Introduction

 There are no guarantees with CRF, but this section aims to show how some other CRF cats have overcome crises and regained a good quality of life, or have simply quietly continued to enjoy life despite a CRF diagnosis. The current record is held by Paris, who was diagnosed with CRF at the age of six months, yet who lived a long happy life for a further 16 years, dying at the age of 17 years and 2 months.

Whilst these histories are anecdotal to some extent, in Prolonging the life of the renal failure patient (2000), Waltham Focus 10 (3), Dr Jonathan Elliott states that "in a retrospective study, the correlation between plasma creatinine and survival in cats who presented with signs of stable CRF was very poor, with only 5% of the variation in survival time being predicted by the initial plasma creatinine concentration". This supports the Feline CRF Information list's's mantra, "treat the cat, not the numbers", and there are some excellent examples of this in the success stories below, which are divided into the following categories:

1. cats with high numbers at diagnosis whose numbers reduced following treatment;

2. cats with high numbers at diagnosis, whose numbers did not reduce with treatment, but who still had or have a good quality of life;

3. cats with low to medium numbers at diagnosis whose numbers have remained stable, or have even improved. 

Note: values in brackets are international values. Please see the What Do All Those Test Results Mean? page for information on the various test results quoted and Treatments for the treatments mentioned in the stories.

1.      High Numbers, Reduced After Treatment

Rad and Purr Box (diagnosed October 1999 aged 13, survived five years and seven months after diagnosis, died 14 May 2005 aged 18 years and 11 months of an unrelated condition)

Helen and Colleen, and Simon (Colleen diagnosed April 2002 aged 16, survived two years and two months after diagnosis, died 26 June 2004 aged 18; Simon diagnosed December 2002 aged 9, died of cancer on 26 September 2005 aged 12)

Leonor and Fred (diagnosed August 1999 aged 15.5, survived one year, eight months after diagnosis, died 11 April 2001)

Vickie and Isis (diagnosed July 2000 aged 6, survived three years and eleven months after diagnosis, died 11 June 2004 aged 10 after developing heart problems)

Tammy and Chula (diagnosed June 2003 aged 12, died 21 September 2007, aged 16)

Cori and Ebony (diagnosed May 2005 aged 13, still alive)

Jaye and Morgan (diagnosed October 2004 aged 3, still alive)

2.     High Numbers, No Change After Treatment

Susan and Moses (diagnosed August 2001 aged 7, survived one year after diagnosis, died August 2002)

Deb and Laney (diagnosed July 2001 aged approximately 10, survived two years after diagnosis, died July 2003)

3.     Low Numbers, Remained Stable

Darlene and Pooter (diagnosed 1996 aged 15, survived almost seven years after diagnosis, died May 2003 aged 22 of an unrelated condition)

Tina and Bandit (diagnosed March 2000, aged 10, survived 3.5 years after diagnosis, died 7 September 2003)

Sheri and Lucky (diagnosed June 2000, survived 2 years, 10 months after diagnosis, died 10 April 2003)

Jenney, Merlin and Circe (diagnosed August 2001 both aged 8, Circe still alive, Merlin died on 22 July 2007 aged 14) 

Linda and Mittens (diagnosed September 2001 aged 15, survived three years and seven months after diagnosis, died 7 April 2005 aged 18.5)

Jan and JR (diagnosed December 1995 aged 3, survived six years after diagnosis, died January 2002)

Voula and Pebbles (diagnosed in 1997 aged 14, survived four years after diagnosis, died in 2001)

Lynn and Hope diagnosed October 2001 aged six months, still alive)

Melinda and Killian (diagnosed October 2002 aged 4, still alive)

Dorothee and Paris (diagnosed January 1990 aged six months, died September 2006 aged 17 years and 2 months)

Mieke and Pimmy (diagnosed April 2006 aged 17, survived 19 months after diagnosis, died December 2007 aged 19 from heart disease)

Cindy and Custard (diagnosed October 1999 aged 10, survived eight years, died September 2007 aged 18 from cancer)

1.   High Numbers at Diagnosis, Reduced following Treatment

We are not your typical case, Purr Box and I. We stopped at the threshold of death’s door more than five years ago and have not taken that last step yet. I can say that without exaggeration because the veterinarian recommended euthanasia in October of 1999 and fortunately, my wife and I did not take that advice. We are not typical and I know that because I have known many people whose cats have "crossed over the rainbow bridge" due to CRF since Purr Box was diagnosed.

Purr Box was diagnosed in mid September, 1999 - 13 years old and just a few months after getting a clean bill of health. Her BUN was 159 (urea 56.8), her creatinine was 12.9 (1140) and her prognosis was very poor. Reluctantly, our vet said that we could try IV fluids for a couple of days. Her numbers rose slightly in the first 24 hours and after 48 hours dropped by an amount deemed to be insignificant. Euthanasia was the recommendation as it would "probably be easier on everyone". He said that Purr Box would certainly die in a very short amount of time if we did not intervene and if we did intervene, she might have a few days or weeks of questionable quality. After 72 hours on IV we let it be known that we were not giving up, and the vet agreed that Purr Box could continue to receive IV fluids for 9 hours per day in his office and then come home at night. We pressed on as there was no way in the world that we could bring ourselves to euthanize our buddy of 13 years while she was still responsive and quick to purr. We hit the books and the internet with the time we had bought and, after a crash course in CRF, decided that we would fight as long as Purr Box was willing and able to do so.

Her numbers started to fall more rapidly on the sixth day and continued to drop through day 11 when we brought her home, hopeful but afraid. She was sent home with a prescription diet and vitamins as her only treatment, and when we asked about sub-Q fluids, we were told that they were ineffective. As a result, her numbers slowly rose over the next eight weeks and by the time December arrived, she was back in the hospital on IV fluids again. This time we saw a different veterinarian in the same practice and successfully lobbied him to prescribe sub-Q fluids if we could get Purr Box's numbers under control again. We were lucky and a few days later started sub-Q's on a daily basis.

All was well for the next three months - until diabetes struck. We learned how to administer insulin but after eight weeks of trying to find the correct dose, the diabetes vanished just as mysteriously and as quickly as it appeared. The diabetes brought us into contact with a specialist and in the course of events we learned through an ultrasound that Purr Box had significant hypertrophic cardiomyopathy (see Related Diseases) - the cause of her previously undiagnosed heart murmur. Three pills a day were added to the regimen.

She crashed again just two weeks after starting her new heart medication and her BUN and creatinine soared to nearly the same levels that they were at diagnosis. We feared that Purr Box's end was very near but once more she rallied after being on IV for a week. That was in May of 2000 and we have not looked back. She is still with us, living life and loving it, and we have shared countless hours of play, purrs and love since the vet recommended that she be euthanized. Her bloodwork in November 2004 was BUN 43 (urea 15.3, creatinine 3.4 (300) and phosphorus 49 (1.58). Three times a day she takes her pill and had more trouble adjusting to them than she did her fluids. Now, she takes them in her stride. Every other night she receives sub-Q fluids and watches me warm them. For the first three and a half years, almost unbelievably, she voluntarily joined me on the couch after seeing me hang up the bag. These days I carry her to the couch, but she is as patient as can be for the four minute session during which she enjoys her favorite treat, beef baby food, hand fed from a demi-tasse spoon. She often wants to play after the session. (Purr Box is the model in How to Give Sub-Cutaneous Fluids: Giving Set Method).

After 1000 fluid sessions, 5200 pills and many trips to the vet, Purr Box remains a happy cat. Throughout all of the tribulations she has proved to be resilient: remaining loving, trusting, affectionate and playful - quick to purr and eager to find a warm lap. We count our blessings every day.

