Kidney Failure and Disease 2


Kidney Failure and Disease 2

Kidney Problems and cyproheptadine (Periactin Rx) in Himalayan

Q: Dear Dr. Richards, I have a Himalayan cat, approx. 11-12 years old. He was diagnosed with kidney problems back in Sept. of 98. I had noticed that he was drinking a lot of water and his appetite was poor, along with frequent urination. I was told to try to get him to drink as much water as possible every day and to have him eat mostly canned foods. I have been giving him water mixed with a couple of teaspoons of turkey or chicken baby food to be sure he drinks enough. Because of his poor appetite, I am also giving him "Periactin" to stimulate his appetite. The dosage is 2 mg., 2x a day, as needed. I usually only give him 1 dose per day. Do you feel it is safe for him to take this medication for a long period of time, even for the rest of his life? I get worried that I use it too much but when I skip a day or two, he definitely doesn't eat as well. Even with the medicine, he doesn't eat as much as I'd like; maybe a half of a 6 oz. can of food, if I'm lucky, and an eighth of a cup of "Rx" dry food, but he does seem to be maintaining his weight. I recently had to put my other cat to sleep and I am very heartbroken so I just want to be extra certain that I am doing the right thing for this cat so that he is with me for a long time to come. Thanks in advance, Julieann

A: Julieann- I can not find any information that suggests there is a problem with long term use of cyproheptadine (Periactin Rx). It is sometimes used for asthma in cats on a long term basis, so if there was a major problem with it I think that there would be reports of the problem. It may be a good idea to consider more aggressive therapy for the renal disease, though. There have been several recent articles that say that cats given calcitriol when they have renal failure feel a lot better and eat better. It sometimes helps to use an ACE (angiotensin converting enzyme) inhibitor like enalapril, too -- at least according to reports. We have used amlodipine (Norvasc Rx) and feel that it has worked well enough for us that we haven't had as much experience with enalapril. So it is another option, too. We have usually waited until there were signs of hypertension (high blood pressure) in the past before starting one of these last two medications but newer reports seem to indicate that it is worthwhile to consider them before there are clinical signs of hypertension since so many cats with renal failure that develop high blood pressure. We use subcutaneous fluids when there is a drop in appetite in cats we know have renal failure. This really seems to help in our practice. Keep working with your vet and let him or her know that you are interested in aggressively caring for your Himalayan (if you think you can give more than one medication a day and if you want to). Good luck with this. Mike Richards, DVM 4/16/99

