My 13 year old cat is dying of renal failure. Just found out

>>2355877
I'm so sorry for the situation you're in, anon. Go with your instinct, watch him closely and judge whether or not you think he's in pain and/or gonna make it through this.

The worst thing possible for a pet owner is to stay in denial that their pet isn't in any kind of pain due to their own feelings and not wanting to let go.

I know you'll make the right choice, anon.

Sorry for you anon

My 8 year old cat died yesterday from a pancreas problem. I can't help you with your choice and I can't imagine how hard it must be, mine died in the clinic being treated but my pain is lessened knowing I did everything I could. I don't feel sad until I mention him, I just feel like there's a big hole in my life

>>2355920
I understand your feels, anon. You did everything in your power to help him, and that's all you could do.

Just enjoy the time that you two had together.

>>2355877

subQ fluids definitely help, it will sort of like...flush his system of the toxins which have built up since his kidneys aren't filtering too well right now. Once he is stabilized, you will probably have to put him on a specialized renal diet for the rest of his life (special food with really low protein. Wet food is best, and I usually add a little water as well to keep my cats fluids up. this helps keep the toxins from building up and prevents more damage happening to the kidneys), and depending on the severity of the disease, possibly medications.

Renal failure isn't necessarily a death sentence for cats (Dogs are almost always fucked). Cats can live with it for years without it progressing for some reason. I have a 17 year old cat with renal failure and she is doing great. She was given a 500 day prognosis like, 3 years ago and she hasn't slowed down at all. I don't want you to get false hope though, your cat may be farther along in the disease than mine is.

BUT, you should probably ask your vet for a frank discussion on how bad your situation is. Tell them your concerns about prolonging what may or may not be inevitable. Be honest about your concerns on his chances, and how much time he may or may not have left. Remember that vets generally have a rule of always suggesting the "best" treatment, but in my experience they will usually be honest if they feel their treatment will only prolong the animals suffering.

good luck OP

Thank you for the kind responses.
>>2355926
Vet said his BUN levels were over 200, normal is around 30. He couldn't give me a straight answer on whether or not the fluid treatment would help, or how much longer a life it would give him if it did. I'm just not sure if it's a gamble that's worth another $300, on top of the $260 I spent just to get this diagnosis. And then if he thinks it will work and extend his life another few years as yours has, like you said all the additional money for a specialized diet and medications that I'm not sure I have.

I can try asking him again in the morning. Hell, half the reason I'm here is because he's not available and I'm anxious as all hell about it. Thank you, again.

>>2355971
One last thing that I meant to add. While I wasn't able to get a straight answer out of the vet, it sounded to me like he was talking weeks/days without treatment, and maybe months with. I can try for more clarification, but that's where it seems to roughly be at.

>>2355971

Vet student here, the issue with renal failure is that we are not looking at treatment more palliative care. We can most certainly make your cat more comfortable with analgesics, but we can't repair nephron damage. The other issue with renal failure is that it often shows up extremely late, we don't actually have a good good standard yet that can pick up nephron loss before it gets above 50% ish.

Now, the subcut fluids will help as essentially your cats kidneys can no longer concentrate his urine properly. So essentially all the water you are putting into him is coming out at the other end, unlike with a normal cat where if water was scarce one day it would reabsorb some of that water to maintain body fluids. So, the subcut fluids here are used to try and prevent dehydration.

As for medications, theee are a variety of diets and meds out there, but as I said these are more aimed at managing the situation as oppose to curing it. The diet for example limits protein and only gives a highly digestible source so the kidney does not have to cope with extra urea produced from the breakdown of amino acids. We often use medications to try and increase the flow rate through the kidney, but honestly this would be best discussed with your vet as he has seen your cat and looked in depth at its blood test results.

If you are considering euthanasia, then I would have a look at the HHH scale (afraid I'm on my phone at the moment or else I'd link it, but give it a Google). It gives you a numerical scale to actually quantify quality of life, and I often find clients find it a very useful tool to gauge where their cat is at.

Do you want some more info on CKD? Happy to try and explain it if you like in more depth!

>>2355992
>HHH scale
Is this what you're referring to?
http://pawspice.com/clients/17611/documents/QualityofLifeScale.pdf

If so, I would say he's passing with more than a 35. He doesn't appear to be in any real pain right now, though that may change when the meds wear off.

Everything there appears to be okay except for Happiness. He still purrs, but honestly all he's done in the last 24 hours is lay on my bed. He seems indifferent to affection, and I had to bring food to him and coax him into eating it. Hearing that renal failure requires a low protein diet is making me second guess giving him chicken, though.

Any more info would be very helpful.

>>2356010

Sorry for the late reply, but I'm in practice at the moment and didn't get a lunch break today.

Firstly, yes that's the scale. Obviously quality of life is a subjective decision, but I personally like using that scale as it gets the client to start thinking and hopefully helps them to reason through any decisions.

Right, kidney function. I do apologise if this sounds a bit basic, but I thought I'd start from scratch! Basically, the kidney is an organ which sieves the blood- and then absorbs anything the animal needs (glucose, amino acids, water) whilst getting rid of waste products (urea, excess salts, excess water etc). It does this by pushing the blood from the renal artery into the glomerulus, where essentially any small particles (e.g glucose) will pass into the bowman’s capsule whilst larger particles (e.g red blood cells) will stay in the blood. From the bowman’s capsule it proceeds to go through into the nephron where there is a huge series of processes to absorb and regulate the contents.

