Dehydration is a common problem in CKD cats. If CKD cats "crash" and are in crisis they are
usually severely dehydrated and intravenous fluids (IV) at the vet's may
be required for several days - Thomas had these twice and they were very
Of course, ideally you do not want things ever to progress to
this stage, so to avoid dehydration in the first place, fluids may be
given under the skin at home (sub-cutaneous fluids).
Therapy is so essential in the
treatment of CKD that it has its own page.
This can be a sign of dehydration, so should improve once your cat's
hydration is under control.
bark is often used to control excess stomach acid and to help with
mouth ulcers, but as a side effect it often improves the cat's coat.
Overhydration: Fluid Retention/Build-Up
Some CKD cats may develop problems with fluid retention.
This is not uncommon in cats who are receiving too much fluid, either via IV or sub-Qs.
Some vets say it is not possible to
overhydrate a cat using sub-Qs, but believe me, I've heard of plenty.
If your cat feels "squishy" when you stroke him or her, this may indicate
fluid retention, in many cases caused by overhydration from excessive
sub-Qs. The cat may also show loss of appetite, because the fluid may be
pressing on the stomach causing a feeling of fullness.
Overhydration may also cause
hypertension. In such
cases, you may find that reducing the amount or frequency of sub-Qs solves
the problem; so speak to your vet about this. The
Subcutaneous Fluids page has information on amounts and frequency of fluids.
Sometimes fluid retention may become more serious, and in the worst cases
may lead to or be caused by
in the lungs (pulmonary oedema)
around the lungs (pleural
in the abdomen
If your cat has loss of appetite, appears to be
gaining weight rapidly or suddenly, particularly if he/she also starts
coughing and/or develops a nasal discharge, you need to see a vet quickly.
If s/he starts breathing with the mouth open or has a limp, this is a
medical emergency and you need to get to a vet as quickly as possible. Your vet
will probably arrange an x-ray which will show clearly whether there is
fluid in or around the lungs or abdomen. If there is a lot of fluid, they
will arrange to remove it either manually via
thoracentesis (if the fluid
is pleural effusion, around the lungs) or by using a type of drug called
Do not give sub-Qs to a cat exhibiting any of
the above symptoms until you have spoken to your vet. You should also
never give a cat sub-Qs until the fluids from the previous session have
If your cat does exhibit these problems and you can afford it, I would
recommend a visit to a feline cardiologist to discuss future treatment
options for your cat. It may still be possible to give sub-Qs in the
future if your cat needs them, but it is a careful balancing act between
the needs of the kidneys and the needs of the heart.
If your cat is prone to overhydration, I would
recommend weighing him
or her daily, so you can be alert to possible problems. Remember, your cat
will weigh more after being given fluids - 100ml is a little under 4 ounces.
Most people are delighted when their CKD cat gains weight, and certainly
if weight gain is slow and steady, this is good news. However, if your cat
gains weight very quickly - I have heard of people who are delighted
because their cat has gained 2 lbs in a week, a phenomenal rate of weight
gain as a percentage of the average cat's size - you need to
investigate the cause. A sudden increase in weight, particularly if your
cat is receiving sub-Q fluid therapy, can indicate fluid retention and
possibly heart problems. If your cat feels "squishy" when you stroke him
or her, this may also indicate overhydration. If your cat appears to be
gaining weight rapidly or suddenly, particularly if he/she also starts
coughing and/or develops a nasal discharge, starts breathing with the
mouth open or has a limp, you should contact your vet as soon as possible.
Further information on fluid retention and heart problems can be found on
the Heart Problems page. If your cat is prone to such problems, you
may wish to monitor your cat's weight with baby scales.
Digital Baby Scales 1584, which weigh in one ounce (20g)
increments, are popular on Tanya's Support Group. They are available for
around US$140. You might also be able to buy a set of
scales secondhand from EBay or similar.
I have a Redmon
baby scale which I like (it can be stored
on its side when not in use, saving space), but it no longer seems to be
Comfort for Less sells another Redmon model
Dehydration can lead to problems with constipation in
CKD cats. There is a separate page about constipation
In many cases, diarrhoea will only last for a day. However, if it goes on
any longer, or stops and then starts again, I'd recommend a trip to the
vet because the cat may quickly become dehydrated
(which does not only mean water loss,
the cat may also be losing potassium).
appears to be able to help with both diarrhoea and constipation. It
soothes the lining of the gut and gives the digestive system time to heal.
Psyllium may also help.
If the diarrhoea is a result of
changing food too suddenly, stop feeding the new food and go back to your
cat's old food until the problem is under control. Then gradually
re-introduce the new food as described in
Which Foods to Feed.
If your vet agrees, you can try a medication containing
pectin and kaolin for a few days. However, be sure you use a formulation
suitable for cats; kaopectate used to be suitable, but as the
American Medical Veterinary Association
explains, the formulation has changed and is no longer safe for cats. Pet
is a brand of pectin and kaolin which is safe for cats. It is
Arcata Pet Supplies.
