Clinical use: Porus One should be considered as part of a holistic care plan for any cat with renal compromise. Your participation makes AVMA a stronger advocate for our profession. 9. Sorry, something went wrong and the translator is not available. 5. In what direction are we headed? 14. There's no cure for chronic kidney disease in cats, but with the right management, your cat can still have a good quality of life. Taylor S. Dehydration. Cats in the earlier stages can, if the underlying disease is treated appropriately, live a normal life. Early diagnosis and intervention are keys to maintaining quality of life. Sent U, Gssl R, Elliott J, Syme HM, Zimmering T. Comparison of efficacy of long-term oral treatment with telmisartan and benazepril in cats with chronic kidney disease. Histologic changes are not process specific and, therefore, an etiologic diagnosis is frequently not established. Abnormal renal palpation or ultrasonographic/radiologic findings, Urine concentrating deficits due to renal disease. In the absence of targeted treatments, clinicians must focus on managing patient wellbeing and supporting the functionality of the remaining nephrons. 11. Novel options for cats with CKD include telmisartan (Semintra), an angiotensin II receptor blocker, for the treatment of feline hypertension; capromorelin (Elura), a ghrelin receptor agonist, for mitigation of weight loss; nutrient-enriched water (Hydra Care) to promote adequate fluid intake; and AST-120 (Porus One), an oral adsorbent, to reduce gastrointestinal uptake of key uremic toxins. Also, cats will display rippling skin over their lumbar spine.) Persistent (at least 2 positive test results separated by 1014 days). Chronic kidney disease (CKD) is very common in older pets and affects approximately 3 in 10 geriatric cats 1. Impacts of indoxyl sulfate and p-cresol sulfate on chronic kidney disease and mitigating effects of AST-120. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in cats with chronic kidney disease. J Vet Intern Med 2007; 21:402-409. Older cats aren't the only ones at risk. Dr. Quimby has been looking at the aging kidney and how it starts to malfunction. Congenital kidney dysplasia is a condition that leads to small, nonfunctional, or underdeveloped kidneys. Approval status: Not applicable (over the counter), Mechanism of action: Hydra Care is a poultry-flavored opaque liquid containing amino acids from whey protein, hydrolyzed protein from poultry, and glycerol; sodium and phosphorus content are minimal.18, Indication: Hydra Care is designed to address the issue of suboptimal fluid intake in cats with various conditions, including CKD. Prevalence of feline CKD increases with age; as many as 30% to 50% of cats older than 15 years of age have CKD.24 Frequency of CKD in male and female cats is similar, but male cats are often diagnosed at a younger age than female cats.5 Certain breeds appear to be overrepresented, including Maine Coon, Abyssinian, Siamese, Burmese, and Russian blue.4. Indication: Elura is labeled for the management of weight loss in cats with CKD. Weve also made many improvements in medical management.. A normal dog or cat should excrete very little protein and have a urine protein:creatinine ratio that is less than 0.4 or less than 0.2, respectively; persistent proteinuria above this magnitude warrants attention. FIGURE 3. It also supports growth hormone secretion and has prokinetic and anti-inflammatory effects. Steering the Course: Treatment and Management of Kidney Disease in Cats. This is a good time to consider the use of calcitriol (active vitamin D supplementation) if one is going to do so. Diagnosis of early chronic kidney disease in cats, followed by appropriate treatment, shows promise for improving survival rates for these patients. However, if your cat really loves dry food or the budget is tight, dry kidney diets will cost on average $35-$65 per month. A box of the product contains 30 single-dose pouches. Hydra Care is a highly palatable nutrient-enriched fluid; cats offered this product showed a clear preference for this compared to water, with an increased total daily fluid intake. The staging system also offers substaging on the basis of severity of proteinuria and hypertension. DiBartola SP, Rutgers HC, Zack PM, Tarr MJ. Both of these factors are helped by using a renal supportive diet but if that proves inadequate, medications may become needed. Keep track of product alerts for pet foods, animal feed, and products used by veterinarians or animal owners. Gastrointestinal signs: Cats with CKD have been shown to have gastric mineralization and gastric gland hypertrophy. Even though its a very common disease, there is actually a lot about the pathophysiology, or the disease process, that we dont really understand for cats, she said. AST-120 (Porus One) traps indoxyl sulfate and p-cresyl sulfate within the gastrointestinal tract; these uremic toxins are associated with ongoing nephron loss and are thought to contribute to the progression of CKD. Dr. Michael Kearley graduated from the University of Florida College of Veterinary Medicine in 2013. For dogs and cats with all forms of kidney disease, measurement of systemic blood pressure is always indicated to identify hypertension that can cause end-organ damage. a therapeutic kidney diet (n = 22) or an