Chronic renal failure (CRF) is a common cause of illness in older cats. Unlike some other organs like the liver, can damage the kidneys can not be repaired. Signs of kidney disease is usually seen once, at least 70-75% of kidney tissue is irreversible, and once established, CRF is usually a natural mode progressive. Progression of disease can vary cat to cat. There is no cure for CRF and in people with this condition, dialysistreatment followed by transplantation of the kidney are the main options. None of these treatments are currently available in the UK, although it is possible to improve the quality of life of affected cats by working with a variety of medical treatments tailored to individual needs. In recent years, progress has been a lot of treatment, and now there are more options available for owners who wish to provide their cats with CRF. Before discussing these treatmentsdetail, it is important to assess what is the normal function and therefore the scale of problems that cats with CRF may have.
In normal cats, the kidneys play many important roles, including:
The removal of waste, drugs and toxins from the body through the urine
Change the acidity of the body, levels of electrolytes (calcium, phosphorus, potassium, sodium and chloride) and water balance
The production of hormones such as erythropoeitin (required forstimulates production of red blood cells in the bone marrow) and renin (important in the management of water and salt balance)
The activation of vitamin D (important in the control of blood calcium and phosphate)
Regulation of blood pressure
Signs of CRF develops when two thirds to three quarters of renal function was lost. Cats with CRF are vulnerable to problems including:
Accumulation of degradation products of proteins (including urea and creatinine, which can be measured inSamples of blood), which is associated with clinical signs of disease (eg nausea, vomiting, loss of appetite)
Dehydration
Acidosis (increased acidity of the blood)
Electrolyte abnormalities
Anemia (in part because of the lack of production of erythropoeitin)
High blood pressure (systemic hypertension)
CRF cats often exhibit nonspecific signs of illness as a variable or poor appetite, weight loss, depression and illness. Thirst seen in about one third ofcats with CRF, although these clinical signs can also use various other conditions commonly seen in middle-aged to older cats and hyperthyroidism and diabetes mellitus (diabetes). diagnosis of CRF therefore requires the collection of blood and urine for analysis. Regel a diagnosis made after identification of azotemia (accumulation of products of protein degradation of creatinine and blood urea) and the loss of ability to concentrate urine (ieurine is more diluted than it should be). Further tests may in some cats need to be the cause of renal disease. For example, the ultrasound examination of the kidneys is usually a simple technique for identification of polycystic kidney disease (PKD).
The management of cats with CRF involves a wide range of treatments is adjusted according to individual needs.
What is the ideal diet for cats with kidney problems?
E 'commonprescribe specific diet therapy, as they have demonstrated improved quality of life and survival of cats with CRF and may reduce the rate of disease progression. Renal function, nutritional levels typical of high quality protein, which limits the amount of protein breakdown of waste products the kidneys excrete in trouble limited. Phosphate content is also limited, because cats with CRF have a tendency to store excessive amounts of this in the body that can contribute tofeels good. Renal diets have increased amounts of potassium and B vitamins that CRF cats are vulnerable to losing their urine and increased the number of calories to help CRF cats with little appetite to maintain a normal body weight. Renal diets are generally lower levels of sodium in them which can help reduce the risk of developing hypertension.
E 'possible to prepare home-cooked diet for cats with CRF and veterinary prescriptionsavailable for this purpose. Most owners do not want the protocols of home cooking, so it is a long time, and therefore not a practical choice in most cases.
Cats with CRF often have a poor appetite, and can offer a special kidney diet that appeals may be directed to the cat can not get worse. In some cases, the use of appetite stimulants, such as anti-histamine cyproheptidine (trade name Periactin) or anabolic steroids to be useful in promoting a good appetite.More recently, some veterinarians treat cats with persistent lack of appetite by putting a tube in his stomach. The probes can be successful in the stomach by endoscopy, and called PEG tube when it is done (percutaneous endoscopic gastrostomy tube down). Even if an anesthetic and a short period of postoperative hospitalization is required for the pipe, where the position of this for long periods can be used to administer food and fluidsmedicine for the cat.
