Q,

Unfortunately, the answers you are looking for don't exist for exactly the reasons you have already stated. No two cats respond to this disease the same way, so there are no timelines or typical progressions to offer you.

I have had two CRF cats so far ... three, most likely, though the first was never diagnosed or treated. Pea was diagnosed with renal failure at age 18 and lived for four more years. She did very well until her last few months when she went steadily downhill. I didn't know anything about managing CRF with her until those last months. If I had administered fluids a lot sooner, she might have lasted even longer.

My second CRF cat, Bitsy, was diagnosed last November. In spite of my doing everything possible to manage his symptoms and doing frequent bloodwork to monitor his numbers, I had to let him go in Feb. I just could never get his numbers stabilized. He presented me with a lot of complications that Pea had never experienced: overhydration (essentially drowning in unabsorbed fluids), high phosphorous, liver infection, dehydration, constipation (Pea had also experienced this), anemia, etc. I learned a LOT more about CRF and its management from Bitsy, in spite of the fact that his battle with this disease was comparatively short.

My best advice to you is to do frequent bloodwork on Kitty to keep an eye on her various levels. Also, keep copies of all of her bloodwork and maintain a database at home so that you can chart each level and any changes from one test to the next. If something goes out of whack (which is inevitable as the disease progresses), the sooner you catch it, the sooner you can correct it.

It's also extremely important to become acquainted with all of the symptoms and associated conditions that may arise with CRF so that you will recognize when something is wrong. I can't tell you how many hours, days, and weeks I spent reading and rereading the CRF websites to drill the information into my head so that I'd have a better idea of what to watch for, why it might be happening, and what to do about it. There are several extremely useful CRF sites available. I will offer them in my order of personal preference:

Tanya's Feline CRF Info Centre
Feline CRF Information Center

I also strongly recommend you join the Feline-CRF-Support mailing list at Yahoo Groups. It is a large, active group of folks who know more about CRF and its management than any other resource you can find. You can post any questions or concerns you may have or simply search their message archives for information related to your query. They were an invaluable resource for me when I was caring for my CRF kids.

I wish you and Kitty the best possible outcome.

Laurie

Laurie, I thank you for your post. It really is what I am looking for- general experiences with the disease. I have wondered, with her hyperthyroid, that when things go bad, will they go bad very quickly? Obviously we won't know until then, but it is very helpful to know what others have gone through.

I am so sorry that you have been through this more than once. When she was first diagnosed, I was worried about the financial stress, but the emotional and mental stress is way more daunting. I am glad she is doing as well as she is, but wish I had better ideas about what to expect as time goes by.

I am very familiar with one of those websites, thank you for posting them. I did join the Yahoo group, but found it too overwhelming; the sheer amount of information that came in was well more than I could look at.

Thank you again for sharing your experiences, I appreciate it so very much. If anybody else has experiences to share, I would appreciate them as well.

Q, thankfully hyperT is one of the only major feline diseases that I have not yet had to deal with, so I can't offer any personal experience with it, esp. in combination with CRF.

I can certainly relate to the emotional stress being far more difficult than the financial strain. I live every moment on pins and needles when one of my animals is sick. Thing is, I almost never have just one animal sick at a time. Around here, illness happens in clusters. We can go for months without a veterinary concern, then suddenly three emergencies send me racing to the vet within days of each other. It's as though when one animal gets to go see "Uncle Paul", they ALL want to go see him. I may as well just build "Uncle Paul" a new clinic next door. Sometimes these kids get me so stressed out that I think I'm going to explode.

That's where the CRF mailing list comes in. I know that the amount of information that comes through that list can be overwhelming, but it's also a great place to dump your stress when you're on emotional overload. Everyone there understands this stress, and no one will judge you harshly for "exploding" on-list. Rejoin and put yourself on web-read only so that you won't be overwhelmed with list messages in your email account. That'll give you access to posting if you feel the need and will also allow you to search the message archives for information.

