Kidney disease in cats and dogs
By following these instructions you will minimise the risk of your pet having a relapse.
The following notes have been prepared to help you cope with the after care required to maximise the quality and quantity of your pet's life.
By the time your pet has shown signs of renal disease we know that 75% or more of their innate renal function has been lost. In the equivalent human situation one would be considering dialysis until a kidney transplant were possible. Unfortunately this option is not available for cats and dogs in NSW (and in any case the success rate is very poor).
What we aim to do for your pet is to minimise the workload of the remaining kidney and thus improve their well being.
Diet
Is a major consideration. As you know your pet already has a poor appetite. In renal disease waste products build up in the blood and produce a feeling of malaise, nausea and inappetence. To a great degree because you pet has not been eating well, it has begun to metabolise its own body tissue, hence the extreme weight loss that can occur in renal disease. Metabolising their own protein is a poor source of energy and produces high levels of waste products, which in turn will make your pet feel worse.
To break this debilitating cycle we advise:
- Feed low phosphate low protein diets of high quality. At Seaforth Veterinary Hospital we sell a range of such products, in both dry and canned formulation. They have been fully balanced for the renal compromised patient, with emphasis on palatability.
- Feed white meats as a supplement: Chicken and fish are useful for tempting <<Patient>> back to eating. Once eating try to aim for a fully balanced renal diet.
- Refusing to eat anything! In this case we advocate anything is better than nothing! Do not starve a renal patient simply because they won't eat what you offer. Once eating, try stage 2 then 1 above.
- Vitamins: Renal patients lose excessive amounts of water-soluble vitamins due to their excessive thirst and urination. Try offering / crumbling a multivitamin tablet into their diet once they are eating.
- Low salt diets: If preparing food yourself make sure you do not add salt. It only worsens the hypertension and excess drinking associated with this disease. Most pet food manufacturers realise that salt is a flavour enhancer for cats and dogs therefore may add it too liberally for the needs of a renal patient. The diets discussed in 1 above take this into account.
- Water: Never restrict a renal patient from ad-lib water. Doing so rapidly leads to dehydration and possible death.
Medicines
To aid the above processes a few medications are also in order:
- Anabolic Steroids. A bit of an old approach but repetition of an anabolic steroid course every 4-6 weeks may help reduce weight loss and stimulate appetite. They are slow to act so do not expect miraculous instant results. By reducing body protein breakdown they can help reduce urea levels hence the nausea and inappetence that can occur.
- Ace inhibitors (ACEI): Renal disease, especially in cats is associated with hypertension. ACEI’s reduce blood pressure at the level of the nephron (the functional filtering unit of the kidney). This reduces further nephron damage and helps preserve what little kidney is left. They are particularly indicated what the patient exhibits high levels of protein in the urine.
- Antihypertensives: It is not uncommon for systemic hypertension to lead to acute onset irreversible blindness in cats. Measuring blood pressure is therefore important in the renal patient. Ace inhibitors help reduce systemic blood pressure, but we often need something more specific for the job, and that is Amlodipine (Norvasc).
- Antibiotics: High toxin levels can result in ulceration of the mouth and tongue. This is painful and only contributes the downward spiral of inappetence and weight loss. Thus we may also issue antibiotics to control secondary infection of ulcers.
- Antiulcer agents: To protect the stomach from ulceration we often employ safeguards such as Losec that reduces gastric secretions. Sucralfate can also be used to add a protective layer to the gut.
- Phosphate Binders: High blood phosphate offer a poor prognosis. Phosphate binders are added to home prepared diets to keep levels of intake down. They really do help.
- Dental attention: It has been suggested that periodontal disease can contribute to renal disease through toxins released by the responsible bacteria. Thus cleaning the cats teeth and antibiosis could help the kidneys.
- Subcutaneous fluids: Renal duffers are very prone to dehydration, and when it occurs leads to a downward spiral of events. Some patients require every day to every 3rd day subcutaneous fluids. A technique we can teach a client, but if they prefer our nurses are dab hands at this.
As you can see, there is no one magical thing that you can do to help the renal patient; it is a combination of diet, management and medicines that ensure the best results.
Dialysis?
Is now available in Sydney, however it is prohibitively expensive for most clients.
Renal transplants
Have been available in Queensland for some time however the expense is high and the success rate low, often mitigating this option.
Further blood testing?
Finally, we recommend a periodic check be performed on both your pet's urea and creatinine levels and possibly the red blood cell count.