Advanced kidney disease

[OhYouBadBadKitten]

Back from the vet with my old badcat. We had been noticing some behaviour changes (weeing in inappropriate places, howling), bad breath and weight loss.

I suspected it might be her kidneys but didnt think it would be as bad as it appears so I'm writing this sobbing. The vet turned around the blood work within an hour (lovely man). Creatinine and urea are both very high. We need to get him a urine sample, which we will do for Monday so he can see if there is any point in trying any medication to help perfuse the kidneys.

I've been looking at Tanya's CKD site and am going to talk to the vet about whether slippery elm might help badcats tummy - she is occasionally sick and I hadn't connected it all together. I hadn't realised her funny tiny twitches were a symptom either.

I was wondering if anyone who's been through it has any advice. Please be really gentle as I'm finding it really hard to face up to and if anyone is brave enough to hand hold I'd very much appreciate it.

Any tips for getting more water in? I just tried mixing her food with water. She is Not Impressed. My Very Bad Cat gave it a good go though.

Hi YouBad. My cat likes to drink from dirty old puddles rather than her bowl! Actually I think she prefers the taste of rainwater so DH filled up all their bowls with that this morning. We are also putting an extra water bowl upstairs just to make it more accessible for her. She does drink a LOT though.

We've decided not to go for any extra treatments for the kidney failure, just keep pain controlled and make sure she's comfortable.

How is your girl today?

I could bring in some pond water! She likes that.

She's a bit quiet, not climbing on top of my ipad like she normally does and a bit restless, but I think I'm probably acting differently to her and she's very sensitive to mood. Not so twitchy though.

How is your girl this evening?

Hi - Thanks for asking - She seems to be better in mornings/lunchtime, she was wanting a stroke, sat outside in the sun & wandered around munching a little food. But after a long afternoon nap she looked really dishevelled & stumbled around a bit. She wouldn't take her painkiller (it tastes yeasty & she has previously eaten it from my hand like a treat) so I had to hold her and give it, which I hated doing as she seems so frail. She's eaten a little and has gone to sleep on my bed for now.

It explains why DH & I have quite different views on how well/unwell she is, as during the week I mostly see her in the evenings when she looks terrible! He has her in the daytime and thinks she is relatively ok although clearly not well.

We'll see how it goes. I'm thinking we maybe have a few more weeks with her at most because I can't see her going on much longer if the weight loss continues.

It makes me very sad but I'm trying to be realistic about it.

I wonder why she is worse in the evening. Puzzling. Is her tummy ok with the pain killer?

My cat seems happier today. We've discovered she likes drinking out of our little glass bowls and she's drinking much more. Got to try and get a urine sample tonight. The vet has given us some non-absorbent crystals for the litter tray. The good thing is that they looking remarkably like the litter she uses. The bad thing is its such a little packet that she's going to think we are having a laugh!

A saucer, Oh. (Stuck underneath from the back at the appropriate juncture - if you see her squatting.) I'm an expert at this.

That could be tricky, it's one of those covered litter trays. She's going to be very shocked if a hand wielding a saucer zooms in!

Ah.

I guess it's the Katkor. Even though it's less than the usual amount of litter it actually works really well.

It is :) thank goodness for that. We also have the slightly miraculous situation that the only cat that uses the litter tray is Bad Cat. Though I wouldn't put it past my Very Bad Cat to use it just for a laugh tonight.

OhYou - really pleased to hear that your cat is brighter today. Hopefully she was subdued because of the trip to the vet, and will continue to perk up.

We have made the really really sad decision to take my old girl to the vet tomorrow to have her put to sleep - I had hoped she would soldier on but having watched her for the last 2 days, the spark seems to have gone out of her and I don't think there is anything reversible, or if there is I think she is too weak & tired now. She is still eating (a tiny bit), drinking, she has been outside in the yard today but just sits, she doesn't nudge my hand for strokes any more and since last night she has struggled to get up the stairs, although she has gone up and down several times today.

I think if we leave it much longer there will be a risk that she'll have some awful crisis, a fit or something, and she may suffer which I don't want.

