Sunday, January 16, 2011

Constipation in Cats with Kidney Disease

Cats are apparently more prone to constipation than dogs, due to their constant grooming. They tend to ingest large amounts of fur. Also, a cat that mainly eats dry cat food can become dehydrated, which contributes to constipation.

Chronic kidney failure can also lead to constipation because you cat loses excessive amounts of water through more frequent urination.

I'm sure you know how rotten it feels to be constipated. Like you, cats will have small, hard poops or barely poop at all. Unlike you, your cat may have small pieces of poop that stick to their rear end. In this case, your cat may "scoot" – that is, drag its butt across your floor (or carpet) to try to dislodge the offending poop. Not a pretty sight or result.

Steps to take:

1. First, check to see if your cat is dehydrated. Use the "pinch test." Squeeze a bit of skin on the scruff of your cat's neck, about 3-4 inches back behind its head. Make a little tent with the skin if possible. If the skin immediately snaps back into place, then your cat is probably hydrated. If it barely moves back into place, or you can't make a little tent of skin at all, then that's a sign your cat is dehydrated.

Another trick is to check your cat's gums. They should feel slippery. If your cat's gums feel sticky, then your cat may be dehydrated. Try to give you cat more water. Or increase the frequency of your fluid treatments (see Fluid Treatment for Cats with Kidney Disease).

2. Speak with your vet if your cat is constipated. Your vet may suggest special remedies for constipation, such as laxatives, prokinetic agents, or enemas. A prokinetic agent is a type of drug which enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm.

3. Try some simple remedies for constipation. My favorite is Kitty Malt – yes, the same remedy you may use to prevent hairballs. Kitty malt is a gel-like substance that's made with glyercine and fat. It can help coat their gut and may reduce constipation. It may also stimulate your cat's appetite.

Some other remedies include:

Canned pumpkin. Not all cats will eat it, but it's an excellent natural, mild laxative. Try a spoonful directly or mixed in with food.

Psyllium husk is a powder that can be sprinkled on top of your cat's food and mixed in. Psyllium husk is an excellent source of dietary fiber that promotes regularity. It's an ingredient in popular human laxatives such as Metamucil.

Lactulose is reported to be an effective treatment for constipation and may have the additional benefit of trapping urea (a urine waste product) in the bowel, and therefore helping your cat expel urea with less stress on the kidneys.

Laxatone is a well-known bowel stimulant for cats that's used to relieve hairballs as well. You can give you cat ½ to 1 teaspoon of it a day, then taper off. Laxatone contains mineral oil, which can help increase the "motility" of feces through your cat's intestines.

Nutri-Cal is another dietary supplement that is mentioned for cats with constipation. It contains various vitamins and minerals. But I also noticed that it contains phosphorus and, as you may know, cats with kidney problems are often on a low-phosphorus diet, since their kidneys have a harder time getting rid of phosphorus. So it doesn't seem to make sense to use this supplement for your cat if your cat has kidney problems.

Prolonged constipation can be more than uncomfortable. It can lead to loss of appetite, weakness, lethargy and vomiting. So it's important that you discuss your cat's constipation with your vet and take steps to treat it right away.

Wednesday, January 5, 2011

Okay, it's not ALL serious stuff...

Here's a reminder of why we love and cuddle and care for our little kitties, the way we do. I think the video says it all.


Here's the link to the actual video

Saturday, January 1, 2011

Advanced Treatments for Cats with Kidney Disease

I'm sure you care deeply about your cat and want to do everything you can to make her comfortable and extend her life. Hopefully, you'll find a lot of answers on this site and elsewhere.

However, at some point, every pet owner has to decide just how he or she wants to go to care for a cat with kidney disease. It's going to be a different decision for everyone, depending on resources.

We were prepared to do everything possible – diet, fluid treatments, extra care, probiotics, hand-feeding and more – but short of what we considered "heroic" efforts. By that I mean treatments normally used for humans – kidney dialysis and kidney transplants.

Believe it or not, both are now available for the treatment of feline chronic kidney failure. Here's a snapshot of both.


As you may know, with kidney dialysis, a catheter is inserted into a vein and the blood is circulated through an artificial, mechanical "kidney" machine. This machine filters out toxins and waste products from the blood. Blood is circulated several times during the course of one treatment. These treatments can last from three to five hours.

