TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 
   

SYMPTOMS: BODY FLUID REGULATION AND URINARY ISSUES

 

ON THIS PAGE:


Dehydration


Overhydration


Urinary Issues


 

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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.)


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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)


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Nutritional Requirements of CKD Cats


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FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


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How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


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Home > Symptoms > Body Fluid Regulation and Urinary Issues

 


Overview


  • This page discusses the various symptoms that are associated with the regulation of body fluid.

  • It includes both dehydration and overhydration.

  • It also discusses symptoms associated with urination, such as urinary tract infections, incontinence and proteinuria (protein in the urine).

  • For a complete list of CKD symptoms, or to look up a symptom which is bothering you, please see the Index of Symptoms and Treatments, where all the symptom are listed alphabetically, with quick links to each individual symptom and appropriate treatment options.


Symptoms Associated With Dehydration                                                       Back to Page Index


 

Dehydration


As discussed below, the ability to produce concentrated urine gradually deteriorates in a CKD cat as the kidneys fail. Although the cat will drink more in an attempt to compensate for the increased urination, eventually it becomes impossible to maintain a balance, and dehydration occurs.

 

Many people believe that dehydration means the loss of water from the body. However, it actually means the loss of both fluids and electrolytes - salts which the body needs in order to function properly.

 

It is not possible to diagnose clinical dehydration until the cat is already at least 5% dehydrated, so by the time you see signs, you already have a definite problem. Colorado State University gives information on the likely degree of dehydration based on physical signs (scroll down to section 7).

 

Recently sunken eyes may indicate dehydration, as may vomiting. Cracked paw pads are also occasionally seen, and litter may stick to the cat's paws. Sometimes a cat with dehydration hangs his/her head over the waterbowl, though more commonly that is a sign of excess stomach acid. The cat may also grind his/her teeth, or lip his/her lips.

 

You should regularly check your cat's hydration levels: the most common method is to pinch the skin, usually at the scruff of the neck - the skin should fall back into place immediately. Most CKD cats experience some degree of dehydration so the skin may not fall back as quickly as in a healthy cat, but if it takes a few seconds you should look into improving your cat's hydration. Virtuavet has photos showing how the skin looks with varying degrees of dehydration. Another way to check is to feel your cat's gums: they should look shiny and feel slick. If they feel sticky, your cat is probably dehydrated. Pet Education has some information about how to use these two assessment methods. Virtuavet has photos showing how the skin looks with varying degrees of dehydration.

 

Some people weigh their cats daily, finding this a good guide to their cat's degree of hydration.  

 

If you've ever been dehydrated, you know how awful it feels - like a bad hangover, with a dreadful headache and stomach ache. Dehydrated cats often stop eating, which then makes them even more dehydrated because they are not obtaining any fluid from their food. To make matters worse, cats who do not eat are at risk of developing a potentially life-threatening condition known as hepatic lipidosis; Mar Vista Vet has more information about this. Therefore, it is important to detect and treat dehydration as quickly as possible.

 

Pet Place has some information about dehydration in cats (you don't need to register to read the article, just click on the Close This Window link at the bottom of the registration pop-up).

 

Increased Urination (Polyuria)


The cat is an unusual animal in that it has the ability to concentrate its urine, a little like a camel; this is believed to be a legacy of its African heritage. However, in cats with CKD, this ability gradually disappears, and cats then produce a very dilute urine: the urine looks weaker in colour, has little odour, and the cat will often produce copious amounts. 

 

The ins and outs of polyuria and polydipsia is an article by Dr Carl Osbourne of the University of Minnesota College of Veterinary Medicine.

 

Increased Drinking (Polydipsia)


The increase in urination that occurs in CKD leads the cat to drink more and more in an attempt to avoid becoming dehydrated. Some cats, like Tanya, develop new behaviours, such as drinking from showers or gutters, or hanging around sinks and begging for fresh running water from the tap. Some cats like to play with their water bowls from an early age, but some CKD cats develop a bit of an obsession with water, and may play with their water bowl or paw at the water.