Acute kidney failure - feline

Q: Dear Dr. Richards I would like your advice on how best to keep my persian cat who has been diagnosed with acute kidney failure. Perhaps I should start with the beginning: In early May 1998, my 8 1/2 year old Persian cat who has never been sick before refuse to eat or drink. I took her to my usual vet, who gave her a Vitamin B injetion and some appertiser but by the second day, she still refuse to drink or eat and look really sick. I rush her to the vet again and she said that she was dehydrated and needed to be hospitalized. I rush her to the only animal hospital we have in Singapore, where the vet felt a lump in her abdomen. He took an x-ray and on looking at the result diagnose that it could be a fur-ball or a tumour but needed to run further test. However, as she was badly dehydrated, he suggested that she be put on a drip and kept overnight. In the morning, the resident vet said that he had to operate as the lump felt quite large. He warned me that if it was a tumour it would be pointless to let the cat live but if it were a fur-ball, he would remove and then see what happens. He also warn me that the anasthetic could be dangerous for the cat and that it had adverse effects on various cat. Luckily, when he operated he found that it was fur-ball trapped in her stomach. After the surgery, Bluey, my cat was in critical condition for 3 days and I nearly lost her. However, on the 4th day, her condition stablized and the vet began feeding her liquid food. The vet had inserted a tube directly to her throat to allow her to be fed by liquid food. After a week, Bluey, still look bad, however, the vet felt she would be better off in the home environment. The family took turns to feed her 4 times a day according to the vet's instructions. We also gave a vitamin, liver tonic as well as glucose water. She was 3.5 lbs when she left the clinic. She slowly recovered but it took almost 8 weeks before we could remove the feeding tube. After that she began to eat on her own. The vet suggest that I don't bring her to the clinic too often to eliminate the stress she is put through. I initially fed her with her usual cat food, Friskies and also introduce Hills KD diet but she didn't like it much and sometime when hungry. So I decided to change the cat food to IAMs mixed with the KD. She gained weight and by the time I visited the vet in August 98, she was an almost 8 lb. cat. The vet was very pleased but when he did the blood test and found that her creatnine level when up from 3.2 to 3.5, he suggested that I put her on a Hills KD diet again. Bluey doesn't like the KD Diet and I alternate it with the IAMs cat food, she would refuse to eat and rather starve. In January this year, I took her to the vet and her blood test shows that the creatnine has gone up to 4.3. Bluey just refuses to eat the KD diet, and by February, she was ill again refusing to eat and her weight when down to 6.5 lbs. I took her back to the vet, he gave her some vitamins and antibiotics which I had to administer daily. The blood test indicated that creatnine had gone up to 4.6. I am now giving her on a daily basis a vitamin/appetizer call VAL Syrup given by the vet and a laxative 2 times a week to take care of the fur ball. I have put her on a diet of fresh boiled fish alternating with Hills Low Magnesium Liver & Chicken as well as Eukanuba Veterinary Diets, Moderate pH/0. Bluey seems to like the Eukanuba cat food and laps it up. She initially use to urinate very little at a time but after the completion of the antibiotics, she now urinates quite a bit. She still drinks quite frequently and likes running tap water. She has gain weight and is around 7.5 lbs. She is now 9 1/2 years old. I also occasionally give her some Cat barley green. I would like to know what I can do to stabalize her condition. I still think she is a young cat and if given the proper care, she could live comfortably for another year or two. Do you have any recommendation on diet or supplements that I can give my cat. Am I doing the right by giving her food that she enjoys? Your advice would be greatly appreciated. I have visited the site on Kidney illness and have taken some advise but I would like to hear from you. Regards Margarita H

A: Margarita- Persian cats should be examined for polycystic kidney disease when renal failure starts at an early age (I think that your cat still qualifies). This is best done by ultrasound exam, if that is possible for you to arrange. A good website for information on polycystic kidney disease is: < If this disease is present, the progression of the renal disease will probably be faster than if it is not present but otherwise the treatment is roughly the same. At present, the only thing that I can add to the information we have online concerning kidney failure maintenance therapy is that many vets feel that angiotensin converting enzyme (ACE) inhibitors seem to help slow the progression of renal disease. Enalapril (Enacard Rx) is the one most commonly recommended in the United States. Fluid therapy, usually given subcutaneously, is the mainstay of treatment for renal disease, otherwise. It helps a lot if you can learn to administer the fluids at home so they can be given frequently and to minimize stress for the cat. Calcitriol is also advocated by many veterinarians at this time to help keep phosphorous levels low and provide a better level of overall health. I do not think that there is a commercially available calcitriol product. As far as I know, it is made by compounding pharmacies for the vets using it. Usually calcitriol is started at dosages approximating 2.4 ng/kg of body weight but when creatinine is already pretty high it may be necessary to start at a higher dose to get a good effect. I am not sure what references might be available to your vet but there is a good article on using calcitriol in the November 1996 issue of the Clinics of North America. The effect of diet on kidney disease is still being debated in veterinary journals by researchers on the subject. At this time I still think it is important for cats to eat so I don't try to starve them to get them to eat a special food. If a cat will eat a mixture of 1/2 k/d or Purina NF and 1/2 its favorite food, that is a good compromise. Hope this helps some. Mike Richards, DVM 3/29/99

Feline kidney failure and methimazole (Tapazole Rx)

