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Chronic Renal Failure in Cats: Can we Halt the Decline?

Chronic Renal Failure in Cats: Can we Halt the Decline?. Martha Cannon BA VetMB DSAM( Fel ) RCVS Specialist in Feline Medicine. Oxford Cat Clinic 01865 243000. Chronic Kidney Disease. Chronic Kidney Disease. Consequences of Kidney Disease Polyuria / polydipsia  dehydration

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Chronic Renal Failure in Cats: Can we Halt the Decline?

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  1. Chronic Renal Failure in Cats: Can we Halt the Decline? Martha Cannon BA VetMB DSAM(Fel) RCVS Specialist in Feline Medicine Oxford Cat Clinic 01865 243000

  2. Chronic Kidney Disease

  3. Chronic Kidney Disease • Consequences of Kidney Disease • Polyuria / polydipsia  dehydration • Nausea  vomiting / inappetence • Renal secondary hyperparathyroidism ( Phos) • Proteinuria • Hypertension • Hypokalaemia • Urinary tract infections • Anaemia

  4. IRIS Staging System • Creatinine • Serum Phosphate • Proteinuria • Blood Pressure

  5. CRF: IRIS Staging System • Creatinine: After treating dehydration • Stage 1: Non-azotaemic • > 33% nephrons • Stage 2: Creat 140 – 250 • 33-25% nephrons • Stage 3: Creat 251 – 439 • 25-10% nephrons • Stage 4: Creat > 440 • <10% nephrons

  6. Aims of Treatment • Stage 2: Creatinine 140-250 μmol/l • Aim: (Reverse the cause) Prevent progression • (Serum phosphate, urine protein and UTI’s, blood pressure) • Stage 3: Creatinine 251-439 μmol/l • Aim: Prevent progression and manage azotaemia to improve quality of life • Stage 4: Creatinine >440 μmol/l • Treatment mostly aimed at managing azotaemia

  7. IRIS Staging System • Creatinine • Serum Phosphate • Proteinuria • Blood Pressure

  8. Hyperphosphataemia • IRIS recommendations: • Stage I + II: 0.81-1.45 mmol/l • Stage III: 0.81-1.61 mmol/l • Stage IV: 0.81-1.94 mmol/l Recommended levels are well within laboratory reference ranges

  9. Hyperphosphataemia • Reduced phosphate diet is most effective treatment • Additional advantages of prescription diets • Reduced azotaemia, K+ supplement, Vit B supplement, soluble fibre, ? Omega-3 FAs

  10. Hyperphosphataemia • Protein Restricted Diet • Reduces uraemia • Improves well-being, appetite, activity • Reduces dietary phosphate intake • Controls hyperphosphataemia • Prolongs life-span • Median 800 days vs 264 days

  11. Hyperphosphataemia • Reduced phosphate diet is most effective way to control phosphate • Additional advantages of prescription diets • Reduced azotaemia, K+ supplement, • Vit B supplement, Soluble fibre, • Omega-3 FAs ... ...

  12. Chronic Kidney Disease • Nutritional Management • Ensure adequate intake • Delay introduction until cat feels well • Learned food aversion • Canned diets • Energy from fat cf carbohydrate • Increased fluid intake

  13. Phosphate Binders • Hyperphosphataemia despite dietary control • Allow 6-8 weeks for control of phosphate • Gradual introduction of binder if phosphate remains high

  14. Hyperphosphataemia • Intestinal Phosphate Binders • ~10% reduction in serum phosphate • Give mixed with food • Divide between all meals • Introduce gradually and titrate to effect • Monitor serum calcium when introducing binders

  15. IRIS Staging System • Creatinine • Serum Phosphate • Proteinuria • Blood Pressure

  16. IRIS Staging System • Rule out UTI / FLUTD • Must check urine sediment or culture • Asymptomatic bacterial urinary infections are common in cats with CKD, • especially female cats

  17. IRIS Staging System • Proteinuria with no active sediment • UP:C > 0.4 = proteinuric • Treat with an ACE inhibitor • UP:C < 0.2 = non-proteinuric • No treatment required • UP:C 0.2-0.4 =borderline • Monitor / treat

  18. Chronic Renal Failure • Urinary Tract Infections • Asymptomatic UTI’s • Female cats • Low urine SG • ? Occult pyelonephritis • Risk of ascending infection  renal damage

  19. Chronic Renal Failure • Urinary Tract Infections • Treatment • 4-6 weeks of antibiotic • Bactericidal antibiotic • Repeat urine sediment +/- culture • Before end of antibiotics • 10 days after ceasing antibiotics

  20. IRIS Staging System • Creatinine • Serum Phosphate • Proteinuria • Blood Pressure

  21. CRF: IRIS Staging System • Hypertension • Common consequence of CRF • Contributes to progression of CRF

  22. CRF: IRIS Staging System • Blood Pressure • “Risk of end organ damage” • < 150 mmHg = Minimal risk • 150-160 mmHg = Low risk • 160-180 mmHg = Moderate risk • > 180 mmHg = High risk • www.iris-renal.com

  23. CRF: Blood Pressure • For cats with CRF • Maintain BP below 170 mmHg • Amlodipine: 0.625 – 1.25 mg per cat per day • 1/8 or 1/4 of a tablet once daily • Adjunctive Treatment • Benazepril

  24. Chronic Renal Failure in Cats: Can we Halt the Decline? Martha Cannon BA VetMB DSAM(Fel) RCVS Specialist in Feline Medicine Oxford Cat Clinic 01865 243000

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