Kidney failure in cats: symptoms, treatment, proper nutrition

One of the most common and serious health problems in cats is kidney failure. The main function of the kidneys is to remove harmful substances produced in the body and from the environment. In animals with kidney pathologies, harmful substances are not completely removed, accumulating in the body. As a result, acid-base and osmotic imbalance develops, which over time inevitably leads to malfunctions in all organs and systems.

Symptoms of kidney failure

Clinical signs of renal failure often appear in the later stages of the disease; they are caused by poisoning of the body with unresolved toxins. Unfortunately, the kidneys are then already severely damaged and the damaged nephrons are no longer restored.

Symptoms of this disease include:

• deterioration of coat condition;
• unpleasant odor from the mouth;
• lethargy, apathy, drowsiness;
• frequent urination;
• loss of appetite;
• sudden weight loss;
• vomit;
• digestive disorders (diarrhea or constipation);
• in the terminal stage - loss of coordination of movements, convulsions.

Symptoms of protein deficiency

Mild forms of protein deficiency usually resolve without symptoms. The only exception is hereditary deficiencies of certain amino acids, which are structural components of protein molecules. The characteristic symptoms of such deficits are usually observed in early childhood.

External symptoms of protein deficiency:

• constantly decreasing weight;
• nails become brittle;
• hair becomes brittle, dull, and begins to fall out;
• swelling appears;
• the skin becomes dry and flaky;
• general weakness appears.

Nervous system symptoms:

• headache;
• mood swings;
• severe fatigue, lethargy;
• insomnia;
• mental activity decreases.

Symptoms from the musculoskeletal system:

• muscle weakness;
• growth slows down in children;
• weight and visible muscle volume decreases;
• Muscles begin to ache, less often joints.

Symptoms from the digestive system:

• nausea;
• abdominal pain, bloating;
• craving for sweets increases;
• stool is disrupted (constipation, which is replaced by diarrhea);
• the liver enlarges.

Causes of renal failure and forms of the disease

Renal dysfunction is most common in older cats. In young animals, this pathology is often genetically inherited: breeds such as Angora, Abyssinian, British, Burmese, Maine Coon, Russian Blue, Persian, and Scottish are predisposed to kidney failure.

The disease can occur in acute or chronic form. Symptoms of acute renal failure appear quite quickly, during the first weeks, and often result in death. The chronic form does not appear immediately, it lasts for years, and with adequate treatment, the prognosis in this case is more favorable.

The causes of kidney failure can be:

• urinary retention due to urolithiasis (urolithiasis);
• dehydration;
• poisoning with toxins that can cause structural and functional changes in the kidneys;
• urinary tract infections;
• trauma or obstruction (closing of the lumen) of the urinary tract; hypovolemia (decrease in the volume of blood circulating in the body);
• arterial hypertension;
• treatment with drugs that affect the organs of the urinary system (diuretics, NSAIDs).

Hills Prescription Diet K/D Feline Renal Health

What to feed a cat with kidney failure? Many veterinarians recommend using Hills Prescription Diet for this purpose. The main indications for the use of nutrition are temporary or permanent renal failure, as well as struvite urolithiasis.

Food improves the pet’s quality of life. Inhibits the progression of the disease. It contains Omega-3, which stimulates blood flow in the kidneys. Helps the animal's body resist the effects of free radicals. The product is characterized by excellent taste. It is allowed to mix dry food from this line with wet food.

The food reduces protein and urea in the urine. Improves kidney function. The granules consist of rice and corn ground into flour. Animal fatty acids are present here, which increase the activity of the pet. Their presence in the diet has a good effect on the condition of the skin and coat. The prepared food also includes turkey or chicken meat. The food helps malnourished animals increase their body weight. Improves laboratory parameters. The feed has reduced the amount of phosphorus, calcium and magnesium, but increased the sodium content.

Hill's food for cats with kidney failure stabilizes the content of magnesium and phosphorus in the body. Prevents their excretion in urine. Normalizes the acidity of urine. Promotes the dissolution of crystals and struvite uroliths.

Food should not be given to pregnant animals and kittens. Do not use food for diseases of the cardiovascular system and hyperkalemia. Metabolic acidosis prohibits its use.