 

Increased drinking can also be a symptom of excess stomach acid or diabetes

 

The ins and outs of polyuria and polydipsia is an article by Dr Carl Osbourne of the University of Minnesota College of Veterinary Medicine.

 

Sneezing and Congestion


This may be a sign of an upper respiratory tract infection (a cold or cat flu). CKD cats may be prone to these viral infections because they are immune-compromised; plus CKD cats are often visiting the vet more often and therefore being exposed to more viruses.

 

However, if your cat has no other signs of an upper respiratory tract infection, then the sneezing may be caused by dehydration - the nasal passages of a dehydrated cat will be drier and therefore more susceptible to irritation, such as dust.

 

Dental problems may sometimes cause sneezing.

 

Another possible cause is the long-term use of cyproheptadine, which may make the nasal tissues swell as the drug becomes less effective.

 

Sneezing and snorting - what should I do? (2001) is a presentation by Brendan McKiernan to the World Small Animal Veterinary Association World Congress 2001.

 

Constipation


In addition to concentrating urine, a cat's body also tries to conserve water by reabsorbing it from the stool through the intestinal wall. This mechanism is very efficient, and remains so even in CKD cats, and since CKD cats are largely on the edge of dehydration most of the time, the intestine will wring every drop of water out of the stool that it can, leaving it quite dry. The lack of moisture as a lubricant makes it more difficult for the cat to have bowel movements and can lead to constipation. Low potassium levels may also cause constipation, as may high calcium levels.

 

Symptoms of constipation include loss of appetite, pooping next to the litter tray, vomiting before, during or immediately after using the tray, dry stools or an ungainly walk. Occasionally a cat may urinate outside the litter tray when s/he is constipated - our Karma peed on the sofa so we took her to the vet for a suspected urinary tract infection, but in fact she did not have one, her problem was constipation. Once the constipation was under control, her inappropriate elimination ceased.

 

The vet can usually feel the backed-up stool when s/he palpates the cat's abdomen, but sometimes an x-ray is necessary to confirm the problem.

 

Sometimes a cat will appear to have diarrhoea but in fact has constipation, and the runny stool is simply what can squeeze around the solid dry stool.

 

Harpsie once had an episode of fast breathing and fast heart rate. He had severe constipation, and his problems resolved once he had been given an enema. If a cat is very severely constipated, toxins can back up in the cat's system causing such problems. The opposite problem may also occur i.e. lethargy and fainting (vasovagal syncope - syncope means to faint). Medicine Net discusses this. Obviously you do not want your cat to have such severe constipation that these problems arise!

 

Feline Constipation is a detailed and helpful website about constipation.

Pets Canada has information on the different colours of cat poop.

Newman Veterinary mentions that constipation may cause vomiting (scroll down a bit).

 

Weight Loss


This is a common symptom of CKD, and was the first sign with both Tanya and Thomas. Not only did they lose weight, but their spines became very bony (and their coats became dry with dandruff). This occurs because as the cat drinks and urinates more, s/he may lose protein and/or electrolytes. Weight-loss can also be associated with phosphorus imbalances or metabolic acidosis (particularly when accompanied by a bony spine), or may be a symptom of other diseases such as diabetes or hyperthyroidism. Other possible causes include IBD (Inflammatory Bowel Disease) or cancer.

 

Pet Place has some information on weight loss in cats (you don't need to register to read the article, just click on the Close This Window link at the bottom of the registration pop-up).

 

Dull Coat/Dandruff/Spiky Fur


This reflects the general loss of condition of a CKD cat, and is also influenced by dehydration. The body is fighting a tough battle with CKD and concentrates its efforts on its more critical functions; a glossy coat is not one of them. Occasionally spiky fur may indicate a lack of essential fatty acids, or may be a symptom of hyperthyroidism.

 


Symptoms Associated With Overhydration                                                   Back to Page Index


 

Fluid Retention/Build-Up


Sometimes a CKD cat may develop fluid retention or fluid build-up. A cat with fluid retention may:

  • exhibit loss of appetite, because the fluid may be pressing on the stomach causing a feeling of fullness.

