Kidney Disease

[LunasMom]

We got the news today that Luna's kidney numbers are up (1 1/2 and 3). They are starting her on SubQ fluids and a special diet. I adopted her a few years ago from PAWS after the death (Kidney failure) of frankie.

I haven't really dealt with this before. When Frankie got it it was a matter of 24-48 hours after that he was gone. He ate the menu foods junk that was put out back in 06-07 (lawsuit still pending against them).

I am trying to find any information, help or guidance anyone can give on this. I go in Wed. to learn how to do her SubQ fluids but she has already been started on her special diet of Purina HF (I think that's the name) along with Amox/Dex drops for a UTI. I am trying to build up a question list for the Vet while at the same time looking for another vet to get a second opinion. I plan to get her blood work and records wed. when I go in just to make sure 100000% percent that I am doing all that I can for her.

I lost one cat to Kidney problems I plan to fight to the bitter end with Luna. She deserves it!

PS: Just so its known, the main reason why I want a second view is because for the past year we have been telling them "She throws up alot and drinks ALOT of water" and they would just brush it off. It took her losing almost 2LB's before they took anything we said seriously and for them to do blood-work. She has gained most the weight back though, thankfully!

[laurief]

I'm so sorry for Luna's diagnosis. I haven't got time right at this moment to write a long response (I'll try to do so later today), but I wanted to get you started with the most valuable website on CRF:

Tanya's Comprehensive Guide to Feline Chronic Renal Failure

Bookmark this site. You'll find yourself returning to it probably multiple times a day to read more about CRF. It'll answer virtually every question you may have about this disease. It will, though, be overwhelming for you at first. I suggest you start with the sections that related directly to you right now - sections explaining CRF in general, diagnosis, bloodwork interpretation, subQ fluid administration, and diet.

If you have any specific questions about anything you do or don't read on that site, post them here, and I'll try to answer them for you.

I'll post again later ...

Laurie

[Mary_NH]

years ago I had a CRF cat and she did quite well on the prescription foods. She was diagnosed at 8 years of age and went to Rainbow Bridge shortly before her 16th birthday. She was frequently at the vets requiring fluids but not drastically so. She did end up passing in her sleep and it was from heart problems not her kidneys.
Having said that I recently lost one to kidney failure and like the kitty you mentioned it was very quick. We were treating Catnip for an overactive thyroid when her kidneys shut down but I understand that thyroid issues and kidney disease can mimic each other so while trying to get one under control the other was killing her.
My old girl Missy is suffering from geriatric kidney shrinking. So far she's doing well but what I've learned so far...and would curious on your vet's take on this
nauseau is a problem with kidney disease. Cat will stop eating when they feel ill (the major cause of the vomiting). Pepcid AC (1/4 tablet per day) helps stave off the nauseau (and I know I'm spelling that wrong). By staving off the nauseau the cat eats which is very important with CRF.
My Missy will be 16 years old this summer. I was torn between prescription diet and keeping her on what she'll eat. Since I have 4 cats and Missy weighs a huge 6 pound pounds I decided to keep her on what she'll eat - so she will eat. I know the prescription foods will be better for her kidney problems but what good will they be if she won't eat them?
She gets a Pepcid AC every evening and I gotta say she's doing quite well.
she had a pee check last week and it was purrfect for a geezer meezer - so I was happy.
I would be curious on your vet's take on the Pepcid AC and the importance of a cat with CRF eating even if it's not food geared toward kidney.

[Time Bandit]

I've never had to deal with kidney disease in animals before, but I wish you and Luna all the best in dealing with this, and I hope she's feeling better soon.

I don't blame you for wanting a second opinion. This is your cats life here. The first vet doesn't sound like they were really listening to what you were saying, and that is incredibly infuriating to me.

[LunasMom]

Originally Posted by laurief

I'm so sorry for Luna's diagnosis. I haven't got time right at this moment to write a long response (I'll try to do so later today), but I wanted to get you started with the most valuable website on CRF:

Tanya's Comprehensive Guide to Feline Chronic Renal Failure

Bookmark this site. You'll find yourself returning to it probably multiple times a day to read more about CRF. It'll answer virtually every question you may have about this disease. It will, though, be overwhelming for you at first. I suggest you start with the sections that related directly to you right now - sections explaining CRF in general, diagnosis, bloodwork interpretation, subQ fluid administration, and diet.

