Chronic Kidney Failure in Cats

Kidney disease, also known as renal disease, is one of the most common diseases in dogs and cats that come to Sunset Vet. Kidney disease is very serious, as the kidneys are essential to filter the blood, excrete excess nitrogen and other toxins, regulate water and electrolyte balance, and produce hormones. When the kidneys become damaged and can no longer filter the blood, they cannot carry out those functions properly. Furthermore the kidneys are very poor at healing, unlike other organs. This means that the damage is usually irreversible.

On the plus side, all mammals are born with 2 kidneys and can usually function well with just one, so there is some spare capacity. In fact pets do not start showing signs of kidney failure unless there is less than 30% functionality left. This is the reason why humans can donate a kidney to a relative in need of one, and still live a normal life with one kidney, as long as that remaining kidney is a healthy one. In other words, when we start to see symptoms of kidney failure, this means that already 70% of the kidneys have been damaged.

There are two different types of kidney disease – acute (sudden) or chronic (long-term). Chronic kidney disease is more common in cats, and what we will discuss here. The earlier we treat chronic kidney disease, the longer we can prolong life expectancy.


Symptoms of chronic kidney disease

Some of the following symptoms of chronic kidney disease are seen late in the disease. Early detection of any of the following signs can help to treat kidney disease and preserve the remaining functioning parts of the kidney.

  • Polydipsia/Polyuria (increased thirst/urination)
  • Losing weight
  • Poor coat quality
  • Lethargic
  • Bad breath (halitosis)
  • Mouth ulceration
  • Losing appetite
  • Vomiting
  • Diarrhoea
  • Sudden onset blindness (retinal detachment)


What can cause chronic kidney disease?

Chronic kidney disease has a number of possible causes. Some have the potential for prevention or effective treatment if detected early enough.

  • Degenerative kidney disease, associated with ageing
  • Bacterial infections (these can ascend from the bladder, or spread through the blood stream)
  • Congenital abnormalities of the kidney (e.g. Persian cats born with polycystic kidneys)
  • Kidney tumours (Lymphosarcoma is the most common, a cancer of white blood cells)
  • Hypertension (high blood pressure)
  • Viral infections (Feline Immunodeficiency Virus (FIV) or Feline Infectious Peritonitis (FIP))
  • Amyloid deposition in the kidney


How is chronic kidney disease diagnosed?

Many of the clinical signs indicative of chronic kidney disease are vague, and can also be indicators of other disease processes occurring. In order to diagnose kidney disease, it is important that further tests are carried out. These tests can be done before the cat is unwell, when early detection is still possible.

  • Physical Examination – during your annual check-up the vet can palpate the kidneys and will take a full history about how much the cat is drinking and urinating. The normal drinking amount is around 50ml/kg/24hrs. If your pet is drinking >100ml/kg/24hrs then this could be an indicator of kidney disease.
  • Blood Test – A ‘biochemistry’ blood panel is important to check levels of urea and creatinine in the blood (indicators of kidney function), red and white blood cells, potassium, phosphorous and other electrolytes.
  • Urine Sample – A urine sample will be assessed based on its concentration (‘specific gravity’), giving an indication of how well the kidneys are able to concentrate or dilute the urine. If the Specific Gravity is over 1.012 then the kidneys are still able to reabsorb water and concentrate the urine. The urine will also be assessed for protein, red and white blood cells, and any bacteria for further information. Additionally, a further test may be performed to check where damage has been done in the kidney. This is called a “urine protein creatinine ratio” and can guide medications to help minimise protein loss.
  • Abdominal Ultrasound – an ultrasound (USG) is a non-invasive way to assess the kidneys. This can be done conscious without sedation, but may require clipping of the fur on the flanks. The vet can look for signs of amyloid deposition, shrinking of the kidneys due to fibrosis,  a tumor or swelling due to infection.


Cat Kidney Disease Treatment Options

The appropriate treatment depends on how advanced the kidney disease is, based on the above diagnostic tests.

  • Intravenous Fluids – This is the first line treatment recommended for a sick, dehydrated cat. IV fluids help to flush the kidneys,  reduce toxin levels in the bloodstream, and rehydrate your cat.
  • Appetite Stimulants (cyproheptadine) and AnabolicSteroids (laurabolin) – These are used to get your cat  eating again, and to combat muscle wastage.
  • Dietary Change – A prescription kidney diet has reduced levels of protein and phosphorus. This will minimise the work the      kidneys have to do, and the levels of toxins in the blood stream.
  • Phosphate Binders (Ipakitine) – Damaged kidneys have a   limited ability to process phosphate. This medication will bind phosphorus in the intestines so it doesn’t cross into the circulation and build up in the blood stream.
  • Antibiotics – If a urinary tract or kidney infection is, appropriate antibiotics will be prescribed – usually ones excreted in the urine such as amoxicillin.
  • Potassium Supplementation –   Excessive loss of potassium when kidneys fail results in muscle weakness and poor coat quality.
  • Blood Pressure Monitoring – Blood pressure is monitored in order to reduce the chance of further damage to kidneys. Treatment (usually enalapril or amlodipine) will be started if high blood pressure is detected.
  • Anaemia monitoring and treatment – Damaged kidneys fail to produce the hormone ‘erythropoietin’ needed for the production of red blood cells. If available, this can be given in synthetic form to stimulate red blood cell production.
  • Providing lots of water – Encourage your cat to drink with multiple water bowls, ensuring they are always full with fresh water as cats with chronic kidney disease are at increased risk of dehydration.


Early detection during annual check-ups

At Sunset Vet we recommend all cats over 12 years old come to the clinic at least every 3 months for a geriatric check-up, so that if diseases such as chronic kidney disease, hypertension or hyperthyroidism are present, we can catch and treat them early and maximise your pet’s life expectancy.


Sunset Vet offers veterinary services via their Kuta (24hr) and Ubud (8am-10pm) clinics. For further information or to make an appointment call them on 03619348915 (Kuta) or 0361975296 (Ubud), or visit or or Instagram: sunset_vet_bali


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