Chronic Kidney Disease in Cats

What is chronic kidney disease in cats?

Chronic kidney disease (CKD) is the persistent loss of kidney function over time. Healthy kidneys perform many important functions, most notably filtering the blood and making urine, so problems with kidney function can result in a variety of health problems for a cat. Among the many different kidney diseases that may affect cats, CKD is the most common.

The kidneys are part of the renal system, the body’s system for filtering impurities out of the blood. Urine produced in the kidneys is carried to the bladder by the ureters and from the urinary bladder to the outside world by the urethra.

Clinical Signs and Symptoms of Chronic Kidney Disease in Cats

Cats with CKD may experience a buildup of the waste products and other compounds in the bloodstream that are normally removed or regulated by the kidneys. This accumulation may make them feel ill and appear lethargic, unkempt, and lose weight. They may also lose the ability to concentrate their urine appropriately, and as a result they may urinate greater volumes and drink more water to compensate. The loss of important proteins and vitamins in their urine may contribute to abnormal metabolism and loss of appetite. They may also experience elevated blood pressure (hypertension), which can affect the function of a number of important systems, including the eyes, brain, and heart.

Another cause of lethargy in cats with CKD is the buildup of acids in their blood. The kidneys of cats with CKD may not excrete these compounds appropriately, making affected cats prone to blood acidification, or acidosis, a condition that can significantly affect the function of a variety of organ systems in the body. CKD may also decrease a cat’s ability to produce red blood cells, which can lead to anemia, a reduced concentration of red blood cells in their blood. This may cause their gums to appear pale pink, or in severe cases, whitish in color, and may make them lethargic.

Diagnosis of Chronic Kidney Disease in Cats

To evaluate kidney function, veterinarians will most often turn to blood tests and urine analysis (urinalysis) to evaluate the concentrations of waste products and other components that healthy kidneys normally filter or regulate.

Blood tests can determine the concentration of two important waste products: blood urea nitrogen (BUN) and creatinine, but creatinine is generally recognized as a more specific indicator of kidney function. An increase in the concentration of these compounds in your cat’s blood may suggest that his kidneys are not functioning properly, although these values must be interpreted in light of a number of factors. Dehydration, for example, can cause BUN and creatinine concentrations to increase in spite of the fact that a cat’s kidneys are functioning normally. Ideally, a veterinarian will base his or her interpretation of kidney function on at least two blood samples, obtained within two weeks of one another, from a normally hydrated cat that has fasted for 12-24 hours. The concentrations of other blood components, including various electrolytes (like sodium and potassium), phosphorus, red blood cells, and proteins are also important to evaluate in a cat being examined for CKD.

In a urinalysis, your veterinarian will consider the concentration of the urine, its pH, and the presence of protein, blood cells, bacteria, and other cells that generally should not be found in feline urine, all of which provide important information regarding the health of a cat’s kidneys. It is also important to culture a urine sample to rule out the possibility of bacterial infection of the urinary tract in suspected cases of CKD. Urine samples may be obtained either by collection from a litter box filled with non-absorbent beads designed for this purpose, by catheterization of the urethra (the opening of the urinary tract to the outside world), or by cystocentesis, a technique that extracts a urine sample by passing a very fine needle through the abdominal wall into the bladder. Cystocentesis is generally considered a safe procedure and in most cases will provide the most diagnostically useful sample for analysis.

Other studies that can be useful in evaluating a cat with suspected CKD include imaging studies such as abdominal ultrasound, radiographs (X-rays), and, in some cases, microscopic evaluation of biopsy samples. Given the potential for hypertension in cats with CKD, measurement of a cat’s blood pressure is also an important part of the medical evaluation for this disease.

Treatment of Chronic Kidney Disease in Cats

Although there is no definitive cure for CKD, treatment can improve and prolong the lives of cats with this disease. Therapy is geared toward minimizing the buildup of toxic waste products in the bloodstream, maintaining adequate hydration, addressing disturbances in electrolyte concentration, supporting appropriate nutrition, controlling blood pressure, and slowing the progression of kidney disease.

Dietary modification is an important and proven aspect of CKD treatment. Studies suggest that therapeutic diets that are restricted in protein, phosphorus and sodium content and high in water-soluble vitamins, fiber, and antioxidant concentrations may prolong life and improve quality of life in cats with CKD. However, many cats have difficulty accepting therapeutic diets, so owners must be patient and dedicated to sticking to the plan. It is important to make a gradual transition to a therapeutic diet and to consider food temperature, texture, and flavor. Cats with CKD that go without food for relatively short periods of time may develop significant health problems, so it is crucial to make sure that your cat is eating during a transition to a therapeutic diet.