If your cat is regularly feeding this food, a urine pH test should be done every six months.

Diagnosis of kidney failure in cats

For differential diagnosis of renal failure, cats are prescribed:

• General urine analysis. The presence of pathology is indicated by reduced density and high protein levels.
• Bacteriological culture of urine. The analysis will show the presence of infection.
• General and biochemical blood test. At stages 3-4 of the disease, an increase in the level of leukocytes and a decrease in hemoglobin levels are usually detected. A high level of the T4 hormone indicates the presence of a concomitant disease - hyperthyroidism.
• Ultrasound of the kidneys. Ultrasound examination can detect cysts and other neoplasms, expansion of the renal pyelocaliceal complex (hydronephrosis).

Purina Veterinary Diets NF

Purina cat food for kidney failure is considered one of the best. All cats eat it with pleasure. The product is indicated for chronic renal failure. Veterinarians recommend it to prevent urates and cystines and reduce the frequency of their occurrence.

The food is not suitable for kittens, pregnant or lactating cats.

Slows the progression of kidney disease. Positively affects the quality of life of pets. Contains potassium citrate, which reduces the likelihood of hypokalemia. Brings urine pH to a neutral position. Rich in B vitamins. They are usually lacking during diuresis. Contains Omega-3 fatty acids. Prevents the formation of stones.

The product is characterized by low phosphate content and high quality protein. It contains rice, corn, soy and wheat flour. The food contains animal fats, egg powder, beet pulp, and pea fiber. Cat food is fortified with vitamins and minerals. The food contains up to 26% protein, about 12% fat, 3% crude fiber, and 4.5% crude ash.

Treatment of kidney failure

Chronic renal failure cannot be completely cured. By controlling the development of the disease, you can improve the animal’s condition and prolong its life. Treatment tactics depend on the stage of the disease.

If the pathology was detected in the initial stage, it will be necessary to provide the cat with monitoring of vital signs: measure body weight, blood pressure, and monitor the general condition every few months. The problem in this case may be loss of appetite due to the need to follow a “tasteless” diet.

At stages 3-4, if there are no severe clinical manifestations, the therapy will be the same. However, in case of an unstable condition, the cat will have to be brought out of the decompensation stage in a hospital setting. The treatment plan will depend on the symptoms:

• In case of dehydration, infusion therapy is carried out; for this, the cat is given an intravenous catheter.
• Antiemetics (Maropitant, Metoclopramide) are prescribed for vomiting cats.
• If the hematocrit level is very low (anemia), a blood transfusion (blood transfusion) may be prescribed.
• Painkillers are used to relieve pain and inflammation.

After achieving positive dynamics, the cat is prescribed a course of long-term therapy: injections of electrolyte solutions are prescribed to restore water-salt balance, as well as drugs that replenish protein loss.

How to feed animals with kidney pathology?

In this article we will look at the basic principles of a nutritional approach to animals with kidney disease.

Animals with one or another kidney disease may suffer from the accumulation of nitrogen-containing waste, which, in turn, causes intoxication of the body. The animal may suffer from nausea, vomiting, and loss of appetite. Therefore, the level of energy consumed by the animal must correspond to its needs, which is why it is necessary to regularly weigh and determine the patient’s nutritional status, using a scoring system. Typically, cats' daily energy needs are 50-60 kcal/kg body weight.

The duration of the diet is determined by a veterinarian and depends on the stage of kidney disease, the clinical condition of the animal, and data from laboratory and instrumental studies. In some cases, dietary therapy can help prevent the progression of kidney disease. Recommendations for therapeutic feeding, as well as other forms of treatment and support for the patient, should be tailored to the needs of each patient according to his clinical condition and laboratory test results.

There is an opinion that the main difference between dietary food that supports kidney function is its low protein content. Yes, in the lines of renal diets, indeed, the percentage of protein is lower than in other foods, but they also have a reduced phosphorus content, increased levels of omega-3 polyunsaturated fatty acids, vitamins, and a moderate amount of potassium and sodium. All this is necessary for animals with reduced kidney function.