  • find it uncomfortable to lie down on his or her side, or may sit up and refuse to lie down; this is because it is easier to breathe in this position.

  • appear to be gaining weight rapidly or suddenly (within the space of a few days)

  • be breathing faster (see Diagnosis for normal respiration rates)

  • start coughing

  • purr with a rattly noise

  • develop a nasal discharge

  • have runny eyes

  • start breathing from the flanks (as if pushing every breath out)

Fluid retention may be a sign of worsening kidney values  or of heart problems, but in many cases it is actually  a sign of overhydration from either intravenous fluids (IV fluids) or subcutaneous fluids (sub-Qs). Some vets believe it is impossible to overhydrate a cat through sub-Q fluids but unfortunately this is simply not true. Over the years, I've heard from quite a few people whose cats developed precisely this problem. In Renal disease (2006), Dr D Polzin states "Chronic subcutaneous fluid therapy can result in fluid overload in some patients, particularly when fluid volumes in excess of those recommended here are used. We have seen several cats given large quantities of fluid (200 to 400 ml/day) present with severe dyspnea due to pleural effusion. This condition can usually be avoided by reducing the volume of fluids administered."

 

If your cat feels "squishy" when you stroke him or her, this may indicate fluid retention caused by overhydration from excessive sub-Qs (although sometimes it merely means that air got into the line, in which case you need to work on your sub-Qs technique).

 

If you see any of these symptoms, you need to see a vet. If you see these symptoms while the vet is closed, it is probably OK to wait a few hours but monitor your cat closely and of course do not give sub-Qs.

 

Unfortunately, you may not always see symptoms until the problem is severe. If your cat starts breathing with the mouth open, or has a limp and the limping leg is cold to the touch, this is a medical emergency indicating heart problems and you need to get to a vet as quickly as possible. 

 

Do not give any sub-Q fluids if you see any of the symptoms above until you have had your cat checked by a vet. You should also never give a cat sub-Qs until the fluids from the previous session have been absorbed.

 

If you suspect your cat has fluid build-up, you and your vet do need to investigate this because your cat probably feels uncomfortable, and if the fluid is permitted to continue to build up, particularly in a cat with heart issues, your cat could develop congestive heart failure. In such a situation a chest x-ray is a good idea. In many cases, you may find that invasive treatments are not necessary and that simply reducing the amount or frequency of sub-Qs solves the problem; so speak to your vet about this. Subcutaneous Fluids has information on amount and frequency of fluids.

 

If your cat is prone to such problems, you may wish to monitor your cat's weight with baby scales.

 

Cats who are on corticosteroids may also develop fluid retention.

 

Warning signs for congestive heart failure is a helpful site by an individual whose cat, Coco, had both CKD and heart problems, and gives useful information on what to watch for. Coco lived with CHF for quite some time.

Emergency respiratory assessment (2001) Hughes D is a presentation to the World Small Animal Veterinary Association World Congress 2001. It is rather technical but may still be of use.

Managing fluid and electrolyte disorders in renal failure (2008) Langston CL Veterinary Clinics Small Animal Practice 38 pp677-697 explains about the signs of overhydration.

 

Swelling in the Legs (Oedema), Abdomen (Ascites) or Face


In the worst cases, fluid may collect in the lungs (pulmonary oedema), or around the lungs (pleural effusion) or in the abdomen (ascites). Your cat may appear swollen in the legs, face or abdomen. When Harpsie developed ascites (in his case, because of cancer), it felt like he had a hard little football in his abdomen. However, it is normal for cats to have a soft, squishy "pouch" of fluid after sub-Qs, which may move down into the front legs; this should gradually disappear as the fluids are absorbed.

 

Swelling may also be a sign of proteinuria. Alternatively it may be a sign of heart problems.

 

Occasionally (rarely in cats), such swelling may be a sign of nephrotic syndrome. Nephrotic syndrome is not a disease in itself, but rather a collection of symptoms that may be seen as a result of glomerular disease. The primary symptoms of nephrotic syndrome include proteinuria, low albumin levels and high cholesterol levels. You may also see diarrhoea, reduced urine output, anaemia and occasionally saddle thrombus (a blood clot in the leg).