Very few veterinary facilities are equipped to offer hemodialysis for cats. However, if you are interested in more information about this, visit the Feline CRF site for a list of facilities that do offer feline dialysis.

Kidney Transplants

Admittedly, this would seem like a very extreme measure to go to save your cat's life. However...

Kidney transplants in animals apparently date back many years. In the mid-1980s, the School of Veterinary Medicine at the University of California, Davis, pioneered a kidney transplant program in animals. Transplants are now available in other areas of the country and the procedure and post-operative protocol have reached the point where kidney transplants for cats is no longer considered experimental.

Kidney transplants are most often performed on older cats, with the goal of extending life expectancy anywhere from 2 to 6 years. To date, according to the Feline CRF Information site, a cat has survived for as long as 10 years after the operation. They even say "feline renal transplantation is now an accepted and relatively safe treatment for patients in renal failure" and note the success rate is nearly 90 percent. For more details on the history and actual process of kidney transplantation in cats, visit the CRF Info Page.

If you or any of your friends know of the costs associated with this procedure, please let us know as a service to other readers of this blog. You can add your comments below. Thanks.

Friday, December 24, 2010

Medications for Cats with Kidney Disease

The feline CRF Information Center has an extensive list of medications available for treating cats with kidney disease, along with detailed descriptions of what each medication is designed to do. I urge you to consult their site before starting any drug treatment, for the latest research or news about drug recalls.

I'll give you a summary here, with one caveat: like medications for humans, most drugs come with a set of side-effects. So you'll have to weigh the advantages of using these medications against their detrimental effects (and the cost). We have been fortunate enough to manage Michou's CRF for over three years without the use of any prescription drugs -- just diet changes, fluid treatments, careful feeding, and probiotic supplements. So I'll let you decide for yourself.

For Anemia – medications used to stimulate the production of red blood cells include forms of the drug erythropoietin, such as Eprex.

For Appetite – Winstrol-V (stanozolof) is an anabolic steroid used to improve appetite and quality of life for cats with kidney disease. It is administered in tablet form or by injection.

Some vets prescribe Periactin, an antihistamine used for humans, to stimulate appetite in cats. It does not work for all cats but reportedly has fewer side effects than tranquilizers used for appetite stimulation.

And believe it or not, some vets even prescribe Valium for cats to boost their appetite!

For elevated Calcium levels – Calcitriol, an active form of vitamin D, is often prescribed. This is not a medication per se, but more of a nutritional supplement. Calcitriol helps prevent excess calcium from being absorbed into the body. However, there is a difference of opinion on the interrelationship between calcitriol, phosphorus, and calcium levels. For a more in-depth discussion, see the CRF Information Center website.

For excess Phosphorus – your vet may prescribe phosphorus "binders" to be given just before or after each meal, or with food. These substances bind with phosphorus to decrease the absorption of the mineral into your cat's bloodstream. Some common phosphorus binders include Alu-Cap, AlernaGEL, Amphojel, and Basaljiel. There are two main types of phosphorus binders on the market: calcium-based and aluminum-based. An aluminum-based binder will not elevate your cat's blood calcium levels, which can lead to other problems. Some phosphorus binders have been discontinued by their manufacturers or are difficult to obtain. Check with your vet.

For High Blood Pressure (hypertension) – Norvasc, a calcium channel blocker, is the most common medication prescribed for cats with both compromised kidneys and hypertension. There is also some research being done with ACE inhibitors (see below).

For Low Potassium – Tumil-K and RenaKare, forms of potassium gluconate, are available. This must be carefully considered and monitored, because the reverse problem – too much potassium in cats with compromised kidneys (and thus an inability to get rid of potassium) -- could potentially cause heart failure and other problems. So it's vital to consult and work with your veterinarian when addressing potassium levels.

For Stomach Irritation – You'll recognize Pepcid AC (famotidine) from the TV commercials for humans. This drug, available over-the-counter from your vet, can inhibit the production of stomach acid which can sometimes cause cats not to eat. Note that the tablet must be broken into smaller pieces for a dosage that is appropriate for cats. Other acid-reducing medications include Zantac (ranitidine) and Prilosec (omeprazole). Anti-nausea medications include Zofran (ondansetron) and Reglan (metoclopramide). They are all meant to reduce stomach acid and/or control nausea, which can suppress your cat's appetite.