Laurie

In treating renal failure, you really do just take it day by day. If she gets more azotemic (increased BUN and creatinine) you can help by using a restricted protein diet and increasing fluids. If she gets hyperphosphatemic, feeding a renal diet has restricted phosphorus and if that doesn't help you can use aluminum hydroxide or other phosphate binders. If she gets anorexic, you can start famotidine or other antacids because renal disease can cause acid stomach and make her not want to eat. You can also give appetite stimulants. Eventually towards the end her kidneys won't be able to make enough erythropoietin and she'll become anemic, but you can get erythropoietin shots. Basically managing kidney disease is just managing the symptoms as they arise. Unfortunately there is no way to predict how long a particular kitty will be able to be managed. Some go years and years just on fluid therapy, others rapidly progress through the stages to end stage renal failure quickly. But with careful monitoring and symptomatic treatment, many cats live relatively well for some time.

Is your kitty being treated for hyperthyroidism? Some vets like to titrate methimazole so that the kitty is slightly hyperthyroid (usually they try to get T4 into normal range). That seems to help some cats. Other vets think it is easier for most owners to manage just one chronic disease rather than 2. Some cats simply cannot take the thyroid medication- they get a strange reaction that causes them to scratch the skin off their faces- and you're left with no choice but to cure the hyperthyroidism with radioactive iodine or to leave it untreated (which causes it's own set of problems).

There are many things you can do for your kitty if your kitty is OK with it. Managing renal disease is a lot of work- many trips to the vet to monitor bloodwork, many medications to give, trying to make sure kitty stays comfortable at home. Unfortunately, renal disease is fatal- we cannot cure it, and eventually we run out of ways to help. The resources Laurie mentioned are excellent. Hopefully your kitty is one that will respond well to treatment and live happily for a long time.