Update: Purr Box was put to sleep on 14 May 2005, one month shy of her 19th birthday. Her CRF was still under control,  but her quality of life was suffering because of severe spinal pain, and the usual treatments could not help.

Helen and Colleen, and Simon Too

Colleen was diagnosed with CRF in April 2002 at the age of 16.  She had seemed a little under the weather for a week or so, but I didn't think she was ill enough to see a vet. Then, over the course of two or three hours, she took a sudden turn for the worse.  I found her trembling, barely able to stand, and only then did I realize she was severely dehydrated.  I rushed her to the emergency clinic; the vet took one quick look at her, smelled her breath, and told me her kidneys had failed.  I was devastated, and I felt guilty that I hadn't taken her to a vet earlier.  Colleen was kept at the emergency clinic for IV fluids overnight.

I picked her up the next morning, in tears, to take her to my regular vet.  I was sure she was going to have to be put to sleep; in fact, I thought about taking her home for a couple of hours so that we could say our goodbyes.  But bringing her home then putting her through the trauma of taking her out again would be cruel; I was being selfish.  With a heavy heart I drove straight to my regular vet's office, as ready as I'd ever be to let her go.

I will always be grateful to my vet for urging me to treat Colleen.  I knew almost nothing about CRF and even less about how it was treated. Perhaps it was better that I didn't know how bad her lab results were on the papers I brought from the emergency clinic, or I might have insisted on euthanasia.  My vet wisely made no predictions and simply assured me that cats with CRF could live for weeks, months, or even years with supportive care.

Colleen remained at the clinic for another three days of IV fluids, then she came home with fluids for subcutaneous administration, prescription foods, and several medicines and supplements.  She's always been nearly impossible to pill, so I was sure that she would not tolerate my giving her sub-Q fluids every day.  But she surprised me - she co-operated, though grudgingly.  She hated the needle stick, but as my technique improved with practice, she grumbled less.  She still does her best to avoid me if she thinks it's fluids time, but once I catch her doesn't protest.  She knows that a favorite treat of baby food and a drop of milk follows the session, which helps both of us end on a positive note, and then she climbs onto my chair for a cuddle-and-purr session to let me know she's forgiven me.

At the ER, Colleen's BUN was over 130 (urea 46.4) (the highest their instruments could measure), her creatinine 9.3 (82), and her phosphorus 9.7 (3.1).  After three days  of IV fluids at my regular vet, her BUN was 154 (urea 55) and her creatinine had dropped to 7.3 (645), but her phosphorus had risen to 12.1 (3.9).  So we began administering a phosphorus binder to limit her absorption of phosphorus.  That wasn't so easy as the fluids; she hated the taste of the liquid that had been prescribed, and she wouldn't touch it mixed in her food.  Fortunately, I learned there were tasteless powdered binders that she doesn't find unpalatable.  So that I didn't have to pill her with Pepcid, my vet gave me a prescription for famotidine injectable, which Colleen gets with her fluids.  At first, she also took Reglan injectable for nausea and vomiting, but we were able to discontinue it after several weeks, and so far the nausea has not returned.

She wouldn't eat enough of the prescription foods to maintain her weight, and I started trying to find a low-phosphorus regular food that she would accept.  Hundreds of dollars later, I gave up entirely and went back to her preferred Fancy Feast, sticking with the varieties that were lower in phosphorus.  I increased the binder dose to help compensate for the high phosphorus, but we still had a battle ahead of us.

Over the next few weeks, her creatinine rose again.  By June it was 8.2 (725), and her BUN was 177 (urea 63.2).  Her phosphorus had come down to 9.1 (2.93) but was still dangerously high.  I increased the binders and continued to let her eat her favorite foods along with some treats.  By now we were fighting anemia as well, so she started on an iron supplement and injectable B-complex vitamins.  Her rear legs were still weak, so her potassium supplement was increased.

The next test, in July, was greatly improved.  Her BUN had dropped to 105 (urea 37.5) and her creatinine to 6.4 (566).  I hoped that we could keep her at that level for a while, as further improvement seemed unlikely.  But she surprised us.  By December 2002, her BUN had dropped to 93 (urea 33) and her creatinine to 4.8 (424).  Her phosphorus was a reasonable 5.6 (1.8), which took her out of the danger zone for soft tissue calcification.  Shortly thereafter we started her on calcitriol, a medicine for the secondary hyperparathyroidism that develops in CRF, and it has given her more energy and improved her appetite.   In February 2003, blood tests revealed a BUN of 73 (urea 26.1) and creatinine of 4.0 (354), with phosphorus holding steady at 5.5 (1.77).  We are thrilled by how well she's doing.

Today Colleen is maintaining her fighting weight of just over 6 lbs.  Her appetite is excellent; she eats on her own and demands to be fed.  If she doesn't want what I serve, she turns up her nose and waits for me to open another can, which I do with a smile.  Her fur is sleek and glossy, the uraemic smell is long gone, and her strength has returned completely.  I have been able to remove the ramps I put up so that she could clamber up to her favourite high spots; she again jumps two to three feet with ease and precision.  She's perky and affectionate.  I've caught her doing the "mad dash" around the house, racing up and down the stairs, and playing with her toys.  She's as energetic as a kitten at times.

Her unrelated brother, Simon, was diagnosed with early CRF in December 2002, with BUN 61 (urea 21.8) and creatinine 3.1 (274).  He is only 9 years old.  I was saddened, of course, but at least I knew what we needed to do for him, so I took it in stride.  His treatments are virtually identical to Colleen's, including fluids every other day, but he also takes medicines for other health conditions.  Treating two CRF cats isn't much more work than treating one, and fluids take less than five minutes per cat.  We're all coping well with the daily routine, leaving me some time to spend with my other two healthy cats so they don't feel left out.

Colleen's and Simon's current treatments include supplemental potassium, iron, and B complex; an antioxidant formula; subcutaneous fluids; famotidine; phosphorus binder; calcitriol; and lactulose syrup for Colleen to prevent constipation.  I bought a pet fountain on the recommendation of other CRF cat caregivers, and it's the most popular spot in the house - sometimes one cat is drinking and another is queued up for a turn!  Their appetites are good, and they clearly are enjoying their lives.

While CRF is not curable, many cats live comfortably for years, including some with worse numbers at diagnosis than Colleen's.  From my online CRF support group, I've learned many tricks and tips from long-time CRF caregivers.   As long as Colleen and Simon are feeling well and enjoying their lives, I will continue to provide them with the best care I can.

In November 2002, Colleen celebrated the 17th birthday we never expected her to see.  Colleen is truly my miracle kitty and a testament to veterinary medicine. 

Note: Colleen was put to sleep on 26 June 2004 aged 18 and 8 months. Simon was put to sleep because of cancer on 26 September 2005, aged 12.

Leonor and Fred

Fred was 15.5 years old when he was diagnosed with CRF, on August 6, 1999. CRF seemingly took us all by surprise. Fred had had his minor ailments in the past in the form of an impacted anal gland that every 18 months or so had to be treated. When he was 9 years old, he had a very bad reaction to a "light" cat food, and we very nearly lost him, but luckily someone thought of changing his food, and within 48 hours he had stopped vomiting and was eating normally again, and a week or so later, he regained his strength and nearly all the weight he lost.