How can dehydration be prevented and treated?
Cats with CRF are vulnerable to dehydration because they are able to produce concentrated urine. Diet Encouraging cats to drink and to maintain normal hydration is useful, if possible, and damp is probably preferable. Offering flavored water may be to encourage cats to drink more (eg, fish broth), but it is important that the saline fluids, because it can increase the risk of strong demandblood pressure and other problems develop. Many cats with CRF, although the kidney dry diet choices, and can be difficult to encourage drinking. In recent years, a treatment that a lot of attention, control of fluid under the skin of the cat's owner (administration of fluids subcutaneously).
There is currently a general recommendation in the United Kingdom, although many Americans CRF cat owners are finding a simple and valuable technique to help their cats. Insevere cases, dehydration may require treatment with intravenous fluid therapy (eg, cats are allowed at a veterinary clinic and placed on a drip). To give extra fluids at home, may be useful to prevent this. Furthermore, additional treatments such as potassium to the fluids added. Subcutaneous fluid administration usually involves giving about 150 ml of liquid under the skin twice a week. The technique is well tolerated by most dogs and owners to include a report of a 19-year-oldold cat with CRF managed in 6 years with subcutaneous fluid therapy as part of the management protocol. If it is necessary for the regime to greater fluid administration often changed. The owner will be on how to use this technique to be a vet or a nurse trained to be – it is important that the liquid is carefully recorded in a sterile manner, so that infections occur at the injection site does not. Some cats tolerate this procedure and therefore may not be suitablefor all cats with CRF.
How can electrolytes Dealing with problems and has prevented?
Electrolytes, salts present in the body that are necessary for normal cell functions. The most common electrolyte disorders in cats CRF include potassium and phosphate. CRF cats are vulnerable to loss of potassium in the urine, which can lead to a decrease in blood potassium (hypokalemia). Hypokalaemic Cats can have a very weak and lose their appetite.Even if the diet contains kidney, increased amounts of potassium in them, a pair of cats with CRF have low levels of potassium in the blood to develop. Extra potassium may order these treasures as powder, tablets or liquids down.
CRF cats are vulnerable to the accumulation of phosphates, which can make them hyperphosphataemic phosphate (high). Oral phosphate binders are substances that bind to the phosphate is present in the diet and the restriction, which is occupied by intestine, cat.These drugs are in CRF cats whose blood phosphorus remains high, despite a diet therapy, or those cats in which a diet prescription that will not be necessary.
What can be treated and prevented systemic hypertension?
High blood pressure (hypertension) occurs in 20 – 30% of cats with CRF and may have serious consequences, including blindness. Monitoring of blood pressure is important, so that hypertension can be identified quickly and, if treatedarising. Most practices now have the opportunity to measure blood pressure in cats, and is a technique that is simple, painless and only takes minutes to perform. In those cats that require treatment, the antihypertensive medications (like oral amlodipine or benazepril) may be prescribed. Gatti Most once-daily therapy to maintain normal blood pressure.
What other treatments may be needed?
Further treatment in accordance with the requirementsthe cat, which include:
Erythropoietin: Anemia is common in cats with CRF and one of the reasons is that a reduction of erythropoietin produced by the kidneys. Erythropoietin, a hormone that induces the production of red blood cells in bone marrow and in the treatment of anemic CRF cats with human erythropoeitin may be useful for the reversal of anemia. Unfortunately, this treatment can be expensive and may not always have a lasting effect as the hormone has been recognized as a humanforeign substance, such as the cat's body, which produces in the final analysis, antibodies against the substance to prevent an effect. Another possible side effect of this treatment is the development or aggravation of hypertension, so cats to this treatment should be carefully monitored. Studies are underway at two U.S. universities, the development of a feline erythropoietin, which would be much more useful and should result in the production of antibodies, not the cat.