Controlling hypertension, decreasing urinary protein loss, and addressing anemia are important therapeutic goals in cats that develop these conditions. Hypertension is usually controlled with oral medication, and urinary protein loss may be treated with angiotensin converting enzyme inhibitors. Anemia in a cat with CKD may be treated by replacement therapy with erythropoietin (or with related compounds), which stimulates red blood cell production. Cats with CKD may produce less erythropoietin, and there is some evidence that replacement therapy can increase red blood cell counts. In some cases, blood transfusions, which may be used to restore normal red blood cell concentrations using blood obtained from a donor cat, may be necessary.

Although a number of other therapies, including phosphate binders, potassium supplementation, antioxidant supplementation, alkalinization therapy, and administration of fluids either intravenously or subcutaneously, have the potential to help cats with CKD, these approaches have not been fully validated, and controlled studies are needed to determine whether they offer any benefits. The same is true of hemodialysis (the removal of toxic waste products from the bloodstream by specially designed equipment) and kidney transplantation. These controversial, complex, and expensive treatments offer potential benefits to cats with CKD, but they have not been subjected to studies to prove their effectiveness, so they should be explored with the careful guidance of a veterinary specialist.

Prognosis of Chronic Kidney Disease in Cats

Some cats respond very well to treatment for CKD while others do not, so the prognosis for CKD in affected cats is quite variable. Some studies suggest that cats that lose more protein in their urine have less favorable prognoses. There is evidence suggesting that the earlier CKD is diagnosed and treatment is initiated, the better the outcome with respect to quality of life and survival.

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Fungal Disease in Amphibians (Chytridiomycosis)

Chytridiomycosis

Chytridiomycosis is a serious infectious disease caused by Batrachochytrium dendrobatidis, a zoosporic fungus related to water molds. The fungus feeds on keratin, a protein found in the outermost layers of the skin, and survives in most environments, even without a host. It is believed that the decrease in the population of frogs in many areas is due to chytridiomycosis.

A common way to recognize chytridiomycosis is to check your amphibian's skin for sloughing or shedding. The disease can be fatal for amphibians left untreated. Therefore, owners suspecting chytridiomycosis in their amphibian must seek immediate veterinary care.

Symptoms and Types

An amphibian suffering from chytridiomycosis may shed excessively, develop thickened or pale skin and, in the cases of tadpoles, disfigured beaks. Other common symptoms or signs include:

• Lethargy

• Loss of appetite (anorexia)

• Constriction of the eye's pupil

• Abnormal posture of the hind legs

• Abnormal behavior and disposition

• Hyperemia (an increase in blood flow to different body tissues)

Some amphibians present no clinical symptoms of the disease, but are still infected with the Batrachochytrium dendrobatidis fungus. These animals are carriers of the disease.

Causes

Chytridiomycosis is due to an infection with the B. dendrobatidis fungus. Generally, amphibians contract the fungus through their skin while in contaminated water.

Diagnosis

Veterinarians diagnose the disease by examining skin scrapings or toe clips that are stained and put under a light microscope. Placing an infected animal in a shallow dish of water will often confirm the sloughing of skin, a common symptom for chytridiomycosis.

Treatment

To treat chytridiomycosis, your veterinarian will prescribe antifungal medication, such as itraconazol, which is usually diluted and administered as a bath. Supplemental treatment may include ultraviolet light therapy.

Living and Management

For unknown reasons, chytrid infections have a high mortality rate. Therefore, it is important you follow your veterinarian's instructions and provide a clean aquatic environment and an appropriate temperature range for your amphibian.

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Puppy Dental Care: Teeth, Teething and Tooth Care

Just like human babies, ​puppies have baby teeth that fall out. Most puppies are born without teeth and go through a process known as puppy teething. From birth to six months, sharp puppy teeth erupt from the gums in the jaw in a predictable timeline. Puppies go through teething stages during the development of their teeth, including sore gums, and eventually—the eruption of 28 baby teeth. During teething, puppies may target all kinds of unexpected objects to gnaw and chew on, like baseboards and shoes, to relieve the discomfort. However, most dogs never outgrow the urge to chew. Pet owners are encouraged to learn about how their puppy's teeth grow in so they can best handle their dog as it ages.

Stages of Puppy Teeth and Teething

Birth to 2 Weeks

When your puppy is born, there are no teeth yet. During the first two weeks, you'll notice your puppy nursing and first opening its eyes.

