Cat has severe kidney failure - treatment options?

[ravenclaw]

My 12-year-old kitty started not feeling well last Wednesday (decreased appetite, lethargic, constipated). I took him to the vet on Friday. Got the results of the bloodwork this morning. The vet said he is in severe kidney failure.

The vet said all I can really do for him is IV fluids or subcutaneous fluids. Just wanted to see if anyone has other suggestions for things that helped with their cats?

I am so sad. This cat is the best and I have a special bond with him. I have lost another cat to kidney failure, but with that cat the symptoms were slower and more gradual. She lasted for a few years after the first symptoms showed up.

[Alex_and_Bodie_s_Mom]

Sadly, there’s not much you can do when they go that fast.

There is a supplement - Epakitin - that helps bind the proteins and can help with renal issues, but I’m not sure how helpful it will be if he has advanced renal failure.

I just lost my 18-year old to renal failure last month. We did subQ’s, but it wasn’t enough to rally him meaningfully. I’m so sorry. Hugs to you. Maybe someone else will have another idea to try.

[Simkie]

I’m so very sorry about your kitty

“Severe” kidney failure sounds like he’s awfully far down the path already. Has the vet offered any sort of timeline?

There are definitely things that can help manage the symptoms. Nothing brings back the kidney function. But you can try to address the nausea that makes living with kidney failure miserable for them:

Fluids do help. How often are you giving them? My vets have always said that fluids don’t prolong life, but improve quality.

Meds. My preference is to hit them hard and get them feeling BETTER. I don’t really see the point in keeping them around if they’re going to be miserable, you know? High kidney values make them feel really pukey so:

• Pepcid addresses the acidy belly and the stomach/mouth ulcers
• Zofran for the vomiting/nausea
• Cerenia also helps with the nausea and provides some visceral pain relief
• Mirtazipine gets them to eat

It’s not a whole lot of fun pilling sick cats. The mirtazipine can be compounded into a transdermal prep by Wedgewood. For the others, I’ll bundle it all up into a scrap of pill pocket (just enough to cover the pills) and only have to pill them ONCE.

I’ve never had a vet offer Zofran, but it works much better than Cerenia for nausea, in my experience. I’d drop the Cerenia before the Zofran, if I had to choose, but they seem to work very well together. I’ve always had to aggressively advocate for my cat. Vets have always been willing to help, but I have always had to ASK and bring up things I’d like to try.

I use the appetite as my gauge. If they eat, we have control over the nausea. Once they stop eating, I call it and have the vet out to the house to euthanize asap (that day, preferably.) While it’s possible to lose control of the nausea and regain it, it’s just a signal that things are going downhill.

Depending on the cat, they can do pretty well for quite awhile. The kidneys also produce the hormone that triggers red cell formation, and kidney failure will eventually also = a very badly anemic cat. You can do procrit to help that, or transfusions. I’ve never had one last that long, but it’s an option if you do.

I’ve been through this a few times. It doesn’t ever get easier. I’m really sorry

[CindyCRNA]

What is the kidney failure secondary to? If you can support the kidneys and fix the cause, you kitty may have many years to come.

[ravenclaw]

Thanks to everyone for the suggestions and sympathy. I wasn’t really surprised that my cat has kidney failure because he has been drinking more water lately. I know from my other cat that this is one of the symptoms. But I was surprised that it’s so bad. The vet told me that the normal range on the bloodwork is from 14-36. My cat’s level was 113.

Other than the increased drinking, he has been fine until last week when he started having a decreased appetite, acting lethargic, and being constipated in the litter box. He still kept drinking and peeing. He threw up 3 times last Wednesday night but other than that, I haven’t seen him throw up. His fur still looks good and his weight is OK, although I’m sure his weight will start going down since he’s not eating a lot. But he is eating a little. He is acting more like himself now than he was over the weekend.

I haven’t started him with fluids yet (I just got the results yesterday). The vet mentioned I could take him to the clinic for IV fluids, but he would have to stay a couple of days for that. If he doesn’t have much time left, I’m not sure if I want him to be away from home for those days and it would be stressful for him. Could I just do subQ fluids at home?

The vet didn’t mention doing anything besides the fluids. I’m not one of those people who wants to give every medicine and do every treatment, but if there are some things I can do at home to help him feel better and get more time with him, I’m interested in trying them.

Does anyone think it’s worth taking him to another vet for another opinion? I asked and he didn’t give me any treatment options except the fluids. Also, when I took him to the vet last Friday, he gave him a shot of a long-lasting antibiotic (Convenia). This was before getting the results of the bloodwork. I’m not happy about him getting this antibiotic. Since it’s long lasting, it might not be great for his kidneys. I wasn’t told he was getting the antibiotic until after it was done.

[ravenclaw]

CindyCRNA - I’m not sure what you mean about the kidney failure being secondary to something else. With both of my cats, the vet just told me that they were in kidney failure.

[Simkie]

Yes, you can absolutely give subq fluids at home.

Antibiotics are often prescribed because kidney infection can cause acute failure. Did the vet check the urine for signs of infection?

