discusses the various symptoms that are associated with the regulation of
both dehydration and overhydration.
discusses symptoms associated with urination, such as urinary tract
infections, incontinence and proteinuria (protein in the urine).
complete list of CKD symptoms, or to look up a symptom which is bothering
you, please see the
and Treatments, where all the symptom are listed alphabetically,
with quick links to each individual symptom
and appropriate treatment options.
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. Another way to check
is to feel your cat's gums: they should feel slick. If they feel sticky,
your cat is probably dehydrated.
Pet Education has some information about
how to use these two assessment methods. Some people weigh their cats daily, finding
this a good guide to their cat's degree of hydration.
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
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
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
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.
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
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.
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
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.
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.
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
This is a common symptom of
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
(particularly when accompanied by a bony spine), or
may be a symptom of other diseases such as
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
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
CKD cat may develop fluid retention or fluid build-up. A cat with fluid retention may:
loss of appetite, because the fluid may be pressing on the stomach
causing a feeling of fullness.
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)
purr with a rattly noise
develop a nasal discharge
breathing from the flanks (as if pushing every breath out)
Fluid retention may be a
sign of worsening kidney values or of
problems, but in many cases it is actually a sign of overhydration
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.
Renal disease (2006), Dr
"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
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
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
Unfortunately, you may not always see symptoms until the problem is
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
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.
f 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
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
frequency of fluids.
If your cat is prone to such problems, you may wish to monitor your
cat's weight with
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
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
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
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.
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
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
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.
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
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:
states that up to 30% of CKD cats have them.
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
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
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
performed. Antibiotics can usually treat UTIs effectively, though
some types of antibiotic may cause inappetance and vomiting in some cats.
Checkup is a product that
checks for blood in urine, and which may also be used to check for other
issues, such as diabetes.
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.
Alternatively, there is a very serious medical condition called a urinary
tract blockage, which you can read about
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
but be sure to rule out the causes outlined above before fearing the
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
infection, or may be a
symptom of uncontrolled
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.
One of my cats used to get regular kidney infections, and the main sign for him
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.
This is a
polite way of saying your cat urinates (and/or defecates) outside the
litter tray. This can be a sign of a
infection or constipation, and it may also be a symptom of uncontrolled
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.