Now, with chronic kidney failure, essentially what has happened is that these nephrons for one reason or another have failed. In basic terms, this means that blood goes through into the glomerulus and is not regulated- so essentially gets thrown out as urine without reabsorbing anything. Hence why cats with renal disease tend to drink and pee so much- as they as isosthenuric (aka their urine isn’t concentrated or diluted- or the contents has not been adjusted) they basically pee all the water they take in out.

Now, renal disease is often defined by the percentage of nephrons lost. As I said previously (badly, I do apologise for the spelling mistakes on the last post- I was typing it on the phone between ops), the issue is that we do not have a gold standard for picking up early renal disease. Often we DON’T pick renal disease up it is extremely late, and cats especially are extremely good at hiding any problems until it is too late.

>>2356334

What your vet looked for – BUN, stands for blood urea (from the breakdown of amino acids) and nitrogen, is an extremely good indicator of kidney function- however the basic problem is that it often rises extremely steeply when a good 70-75% of functional nephrons are lost. I’m sure I don’t need to explain to you that by the time we have gotten to that level of nephron lost, the kidneys are struggling. He likely looked at this alongside creatinine (which you can use to measure GFR- glomerular filtration rate) as it is a small protein produced by the breakdown of muscle freely filtered by the glomerulus – and is typically not reabsorbed into the body- so it’s a really fantastic marker. (There’s all sorts of things we can measure using creatinine clearance, and it’s the current protein of choice for research to identify earlier renal patients).

When we have a loss of nephrons, the filtration in the remaining nephrons goes up- which puts even more pressure on the healthy nephrons. This forms a vicious cycle as I’m sure you can imagine, contributing to the progression of the disease.

The other problems we have is that with the nephrons not working, we get changes in acid-base status (aka the pH of the blood). Acids (e.g phosphate and sulphate) build up in the blood, whilst bicarbonate (HCO3-) is not reabsorbed to help buffer this – so we can seet metabolic acidosis (which causes all sorts of problems- aka where the blood is too acidic). Also, the kidney produces a protein called erythropoietin, which is the precursor to producing new red blood cells, which can lead to anaemia in some cases.

>>2356335

As for treatment, as I said before, this should be discussed with your vet as to what he feels is appropriate. However, we typically feed a phosphate and protein restricted diets – as this reduces the amount of stuff the kidney actually needs to process- but, these diets are often really unpalatable, so you might struggle to have your cat eaten it! Normally we introduce the diet before the cat starts to really feel poorly from renal failure – as we can struggle to get them to eat it afterwards. There are plenty of other medical options, from recombinant erythropoietin and fluids to ACE-inhibitors (this dilates the vessels leading out from the glomerulus, which reduces the capillary pressure to hopefully slow the progression of the disease).

You really do need to go have a discussion with your vet, there are various stages of renal disease- also known as the IRIS staging. Dependent on where your cat is depends on what treatment options are available/how long you have left with your cat. I hope this helps somewhat! It sounds like you need to go in and have a frank discussion with your vet, don't be afraid to explain about your worries r.e quality of life.

OP here. Just an update for anyone who's following.

I got in contact with my vet about an hour ago, and I was finally able to get some hard numbers out of him. For one, we wouldn't be able to do the IV fluid flushing treatment until Monday, because they'd have to hold him for a couple days and they're not open on weekends. I could send him to the ER, but that's far more money than I can even stretch myself out for.

So the option for treatment would be to give him more subcutaneous fluids, hope he survives the weekend, then get IV treatment on Monday. I had my terms mixed up initially, the subcut fluids are what he got when I brought him in on Tuesday, the IV treatment would be the expensive procedure to hopefully give him more time.

Having seen how he behaves as a result of subcut treatment, I don't know if I could subject him to it again, and then IV treatment on Monday which, according to my vet, only has a 5% chance of having any effect. Where he's at right now isn't life, it's just existence. Prolonged existence, at that. And I don't think he's happy.

So, it's a tough decision, but I think it's time to let him go. I can't spend all that money for a hail mary that has even worse chances of helping him than I originally thought. I can't bear to put him through multiple more trips to the vet which he fucking hates. It's all too much.

>>2356910

Sorry to hear that anon. Give your kitty a huge slab of whatever he loves to eat the most and a cuddle.

I went through this with my last cat, sadly she only made it to 7~8ish. Her health improved dramatically after a stay at the vet, but she didn't seem that interested in getting subcutaneous fluids regularly (would run away) and her health deteriorated rapidly. By the time I felt she was definitely ready to be put to sleep, she passed away that night.

All of the running around was a $1000 lesson (diagnosis, keeping the cat for several nights, foods and meds etc). If my cats every get critically ill like that I am not going to chase after a miracle.

Especially at 13 years I would just call it a wrap bruh. Sorry to say.

>>2355877
F

>>2357260
My cat was also diagnosed with chronic renal failure, she's nearly 14 (2 months away) and when she was diagnosed she had stopped eating.
After a stay at the vet however she has managed to get through it and now with the special food and daily medication she seems to be doing fine, she's even developed a good appetite for the new food.

However are there any early signs things may be getting worse? I'd like to know what to watch out for in terms of behavior etc. and what to do (other than contacting the vet asap). I'd like to give her as long and good a life as possible.