Here's my experience: I had 3 cats, two yellow males and a yellow female, all from the same litter. They showed up here as feral kittens. After feeding them for awhile, we finally tamed them, got vaccinations, spayed and neutered and started keeping them inside. About 5 years ago,when they were about 9, one male got sick. I took him to the vet, he was diagnosed with renal failure. The doctor said we might try giving him fluid and trying to keep him alive, but she didn't sound very hopeful about the outcome, so I had him euthanized. I had bloodwork on the other 2 done then, and they were normal, although the other male was in the high normal range. The vet didn't suggest that I should have him rechecked after some time had passed, so I assumed I didn't need to worry about his kidneys. After about a year and a half passed, the other male lost weight (down to about 8 pounds from about 11) and I suspected he had renal failure too. I took him to the vet, a different doctor saw him, and it was renal failure. He convinced me to do the fluid and see if he would improve. So I did. After about 3 days of force feeding him canned Hills AD, he started eating dry Hills KD and gained weight. His appetite was fine once he started eating. He eventually gained weight to 10 pounds, and maintained it until a few months ago. He started out with fluid every day until his creatinine and bun went down some. Then every other day. Then every third day. Early on, he was anemic, so the doctor started him on EPO injections. That took care of the anemia and he didn't develop the antibodies that some cats develop. After a few months I asked the doctor (this time it was the doctor who had seen the first cat) if I needed to be concerned about his blood pressure, and she said that she was sure his blood pressure was fine. (They couldn't check it anyway, no Doppler machine.) One evening about a week later I realized he was blind. I took him to the emergency clinic in Charlotte, NC and his blood pressure was so high it wasn't readable. They kept him overnight, got his bp down, and sent him home with a prescription for Norvasc and told me to give him Pepcid daily, as well. That took care of that problem. While at the emergency place, which is also a specialty veterinary clinic, he was transferred to internal medicine, and was fortunate to get an excellent doctor who told me his specialty is nephrology. I started taking him there for his regular bloodwork and checkups, even though it was more expensive. There's no doubt in my mind that taking him to the specialist made a big difference in how well he did for so long. As time passed, and his creatinine started rising as his remaining kidney got worse, I increased the fluid to 200 ml. once a day. His creatinine never did go down near normal. It was always over 5, and even when it was around 8 his appetite was good and he seemed to feel fine. That's how I gauged how he felt, by how he was eating and how he acted. About 6 weeks ago his creatinine had gone up from 6.6 to 10. I could tell he was not feeling as well, and he wasn't eating as much. I increased his EPO injections to once a week, from every other week. Dr. Jaeger said EPO seems to help lower the creatinine in some cats. When I took him back about 10 days ago his creatinine had only gone down to 9.6 from 10.1. His blood pressure was a little high, too. He wasn't eating much at all, so I got Cyproheptadine (appetite stimulant). That was on Friday, July 6. He was scheduled for another appointment on July 26. When I brought him home that Friday, I persuaded him to eat a little canned Hills AD twice that evening. Saturday he ate a little more of it. Sunday he wouldn't eat it, so I tried no salt added canned tuna. He ate just a few bites. He also was not drinking much at that point. I was still giving him 200 ml fluid daily, and his medications. Monday he wouldn't eat at all and had not drank more than a couple tablespoons of water. Thinking it might take a while for the appetite stimulant to work, I put off calling the vet. Monday night I opened his mouth like I would to give him a pill and popped a little tuna in. He swallowed it but wasn't interested in eating at all. Tuesday I called the specialist and he said to bring him in. We had discussed at the previous appointment that he was near the end, and the doctor and I agreed that I wouldn't force feed him since he wasn't going to get any better, but the doctor thought he'd be ok for another 3 weeks or so. Our objective was to keep him comfortable if possible. By Monday night I had already made up my mind that it was time to end it before he got in worse shape. I had also realized Monday that he wasn't urinating as much as he should have been for the past couple days, so his remaining kidney function wasn't enough to produce much urine. I weighed him and it looked like he had gained about a pound, but I know it was fluid because he hadn't eaten enough to put on any weight. So when I took him to the doctor Tuesday morning he examined him and said that there was nothing we could do to help him at this point. So I had him euthanized. I hated to do it but I know it was the right thing to do. I feel better about it knowing that he only seemed to feel really really bad for a couple days at the most. Monday night, before I took him to the doctor Tuesday, he jumped up on the bed and I petted him for a good while. He purred while I petted him, even though he hadn't purred for at least a month. Now, here's what happened with his sister. She had some spells of vomiting, starting 6 months ago. The regular vet couldn't find anything wrong with her. Her bloodwork was fine, although her calcium was a little high. After a couple days she'd be fine, and start eating again. She had gradually lost some weight, but he attributed it to her getting older (she was obese at 15 pounds for a long time, and even when she got down to 10 pounds she looked chubby, because she was a small cat). After one of the vomiting spells, I took her to the emergency clinic at night because I thought she might be dehydrated. They did bloodwork and it was fine, but the specific gravity of her urine was not quite normal, and could possibly be an indicator of early renal disease. They didn't suggest she needed to be transferred to internal medicine, so I didn't worry about it. That was in April, I think. She seemed fine for a while. Then about 6 or 7 weeks ago, she was sick again so I took her to the regular vet, mostly because I thought she might need fluid and I couldn't tell if she was dehydrated, so I didn't want to do fluid at home if she didn't need it. They did bloodwork and her creatinine and bun levels showed renal failure. Other than the urinalysis being somewhat abnormal earlier, we had no clue that it would be renal failure. I don't remember how high it was, but she needed IV fluid at least overnight, so the new young female vet at the regular vet's office said that if it was her cat she'd take her to the specialty vet, and since he was already seeing my male, I knew he'd see the female too. They took her as an emergency patient, hospitalized her, and kept her for about 4 days. He said her kidneys were worse than the male's. Her creatinine didn't go down much, but I brought her home and started the same routine with her, fluid, blood pressure meds, pepcid. She seemed to do a little better, and started to eat, so I took her for her followup appointment around the first of June. Her creatinine wasn't going down much, but we didn't think she was in any danger of getting worse quickly and her appetite had improved. That afternoon when I brought her home from the appointment she went to the bowl and ate some food. I thought she was ok, but from then on, she went downhill fast. I had an appointment for her about a week later on Tuesday, June 12, but she got so sick I took her to the emergency clinic the following Saturday night instead of waiting til Tuesday. She wouldn't eat, I was forcefeeding her canned Hills AD. She hated getting the pills but got too weak to object much. She couldn't even walk to the litter box. I had to carry her. They called Sunday morning to say she had perked up some, but wasn't ready to go home. So I thought she might be ok. Then Sunday night the emergency doctor called and said she wasn't doing well at all. She wasn't producing urine and had fluid in her chest and abdominal cavities. That doctor had called the specialist (who had not been able to see her that time because of an out of town conference, but had just got back into town), and he agreed that there was nothing they could do for her, so I had her euthanized. It was harder with her, because with the male, I had about 3 years to know it was going to happen eventually. She had seemed ok (except for the occasional vomiting spells) up until a few months ago. The specialist said that the male had done much better than he would have predicted when he first saw him with the high blood pressure, and the female went down much quicker than he expected, although he knew her kidneys were worse than the males. The male was diagnosed in September of 2004, I think, and he lasted until this past Tuesday, July 10. The female was diagnosed this past May 21, and I lost her on June 10. Exactly a month apart. One thing the specialist said early on was that you never can predict how long the cat will live or how they'll respond to treatment. He didn't think my male would live much longer from when he first saw him in Dec. 2004, and he's had a lot of renal failure patients.

