Feline Chronic Kidney Disease continued from pg 1:
paler gums, and signs of GI upset such as vomiting and
diarrhea. These are all non-specific signs that indicate underlying illness, and might indicate chronic kidney disease.
Early detection of
chronic kidney disease
Many cats with
is the key to starting a
kidney disease can
monitoring and treatlead long healthy
ment program to maxlives with appropriate imize your cat’s health
and slow progression of
monitoring and
the disease.
We recmanagement of
ommend regular bloodtheir disease.
work and urinalysis for
our senior patients to
monitor for changes in organ function, including BUN
and creatinine, urine specific gravity (urine concentration), and protein in the urine, which are markers of kidney function. Kidney disease can also cause anemia, and
we monitor the hematocrit as a marker of this problem.
We also monitor changes in minerals and electrolytes
such as phosphorus, calcium, sodium, potassium, and
chloride as these levels may be altered with kidney disease as well. When changes in kidney values are detected, other recommended tests include culture of the urine
to rule-out a urinary tract infection, quantification of protein in the urine and measurement of blood pressure,
both of which can be elevated secondary to kidney disease, and imaging of the kidneys with abdominal radiographs and ultrasound to assess their size and look for
evidence of urinary tract stones or kidney infection. All of
these tests help us to determine if the kidney disease is
acute, chronic, or a combination of the two. It is important to identify any causes of acute kidney damage
and to treat these underlying causes to minimize risk of
chronic and permanent damage to the kidneys.
When we diagnose chronic kidney disease, we determine
the stage and substage of the disease to help us to develop a unique monitoring and treatment plan for your cat.
There are four stages of chronic kidney disease. Staging is
determined by your cat’s creatinine level. Stage 1 is very
mild and cats typically show no clinical signs. Cats with
stage 2 are frequently asymptomatic as well, but we may
recommend starting treatment at this stage. Cats with
stage 3 have a moderate elevation in creatinine and tend
to show signs of kidney disease – treatment is recommended at this stage to slow progression of disease. In the
most advanced stage, stage 4, cats tend to show the most
clinical signs and treatments focus on slowing progression of disease and treating signs that are associated with
higher levels of toxins that would normally be filtered out
by the kidneys. With stage 4, GI signs such as nausea,
vomiting, and decreased appetite are commonly present,
although they may be detected in earlier stages as well.
Blood pressure and protein in the urine are two other
monitoring parameters to substage chronic kidney disease. We often measure the blood pressure and urine
protein levels multiple times over several days to weeks
as they can vary and we want to verify that they are persistently elevated prior to starting specific treatment to
correct these abnormalities.
There are various treatments that are recommended to
help your cat feel their best, including fluids to help
maintain good hydration, a special renal-specific diet to
provide important nutrients and decrease the work load
on the kidneys, medications and supplements to maintain target concentrations of minerals and electrolytes,
and certain medications to help control high blood pressure and protein loss through the urine. Cats with chronic kidney disease may also become severely anemic, and
we may recommend treatment to help stimulate red
blood cell production and to improve your cat’s energy
level and overall well-being. We monitor your cat over
time with blood and urine tests and monitoring of blood
pressure. The frequency of monitoring is dependent on
the stage of disease and whether the disease is stable or
is progressing over time. The monitoring helps us to detec t changes and try to intervene when we see evidence
of progression of disease.
Many cats with kidney disease can lead long healthy
lives with appropriate monitoring and management of
their disease. It is not unusual for cats to have elevated
but stable kidney values and well-controlled clinical
signs over several months to years. If you note any
changes at home such as increased thirst and urination,
decreased appetite, weight loss, GI upset, lethargy or
other changes in behavior, it is best to make an appointment as soon as possible to see your veterinarian. This
will allow us to talk about these changes, evaluate your
cat to make sure that they are in good health, and to start
therapy if indicated for chronic kidney disease or other
illness that might cause similar signs.
Congratulations to
Sean Cabello, CVT, VTS
(Emergency & Critical Care)
We would like to congratulate Sean
Cabello, CVT on his certification
with the Academy of Veterinary
Emergency & Critical Care Technicians (AVECCT). Sean has been a
part of our over-night emergency &
critical care team for the past seven
years.
3 3• •Furry Free Press • •Summer 2012
Furry Free Press
Spring 2014