For reducing toxins – Drugs such as Covalzin® and Kremezin may lower the amount of toxic dietary protein metabolites. Another drug called Azodyl is reportedly designed to lower blood Urea and creatinine levels by populating the cat's bowels with beneficial microorganisms.

It is interesting to note that the probiotic supplement I mentioned in the Appetite Boosters for Cats with Kidney Disease post would also increase the number of beneficial microbacteria in your cat's gut.

For fighting infections – No surprise here. You vet may prescribe various antibiotics, not to fight the kidney disease, but to ward off infections that may result from your cat's weakened immune system. As you may know, antibiotics, while they kill bad bacteria, also destroy the good bacteria in your gut. So you may want to follow-up any antibiotic treatment with a probiotic supplement (see above).


The CRF Information Center mentions that there are research projects underway testing the use of ACE inhibitors and calcium channel blockers on cats. The theory is that these medications dilate blood vessels and increase blood flow in a way that doesn't over-tax the kidneys. You may want to Google ACE inhibitors and cats to find the latest research.


Many of these medications are made for humans with similar problems. Thus, the dosage in the human version would be much too high for a cat. You may need to locate something called a "compounding pharmacy" to have them prepare a dosage that is appropriate for your feline.

NEVER give a human pill to a cat! And always discuss a medication and its possible side-effects with your vet before trying it. There is an excellent article you may want to read, How to Give Your Cat a Pill.

If you notice any unusual behavior after starting a particular medication, tell your vet immediately. You may need to change the dosage or stop using the medication.

Monday, December 20, 2010

Nutritional Supplements for Cats with Kidney Disease

If you're like me, you may view medications as a last resort, due to the possibility of side effects. I would much prefer to take natural substances that support the body's own ability to heal, rather than introduce synthetic chemicals.

So, in addition to medications that your vet may have prescribed, you should know that there are nutritional supplements you may want to consider for your cat with kidney disease. These supplements can help keep important minerals such as calcium and potassium in balance, and may help improve your cat's appetite.

Your vet may tell you about Calcitriol, which is an activated form of vitamin D that helps your cat regulate the absorption and storage of calcium and phosphorus in the bloodstream. In our case, the vet noticed an increase in Michou's calcium levels during one of her blood tests. Calcitriol is a liquid which you can squirt into your cat's mouth using the eyedropper provided. Fortunately, it only requires a very small dose – 0.5 ml. But as you may know, prying open your cat's mouth and squirting something inside is never really a fun time for either party. Especially when kitty starts realizing what's coming. Nevertheless, Calcitriol is thought to be very helpful for cats with kidney failure, especially in the early stages.

Some cats may benefit from a vitamin B complex, particularly one with iron, which may be used to help treat anemia in cats with kidney disease. Some popular vitamin B supplements include Nutrived, Pet-Tinic, Procrit, Epogen, and Aranesp.

Cats that are urinating excessively may suffer from lower levels of potassium. Potassium is involved in many different bodily functions, including fluid balance, protein synthesis, energy, muscle contractions, even control of the heartbeat, to name a few. So your vet may recommend a potassium supplement to bring your cat's potassium levels back into balance. Some common potassium supplements are available in powder, gel, or tablet form. They include Renakare, Tumil-K, Renal K+ powder, Potassium Gluconate powder and an injectible Potassium Chloride supplement that can be mixed with the subcutaneous fluids you may be giving to your cat.

Omega-3 fatty acids may be helpful for cats with compromised kidney function. There is a nutritional supplement called Renafood from Standard Process that contains omega-3s and reportedly helps to maximize kidney function. One important note: Renafood is a supplement for humans with kidney problems.

As I mentioned in the Appetitie Boosters section, you cat may benefit from Probiotic Supplements to help digestion, improve appetite and prevent weight loss. There is a supplement called Renal Advanced from Candioli Pharma, an Italian company, that contains active lactobacillus acidophilus (helpful bacteria), bioflavinoids and other nutrients. One of our vets told us about it. It is a fine powder that can be sprinkled over wet cat food. It was recommended to improve digestion, cut down on nausea, and boost our cat's appetite. So far, it seems to have helped boost Michou's appetite and the amount she eats each day.

