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
,
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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
gastric hyperacidity, 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
On 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.
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
Internet Explorer. I know it doesn't always display too well in other
browsers, but I'm not an IT expert so I'm afraid I don't know how to
change that. I would love it to display perfectly everywhere, but my focus
is on making the information available. When I get time, I'll try to
improve how it displays in other browsers.
This site is a labour of love that I make freely
available to everyone. Please do not steal from me by taking credit for my work.
If you wish to
link to this site, please feel free to do so. Please make it clear that
this is a link and not your own work. I would appreciate being informed of
your link.
To
the right is a photograph of Tart in the meatloaf 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.