Weeks 2 to 4

In the front of the mouth, narrow-edged teeth known as incisors will begin to emerge. The incisors are the first to appear at about two to three weeks of age. Puppies have six incisors on both the top and bottom jaw.

Premolars and molars also begin to grow behind canines (the pointed teeth between the incisors and premolars) at three to six weeks of age, with three on the top and bottom of each side. Four needle-like canines appear at age four weeks and frame the incisors, one on each side, top, and bottom.

Weeks 5 to 8

The last molars appear by six to eight weeks of age. At about eight weeks, the puppy’s permanent teeth begin pushing out deciduous or "milk teeth." The roots of the baby teeth are absorbed by the body, and in most cases, milk teeth simply fall out.

When the deciduous teeth don't fall out on time, puppies may appear to have a double set of teeth. Retained baby teeth should be extracted by a veterinarian so that permanent teeth have room to grow. Sometimes, a crowded mouth pushes teeth out of alignment, resulting in difficulty eating or poor dental hygiene (which can lead to periodontal disease).

All of your puppy's 28 baby teeth are expected to come in by this time. This is when puppies start to learn how to eat moist and soft puppy food.

Weeks 12 to 16

Breeders often let their puppies go to their new owners' homes around eight weeks. Baby teeth will begin to shed, and permanent adult teeth will start to come in. This process is painful for dogs, so providing puppy safe chew toys is recommended. This is a good time to socialize your dog more, look and touch the inside and outside of its mouth, and prepare for teeth brushing.

6 Months and Older

At this point, all puppy teeth should be gone, and adult teeth emerge. If there are any baby teeth left, let your vet know so it can be removed. Permanent teeth replace the milk teeth tooth-for-tooth and add four premolars and 10 molars. Most pups will have 42 permanent teeth in place by about seven months of age.

Signs to Keep an Eye on During Teething

While it can vary somewhat between breeds, there is a progression you can expect as your puppy develops new teeth. It's important to begin handling your puppy's mouth while it's young so you can periodically check for any potential tooth problems. Any type of facial swelling, changes in eating habits, unexpected night awakenings, or rubbing of the face are signs of possible oral discomfort.

You'll want to take your pup to the veterinarian if you see:

• Two teeth occupying one spot in your puppy's mouth. This can cause the adult tooth to come in crooked, possibly causing later problems.

• Spots of blood on your dog's toys, brown tartar on the teeth, or gums that are bleeding, inflamed, and/or sore. These are common symptoms of periodontal disease, a large oral issue for dogs.

• Broken or cracked teeth. This can cause the nerve of the tooth to expose itself, causing your dog pain or infection.

• Crooked teeth or malocclusion (misalignment of the upper and lower jaw). While some breeds have a trademark bite, unusual ones could cause chewing issues.

• Loose adult teeth. Most often, this is caused by trauma to the mouth or from gum loss due to advanced periodontal disease. It could also be a sign of illness.

How to Keep Teeth Healthy

Schedule a visit with your veterinarian for an initial dental exam for your puppy. This examination will include a look at the teeth, gums, and oral cavity. Ask your vet to demonstrate how to clean your pup's teeth. This way, you'll know what brushes, toothpaste, and techniques to use.

Get your pup used to the idea of tooth brushing around six months when its adult teeth start to come in. Regular brushing will prevent plaque, stinky breath, disease, and other medical problems. It's ideal to brush your puppy's teeth daily, but once or twice a week will work.

The Purpose of Each Dog Tooth

Different kinds of teeth serve various functions, based on the position of the mouth and the shape of the tooth. With some breeds, the shape of the jaw impacts how each type of tooth functions. Most dogs have V-shaped upper and lower jaws which allow the mouth to be opened very wide for grasping and capturing prey—or grabbing and holding toys during play. There are several ways dogs use their teeth:

• Dogs use their incisors to rip and scrape meat from bones. They also use them as a grooming tool to nibble burrs or dirt from their fur.

• Dogs use their two canine teeth, found on each side of the jaw (on the top and bottom), as pointed daggers to inflict stabbing and slashing wounds.

• Dogs have eight premolars in the upper jaw and another eight in the lower jaw. They also have four molars in the top and six in the bottom. The extra molars are designed to crush and are used to process vegetable foods and bones.

• Dogs have specialized carnassial teeth composed of premolars and molars. As they pass each other during the mouth's closure, these teeth act like scissors. The carnassial teeth are innovations of the carnivorous animal that requires shearing action to process flesh.

