An alternative approach to chronic renal failure

Vets CornerChronic Renal Failure is a very serious condition which is common in older cats. But if treated properly there is no reason why your pet can’t live a long and healthy life. Paul Boland looks at its causes and what you can use in terms of alternative treatments.

We do not fully understand the underlying causes but it has been suggested that there may be a link with the development of renal failure and the distemper vaccination. It is also thought that it may  be a connected with the ingestion of long term use dry food diets. Sometimes a specific cause of chronic renal failure, such as bacterial infection, can be identified and in these cases its progression can be stopped, however most of the time the causes are not as simply identified as this.

What do the Kidneys do?

Every day, the kidneys process huge quantities of  waste products and extra water which become urine. The waste come from the normal breakdown of tissues and from food. After the body has taken what it needs from food the left overs are sent to the blood and if the kidneys do not remove the waste they can build up in the blood. The kidneys are made up of nephrons and during this process the water and waste leaves the blood in a complicated series of chemical exchanges.

The word renal refers to the kidneys and the term renal function and kidney function mean the same thing with health professionals using the term renal function when talking about how efficiently the kidneys filter blood.

The kidneys are remarkable organs and as well as being responsible for the excretory function are required for a range of other vital functions including:-

– Activation of Vitamin D

– Production of the hormones essential for the formation of red blood cells and the body’s water and salt balance.

– Maintains hydration

– Elimination of waste products via the urine.

The kidneys are so efficient at performing these functions that by the time many of the signs of failure are evident there is generally a loss of 75% of the nephrons which are the building blocks of the kidneys.

It is this reduction of functional nephrons to the point where there aren’t enough to maintain adequate excretory function that leads to chronic renal failure.

Signs

The main sign is excessive thirst and urination, but a cat may also show signs of weight loss, anaemia, poor hair coat, drooling, jaw-clicking, listelessness, muscle weakness and ammonia-scented breath. Unfortunately renal failure is not curable and could lead to a kidney transplant, however if its not severe it can be managed through diet and hydration therapy.

It has been estimated that about 25% of cats with chronic renal failure suffer from hypokalaemia. This is thought to be partly due to lack of potassium intake as well as increased potassium loss from the kidneys. Hypokalaemia can lead to worsened renal function, weakness, loss of appetite and even muscle necrosis which is effectively the wasting away of muscles. You’ll be happy to hear all of the signs of hypokalaemia can be reversed with the correct approach.

Diet Management

There are a number of diets specifically aimed at managing chronic renal failure and Hypokalaemia.

Ideally a cat with CRF should have a diet with a restricted protein content. Protein breakdown can lead to accumulation of toxic products in the blood in cats with CRF.

I would suggest obtaining a specific food designed for renal issues rather than trying to mix your own. These diets are very calorie dense, non acidifying, and contain low protein, managed levels of phosphate and low levels of salt.

Managing the change to a new diet

In general, cats do not like change and develop a strong preference for particular diets. Low protein diets tend to be less palatable than normal diets and this can add to the challenge of introducing a new diet.

I would suggest the following tips when changing the diet.

i) Start by mixing a very small amount of the new food into the cats old food ensuring it is well mixed.

ii) Only increase the new food slowly once your cat is eating the new mixture.

iii) Try warming the food to body temperature as this may help the palatibilty

iv) Take several days or even weeks to reach your goal of introducing the new food and don’t rush it.

Hydration

Cats with these conditions are very vulnerable to becoming dehydrated due to the reduced ability of the kidneys to conserve water. Extra care should be taken to ensure adequate hydration levels are met. It is hard to encourage Cats to drink sometimes, however you should ensure there is always easy access to water. Offering water from different bowls can help and using flavoured water such as chicken or tuna flavour can be a good idea. A wet diet will also help hydration levels. If your cat will allow you can also try adding further water to the wet food.

Supplementation

Even with changes in diet and hydration levels some cats don’t improve and need further supplementation. I would always advise doing this as part of the overall management process.

