Kidney Disease

The end of 2017 is upon us and the start of a new year is around the corner.

This is a time when many of us sit back and reflect on the events that have happened throughout the last year, and speculate about all the things that may happen in the year to come. This last year has brought every emotion on the spectrum into my life - both good and bad, birth and loss (human and animal), and lots of anxiety. I honestly can’t wait to see what changes will come with the new year.

One of the most notable changes my family experienced this year was that of our elderly kitty (the first pet owned by my husband and me - our first fur baby). At the age of 15, he lost his battle with kidney disease and left a hole in my heart that may never heal; Sebastian was a wonderful friend and is still greatly missed. Like my sweet Sebastian, many kitties as they age can develop chronic kidney disease; with cats living longer these days, it is actually one of the most common issues we see in elderly cats. The kidney is a vital organ to the body. Not only do they filter out toxins, create urine and maintain electrolyte balance, they produce a hormone responsible for red blood cell production and help regulate blood pressure. There are two major categories of kidney disease- acute and chronic. It is important to note that most causes of acute kidney disease can be reversed whereas the same cannot be said once the disease becomes chronic.

Acute kidney disease is often caused by toxins, infections, blockages (either in blood flow to the kidney or outflow of urine), trauma, shock, dehydration and heart failure.

The causes of chronic kidney disease are often difficult to determine; lesser known, persistent infections (like dental disease), incomplete blockages, cancers and high blood pressure have all been described as conditions contributing to failing kidneys.

With the numerous chores our kidneys do to maintain our normalcy it is no wonder that once they start to fail any number of clinical signs can appear. The most commonly noted clinical signs seen are an increased amount or frequency of urine (maybe even outside of the litter box) and increased thirst. Other signs include; weight loss, decreased appetite and vomiting, tongue and gum ulcerations, diarrhea, bad breath (a different smell than that from dental disease), dry and brittle hair coat and generalized weakness.

Diagnosing kidney disease is usually done with blood work and urinalysis. Elevated levels of BUN, Creatine, certain electrolytes along with protein in the urine and inappropriately concentrated urine are all signs that the kidneys are not functioning properly. Imaging, like x-rays and ultrasound can also be used to identify some blockages (like a stone), measure the size of the kidneys, and even evaluate the internal structure and blood flow to these organs. Blood tests have become even more invaluable in recent years, a newer parameter called symmetric dimethylarginine (I know- long word, most of us just call it SDMA for short) is a kidney specific marker that can be used to detect loss of function as soon as roughly 25% loss whereas other tests generally require almost 75% loss of function.

As I mentioned before, acute kidney injuries can be reversed if the cause is found and eliminated and appropriate care is taken to maintain hydration, blood pressure and electrolyte balances. Unfortunately, with chronic cases there is no such hope for reversal. Usually the goal for treatment of chronic kidney disease is to prolong quality of life by creating less work for the kidneys. Diets lower in salts and protein are utilized as are fresh clean water sources to maintain hydration. Some kitties are not able to drink enough to sustain the amount they are losing through their kidneys, so fluids can be given under their skin where they are absorbed over a few hour period of time. Other treatments work to manage blood pressure abnormalities and replace hormones for red cell stimulation can be employed if the need should arise. There are studies attempting kidney transplants as a method of treatment, but so far that is not a widely used therapy.

Since there is no reversal of the condition and our treatments are only to prolong quality of life, kidney disease is a progressive and often terminal. There is no set in stone timeline for the progression of disease, as each individual will develop differently. Once the disease becomes advanced enough that quality of life is poor (their pets hardly walk around, are not eating anymore and can’t maintain any weight) most owners decide on humane euthanasia, but sometimes this doesn’t occur for a number of years following the diagnosis.

If you have an old kitty and you are worried about his/her little kidneys, it’s time for blood work!! Early detection and intervention will prolong their life!!

Happy New Year!