adult maintenance diet (n = 23) and evaluated for 24 months.2 In the therapeutic diet group, no cats experienced a uremic crisis and no renal-related deaths occurred, whereas, in the maintenance diet group, 26% of cats had uremic crisis and 21.7% of cats died of renal-related causes. The IRIS stages, from 1-4, are based on serum creatinine and SDMA concentrations, the latter added recently. A pet with insufficient kidney function will not be able to make concentrated urine and will need to drink extra water to process the body's waste chemicals. Copyright 2023 Today's Veterinary Practice Web DesignbyPHOS Creative. Abstract Proteinuria is a negative prognostic indicator for dogs and cats with chronic kidney disease. Treatment Not eating? Note that this staging system suggests that azotemia in cats begins with serum creatinine concentrations of 1.6 mg/dL or greater. These figures emphasize the need for early diagnosis and intervention. If abnormalities are found, they are usually checked quarterly for any sign of progression. Chakrabarti S, Syme HM, Brown CA, Elliott J. Histomorphometry of feline chronic kidney disease and correlation with markers of renal dysfunction. Key clinical data: In studies in healthy cats, those offered Hydra Care along with a dry food diet consumed on average 50% more liquid each day.18 It is noteworthy that these cats demonstrated a clear preference for Hydra Care compared with tap water, choosing to take in >90% of their daily free liquid in the form of Hydra Care when given the choice. 13. Renoprotective treatments include dietary change that reduces serum phosphorous concentrations9 and decreases soft tissue mineralization (Figure 3). Dr. Vaden was speaking during the New Therapeutic Approaches to Chronic Care Symposium at the AVMA Virtual Convention 2020 this past August. The ultimate classification for the patient will reflect all of these things ("Stage 3, non-proteinuria, normotensive" would be an example). The next step is staging according to the system from the International Renal Interest Society. His clinical and research interests involve the small animal urinary system. Thus, with proper treatment, your cat might have several years of active and good quality life ahead . Rather than one-size-fits-all, I try to identify which problems are present and then address those. 3. Administration: The starting dosage is 1.5 mg/kg PO q12h for 14 days, followed by 2 mg/kg PO q24h. In October 2019, Antech announced RenalTech, a predictive diagnostic tool for chronic kidney disease in cats based on machine learning, which is a type of artificial intelligence that uses algorithms to identify patterns in data. Several feline-specific products have recently been developed to address common causes of clinical compromise in feline CKD, such as hypertension, weight loss, dehydration, and ongoing tubular damage. Congenital kidney dysplasia is a condition that leads to small, nonfunctional, or underdeveloped kidneys. Note the fibrous scar tissue replacement (arrows); and mononuclear cell infiltrates. Comparison of serum concentrations of symmetric dimethylarginine and creatinine as kidney function biomarkers in cats with chronic kidney disease. Both short-term and long-term prognosis for cats with CKD may vary . The most common histologic diagnosis is chronic tubulointerstitial nephritis.6. Zanghi BM, Gerheart L, Gardner CL. Chronic renal failure (CRF), renal insufficiency, and chronic kidney disease (CKD) are medical terms used interchangeably to describe the same condition. . Even though kidney disease in cats may not be very painful, its associated symptoms can cause a lot of discomfort and pain. Stability of renal function is assessed by serial monitoring of abnormalities identified during the initial characterization of renal disease. One of the challenges associated with the management of cats with CKD is maintaining an adequate level of hydration. Key clinical data: In a placebo-controlled study of cats with hypertension, Semintra reduced SABP by an average of 19.2 mm Hg after 14 days, and more than 50% of treated cats had an SABP <150 mm Hg at day28.9 Another study described a cohort of cats receiving Semintra for up to 6 months and reported a long-term response rate of >60%.10. We only need enough nephrons to fill up about 1/3 of one kidney to manage normal kidney function and we start with two full kidneys packed with working nephrons at first but there may come a time when we just don't have enough anymore. Polzin DJ, Osborne CA, Ross S, et al. . J Fel Med Surg 2017;19(3):288-303. J Vet Intern Med 2006; 20:1054-1064. 