinine levels, because they cannot
produce as much creatinine. See
above for more on
this.
Cats with hyperthyroidism may have low creatinine levels, because they
tend to lose a lot of muscle, plus hyperthyroidism masks true kidney
function, making BUN and creatinine look lower than they truly are.
If BUN (urea)
levels and phosphorus levels are high yet creatinine is normal or only a
little elevated, it can mean that there is a
pre-renal factor at work,
for example:
If your cat is
eating a reduced protein therapeutic kidney diet, this ratio is likely to be in the region of
10:1 or 12:1 (e.g. if creatinine is US 4, BUN is likely to be around
40-48).
Since BUN is affected by dietary intake, if your cat is eating a higher protein diet, this ratio will be
higher, with 18:1 or 20:1 not unusual (e.g. if creatinine is US 4, BUN will
be around 80-96).
Severe
metabolic
acidosis,
which affects protein metabolism, may contribute to a high BUN:creatinine
ratio. Dehydration also affects this ratio.
Gastrointestinal
bleeding may also cause an increase in the BUN:creatinine ratio (since
blood is a form of protein), which needs to be treated if present, since
it may cause or worsen
anaemia.
SDMA
This is a
relatively new test available exclusively from IDEXX Laboratories which
aims to detect CKD at an earlier stage than is possible when measuring
creatinine or BUN levels.
Comparison of serum concentrations of symmetric
dimethylarginine and creatinine as kidney function biomarkers in cats with
chronic kidney disease (2014) Hall JA, Yerramilli M, Obare E,
Yerramilli M & Jewell DE Journal of Veterinary Internal Medicine
28 pp1676–1683 found that SDMA levels in cats who developed CKD rose above normal by a mean of
17 months before there was an increase in creatinine levels.
IDEXX claims that the SDMA test can
therefore potentially detect CKD when up to 40% of function has been lost, whereas
traditionally you could only detect CKD when 60-70% of function had been
lost.
There is more
information about the SDMA test on the
Early
Detection page.
Azotaemia is
divided into three categories (bear in mind that blood flows to the
kidneys where it is filtered):
Pre-renal
Azotaemia ("Before" the Kidney)
This means
that the azotaemia does not involve the kidneys; rather, it is caused by a problem before the blood reaches the kidneys
which reduces blood flow within the kidneys. For example:
infection
fever
a high protein diet
heart problems
dehydration
low blood
pressure
Renal Dysfunction in Small Animals (2013)
Brown SA Merck Veterinary Manual says
"Prerenal azotemia is due to a decrease in glomerular filtration rate
(GFR) from circulatory disturbances causing decreased renal perfusion
(hypovolemia, cardiac disease, renal vasoconstriction)."
In order to distinguish between pre-renal and renal
azotaemia, urine specific gravity (USG) needs to be assessed.
If USG is
above 1.035, then the azotaemia is likely to be pre-renal, if lower than
that, it is likely to be renal. However, this may not apply if other
factors are affecting urine concentrating ability, such as CKD, or if
proteinuria is present.
If you can
treat the cause of the pre-renal azotaemia promptly, there may be no
permanent damage to the kidneys.
This means
the azotaemia is caused by a problem
"after" the kidney, i.e. lower down the urinary tract, after
the blood has already flowed into and through the kidneys.
A common cause is a urinary tract obstruction, such as that caused by
kidney stones or
struvite
crystals, which stop urine from leaving the body, so toxins build
up.
Uraemia means that a cat has azotaemia (increased nitrogenous waste in the
bloodstream), but also exhibits the associated problems commonly seen in CKD patients such as vomiting etc.
You may see reference to uraemic toxins: these are the toxins which the
cat's damaged kidneys are unable to filter properly, so they cause many of
the symptoms of CKD.
Potassium and
sodium are electrolytes (salts), which are essential to the functioning of the
body. The increased urination that occurs with CKD may
cause imbalances in these electrolytes
Potassium is
used at cellular level, in particular to help muscles function properly.
If there is an imbalance, weakness, twitching and seizures may be seen.