If the diarrhoea is caused by antibiotics, you may need
to re-balance the bacteria in the gut. A small amount of natural,
unflavoured yoghurt may help, but since many cats are lactose intolerant,
there is a risk that this might actually make the diarrhoea worse. You may
therefore find it easier to buy a commercial product instead.
Regulation of Waste Products page for more
Occasionally a cat may appear to have diarrhoea, but it
is in fact constipation with a small amount of liquid squeezing around the
hard stool. This requires treatment for
Although loperamide (Imodium) is available without a
prescription, please do not use it without your vet's knowledge and
approval. According to
Pet Place, it is a controversial
treatment for animals, and can cause side effects in some cats,
particularly those suffering from certain conditions including kidney
disease. It is also hard to work out a cat-sized dose. Other treatments
outlined here are much safer.
is the leaking of excessive amounts of protein into the urine. It may
cause foamy urine, weight loss and swollen legs, face and abdomen. Its presence may
make the CKD progress faster.
There is some evidence that
ACE inhibitors, such
as benazepril (Fortekor or Lotensin) or enalapril (Enacard) may help with
this problem. A new treatment, an angiotensin II receptor antagonist
telmisartan (Semintra) was launched in September 2013 for the
treatment of proteinuria in CKD cats in Europe. Sometimes
used, but this should only be done under veterinary supervision since
aspirin can be toxic to cats.
In a later (2004) study reported by
Science Daily, researchers found that the
bacteria commonly involved in UTIs pass through four distinct
developmental stages, including a dormant stage in some cases which may
help explain why UTIs often recur.
Humans with cystitis are sometimes advised to take
cranberries. However, cranberries are not appropriate for CKD cats (see
Holistic Treatments for more information on this). The active
ingredient in cranberries is D-mannose, so you could consider giving this
by itself, see below.
n order to be sure that the bacteria are
completely eradicated and the infection completely cured, CKD cats are
often given a prolonged
course of antibiotics, for four weeks or longer. This is even more
important for a cat with a kidney infection, where a 4-6 week course of
antibiotics should be given.
Urinary tract infection: how to diagnose and treat
correctly (2003) is a presentation by Claudio Brovida to the
World Small Animal Veterinary Association World Congress, which
explains why lengthy courses of treatment are sometimes necessary.
Some vets choose to
put CKD cats on a low level dose of antibiotics on an ongoing basis, or
recommend pulse dosing, where the cat is given antibiotics at regular
intervals for several days at a time, e.g. for the first five days of
every month. If your vet wishes to do this, discuss it and decide whether
you think it is a reasonable treatment for your cat: infections can be
hard for the weakened immune system of a CKD cat to cope with and to
recover from, so in some cases this is not an unreasonable option.
If your CKD cat is prone to persistent, ongoing or repeated UTIs, speak to
your vet about using D-mannose, a simple sugar treatment which is supposed to be very helpful when
dealing with infections where the bacteria have burrowed into the bladder
wall (see above). There is more
information about it on the
Treatments page. If your vet recommends antibiotics, you can use
D-Mannose as well, but it should not take the place of antibiotics.
Kidney Infections (Pyelonephritis)
is a bacterial infection of the kidneys. The cat may also have a lower
urinary tract infection - in some cases, untreated lower urinary
tract infections rise into the kidneys - but not always. Cats with PKD are
particularly prone to pyelonephritis, since the bacteria can burrow into
the cysts. Our PKD cat, Harpsie, used to get regular bouts of pyelonephritis.
Please see the
diagnosis section for how to test for pyelonephritis.
In order to be sure that the bacteria are completely eradicated and the
infection completely cured,
Urinary tract infection (UTI): how to diagnose
correctly and treat (2003), a presentation by Dr C Brovida to
the 28th World Congress of the World Small Animal Veterinary Association
antibiotic treatment should continue for 4-8 weeks in the case of
kidney infections. The longer period is necessary because blood flow to the site of most kidney infections is poor,
so it can take a while for the antibiotics to reach and kill the bacteria.
You should check the urine again 7-14 days after stopping the antibiotic
to make sure the infection has completely gone.
If your cat has a kidney infection, the bloodwork may
improve once the infection is under control.
This means that the cat has limited control of where s/he urinates.
This may sometimes be caused by either a
urinary tract infection or
occasionally by a kidney infection (pyelonephritis).
A urine culture and sensitivity test should show the presence of a urinary
tract infection, but will not detect kidney infections. One of our cats,
Harpsie, was prone to kidney infections, partly because he had PKD (in PKD
cats, the bacteria can enter the cysts in the kidneys and cause a
deep-rooted infection). We always knew when Harpsie had a kidney infection
because he became incontinent, but the incontinence would go away within a
couple of days of starting treatment with antibiotics (although the
treatment would continue for 4-6 weeks to ensure the infection was
If there is no infection present, you might want to try using
in the form of methylcobalamin in case that helps - some
Tanya's CKD Support Group
members have found it helpful.
Please also read the
Elimination section below in case some of it applies to your
cat's situation, and for tips on dealing with the problem from a practical
While you are trying to resolve the problem, using incontinence supplies
can help keep your home clean and make this stressful experience a little
less stressful for you.
sells incontinence supplies, including protective
covers for beds and chairs. You might wish to place these where your cat
spends time, with a
blanket on top which can be easily washed.