It is unreasonable, in my very humble opinion, to take a cat in kidney failure and not euthanize but also not use the basic tools we have available to make them feel better. Kidney failure is a terrible, terrible way to die. They feel awful throughout. We have the incredible ability to see into the future, and if the direction is all downhill, why would we not prevent that suffering? If you’re not interested in medicating to make them feel better, it is so much kinder to them to euthanize. These meds are not expensive or difficult to dose (as long as your cat CAN be pilled, the decisions are different with one who just cannot be pilled.)

If you’d like to pursue management with fluids and meds, try asking your current vet for the list above. Pepcid is OTC, but everything else is RX, so you do need buy in from the vet. I’ve never had one tell me no. If your vet does say no, then yeah, I’d find another vet. The meds I listed are about making them feel good by managing the symptoms of the disease vs prolonging a life past it’s natural endpoint. There certainly are people who do that with their kidney cats. There are even hospitals who will do a kidney transplant.

Yes, unfortunately, that inappetance is directly related to his lab values and he’s not eating because he feels badly. Appetite is a really great monitoring tool. Cats are so very stoic.

[Alex_and_Bodie_s_Mom]

There’s no reason you can’t do subQ’s at home. My vet does them all the time - kitty goes in, gets the fluids, comes home. No problem. If your vet won’t do this, I don’t understand the reason why.

An appetite stimulant can help. I’m surprised your vet didn’t mention it. If the cat eats (and if you get the nausea under control), then they can start to improve. Nausea meds, too, can help. Did the vet give you a nephron count? That could help determine what stage your kitty is at, and what might be an option for you.

When I was fighting with Rascal’s kidney failure, the vet told me that they can be very, very sick, and then turn around - but the treatment needs to be aggressive, and it needs to work. Another of my cats, Mick, came out of acute renal failure just fine and has been fine for several years now. But Rascal didn’t. There are definitely other treatment options. You can either ask your vet about specific ones (sometimes we have to push our vets to try treatments), or take your kitty to a different vet for a second opinion.

[ravenclaw]

I’m not sure if the vet did a urinalysis or just the bloodwork. I’ll find out. When the vet took him into the back room, he just said he was taking him to draw blood. I have been quite worried about my cat so sometimes I don’t think to ask everything that I should. My vet will tell me things if I ask him, but sometimes he doesn’t tell me unless I ask.

I don’t know how my cat would be for pills or subQ fluids but I’m willing to try. I have been able to pill 2 of my other cats, but this cat can be less cooperative. He’s not very cooperative about brushing/combing certain areas or if I need to check inside his ears, etc.

The vet mentioned they could show me how to do subQ fluids at home, but he also mentioned doing IV fluids at the clinic (which my cat would need to stay 1-2 days for that). He didn’t mention an appetite stimulant and not sure about the nephron count. When I talked to him, he said his “kidney level” was 113 (normal range is 14-36). I’m not sure if my cat needs nausea medicine right now. He has been eating a little and as far as I know, he only threw up last Wednesday and not since then.

Thank you all soooo much for the suggestions and support!

[Simkie]

@ravenclaw

I’m not sure if my cat needs nausea medicine right now. He has been eating a little and as far as I know, he only threw up last Wednesday and not since then.

Cats are incredibly stoic little creatures. Usually the only sign we get that indicates nausea is they don’t eat as well as usual.

High kidney values cause nausea. That his values are high, and that he’s not eating as well as usual, are both good indicators that he would very likely benefit from the meds listed earlier.

Good luck, hope you’re able to find a path forward

[rubygirl1968]

If his numbers are that high, he might feel much better after getting the iv fluids.

When I had to give fluids to my kitty he at first hated it. I found Terumo UTW needles in 20 gauge and warming the fluids before he got them to be the trick. He would come running and hop up on the bed when he saw me get the bag of fluids out. I think they made him feel better, plus I always gave him a couple of his favorite treats afterwards.

All the other cats got used to the routine and would lay on the bed with Thomas while he got the fluids and they all got a treat.

[CindyCRNA]

It means what has caused the kidney failure. 12 is pretty young for end stage kidney failure. What caused the damage to kitties kidneys? High blood pressure, diabetes? In people high blood pressure is a common cause.

[shiloh]

Another yes to giving sub-q fluids at home. It is much easier than you would think. Have vet tech at your office show you how. And then start searching the web for Lactated ringers. Prices can be high but sigh…it is what it is. Also, go to Big D tack and supply and get some 14g needles. Yes, that is large but a needle is a needle is a needle. These ones help the fluids run faster because some cats will wiggle. You will need to change the needle every use because too many uses and they get really dull and it hurts when you stick them. If you have any friends at a local hospital see if you can get some IV line from them, the longer the better. If I had any extra I would offer but I found I only have 2 sets. Sorry. Another thing I found was helpful was the Anitra Frazier book The Natural Cat. It has a whole section on how to do sub-q fluids. Be prepared to feed kitty whatever he wants. I had a cat that would only eat Temptations treats and those little dried shrimpies for a time. If that was what she wanted, then she got it. I live by the words of my one vet: When they are sick, it does not matter what they eat so long as they are eating.