 

Pet Place has some information about pleural effusion (you don't need to register to read the article, just click on the Close This Window link at the bottom of the registration pop-up).

Macmillan Cancer Support explains more about pleural effusion.

Pet MD discusses pulmonary oedema in cats.

Pet MD has information about ascites.

My Optum Health explains more about ascites. 

 

Weight Gain


Sometimes a CKD cat will suddenly gain a lot of weight in a short period of time, a matter of days or a week. This may indicate fluid retention, and needs to be investigated urgently, particularly if accompanied by fast heart rate, coughing, loss of appetite, breathing from the flank (as if pushing every breath out), limping, and particularly open-mouth breathing. If you see the last three symptoms, your cat's heart or lungs may be affected and you need to go to the vet immediately. Do not give any sub-Q fluids if you see any of the above symptoms or if your cat has gained a lot of weight suddenly or quickly until you have had your cat checked by a vet.

 

Sometimes a weight gain may seem small but we have to allow for the relatively small starting weight of a cat. So if, for example, a cat who weighs 8 lbs gains 1lb in a week, that is a weight gain of 12%. The human equivalent would be a 140lb person gaining almost 17 lbs in a week, which clearly is not possible in terms of actual weight.

 

I recommend weighing your cat every day and monitoring trends. What is a reasonable weight gain? Be guided by your vet, but if your cat has just eaten or has been given fluids and has not yet urinated, then these will affect weight. 100ml of fluids weighs about 3.5 ounces (100g), for example, so if you weigh your cat immediately after giving fluids you might panic about a non-existent weight gain of 3.5 ounces. If you are trying to get weight onto your cat, an acceptable rate of actual weight gain should be determined by your vet, based on your cat's current weight and goal weight, but roughly speaking an increase of 2-3 ounces (50-75g) a week should be acceptable.

 

Coughing


As with weight gain, coughing may be associated with fluid retention.

 

Nasal Discharge and/or Runny Eyes


This may indicate fluid retention, particularly overhydration with sub-Qs. Other causes of runny eyes include an upper respiratory tract infection or dental problems.

 


Urinary Issues                                                                                                      Back to Page Index


 

Proteinuria


Healthy cats only have tiny amounts of protein in their urine because their kidneys do not allow the protein to leak through. In CKD cats, this mechanism can be faulty and excess levels of protein in the urine, known as proteinuria, may occur. The main proteins which leak through are albumin and globulin

 

One commonly seen symptom of proteinuria is foamy urine. Proteinuria may also cause weight loss, and swelling in the legs, abdomen or face

 

Other causes of proteinuria include hypertension and diabetes. 

 

The National Kidney and Urologic Diseases Information Clearing House is a human site with information about the symptoms of proteinuria.

 

Urinary Tract Infections


The concentrated urine of a healthy cat has the correct levels of acidity and good bacteria, which inhibit the development of bad bacteria which multiply and cause infections. The dilute urine of a CKD cat does not offer this protection, and so urinary tract infections (UTIs) are relatively common in CKD cats: Antech Diagnostics states that up to 30% of CKD cats have them.

 

Urinary tract infections may manifest themselves in your cat visiting the litter tray more frequently and producing little or no urine; or there may be slight traces of blood in the urine (see below for other causes of blood in urine); or howling in the litter tray; or licking the affected area a lot. Occasionally the urine will smell. Often there are no obvious signs, or less obvious signs such as urinating in inappropriate places such as on rugs or beds (see below).

 

UTIs can be very painful so keep a close eye on your cat and seek your vet's advice if you have any doubts; it may also be worth having regular urine cultures performed. Antibiotics can usually treat UTIs effectively, though some types of antibiotic may cause inappetance and vomiting in some cats.

 

The Pet Checkup is a product that checks for blood in urine, and which may also be used to check for other issues, such as diabetes.

Health Meter Cat Litter can detect blood in urine, and also checks urine pH. 