Studies have been conducted more than once on the effectiveness of the renal diet of dogs and cats. For example, in a study conducted by Dr. RossSJ and his colleagues, 2 groups with stage 2 and 3 CKD were recruited. In the first group, 22 cats received a therapeutic renal diet for 24 months. In the second group, 23 cats received a maintenance diet for adult cats. The results showed that in the first group, not a single cat suffered from uremia subsequently, and life expectancy increased significantly. While in another group, 26% of cats had uremic crisis, and 21.7% of cats died due to renal failure. (1)

A similar study was conducted by Dr. Jacob and his colleagues on dogs. Two groups of dogs with stage 2 CKD were recruited. In the first group, 21 dogs received a line of kidney food, in the other group, 17 dogs received a maintenance diet for adult dogs for 24 months. It was found that dogs in the first group had an average time to uremic crisis (1 year 7 months) and an average of 594 days (1.6 years) until death. While group 2 had 0.7 years before uremic crisis and 0.5 years before death, respectively. (2)

Table 1.

A number of dietary components in feed to support kidney function.

There are certain requirements for protein content in the diet.

Protein requirements for adult dogs and cats were created using nitrogen balance. Studies have been conducted in which nitrogen intake is equivalent to nitrogen loss.

The National Research Council (NRC) has established minimum protein requirements based on research. (Table 2)

The American Feed Control Association (AAFCO) also recommends specific crude protein levels for adult dogs and cats, taking into account not only the NRC recommendations, but also the changes that occur to the protein during processing in production. (Table 2)

table 2

Dietary protein requirements for adult dogs and cats.

• The values ​​in the table are given in g/1000kcal.
• Low, medium and high protein content is a common comparison among commercial pet foods.

Protein restriction in the presence of kidney disease.

At the moment, it is not precisely determined how much protein should be limited in kidney disease, and discussions are still ongoing on this issue.

Categories of low, medium and high protein diets are provided. (Table 2). Currently, therapeutic diets labeled for different stages of CKD range from 25 to 55 g protein/1000 kcal for dogs and 58 to 82 g protein/1000 kcal for cats, with some tailoring of protein content to patient needs.

In the presence of renal proteinuria, the prescription of a therapeutic diet is more than justified. Thus, in dogs with proteinuria secondary to glomerular kidney disease, it is recommended to reduce the amount of protein consumed. An additional study found that dogs with spontaneously developing CKD and a urine protein/creatinine ratio greater than 1 had an increased risk of developing uremic crisis and death compared with dogs with a ratio less than 1. In dogs with hereditary glomerulonephropathy, proteinuria was significantly reduced when they were switched from a diet containing 72 g protein/1000 kcal to 33 g protein/1000 kcal, but this result was not evaluated in relation to life expectancy. Based on the severity of proteinuria, azotemia and the presence of clinical manifestations of kidney disease, it is recommended to reduce the protein content in the diet by 25%-50%.

In cats, the independent effect of protein on disease progression remains unknown in the early stages of CKD.

In advanced IRIS stages 3 and 4 CKD in cats and dogs, reducing protein intake may help reduce the accumulation of nitrogenous waste products that contribute to azotemia and uremia. Although urea is not a major uremic toxin in cats and dogs, it is a marker of nitrogenous wastes that contribute to uremia.

Preventing cachexia and protein malnutrition are the main reasons doctors discuss protein restriction. Each patient should have their protein intake and intake assessed based on the degree of cachexia, and of course, the presence of uremia as well as proteinuria should be taken into account.

Phosphorus limitation.

Renal phosphorus retention and subsequent hyperphosphatemia are common in patients with CKD due to decreased glomerular filtration rate. This results in renal secondary hyperparathyroidism and calcitriol deficiency and can lead to soft tissue mineralization and fibrous osteodystrophy.

Phosphorus restriction, independent of other dietary factors, delays the progression of CKD. Due to the high phosphorus content of many meat-based proteins, reducing the amount of protein also helps reduce the overall phosphorus content of the diet. Maintenance diets often contain added phosphorus beyond what is contained in the protein because phosphorus deficiency is more common than phosphorus excess in healthy animals. While the phosphorus content of maintenance diets typically ranges from 0.4 to 1.2 g/1000 kcal phosphorus, the phosphorus content of typical therapeutic diets labeled for different stages of CKD ranges from 0.4 to 1.2 g/1000 kcal phosphorus. .8 to 1.35 g/1000 kcal for dogs and cats, respectively.

