Tanya

 

TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

   

SYMPTOMS SECTION OVERVIEW

 

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WHAT IS CKD?


What Happens in CKD?


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


All About Anaemia


All About Constipation


Potassium Imbalances


Metabolic Acidosis


Kidney Stones


 

SUPPORT


Coping with CKD


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SYMPTOMS


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

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My Three CKD Cats: Tanya, Thomas and Ollie


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Home > Symptoms

 


Overview


  • The symptoms of CKD are many and varied.

  • If your cat suffers from one particular CKD-related problem, there may be several symptoms present, some of which you might not necessarily associate with each other. For example, you may know that weakness is a common symptom of anaemia, but not many people realise that eating litter is often a sign of anaemia.

  • This chapter aims to describe the various symptoms which you may see and their possible causes.

     


Finding The Symptom You Need: Index of Symptoms and Treatments


 

The best way to find a symptom is to visit the Index of Symptoms and Treatments page, where all the symptom are listed alphabetically, with quick links to each individual symptom and appropriate treatments.

 

Although the number of symptoms may appear overwhelming, you will not necessarily see all these symptoms, and which ones you see at any one time will depend upon the severity of your cat's CKD and his/her own particular weaknesses. Almost all of the symptoms are treatable, so don't give up hope. .

 

If your cat is showing any of the symptoms listed, make an appointment with your vet, since some of the symptoms may have more than one cause, so you need an accurate diagnosis in order to treat properly.  

 

Diagnosis and management of chronic renal failure in cats (c. 2000) Sparkes A, has a list on page 2 of the most commonly seen symptoms in CKD cats.

 

Vet Help Direct allows you to select your cat's symptoms, answer a number of questions and be given advice on possible causes of the symptoms.

 

Go to Index of Symptoms and Treatments

 


IMPORTANT: CRASHING


 

Crashing in a medical context means a sudden and severe downturn in the patient's condition. In a CKD cat it indicates a crisis, which is often associated with severe dehydration, but which may also be triggered by something such as a kidney infection or kidney stones.

 

Crashes are rarely treatable at home - in most cases the cat will require hospitalisation. If, after reading the information below, you think your cat may be crashing, please seek veterinary advice urgently. 

 


Body Fluid Regulation and Urinary Issues


 

This page covers fluid and urinary-related symptoms. It includes the common signs of increased urination and drinking, dehydration and its opposite problem, overhydration, blood in urine, reduced urination, incontinence, inappropriate elimination, weight gain and swelling, coughing and runny eyes.

 

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Regulation of Waste Products in the Body (Uraemia)


 

As the kidneys gradually lose their ability to regulate and remove waste products effectively, these waste products build up in the blood; this is called uraemia and can make a cat feel very unwell. Symptoms include vomiting, appetite loss, gastrointestinal bleeding and mouth ulcers.

 

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Regulation of Minerals in the Body (Phosphorus, Calcium and PTH)


 

Phosphorus and calcium are minerals used in the body, but imbalances may arise in CKD cats and lead to a condition known as secondary hyperparathyroidism, which may make the CKD progress faster. 

 

Symptoms include appetite loss, itching, twitching, back leg weakness and unco-ordinated limbs, knuckling, plantigrade, teeth grinding, constipation, weakness, weight loss, eating litter, licking concrete, low temperature

 

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Potassium Imbalances


Potassium is an electrolyte essential to the functioning of the body at cellular level, but with increased urination, imbalances may arise, and may cause the following symptoms:

 

Lethargy, weakness and muscle wasting, a plantigrade posture, where the cat walks on his/her hocks instead of his/her feet, stilted gait, stiff neck, hoarseness, trouble breathing, constipation, increased night time urination, seizures or twitching.

 

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Metabolic Acidosis


 

This is an imbalance in the acid-base of the body, and is quite common in CKD cats. Symptoms include weight loss, particularly lean muscle loss and a bony spine, breathlessness, mouth ulcers, vomiting and twitching.

 

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Nausea, Vomiting, Loss of Appetite and Excess Stomach Acid


 

Many CKD cats have problems with excess stomach acid.  Symptoms that may be seen include: Loss of appetite, vomiting, nausea, vomiting water, playing with water, hunched over water bowl, liplicking, teeth grinding, yawning, eating grass, itching, twitching, howling, hoarseness.

 

Go to page

 


Constipation


 

This is also very common in CKD cats. Symptoms include vomiting before, during or immediately after using the litter tray, loss of appetite, pooping next to the litter tray, dry stools and an ungainly walk.

 

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Anaemia


 

The kidneys produce a hormone called erythropoietin, which stimulates the bone marrow to make blood cells. As the kidneys fail, they cannot produce enough erythropoietin, and a particular type of anaemia called non-regenerative anaemia results (other types of anaemia must be excluded, of course). 