Around 30% of
CKD cats have low potassium levels (hypokalaemia). However, around 13%
have high potassium levels (hyperkalaemia), normally cats with more
advanced CKD.
Since potassium imbalances are so common in CKD
cats, there is a
dedicated page all about
it.
Approximate normal levels (precise ranges vary from laboratory to
laboratory) for cats are in this
table.
Sodium
is excreted by the kidneys, but levels may rise (hypernatraemia) in CKD cats because the
kidneys are no longer working as efficiently and cannot adapt to changes
in sodium levels as quickly. Vomiting or diarrhoea may also be factors.
Magnesium is a mineral found mainly in the bones and muscles which is
important for many metabolic functions, such as helping to balance potassium
levels in the body. It also helps regulate calcium, and since it inhibits
parathyroid hormone, it has also been associated with
CKD-MBD (CKD-mineral and bone disorders).
High magnesium levels may cause nausea, weakness and a slow heart rate.
Cats with high magnesium levels should not be given
phosphorus binders
containing magnesium. They should also not be given
Normosol if they are receiving fluid therapy, because Normosol
contains magnesium.
Pet MD has
some information about high magnesium levels.
Usually CKD cats with low magnesium levels will also have
low
potassium levels.
Mechanism of hypokalemia in magnesium deficiency
(2007) Huang C-L & Kuo E
Journal of the American Society of Nephrology18(10) pp2649-2652
discusses the role of low potassium levels in this situation.
Symptoms of low magnesium levels may be similar to those seen with low potassium levels, such as
weakness or twitching
Cats with
hyperthyroidism
tend to have low magnesium levels, so if your cat has both
hyperthyroidism and low potassium levels, you may wish to have magnesium
levels checked.
Evaluation of ionized and total serum magnesium
concentrations in hyperthyroid cats (2006) Gilroy CV, Horney BS, Burton SA & MacKenzie AL Canadian
Journal of Veterinary Research 70(2) pp137–142 focuses on
cats with hyperthyroidism but also has some useful information about
magnesium levels in cats generally.
Hypercalcemia in chronic kidney disease (2018) Van den Broek
International Renal Interest Society states "We derived a reference
interval for plasma total magnesium from 120 apparently-healthy senior
cats of 1.73-2.57 mg/dL or 0.71-1.06 mmol/L.".
If your cat has both low potassium
levels and low magnesium levels, initially you
should ask your vet about starting a
potassium supplement. You may
well find that both potassium and magnesium return to normal once the potassium supplement is begun.
If, however, your cat has low potassium levels which do not rise despite
the use of a potassium supplement, it is possible that the low magnesium
also needs to be treated. In such cases, you are unlikely to be able to
raise the potassium to an acceptable level until you have also treated
the low magnesium. Your vet should also consider the possibility of
hyperaldosteronism if your cat has persistently low levels of
magnesium and potassium, especially if
hypertension is
also present.
It can be challenging giving magnesium supplements to a CKD cat.
Choosing a dose and monitoring can be difficult, and you must be very
careful because elevated magnesium levels can be risky, particularly in
a CKD cat whose damaged kidneys may not excrete excess magnesium
efficiently.
Magnesium supplements made for cats do not exist to my knowledge,
so you would have to use a human product. There are simple forms of
magnesium, such
as magnesium oxide or
magnesium hydroxide, or magnesium
complexes, such as magnesium citrate (the citrate apparently helps
increase absorption) or magnesium malate. Many human supplements
containing magnesium oxide seem to contain
250mg per tablet, far too much for a cat.
Newman Veterinary explains more about
low magnesium levels, and suggests a dosage of 1-2 mEq/kg daily, with a
check one week after starting the supplement.
Plumb's Veterinary Drug Handbook also suggests a dose of 1-2 mEq/kg per
day if using oxide or hydroxide salts.
One person I knew of gave her cat an eighth of a 250mg magnesium oxide
supplement each day, i.e. around 30mg per day.
A member of Tanya's CKD Support Group gave her 4 kg cat 1.8ml of milk of
magnesia, as recommended by her vet. This contained around 60mg of
magnesium, so twice the dose of the person in the preceding paragraph.
