TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 
   

EARLY DETECTION

 

ON THIS PAGE:


Regular Examinations, Including Annual Bloodwork


Urine Specific Gravity (USG)


Proteinuria


Glomerular Filtration Rate (GFR)


 

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WHAT IS CKD?


What Happens in CKD?


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


All About Anaemia


All About Constipation


Potassium Imbalances


Metabolic Acidosis


Kidney Stones


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

RELATED DISEASES


Heart Problems


Hyperthyroidism


Diabetes


Polycystic Kidney Disease (PKD)


Pancreatitis


Dental Problems


Anaesthesia


 

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Home > What is CKD? > Early Detection

 


Overview


  • As discussed on the What Happens in CKD? page, it is normally not possible to detect CKD until the cat has already lost 66-75% of his or her kidney function.

  • It is therefore highly unlikely that you could have prevented your cat developing CKD; so please don't feel guilty.

  • This page discusses some areas of investigation into ways in which earlier detection may be possible.

  • It is not currently possible to prevent CKD; but the earlier it is diagnosed, the better your chances of helping your cat.

Assessment of renal function: what can be done in practice (2002) is a very interesting paper about the various methods of detecting CKD presented to the World Small Animal Veterinary Association Congress 2002 by Dr Jonathan Elliott.

 


Regular Examinations                                                                                                               Back to Page Index


 

Although occasionally younger cats get CKD, it tends to be a disease of the older cat. I therefore make it a rule to take any of my cats who are over the age of eight to the vet each year for a check up. The check up includes a physical examination and blood tests (including testing for hyperthyroidism) and a blood pressure check. Once cats reach the age of ten or twelve, you might want to consider checks every six months.

 

I would also recommend weighing your cat regularly in order to spot any weight loss early, which may indicate CKD or other health problems such as hyperactive thyroid.

 

The American Association of Feline Practitioners provides guidelines on how to be proactive in caring for a senior cat. It recommends (page 3) that blood tests, urinalysis and a blood pressure check should be performed every year in cats starting between the ages of 7 and 11 with no clinical signs of disease.

Cornell University College of Veterinary Medicine has information on what to expect as a cat ages.

Antech Diagnostics discusses the results of a study at a Los Angeles veterinary hospital into the benefits of bloodwork and other tests performed in cats over the age of 7 who were apparently healthy.

 


Urine Specific Gravity                                                                                          Back to Page Index


 

Measuring urine specific gravity may indicate loss of concentrating ability before anything shows in bloodwork. However, a cat may have dilute urine for other reasons, such as diabetes, so this is only a guide, not a definitive method of diagnosis.

 


Proteinuria                                                                                                             Back to Page Index


 

The International Renal Interest Society uses protein in the urine as a risk factor for the development of CKD, and as a factor to determine the severity of the CKD.

 

Evaluation of predictors of the development of azotaemia in cats (2009) Jepson RE, Brodbelt D, Vallance C, Syme HM, Elliott J. Journal of Veterinary Internal Medicine 23(4) pp806-13 reports on a group of older cats who were monitored to see if they developed CKD. The study concludes that "Proteinuria at presentation was significantly associated with development of azotemia although causal association cannot be inferred."

 

Protein in the urine may have causes other than CKD. There is more information about proteinuria on the Urinalysis page.

 

If you know your cat has proteinuria early on, you can take steps to control it, see Treatments.

 

The following tests may be helpful in assessing the presence of proteinuria:

Idexx Urine P:C Ratio


Idexx Laboratories is now offering a new test in a number of different countries which can calculate the protein:creatinine ratio.

 

How to integrate UPC ratios into your practice and uncover early renal disease is a video presentation about the new Idexx test (this lasts an hour).