Q: Dr. Richards,

I'm glad I found your website and only wish I had sooner. I'd like your opinion regarding my cat Bing. Bing is sixteen or seventeen years old, I inherited her when she was about eight or so (am not sure of her real birthdate) and she's been a member of the family ever since. She is a longhair calico and has been relatively healthy except for a few urinary tract infections. She has always been a small cat (about 7 pounds) since I got her. She was tested for and diagnosed with a hyperthyroid problem about four months ago after I noticed her acting a little unusual and losing a bit of weight. Her T4 measured at 11 so she was put on 10mg/day of tapazole. After a followup blood test I was told her T4 levels were in the normal range and she was kept on 10mg/day. She developed a urinary tract infection about a month ago, was put on Clavamox and a followup urinalysis showed her specific gravity at 1.018. There was a question of her kidney function although I know Clavamox makes her very thirsty and wondered if it could have affected her spec. gravity. At this point she had also been on tapazole for about 3 months. I told my vet I wanted to get a blood test to check her kidney function and recheck her T4 levels. When the results came back, I was told Bing was in the early stages of kidney failure and anemic. Also her T4 was low at 0.4. It turns out no one checked her baseline kidney function or hemoglobin prior to putting her on tapazole so I don't know what if any negative effect the medication might be having on her. The tapazole has been reduced to 5mg/day and Bing seems to have more of an appetite. She was also put on an iron/vitamin supplement (Petinic) to help with the anemia and stimulate her appetite.

Her blood values were as follows:

BUN 51 Creatinine 4.3 Alk Phosphatase 3 Amylase 1225 Hemoglobin 6.0 Hematocrit 17.4 RBC 3.58

In spite of all this Bing doesn't look bad. She seems pretty alert, has a decent appetite (the Petinic also seems to be helping) and doesn't seem uncomfortable. At this point I'm not quite sure what to do. Does she need to be on fluid therapy; knowing her I'm not sure if she'd let me do that to her? But I'm in the medical field, do venipunctures and set up IVs on people so I probably would'nt be too uncomfortable with doing it if she let me. I assume the tapazole probably isn't helping with the kidney problem and wonder if its also affecting her hemoglobin levels or if that's just being affected by a decrease in Erythropoeitin. I wonder whether I should have her thyroid irradiated to get her off the tapazole, or wait to get another blood test in a month or so to see if the decrease in tapazole and iron supplement helps. I'm reluctant to blood test an anemic kitty too often. I know you probably see cats much worse off with CRF than Bing but other than knowing her blood levels are abnormal I don't know what to expect in terms of how quickly she will get much worse. I know no one can predict in any one case, and at this point my vet doesn't seem to be superconcerned but they suggested fluid therapy anyway. I'm sure you know how emotionally wrenching this all can be. Any suggestions or advice would be greatly appreciated.

Thanks and sorry for the long letter, Dennis

A: Dennis Based on nothing other than my clinical experiences I think that methimazole (Tapazole Rx) is very very likely to be the cause of the anemia. This is the complication of its use that we have experienced most frequently in our practice. Fortunately, almost all cats have responded to lowering the dose or using alternative treatments such as surgical excision of the affected thyroid gland or radioactive iodine therapy. Kidney failure does cause anemia as well, for exactly the reason you point out in your note. The kidneys produce the hormone erythropoetin, which is responsible for stimulating the bone marrow to produce red blood cells. So it can't be ruled out as a cause, especially if withdrawal of Tapazole doesn't resolve the anemia. It would be a good idea to find out what her phosphorous and potassium values are, too. Keeping serum phosphorous levels down is helpful in slowing the damage during chronic renal failure and potassium levels often fall with kidney failure and this affects muscle function, possibly appetite and possibly even the progression of the renal disease. The relationship between renal failure and hyperthyroidism is very complex and it can be difficult to decide what to do when patients have both problems. The high blood pressure induced by hyperthyroidism causes more blood flow to the kidneys which MAY help them function better. When cats that have kidney failure are treated for hyperthyroidism the reduction in blood flow to the kidneys as the high blood pressure from hyperthyroidism drops may cause worsening of the kidney failure. This effect is worse when hypothyroidism results from treatment for hyperthyroidism. So in some cats, adjustment of the Tapazole dose so that there are reasonable thyroid hormone levels or even addition of thyroxine by oral supplementation may be necessary. The bottom line is that it is often necessary to aggressively treat chronic renal failure during treatment for hyperthyroidism. This may be very important to do if it is necessary to give up on Tapazole due to complications associated with its use and to have surgery or radioactive iodine therapy. It is hard to decide what to do but I think that your vet is probably following the safest course at this time -- reducing the methimizole dosage to try to determine which problems are due to methimazole and which to renal failure a good first step. Instituting aggressive therapy for the renal failure may also be a good idea. It would be a good idea to talk with your vet and try to determine the best way to do this since your vet will have a better idea of how your cat may react to the various treatment options. Good luck with all of this. Mike Richards, DVM