7. The prognosis depends on all the factors involved. Kidney disease in cats can be a scary diagnosis to receive, but with the right . Most common side effects: Ptyalism was routinely noted in both efficacy and safety studies, occurring soon after administration.15 Other side effects include vomiting, lethargy, and behavior change. So here is what your kidneys do for you and for your pet, what they become unable to do in renal insufficiency, and some of the parameters your veterinarian will want to track. To make a prediction for an individual cat, RenalTech requires measurements from two visits within 24 months and more than 60 days apart. For simplicity's sake in terms of this article, the term kidney failure will be used to reflect all these terms or conditions. Elura is a liquid formulation (20 mg/mL) and may be given with or without food.15. Persistent hyperphosphatemia requires intestinal phosphate binders. The most important risk factors identified for the development of diabetes in cats include obesity, increasing age, physical inactivity, male gender, and the use of glucocorticoids (steroids) to treat other illnesses such as feline asthma. Copyright 2023 Today's Veterinary Practice Web DesignbyPHOS Creative. When enough damage has occurred (losing about two-thirds of kidney function), signs become apparent and regeneration will not occur, leading to chronic kidney disease. Urinalysis 1. Dr. Ogeer said co-morbidities identified as significantly associated with an increased likelihood of CKD versus no CKD were hyperthyroidism, diabetes mellitus, hepatopathy, and being underweight. Systolic Blood Pressure Fortunately, new products specifically designed for cats with CKD (TABLE1) provide practitioners with additional options for these patients and should be incorporated as appropriate into truly holistic treatment plans. By working closely with your veterinarian and making dietary changes as needed, you can help to manage your cat's kidney disease and ensure that they live a happy and . Stay current on important veterinary news, AVMA activities, and member services. This form of kidney failure has the most potential to reverse or partially reverse, so it is important to culture the urine for it early. So again, trying to look at those as a mosaic and trying to see what we need to address, what we can address to make an animal feel better.. A newer parameter called SDMA (symmetrical dimethylarginine) becomes abnormal much earlier than creatinine does and is becoming more commonly tracked. Eliminate ongoing blood loss, and reduce concurrent infections. Kidney disease can be caused by a variety of factors: For some cats, the disease could have occurred after a serious kidney injury, from a severe infection (including feline infectious peritonitis, feline immunodeficiency virus, and pyelonephritis), ingestion of a toxic substance (like antifreeze or lilies), and from certain medications. Protein restricted diets are commonly recommended for the management of CKD in both cats and dogs. Additionally, for all stages of kidney disease, fresh water should always be available. Another thing that Dr. Quimby focuses on is nutrition: picking the best nutrition for cats with CKD and making sure the cats are actually eating the food. Pathophysiology of CKD can be considered at both the organ and systemic level. Researchers are trying to learn more about the disease process in cats, including why it starts in the first place. 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This can obstruct the ureter completely and the backlog can destroy the kidney. These three markers are central to determining the severity of a kidney problem. Insufficient kidneys lose their ability to conserve potassium and potassium levels begin to drop, leading to weakness. Key clinical data: In a field study of cats with stable CKD and >5% weight loss managed at first-opinion practices, cats in the treatment arm gained an average of >5% body weight in just 56 days; cats in the control group lost an average of 1.6% over the same time period.16 Many of the cats receiving Elura had measurable improvement in body weight after just 2weeks of treatment. Administration: The recommended dosage is 2 mg/kg PO q24h. It is an indication of infection and/or kidney damage. Normally, healthy and happy kidneys do a miraculous job of: Eliminating protein wastes Balancing body water, salts and acids Producing high quality urine They conserve water and protein and play an important role in maintaining blood pressure and red blood cell production by making a hormone called erythropoietin. Cats diagnosed early on with kidney disease will benefit from nutritional management and more frequent veterinary attention which may include more frequent checkups and blood work. The technical storage or access that is used exclusively for statistical purposes. At this point, more aggressive treatment will be needed to stabilize the patient and the goal is going to be improving the dysfunction to a level where the patient has acceptable life quality and comfort at home. Schulman G, Agarwal R, Acharya M, Berl T, Blumenthal S, Kopyt N. A multicenter, randomized, double-blind, placebo-controlled, dose-ranging study of AST-120 (Kremezin) in patients with moderate to severe CKD. Based on the cause, additional therapy may be instituted, such as: Aggressive IV antibiotics, if infection is present, Immunosuppressive-type drugs for auto-immune diseases, Antithrombotics (to prevent blood clot formation), Chemotherapy and/or surgery (if cancer is part of the underlying cause). For more details on these substages, see the articles on glomerular disease, and hypertension. Polycystic kidney disease is another inherited condition seen in Persians. Diagnosing Kidney Disease. For a cat in stage 4, Dr. Vaden characterizes and treats the many complications of chronic kidney disease. Chakrabarti S, Syme HM, Elliott J. Clinicopathological variables predicting progression of azotemia in cats with chronic kidney disease. Symptoms of CKD When to contact your