But, CRF was a dark horse for us. From one day to the next, Fred stopped eating, acted listless, smelled very strange, and hovered over the water bowl. I thought he had an upset stomach, so I rushed out to buy him his tried-and-true comfort food (Purina EN), which he immediately gobbled down. I would have let things go at that, but there was something about his demeanor that was not "quite right," and he looked thinner than usual. The vet's advice was to take him in for an exam as soon as possible, and we immediately followed that advice. A call that afternoon to the vet produced the news that Fred was in kidney failure with a creatinine level of 9.8 (866)! We were lucky - the vet was very well versed in the ups and downs of CRF, and he advised immediate IV treatment bolstered with potassium.

Friday, August 6, 1999... Fred spent the day on IV at the vet's and in the afternoon, I moved him to a local emergency clinic, where the vet in charge was amazed that Fred was in kidney failure - his remark was, "He looks so good, so healthy!" Fred was not released until the following Monday morning. I spent hours visiting him off and on throughout the weekend. When I wasn't there, Fred's temperature would drop, he would stop eating, and he would urinate all over himself. When he saw me, he responded to my coaxing with food and he used the litter box.

When Fred came off the IV, his creatinine had dropped to 5.1 (451). We began a regime of sub-Q treatments, 100 ml of Lactated Ringers Solution (LRS) once daily. A vet tech, who would later care for Fred every time I was away, trained me in giving sub-Qs. It took me months before I felt confident enough to sub-Q Fred on my own. The most difficult thing for me was removing the cap from the needle! Fred was a patient and tolerant recipient of the sub-Qs nearly all the time - OK, he did squirm once in a while... and he hid from the vet tech.

Fred flourished at home. When I was at work, he was left in the care of Renata - his then 19.5 year old grandmother. She showed Fred how "yummy" Hill's K/D tasted, and he followed suit. As she had always done, she led Fred to his food bowl, and they both enjoyed their K/D "treat." Renata had an incredibly stabilizing influence on Fred. He felt protected. He was back in his own environment, and nothing was different for him, except for a few pills, and a 5-minute sub-Q treatment as well as a change in diet that grandmother Renata assured him was truly yummy.

At his next blood test, three weeks later, Fred's creatinine dropped to the 4.0 (353) range. A month after that, Fred's creatinine was at 3.1 (274). We increased the time between sub-Qs. Perhaps that was wrong; I now know more about CRF and understand that it probably would have been better for Fred to get more frequent sub-Qs with less LRS per sub-Q.

For the major part of Fred's last twenty months of life, his creatinine remained below 4.0 (353), and with the help of Pet-Tinic (iron medication), his PCV was just below 29.0 (ranged between 26.0 and 28.0), the lowest normal reading. Fred was active, agile, and alert, and he maintained his weight. As time went on, we dropped cyproheptadine (appetite stimulant) from Fred's treatment (in reality, Fred didn't require cyproheptadine for more than a couple of weeks - Renata did a good job of convincing him to eat again, and he felt so much better on sub-Qs). We had to add Tumil-K (for low potassium), Norvasc (for high blood pressure), and Renagel (phosphorus binder). Fred was fairly easy to pill, and he was equally easy to sub-Q. He was angry with me post-sub-Q treatment, but within five minutes, he forgave and forgot (in reverse order, of course).

The vet revised his original prediction that Fred would live from six months to possibly a year following diagnosis to an undetermined life span. Fred seemed to be beating the odds.

Fred's sudden decline was at about 18.5 months post diagnosis. His BUN and creatinine were relatively low (creatinine was close to 5.0 (422) at the highest reading then). He started having visual difficulties. Anemia caught up with him, and he suddenly failed massively. He required an emergency transfusion before starting Epogen. One morning, the vet tech had to rush him to our vet because I had to be at a (silly) meeting at work. At that time, Fred had developed pancreatitis and was hospitalized - the vet donated the special IV treatment Fred needed. Then, he required emergency dental surgery. Pancreatitis hit again. Nothing we did seemed to help once the pancreatitis was diagnosed for a second time. Both the emergency vet and Fred's own vet suggested that he be helped to cross. I went to the emergency clinic on April 1, 2001, not knowing what to do. Fred stood up, walked over to me, and talked to me, and then ate from my hand. He also ate from the hand of the vet tech who had been treating him at the clinic. He wanted to come home, and I honored his wishes.

Fred declined at home, but a day before he went into a coma, he seemed to rally. Renata hovered over him all the time. She would prod him and deliberately eat his food to get him to react. He was listless, he lost the use of his back legs, he ate very little, and he fought every attempt I made to syringe-feed him (but I did get some food down). Renata just watched him - he stayed on the floor next to my bed on a special hospital padding, and Renata was always a few feet from him, if not next to him. She never left the bedroom. Fred spent his last night on the hospital padding, asleep next to me, with Renata curled around him on his other side. At that point, he gave up and lapsed into a coma - he seemed to be sleeping peacefully and breathing evenly with no stress, but he would not respond. I knew I would have to help him cross. He left this world around noon on April 11, 2001. Renata knew he was gone.

Fred left a void that has never been filled. Renata followed him on September 29, 2001, when she was 21 years 7.5 months old. I believe that she never recovered from having lost her Fred. No one could ever take her place, or Fred's.

Fred and Renata's Memorial Page shows their photos, in each case taken not too long before they passed, and tells their life story.

Vickie and Isis

My little Isis was diagnosed with CRF on July 3, 2000. Her sister, Sheba, had been diagnosed in February of 2000. The vet I had at the time said "her numbers are off the chart", and told me that every day would be harder for little Sheba. That vet told me I should put Sheba to sleep. I trusted him and his advice, and sent my little Sheba to Heaven that same day.

Since Sheba was only 6 years old, the vet told me that the CRF was probably congenital. I asked him to test Isis to see how she was, but for reasons that never made sense to me, he wouldn’t do it.

In June of 2000, Isis started having problems with her back legs. It seemed like she was always limping and/or hurting herself. It wouldn’t really last long, but in July of 2000, I took her to the vet and insisted that bloodwork be done on her. That’s when she was diagnosed with CRF. Her creatinine was at 7.9 (intermational: 698)… all other numbers were within normal ranges.

That vet wouldn’t do anything for her. He was apparently against sub-Q’s, saying that her quality of life would be an issue if we went that route. He said to let him know if Isis quit eating and drinking… that would be the time to put her to sleep.

Luckily, in the months since Sheba’s death, I had started volunteering at a no-kill shelter where they had a vet on staff. This vet is a pioneer in the CRF field, being one of the first vets to do peritoneal dialysis and kidney transplants. When I received Isis’ diagnosis, I spoke to this vet at the shelter, who suggested I bring Isis in. She confirmed the diagnosis, but had me start Isis on sub-Q’s. When I asked her what I could expect, she told me that "an excellent outcome would be if Isis lives for two years". Also, we tried to get Isis onto several different renal foods, but Isis has never gone for any of them. The vet always told me that keeping her eating was the most important thing, and not to worry too much about the quality of the food. I had always given Isis the Iams dry food (free feeding). She went on the Iams canned chicken catfood, and has pretty much remained on that through the years.

After two weeks, Isis’ creatinine came down to 5.9 (522). Over the next few months, her creatinine wavered, but finally seemed to settle in at about 4.5 (398). The only treatment she was getting was sub-Q’s which eventually went up to 250ml every day.

Isis was always EXTREMELY traumatized at the vet’s office. When we lived in California, we had a wonderful vet and Isis was fine there. But when I moved to Ohio, the vet I first took Isis to was an idiot! Isis is aggressive at the vet’s office. Apparently, this vet was afraid of aggressive cats, so she muzzled Isis. When I say "muzzled", I mean she put a muzzle over Isis that closed off her mouth, her eyes, her ears… all her senses. Then, she turned away from Isis while she was on the examination table. When Isis stumbled and started to fall, this idiot vet grabbed her by the hair around her sides, pulling a lot of hair out. This is when I told the vet to take a flying leap, and I got Isis out of there. Unfortunately, however, the damage was already done, and Isis has had a very difficult time with any vet since then.