Kidney Failure - diuresis

Q: I have an almost 18 year old female Siamese cat who has been diagnosed with degenerative kidney disease. She is VERY skinny, although her drinking, eating and litter habits appear to be fairly normal. We started off giving her medication, then came to the conclusion that, except for feeding her a low protein diet, it would be better for her if we just left her alone. This is fine to a point...we just want to make sure that she doesn't suffer unnecessarily and we've reached the point where we have to give her wet food in order to get her to eat. She hasn't been to the vet recently as we prefer not to cause her stress if we don't have to. So, bearing all this in mind (grin), how do we tell when she's reaching the last stages? What are the last stages? Obviously, we'd like to keep her as long as possible, but we'd like to end things for her before she begins to suffer. Thank you for your time. Michelle

A: Michelle- It is very difficult to slow the degeneration in chronic kidney failure without using fluids to diuresis the patient. This can be done at home and many cats tolerate it quite well. I mention this because it sounds like your cat is at the stage where you have to choose to use fluid therapy and possibly medications for appetite stimulation, potassium supplementation and possibly other secondary problems. When cats lose their appetite for "normal" foods it often indicates that the level of toxins in their bloodstream has exceeded the level they can tolerate. Without diuresis or dialysis, it is much less likely that a cat will be able to stabilize the kidney function and get back to a state of "compensated" kidney failure. In most cases, the relief afforded by the use of fluid therapy and medications is worth the stress of the trips to the vet. From a medical standpoint there isn't much question in my mind that the trade-off is clearly in favor of treatment, in this condition. I know that many cats do not tolerate medications well and for many people, administering fluids subcutaneously at home is not an acceptable option. When this is the case, letting go is necessary when obvious signs of distress occur, such as several days of refusing to eat, difficulty moving or extreme depression. Talk to your vet about this too. He or she will know you and your cat well enough to give you better advice about when the time is right to consider euthanasia in your particular situation. Mike Richards, DVM

Kidney Failure

Q: My cat, last year was diagnosed with chronic kidney failure, the vet ran alot of tests, and wanted him to come in every day, twice a day,for sq fluids, his creat eas 3.02, his bun was 38.8, his alt was 29, they said he didnt have long to live, later I took him back for a check up, that vet said he had a gallop heart rythem, and a thyroid nodule that was cancerous. Generally saying, he's dying. In sheer panic I took him to a homopathic vet, she prescribed catalyn 2140, renafood 7115, fbiotic, also put him on a homopathic diet, after giving him the pills he had a seizure, we took him to the emergency room, 3 doctors saw him there, who also have private practices, he stayed there for 3 days, while they ran up bills, with more tests. He never had a seizure since. They suggested taking him to a specialist, I did. They ran up alot of bills too. That all started last year june 20th. I said to hell with the vets. From all the stuff I read, the homopathic vet made me od the cat on vitamins, no other vets will admit it. What do you think? We found a new vet, that we like, who is honest, and intelligent. WeeWee is still alive, his creat is 3.1, it went down, three months ago it was 3.3. Can you explain, why this cat is still alive, that year he was suppose to be dead, and needed alot of tests, sqfluids, and so on? I'm puzzled, is there any kind of vet board, in Texas to report these so called vets to? WeeWee celebrated his 13th birthday, April 22nd. He's going fine. And still alive. Do you have any advice? Patricia