What a Proper Bite Looks Like

When the mouth is closed, dogs should have a normal "bite." This is very important so that dogs can eat and use their mouth normally.

A normal bite looks like this:

• The lower canine teeth are situated in front of the upper canines.

• The upper incisors overlap the lower incisors.

• The upper premolar points fit into the spaces between lower premolars.

• The upper carnassial teeth overlap the lower ones.
  

Malocclusion refers to the abnormal "bite" or fitting of these teeth. Malocclusion can be normal for certain dog breeds due to differences in the shape of the jaw and mouth. For instance, the flat-faced (brachycephalic) dog breeds like Bulldogs have a normal malocclusion because their lower jaw is longer than the upper. However, this allows the teeth to fit incorrectly, which can cause mouth damage as the dog chews. Thus, a veterinarian or veterinary dentist with orthodontic correction should be aware of malocclusion.

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Diabetes Ketoacidosis (DKA) - A Complication of Diabetes in Cats and Dogs

Unfortunately, as veterinarians, we are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). You're probably wondering if you just had a dog or cat diagnosed with diabetes mellitus—what do you do? First, we encourage you to take a look at these articles for an explanation of the disease:

• Diabetes in Cats

• Diabetes in Dogs

This article will teach you about life-threatening complications that can occur as a result of the disease; specifically, a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it.

What is DKA?

When diabetes goes undiagnosed or difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells — resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body.

Symptoms of DKA

Clinical signs of DKA include the following:

• Weakness

• Not moving (in cats, hanging out by the water bowl)

• Not eating or complete anorexia

• Vomiting

• Excessive thirst and urination (clear, dilute urine)

• Large urinary clumps in the litter box (anything bigger than a tennis ball is abnormal)

• Weight loss (most commonly over the back), despite an overweight body condition

• Obesity

• Flaky skin coat

• Excessively dry or oily skin coat

• Abnormal breath (typically a sweet “ketotic” odor)

• Diarrhea
  

In severe cases DKA can also result in more significant signs:

• Abnormal breathing pattern

• Jaundice

• Abdominal pain (sometimes due to the secondary problem of pancreatitis)

• Tremors or seizures

• Coma

• Death

What can cause DKA?

When DKA occurs, it’s often triggered by an underlying medical problem such as an infection or metabolic (organ) problem. Some common problems that we see with DKA include the following:

• Pancreatitis

• Urinary tract infection

• Chronic kidney failure

• Endocrine diseases (e.g., hyperadrenocorticism [when the body makes too much steroid], or hyperthyroidism [an overactive thyroid gland])

• Lung disease (such as pneumonia)

• Heart disease (such as congestive heart failure)

• Liver disease (such as fatty changes to the liver)

• Cancer

Diagnosing DKA

While diagnosing DKA is simple, by looking at the blood sugar levels of dogs and cats and by measuring the presence of these fat breakdown products in the urine or blood, treatment can be costly (running between $3-5000). A battery of tests and diagnostics need to be performed, to look for underlying problems listed above, and treatment typically requires aggressive therapy and 24/7 hospitalization.

Treatment of DKA

Treatment, typically, is required for 3-7 days, and includes the following:

• A special intravenous catheter called a “central line” (placed to aid in frequent blood draws)

• Aggressive intravenous fluids

• Electrolyte supplementation and monitoring

• Blood sugar monitoring

• A fast acting or ultra fast acting insulin, regular or Lispro, typically given intravenously or in the muscle

• Blood pressure monitoring

• Nutritional support (often in the form of a temporary feeding tube)

• Anti-vomiting or anti-nausea medication

• Antibiotics

• Long-term blood sugar monitoring and a transition to a longer-acting insulin

Thankfully, with aggressive supportive care, many patients with DKA do well as long as pet parents are prepared for the long-term commitment (including twice-a-day insulin, frequent veterinary visits to monitor the blood sugar, and the ongoing costs of insulin, syringes, etc.).

Preventing DKA

By following your veterinarian’s guidelines and recommendations you can help regulate and control your pet’s diabetic state better and monitor your pet carefully for clinical signs. For example, if your pet is still excessively thirsty or urinating frequently despite insulin therapy, they are likely poorly controlled and need an adjustment of their insulin dose (of course, never adjust your pet’s insulin or medications without consulting your veterinarian).

When in doubt remember that the sooner you detect a problem in your dog or cat, the less expensive that problem is to treat. If you notice any clinical signs of diabetes mellitus or DKA, seek immediate veterinary attention. Most importantly, blood glucose curves (when a veterinarian measures your pet’s response to their insulin level) often need to be done multiple times per year (especially in the beginning stages of diabetes mellitus).