Pets at Home sells puppy pads - I use
these ones to protect my sofas from cat vomit.
sometimes sell plastic sheeting to protect your
furnishings when decorating. It is really thin, like those bags used for
fresh fruit and vegetables in supermarkets. It comes on a roll about
18ft long and 6 ft wide, and costs about £3 ($5). I used this stuff to
cover the bed for Ollie, it was wide enough for my king size bed and I
just cut it to the right length. It's so fine that you can't feel it on
the bed, but it helps protect the bed, although urine
can pool in it to a degree, plus it is so fine that it might slip
off the bed, so I used mine in conjunction with
a washable throw on top. I got mine from Wilkinsons.
sells piddle pants for cats in several sizes.
This means that
the cat is urinating (and sometimes defecating) in the
wrong place. There can be a number of possible reasons for this, but it is
definitely not done out of spite. Your cat is trying to tell you something
and you need to try to work out what it is.
Sometimes this is a behavioural problem, but there may be
some other reason for it in a CKD cat. Firstly and most importantly, it
can be as a result of a urinary tract infection (UTI)
whereby the cat associates the litter box with the pain of the UTI or
constipation, so starts urinating and/or defecating elsewhere. You should
also consider the possibility of a
kidney infection - our
cat was prone to them and used to leak urine uncontrollably when he had one
(incontinence), which could have been mistaken for inappropriate
and constipation can be very painful, and UTIs and kidney infections
may also damage your cat's kidneys further, so if your cat urinates or
defecates in the wrong place more than once, you should go to the vet as
soon as possible in order to have tests done and treatment begun if
inappropriate elimination can be associated with the general weakness and
weight loss of a CKD cat. If your litter box has a high edge, it might
simply be too hard for your cat to clamber into. Try to provide a lower
litter box and see if this makes a difference.
weight loss of CKD can make your cat's paw pads rather tender, which makes
standing on litter uncomfortable. This can be remedied by providing softer
litter, or by placing a few layers of newspaper on top of the litter which
can easily be thrown away with the litter.
Fourthly, in view of their increased need to urinate, many cats simply get
"caught short" and cannot make it to the litter box in time. This is
easily remedied by placing several litter boxes in various locations,
including on every level if your home has more than one floor, and/or by
using larger litter trays. You may also need to clean the litter
boxes more often or provide more to offset the increased urination, so the
cat always has a clean place in which to go.
If you have recently had new carpets laid, it is possible that the carpet
actually has a urine-type aroma to the cat, which leads the cat to
associate the carpets with the litter tray and urinate on them.
New carpet smells like smelly urine?
has more information on this intriguing possibility.
If none of these approaches helps, you need to consider the possibility of
a behavioural problem not necessarily related to the CKD. As a rule of
thumb, in a multi-cat household you need one litter tray per cat, plus
one. Some cats prefer one litter tray to urinate in and a separate one to
defecate in, and some cats like a covered litter tray, while others prefer
uncovered; almost all cats prefer a tray out of the way of household
traffic which offers some degree of privacy. For most cats, the bigger the
litter tray, the better. Some people have had good results with a
particular type of litter which is supposed to appeal to cats called
Try to keep the trays as clean as possible (although be careful not to
clean them too much; they need to retain toileting associations for the
cat), and experiment with the type of litter you use.
If your cat has been urinating in one particular spot, you need to clean
it very thoroughly to remove all traces of the smell - even if you can no
longer smell it, your cat, with his/her better sense of smell, probably
can. Ideally you need an enzymatic cleaner which really remove the smell,
though of course you must make
sure you do not use a product which is harmful to cats. A product called
Anti-Icky-Poo, available to purchase online in the USA
here (has a link for purchasing it in the UK), or at
Amazon, has an excellent reputation. After the area is
completely dry, try putting a litter box in the cat's chosen spot, or if
that is not possible try a food bowl (cats usually do not urinate where
they eat), a pot plant or aluminium foil (cats do not like the texture).
Unfortunately, for some CKD cats, urinating and/or defecating
inappropriately continues regardless of any measures you might take, and
you may have to grit your teeth, minimise access to favoured zones and try
to focus on the fact that this is related to the illness in some way and
your cat probably can't help his or her behaviour. We had to do this
with Tanya, who seemed to get caught short, but we figured twelve years of
her love more than compensated us for her behaviour. You may derive some
comfort from knowing that, since CKD cats have dilute urine, most of their
accidents only have a mild smell, if any. For cats who urinate on beds or
sofas, try limiting their access to such areas by closing doors, or if you
are reluctant to do this, cover the bed or sofa with incontinence pads or a plastic sheet
supplies), and put a machine-washable blanket on top for the cat to
lie on: this will protect the bed and so reduce your stress levels, whilst
allowing the cat to lie on a comfortable but easily washed blanket. Please, do NOT rub your cat's nose in the accident, it is extremely cruel
and achieves nothing, cats do not associate the punishment with their behaviour.
Pet Place has some information about