Acute kidney failure can be reversed
if the underlying cause can be corrected before it permanently damages the
nephrons. If the insult is severe, hemodialysis (more commonly called dialysis)
may be necessary to try to give the kidneys a chance to heal. Dialysis is most
commonly used short term to treat acute renal failure or toxicities, or while a
search is conducted for a transplant candidate. Dialysis is extremely
expensive, can only be done at a few veterinary referral centers, and still
requires extensive medical management of the cat in addition to the dialysis
Most cases of chronic kidney failure occur in cats who have sustained
irreversible damage to the kidneys. However, these cats may still have many
happy months or years of life ahead, with proper treatment. It is extremely
important to be sure these cats take in enough water to compensate for their
large urine output. A supply of fresh, clean water should be available at all
times. Many cats will need supplemental fluids, given either intravenously at
the veterinary hospital or subcutaneously at home.
Your new cat is coming home from the animal shelter tomorrow. Busily you shop, checking off the items on your list, including cat food, toys, a scratching post and myriad other goodies.
And at the very top of the list are litterbox necessities. You head to the nearest pet supply superstore, and are faced with row after row of “all things litter.” Pastel-colored clumping litter, good old clay litter, some that’s made from pine and some that’s made from newspaper...What to choose, what to choose?...
The diet of a uremic cat should include protein of high quality, but lower
in total amount, to minimize the amount of phosphorus and nitrogen that must be
excreted by the kidneys. Special diets are available through your veterinarian.
Canned foods are better than dry foods, because the canned food adds fluid to
the diet. Prescription diets that are used for cats with kidney failure include
Eukanuba MultiStage Renal, Purina Veterinary NF, Hill’s Science Diet k/d, Royal
Canin Modified Formula, and Royal Canin Renal LP 21. Your veterinarian can also
guide you to appropriate homemade diets.
Phosphorous restriction in the diet is important, although phosphate
binders, such as aluminum hydroxide salt (Amphogel) can also be given.
Vetoquinol has produced a veterinary product called Epakitin that is a
palatable powder that also binds phosphates. However, this product also
contains calcium, which may be contraindicated in the later stages of renal
Large amounts of B vitamins are lost in the urine of uremic cats. These
losses should be replaced by giving vitamin B supplements. Sodium bicarbonate
tablets may be indicated to correct an acid-base imbalance. Potassium may also
need to be supplemented. The kidneys are also important in the production of
vitamin D. Cats in chronic renal failure may benefit from the addition of
calcitriol to their therapeutic regimen. Your veterinarian may need to order
special compounded versions of calcitriol to get the appropriate dosage for a
Vomiting may need to be
controlled with medications such as famotidine, ranitidine, omeprazole, or
others, until the renal condition is stabilized.
Erythropoietin may be used to help counteract the anemia associated with
long-term renal failure. Currently, human recombinant erythropoietin is used,
which may lead to immune-based destruction of red blood cells and a renewal of
the anemia over time. Research is continuing for a safe feline alternative.
Cats with hypertension will need therapy
to lower their blood pressure.
A uremic cat who becomes ill, dehydrated, or fails to drink enough water may
suddenly decompensate; this is known as a uremic crisis. The cat should be
hospitalized and rehydrated with appropriate intravenous fluids and balanced
Some exercise is good for a uremic cat, but stressful activity should be