Thursday, December 16, 2010

Appetite Boosters for Cats with Kidney Disease

I've talked about how important it is to switch your cat to a low phosphorus, low protein diet if your cat has kidney failure. But cats are finicky, and if they won't eat the new food so quickly, and continue to lose weight, you've got a problem. So the very first rule is:

Rule #1: Get them to eat.
You have to balance the benefits of a low-protein diet with Rule #1: making sure your cat is eating.

If your cat's not eating and gradually losing weight, then its health is in danger. You have to get calories into him. Here are some of the little tricks we've used that seem to work:

Microwave the canned food. Just a few seconds in the microwave (5 seconds for room temperature food; 15 seconds if the food has been refrigerated). This tends to release the aroma of the food more, attracting the cat. It also (and this is gross but real), makes the food seem more like a freshly-killed animal meal. A warm kill. Like I said: gross, but that's a cat's life.

Feed her smaller meals, more often. Rather than the regular morning meal and night feedings, break things up into breakfast, a mid-day snack, dinner, and a bedtime snack. Maybe even more often, if you're around the house and able to do it.

Spoon-feed. Every so often, Michou will either stop eating, or not be willing to get out of her bed when we bring her food. When she appears particularly weak, we bring the food to her. We either spoon-feed at least half of her meal, or use our fingers to pick up clumps and hand-feed her. We're always surprised by how much she does eat – even when she refuses to eat by herself.

Little treats. I know that I said feeding any protein or meat food cancels out the benefits of your cat's low-protein diet. And it does. But just to perk up her appetite when we notice she's not eating, we sometimes try:

o Tuna juice: this is the water from an open can of tuna. She seems to like the flavor and lapping up the juice helps with her hydration, too. We put a few, tiny slivers of tuna in with the juice as a treat.

o Table treats: a tiny piece of chicken or beef from a meal. I know, this is protein. But it perks up her appetite. And she obviously craves it, because she'll sit and meow for more. In fact, when we bring grilled chicken kabobs from our favorite restaurant home for dinner, Michou can smell them from upstairs. Our previously lazy cat who's too apathetic to get out of bed for her canned cat food suddenly shows up at our feet, giving us the eyeball treatment.

o Kitty malt. This is a gel-like substance for cats to help them avoid hairballs. But it's also a tasty treat that can perk up their appetite. It's made with glyercine and fat that can help coat their gut and may reduce constipation as well.

Probiotic Supplements. There is a supplement called Renal Advanced from Candioli Pharma, an Italian company, that contains active Lactobacillus acidophilus cultures, bioflavonoids, and other nutrients. One of our veterinarians told us about it. It is a fine powder that can be sprinkled over wet cat food. It was recommended to improve digestion, cut down on nausea, and boost our cat's appetite. I can't refer to any clinical studies but anecdotally, we have noticed that Michou's appetite improved and she eats a greater volume of food per day, when we add this to her food. It is also very easy to incorporate into your daily routine. The vet had suggested another probiotic, but it was in pill form. The idea of having to fire a pill down Michou's throat each day wasn't something we wanted to pursue.

How about you? Have you developed a few little tricks or treats to get your cat to eat more or more often? Add your comments below.

Friday, December 10, 2010

Watching the Weight of Cats with Kidney Disease

Next to noticing that your cat is drinking and urinating more often, the other big tip-off that your cat may have kidney disease is a sudden loss of weight.

The weight loss is often because one of the symptoms of kidney failure is a loss of appetite and possibly nausea. Unfortunately, you may not notice that your cat is eating less until he or she has dropped several pounds. Weight loss is considered to be a serious problem when it exceeds 10 percent of your cat's normal body weight.

You may eventually notice the weight loss as well as an overall boniness to your cat that you didn't see before. Their spines and haunches may stick out. It could be due to the nausea and loss of appetite. Or the fact that your cat is drinking and urinating more, and therefore may be losing protein and electrolytes.

However, weight loss is associated with other feline diseases such as diabetes, thyroid disease, and inflammatory bowel disease, too. So it's important to get your cat tested by your vet to determine the cause of the sudden weight loss.

Presuming that your cat is diagnosed with kidney disease, you'll start a new special diet for her and start doing everything you can to maintain her weight, including low-protein foods, hydration, treats, and more.

See also:
 Appetite Boosters for Cats with Kidney Disease
 Nutritional Supplements for Cats with Kidney Disease