From: catlover1956 (Original Message) Sent: 02/01/2004 3:05 PM
One of my cat's, Blockie, recently succumbed to Feline Kidney Failure. I had wanted to have him put down a few days prior to his passing and my wife was against that. She said that she would rather he passed naturely. I explained to her that the most humane thing to do is to have him euthanized so he doesn't have to endure any pain during his last few days.
Does anyone know whether a feline who succumbs to Kidney Failure experiences pain ? I believe they do feel pain and I feel so bad because I wasn't more insistent with my wife to have him euthanized............... From: Purrsonę Sent: 02/01/2004 6:28 PM
I don't beleive they have pain so much as discomfort. Their skin and coat can be itchy, and they feel nausea as poisons build in their blood stream. I have lost several kitties to renal (kidney) failure. I nursed Sneakers for a few years, doing Subcutaneous fluid therapy at home, until he lost interest in eating. He was 7 LBs at the end when we euthed him, yet still awake and interested in surroundings, coming out at the vets and watching the fish tank before we were shown to a room. In his prime he was 16 Lbs. People here didnt know me when I had him, but have heard me speak of him.
Our sympathies to you in your time of loss, please visit our Rainbow Bridge page and if you like add his pic.
I also lost Tigger and Freckles to renal failure.
And Missy From: SpinnerLady1 Sent: 18/01/2004 4:12 AM
Sorry to hear of your loss, I guess you are going thru all the stages of grieving at present and asking yourself questions. Don't feel guilty and don't blame yourself for not being more insistant on having your dear pet put to rest.
I have an 18 yr old cat who has been coping with kidney waste for some years now, I have researched as much as anyone can. My vet has told me that in the end she will not be in pain, that she will feel lethargic and off colour more than anything, she will know she is unwell and will either pass away from the build up of toxins in her system or her little heart will fail and she will go peacefully.
So please let Purr and my information lessen your load and lift the guilt that you may feel hanging over you. Be assured you cat went painlessly.
Maureen/SpinnerLady From: thelordismyshepard Sent: 26/04/2004 3:32 AM
is there no cure? on friday i lost by baby girl--angel to renal failure i was doing fliuds and finger feeding her since she was not eating on her own. last month when she was diagnosed i thought she was going to pull through. but like you no way was i going to have her put to sleep. i lost another baby in 2000 also in renal failure. i don't think either was in pain. i do miss them both esp angel whom i just lost. i'm still crying. but i have 3 big fat spoiled boys still with me. they are a great comfort to me now. but the recent loss is rough. From: Purrsonę Sent: 26/04/2004 4:45 AM
LIMS Sadly I dont think anything can be done, perhaps slowing the inevitible but that is all. Like all living creatures, there is a set point beyond what the body cant go.
I dont think there is pain related to kidney failure, at most discomfort from nausea and feeling itchy as toxins build up and are not eliminated. I have lost several to kidney failure. I did home fluids and finger feeding on my second kitty kept him going for a few years. I was out of town when Tigger had symptoms and was diagnosed. The vet said he was pretty far advanced so on phone we decided to let him go.
Freckles developed it a few years later, he was intially admitted for 3 days of iv fluids then we brought him home and I tried to do sub Q fluids, but as post hospitilazation labs didnt show a response, and he was my skittish kitty who we adopted from the street, together we elected not to force him to keep on like that.
Its always a hard decision.
I also lost one to liver failure, and one to Fe Leuk. From: rosieprosie Sent: 30/04/2004 5:58 AM
My beloved poodle, Beau, died of kidney failure. The vet came every day for a week but, in the end, said he wouldn't see out another week, so with much regret, I elected to have him put down rather than prolong his misery. He died in my arms. He is still in my thoughts and therefore not far away from me. I miss him heaps but I have so many fond memories of him - his happy face when he knew he was up to mischief, his happy prancing around, the way he followed me everywhere - even into the bathroom and toilet, his escapades and most of all his devotion to me.