IronSubsidy: Some CRF cats were anemic iron deficiency, so the measure of iron status and treatment of iron supplementation may be useful. Iron is needed for the production of hemoglobin, the carrier of oxygen in red blood cells.
Cats Anti-sickness pills for vomiting with CRF may suffer from what is called uremic gastritis (inflammation of the stomach due to waste storage and hormones, which usually separates the kidneys). Anti-diseaseincluding antacids and anti-vomiting drugs can be very useful in the treatment of this problem, which can help the cat feel better.
Prevention and treatment of acidosis: Cats with CRF are vulnerable to becoming acidosis (ie, their blood is more acid than it should be). Has many effects that will make the cat feel more at ease. Where possible, cats with CRF should not be acidifying diet (this diet is often prescribed for cats with lowerurinary tract problems, such as cystitis and bladder stones), because it increases the risk of acidosis. Treatment of acidosis involves the use of substances such as sodium bicarbonate.
Calcitriol (vitamin D). Although still a bit 'controversial, many doctors use this treatment in selected patients, CRF, and found useful for maintaining normal levels of calcium and phosphate.
ACE (ACE) inhibitors such as benazepril (Fortekor ®,Novartis): This treatment has recently been recommended based on research in people with CRF, that ACE inhibitors have been found to survive the times. Data from a recent clinical trial in cats with CRF suggested that cats who receive this treatment has a better quality of life has been (as rated by their owners), a reduction in the amount of protein lost their urine and po 'increased survival times. Fortekor the parameters used to determine not to reduce kidney(function of urea for example, in blood levels of creatinine). In the same clinical study, a specific sub-set of cats with CRF, who lost a large amount of protein in urine was an excellent response to treatment Fortekor ® (significantly improved the survival of appetite and weight gain). Unfortunately, this manifestation of CRF is only a small percentage of all cats with CRF.
ACE inhibitors also lower blood pressure and thus can be prescribed as an anti-hypertensivetherapy.
Antibiotics: Recent studies have shown that up to 30% of cats with CRF suffer from a bacterial cystitis, at some point during their illness. In some cats this infection may spread to the kidneys further deterioration of renal function. In other cats, bacterial cystitis due to a bacterial infection of the kidneys (pyelonephritis). Cats with CRF may be more vulnerable to the development of bacterial infections of the urinary tract asurine they produce is so watered down. Unfortunately, in many cases, bacterial infection, no sign of cystitis cases (such as urinating more frequently to urinate, frequent urination of blood), the diagnosis of this complication is difficult. Diagnosis requires collection of a urine sample that is assessed for microscopic evidence of bacteria and bacterial growth media inoculated for growth in a laboratory. A course of antibiotics, sometimes for weeks ormonths, as may be necessary for the success of bacterial infections of the urinary tract off.
Other drugs can not be discussed in some cats with CRF is necessary, and it is important to change the treatment to the specific needs of each individual cat. The website FAB (http://www.fabcats.org/) contains useful information about kidney disease, which makes the website an owner of a cat with CRF design http://www.felinecrf.com/
What is the prognosis forcats with IRC?
The long-term perspective for cats with CRF are highly variable, ranging from a few weeks after the diagnosis in many years. CRF is believed to be a progressive condition in most if not all, cats, even if the rate of progression can vary greatly depending on the cause of the disease, and other individual factors. The prognosis is also influenced by other issues, as if the cat has other medical problems that the influence of his condition and the severitythe effects of kidney disease. For instance, cats often suffer from anemia of CRF has a very poor prognosis for long, because it is difficult to treat effectively for longer. Ownership and control of affected cats veterinarian to help assess the degree of progression of the disease and to ensure that affected cats have received the care they need for good health. Care of affected cats at home can be very rewardingand useful in order to ensure that CRF patients with the best quality of life as long as possible.
A comprehensive book gives a cat with renal failure 'by Dr Sarah Caney is available through its website as an e-book or a print on demand Soft back.
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