This page
discusses the various symptoms that are associated with the regulation of
body fluid, including
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
Healthy cats produce concentrated urine but the ability to do this 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.
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.
Although most dehydrated cats drink more (see below), if they feel really
bad they may stop drinking, which increases the risk of a
crash. Therefore, it is important to detect and treat dehydration
as quickly as possible.
Pet Place has some information about
dehydration in cats.
Checking For Dehydration
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. Fluid
therapy: calculating the rate and choosing the correct solution
(2010) Terry B
Firstline
describes the likely degree of dehydration based on physical signs.
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 look shiny and feel slick. If they feel sticky,
your cat is probably dehydrated.
PetCoach 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.
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.
Cats with
chronic
pyelonephritis (a kidney infection or inflammation) may exhibit
polydipsia and polyuria.
Polyuria and polydipsia in dogs and cats
(2013)
Grauer GF Clinician's BriefMar 2013 states
"Chronic pyelonephritis is more difficult to recognize because clinical
signs may be subtle or absent. Polyuria and polydipsia are frequent."
(2003) Osborne CA DVM360 Magazine
discusses polyuria.
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.
Cats with
chronic
pyelonephritis (a kidney infection or inflammation) may exhibit
polydipsia and polyuria.
Polyuria and polydipsia in dogs and cats
(2013)
Grauer GF Clinician's BriefMar 2013 states
"Chronic pyelonephritis is more difficult to recognize because clinical
signs may be subtle or absent. Polyuria and polydipsia are frequent."
Increased
drinking may also be a symptom of
gastric hyperacidity. The cat may drink more because, according to
A glass of water immediately increases gastric pH in
healthy subjects (2008) Karamanolis G, Theofanidou
I, Yiasemidou M, Giannoulis E, TriantafyllouK & Ladas SD Digestive
Diseases and Sciences 53(12) pp3128-3132, drinking water may
briefly (only for a few minutes) reduce levels of stomach acid.
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 may be visiting the vet
more often and therefore can be 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.
— what should I do?
(2001) McKiernan B Presentation to the World Small Animal Veterinary Association World Congress
discusses these symptoms.
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.
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).
Weight loss
may occur because as the cat drinks and urinates more, s/he may develop
proteinuria. 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
Pet Place has some information on weight
loss in cats.
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.
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
gastric hyperacidity.
The cat may also grind his/her teeth, or lick his/her lips.
Increased vocalisation in elderly cats
(2015) Gunn-Moore DA European Journal of Companion Animal Practice 25(3)
pp20-29 states "Chronic kidney disease can result in increased vocalisation when
associated systemic hypertension
causes cerebral vascular compromise (as in CDS). It can also occur when
polyuria without adequate access to water cause cerebral dehydration,
when polydipsia/polyuria predisposes to a secondary UTI (see UTI), or
when severe uraemia results in uraemic encephalopathy."
Symptoms Associated With Overhydration
Fluid Retention/Build-Up
Sometimes a
CKD cat may develop fluid retention or fluid build-up.
This 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)
Polzin DJ
Delaware Valley Academy of Veterinary Medicine, Dr
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."
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
have
flaring nostrils
start
breathing from the flanks (as if pushing every breath out)
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 (see
Heart
Problems for information on monitoring your cat's respiration rate)
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 that your cat might be in
congestive heart
failure and you need to get to a vet as quickly as possible.
In such a situation a
chest x-ray is a good idea.
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.
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.
Monitoring your
cat's weight with
baby scales
is a good idea because sudden weight gain may alert you to this problem.
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.
Swelling in the Legs (Oedema), Abdomen
(Ascites) or Feet
If overhydration is severe,
fluid may collect:
in the
lungs (pulmonary oedema)
around the lungs (pleural effusion)
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.
(2017) Clinical/research abstracts accepted for
presentation at ISFM World Feline Congress 2017 p967 mentions that
it has been seen in cats with concurrent conditions that include
glomerulonephritis.
Veterinary Partner
has some information about this condition.
Pet Place has some information about
pleural effusion
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
is clearly not possible in terms of true weight gain.
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
Proteinuria
(Protein in the Urine)
Please visit the
Proteinuria page for more information.
Urinary Tract Infections and
Kidney Infections (Pyelonephritis)
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.
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
either of these is suspected, you need to see your vet urgently.
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
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
or kidney 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.
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.
In some
cases in older cats, as mentioned in
Geriatric cats and cognitive dysfunction syndrome
(2008) Gunn-Moore DA Presentation to the33rd World Small Animal
Veterinary Association Congress,
this can be a sign of cognitive dysfunction ( senility or "kitty
Alzheimers").
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.
Litter box aversion Johnson-Bennett P is
a series of articles on various aspects of this problem, including cats
who pee on the bed.
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, and has high sides so they feel more secure.
Occasionally, 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
It
is possible to treat all of the above symptoms, in many cases effectively,
and details can be found in the
Treatments section.
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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