Our dear Mrs. B died last fall at the age 17. As a CRF kitty, we gave her fluids at home, and she took an awful lot of medication too (more pills than food sometimes it seemed). As the others have said, every situation is different. But I will say her decline was long and slow, probably would have been faster w/o the meds. As she failed, she spent more and more time in her bed. We finally put a heating pad under a stack of blankets so she could stay warm enough because she was skin and bones. We brought her into the kitchen so we could keep a close eye on her and she would not be alone.

I'm glad your kitty still enjoys life, playing and snoozing. She's lucky to have such wonderful care from you.

One bad experience we did have was with the medication Epogen which our vet gave Mrs. B. This medication causes the blood pressure to rise, which the vet did not treat, and so Mrs. B became blind. It was so sad, however, with BP treatment her vision returned in one eye. So if you ever do get to the point where the vet recommends Epogen, remember the BP problem.

I'm not allowed to post the Yahoo CRF Forum website here, but you can search and find it. Lots of people there asking questions and sharing info.

Good luck. Mrs. B.....

{{gwi:2013541}}

Our cat Rufus has CRF and hyperthyroidism. The vet is treating the hyper but since Rufus' numbers were pretty bad to begin with he was afraid that Rufus would go into renal failure when they treated the thyroid. But Rufus was losing way too much weight. His topside is very bony. His kidney numbers are slightly worse after treating the thyroid (he didn't go into failure) and now we're cutting down the thyroid meds slightly. He hasn't lost anymore weight. He gets an IV daily but no other meds other than the prescription food, should he be?

Thank you for your experiences and information, it is so, so helpful to me right now. I worry and wonder if once we get to a point that the fluids are not keeping up with the declining function, she will fail very rapidly. I know it sounds horrible, but part of me hopes that when things go bad, they go bad fast. A decade ago I lost a cat to a vaccination site sarcoma and the lingering and making decisions was horrible.

Kitty also has some slightly increased liver values that the vet has pushed to the backburner, feeling that it is probably not a major problem when compared with the other issues she has. I don't know how the liver issues will eventually factor into things, but as the vet says, it's just that 3rd big thing that cats often face as they get older. With so many issues, we are treating her conservatively and taking it one day at a time. I don't want to get into doing things to her that make her feel more miserable- the goal is quality of life, not quantity.

Meghane- my kitty eats a low protein, low phosperous diet already and that does seem to help. She is being treated for the hyper-T (methimazole); the vet tries to keep her thyroid numbers in check, but okay if they are slightly on the high side for the sake of the kidney disease. She has done really well with thyroid and kidney balancing, it seems.

irislover- I'm so sorry for your recent losses to CRF, but thank you for sharing your stories. You help give me some bearings on what type of things I might expect over time.

Socks- I will write the name of that med on the front of Kitty's folder- that way if it comes up, I won't forget what it was. I am so sorry for the loss of Mrs. B from this disease- what a beautiful girl. We are going to buy a heated bed this winter because even though she has gained weight, towards the end of this past winter there was an obvious positive difference on days when she stayed warm.