A: Patricia- It does not surprise me that your cat is still alive today. Kidney failure in cats tends to be a long drawn out process. It is important to monitor certain lab values over the course of the kidney failure, in particular the blood (or serum) urea nitrogen (BUN), creatinine, potassium (K+) and phosphorous. These values give an indication of the progression of the disease. Your cat may also have hyperthyroidism based on the history of a thyroid nodule. This can make kidney failure worse -- although sometimes if hyperthyroidism is treated the kidneys will recover. The high blood pressure often associated with hyperthyroidism seems to give the kidneys difficulty but to be a reversible change. The standard therapy for kidney failure in veterinary medicine is diuresis using subcutaneous fluids on a long-term basis or sporadically as necessary. In addition to this, it may be necessary to supplement potassium, use phosphate binders, appetite stimulants or medications to reduce high blood pressure that often accompanies kidney failure. Calcitriol has been advocated recently for use in kidney failure. It requires monitoring the lab values a little more closely since it shouldn't be used when the phosphorous levels are very high. As long as it is used carefully it seems to be beneficial. Dialysis and kidney transplants are available in some areas of the country for treatment of renal failure but these are costly treatments. I am not familiar enough with homeopathic remedy names to give you an opinion on this aspect of the treatment. In general homeopathic medicines are safe but their efficacy is questionable. Vitamin therapy is not likely to cause much problem if the dosages are reasonable. The standard treatments for hyperthyroidism are radioactive iodine therapy, surgical removal of the affected gland or medical suppression of thyroxine release using methimazole (Tapazole Rx). Doing enough testing to confirm whether or not this is really a problem would be a good idea -- but may have already been done. If it is present, treatment may resolve all of the clinical signs or you may still have to treat for kidney failure. You always have the option of asking your state veterinary board to review a veterinarian's treatment of your pet. I think that all states have a veterinary board. I can't find a phone number or address for the Texas board in the AVMA directory, though. I'm sure that your vet can supply this information. It is possible to manage chronic renal failure in cats for a long time. It takes close cooperation between you and your veterinarian. It is somewhat costly but the costs tend to be spread out over time. Good luck with this. Mike Richards, DVM

Feline Kidney Failure

Q: Dr. Richards, Thank you very much for your reply and helpful advice. As a testament to your expertise, my cat (since I wrote you my letter on May 15th) was diagnosed with kidney disease and put on (as you suggested) Norvasc immediately. Within just a few days her pupils began dialating and contracting normally again and now it appears (through her actions and ability to follow my hands) that she has regained a significant amount of sight. It's very rewarding to be able to look your animal in the eyes and recognize that it is looking back at, and acknowledging, you. With regards to her kidney problems (I believe after the blood test she registered a 6.2 with 2.0 being normal) the vet simply suggested that I try to switch to Hill's low protein food. This the vet said could give my animal an estimated two years or so left in her life span. Since you were so accurate in your last assessment, I was wondering how this diagnosis strikes you and what else I might be able to do (medicines, etc.) to help out the situation. Thanks a lot for your time. Mr. R