My current dog, Nure, cannot replace Beau but she has another spot in my heart and I love her dearly as I love my two ginger cats (Leo and Xena) and Bunny (the latest member of the family). They are all my babies. From: DocGionet1 Sent: 01/05/2004 9:39 AM
If this were a freak occurrence, I would not answer about the "pain" issue, because it would only make some feel badly and would serve no good whatsoever; however, since Kidney Failure is the largest killer of old cats, it happens constantly, and if you have cats, you may well see it again.
It is unfortunate that anyone would not recognize that cats have TREMENDOUS capacity to feel pain.
Here is what happens in kidney failure in any species:
The kidneys no longer are able to adequately do their job, which is to recycle water through the system and remove toxins from the blood.
The water is lost, therefore, through excessive urination. Desperate thirst is the result, and the patient is trying unsuccessfully to replace what is a very uncomfortable need for rehydration. No matter how much they drink, they cannot keep up.
In humans, DIALYSIS and IV fluids are used to keep the system flushed and to keep the patient comfortable and non-toxic. Vitamin Bs and other substances (like Potassium) have to be carefully measured and replaced to stay balanced, as these are lost with the unregulated urination.
Toxins like ammonia build up, and, if allowed to continue, can be smelled on the breath; eventually they cause painful ulcers on the tongue, in the mouth, and through all mucus membranes, and dementia and detachment start to set in (this can be seen more easily in human patients.)
Eating becomes painful and impossible and Phosphates build up, making that worse; vomiting is common. Starvation begins. Joints hurt for lack of urination and toxin build up.
Dehydration becomes uncontrolled and in humans, pain medication is used freely by this stage. The eyes sink back in the head and systems start to shut down.
Euthanasia is not legal in humans, so massive efforts are made to keep the patient as comfortable as possible until death comes.
In our animals, euthanasia is allowed and recommended when PAIN exceeds HOPE. We cannot usually provide the needed support (because of cost and system availability) for our animals as we do for people, so at some point euthanasia is the kindest thing left to offer.
I am truly sorry you had to go through this; I have lost old cats of my own (my 19 year old Siamese's ashes are on the shelf above me as I write this; we battled kidney failure a long time before I had to admit defeat) and know well what you are experiencing.
I am hoping to educate here, NOT to condemn. If someone can learn from your experience, perhaps they will be more prepared for what another kidney patient faces IF allowed to "go naturally." In no way do I recommend not trying to sustain life; anyone can learn to do subcutaneous fluids daily at home, and many things are available for kidney patients that can easliy extend life without pain for a very long time; I only mean that there is nothing "natural" about letting a patient in pain simply linger and die in this situation; doing nothing is not natural nor kind, and other options are available, so perhaps others will learn and other kitties (and dogs) will not be left to pass without relief.
Dr. Gionet From: ChristinaNightNurse Sent: 07/05/2004 11:56 PM
I am an RN specializing in kidney dialysis, and the symptoms desribed by Dr. Gionet are opposite of what my pts experience.
In renal failure, people and animals cannot excrete enough urine (or toxins), which causes excessive fluids to build up in the vasculature and leak into the tissues. This causes edema, high blood pressure, and ultimately, death from congestive heart failure.
Potassium cannot be ectreted and builds up in the body causing lethal hypercalemia.
Pts are placed on very rigid fluid restriction and a low potassium, high protein diet.
Build of uric acid causes extreme itching and mental confusion. Build up of phosphates in the blood causes calcification of soft tissues and severe heart damage.
Being unable to produce erythropoetin, renal failure pts are severely anemic. From: DocGionet1 Sent: 09/05/2004 12:07 PM
Thank you for the Nursing Specialist perspective. Having attended the decline of perhaps (very unfortunately) over a thousand or more kitties (less so dogs, they do not have the high kidney failure rate cats do) over the years, and as a doctor, and having spend additional time at UF Medical School in VA clinics to gain more human information, I stand by my perspective.
