Tanya

 

TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 

TREATMENTS FOR BODY FLUID AND URINARY TRACT ISSUES

 

ON THIS PAGE:


Fluid-Related Issues:


Dehydration


Overhydration and Fluid Build Up


Diarrhoea


Urinary Tract Related Issues:


Proteinuria


Urinary Tract Infections and Kidney Infections (Pyelonephritis)


Incontinence


Inappropriate Elimination


 

 

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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: PROLONGING LIFE


Phosphorus Control


Hypertension

(High Blood Pressure)


Proteinuria


Anaemia


Potassium Imbalances


Pyelonephritis (Kidney Infections) and Urinary Tract Infections NEW


Metabolic Acidosis


Kidney Stones


 

KEY ISSUES: HELPING YOUR CAT FEEL BETTER


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The B Vitamins (Including Methylcobalamin)


Constipation


 

CAT FOOD DATA


Ways of Assessing Food Content, Including What is Dry Matter Analysis


How to Use the Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Brands: Helpfulness Ratings


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SUPPORT


Coping with CKD


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Success Stories


 

SYMPTOMS


Important: Crashing


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?


Early Detection


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)


Phosphorus Binders


Steroids, Stem Cell Transplants and 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


2007 Food Recall USA


 

FLUID THERAPY


Oral Fluids


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)


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MISCELLANEOUS


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SITEOWNER (HELEN)


My Three CKD Cats: Tanya, Thomas and Ollie


My Multi Ailment Cat, Harpsie


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Home > Treatments > Fluid and Urinary-Related Issues

 


Overview


  • Since one of the kidneys' functions is to regulate fluid levels in the body, problems in this area are common in CKD cats.

  • This page discusses possible treatments for these sorts of problems.

  • It also discusses urinary tract issues.

 


Regulation of Fluid Levels in the Body


 


Dehydration


 

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 effective.

 

Of course, ideally you do not want things ever to progress to this stage, so to avoid dehydration occurring in the first place, fluids may be given under the skin at home (subcutaneous fluids). 

 

Fluid Therapy is so essential in the treatment of CKD that it has its own page.

 

Dehydration: Dry Coat


This can be a sign of dehydration, but should improve once your cat's hydration is under control.

 

Slippery elm bark is often used to help with gastrointestinal issues including mouth ulcers, but as a side effect it often improves the cat's coat.

 

Essential fatty acids may also help.

 

Dehydration: Constipation


Dehydration can lead to problems with constipation in CKD cats. There is a separate page about constipation here.

 


Overhydration and Fluid Retention


 

It is possible for cats to be overhydrated, i.e. given 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. Overhydration may also cause hypertension.

 

Cats with heart problems can also develop problems with body fluid build up. If your cat is receiving sub-Qs and has undiagnosed heart problems, it may be that the amount of fluid would be fine for most cats but is too much for your cat. It is also possible for cats with heart disease to develop fluid retention even if they are not receiving sub-Qs.

 

Fluid may collect:

  • in the lungs (pulmonary oedema)

  • around the lungs (pleural effusion)

  • in the abdomen (ascites).

If your cat:

  • feels "squishy" when you stroke him or her

  • has loss of appetite (which may be caused by the fluid pressing on the stomach causing a feeling of fullness)

  • appears to be gaining weight rapidly or suddenly. 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), this may be a sign of fluid build up.

  • starts coughing and/or develops a nasal discharge

you need to see a vet quickly.

 

If your cat starts breathing with the mouth open or develops a limp, this is a medical emergency and you need to get to a vet as quickly as possible.

 

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 been absorbed. 

 

The Heart Problems page has more information about fluid build up and congestive heart failure, including symptoms, causes, what happens, and how to treat.

 

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 the problem was caused by giving too much fluid, you may find that reducing the amount or frequency of sub-Qs given in the future prevents this problem arising again; so speak to your vet about this. The Subcutaneous Fluids page has information on amounts and frequency of fluids. 

 

Weighing Scales


If your cat is prone to overhydration and/or fluid retention, you may wish to monitor your cat's weight with baby scales. I actually recommend that everybody weighs their cat regularly

 

Tanita 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 available.

 

Amazon sells other Redmon scales for US$47.63.

 

Drs Foster and Smith sell Redmon scales for US$59.99.

 

Amazon sells Salter scales for US$48.93.

 

Amazon sells Beurer scales for US$52.36.

 


Diarrhoea


 

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 electrolytes such as potassium).