 

Blood in Urine (Haematuria)


This may be a sign of a urinary tract infection, or bladder or kidney stones. It may also indicate high blood pressure. Sometimes this is caused by cancer. If your vet obtains a urine sample from your cat via cystocentesis (a needle into the bladder), this may sometimes cause blood in the urine.

 

Occasionally it may not be possible to ascertain the cause. There is a condition called "benign renal haematuria" which means there is bleeding from the kidneys but the cause cannot be found. However, this is rare in cats.

 

Persistent haematuria and proteinuria due to glomerular disease in related Abyssinian cats (2008) White JD, Norris JM, Bosward KL, Fleay R, Lauer C & Malik R Journal of Feline Medicine & Surgery 10(3) pp219-29 discusses how in Abyssinian cats with haematuria, the cause may be glomerular disease.

 

Severe or ongoing haematuria may cause or worsen anaemia, so you should always take your cat to the vet if you see this symptom.

 

Pet Place has some information about haematuria in cats.

Pet MD explains more about blood in urine.

 

The Pet Checkup is a similar test that checks for blood in urine, and which may also be used to check for other issues, such as diabetes.

Health Meter Cat Litter can detect blood in urine, and also checks urine pH. 

 

Reduced Urination (Oliguria) or No Urination (Anuria)


If your cat is struggling to urinate, i.e. visiting the litter tray more frequently but producing little or no urine, the most likely cause is a urinary tract infection.

 

Other possible causes of reduced or no urination include acute kidney injury or kidney stones.

 

If your cat is urinating a lot because of diabetes and you get the diabetes under control, you may see a reduction in urination.

 

Certain antihistamines used as appetite stimulants such as periactin (Cyproheptadine) may cause reduced urination.

 

Alternatively, there is a very serious medical condition called a urinary tract blockage, which you can read about here. This is a medical emergency, but fortunately such blockages are relatively rare in CKD cats.

 

However, cats who are at the very end of their CKD journey may cease to be able to urinate because basically their kidneys have shut down. You can read more about this here, but be sure to rule out the causes outlined above before fearing the worst.

 

Incontinence


Incontinence means that your cat is unable to control when s/he urinates - s/he may urinate where s/he lies or walks, or perhaps urinate in his/her sleep. This may be caused by a urinary tract infection, or may be a symptom of uncontrolled diabetes. In my cat's case, it was a sign of a kidney infection. Occasionally, it may be your cat is simply getting "caught short", particularly if you are giving subcutaneous fluids, and the litter tray is a long way away. In some cases, it may indicate advanced renal damage.

 

Washington State University College of Veterinary Medicine has some information about incontinence.

 

Kidney Infections (Pyelonephritis)


One of my cats used to get regular kidney infections, and the main sign for him was that he became incontinent when the infection first appeared. However, this is not inevitable with kidney infections - you may simply see more subtle signs, such as lethargy and inappetance. If you see these signs, particularly if your cat's bloodwork is worsening, ask the vet to consider that a kidney infection could be the cause.

 

Inappropriate Elimination


This is a polite way of saying your cat urinates (and/or defecates) outside the litter tray. This can be a sign of a urinary tract infection or constipation, and it may also be a symptom of uncontrolled diabetes; but sometimes it is a behavioural problem. 

 

Litter box aversion: is it medical or behavioral? (2012) is a blog entry by Pam Johnson-Bennett which aims to help you narrow down the possible cause, but I would still take your cat to the vet to rule out medical issues even if you think it is behavioural.

 

Lying in the Litterbox


Cats may lie in the litterbox if they have a urinary tract infection, or are constipated. This may also be a way to comfort themselves - many cats lie in their litter tray whilst hospitalised because it is the only thing that smells familiar to them.

 

In some cats, lying in the litter box is simply a sign of dominance - Harpsie loved lying in the litter tray, thus controlling the other cats' access to it.

 


Treatment Options                                                                                                Back to Page Index


 

It is possible to treat all of the above symptoms, in many cases effectively, and details can be found in the Treatments section.

 

 

 

Back to Page Index 

This page last updated: 18 September 2013

Links on this page last checked: 27 March 2012