I’m sorry about your poor kitty. I hate seeing them go that way. And @Simkie is right - it does not get easier.

[ravenclaw]

My sweet boy is at the vet right now getting fluids while I’m at work. When I go to pick him up, they will show me how to give the fluids at home. I used to give IM shots to my horse so I don’t mind giving the kitty fluids. I just hope he will cooperate. I’m also going to ask about getting something to help with his appetite and nausea.

I hope the fluids help him feel better. I decided to take him in today since the clinic isn’t open as much the next few days because of Thanksgiving.

Shiloh - I agree about feeding the kitty whatever he wants. This kitty had a urinary infection several years ago and I have had him on food for cats with urinary issues. But since he started feeling bad, I have been letting him eat the other cat food that I have (he prefers it). I figure letting him eat the “wrong” food is better than him eating no food.

Thank you all SO much. It really helps to have the support and sympathy of people who have been there and know how awful it is. I’m still processing the whole thing. It’s different this time. I lost another kitty to kidney failure but with her, it was much slower. With the kitty now, he didn’t show any symptoms until it was advanced.

[rubygirl1968]

I hope he feels better after the iv fluids. I’m glad you were able to get him in for them before the holidays and the weekend. Hopefully they can give you something for the nausea too. I gave mine pepcid and it worked quite well on him.

Don’t panic about the fluids. Find a spot he likes and be creative on where to hang the bag. I found that Thomas liked the bed best so I used an over the door hook and put the fluids there.

I don’t know where you get your supplies usually but I used medvet and never had any issues.

Terumo Needle, 20GX 1 1/2in., Hypodermic, 100/BX, NN2038R

These are the needles I used. The smaller gauge took too long and the larger gauge he despised and wouldn’t tolerate.

I got the drip lines there too, with the injection site so I could do the vit. b through it and not the whole bag. He wasn’t comfortable with the vit. b added to the whole bag - seemed like it burned. I think they were a dollar or so per line.

Good thoughts for your guy!

[HenryisBlaisin]

My vet wrote a prescription for the fluids and IV kit and I ordered them from Chewy–they were fast and even including shipping, cost much less than the vet’s office charged. I work at a feed store and got the needles there. I used 18 gauge.
My cat hated getting fluids; I had to burrito him in a couple of towels, but once he was wrapped up it was easy to do. It bought him four or five good months. His kidney failure was caused by an infection, but even after weeks of antibiotics, it recurred a few months later; my vet said that’s not unusual, unfortunately. I lost him in July, but his last few months were normal other than giving the fluids, he just couldn’t bounce back from the second infection.

[BAC]

@Simkie

It is unreasonable, in my very humble opinion, to take a cat in kidney failure and not euthanize but also not use the basic tools we have available to make them feel better. Kidney failure is a terrible, terrible way to die. They feel awful throughout. We have the incredible ability to see into the future, and if the direction is all downhill, why would we not prevent that suffering? If you’re not interested in medicating to make them feel better, it is so much kinder to them to euthanize.

I couldn’t agree more, I have had a number of cats with renal failure, did subQ fluids, Pepcid, etc. with varying results.

OP I am so sorry for you and your kitty. SubQ fluids are very easy to give, I even managed it with a feral, with some I mashed up the Pepcid and mixed with a tiny amount of water and gave it through a syringe, you can mash up meds in sardine oil, but if they are not treatable and don’t show improvement then please don’t allow your kitty to suffer.

[BAC]

@shiloh

Also, go to Big D tack and supply and get some 14g needles. Yes, that is large but a needle is a needle is a needle. These ones help the fluids run faster because some cats will wiggle. You will need to change the needle every use because too many uses and they get really dull and it hurts when you stick them.

Big needles make the fluids go faster but I have had cats that just won’t tolerate them and with the smaller needle, although it takes more time to get the fluids into them, the cat stayed quiet and it was less stressful for both of us. Absolutely change the needle with every use! Its not sanitary to reuse them. The OP just has to see what works best with her cat. And for a newbie I think it might be easier on the OP to start with the small needle.

[shiloh]

True about what works best. But again a needle is a needle, etc…Some cats will sit quietly if fluids are flowing slowly (like thru a smaller needle) but some just hate the whole thing and I try to fix it so it’s over as soon as possible. It seems a little sad that we have gotten to the point that we have so much experience we can speak knowledgeably about this. How I wish this were only a once in a lifetime occurrence, but I guess if you love pets and cannot live without them, this is what we do.

[CindyCRNA]

I found warming the fluids helps too. I was able to procure 60cc syringes. I would fill both, cap them off then put them in a tall Quick Trip cup filled with very warm water for maybe 5-6 min. I would test the temp on my forearm. I had a different technique for fluids. I would take an IV needle, insert that sub q, attach an IV extension on the 60 cc syringes and inject that way. Warm the fluids whatever you do but test on your arm to make sure they are not too warm.