TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

    

 
   

WHAT HAPPENS IN CHRONIC KIDNEY DISEASE

 

ON THIS PAGE:


Main Functions of the Kidneys


Why CKD Occurs


The Role of the Nephrons


Why CKD Cannot Normally Be Detected At An Early Stage


Links


 

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WHAT IS CKD?


What Happens in CKD?


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


All About Anaemia


All About Constipation


Potassium Imbalances


Metabolic Acidosis


Kidney Stones


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


Alphabetical List of Symptoms and Treatments


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


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


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


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


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


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


Urinalysis (Urine Tests)


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


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


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


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


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


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


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


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


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

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Home > What is CKD > What Happens in Chronic Kidney Disease

 


Overview


  • This page explains more about the various functions of the kidneys.

  • It is because the kidneys have so many functions that there are so many possible symptoms of CKD. Which ones you might see depends upon which functions are affected.

  • This page also explains why CKD is so common in cats.

  • It discusses why CKD cannot normally be detected until two thirds of function has already been lost.


Main Functions of the Kidneys


 

The kidneys have five main functions:

  1. the regulation of fluid levels in the body;

  2. the regulation, including filtering and disposal, of waste products in the body;

  3. the regulation of electrolytes (salts in the body's cells which are necessary for survival) in the body;

  4. stimulation of red blood cell production; and

  5. production of renin, which controls blood pressure.

In cats with CKD, as the kidneys become more and more damaged and their ability to function declines, an imbalance can arise in any or all of these areas.  So, for example, a cat whose kidneys struggle with the production of red blood cells will develop anaemia.

 


Why CKD Occurs


 

Most cats develop CKD as a result of aging. Studies indicate that around 10% of cats over the age of ten will develop CKD. Older cats are at even greater risk: as many as 30% of cats over the age of 15 have the disease. Therefore, if you have a cat aged 15 or over, s/he has a one in three chance of developing CKD.

 

Younger cats may also develop CKD but it is less likely. If they are very young (less than two years old), this may be because of a congenital problem. Other possible causes include kidney infections, blockages or exposure to toxins. 

 

Dr Katherine James mentions that up to 30% of cats aged over 15 develop CKD.

Clinical benefit of calcitriol in feline chronic renal failure (2005) is a report by the Morris Feline Foundation on a study by Dr David Polzin into the use of Calcitriol in cats with CRF. Dr Polzin mentions that 10% of cats over the age of 10 and 30% of cats over the age of 15 develop CRF.

Management of feline chronic renal failure (1998) Brown SA Waltham Focus 8 pp27-31 mentions that up to a third of geriatric cats may have CKD, and also discusses the disorders that may cause renal disease, but does mention that for many cats, the cause can not be found.

The Cat Doctor mentions that CKD occurs twice as often in Siamese, Maine Coon, Abyssinian, Russian Blue and Burmese cats.

 

The Causes of CKD page explains more about the various possible causes, but in most cases the treatment will be the same whatever the cause.


The Role of Nephrons


 

The main work of the kidneys is performed by units called nephrons, which filter the blood flowing into the kidneys. The measure of the nephrons’ function is called glomerular filtration rate (GFR).

 

Khan Academy has a clear video showing how the nephrons work.

 


Why CKD Cannot Normally Be Detected at an Early Stage


 

A cat’s kidneys contain around 170,000 - 190,000 nephrons. This is actually many more nephrons than are needed for normal function; plus nephrons can increase their individual function to some extent when other nephrons die. This is why people can donate a kidney and still manage perfectly well with one kidney. In the case of a kidney transplant, if you remove one kidney from the donor, the donor's GFR (glomerular filtration rate, a measure of kidney function) will immediately fall to half of what it was, but will then gradually improve as the remaining nephrons increase their function to compensate for the loss of one kidney. Eventually the nephrons in the remaining kidney will reach almost the same level of function as two kidneys.

 

It works in a similar way in a cat with kidney disease, i.e. as damaged nephrons die (they are often described as "scar tissue"), other nephrons take over their work. Eventually, however, all the remaining nephrons will be working fulltime (i.e. there will be no "renal reserve" left). It is at this point, when around 66-75% of function has gone, that you will probably start to see symptoms in your cat, as the remaining nephrons start finding it harder to cope with the workload.

 

This is also why it is actually normal for CKD not to be diagnosed until at least 66% of function has been lost. So please do not feel guilty for not noticing sooner - there was probably nothing for you to notice, plus cats are very good at hiding signs of illness. CKD is not normally painful, so this makes it easier for the cat to hide what is happening. There are a number of possible methods of Early Detection, but some of these are quite specialised, and most people wouldn't know about them; in fact, not all vets are familiar with all of them.

 

Don't waste your energy beating yourself up. What you need to focus on is the fact that cats with CKD can often manage quite well on limited kidney function - for some cats, things only become critical when they have lost as much as 90% of function, and there are  some cats who cope astonishingly well with even less function. So the goal is not to worry about the function that has already been lost, but to try to retain the remaining function for as long as possible, and keep your cat feeling as well as possible. This site aims to help you with both goals.

 


Links to More Information


 

Long Beach Animal Hospital clearly explains more about the way the kidneys work.

The Merck Manual explains kidney function (with diagrams).

Feline Good describes how the kidneys work. 

Cornell University College of Veterinary Medicine has a helpful video overview of feline kidney disease - click on Understanding Kidney Disease.

People and pets: common diseases - kidney disease is a video from University of California at Davis which provides an overview of what happens in CKD and shows a dog receiving dialysis. It also features a human CKD patient talking about how CKD feels.

Kidney Disease is a podcast by Dr Harriet Syme from the Royal Veterinary College which you can download. Scroll down to RVC10.

 

Back to Page Index

 

This page last updated: 22 March 2012

 

Links on this page last checked: 23 March 2012

   

*****

 

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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