 

Signs of anaemia include nausea, appetite loss, weakness, feeling cold, liplicking, pale nose, gums or eyelids, lethargy, back leg weakness, heavy breathing, fast heart rate, wheezing, eating litter, ice or snow, low temp.

 

Severe anaemia is life-threatening, so please read up on it.

 

Go to page

 


Hypertension (High Blood Pressure)


 

High blood pressure is common in CKD cats. It is essential to watch for it and treat it if present because it can cause some serious problems, such as blindness or a stroke.

 

If your CKD cat suddenly becomes blind, hypertension is the most likely cause, and can be reversed in some cases if you treat it quickly enough.

 

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Miscellaneous Symptoms


This page includes pain, hiding, increased appetite, seeking you out, purring, and symptoms relating to the coat, such as hair or fur loss, pulling out hair or coat colour change.

 

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Crashing


Crashing refers to a crisis situation for your cat. It may happen suddenly and be what finally alerts you to the existence of CKD in your cat; or it may happen after your cat has been suffering from CKD for some time.

 

Most CKD cats who crash will be suffering from severe dehydration and uraemia.

 

Some cats who crash who were not previously diagnosed with CKD may actually have acute kidney injury (AKI), which may be triggered by something such as a kidney infection or kidney stones, or toxins. Sometimes cats can make a complete recovery from AKI.

 

It is also possible to have acute kidney disease on top of CKD. This used to be called AoCRF (acute on chronic renal failure, but I presume the name will change to acute on chronic kidney disease). The most common cause of this in my experience is a kidney infection affecting already damaged CKD kidneys.

 

Cats who have crashed often lie in the meatloaf position. People get so worried about this that I am including photos below showing a cat in meatloaf position and a cat in normal lying (Sphynx) position.

 

The Meatloaf Position: Photos


What does the meatloaf position look like? Here are some photographs to help you.

 

To the right is a photograph of Tart in the meatloaf position.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

Luna

 

Hopefully you can see the difference compared to Indie below.

 

The Meatloaf Position: Other Criteria


On its own, even this position is not a reason to panic. Cats with excess stomach acid, for example, may lie in this position, and that can usually be treated at home. It may also be seen in cats with pancreatitis.

 

It is when you see the meatloaf position in conjunction with the following symptoms that your cat may be crashing:

  • is severely dehydrated

  • has extremely strong bad breath

  • has a strong body odour

  • the eyes are dull and the cat usually refuses to make eye contact

  • is refusing to eat and possibly also to drink

 

The day Tanya died, she lay in this position. She refused to raise her head and her eyes were dull. She also stayed in that position, seemingly unwilling to move. 

 

Crashing does not necessarily mean the end is near, but it does mean you need to contact your vet urgently. It usually occurs because your cat has reached a crisis point, and this is often be a crisis in terms of balancing his or her fluid intake and output.

 

The cat has probably been drinking more to compensate for the increased urination associated with CKD, but can no longer drink enough. As a consequence most cats who crash are very dehydrated, and their bloodwork values when tested are very high. The bad breath smell will be particularly strong, perhaps with mouth ulcers present, and your cat may also have a generally strong body odour. The cat will often be unable to get comfortable because of all the toxins in the body - this may explain the meatloaf position. He/she will have dull, perhaps sunken eyes and not make eye contact. Your cat will probably refuse to eat and may also refuse to drink.

 

Crashing is a medical emergency. Your cat will usually need rehydration therapy at the vet's in an attempt to combat the dehydration and reduce the bloodwork values, and you should contact your vet WITHOUT DELAY. Delaying could be very serious for your cat, as the toxin levels in the body will continue to rise if left untreated. When Thomas first crashed, I didn't realise what it was and I did not call the vet because it was a Sunday and I didn't like to bother her - she told me off, and said waiting had been very risky and at the very least had condemned Thomas to another day and night of feeling awful. If caught early enough, your vet may be able to save your cat as our vet saved Thomas on two occasions, so don't take any chances.

 

During Thomas's first crash, his BUN was 86 mmol/L (US: BUN 241 mg/dl), and this value did not change at all after four solid days and nights of IV. However, with home treatments, we did gradually reduce his numbers to urea 27 mmol/L (BUN: 76 mg/dl) and creatinine 316 µmol/L (US: 3.57 mg/dl), where they stabilised for some months. You can read Thomas's story in the Tanya, Thomas and Ollie section.

 

The Sphynx Position


A cat who has crashed will often be lying in a "meatloaf" position, which is very similar to the Sphynx position but with the head down and the front paws close to the body.

 

I find this section of the site can really worry people. I am often asked exactly what the meatloaf position looks like and how it differs from the Sphynx position. Indie to the left is lying in the Sphynx position. Many healthy cats such as Indie assume this pose, so it is not grounds for worry. Here Indie (non CKD) is lying down, but her head is not down, her eyes are not dull, and she's making eye contact.

 

 

 

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This page last updated: 13 August 2017

 

Links on this page last checked: 28 May 2017

   

*****

 

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.

 

*****

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