So, because Isis is so traumatized at the vet’s office, my new vet wanted to limit the visits to as little as possible, because it would take Isis a full week after a visit to get back to eating and behaving normally.

In August of 2001, Isis didn’t seem to be doing very well. She wouldn’t eat, her weight was dropping, etc. So I took her in for bloodwork, expecting the worst. However, I was pleasantly surprised… her creatinine had come down to 2.9 (256)!! Isis seemed to be having some sinus/allergy problems: her eyes would water a lot. Anyway, I switched over to some Iams catfish food, and she gobbled that up. The vet was VERY encouraged by her numbers. She told me I could expect Isis to have pretty much of a normal lifespan. Imagine my joy!

In March of 2003, Isis started acting very weird after receiving her fluids. About 90 minutes after I gave her fluids, she’d slink off of wherever she was and slither to the ground, like she was terrified. Sometimes she’d cry if I came near her. She would go hide under a bed, and stay there for hours. It always happened about 90 minutes after giving her fluids. My regular vet was out of town, but I was able to reach her. She felt it sounded like a blood pressure problem, and told me to get her to a vet immediately, which I did. Her blood pressure was fine, but her creatinine had risen to 5.4 (477). According to the stand-in vet, "she had rounded her last bend". Both this vet and my regular vet told me to prepare myself…they said she wouldn’t make it to Christmas.

We increased her fluids to 300ml per day, and added Pepcid AC, Calcitriol, and Pet-tinic to her daily routine. Also, I started warming her fluids, which I had never done before. Within a few days, she was back to her old self. We never did determine what the initial problem was.

My regular vet said there was no need to do any more bloodwork (the stand-in vet actually had to anesthetize Isis to do a blood draw…it was horrible). She said there wasn’t really anything we would change in her treatment, even if her creatinine continued to rise (remember, all other numbers were still pretty much within normal ranges). We couldn’t increase her fluids any higher, so she felt there was no reason to put Isis through the trauma of any more visits.

Right after Isis was diagnosed, I purchased a vet scale to keep track of her weight. I have weighed Isis every Friday morning since she was originally diagnosed. From July of 2000 to December of 2003, her weight never fluctuated more than 3 ounces. However, in January of 2004, her weight started dropping. I was having a hard time finding something that she would eat; however, I felt that she was hungry. I always felt that if I could just find the right food, she would eat it. Isis would only eat certain dates of the Iams food…I could put down 10 plates of food, and she would pick out the one plate that had a particular date on the food that she liked! So, about every 6 weeks, when I had run out of that particular date, I would have to start over, trying to find one that she liked. In January of 2004, I just couldn’t find anything she liked.

When I mentioned this to my vet, she suggested that I quit weighing her every week. She would send a "cocktail" of appetite stimulants home with me to give Isis, but she felt it was just stressing both Isis AND me to see her weight dropping. So, I haven’t weighed her since the middle of February. However, towards the end of February, I was able to find food she liked, and she has continued to eat well every since then. I believe her weight started to come back up.

Last week, I noticed that she wasn’t absorbing her fluids by the time I was to give her more. Just this past Tuesday, I spoke to the vet, who had me reduce her fluids to 150ml per day. She feels that Isis has developed some circulatory/heart problems, so we now begin that balancing act between making sure she has fluids to keep her hydrated, and not giving her so many that it will compromise her heart or lungs.

I feel the end is very near…but I have included a picture of my precious little Isis that was just taken last week. As you can see, to anyone who isn’t aware of her story, she looks to be the picture of health… and I believe she will continue to defy the odds.

Note: Isis was put to sleep on 11 June 2004 after developing heart problems.

Tammy and Chula

Chula first crashed on 7th June 2003 at 12 years old. She had never been sick and although she had been losing weight I attributed it to her aging years since she showed no other signs. Her crash literally happened overnight. We went to bed with her acting normal, sleeping by my side as always and woke up with her hiding and not letting me touch her. That was a Sunday and first thing Monday morning she was at the vets for blood tests and x-rays. When the vet called me with the diagnosis of chronic renal failure I honestly did not understand the depth of what she was saying. I certainly know the meaning of all those words but my mind could not wrap itself around what it meant. When I dropped her off to start IV fluids and one of the other vets at the clinic (not Chula’s vet) said I could probably buy her a few months with sub-q’s at home it finally sank in that I was dealing with a fatal disease.

Her BUN was too high for their labs to read, her creatinine was 13 (1149) and her phosphorus was 16 (5.16). At the check after 48 and 72 hours her numbers actually climbed higher. She was also diagnosed with a grade 2 heart murmur. I am very fortunate that the vet who initially treated her refused to give up and only told me afterwards that she had been scared we were going to lose her. After almost 6 full days of IV fluids in the ICU her numbers finally came down into a manageable range and she came home. I was given lessons on sub-q’s, K/D renal diet and that was it at that point.

I found this site and the support group and started learning everything I could do to help my girl. She was not due to go in for re-testing for 3 months but had another crash again in August with numbers not quite as high as the first time but again she was dehydrated. We had been doing fluids every other day and decided she was going to need 100ml daily fluids to maintain. She also would not eat any of the renal diets and try as hard as I might could not get her switched over from her much loved Fancy Feast. So aluminum hydroxide binders were added to the regimen to try and compensate for the phosphorus. Her stools were a little on the hard side so Lactulose was added for her constipation and we started her on Pepcid AC since she had started vomiting the foamy acid She again seemed to rally well, her kidney values came back down to just over normal and overall she seemed to be doing really well. But still there were days when she just seemed worn out and her appetite was still horrible.

It was then that I found out that dehydration can mask anemia. Her HCT had come back in normal range each time we had blood run so I had felt there was no reason to worry. Well the only time her HCT had been done was the times she had been dehydrated. We had values run again in Dec 03 and she was found to be slightly anemic. I immediately started her on Fer-in-Sol and in spite of giving her double the dose of Lactulose it caused her to become so constipated she ended up at the vets for an enema. She took about 10 days to fully bounce back from it, was started on Pet-Tinic, folic acid and B vitamins and within 3 weeks her HCT went from 23% to 29%. At the same time we had her BP checked and it was 210-220 so we started her on Norvasc. Her dose had to be adjusted but within 6 weeks had come down to 165, a level we were comfortable with.

We had several good months until all of a sudden in April 04 her eating went downhill again. She had managed to gain back three of the four pounds she had initially lost and now was losing again.

The problem turned out to be her teeth. She has FORL and one of the teeth that was being re-absorbed was cracked and causing her mouth pain. After talking to her vet and feeling confident that they would do all procedures that were recommended for CRF kitties when having a dental done, (they actually practice this on all geriatric or compromised patients) we went ahead with it.

She came through the procedure great, was treated for a mild urinary tract infection and has been doing great since.

She continues on 50ml of fluids daily, BP medicine, B’s and iron, phosphorus binders (still loves that FF), and Lactulose. It takes less than 10 minutes a day for all the meds and her quality of life is great.

We just ran her kidney values again 6 weeks after her dental and her BUN was 50 (17.85), creat 2.5 (221) and phos at 5.6 (1.8). Her BP has remained stable, her eating has been great and most days no one would believe she is sick or was near deaths door at her initial diagnosis.

