Problems Related to CRF
As CRF progresses, other medical problems may develop
as a result. The list below is not exhaustive nor is the information
given for each condition complete. Consult your veterinarian for accurate
diagnosis and correct treatment.
acidosis occurs in CRF cats because the kidneys cannot rid
themselves of excess acids from the diet. Ionized Hydrogen
(H+) builds up in the blood. The body buffers this by combining
the H+ with bicarbonate (HC03-), causing the bicarbonate levels
to fall. Bicarbonate can be measured as part of a blood gas
analysis, which requires specialized equipment. However, a
good approximation can be done as part of a blood test by
measuring total Carbon Dioxide (CO2). Since about 95% of total
CO2 in the blood is bicarbonate, when bicarbonate levels fall,
so does total CO2. When using this method, care must be taken
to be certain that there is no air in the tube above the sample
as the CO2 in the air will alter the reading. Metabolic acidosis
is treated by raising bicarbonate levels either by using bicarbonate
or citrate which is a metabolic precursor to bicarbonate.
anemia is quite common with CRF cats, especially as the disease
progresses. The cat's kidneys normally produce the hormone
erythropoietin which stimulates the bone marrow to produce
red blood cells. CRF lessens the production of erythropoietin
and the bone marrow is less stimulated, thereby causing the
cat to become anemic. Anemia can be monitored with blood tests.
Learn the normal color of your cat's mucous membranes and
check daily for signs of anemia. If the gums, tongue or nosepad
appear pale or bluish in color, contact your veterinarian
immediately for the necessary treatment. Cats with anemia
are also weak and may have rapid breathing and loss of appetite.
Medications are available to treat anemia. Transfusion is
an option, but must be repeated frequently, is stressful for
the cat and is only a short-term solution.
can be a painful problem for CRF cats. While constipation
can have many varied and quite serious causes (such as megacolon),
dehydration and inadequate water intake may be the most common
causes of constipation in CRF cats.
to your vet about your catís constipation and what feline
medications and other measures such as adding fiber to the
diet will relieve it. Increasing fluid intake by feeding your
cat canned food, adding water to dry food and administering
sub-Q fluids all may be helpful. The most well-known feline
constipation medication is Lactulose which must be prescribed
by your veterinarian. NEVER
give your cat a human laxative or enema by yourself. This
procedure should only be done by a veterinarian.
is an abnormal depletion of body fluids that is usually a
constant problem for CRF cats because the kidneys cannot concentrate
urine. The problem becomes more serious with excessive or
chronic vomiting and/or diarrhea. To check for dehydration,
gently pinch a bit of skin at the back of the cat's neck.
When released, it should immediately fall back in place. If
it takes a few seconds, it's indicative of loss of elasticity
which is a characteristic of dehydration. Another test for
dehydration is to touch the cat's gums. They should feel slick.
If they feel tacky, the cat is dehydrated. Be
aware that only cats who are SERIOUSLY dehydrated show these
can be significantly dehydrated before clinical signs are
obvious. If your cat is dehydrated, you should contact your
vet as soon as possible.
You may have to begin subcutaneous fluid therapy, or, if you
already giving sub-Q fluids, you may need to increase the
frequency or volume.
glands maintain a balance of phosphorus and calcium levels.
During CRF, high levels of phosphorus accumulate in the blood
(hyperphosphatemia) because the kidneys can no longer efficiently
excrete it. When phosphorus is excessive, the parathyroid
glands produce more of the parathyroid hormone (PTH) in an
attempt to restore a calcium/phosphorus balance. The overproduction
of PTH results in calcium being removed from the bones to
balance the excess phosphorus.
abnormally high blood pressure, can be either a cause of CRF
or be caused by CRF. It occurs when the kidneys are unable
to excrete sufficient quantities of sodium. It can be diagnosed
by taking the cat's blood pressure or by an ophthalmologist.
Hypertension can cause further kidney damage or damage to
other internal organs, cardiovascular problems, seizures,
retinal lesions, retinal detachment and blindness.
detachment, in which the retinas develop cysts and detach,
is common in CRF cats. Unfortunately, visual impairment may
not be recognized until retinal detachment occurs and the
cat becomes blind and disoriented. This condition is usually
treatable and can be controlled with medication if hypertension
is diagnosed early.
caused by detached retinae occurs, it can sometimes be reversed
partially or even fully if high blood pressure medication
is given within a day or so of onset. It is crucial to take
your cat to your veterinarian as soon as possible if you suspect
that your cat is having vision problems.
(potassium depletion) can result from chronic vomiting and
excessive urination. Unfortunately, most CRF cats eventually
become hypokalemic. It can occur quickly and the cat may have
a generalized muscle weakness or possibly weakness in the
hindquarters. There may also be an inability to hold the head
up, an awkward gait, stiffness, an unwillingness to move and
the cat may tire easily. Other symptoms may resemble some
of the symptoms of CRF, including anorexia, weight loss and
anemia. Potassium depletion can be controlled with potassium
(excess potassium) may result from the inability of the kidneys
of end-stage CRF cats to sufficiently rid their bodies of
excess potassium. Hyperkalemia can stress the heart and could
potentially cause heart failure and/or other associated problems.
It is crucial to always consult your veterinarian when supplementing
potassium, whether your cat is in the early, middle, or end-stage
| Oral Ulcers
and tongue ulcers, common in CRF cats, can cause discomfort
and may prevent a cat from eating, thus causing substantial
weight loss. In some cases, ulcers may extend into the esophagus.
There may be an indicative odor from the cat's mouth. The mouth
should be checked frequently by you and your veterinarian. Antibiotics
and human ulcer medications (compounded to cat-size dosage)
are available to heal mouth ulcers.
Irritation (Uremic Gastritis), Nausea and Vomiting
tend to have a buildup of excess stomach acid and this can
be a real factor in depressed appetite. At some point, vomiting
may become a serious and ongoing problem due to nausea caused
by blood chemistry or increased bile/gastric acid production.
Vomiting causes dehydration and loss of potassium. The cat
may lick its lips frequently as if trying to get rid of a
bad taste. Some CRF cats tend to vomit clear liquid on a regular
basis. Anti-ulcer drugs and protective agents may alleviate
the nausea enough so that the cat regains its appetite.