In Memoriam

This weekend (yesterday actually) was the one year anniversary of the day our first cat, Marquis, passed away after his battle with chronic renal failure.  He had been diagnosed over a year earlier and his death hit us pretty hard since we had been dedicated to his treatment for a year and he had seemed to be doing well until his health just crashed at the very end.  It was one of the motivations to start this site in the first place.

Last image of our Snowshoe cat Marquis

I had been meaning to write more about our battle with feline chronic renal failure, but it was a subject that I've been avoiding for awhile.  Certain breeds of cats such as Siamese and Snowhoes, of which Marquis was, tend to suffer more from chronic renal failure or CRF.  CRF, as opposed to acute renal failure, is a gradual weakening and deterioration of the kidneys.  Acute renal failure might be due to the cat eating something toxic, but can usually be treated with full recovery.  However, chronic renal failure is more insidious.  Kidneys are strong organs, but unfortunately this has the side effect of not being able to detect the progress of CRF until more than 70% of the kidney function has been irreparably lost.

The kidney has several important functions:

1)  Filters out waste material from the blood (these tend to be nitrogen-containing molecules from the breakdown of proteins from food)
2)  Regulates electrolyte concentration (sodium and potassium ions, which have an effect on ion channels)
3)  Produces EPO (erythropoietin), a hormone involved in producing red blood cells

Once the kidneys become compromised, the body slowly gets weakened, which accelerates the deterioration of the kidney function.  The blood starts to accumulate waste since the kidneys are not as effective at filtering them out.  This can be tracked through blood tests for creatinine and BUN (blood urea nitrogen) levels, which are markers for this waste.  Elevated levels are a key marker of renal failure and are one of the first indicators of CRF.

So how can we treat this?  The standard method is to approach the problem from two directions.  The first is to switch to a low protein "renal" diet.  This is food that has low amounts of protein (which contain phosphorus and nitrogen) so that when the body metabolizes it, there are less nitrogen-containing waste products poisoning the blood.  There are several veterinary diets that you can use, but you can also look up the phosphorus levels of common cat food.

Dry Cat Food Phosphorus Analysis
Wet Cat Food Phosphorus Analysis

The other approach is to dilute the waste products in the blood stream.  This is done by giving the cat water---most CRF cats tend to be more thirsty than normal due to this.  As a result, the cat urinates more frequently which also helps to remove the poisons.  Wet cat food is highly recommended over dry food to the water content.  But to take it one step farther, one standard of care is to give the cat subcutaneous saline injections directly---the saline is then absorbed into the bloodstream.  This is not a pleasant act, but Marquis was actually very good about it---in the morning we would sit him on the couch, pinch up the skin of this neck, and then slowly inject the saline.  He would sit there and wouldn't complain and we would give him a treat afterwards.  He became used to it after a while.

Subcutaneous saline injection therapy for CRF cats

There are other more involved treatments that you can do, such as potassium supplements (to make sure that the cat's electrolytes are balanced), iron supplements (to battle anemia due to low red blood cell count), and EPO injections (highly expensive).  We ended following the diet and saline injection approaches.  We found a low phosphorus wet food and we gave him daily injections of ~50 mL of saline.  This worked well for Marquis---he lasted for over year and basically showed no symptoms of his illness until his kidneys finally started to fail.  At that point, he became too sick to eat regularly and he quickly lost his weight and strength.  At the end, he had lost more than half of his weight and wasn't able to walk or stand.  It was heartbreaking.

CRF is a devastating disease and it is a terminal disease.  However, there are steps that you can take to treat it and give your cat good quality of life.  Some good sites that helped us with it:

Tanya's Comprehensive Guide to Feline Chronic Renal Failure
Feline CRF Information Center
Sub-Q Survey of CRF Cats

And the best community for owners of CRF cats is at The Feline CRF Support Group at Yahoo Groups.  This is an amazingly supportive community of people who have been through CRF.  They gave us very kind messages of support and understanding and helped us get through the situation.  Thank you!