While I know that CRF is terminal and I know that things can certainly change quickly with this disease I feel so blessed to have had an extra year (so far) that I never believed I could have and I pray for many more cuddles with my “Mama’s baby” .

Update: Chula died on 20 September 2007 aged 16.

Cori and Ebony

Ebony was diagnosed with renal failure on May 18th, 2005 at 13 years of age, and was admitted to the hospital and put on IV fluids for 3 days. I brought her in because she had crashed, though I didn't know that was what we call it at the time. I had noticed some bad breath for a while, though ignorantly didn't know just how much of a danger sign that could be. I had noticed she'd been losing a bit of weight, but as I was focused on my new baby I didn't quite notice just how bad it was until I noticed she looked really ill and I picked her up and she felt light as a feather - she had dropped to between 4-5 pounds and is normally an 8 pound cat. We immediately got her in to the vet.

We brought her in Monday morning and they did bloodwork and sent her home, which concerned me because of how bad she looked. The next day I insisted she be admitted to the hospital because of how ill she looked and how dehydrated she was. Her labs came back the next day with a BUN of 253 (international: 90.3), creatinine of 18.2 (international: 1609) and phosphorus of 25.8 (international: 8.3). Needless to say my little girl was in dire straits. To add to her condition, she wasn't eating the whole time she was in the hospital, which concerned me greatly and I went in every day to try to get her to eat. The vets basically said that with the IV therapy her numbers might come down and that if they headed downwards there might be hope. After 3 days of IV fluids her levels dropped to BUN still over 130  (international: 46.4) and phosphorus 13.2 (international: 4.26), but creatinine remained the same at 18.2 (international: 1609). Even though the numbers had come down some, they said that it wasn't enough and that there was no hope. I was devastated because I blamed myself for not being more attentive to her and noticing how ill she was earlier. The recommendation was to put her to sleep.

It was the same day we got that dreadful call that I found this website, and what a lifesaving find that turned out to be. Through the site I came to realize that there might be hope and I also found a CRF support list. After a desperate plea for help several very caring individuals offered me advice and support. I was still expecting the worse when we went to pick Ebony up from the vet, for what we thought would likely be our final evening together before saying goodbye. I spoke with the vet about treatment options but they basically said that the only thing that could be done was to keep her on an IV, or try 300ml  of sub-q fluids, but that in her case there really wasn't hope. I was sent home with the comment that we'd see how she was doing by the next day and maybe (if she was still alive) they would give her some fluids for me to administer at home. I wasn't as sure as they were that she was on death's door - she still had that gleam in her eye and she had perked up somewhat and I felt like she was telling me she wasn't ready to go.

I didn't actually spend much time with Ebony that evening because I spent about 8 hours online giving myself a crash course in feline CRF. My mind was swimming and I was nearing a breakdown because I felt I couldn't handle this. A kind listmember gave me some advice that I needed to take things one at a time, focus on the basics of getting food in her, getting phosphorus binder, and getting sub-Q fluids. I found that writing notes was extremely helpful in keeping track of what I needed to do for Ebony.

We got started on the 300ml of fluids a day, but Ebony seemed to be reacting badly to it, she looked lethargic, very fluffy, and like she was having difficulty breathing. After consulting the group, I was very concerned about filling her with so much fluids that her lungs would fail, or overworking her heart. I called the vet and the answer I got was basically that 300ml was the only amount I could give that might help her. Well, I went with my gut and the advice of the experienced members of the group, and cut it back to 150ml a day. Ebony did much better and was looking more herself.

During this time I had also discovered that I had to make my kitty eat if she was going to have a chance at life, so we started doing that the night she came home. Thankfully she didn't reject the food, and in time we learned the best methods for feeding her. She was assist fed three times a day for several months. We had to give her Zantac, then Pepcid, to help with her upset tummy, and we got the phosphorus binders (aluminum hydroxide powder) to help bring her phosphorus down. Ebony also had a raging infection during the first couple months and was put on Baytril for 9-10 weeks. She was also on Tumil-K to increase her potassium. After several months Ebony started munching dry KD on her own, eating a little more over time and so we tapered back her assist feedings until she was eating entirely on her own, which took many months to achieve. Though I felt at first like I was doing something cruel to her, I now realize that what I gave her was time – time for her body to heal, while still being nourished, until she was able to eat on her own. She now eats a mixture of dry KD and senior formula.

Within about a week after being diagnosed with CRF we discovered she was getting dangerously anemic and learned about epogen. We also changed vets at this time, and thankfully our new vet was very willing to work with us, and she was open to hearing the advice of listmembers. Her attitude was that the collective experience of the listmembers was more than she would ever have in her career and it was worth listening to. I was so thankful for her. She has continued to be Ebony's vet, and she has been grateful for all that she has learned through Ebony's case. Her willingness to listen to listmember advice was what got us through her complete inexperience with Epogen. Ebony responded very quickly to the Epogen and her levels rose very fast, to a point of concern (for both potential Epogen antibodies and fear of high blood pressure and clots), so we ended up stopping the Epogen. After a month her levels started to decline and we were concerned about antibodies because of how fast it dropped. We consulted with various experts, and it was suggested that we wait to start Epogen until it got down to 20%. During the entire time of her anemia she was given Super B complex and Pet Tinic, and still gets these. Well, thankfully Ebony's little reticulocytes started producing again on their own and her HCT slowly began rising over a couple of months and has remained in normal range ever since.

It has been a very emotional ride, we went from the rollercoaster to the merry-go-round, and now it feels like we're on the tram (only a few little potholes here and there to jostle us about). I couldn't have gotten through this without the wonderful members of these groups. Ebony, now 14, is doing great, she's a plump 8½ pounds, eats well (perhaps a little too well), is her normal "kitten-boo" self who loves to spaz through the house and go flying up the cat tower. Her levels are now (as of June 2006) down to BUN 50 (international: 17.85), crea 3.2 (international: 283), phosphorus 3.7 (international: 1.19) and have stayed steady at these levels for the past 6 months. Ebony is on 75ml of fluids a day, gets her Super B and Pet Tinic and phosphorus binders still, but she is thriving and looking very healthy, but most importantly - happy. I have cherished every moment I've had with her. There were many prayers given on her behalf and I believe that many were answered through the angels I met through this site. While I've had friends tell me I was crazy for spending as much money on Ebony that I did to get her where she is today, I say she is worth every penny.

As a final note, I had created an excel spreadsheet to track Ebony's bloodwork and have found it to be very helpful in watching trends and doing comparisons. Others have found this chart helpful and I have placed this chart online for anyone to use. It is available here.

Update March 2007: We are nearing Ebony’s two year anniversary of her CRF diagnosis and Ebony is doing great. She is a chunky 8lbs 6oz (actually overweight for her), she’s got great muscle tone; she’s eating well and has lots of spunk. Ebony just recently had a checkup and her blood pressure was 148 (under stress) and her bloodwork came back with a BUN of 47 (international: 16.77),  creatinine of 2.8 (international: 248), phosphorus of 3.5 (international: 1.13) and her CBC was great, all normal. Her heart and lungs sound good and overall the vet says that she seems to be doing great. Ebony gets 75ml sub-q a day with some Super B complex and phosphorus binder in some wet food. She eats a mixture of Hills Feline Senior and K/D dry. We make sure she gets lots of water and LOTS of love. I never imagined Ebony would have the levels she does now based on where we started, but lots of TLC and lots of help from Feline CRF listserv friends have helped us reach this point. Here’s hoping for a long time yet with our Boo-kitty.

Jaye and Morgan

Morgan’s case is an unusual one. First, she was diagnosed very young, and second, she’s a genuine UK success story! I’m writing this in the hope that other UK people will read this and take heart. CRF is not an automatic death sentence, no matter what your vet may tell you!

