Seeking Advice for Cat with Severe Kidney Dysfunction

Hi everyone, I am seeking advice and suggestions for my cat who has been diagnosed with severe kidney dysfunction. Here is some background information: Species/Breed/Age/Weight: Domestic shorthair, 5 years old, 5.2 kg Clinical Signs: Vomiting, lethargy, fever (41°C on the first day of illness), drinking a lot on the first day of illness, not eating, drinking, or urinating now, urinated in sleep on the first day of illness, hard stomach. Duration: Started a few days ago. Test Results: Bloodwork: Significantly elevated levels of urea (46.4 mmol/L, reference range 5.7-12.9 mmol/L), creatinine (likely over a thousand according to the vet, reference range 71-212 μmol/L), and phosphorus (5.20 mmol/L, reference range 1.00-2.42 mmol/L). Total protein and globulin are at the high end of the reference range. Other values (RDW, reticulocytes, lymphocytes, platelets, eosinophils, PDW, MPV, plateletcrit) are within or near the reference ranges. WBC abnormal distribution noted. Imaging: Abdominal X-ray showed no obvious abnormalities. Kidneys and liver appeared normal in size, shape, and consistency. History: The cat is an outdoor cat and ate a rat a day before the illness started. He sometimes drank pool water containing chloride. He is castrated, not vaccinated, and received parasite prevention a few months ago. He has not traveled recently and has no history of significant illness or injury. He goes out a lot. The veterinarian suggested IV fluids but mentioned that it may only provide temporary relief and that the underlying issues would likely persist. No further diagnostic tests, such as urinalysis, urine culture, or abdominal ultrasound, were recommended by the vet. I am looking for any advice or suggestions on possible causes of the kidney dysfunction, additional diagnostic tests that may be helpful, and potential treatment options. I understand that the prognosis may be poor given the severity of the kidney dysfunction, but I want to explore all possible options to give my cat the best possible quality of life. We are thinking it might be AKI/ARF and hoping that is cureable but understand that it might be CKD. Clinic that we went to has a bad reputation and it felt really hurried. Thank you in advance for your help. Best regards, Andreas Siimon

Hello - I'm sorry to hear that your cat is having a hard time.  Often when a cat presents acutely with renal failure (which may turn out to be ARF or a sudden presentation of CRF), the priority may be to support the kidneys with intravenous fluids.  The kidneys' ability to concentrate urine (the SG or specific gravity) may need to be established eg using urine samples from a hydrated cat (when an animal is dehydrated, the SG may be less useful).  Vets can then use various data, including the SG, to 'stage' kidney disease / attribute something known as an IRIS score and once they know this, there is a well-established decision-making tree as regards appropriate interventions. Good questions for your vet therefore include, 'Does my cat have ARF or CRF or something else?'   'If you don't know, what needs to happen to establish this?"   What is my cats' IRIS score?'  'What are the differentials for my cats' condition at the moment?'   'If there is more than one differential (that is, possible diagnosis) what needs to be done to get to the bottom of the situation?'   I never set much store by a vets from the reputation at street-level because, as a locum who used to work at many different vets, I tended to find that the corrolation between the technical standard of care and the general owner opinion was not always reliable; rather owner opinion relates more to the communication of the care happening between that vet and owner. To my mind it is important that communication remains excellent, but it's difficult to take in when your pet is poorly.  Therefore it is always okay to ask your vet to explain the situation again.

Hello - I'm sorry to hear that your cat is having a hard time.  Often when a cat presents acutely with renal failure (which may turn out to be ARF or a sudden presentation of CRF), the priority may be to support the kidneys with intravenous fluids.  The kidneys' ability to concentrate urine (the SG or specific gravity) may need to be established eg using urine samples from a hydrated cat (when an animal is dehydrated, the SG may be less useful).  Vets can then use various data, including the SG, to 'stage' kidney disease / attribute something known as an IRIS score and once they know this, there is a well-established decision-making tree as regards appropriate interventions. Good questions for your vet therefore include, 'Does my cat have ARF or CRF or something else?'   'If you don't know, what needs to happen to establish this?"   What is my cats' IRIS score?'  'What are the differentials for my cats' condition at the moment?'   'If there is more than one differential (that is, possible diagnosis) what needs to be done to get to the bottom of the situation?'   I never set much store by a vets from the reputation at street-level because, as a locum who used to work at many different vets, I tended to find that the corrolation between the technical standard of care and the general owner opinion was not always reliable; rather owner opinion relates more to the communication of the care happening between that vet and owner. To my mind it is important that communication remains excellent, but it's difficult to take in when your pet is poorly.  Therefore it is always okay to ask your vet to explain the situation again.

The IRIS website iris-kidney.com may be a useful source of technicial information.   I hope that something here is helpful