 

E.R.D.-HealthScreen Urine Test                                                                                           


 

The E.R.D.-HealthScreen Urine Test is another test which may assist with detecting CKD in its early stages by detecting low levels of protein (microalbuminuria) in the cat's urine. The manufacturer claims that the test is able to detect cats at risk of CKD at a much earlier stage than other tests, i.e. when there is as little as 25% damage, compared to the minimum 65% damage that occurs before anything shows up in bloodwork.

 

The test is only available through your vet, who has to run the test in-house. If your vet does not have any in stock and you are in Europe, s/he can contact Heska's European distributors to obtain the test. Heska also has a list on its website of its distributors in other parts of the world.

 

In the USA it should not cost more than US$20-30 if performed in addition to other tests (Antech charges much less); it may cost slightly more if run in isolation. Unfortunately, it appears to be much more expensive in Europe, costing up to 200, though many vets will charge less.

 

The test is non-invasive, requiring only a urine sample, with results available in-house in less than five minutes. If the test is positive, further investigations should be performed, e.g. for high blood pressure. The test may also be positive if certain inflammatory diseases such as IBD or dental disease are also present, or if the cat has certain other conditions such as diabetes or hyperthyroidism.

 

Drugs has some information about the test.

 


Glomerular Filtration Rate                                                                                  Back to Page Index


 

Measuring the Glomerular Filtration Rate (see What Happens in CKD) can be a useful tool, and in fact the International Renal Insufficiency Society states that GFR is the "most accurate measure available for assessment of renal function." IRIS believes that eventually GFR will be the measure by which CKD can be categorised, although it will take some time to determine appropriate reference ranges.

 

The main problem with measuring GFR is that it is quite cumbersome, which is why few vets are able to do it.

 

Managing chronic kidney disease: 10 common questions (2012) Brown SA Presentation to the 83rd FVMA Annual Conference discusses more about GFR and the various ways of measuring it.

 

The following tests may be helpful in assessing GFR:

Iohexol Clearance Test (Plasma Iohexol Clearance Test)


This test uses iohexol, an iodinated radiographic contrast medium. Basically, the test measures how long it takes to clear a measured amount of iohexol from the kidneys, and this is then used to calculate the GFR. This test, sometimes referred to as the Plasma Iohexol Clearance test (PIC) is highly specialised and only available at a limited number of places in USA such as the Animal Health Diagnostic Laboratory at Michigan State University; I am not aware that the test is commercially available in Europe. This test may be particularly helpful  before opting for one of the more permanent methods of treating hyperthyroidism.

 

Estimation of glomerular filtration rate via 2- and 4-sample plasma clearance of iohexol and creatinine in clinically normal cats (2009) Heiene R, Reynolds BS, Bexfield NH, Larsen S & Gerritsen RJ American Journal of Veterinary Research 70(2) pp176-85 is a study into determining appropriate reference ranges. It found that the weight of the cat is a factor.

Michigan State University Diagnostic Center for Population and Animal Health has more information on this test (Volume 14 (1997) Number 3).

Current concepts for the management of chronic renal failure in the dog and cat - early diagnosis and supportive care (2005) is a presentation by Dr S Sanderson to the World Small Animal Veterinary Association World Congress which mentions this test.

 

Inulin Clearance Test


Like the iohexol clearance test, the inulin clearance test measures how long it takes the kidneys to clear a measured amount of a particular substance, in this case inulin. This test only requires a single IV injection of inulin, followed by the taking of a blood sample three hours later. The test is already commercially available in Germany. This test may be particularly helpful  before opting for one of the more permanent methods of treating hyperthyroidism.

 

Single-injection inulin clearance for routine measurement of glomerular filtration rate in cats (2003) Haller M, Rohner K, Muller W, Reutter F, Binder H, Estelberger W, Arnold P Journal of Feline Medicine & Surgery 5 (3) pp175-81 compared the inulin test to the iohexol clearance test and concluded that "the inulin clearance test is a valuable tool for the assessment of renal function in daily practice".

Alomed in Germany is offering this test.

 

 

 

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This page last updated: 24 June 2012

Links on this page last checked: 27 March 2012