In a study conducted by Dr. Finco and colleagues, 24 dogs with kidney disease were divided into 2 groups and given one of the following diets. Group 1 received dietary phosphorus feeding (0.44% dry matter, approximately 1.1 g / 1000 kcal). And the second group received a high phosphorus diet of 1.50% dry matter in the feed. (3.6 g / 1000 kcal). Over a 24-month period, dogs that received increased dietary phosphorus had significantly decreased glomerular filtration rates and decreased survival. Compared to animals fed a diet with reduced phosphorus content. As a percentage, survival rate was 75% higher. (3). (Scheme 1.)

IRIS recommendations. IRIS recommends maintaining plasma phosphorus at 0.9–1.5 mmol/L for patients with stage 2 CKD. And less than 1.6-1.9 mmol/l for patients at stages 3-4 of CKD. If hyperphosphatemia persists despite dietary intervention, the use of drugs that bind phosphorus in the intestine is recommended. Phosphorus concentrations should be monitored every 2-4 weeks until the target concentration is achieved.

Scheme 1. The effect of reducing phosphorus in the diet on the survival of dogs with kidney disease.

Availability of Omega-3 fatty acids.

Supplementation of EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid) in the diet has a renoprotective effect.

For dogs and cats with CKD, the standard dose is EPA 40 mg/kg plus DHA 25 mg/kg.

Companies often add omega-3 fatty acids, including EPA, DHA, and alpha-linolenic acid, to therapeutic kidney diets. However, alpha-linolenic acid is not sufficiently converted into EPA and DHA in dogs and cats. Therefore, you can consider the option of additionally introducing these acids if their content in the diet is not sufficient.

Dietary sodium content:

Reducing sodium intake may be beneficial for patients with CKD due to sodium retention and the potential for development of systemic hypertension.

The sodium content of typical therapeutic diets labeled for different stages of CKD ranges from 0.4 to 1.2 g/1000 kcal for dogs and 0.5 to 1 g/1000 kcal for cats.

Potassium content in the diet.

Hypokalemia. Hypokalemia is common in cats with CKD. Therefore, lines of specialized dietary feeds contain additional potassium content. Typical potassium content in therapeutic kidney diets for cats ranges from 1.4 to 2.6 g/1000 kcal.

Additionally, the administration of potassium parenterally or orally is determined by the veterinarian, mainly based on laboratory tests and the clinical condition of the animal.

Hyperkalemia. Although hyperkalemia is usually associated with acute renal failure, it can be a complication in some dogs with CKD. Therapeutic diets for dogs contain between 0.8 and 2.1 g/1000 kcal. Therefore, some (albeit limited) commercial therapeutic renal diets provide potassium within the range reported for the correction of hyperkalemia in dogs. However, if it is necessary to further reduce the potassium content in the diet, then you can resort to additional administration of drugs.

Additional components in diets.

Therapeutic diets for the kidneys have the following additional characteristics:

• High in calories and moderate in dietary fat
• Alkalinizing supplements such as potassium citrate to correct metabolic acidosis, which can worsen hypokalemia, especially in cats.
• Increased levels of antioxidants, such as vitamins C and E, also vitamins A, D3, iron, etc.
• Adding soluble fiber to stimulate the growth of intestinal bacteria for nitrogen and urea utilization. Soluble fiber may also be beneficial for cats with constipation, a complication in animals with CKD.

In conclusion, we would like to note that the administration of specialized dietary food can significantly reduce the progression of CKD at any stage of the renal continuum. Diet selection should be based on a complete nutritional assessment of the patient, including staging of CKD. In addition, it is necessary to monitor the response to diet and drug therapy. Regular monitoring makes it possible to judge the condition of the animal as a whole and optimize therapy.