Bluesbarby- it sounds like your Rufus is being treated in the same manner as our girl. She doesn't take anything for the kidney disease at present except fluids and special diet. The vet did recommend tagament (in a cat sized dose) to help with her nausea, but I've had more luck using slippery elm bark for nausea and appetite.

Thank you all again. Your taking the time to share your thoughts and experiences means a tremendous amount to me.

Q

Q, which of her liver values are elevated? If it's her ALT, it may not relate to her liver at all. ALT is sometimes elevated in hyperT cats.

You can get a better understanding of the significance of her blood test results at the link below.

Laurie

Here is a link that might be useful: blood test results

Thankfully with both of mine it wasn't a long slow gradual decline. I think my male was very tolerant of high creatinine levels and that's why he seemed so well for so long.

Laurie, I don't recall which value is up, but I do believe it was ALT- I will take that information and appreciate it greatly!! The vet has suggested that at some point we might want to do a needle biopsy, so having info about increased ALT & hyper-T might be a real boon. I doubt I would go the route of a biopsy anyway though, with her other issues and that she seems to have mostly good days, I'm hesitant to do *anything* that might jeopardize her current well being, especially if there isn't a tremendous amount to be gained- what would diagnosing a specific liver issue really accomplish? The vet seemed to understand my apprehension about doing that and did have some less invasive controls we could try.

Several of her liver levels jumped high last summer and then settled down. Funny thing was that I, too, was having problems with elevated liver levels. The docs chalked mine up to postpartum issues, but I've often wondered if we were both exposed to something here at the house that drove our levels up- under normal, healthy circumstances, we would probably never have known- we would not have gone to the Dr's. At any rate, our levels both went down at the same time except her one that stays high.

I'm still having a lot of guilt about opting to not have her knocked out for tooth cleaning and a few extractions back in March. On one hand I felt like we could do more for her mouth, but OTOH I was very worried about putting strain on her little body with that kind of procedure, and the possibility of changing her eating habits which are quite good at this point in time. It was about 2 weeks after that that our dog passed away and the cat took the loss very hard. She didn't seem like herself for 6-8 weeks, so it was probably better to have not put her through that stress at that particular time. Still, I'm second guessing myself and feel like maybe I am letting her down in some way.

DD is sleeping well today, so I got to look at Tanya's site for a little longer than usual today. I had not read through the individual stories there (not even known they were there) and it was helpful as well.

Irislover, your experience is kind of what I expect. Looking at the Tanya site, it looks like some of the cats seem to be doing well and then crash beyond the point of no return in just a short time.

Thanks yet again :^)

Q,
I'm sorry you have to go thru this. I have a CRF cat, and a Hyper -T and CRF cat. When Jazz was first dx, the vet told me that he would "last" about a year. Thank God I went for a second opinion, this month it will be 6 years since his dx. and he is doing great!! Rex is my CRF plus hyper-t kitty.... he is doing good also. They eat IVD select care modified, get a vitamin twice a day, and fluids every 3 days. I also give them purified water.
Good luck with your baby, and don't worry, it's not that morbid of a question, when I first heard the news about Jazz, I literally thought he was going to die that night.
Hang in there.

Q, Bitsy's liver and pancreas values shot way up on one of his blood tests, and the vet gave him a round of antibiotics which brought them right back down into normal range. You might want to consider discussing a round of antibiotics for your girl to see if they'll help pull her ALT back in line. She may just have some little infection at work on her liver.

If I'd been in your position, I wouldn't have had her teeth worked on, either. With older, ailing animals you have to weigh the pros and cons of any medical procedure, esp. ones that involve general anesthetic. All we can do is gather the facts and follow our gut. I think you made the right decision under the circumstances.

Laurie

I should have mentioned that she was on a course of antibiotics last summer for the liver issue- it was after that they started coming down. The vet thought we might try that again at some point, but the one value that was up was only up slightly. I'm going to try to do a little more research on ALT and hyper-T though.

Ritamay, that is wonderful that your kitty is doing so well. After diagnosis, every day seems like a little gift of sorts.