 

Please see Waste Product Treatments for more information on how to treat diarrhoea.

 


Urinary Tract Issues


 

Here are treatments for urinary tract problems which you may sometimes see in CKD cats.

 


Blood in Urine (Haematuria)


 

If your vet obtains a urine sample from your cat via cystocentesis (a needle into the bladder), this may sometimes cause blood in the urine, which should resolve fairly quickly.

 

Other common causes include a urinary tract infection, bladder or kidney stones or high blood pressure.

 

If you can find the cause, you may be able to treat this effectively.

 


Proteinuria


 

Proteinuria 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.

 

Please see the Proteinuria page for more information.

 


Urinary Tract Infections and Kidney Infections (Pyelonephritis)


 

Please see the new Pyelonephritis and Urinary Tract Infections page for more information.

 


Incontinence


 

This means that the cat has limited control of where s/he urinates or defecates. This section only addresses urinary incontinence.

 

Pet Place has some information about urinary incontinence.

 

Incontinence: Urinary Tract and Kidney Infections


Incontinence may sometimes be caused by either a urinary tract infection or by a kidney infection. 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 polycystic kidney disease (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 completely eradicated).

 

Please see the Pyelonephritis and Urinary Tract Infections page for more information.

 

If there is no infection present, you might want to try using Vitamin B12 in the form of methylcobalamin in case that helps - some Tanya's CKD Support Group members have found it helpful.

 

Please also read the Inappropriate 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 perspective.

 

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.

 

Incontinence Supplies (Puppy Pads Etc.)


Having an incontinent cat is a lot less stressful if you take the time to protect your furnishings.

 

DIY stores 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 to cover the bed for Ollie, it was wide enough for my superking 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. Therefore I used mine in conjunction with a washable throw on top. I got mine from Wilkinsons.

 

USA


Joybies sells piddle pants for cats in several sizes.

 

Handicapped Pets sells pet diapers in a number of sizes.

 

Pet Edge sells puppy pads.

 

Direct Medical sells human incontinence supplies, which can be cheaper, although you do have to buy in bulk.

 

Amazon sells rubber-backed waterproof sheeting.

 

Amazon sells another type of waterproof sheeting.

 

Amazon also sells waterproof picnic blankets.

 

Bed Wetting Store sells a variety of products which might be helpful.

 

Chewy sells 150 pads for $25 but you can get 50% off your first order only.

 

UK


Boots 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.

 


Inappropriate Elimination (Periuria)


 

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.

 

Fortunately inappropriate elimination is usually manageable.

 

Inappropriate Elimination: Possible Causes


Sometimes this is a behavioural problem, but there may be some other reason for it in a CKD cat.

 

It can be helpful to video your cats around the litter tray, especially if you are not sure who is the culprit. Quantification of urine elimination behaviors in cats with a video recording system (2017) Dulaney R, Hopfensperger M, Malinowski R, Hauptman J & Kruger JM Journal of Veterinary Internal Medicine 31(2) pp486-491 found that cats recorded on video urinated more frequently than their caregivers thought they did, and healthy cats spent longer covering their performances than cats with issues. There are links to webcams here.

 

Infections or Constipation


Firstly and most importantly, inappropriate elimination can be caused by a urinary tract infection (UTI) or constipation, whereby the cat associates the litter box with the pain of the condition, 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 elimination.

 

Infections 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 necessary. 

 

Physical Issues


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 in to the tray. Try to provide a lower litter box and see if this makes a difference. 

 

The 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.

 

In view of their increased need to urinate, many CKD 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.

 

Other Causes


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.

 

Inappropriate Elimination: Litter Trays


If dealing with the above possible causes does not seem to help, you need to consider the possibility of a behavioural problem not necessarily related to the CKD. Reviewing your litter tray arrangements is an important part of this.

 

As a rule of thumb, in a multi-cat household you need one litter tray per cat, plus one. Almost all cats prefer a tray out of the way of household traffic which offers some degree of privacy.

 

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. Litter box preference in domestic cats: covered versus uncovered (2013) Grigg EK, Pick N & Nibblett B Journal of Feline Medicine and Surgery 15(4) pp280-284 looked at whether cats prefer covered or uncovered litter boxes. The study found "Overall, there was no significant difference between use of the two box styles. Eight individual cats did exhibit a preference (four for covered, four for uncovered), but individual preference results are not evenly distributed, with more cats than expected showing no preference between litter box types. We postulate that, if boxes are kept sufficiently clean (ie, once daily minimum cleaning), most cats will not show a preference for either box type. The observation that a minority of cats in the study exhibited a preference supports the recommendation of providing individual cats with a 'cafeteria' of litter box styles, including a covered box, to determine whether such a preference exists."

