Chronic Renal Failure, Winston's Legacy

[Elaine]

Chronic Renal Failure, Winston’s Legacy

If you are reading this, your cat has probably been diagnosed with CRF. Your cat may be newly diagnosed or has been fighting this disease for some time.
You undoubtedly feel overwhelmed, frightened and emotionally devastated by the news. Don’t beat yourself up about not noticing anything sooner; cats are masters at masking until they can hide it no longer.


CRF is a very complex issue and all things are relevant. I have tried to keep it as simple and easy to understand as I could. CRF is a progressive, terminal illness and not usually an immediate death sentence. Most CRF cats can go on to live for quite some time. I would like to offer some hope and support where I can.

Winston was 18 and half years old when he was diagnosed. My vet offered me little hope, so I set off, heartbroken, and started to read and learn as much as I possibly could about CRF and am still learning today. It’s not all plain sailing and we had many emotional pit falls but Winston’s quality of life was good and we shared each others lives for another 2 and half years. Winston died at the grand old age of 21 on April 4th 2006.

I am not a vet nor am I an expert on CRF but wanted to share what I have learned and try to explain in layman’s terms. I hope this may help you and your cat.

WHAT IS CRF?

CRF or Chronic Renal Failure is, in my opinion, a little misleading and I prefer to use the term Insufficiency as opposed to Failure.
It’s a term that classifies kidney problems, which eventually results in kidney function being lost.
As kidney function is lost cats are unable to filter, process and eliminate waste products effectively, resulting in a build up of toxins in the blood stream, making your cat feel very sick.

WHAT ARE THE SIGNS OF CRF?

The signs can often be very subtle but usually include some or all of the following.

An increased thirst and/or urination

Loss of appetite

Vomiting

Weight loss

Dull coat

If you think your cat may have CRF, a trip to the vets for a blood and/or urine test will confirm this.

MY VET ADVISES TO PTS MY CAT

Vets may offer this option as it may be an easier solution for an owner who may feel that the cat is near the end or if faced with, what may be years of treatments to help keep the cat stable. Some owners may feel they wouldn’t be able to cope or afford on going treatments.
Many vets talk very negatively about CRF from the start which doesn’t instil much hope or confidence in the owner. It is important that you and your vet can talk openly and honestly with each other thus creating a good working relationship for the benefit of the cat.
Change vets or get a second opinion. Many vets are not very experienced with CRF, or they think that the owners won’t do what is necessary to help and care for a CRF cat.
No one can tell you how long your cat can live with CRF. Some cats may go down hill fast, while others may go on for years. Even cats with high kidney values can sometimes go on to live for quite some time.
Ask for a copy of the blood results and ask your vet to explain the values to you, and what your options are.
You know your cat better than any one else so follow your instincts.

CREATININE AND UREA ARE HIGH

Urea, when protein is broken down through the digestive process, ammonia is absorbed into the gut. The liver then makes a substance call urea from the ammonia. The urea then travels through the blood stream in the form of urea nitrogen to the kidneys, the blood is filtered out and the rest is filtered out as urine. This means that the urea test is to check the level of nitrogen in the bloodstream.
Creatinine is another waste product which is filtered through the kidneys. Creatinine can tell us more accurately of underlying kidney issues because diet, dehydration and stress affect it less.
Many vets will tell you these values and then tell you what the normal ranges are. It’s scary because it sounds like your cat’s values are exceptionally high. By doing this, your vet isn’t giving you a good reference.
Each cat is different. These values are variable and can be reduced with treatment or at least stabilised. Some cats are able to tolerate mid to high levels of Creatinine and Urea quite well.

For example
Normal ranges Urea = 3.5 – 8.0 mmol/L Creatinine = 40 – 180
Winston was stable for over a year with a Urea of 18mmol/L and Creatinine of 360 – 377
Although these numbers look high, Winston was comfortable. He had off days but mostly he was on good form.
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MY CAT WONT EAT THE PRESCRIPTION FOOD

It’s always best to introduce new foods gradually. There are some mixed opinions about prescription food for CRF cats. The important thing is that your cat eats. If your cat won’t eat the prescribed food, try to find a food with the lowest phosphorus that your cat will eat. Senior cat foods tend to have less phosphorus than Adult cat foods. You may also want to discuss the use of phos binders with your vet. A phos binder will bind the phosphorus in the food in the intestine and stops it from being absorbed. A cat with CRF can‘t excrete phosphorus from its kidneys properly, this in turn may affect calcium levels which can have serious consequences. High levels of phosphorus will make your CRF cat feel very sick. It is recommended that the phosphorus level in the food you choose for your CRF cat should be under 1%, most prescription foods have a phosphorus level of under 0.5%.

TEMPTING YOUR CAT TO EAT

It’s very upsetting and frustrating when your cat refuses to eat. You may want to try the following.

Mixing some chicken or tuna into your cat’s food.

Try a variety of foods.

Sit with and talk to your cat while it’s eating.

Excess tummy acid is a big issue with CRF cats, ask your vet about Zantac syrup or similar to help settle your cats tummy.

Slippery Elm Bark may also be useful to help combat tummy acid.
Try mixing some tuna and water together.

Baby foods; just make sure they don’t contain any onion.

Try warming the food or adding a little boiled water to it.

Try assist feeding, sometimes if you can get a little food into your cat, he/she may start to eat on their own. Syringe a little food into the side of the mouth and not directly down the cat’s throat.

You may also want to ask your vet about appetite stimulants.

HIND LEG WEAKNESS

Your cat may have a potassium deficiency. Ask your vet about a potassium supplement.

MY CAT IS VERY SICK AND LETHARGIC

CRF cats are very prone to becoming anaemic. This can be life threatening and must be taken seriously and treated.
PCV and HCT are both values that can indicate anaemia. Your vet can prescribe Epogen or similar to help with this but my favourite is a supplement of B vits and Iron in the form of Pet Tinnic.

HOW WILL I KNOW WHEN IT’S TIME TO LET GO?

This is of course a very difficult time. Some say you will know instinctively, others that their cat let them know. It may be an idea to think about PTS before the time actually arrives. Talk to your vet and ask for their guidance. It’s very rare that a CRF cat will die peacefully in its sleep.
With Winston, it was under discussion for a week or two before; his age and ability to cope, as well as his quality of life were all considered. He was almost 21 years old and frail, his world had become so very small and he barely moved from the bed at this stage. He just seemed miserable and the bad times had now out weighed the good times. I couldn’t watch him suffer any more, despite my best efforts to help him. Sadly, the day after his 21st birthday, I let him go. He had had a long and happy life.

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Chronic Renal Failure, Winston's Legacy