If you have any specific questions about anything you do or don't read on that site, post them here, and I'll try to answer them for you.

I'll post again later ...

Laurie

Thank you so very much Laurie. I bookmarked the site and will be reading it tonight when I get a moment. I ended up not going into work today (kinda sick) so I decided to take her to the vets today to learn to do her IV Fluids.... I was kinda shocked to learn that it was a drip. The Tech that taught me was very nice and showed me how to do it and set us up with enough needles to last us 3 weeks. One bag I was shocked to find out will last 3 weeks also.. and wasn't expensive.

She told me to try to do it at home a few times and if I can't get the hang of it then I can have them to it at the vets.. but gah going into the vets 2-3 times a week will be a huge hassle so I am hoping to be able to do it myself.

I also asked her if it was CRF or ARF and she said that they don't know and so I went on to ask and I quote "Will it be a while before they figure it out?" and she again said she didn't know. She also said that her numbers were 96 instead of the usual 14 or something like that but she has seen far worse so that gave me extreme hope and belief in my ability to give her the IV.

[LunasMom]

Originally Posted by Mary_NH

years ago I had a CRF cat and she did quite well on the prescription foods. She was diagnosed at 8 years of age and went to Rainbow Bridge shortly before her 16th birthday. She was frequently at the vets requiring fluids but not drastically so. She did end up passing in her sleep and it was from heart problems not her kidneys.
Having said that I recently lost one to kidney failure and like the kitty you mentioned it was very quick. We were treating Catnip for an overactive thyroid when her kidneys shut down but I understand that thyroid issues and kidney disease can mimic each other so while trying to get one under control the other was killing her.
My old girl Missy is suffering from geriatric kidney shrinking. So far she's doing well but what I've learned so far...and would curious on your vet's take on this
nauseau is a problem with kidney disease. Cat will stop eating when they feel ill (the major cause of the vomiting). Pepcid AC (1/4 tablet per day) helps stave off the nauseau (and I know I'm spelling that wrong). By staving off the nauseau the cat eats which is very important with CRF.
My Missy will be 16 years old this summer. I was torn between prescription diet and keeping her on what she'll eat. Since I have 4 cats and Missy weighs a huge 6 pound pounds I decided to keep her on what she'll eat - so she will eat. I know the prescription foods will be better for her kidney problems but what good will they be if she won't eat them?
She gets a Pepcid AC every evening and I gotta say she's doing quite well.
she had a pee check last week and it was purrfect for a geezer meezer - so I was happy.
I would be curious on your vet's take on the Pepcid AC and the importance of a cat with CRF eating even if it's not food geared toward kidney.

Luna has shown us that she doesn't like the Purina stuff so we are trying the KB (I think that is the name of it) she so far is eating more of that then she did of the purina. I might have to ask them about the Pepcid, I never thought of giving her something for the nausea/vomiting, tbh. I am weary on introducing products to Luna without intensive research on them and how they may react with a feline. I think my Vet hates that... but after Frankie, one can't blame me.

I am hoping to be able to find a Kidney designed food she will like even if I have to try them all. My next one to try is LP (Royal Canine). She has never been a picky eater but I think the special diet food might not have a good taste for them.

I am glad that your kitty is doing well, I am hoping to be able to say the same next month when they do blood-work again!

[laurief]

Originally Posted by LunasMom

Thank you so very much Laurie.

You're welcome. We CRF caretakers have to stick together to share information and support. There's actually a huge online community of CRF caretakers who subscribe to the CRF Support Mailing List linked here:

http://groups.yahoo.com/group/Feline-CRF-Support/

I strongly recommend you join the list. It's very large, and a number of the members are extraordinarily knowledgeable about this disease. You can learn a ton from them, and they're always happy to answer questions and offer whatever support you may need.