If you have any questions or concerns, you should always visit or call your veterinarian.

Related reading:

• Diabetes in Cats

• Diabetes in Dogs

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Stomach Flu with Bloody Diarrhea in Dogs

Hemorrhagic gastroenteritis is identified by blood in the vomit and/or stool, often due to a food borne illness. Because it is a serious disorder that can be potentially fatal, immediate veterinary care is required.

Symptoms

Continuous vomiting and/or diarrhea are the most common symptoms.

Other symptoms include:

• Lethargy

• Listlessness

• Anorexia

• Weight loss

• Fluid loss

• Electrolyte imbalance

• Dehydration

• Hemoconcentration

• Hypovolemic shock

Causes

Infectious gastroenteritis is caused by pathogens (infectious agents). Some of the pathogens most commonly associated with infectious gastroenteritis include:

• Bacteria (e.g., Campylobacter, Salmonella, E. coli, Clostridia)

• Virus (e.g., Parvovirus, Canine distemper)

• Fungi (e.g., Aspergillus, Penicillium, Fusarium)

• Parasites (e.g., Roundworms, Hookworms, Tapeworms, Whipworms, Coccidia)

E. coli, Salmonella and Corynebacterium are the most significant intestinal pathogens because they can be passed from animal to human or vice versa. Salmonella infections are also important due to the association with reproductive disorders.

Sudden dietary changes and/or dietary toxins may cause irritation and/or affect the immune system. Eosinophilic gastroenteritis, a chronic form of the illness, has been associated with allergens in dog foods. Gastroenteritis may be also observed due to irritation caused by stress, toxins, physical obstruction, ulcers, and abdominal disorders.

Gastroenteritis is not specific to any breed or gender, however, small breed dogs are more prone to infectious gastroenteritis.

Diagnosis

It may be difficult to identify the cause of gastroenteritis. Therefore, invasive diagnostic procedures may be required if routine diagnostic procedures are not successful.

A brief outline of diagnostic procedures:

Medical history:

• Physical obstruction, tumors, ulcers, intestinal blockage, etc.

• Information about the severity, progression and magnitude of the vomiting and diarrhea

• The vaccination record may help in ruling out a parvoviral infection

Physical observations:

• A skin test to determine the presence and extent of dehydration

• An abdominal palpation to check abdominal pain and/or abdominal obstruction

• An examination of mucus membranes to determine hemorrhagic losses

• Cardiovascular function provides information on dehydration and/or blood loss

• Visual observation of the vomit and/or stool to determine if there is blood present

Routine blood/biochemical tests:

• Packed cell volume (hematocrit) data to confirm hemorrhagic gastroenteritis

• Biochemical tests (i.e., liver, kidney, blood protein, and blood sugar)

Fecal study:

• Cultural assays to identify any potential microbiological or parasitic organisms

Radiographs/endoscopy:

• To locate any potential physical obstruction, tumor, ulcer, intestinal blockage, etc.

Treatment

In most of the cases, dogs recover and respond very well. The course of treatment, however, is dependent on the underlying cause of the condition. A brief outline of treatment is given below:

• Fluid and electrolyte therapies are important, especially in cases of hemorrhagic gastroenteritis.

• Antibiotic therapy may be restricted to animals with systemic infections.

• Corticosteroid therapy is useful in cases of shock. Usually hypovolemic shock develops due to dehydration.

• Dog medications that soothe the intestine and bind noxious agents can also be used in supportive therapy.

• Parasitic infections are treated with anthelmintics.

• Physical obstruction, ulcers and tumors may need surgical treatment.

Living and Management

An improved diet may reduce intestinal infections and other gastrointestinal disorders. The main priority should be to provide healing time for the dog's inflamed intestinal area. Thus, food and water should not be given for at least a period of 24 hours to rest the intestine. Then, provide a bland diet for three to seven days, followed by a gradual return to the dog's normal diet.

Often dietary irritants (especially protein) may lead to a recurrence of the problem. In these cases, a special hypoallergenic medical diet may be required.

Prevention

Some veterinarians have recently emphasized the importance of restoring intestinal microflora through food additives (e.g., probiotics, prebiotics, and synbiotics) in order to prevent the infection from recurring.

If dog owners are using homemade diets, the ideal micro- and macro-nutrient profile, along with optimum energy density, must be the focus of formulation. These diets provide highly digestible nutrients, less fats and restricted osmolarity. Consult your veterinarian for a proper, well-balanced diet for your dog.

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