Morgan is a beautiful black part-Persian female with big amber eyes and an even bigger personality. When she first arrived in my life, she was a terrified little 8-week old feral who hissed at me from the back of the cat-carrier. But over the weeks and months that followed, she learnt to trust me and she became my little black shadow. She is the most gentle and loving cat I’ve ever met and we share a very special bond. I was absolutely devastated when, aged only 3 years old, she stopped eating, became very sick and depressed, and was diagnosed with so-called ‘end-stage’ CRF. Her BUN was 221 (international: 79) and creatinine 17.53 (international: 1550). Her vet gave her a week or so (at most) to live.

I wondered – was there anything I could have done to prevent it? Why didn’t I notice the symptoms earlier? I felt so incredibly guilty. But that frame of mind wasn’t going to help Morgan. I had to do something now. So Morgan went on IV for 4 days and nights, and by some miracle, her numbers dropped and she began eating by herself again. She was sent home with no ongoing treatments, just a dry prescription diet that she refused to eat. Normal ‘treatments’ in the UK are prescription diet, steroid injections, vit B injections and Fortekor. My vet was no different. Unsurprisingly, Morgan became dehydrated and when she ‘crashed’ again 5 weeks later, with numbers almost as high as on diagnosis, those were the only options he offered me, although even he wasn’t convinced of the benefits of Fortekor in Morgan’s case.

Eventually, after further IV treatment, Morgan’s numbers dropped again and she was sent home, but when I mentioned this site and the various options available, including Sub-Q’s to combat dehydration and Pepcid AC for stomach acid, he told me to "stop second guessing the treatments and let me do my job". If I had, Morgan would be dead. It’s that simple. I did eventually persuade him to try giving her Sub-Q’s at his practice, but he refused to let me do them at home. Unfortunately, that proved to be the worst of all possible worlds. The vet trips were stressful for Morgan, and twice a week was not sufficient to keep her hydrated. She crashed again 2 weeks later.

It was clear what the vet thought I should do, but I couldn’t give up on her until I was sure there was no chance of stabilising her and giving her quality of life. Besides, Morgan was still on her feet and interested in the world around her – and if she was not ready to give up, how could I?

With the help and encouragement of Helen (the owner of this site) and others, I tried to find another vet. I was given the details of a top UK feline renal specialist who had just moved to within driving distance of where I lived. I told my vet I wanted a referral, and I think he was glad to get rid of me!

The specialist saved Morgan’s life. I have no doubt about that. The delays in getting the proper treatment meant her problems had gone from very bad to even worse. When we went to see the specialist, Morgan’s creatinine had risen to 21 (international: 1850) and on top of these very high numbers Morgan had severe metabolic acidosis. It was amazing she was still alive.

But Morgan’s fighting spirit was very strong, and somehow, she pulled through. There were some ups and downs in the following weeks until we got the right balance of medications, but since January 2005, Morgan has been treated entirely at home, with just the occasional check up and adjustment in medication. She is on 100ml of subcutaneous fluids every day, plus one empty gel-cap a day filled with the following medications: sodium bicarb to treat metabolic acidosis, aluminium hydroxide as a phosphorous binder, ranitidine (zantac) for excess stomach acid, odansetron (zofran) as an anti-sickness drug, periactin as an appetite enhancer, iron for mild anemia, and vit B complex, also for mild anemia. All of this is administered at home and takes less than 5 minutes a day.

Many UK vets either don’t understand the value of Sub-Q’s, or believe they compromise the quality of life of the cat. I ask you – how can less than 5 minutes a day compromise the other 23 hours and 55 minutes? I don’t understand why it is acceptable to treat diabetic cats at home (which also can involve needles), but not CRF. It makes no sense.

As I write this, Morgan is a bright, happy and playful 5 year-old, and you’d never know she has a life-threatening illness. I pray this continues for a very, very long time. At her last check-up, Morgan’s BUN was 60 (international: 21.5) and her creatinine was 4.2 (international: 373).

Morgan’s case has been reported in the Feline Advisory Bureau’s journal and in the February 2006 edition of ‘Your Cat’ magazine, in an attempt to educate people and their vets here in the UK that there are treatments available for CRF. If her story changes the viewpoint of just one vet, or saves the life of just one other cat, then at least it’s a start.

If you have a cat with CRF in the UK and you want someone to talk to – whether you need help or just a sympathetic ear – then I can be contacted via the website owner. I’ll be happy to help if I can.

2.  High Numbers, No Change After Treatment

Susan and Moses

In mid-August 2001, I noticed that Moses was drooling. I assumed it was a tooth problem, and I scheduled him for a dental. He had had a check-up the previous year, and everything was normal. Since he was only 7 years old, we never thought it would be anything more than a bad tooth. Other than the drooling, he was not acting differently.

When we had the preliminary blood work done before his dental, the numbers were frightening - he tested off the scale for BUN/urea and creatinine. My vet immediately put him on IV, and he was alarmed, but he is a "treat the cat, not the numbers" doctor. He thought perhaps it was an infection, but the blood work that was sent off came back confirming kidney failure. BUN was 216 (urea 77), creatinine was 17 (1502), but other key numbers were only slightly elevated. So, he spent a week in the hospital, and, by the week's end, we had no great improvement - BUN 135 (urea 48) & creatinine 10 (884).

My vet sent him home with fluids, supplements, and hope. And, for a year, that is where we hovered - after testing faithfully for several months, we came to accept his numbers - they regularly registered BUN 125 (urea 44.6) and creatinine 9-10 (795-884). He never developed serious anemia, and his phosphorus levels remained stable. He ate Hills Senior Diet and turkey. He refused to eat any of the kidney diets, and I was not going to force him.

We did 150 ml sub-Qs nightly. You would never have known he was "sick." He maintained his routine until the week before he died. It was almost a year to the day that we found out that he was in kidney failure. That week was frightening. It started Thursday... he had a seizure at 2 in the afternoon, and we rushed him to the vet. The vet prescribed a beta blocker, but on the way to the drugstore, Moses had another seizure, and then he had six more. The next day his eyes were dilated, and I posted on the CRF group - detached retinas - the vet gave me a prescription for Norvasc, drug of choice as recommended by the folks on the group who had "been there, done that." Amazingly within the day, he was seeing again, but you could see it was starting to take its toll. He seemed weak, but he was eating... But, he started to show signs of weakness - and he started to look bloated.

By Monday, we knew we were probably facing the final hours... he had a nose bleed, and he seemed to struggle with each step. We took him to the vet Tuesday, and, since our vet had seen him come back before, he did not say, it is over. But you could smell the uremic poison, and so they were going to try an IV flush. A quick blood test indicated the numbers were now deadly. While they were trying to stabilize him, he went into cardiac arrest.

After nearly a year of "normal" life, Moses could no longer fight the disease - his mind was willing, but his body was shutting down. It was hard not only on us, but on the doctors and vet techs as well. They had never seen a cat survive for that long, and they thought for sure he would pull through even in those final hours. But, it was not to be... yet I am glad I did not have a vet who said, put him to sleep when the first numbers came in. We had a year to love him and care for him, and he died knowing that.

Deb and Laney

My sweet little peanut Laney was diagnosed with CRF in July 2001. Her renal failure was considered advanced. At diagnosis, her BUN was 228 (urea: 81.39), her creatinine was 15 (1326) and her phosphorus was 31 (10). The outlook was grim. She was such a petite little girl (at only 5 lbs) – the vet thought she simply had ‘nothing left’. Well, Laney had other ideas. She clearly had a strong will to live, and a personality ten times bigger than her small frame. Once I knew she was willing to fight, so would I.

