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(PLEASE NOTE: We are NOT veterinarians!! However, we want to share our personal research and experiences regarding these important feline health issues with other cat-lovers!! We will be updating this page often!! Send us your ideas and any comments!!)

Look Here!  CRF (Chronic Renal Failure)  Look Here!

CRF is unfortunately very common and very serious in cats of all breeds. The tendency towards a cat ever developing CRF is determined by age, genetics, environment and disease. CRF is the progressive failure of the kidneys, which leads to increasing toxicity in the body. The kidneys are responsible for filtering out the waste products (poisons) in the body, and when the kidney function begins to decline, the levels of toxicity build up in the body. CRF is primarily a disease of older cats, and is one of the leading causes of illness and death in older cats. Once your cat reaches the age of 7 years or older, it is recommended that the cat be specifically checked for signs of CRF during each annual exam. Early detection is absolutely critical to the quality and length of life for a cat with CRF.

How can I know if my cat's kidneys are in trouble?? There are some symptoms that you may be able to observe in a cat with beginning CRF. If you notice them, you should have your cat tested for CRF immediately. If you observe signs of increased thirst (polydipsia) and excessive urination (polyuria), you should have your vet rule out beginning CRF. (There are other medical conditions that may cause these same symptoms.) As CRF continues, your cat may lose his appetite, vomit, lose weight, and his hair coat may become dull and coarse. It's important for you to know that if a cat has CRF, by the time these symptoms are present, he will have already lost approximately 70% of his kidney function ~ time is very critical with this disease!!

How will my veterinarian test for CRV?? Blood and urine tests are used to determine whether or not CRF is present. Blood tests will determine the amounts of creatinine and BUN (blood urea nitrogen) present in the blood. Above normal readings of creatinine (one of the most accurately measurable waste product in the body; creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body depending on muscle mass) in the blood generally means loss of kidney function. When the small filters in the kidneys aren't able to filter the creatinine as efficiently, this waste product, and others, are found in increasing levels in the blood. The higher the levels of creatinine in the blood, the more kidney function has been lost.

Is there a cure for CRF?? Unfortunately, there is no cure for CRF. There are some treatment options, however, and with early detection and treatment, your CRF-positive cat may go on to live anywhere from months to years more, and with a high quality of life.

What are the treatment options for CRF?? The purpose of the treatment options for CRF is to reduce the amount of waste products in the cat as the tiny filters in his kidneys, called "nephrons", are no longer properly performing their filtering task. Treatment options include a special diet; medications; hydration therapy, and most recently, kidney transplants for cats.

What are the medications for CRF?? We have listed the most common medications used for cats with CRF; however, this list is not intended to be complete, not to take the place of what your veterinarian recommends. Never give your cat a pill that was intended for humans without checking with your veterinarian first; also, use of generic medicine should be avoided for cats as they may be slightly less effective for humans (for whom they were developed) and when that slight difference is calculated down to the cat's weight levels, could cause the medication to be too far off the baseline to do what it was intended to do. We will list the medications after the various symptoms for which they are normally prescribed. Please remember to always ask your vet about any possible side-effects to each medication.

ANEMIA- Epogen or Procrit (erythropoietin) is used to stimulate red blood cell production, and is currently only available at this writing in human form. It is given by injection under the skin, which your vet can train you to do at home. Weekly blood test monitoring is necessary while on this medication, and you need to also watch closely for iron deficiency. This medication can help give a cat with anemia more energy.

CALCIUM IMBALANCE- Rocatrol (calcitriol) is used to help absorb calcium through the gut back into the system. When the kidneys are not functioning correctly, often phosphorus levels get too high, which suppresses the production of calcitriol, which is the active form of vitamin D (D3). Testing can be done (parathyroid hormone test) to determine levels of phosphorus and calcium in the animal. By enabling a cat to absorb more calcium, their bones can become stronger and there is less likelihood of muscle cramps.

HYPERPHOSPHATEMIA (TOO MUCH PHOSPHORUS) -- Amphojel (aluminum hydroxide gel) is an over-the-counter human antacid available in tablets or unflavored liquid. The liquid is the most effective since it gets more readily into the system; however, tablets can be ground up and put into your cat's food. It is extremely critical that Amphojel be given immediately before, during or after eating since it is useless it has certain food elements to bind the phosphorus to, which lowers the amount of phosphorus absorbed by the intestines.

HYPOKALEMIA (POTASSIUM DEPLETION) -- Tumil-K (potassium gluconate) is available in tablets, gel, and power form.

LOSS OF APPETITE -- Periactin (cyproheptadine) is an antihistamine used for humans that for some reason, works to stimulate the appetite in cats. It does not always work, but due to the fact that it has less side effects than tranquilizers, it is still prescribed fairly often and is definitely worth a try. There are other alternatives, including Valium (diazepam) or Serax (oxazepam), which are both tranquilizers. You must be extremely careful when giving tranquilizers to cats. Watch them closely so they don't fall off things, and they may be very unsteady, wobbly or uncoordinated while taking these drugs. Also, in some cats, diazepam has caused massive liver and kidney damage, and death in a short period of time. Talk to your vet about some of the newer appetite stimulants available for cats.

STOMACH IRRITATION (Uremic gastritis)-- Pepcid AC Acid Controller (famotidine) is a systemic gastric acid production inhibitor. What it does is to inhibit the production of stomach acid rather than neutralize it. While it does not stimulate the appetite, it can help reduce the discomfort your cat with CRF may be experiencing that is contributing to his lack of appetite.