vet Causes of chronic kidney disease How will kidney disease affect my cat? The cause of acute-on-chronic decompensation usually falls into 1 of 3 categories (Table 6): In a recent retrospective study, survival times were linked to the IRIS CKD staging system (Table 7).17 In Table 7, IRIS CKD Stage 2 was modified to Stage 2b, which included only cats with stable serum creatinine concentrations between 2.3 and 2.8 mg/dL. Some cats with renal azotemia retainthe ability to produce hypersthenuric urine (USG > 1.035) and, in these cases, response to fluid therapy helps diagnose prerenal versus renal azotemia. Chronic kidney disease is usually diagnosed via imaging or by finding persistent azotemia or an increase in serum symmetric dimethylarginine concentration. The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. Jepson R, Brodbelt D, Vallance C, et al. Systolic blood pressure is typically measured by the Doppler method in cats. Some will need only a diet change, and some will need ongoing fluid therapy at home or hospitalization. Boehringer Ingleheim. Prescribing information. Clinical use: Elura is indicated in any cat with CKD and a suboptimal body or muscle condition score or documented weight loss. White blood cell count: if high, it may indicate infection or inflammation. Each patient will have a different stage and a different constellation of issues to contend with. It can be used for early detection of kidney disease. Suggested Articles Hypertension Chronic Kidney Disease Diagnosis: Heart Disease Vomiting Diarrhea Anorexia Anesthesia Hyperthyroidism is a common disease in cats, and mostly afflicts cats middle-aged and older. Also called thyrotoxicosis, hyperthyroidism is caused by an increase in production of thyroid hormones (known as T3 and T4) from an enlarged thyroid gland in a cat's neck. 2023 American Veterinary Medical Association All rights reserved, Donate to American Veterinary Medical Foundation (AVMF), AVMA Congressional Advocacy Network (CAN). Urine culture Managing anemia in patients with chronic kidney disease April 30, 2011 Chronic anemia affects the body negatively in a number of ways and decreases an animal's quality of life. Duranton F, Cohen G, De Smet R, et al. 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Sorry, something went wrong with the translation request. Symmetric dimethylarginine (SDMA): an additional test to help determine if kidney disease is present. Indication: Porus One is indicated in cats with compromised renal function. Most conventional vets will recommend a low phosphorus, low protein diet. Ross SJ, Polzin DJ, Osborne CA. Rhodes L, Zollers B, Wofford JA, Heinen E. Capromorelin: a ghrelin receptor agonist and novel therapy for stimulation of appetite in dogs. King JN, Tasker S, Gunn-Moore DA, Strehlau G. Prognostic factors in cats with chronic kidney disease. The goal of this study was to evaluate the combined effects of feeding betaine and prebiotics on body weight of both CKD and healthy cats. CKD, however, is more prevalentespecially in older cats. Amyloidosis, seen primarily in Persians and Abyssians, is an inherited condition that causes abnormal protein deposits that lead to kidney damage. Consequences of chronic kidney disease are many and managing them is the hallmark of improving patient quality and quantity of life. Serum symmetric dimethylarginine (SDMA) is a new renal function marker that may aid in the early diagnosis of CKD in cats. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria. The balance between calcium and phosphorus in the blood is really important. Because of the severity of signs often seen in cats in stages III and IV and the amount of care and effort required to support these cats, some may be humanely euthanized. What to Expect From Your Pets Echocardiogram, When You Need Antibiotics for Your Pets, and When You Dont, Cardiopulmonary Resuscitation (CPCR): First Aid, Fainting and Dizziness (Syncope): First Aid, Impalement and Penetrating Injuries: First Aid, Physical Exam Checklist for Pets: First Aid, Preventing a Health and Safety Crisis: First Aid, Assessing Quality of Life & Euthanasia in Companion Animals, Behavioral Euthanasia and Quality of Life Decisions, Breeding Information for People Who Want to Breed Dogs. As the introduction of any vasoactive agent can alter renal blood flow and GFR, it is important to recheck both blood pressure and serum creatinine concentration within 7 to 10days. Reduced glomerular filtration results in increased plasma concentrations of substances that are normally eliminated from the body by renal excretion. Evaluation of predictors of the development of azotemia in cats. Stage I is mostly for pets that are known to have kidney disease based on abnormal ultrasound or their slightly elevated SDMA. The nephron possesses a filtration system that keeps the protein in while removing harmful wastes. Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM. Some causes of kidney disease may be preventable (such as toxicologic causes), but unfortunately, most causes are not. Use potassium gluconate for hypokalemia in isolation, and use potassium citrate for hypokalemia combined with metabolic acidosis. Clinical signs are often related to the severity of the kidney disease and underlying cause.
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