With IV fluid therapy, change in diet and a host of other treatments, this little girl lived for exactly two years after her diagnosis. During this two year period, she remained a ‘high numbers’ kitty. On an average check-up, her BUN was anywhere between 80 and 200 (urea between 29 and 71) and her creatinine between 8 and 12 (700 to 1000). However, with a lot of hard work, we were able to keep her phosphorus in check, usually in the mid 4’s to low 5’s (1.45 - 1.6).

In Laney’s particular case, we found that how ‘good’ she felt (playing, eating, general demeanour) was strongly associated with keeping the phosphorus and parathyroid hormone in check with aluminium hydroxide and calcitriol therapy. At one point, we had to give her as much as 2000mg of aluminium hydroxide binders per day to lower her phosphorus. We did not see any ill effects and she clearly felt better. Yet her BUN and creatinine always remained high.

Like all CRF parents, we were victims of the ‘roller coaster’ ride. After Laney's initial diagnosis and subsequent ‘bounce-back’, she crashed four times and had to spend a few days in the hospital on IV therapy. In April 2002, her battle with anaemia began after she lost a lot of blood from a gastro-intestinal bleed. Her anaemia story is told separately on the Feline Anaemia List. Briefly, her anaemia was complex and resulted from gastro-intestinal bleeding, an autoimmune condition, and the ‘traditional’ lack of erythropoietin hormone because her kidneys were not functioning well. After two transfusions, we treated her anaemia with high doses of carafate (sucralfate), Epogen, Pet-tinic, B vitamins and prednisolone.

One of Laney’s crashes was a result of an electrolyte imbalance. However, the kidneys play a role in regulating electrolytes (especially calcium) so it still resulted from her CRF. She was having ‘seizure’ like events. At the ER, we found that her calcium was very low (which is a bit unusual in CRF – usually calcium is too high). We started to supplement her with calcium carbonate and of course calcitriol. With this therapy, we never saw such seizures again.

I know this all may sound bad, but in between the crashes and after the ‘bounce-backs’ she was a happy little girl. She loved us so much and would literally follow me everywhere. At night she would sleep on my head or on my pillow ‘cheek to cheek’. She would often play with the plastic rings on coke bottles and she loved to attack the ‘blanket monster’ or protect us from the ‘plastic bag monster’. She had such a big spirit and was the embodiment of pure love. But I’m digressing….

In my opinion, another key reason for Laney’s two year survival with extremely high BUN and creatinine levels was her vet. We switched from a general practitioner to an internal medicine specialist who is just outstanding. This vet was very knowledgeable about CRF and anaemia, and completely open to new research and new approaches (the calcitriol is one example). Together we formed a partnership that really benefited Laney. Since she was an understandably busy vet, I would communicate my questions or my research findings via fax. Getting an ‘efax’ number helped a lot because I could simply send a fax via email and receive one back via email. She would often respond to my questions/concerns/findings within a day. (The staff at the vet office joked about my ‘love notes’ to Dr. Z, consisting of ‘Laney questions’ and copies of articles).

I also kept track of all of Laney’s test results using a spreadsheet – this was helpful to our vet because she could easily look at trends. I also kept a chart at home so we could keep track of her meds - when they were given – and also make general notes as to how Laney was feeling that day. This also helped the vet if something were to go wrong.

Towards the end, Laney’s calcium and phosphorus became very hard to control. We didn’t know it at the time, but I guess this was a sign that her kidneys were just starting to shut down. Only a week before she died, she was eating well and seemed fine. Whether expected or unexpected, sudden or drawn out, the pain of losing a little one is just so acute. As I write this, it’s been four weeks since losing her and we’re still not over the shock and loneliness of missing her sweet little face and her gentle touch. But I hope her story will somehow help other ‘high numbers’ kitty parents to not lose hope.

It often surprises me to read posts from folks whose babies have a BUN in the 30s (urea in the teens) and a creatinine in the 4s (350 - 450) and the kitty feels really, really bad. Of course, it’s not possible to generalise because some kitties just may be able to tolerate the high numbers better than others. But I often wonder if the feeling of sickness is truly more a function of the phosphorus or the anaemia or the parathyroid hormones, and less associated with high BUN/creatinine. At least that was our experience.

I know this is long – there are so many aspects of Laney that I didn’t touch on, but I hope this will help a panicked fur-baby parent who may think their sweetie is on the verge of death. Please know that this disease can be managed, even if the initial diagnosis/prognosis is grim. Many vets who aren’t aware of all the treatment options may be too quick to judge. I know second-guessing is common, but I sometimes think my little girl could have lasted even longer than the two years.

3.   Low Numbers, Remained Stable

Darlene and Pooter

Pooter was diagnosed with CRF in 1996, not long before his 16th birthday. He'd had a thyroidectomy, and the pre-surgical bloodwork was all normal. He seemed to be recovering, but worsened after a few weeks. His BUN was 26.8 (urea: 9.3) and creatinine 2.78 (245). Not only did the vet say "early CRF" but he was now diabetic.

For the next five years, the only CRF treatment was making Hill’s K/D a significant portion of his food. Due to the diabetes, he was put on scheduled feeding. During the first year of his CRF, his diabetes was virtually uncontrolled, and I consider this a major contribution to the fact that by year two his BUN was 50 (17.9) and creatinine 3.6 (318). Once his diabetes was regulated, his CRF bloodwork remained stable at these levels except for an incident in 1999 - he was ill with very high calcium levels and his creatinine spiked to 4.3 (380) for a time.

In December 2001, a routine geriatric screen showed his kidney values hadn't changed significantly, but his electrolytes were off in all directions. Add to this the fact that he was vomiting occasionally, and the decision was made to treat his azotemia with sub-Q hydration. He was started on normal saline at very high rates (300 ml/day, divided) which didn't bring his numbers down at all, so I backed down slowly, giving him less and less until physical signs indicated I'd gone too far. Currently he's on Ringer's and happy with 50 ml every 1.5 days as long as I keep his glucose tightly controlled. The vomiting was solely associated with the strain of constipation, and the LRS (along with lactulose and fibre) keeps that under control.

Over the last year (2002) Pooter's BUN (urea) has been up and down, but the creatinine has exhibited a small and slow increase from 3.2 to 3.4 (283 to 300). Given that his diabetes and CRF are largely stable now, his electrolyte variations are being addressed. Calcium has run consistently at high normal, chloride consistently low. Phosphorus has been low, then high, then low again, so we change his diet to compensate. Potassium recently went very low and is being supplemented. He has no sign of anemia or appetite problems.

Besides CRF and diabetes, he has an arthritic hip, no thyroid gland, serious gingivitis, and a low-grade and stable heart murmur. We presumed hypertension last winter when he woke up blind one morning, and put him on Norvasc (his sight returned after a few weeks) as well as Fortekor (more for his kidneys than BP). Most of his medications are hidden in a small serving of canned Hill's K/D, the rest are injected.

I can't say I've observed any physical decline that is definitely attributable to his kidney deterioration, except urine pH. He's been "early CRF" for six years, and whenever he's weak and wobbly it always turns out to be failed glucose control. He's 22.5 years old now, and still able to bounce back as soon as I get him normoglycemic again.

My Pooter is a handsome grey tabby. He's been with me since he was a weanling, never caring much where we lived as long as we were together. Pooter had a housemate named Sparrow for 19.5 years, but she succumbed to bladder cancer and now he only has me. He is very smart, feisty or tolerant on his own terms, generous, affectionate, and protective - he once put himself between me and a moose, all fluffed up and growling - my hero!