I bookmarked the site and will be reading it tonight when I get a moment.

You're going to need a whole lot of moments to make your way through that site. I've had Tanya's site bookmarked for a decade, and I still find myself back there reading and rereading pages several times a week, if not several times a day.

I ended up not going into work today (kinda sick) so I decided to take her to the vets today to learn to do her IV Fluids.... I was kinda shocked to learn that it was a drip.

I'm glad you learned how to admin fluids. I know that it can be nervewracking at first, but it won't take long for you to get the hang of it, and it is the single most important management strategy for CRF. There are lots of tips, tricks, and tutorials available through Tanya's site, so be sure to check out that section.

The Tech that taught me was very nice and showed me how to do it and set us up with enough needles to last us 3 weeks. One bag I was shocked to find out will last 3 weeks also.. and wasn't expensive.

Hmm. Once a bag has been spiked (breaking its sterile seal), it's generally recommended to discard it after 10 days even if it's not empty. That's to protect against possible bacterial growth in the bag introduced through the needle and IV line.

Most vets use Monoject needles, which many CRF caretakers refer to as "kitty harpoons" because of their sometimes less than perfect manufacture. We generally recommend Terumo Ultra Thin Wall (UTW) 20 gauge needles for fluid admin. Terumos are sharper than Monojects, making them easier and more comfortable to insert. 20 ga UTW's provide a fluid flow rate pretty much equivalent to 18 ga Monojects, but 20 ga makes a smaller hole in the cat (again, more comfortable for the cat). You can bu Terumos here:

http://www.thrivingpets.com/index.ph...o-needles.html

You can also order IV sets from the same source, but you'll need a prescription from your vet.

If you shop around at pharmacies in your area (esp. those at retailers like Walmart, K-Mart, and Target), you should be able to buy a case of Lactated Ringers Solution for around $25. In fact, I'm picking up a case of 12, 1000 ml bags of LRS for $23 from my local Target pharmacy tomorrow. You'll need a veterinary script for those, too.

She told me to try to do it at home a few times and if I can't get the hang of it then I can have them to it at the vets.. but gah going into the vets 2-3 times a week will be a huge hassle so I am hoping to be able to do it myself.

Don't worry. You'll be able to learn to do it at home with some practice. Just keep a calm, matter-of-fact attitude about it, and be sure to warm the fluids to make them comfortable for your cat (if the tech neglected to tell you to warm the fluids, I can explain why this is important and how to do it). Don't get rattled if it doesn't go smoothly on your first attempt (or your first few attempts). There is a bit of a learning curve to it, but it's really not difficult once you get through the initial awkwardness and nervous stage.

I also asked her if it was CRF or ARF and she said that they don't know

The symptoms are often the same, though ARF typically presents suddenly with higher blood values. ARF has a specific precipitating factor, like poisoning of some sort, while CRF generally comes on more gradually with no easily identifiable trigger. ARF cats are often critically ill at diagnosis and require hospitalization on IV fluids for a period of some days. With prompt and proper treatment, ARF cats can sometimes fully recover. CRF cats, of course, do not recover, though they can often be successfully managed for a significant period of time - sometimes years. A lot depends on how advanced the disease is at diagnosis, and whether the cat can be successfully stabilized.

OK, that's enough for now. I'll let that sink in before loading on more info.

Laurie

[LunasMom]

Hmm. Once a bag has been spiked (breaking its sterile seal), it's generally recommended to discard it after 10 days even if it's not empty. That's to protect against possible bacterial growth in the bag introduced through the needle and IV line.

Wonder why they didn't tell me this today. This lacking of information from them on top of being ignored previously to finding out about her kidney issues just makes me more and more worried that maybe I need to find a whole new vet. Someone mentioned to me about finding a Internal Medicine Vet. to take over Luna's care. I don't know if you have seen a specialist or not but if so do you think it be worth it?


I will be calling them tomorrow to get a script from them to order more bags for her since they said she will be on the fluids for at least a month if not longer. She only gets 100CC/ML each time we do it so it kinda is icky that the rest of the bag will be wasted but I would rather be safe then sorry. I am assuming from how the tech spoke today that she will be on it at least a month if not the a long time all depending how her blood-work comes out.