Another member gave her cat 15 mg of magnesium citrate twice a day.
The safest thing is to let your vet determine the dose.
Monitor your cat carefully (possible side effects include diarrhoea,
more serious problems include heart arrhythmias). Never give magnesium
supplements without your vet's knowledge and approval.
Total Protein (Proteins in the Blood)
Total protein
is the sum of the two proteins in the blood, albumin and globulin.
High total
protein levels may be seen when a cat is dehydrated. In this case, albumin
will probably also be high.
High levels of
total protein may also be seen in cases of infection or inflammation.
Approximate normal levels
(precise ranges vary from laboratory to laboratory) for cats are in this
table.
This is the
main protein in blood. Albumin may be high or low. Approximate normal levels
(precise ranges vary from laboratory to laboratory) for cats are in this
table.
If albumin is
high, it may indicate dehydration. In this case, total protein will
probably also be high.
Albumin: Low
Albumin may be
low in a cat with gastrointestinal bleeding or some other kind of problem
which causes inadequate nutrition.
Prolonging life and kidney function
(2009) Chew DJ & DiBartola SP CVC in
Kansas City Proceedings states
"Maintenance of stable body weight and serum albumin concentration
suggests adequate intake of calories and protein whereas progressive
declines in body weight and serum albumin concentration suggest
malnutrition or progression of disease and are indications to increase the
amount of protein fed."
Cats with a
chronic infection or chronic inflammation, such as Inflammatory Bowel Disease (IBD), may
have low albumin and total protein levels, as may cats with liver disease.
Nephrotic syndrome will often cause low albumin levels, but this
syndrome is quite rare in cats.
Hypoalbuminemia (2019) Allen J Clinician's BriefApr 19
p21 lists the possible causes of low albumin levels.
One of
albumin's roles is to provide pressure to keep water in the blood, so if
it falls too low, there is a greater risk of
fluid build up (oedema or ascites). This can sometimes happen if your
cat is being
overhydrated.
If your cat's
albumin level is very low (below 2 mg/dl US, 20 mmol/l international), please discuss
this with your vet, because it can be quite dangerous.
If albumin is
low, usually
calcium will
also be low.
Globulins
Globulins are calculated from the values for albumin and total
proteins i.e.
globulins =
total protein minus albumin
Globulins contain
antibodies (immunoglobulins), so high levels may be seen when infection or
inflammation is present. Very high globulin levels combined with a low
albumin:globulin ratio may be a sign of
FIP (feline infectious
peritonitis).
Approximate normal levels (precise ranges vary
from laboratory to laboratory) for cats are in this
table.
Hyperglobulinemia (2020)
Allen J Clinician's BriefMay 20
p10 lists the possible causes of elevated globulin levels.
This is as it suggests, the ratio between albumin and globulin. It is
usually around 1:1. If the ratio is lower than 1:1, then normally
globulins are high. If the
ratio is higher than this, then normally
albumin levels are high.
The AG ratio needs to be looked at in conjunction with the total protein
level:
A normal AG ratio with a high total protein level indicates that there is
probably dehydration.
A low
albumin:globulin ratio combined with very high globulin levels may be a
sign of FIP (feline
infectious peritonitis). An AG ratio
below 0.4 combined with elevated globulins, indicates that FIP is quite
likely, assuming other causes of a low AG have been ruled out, whereas an
AG ratio over 0.8 rules out FIP.
Creatine
Kinase (CK) and Creatine Phosphokinase (CPK)
These
are two slightly different names for the same muscle enzyme, which is released when
muscle is damaged. In one study, 60% of sick cats had elevated CK levels,
so do not panic if your CKD cat's CK level is elevated.
In most CKD cats, there is usually only a mild increase if any, and this
might simply be because of the stress of being held and having blood taken
at the vet’s; occasionally, levels also increase after prolonged
inactivity or if a cat has a seizure.
Approximate normal levels
(precise ranges vary from laboratory to laboratory) for cats are in this
table.