I would like to clarify that dialysis is not commonly available in cats; dialysis patients pass through VERY different clinical signs (one of which you mention, is oliguria, and not seen till the very end in most NON dialysis kitties) than kitties dying of kidney failure WITHOUT going through dialysis. Dialysis changes quite a bit for people; it would for kitties as well, and is part of my point. The signs I describe are what happens WITHOUT dialysis. Most humans are able to have access to that service, but rehydration with fluids and supportive care as most of us experience with our cats is not at all the same as dialysis. Many people think giving subcutaneous fluids ( a convenient and extremely common method of fluid delivery in our pets but not humans) is the same as "an IV." It is not. Also, many people think the fluid flushing that goes with subcutaneous or even IV fluids is "dialysis." That is incorrect, also, and these things have very different results. Dialysis is far different and more complicated and far less readily available for our pets. We cannot compare most of our chronic renal failure kitties' tradiotional veterinary treatment to human dialysis patients, as these are different situations entirely.
I cannot tell you how many times owners assure me their cat cannot possibly have failing kidneys because "they drink all the time" and "they urinate a ton of urine." That is a classic warning sign of kidney failure. Oliguria as you describe is one sign usually reserved for dialysis patients or ACUTE or end stage kidney failure, which we are not describing here.
Potassium is LOST during these kitties disease, and kidney kitties are very often and normally placed on added potassium. It is lost through excessive urination. Cats that have a blocked urethra (like "blocked cats," males with "crystalluria") DO retain Potassium dangerously to the point of death through cardiac failure, but one of the critical aspects of veterinary medicine is knowing how to differentiate the different situations. Blocked cats, chronic renal failure cats, acute renal failure cats, and dialysis patients are all extremely differnt scenarios, as any doctor will tell you with great emphasis. In chronic renal failure (what we are discussing here,) Phosphorus is built up and retained. Again, dialysis is different and not what our kitties usually experience; dialysis human patients are a narrow window of a certain KIND of kidney failure and treatment; also, extrapolating human dialysis patients to stereotypical feline renal disease can be dangerous. These are very different scenarios and MUST be treated differently, just as kidney failure from antifreeze ingestion is completely different from that occurring from amyloidosis or simply glomerular decline. You cannot lump all kidney failures in with dialysis patients any more than treating all cancer patients the same way would be a good idea.
I would certainly suggest that anyone with a kitty with renal failure ask your veterinarian for as much information on the disease as possible, both written and oral. If they do not help you, go to an approved educational source such as HSUS, SPCA, www.vin.com
Pet Partners, or other monitored group and learn as much as you can. The information is out there, and can, when used correctly, buy a lot of quality of life for our cats when they need help the most. Erroneous information can do more harm than good, as we all know.
Dr. Gionet From: ChristinaNightNurse Sent: 12/05/2004 8:57 PM
I am not disputing what you are saying about renal failure in cats. I was just surprised by how much the s/s in humans and cats differ.
We have many pts who dialyze for the first time with us. It's incredible how much fluid some of them have on them. There are some people from whom we remove 14 lbs of excess fluid three times a week. Of course, it's mostly the non-compliant pts who have this much excess fluid on them.
In hemodialysis pts, K+ excretion is impaired. In peritoneal dialysis pts, excessive K+ is excreted. Most pts are very hypertensive r/t hypervolemia.
All of our pts take phosphate binders (Ca+).
In our pts, the primary causes of renal failure are HTN, diabetes, policystic kidney disease, Lupus, chemotherapy, and pre/post renal blockages.
What are the causes in cats? From: ChristinaNightNurse Sent: 12/05/2004 9:09 PM
Also, many of our pts are on high dose diuretic therapy prior to starting dialysis, but it is not effective when renal function is severely impaired. most ins companies and Medicaide/Medicare will not pay for dialysis until a pt has only 15% of their renal function remaining. In human chronic renal insufficiency, we see pts w/ dehydration, poliuria and polidypsia r/t inability of the kidneys to concentrate urine, and failure of reabsorption. Pre-renal failure pts are put on low protein diets, while renal failure pts are on high protein diets.
Would you say the feline renal failure is more comperable to human diabetes insipdus than it is to typical human renal failure?
Would you say that renal failure in cats is more comperable to chronic renal insufficiency in humans, because of the similar symptomolgy?
Maybe because much more is done to treat most human renal pts, as compared to animals, most animals with renal failure don't survive long enough to have the same hypervolemic sx as humans?
This topic is very intersting!