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Dr. Kara
Dr. Kara, Veterinarian
Category: Cat
Satisfied Customers: 15389
Experience:  Over 20 years of experience as a veterinarian.
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My five year old male cat was diagnosed 3 years ago with kidney

Customer Question

My five year old male cat was diagnosed 3 years ago with kidney disease, we changed his diet and he had been doing really well. He hasn't been feeling well again, I took him to the vet this morning. His BUN is 140 & Crea is 20.0
He wanted to put him down...he is our baby!! Right now they put him on a catheter & fluids for a few days. What are my options...my kids & I will be devastated if we lose him?
Paula
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Kara replied 1 year ago.
Hello, my name is***** and I have over 20 years of experience as a veterinarian. I am sorry to hear that Charlie is in kidney failure that has suddenly worsened with extremely high blood levels of kidney waste products. He is a young fellow and I am sure that you are devastated by his sudden turn for the worse.
His prognosis will depend upon several things including the cause (toxins or infections causing acute failure or worsening tend to be more responsive and lead to a better long term prognosis if the cat responds to therapy), his degree of failure (mildly elevated enzymes have a better long term prognosis then very high values), whether he is still eating or not (cats that don't eat have a much poorer prognosis) and his response to therapy. Other complicating factors are if he has hypertension (high blood pressure) and whether he is spilling protein in his urine (which indicates more serious disease).
At this point he is exactly where he needs to be and getting the treatment he needs. Intravenous fluids are the fastest way to flush out renal toxins. Cats with acute failure whose values come down into the normal range, or close to it, with fluid therapy, are eating, and don't have large amounts of protein being spilled into their urine have the best prognosis.
All you can do at this point is give him a chance and see how he responds. Ideally he should have his urine cultured. An infection will cause chronic failure to worsen suddenly and if his sudden turn for the worse is secondary to an infection, if it is treated properly it is possible to improve his function.
I also recommend testing him for Feline Immunodeficiency Virus, as this virus predisposes to kidney failure and causes a more severe form of failure.
It may help you to look at this website which explains how kidney failure is staged in cats and dogs. The higher the stage the more severe failure is present and the more guarded his prognosis is: http://www.iris-kidney.com/pdf/IRIS2009_Staging_CKD.pdf
This may help you ask your veterinarian the right questions that will allow you a reasonable estimate of his prognosis.
Long term therapy for this disease is subcutaneous fluid therapy at home if needed to keep the enzyme levels down, proper diet, medication to control hypertension and protein loss if present, phosphate binders if high phosphorus levels are present, and potassium supplements if his levels remain low. Supplements such as Azodyl to change gut bacteria to help decrease urea in the gut which would be absorbed into the blood, epakitin to decrease phosphorus levels and omega 3 fatty acids to reduce inflammation are commonly used as well.
At some point however his kidneys will no longer respond to any sort of therapy, no matter what we do.
At that point your only options are a kidney transplant or euthanasia. Transplants are only done at specialty clinics or at veterinary university teaching hospitals. Veterinary teaching hospitals that perform transplants include: University of Wisconsin, University of Pennsylvania, University of California, Davis, University of Georgia, and Cornell to name a few. If your fellow isn't responding to treatment and you are interested in a transplant your veterinarian can contact your state's veterinary teaching hospital or veterinary specialty center and arrange for him to be seen and evaluated. Cats that are infected with Feline Immunodeficiency Virus aren't candidates because the immunosuppressive drugs needed after transplant surgery are contraindicated in a kitty infected with an immunosuppressive virus.
Best of luck with your boy, please let me know if you have any further questions.