Many labs have
a maximum level of 300, and a level of up to 500 is not usually cause for
concern. If levels are
high, it may indicate some kind of muscle disease; alternatively, very
high levels of CK are often seen when an animal has heart issues. If your
cat's level is over 1800, your vet should investigate further.
High
cholesterol levels do not have the same significance for cats that they
do for humans, but are usually secondary to some other disease. As in
humans, bloodwork results will vary depending upon whether the blood is
taken after fasting. It is not uncommon for CKD cats to have increased
cholesterol levels.
Occasionally, high cholesterol levels are seen in cats
with
nephrotic syndrome, but this syndrome is quite rare in cats.
Approximate normal levels
(precise ranges vary from laboratory to laboratory) for cats are in this
table.
Glucose
is also known as blood sugar. This value may increase suddenly because of
stress — it is not uncommon for this value to be high in cats who get
stressed or frightened at the vet’s. Therefore a high level on one
occasion should not be taken to indicate
diabetes, urine
testing is also required.
Overview of feline bloodwork (2008) Jensen A Zimmer
Feline Foundation states "Glucose also has a tendency to show dramatic
increases in a healthy cat under acute stress. Normal blood glucose
should be well below 150 mg/dl. In most species, a glucose measurement of
over 200 would strongly suggest diabetes. In the feline, however, stress
alone can cause glucose to spike as high as 250 mg/dl. A value over 300
is unlikely to be due to stress alone. One way to differentiate between a
glucose spike due to acute stress and high blood glucose due to diabetes
is through urinalysis. If there is no glucose in the urine in the face of
high blood glucose, it may be due to the fact that the blood glucose has
not been high long enough to overflow into the urine, suggesting an acute
spike. This is not definitive, however. Presence of glucose in the urine
is, however, highly suggestive of diabetes."
has some information on glucose and mentions that stress may make glucose levels
rise (hyperglycaemia) in cats.
ALT (Alanine
Aminotransferase) or SGPT (Serum Glutamic-Pyruvic Transferase)
This is an
enzyme which is largely found in muscle, the liver and the brain. It often
leaks out of damaged liver cells, so it may be an indicator of liver disease,
although it is sometimes elevated in
hyperthyroidism. Cats on
methimazole for hyperthyroidism may also have elevated
ALT or SGPT enzymes
and low white blood cells.
Approximate normal levels
(precise ranges vary from laboratory to laboratory) for cats are in this
table.
Mild elevations are not normally cause for
concern — one of my cats has mildly elevated ALT for years without
problems.
Amylase is a
digestive enzyme made in the pancreas that breaks carbohydrates down into
simple sugars.
Because amylase is made by the pancreas, many vets seem to
assume that an increase in this enzyme must indicate
pancreatitis. Whilst
this is often true for other species, it does not usually apply to cats,
particularly CKD cats, because amylase is excreted by the kidneys, so it
is by no means uncommon for it to be elevated in CKD.
This is not usually
a cause for concern — a value up to 2200 is not uncommon in CKD
cats. However, if the level is much higher, around three times normal
level, and your cat is showing other symptoms of pancreatitis combined with relatively low CKD values that seem
to be out of line with how ill your cat is acting, then you might want to rule it out.
Approximate normal levels
(precise ranges vary from laboratory to laboratory) for cats are in this
table.
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE
EXTREMELY DANGEROUS.
I have
tried very hard to ensure that the information provided in this website is
accurate, but I am NOT a vet, just an ordinary person who has lived
through CKD with three cats. This website is for educational purposes
only, and is not intended to be used to diagnose or treat any cat. Before
trying any of the treatments described herein, you MUST consult a
qualified veterinarian and obtain professional advice on the correct
regimen for your cat and his or her particular requirements; and you
should only use any treatments described here with the full knowledge and
approval of your vet. No responsibility can be accepted.
If your cat
appears to be in pain or distress, do not waste time on the internet,
contact your vet immediately.
This site was
created using Microsoft software, and therefore it is best viewed in
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browsers, but I'm not an IT expert so I'm afraid I don't know how to
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This site is a labour of love, from which I do not make
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If you wish to
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