Interestingly the other 2 cats have been behaving differently towards her, my old blind cat has been near her at all times & has been curled up close to her on the bed (not normal as they usually keep each other at a polite distance!) and the kitten has been desperate to nuzzle up to her and has been tapping her on the paw this evening (he's previously been harassing her in a playful way but this seemed more as if he was trying to rouse her?). Maybe I'm reading too much into it but it's as if they sense she's not right.

She's asleep on my bed now and we're hoping to get through the night without anything untoward happening and give the vet a ring as soon as the phones are switched over in the morning

I remembered I had this book and found it helpful to read through the chapter on how to cope with the death of a cat and how to judge what is the "right time" for the final journey to the vet

I feel it's the right decision but I'm very very sad, I've had her since she was a few weeks old and she will leave a huge cat-shaped hole in our lives

It is the right decision but so very hard even though she will have had a great life with you.

Thinking of you all timtam.

Thanks cozie I have been in tears on and off for the whole weekend, I've had her for her whole life and can hardly remember her not being around. She has been a temperamental old thing but very loyal to me and her usual evening sleep spot is on the sofa resting against my left leg - I will miss her.

It's all part of the responsibility of having a pet though isn't it, knowing when to say goodbye to them

Oh I am so sorry :( you are right, it is part of the responsibility and the last kindness that you can give them. I'm in tears for you and will be thinking about you all tomorrow. Give her a kiss from me.

Thinking of you this morning Timtam.

We seem to have a litter tray stand off this morning. Bad cat keeps walking into it and then walking out in disgust. As shes been miawing for a good part of the night I think she must be busting by now.

She might be a little constipated, Bad. (I recognize the behaviour.) Why not give the vet a little phone?

I was just coming on to bemoan the fact that we were still at an impasse when she flooded used it. She must be so much more comfy now! dh is zooming the sample over as I type.

Well done her. That behaviour is, in my experience, 'I want to go but I can't' though so keep an eye on it. (Maybe she really didn't like the special litter though - that could be it.)

Good luck for the tests later on.

I will keep an eye on it for sure! Shes such a fussy little madam, so I'm hoping its that.

I tried sprinkling the slippery elm into her food. She immediately went to eat from another cats bowl (they are normally really good at sticking to their own bowl) and Very Bad Cat decided that she preferred the Slippery elm bowl.

Not looking forward to the vets phonecall, but hopefully it will show him something to work on.

Whatever it shows (if anything significant) it has to be done. Is he doing the work in house?

He is and has got back to me already. Very impressed!
urine is pretty dilute but she seems to have some ability to concentrate it still. lots of protein in it so it does make her a suitable candidate for treatment.

So we are going to try a renal specific diet and probably an ace inhibitor. He's going to look up semintra and see what he thinks of it before writing a prescription for something. Hopefully when it kicks in she will feel better in herself so I'll drop the slippery elm idea I think - dont want to put her off her food/water.

only semintra is not an ACE is it? It's an ARB. My mistake.

oh I don't know which it is, not that it matters in the slightest bit!

Glad it looks like some treatment is possible, anyway.

Ohyoubad. Semintra is an an ARB (Angiotensin receptor blocker) these are more specific than ACE inhibitors

ACE inhibitor stimulate both the AT receptors giving you good and bad effects. Semintra binds to only the AT1 receptor so you only get the blocking of vascoconstriction, persistet proteinuria and eleate blood pressure. This allows the RAAS system to still control vasodilation, the excretion of salts and inhibition of inappropriate cell growth.
ACE inhibitors get something called ACE escape after and while and so stop helping. ARBs do not get ACE escape.
Hope this helps. For my own cat I would choose Semintra over Fortekor everytime for three reasons Semintra is a liquid so much easier to give, Semintra is a weight dependent dose as opposed to one size fits all tablet of fortekor and finally due to it's higher specificity of action.
Finally if your cat weighs less than 4Kg (which most kidney cats do) Semintra is cheaper than fortekor.
IRIS stage 1 CKD that is proetinuric treated with diet and Semintra have an average survival time of 400 days so carries an excellet prognosis.