Also, for the special food like KD, LP and Purina (not sure what other kidney food is out there) do you also need a script to order those and if yes or no what websites are the best to order the food from?

I am so sorry if I am being a pest and bugging you with all these questions Laurie but I really do thank you from the bottom of my heart for the time and information you have given me.

[LunasMom]

Wanted to add but can't figure out how to edit my post.

We only do her fluids 2-3 times a week. 100 ml each time.

[laurief]

Originally Posted by LunasMom

Wonder why they didn't tell me this today.

Every vet has a different combination of educational and professional experiences with this disease, so every vet is going to have different ways of handling the various aspects of its management. You're going to run into inconsistencies and contradictions all over the place. What's important to remember is that vets can not be realistically expected to know all things about all diseases in all species, so it's up to the owners to become as knowledgeable as possible about the medical conditions of their own animals in order to partner effectively with their vets. This is one way in which the mailing list I linked for you earlier is an invaluable resource. Members of the list work with vets around the world, some of whom are internists or renal specialists. Members who share information from those veterinary specialists help increase the collective knowledge base of the list and provide all of the other members with critical information they can share and discuss with their own vets.

If this disease teaches you nothing else, it will teach you to advocate strongly for Luna. You need to find a vet who, at the very least, is willing to read and discuss information about CRF that you research and bring to him/her. A vet who is unwilling to accept me as an active and credible partner in the medical management of my own animal is a vet who can not earn either my respect or my money. My vet is my consultant. He's not a dictator who I blindly obey to the exclusion of my own research and common sense.

In the end, you need to accept ultimate responsibility for every decision regarding Luna's management. You need to educate yourself about this disease, then you need to find a vet with whom you can consult and partner to help you reach the best possible decisions for Luna.

Someone mentioned to me about finding a [COLOR=Blue]Internal Medicine Vet. [COLOR=Black]to take over Luna's care. I don't know if you have seen a specialist or not but if so do you think it be worth it?

I'd have to travel 200 miles to find such a specialist, though I have been known to do telephone consults with veterinary specialists when I felt the need. Again, you need to find a vet with whom you can partner effectively, regardless of his/her professional credentials or specialties. All things being equal, though, if you found an internist or, better yet, a veterinary nephrologist with whom you could work well to handle Luna's case, that'd be great.

I will be calling them tomorrow to get a script from them to order more bags for her since they said she will be on the fluids for at least a month if not longer.

If Luna does, indeed, have ARF from which she successfully recovers, then she won't require ongoing fluids. Much more likely, though, she will require fluids permanently, not just for a month. BTW, it's always best to maintain as even hydration as possible in CRF cats so that they aren't constantly hitting hydration peaks and valleys. To that end, it would be better to admin 40-50 ml daily rather than 100 ml every 2-3 days.

Also, for the special food like KD, LP and Purina (not sure what other kidney food is out there) do you also need a script to order those and if yes or no what websites are the best to order the food from?

Yes, you will need scripts for prescription foods. http://www.petfooddirect.com sells prescription foods, and I'm sure there are other sources you can find through a Google search or by checking at http://www.amazon.com. Don't waste your money on prescription food orders, though, until you know that Luna will eat them. I, personally, have never had one of my CRF cats be willing to eat any renal prescription foods. They are horrendously unpalatable for many cats. If you can find renal foods that Luna will eat, more power to her (and you), but if she refuses to eat them, then by all means feed her whatever food she will eat. The BEST foods for CRF cats are whatever foods they will eat ... period!

I am so sorry if I am being a pest and bugging you with all these questions Laurie but I really do thank you from the bottom of my heart for the time and information you have given me.

Hey, pester away! I've been down this CRF road several times, and I suspect when I take my Noddy and Tommy in for bloodwork tomorrow, I'll be going down it again with one or both of them. This is regretably familiar territory for me, and I'm happy to share whatever knowledge and resources I have gleaned about this disease and its management with others who need the guidance.