Bibliography:

1. Ross SJ, Osborne CA, Kirk CA, et al. Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats. JAVMA 2006; 229(6):949-957. 3. Elliott J, Rawlings JM, Markwell P
2. Jacob F, Polzin DJ, Osborne CA, et al. Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs. JAVMA 2002; 220(8):1163-1170.
3. Finco DR, Brown SA, Crowell WA, et al. Effects of phosphorus/calcium-restricted and phosphorus/calcium-replete 32% protein diets in dogs with chronic renal failure. Am J Vet Res 1992; 53(1):157-163.
4. Elliott J, Rawlings JM, Markwell PJ, et al. Survival of cats with naturally occurring chronic renal failure: Effect of dietary management. J Small AnimPract 2000; 41(6):235-242.
5. Jacob F, Polzin DJ, Osborne CA, et al. Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure. JAVMA 2005; 226(3):393-400.

Diet and food for cats with kidney failure

Cats with kidney problems need a very strict diet. If your pet is on a natural diet, you will have to exclude from its diet:

• dairy products,
• foods high in carbohydrates,
• fish (it contains a lot of phosphorus).

Meat (veal, turkey, chicken) can be given boiled or well frozen to reduce the risk of infection with parasites. You can give offal in the same form a couple of times a week. It is recommended to include vegetables in the diet, and to give them an attractive smell, they can be boiled in broth or mixed with meat.

Today, a fairly large number of special foods are offered for cats with kidney failure - canned food, pates and dry croquettes. According to veterinarians, they are more effective than those prepared at home, since they contain all the nutrients necessary for the cat’s body, and are guaranteed to have a low content of phosphorus and protein, which are harmful for this disease.

The best manufacturers of food for cats with kidney failure are the following companies:

• Eukanuba (Holland) - medicinal food and Veterinary diets renal cat;
• Hill's Pet Nutrition (USA) - dry and wet food Prescription Diet K/D Feline Farmina Vet Life Renal and Monge Grain Free Vetsolution Renal Feline;
• Purina (USA) - Pro Plan Veterinary Diets NF menu;
• Brit (Czech Republic) - dietary food GF Veterinary Diet Renal;
• Royal Canin (France) - dry medicated food Renal Select Feline;
• Leopold Diet (Ukraine) - dry and wet dietary food;
• Josera GmbH & Co (Germany) - Senior special feed.

Feeding a cat with kidney disease natural food

Some owners note that despite treatment and specialized feeding, the pet’s condition worsens. Many veterinarians consider this fact to be a consequence of a neglectful attitude towards the animal’s food. Most often, owners make the following mistakes when feeding a cat with kidney pathology:

• Treating yourself to a harmful treat. Pity and great love for the pet lead to the fact that sometimes the owner treats him with his favorite product, which is excluded from the diet. In some cases, a slight deviation from the rules leads to irreversible consequences.
• Combination of natural food and prepared food. This combination can lead to an excess of unwanted microelements.
• Increase recommended servings. When the pet gets better, it develops an appetite. However, the animal’s diet is calculated in such a way that it receives the necessary nutrients without harming the kidneys. If the cat eats more, the load on the organ increases.
• Switching to normal food without veterinarian permission. Some owners give up the diet after they see an improvement in the cat's condition. However, with kidney failure, most often you have to adhere to a special diet for a long time or until the end of your pet’s life. Self-refusal to nutritional therapy can worsen the problem.
• Severe fluid restriction. With kidney failure, cats often experience frequent urination. Refusal to drink leads to dehydration and the development of urolithiasis.

Prevention of kidney failure in cats

To avoid kidney problems, cats over 5 years of age are recommended to undergo quarterly medical examinations. Detecting pathology at an early stage will allow for greater success in treatment. Our veterinary clinic AMVet accepts patients around the clock; you can make an appointment by calling the contact number or by contacting the administrator on duty. If a cat detects signs of kidney disease, it will be examined, and if the diagnosis is confirmed, the necessary treatment will be prescribed.

Prevention and recommendations

When chronic renal failure is detected in cats, the prognosis for life is given carefully. The health of your pet directly depends on proper care and compliance with the recommendations of a veterinarian. Basic preventive measures:

• undergoing regular veterinary examinations and tests (at least twice a year);
• compliance with a therapeutic diet;
• ensuring free access to fresh, clean water;
• maintaining a high level of physical activity;
• routine annual vaccination;
• use of medications during exacerbation.

Treatment of chronic renal failure in cats is a long and systematic process. The length and quality of life of a pet depend on the responsibility of the owner and his compliance with the therapeutic strategy.