 

For most cats, the bigger the litter tray, the better. Litterbox size preference in domestic cats (Felis catus)  (2014) Guy NC, Hopson M & Vanderstichel R Journal of Veterinary Behavior 9(2) pp78-82 looked into this and concludes "Results indicate that most cats show a definite preference for a larger litterbox than is typically available to them in homes and that other factors such as box cleanliness and location may have a compounding influence on this choice." The litter box favoured by the cats in the study was 85cm (33.5 inches) in length. Therefore some people get large (100 gallon) Rubbermaid tubs and cut an entrance for their cats.

 

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).

 

Experiment with the type of litter you use, because this can also be important to cats. Cat Attract is designed to appeal to cats and some people have had good results with it, and also with the Senior Cat version. It is available from Amazon, among other retailers.

 

Automatic self-cleaning litter trays which clean the litter tray to a degree after use appeal to some cats, though they can be expensive.

  • Cat Genie is a self-washing, self-flushing system available from Amazon for US$240.

Dr Elsey's litterbox solutions (2017) has more litter box tips.

 

Inappropriate Elimination: Cleaning


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. 

 

Many cleaners contain ammonia which is a component of cat urine, so it attracts them back to the spot. Try to get a cleaner without ammonia in it. Ideally you need an enzymatic cleaner which really removes the smell, though of course you must make sure you do not use a product which is harmful to cats.

 

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).

 

The following products have been used successfully by members of Tanya's CKD Support Group.

 

Anti-Icky-Poo


Anti-Icky-Poo is an enzymatic cleaner and is the product I use for those little accidents. It works really well, and without too much effort.

 

Amazon sells Anti-Icky-Poo.

 

Amazon also sells a three pack.

 

Cat Faeries also sell Anti-Icky-Poo.

 

Mystical


This is another enzymatic cleaner for which I have heard good reports.

 

Needs sells Mystical.

 

Ashleys Green Products sell Mystical.

 

Inappropriate Elimination: Medication


Occasionally cats benefit from medication to help with inappropriate elimination. Feliway and Zylkne are worth considering. There is more information about these treatments on the Subcutaneous Fluids Tips page.

 

In some cases anti-anxiety medications may be used, such as clomipramine or .fluoxetine (Prozac).  Mar Vista Vet has some information on such medications.

 

Inappropriate Elimination: If All Else Fails


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 despite being provided with multiple litter trays, 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 (see incontinence 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. 

 

Inappropriate Elimination: Links to Further Information


Treating feline elimination disorders Overall KL is an excellent article from a veterinary  behaviourist. 

 

Hilltop Animal Hospital has a series of articles with advice on dealing with such problems.

 

International Cat Care discusses soiling indoors.

 

Best Friends has an overview of litter box problems.

 

Litter box aversion: is it medical or behavioral? Johnson-Bennett P helps you consider possible medical causes for the problem.

 

AAFP and ISFM guidelines for diagnosing and solving house-soiling behavior in cats (2014) Carney HC, Sadek TP, Curtis TM, Halls V, Heath S, Hutchison P, Mundschenk K & Westropp JL Journal of Feline Medicine and Surgery 16 pp579598 has tips on managing, treating and hopefully resolving feline housesoiling.

 

Cats International has helpful information about housesoiling.

 

Harpsie's Website  discusses our experiences of inappropriate elimination with a number of different cats which we resolved.

 

Cornell University College of Veterinary Medicine has tips on resolving this problem.

 

Why does my cat pee on the bed? Johnson-Bennett P considers this problem.

 

Pet Place has some information from Dr Nicholas Dodman on inappropriate elimination.

 

Common mistakes people make when trying to solve a cat's litter box problem (2012) Johnson-Bennett P aims to help you deal with litter box problems.

 

Curing the litter box blues (2011) Krebsbach S Humane Society Veterinary Medical Association is a helpful presentation on this topic.

 

Cats Come Clean Animal Behavior Associates is a book from animal behavioursts costing US$5.75.

 

Back to Page Index

This page last updated: 12 May 2018

Links on this page last checked: 12 May 2018

 
   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

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