A: Mr. R- There is a very good site for chronic renal failure support and information on cats that you should check out: We have a link to it on our page on urinary problems as well. There are several medications commonly used for chronic kidney failure complications in cats. Low protein/low phosphorous diets and subcutaneous fluid therapy are the mainstays of treatment. Fluid therapy may not be a good idea until the blood pressure problem is under control, though. If high blood pressure is a complication (as it is in your cat) then Norvasc (Rx) can be helpful. Some cats are constipated from the tendency towards being slightly dehydrated and stool softeners such as lactulose are helpful in those cases. Phosphate binding medications may help lower the high phosphorous levels associated with kidney failure. Appetite stimulants are necessary for many cats at least at times. The two most commonly used ones are diazepam (Valium Rx) and cyproheptadene (Periactin Rx). Many cats with renal failure also need potassium supplementation. It is also a good idea to make sure that there is not concurrent hyperthyroidism since both of these problems are common in older cats. Many cats will need some of the above medications but few cats need all of them. You have to work closely with your vet to do what is best for your cat. Mike Richards, DVM

Kidney failure - heart failure

Q: Dear Dr. Mike, My cat was euthanized one day ago. My cat Sam (15 yrs) had been diagnosed in January with kidney disease. After he was in doctors care for 1 week, we took him home to care for him. His bun was brought down from the 120 range to the mid 40 range. His creatnine levels were reduced from mid 7 to normal range. However, by March, these levels were up again. Bun was 90's. Reading on the web about sub-q fluids, I started administering to him 100cc daily. A further check up one month later, still showed a high bun of 120. I proceeded to double the dosage and was giving 200 cc daily, 100cc morning and 100cc night. He seemed to be in fairly good spirits, up until a week ago, when we noticed he was not eating or drinking. Then two days ago he was breathing harder. We took him to an emergency clinic (Memorial Day) and was told he was suffering from respiratory failure. They put him in an oxygen tent overnight and were giving him diuretics to remove the fluid that was found by x-ray to be around the lung cavity as well as inside the lung. They hoped that thru the night he would urinate, which he did, and that he would breathe without the need for oxygen. Unfortunately, he was not able to leave the oxygen tent without gasping for air. At that point the following morning, we made the decision to end his suffering. My question to you, since we did not have our regular vet available due to the holidays, is the congested heart failure, usually an end result to renal failure? I had been ,up until a month ago, giving him epogen shots, because he had anemia. Once that was under control, the vet said I did not need to give them to Sam, until the next visit, which we were coming up against almost one month later. Could the lack of epogen have caused his sudden heart problems? The vet said his heart was enlarged at the time we brought him into the emergency clinic. I am wondering if this could have been prevented, in any way. I know he was old, but if I could have prolonged his life without suffering I would have done it.I am very saddened by my loss. Thank you for your help and advice in this matter. Faye

A: Faye- It sounds like you and your vet were making the best possible effort to care for Sam. Epogen (Rx) is used to treat the anemia associated with chronic kidney failure. Discontinuing use of it should not have caused cardiomyopathy, to the best of my knowledge. The most common cause of cardiomyopathy in older cats is probably hyperthyroidism. Unless there were clinical signs of this, it seems unlikely that it would have been advanced to the stage where it would affect his heart, though. Heart enlargement is not always due to cardiomyopathy in cats. Sometimes heart failure occurs for other reasons and still results in an increase in the size of the heart. It really does sound to me like you and your vet were providing Sam with good medical care. Please don't make yourself feel guilty unnecessarily. Sometimes, the best we can do is not good enough. Mike Richards, DVM

Kidney failure

Q: My cat, Blackie, had a dramatic weight loss this week. I took him to the vet for some blood work. They determined that his kidneys are failing, and they gave me a number of 9. I don't know what that means, but they said he is pretty bad-off. Also, they suggested a couple of temporary treatments, but they were not optimistic. Is there anything I can do for him that will make him better? I don't want to put him to sleep. He has been my best friend for 15 years! Please help!