I have regrets. I regret neutering him, as he would have greatly improved the local gene pool if he'd bred. I regret not firing promptly enough some veterinarians who didn't do their best, like the one who cost him his hearing. I regret that he didn't go out in a blaze of glory before his once-abundant whiskers became wispy, his powerful legs became unreliable, and his superb vision dimmed. While I am committed to tending one by one all his discomforts, I regret that some day the only way I will be able to relieve his pain is by putting him to death. Loving him to death.

He has always lived with wonderful spirit, grace, and intellect - sometimes I think he will do me the ultimate kindness of simply not waking up one morning. Other times I think he will break the record for the world's oldest cat. Mostly I think he stays because I need him so.

Note: Pooter was put to sleep on 10 May 2003 because of a pulmonary embolism, which was not related to his CRF. He had CRF for almost seven years.

Tina and Bandit

My Bandit was found on a rifle range in late September of 1989, and a friend's landlord brought him home thinking he would be a good pet for her daughter, Marisa, who was just five. He was so malnourished he couldn't even jump up on anything. My friend felt her daughter was too young to take care of him and called me. I hadn't become the cat lady yet - I wasn't sure I wanted to have anything I could love and lose as I had just lost both my mother and grandmother whom I lived with and the home I grew up in the previous year. Well, Bandit moved in and rest is history.

At age five he was diagnosed with feline hyperesthesia syndrome and was put on phenobarbital twice daily to control his attacks, and that necessitated him having bloodwork yearly to check his liver function values. Fortunately he is an easy cat to give pills and, as I found out, any medications. I adopted Dami when Bandit was seven and Finnian when he was ten.

In March of 2000 I came home to find Bandit limping - I guessed he jumped off the sink and landed badly while chasing Finnian as he often did. My vet felt a lump there and gave him a cortisone shot which seemed to work for a few days but then he became weak in the back legs so I took him in and bloodwork was done (I had noticed he seemed to be drinking & peeing more for the last few months). I was given the news of a CRF diagnosis and felt my world had collapsed. His numbers at diagnosis were BUN 82 (urea 29), creatinine 4.7 (416), phosphorus 8.0 (2.58) and HCT 29.4. My vet told me Bandit would have to be on daily sub-Q fluids for two weeks to see if his numbers came down - fortunately my boss is a big animal lover and let me leave work to go and learn how to treat Bandit.

Initially his numbers only came down a little (I hadn't learned to get copies of bloodwork then) - I think his creatinine came down to 4.5 (398) and I was told he had to eat special food - he could not have K/D because the egg would give him diarrhea so I tried the Purina CNM NF (now called kidney failure formula) and continued with regular wet food as he would not eat any prescription wet food. Fortunately all three cats LOVED the Purina (Dami doesn't eat much dry food) so that worked, and in another two weeks his creatinine came down to 3.5 (309); we had also gone to fluids every other day at this point.

By July his creatinine was just barely above normal at 2.5 (221) and we stopped fluids entirely (Bandit was only getting them once a week anyway) but at next bloodwork it started to edge up. Over the next year we gradually increased fluids as the numbers went up a bit each time and in May 2002 when his creatinine went to 3.9 (345) we went to 100mls every day - at next bloodwork his creatinine was 3.4 (301) and it went to 3.5 (309) in November 2002, with BUN of 66 (urea 23.6), phosphorus of 7.0 (2.26) and HCT of 35.4. He looks great and acts wonderful – it might be nice if he didn't roughhouse with Finnian so much. He has lost weight and at next bloodwork if that continues we will do an ultrasound because my vet is concerned he might have irritable bowel disease; his thyroid has been checked and is fine - he also has a good appetite. People who see him don't believe there is anything wrong because he look & acts great. I'm not sure if the weight loss is because Finnian eats faster than Bandit and I have to watch Dami because she has to eat special food for chronic cystitis. I have been feeding Bandit an extra meal at bedtime which seems to be helping and also he is not vomiting at all except when he has a hairball from grooming Finnian! He is the only cat ever nominated for office in the Gaspee Days committee (against me and he didn't win!) and has traveled all over New England and into upstate New York where my family lives. He is two years and nine months past diagnosis and going strong - he will always be the number one man in my life!!

Note: Bandit died on 7 September 2003, after fighting CRF for 3.5 years.

Sheri and Lucky

Lucky was diagnosed June 6th of 2000 and, looking back at his numbers, I'm almost shocked that they started us on sub-Qs. His BUN on an "in-house" test was 51.4 (urea 18.3) on a range of 18.0 to 36.0 (6.42 - 12.85). His creatinine was only 1.76 (156) on a range of 0.80-2.40 (71 - 212). Another test on 27 June 2000 showed BUN 29.4 (urea 10.5) and creatinine 2.67 (236). So, we started sub-Qs immediately and have been on them since, every other day, started at 150ml and have been at 200ml for about 9 months.

His numbers have been up and down but never above BUN 60 (urea 21.4) and creatinine 3.0 (265). The last check in August 2002 had his BUN in the 50s (urea 18 - 21) and his creatinine was 2.7 (239). I now try not to stress over his bloodwork like I had done for 1.5 years. What will be, will be.

We have his blood pressure checked about every 3 months and at the last check (November 2002), it was 100! Our Vet Tech came to the house to get a reading and he was so relaxed!

We have our good days and an occasional bad day but I wouldn't change anything! Well, of course I'd change the fact that we're dealing with this disease but we're managing very well today and, that's what counts.

Lucky has acupuncture once a month. Focusing on his bladder, kidneys and occasionally his lungs. So, we're working with a traditional vet as well as an holistic vet. We love them both!

Lucky also has FIV. That was diagnosed in 1997. I often feel that the fevers he was having a few years ago brought on the CRF but we'll never know. You know, fever = dehydration and dehydration = kidney issues.

Oh! As for his diet, I stay away from the kidney friendly foods. I figure a higher quality protein, the easier it is for the kidneys to break it down. He eats a brand by the name of Wellness. Occasionally some Fancy Feast, and he always gets a jar of Chicken baby food after sub-Qs.

Note: Lucky was put to sleep on 10 April 2003 after fighting CRF for almost three years.

Jenney, Merlin and Circe

My two CRF kitties, Merlin and Circe, were diagnosed in August 2001. Merlin has been stable since then and Circe had a crash this past June but is still here with me today (and I hope for many days, but we take it one by one). 

Merlin and Circe are Siamese littermates. They were 8 years old at diagnosis in August 2001, during a routine pre-anesthetic panel for dental work. At that time Merlin's creatinine was 2.6 (230) and Circe's was 2.7 (239) on a range of 0.8-2.3 (71 - 203), while they both had BUN of 37 (13.2) on a range of 15-34 (urea: 5.4- 12). I didn't know enough to ask for any more blood work, and the vet didn't make it sound earthshaking, just said to feed them K/D. They were both completely symptom-free. 

A re-check in December 2001 revealed the following: 

Merlin: creatinine 3.2 (283), BUN 36 (urea 12.85)

Circe:  creatinine 3.5 (309), BUN 42 (15)

At this point the vet recommended starting sub-Q's, which we did, 100 ml every other day. Both Merlin and Circe were still acting fine, Circe had lost a little weight, down to 11 pounds from 12, but not skinny. 

I changed vets after their March, 2002 checkup. There was not much change in their numbers at that point, but the vet kept calling Circe "he" (arghhh!!!!) and the techs brought her back from her bloodwork with blood all over her chest. I found a great new vet who really seems to care about them.