Potassium

Potassium Gluconate should be used in preference to other potassium sources as this does not irritate the gastric mucosa.  I would recommend approximately 450mg 2-3 times per day for a Cat up to 5kg per day in weight.

Iron

In advanced cases of CRF anaemia is quite common. This is thought to be due to the lack of production of a hormone produced by the kidneys called erythropoitin which stimulates the production of red blood cells in the bone marrow. Severe anaemia can cause lethargy and weakness and I find Iron supplementation essential. Dose would be 70mcg 2-3 times per day.

B-Vitamins

Cats suffering CRF can be deficient in B vitamins and it is important to supplement these.

Pantothenic acid (B5)

Vitamin B5 is utilized in the manufacture of coenzyme A (CoA) and Acyl-Carrier protein (ACP) of which both are compounds that have essential roles in th utilization of fats and carbohydrates for energy production. A dose of 5mg 2-3 times per day should be sufficient.

Pyridoxine HCL (B6)

The active forms of this vitamin are involved primarily in amino acid metabolism. It is also involved in the utilization of glycogen stores and the metabolism of lipids. Dose 1mg 2-3 times per day.

Niacinamide (B3)

Vitamin B3 is a water-soluble vitamin required by all living cells. It is a major constituent of the coenzymes NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate), which are involved in over 50 different metabolic reactions. Dose 5mg 2-3 times per day.

Thiamine HCL (B1)

Found in highest concentrations in liver, heart and kidneys. Dose 1mg 2-3 times per day.

Cyanocobalamin (B12)

Vitamin B12 has been found to be essential for the normal functioning of all cells. Dose 2mcg 2-3 times per day.

Amino Acids

Amino acids are building blocks for protein molecules, which include enzymes, structural proteins, and chemical messengers for intra and inter-cellular communications. They are valuable for the part they contribute to protein formation in the body and have been found to serve a wide variety of biochemical functions within the body. Loss of amino acids is increased in cases of chronic renal failure so I would routinely add a blend of amino acids to my patients with CRF. I would add approximately 1mg of each of the listed amino acid 2-3 times per day for a 5kg Cat.

I suggest you give your pet AminoNatural. This provides the additional nutritional support that a cat needs with a dense nutrient profile including B-Complex vitamins, aqueous liver fractions and essential amino acids.

L-glutamine – Promotes protein anabolism and promotes inter-cellular hydration, improves wound healing and tissue repair.

L-arginine – Improves immune response to bacteria, promotes wound healing and regeneration and assists in release of growth hormone valuable for optimal muscle growth and tissue repair.

L-threonine – Constituent of collagen, elastin and enamel protein and assists metabolism and assimilation.

L-lysine- Ensures adequate absorption of calcium and aids in the production of antibodies, hormones and enzymes

L-methionine -Dietary source of sulphur which contributes to healthy hair, skin and nails. It reduces liver fat and protects the kidneys and is a natural chelating agent for heavy metals. It also regulates the formation of ammonia and helps to acidify the urine.

L-taurine – Taurine combines with sulphur, which are co-factors involved in the control of many biochemical changes involved with aging; helps in the excretion of free radical species. It is essential for cats in their diet, and conditional for dogs.

Recommended products

aminonaturalI suggest you give your pet Amino Natural. This provides the additional nutritional support that a cat needs with a dense nutrient profile including B-Complex vitamins, aqueous liver fractions and essential amino acids.

Medium term treatment

I would advise not waiting too long before starting to instigate these changes. If you are already seeing signs and a diagnosis has been made by your vet the disease has already progressed to a significant level. The good news is many of the signs can be reduced with the correct management and you can make your Cats quality of life much better.

Long term treatment

Unfortunately this disease normally gets worse over time and the aim should be to slow the rate of progression and reduce the signs whilst increasing the quality of life of your Cat. Long term, a Kidney replacement may be an option but this does not mean a cat will survive longer than a cat that has received good supportive care.