A: Chip- The number you are referring to is probably the creatinine level. This is very high but many cats with creatinine values in this range can live for some time with aggressive medical therapy -- several years in some instances. There is a link to a good site on chronic renal failure in cats on our links page and they have a lot of advice on this condition. In brief, fluid therapy (usually subcutaneously administered), blood pressure medications if necessary, checking to be sure there isn't a concurrent problem with hyperthyroidism or diabetes, appetite stimulants if necessary, calcitriol administration, potassium administration and use of phosphate binders may all be helpful in kidney failure. Let your vet know you want to do the best you can in treating this condition and work with him or her to do so. This is a condition for which you may have to act as a strong advocate for your cat with your vet to ensure that the best possible care is given -- care is time-consuming and expensive and many vets think most clients don't want to do it for these reasons. Mike Richards, DVM

Kidney Transplants

Q: Hi Dr. Mike, I am the proud mother of a 5 year old Siamese Seal Point Neutered Male. He was diagnosed December 28th 1996 with Chronic Renal Failure. My husband and I are truely devastated. We have thoroughly checked out the and were able to get so much information. They provide a lot of information about Kidney Transplants but I don't see any reference to the health condition of the cat prior to surgery. My cat at top health weighed only 9.5 lbs. When diagnosed, he only weighed 4.5 lbs. We have only been able to get his weight up to 6.25 lbs. at present. With weight being such an important factor after surgery, I would imagine he would have to have a stable weight or not have lost as much weight as my cat has. Can you enlighten me? What condition should the cat be in, to be considered for such a surgery? The life expectancy of a cat with CRF is 0-2 years correct? With the Transplant surgery I am looking at 0-6? Is that correct? And if all goes well, he will be on anti-rejection meds the entire life just no more sub Q's (just initially). That is if everything goes well... My cats bun and creatine levels were at 6 and 178 at diagnosis, they were only able to bring them down to 4 and 154 which is a significant improvement but still considered high. He is on sub Q-s daily and Tagament for nausea. The Vet is surprised with his levels being so high that he appears as well as he does. He almost looks normal (with the exception of the extremely thin area below the belly), as far as clear eyes etc, compared to other cats with his levels. Also, interesting to note, pedialyte (for babies with diarrhea, electorlytes) works wonderful on my cat with the Sub-Q's. It supplements the fluid therapy and helps him retain his fluids. Any information you can provide would be greatly appreciated.

A: We see cats with chronic renal failure that live longer than two years but it is a condition that continually worsens in most cases so I hate to quibble over that one point. Kidney transplant is not yet a common occurrence at veterinary hospitals, even as a referral surgery, and I do not have much information on the preoperative care. I do know that the surgeons much prefer to have some stabilization of the cat's condition if possible. It is surprising how well some cats do despite very high BUN and creatinine levels. This is a good thing since it gives you a little time to make arrangements for treatment. If you are considering this option it is best to contact a referral center that is doing these procedures as early as possible in the course of disease and to get their help and advice. The kidney transplant site has the names of several facilities performing this surgery, I think. If you wish to correspond with someone who has been through this procedure, I think that clients of ours who have a cat with a donated kidney would be willing to talk with you. Let me know and I will give them your email address. If you elect to go with long term medical care there are a number of things that can help, including appetite stimulation, control of blood pressure (tends to rise as the disease progresses), low phosphorous diets, phosphate binders, cholecalciferol, gastrointestinal protectants and of course, fluid administration. Given your cat's problems at so young an age, it does seem like a transplant might be best if it is financially feasible for you. Mike Richards, DVM

Kidney dialysis and transplantation Q: any information or opinion on kidney dialysis and transplantation?

A: I have not personally had any experience with kidney dialysis in my patients but I do have one patient who has had a kidney transplant and seems to be doing very well with it. There is a very good web page on chronic renal failure in cats that you should visit. There is a link on our links page or the URL is: They have a lot of current information on renal failure in cats. If you have the financial resources to choose either of these options, both of them are probably good options for a cat with chronic renal failure. We have had a good success using fluid adminstration to cause diuresis, coupled with dietary control and medications to treat secondary problems, such as appetite stimulators and blood pressure medications where appropriate. Recently the use of calcitriol has been advocated and also seems to be helpful. These are not as directly beneficial as dialysis or kidney transplant but they are more within the budget of many cat owners who can not afford more definitive treatment. Mike Richards, DVM


Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...