What happens as the CRF progresses and gets worse?? As CRF continues to progress, the following symptoms will appear: excessive urination and thirst; nausea and vomiting; dehydration; hunching over the water bowl; stomach irritation (uremic gastritis); loss of appetite and weight loss; muscle wasting (emaciation); lack of luster in hair coat; weakness and lethargy; halitosis (bad ammonia smell to the breath); depression; oral ulcers, and in end-stage renal disease (total kidney failure) convulsion, low temperature, and coma. This is a terminal disease, and the only question are how long, and how well your cat will live as the disease progresses. It will be up to you and your veterinarian to determine when the quality of life has decreased to the point at which it is the most loving and the right thing to do to let him go.

Tell me more about kidney transplants for cats!! A kidney transplant is a surgery performed where a healthy kidney is taken from a donor cat, and transplanted into the cat with CRF. The donor cat should be fine with one well-functioning kidney, and the recipient cat now has a functioning kidney to counteract his CRF. After the donor cat has recovered from the surgery, he should not need any medications as a result of having donated a kidney. The recipient cat, however, must take anti-rejection medications for the rest of his life, to keep his body from rejecting the donated organ.
First performed in the mid-1980's at U.C. Davis, School of Veterinarian Medicine, there have now been hundreds of kidney transplants done on cats, and the surgery is no longer considered experimental. In the United States, there are at least nine veterinary hospitals with the veterinary surgeons experienced and capable of performing kidney transplants on cats. Initially, the success rate of the surgery was about 65% survival after the first year, but as of year 2000, this rate for kitty CRF transplant recipients in good condition is now about 90%, and adding two to six more years of life to the cat is not at all uncommon. The oldest survivor of the longest known feline kidney transplant is a cat known as OJ, who is 11 years old, and has had his transplanted kidney for over 10 years!! The following facilities have performed feline kidney transplants:

Look Here! University of California, Davis, School of Veterinary Medicine, Davis, CA 95616; (530) 752-1393

Look Here! Angell-Memorial Animal Hospital, 350 S. Huntington Ave, Boston, MA 02130-4803; (617) 522-7282

Look Here! Animal Medical Center, 510 East 62nd Street, New York, NY 10021; (212) 838-8100

Look Here! Michigan State University, Veterinarian Teaching Hospital, College of Veterinary Medicine, Lansing, MI; (517) 353-5420

Look Here! Orchard Park Veterinary Medical Center, 3507 Orchard Park Road, Orchard Park, NY; (716) 662-6660

Look Here! Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, West Madison, WI 53706; (608) 263-7600

Look Here! Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA; (215) 898-4680

Look Here! Companion Animal Hospital, College of Veterinary Medicine, Cornell University, Ithaca, NY; (607) 253-3060

Look Here! Small Animal Hospital, Veterinary Medical Teaching Hospital, University of Florida, Gainesville, FL; (352) 392-4700 ext. 4700

Look Here! Veterinary Medical Teaching Hospital, College of Veterinary Medicine, North Carolina State University, Raleigh, NC; (919) 513-6500 (Ask for the soft tissue surgery service)

Look Here! All-Care Animal Referral Center, Fountain Valley, CA; (800) 944-7387

What is involved with a feline kidney transplant?? This type of surgery is very expensive in financial and emotional terms. 1) Can you afford both the initial and the life-long expense of a transplant, and if so, can you emotionally afford not to try the surgery? 2) Would you rather lose your cat on the operating table in an attempt to save his life, or deal with the progressive deterioration of CRF? 3) How do you feel about the additional stress of dealing with this surgery? 4) It is important that the cat be in good condition prior to a transplant…are you willing to "let go" and risk the surgery early on? 5) Can you adopt the donor cat (who will be giving up one of his kidneys) and can you accept that your cat even after the transplant may die while the donor animal may live? 6) Can you deal with the fact that after a kidney transplant, you will have to give your cat medication every 12 hours without fail for the rest of his life, or he will lose (reject) his new kidney? 7) What about your cat's age…is this really in his best interest to go through such an ordeal? 8) Can you take the time off to go to a feline transplant facility? 9) Can your cat deal with this ordeal? 9) Do you understand that CRF is always fatal…and a transplant (or dialysis, which is a newly emerging option, but one that does not provide the quality of life that a transplant does) may be the only hope? Also, that a transplant is not a cure, only a treatment? 10) Do you have a support system for yourself, as your life WILL be different after going through this?

How much does a kidney transplant for a cat cost?? You'll want to get current figures from several hospitals that perform this surgery and do a lot of them with a high success rate. Including screening tests, pre-operative, donor adoption, surgery for BOTH cats, travel, hotel, extended hospital care, postoperative maintenance, scales and medications, costs range from $7,000 to $15,000, with the university facilities probably being at the lower cost and the private facilities at the higher cost. The surgery itself usually lasts about 4 hours, and costs between $6,000 and $8,000. Cyclosporine is the anti-rejection medication that must be given daily for the rest of the transplant recipient's life, and it costs about $400 and up per bottle, which will last from two to three months.

Foothill Felines wishes to acknowledge the dedication and research of Carol DiFiori, David DiFiori, Sandy Carr and the staff at The Feline CRF Information Center for their major contributions to this article.

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