16 yr old neutered male having problems

My cat was diagnosed with diabetes when he was about 9 years old, and has been managed with diet alone since then (after one week of insulin). So I guess we are lucky but of course I watch what he eats. He is now 16 years old and still glucose is normal, but he is peeing a lot and not in the litter box. He has a choice of 5 litterboxes but he will pee right beside them, not in them. Or in the other room. So a trip to the vet and all values we'd expect might be off were normal. That is good....I guess. But even though his kidneys look good, one thing the vet proposed was a diet for renal failure. And since it would be lower protein, then it would be higher carbs and might make his diabetes return.

I'd welcome any ideas about what I might try other than diet to get this old cat to use the litter box again! Thanks! -Laurie

 

So he had no evidence of a urinary track infection? That's often the case with urinary problems.

A litter that often helps is called Cat Attract. PetSmart has it.

http://www.petsmart.com/product/index.jsp?productId=2751734

Other will be along with more possibilities.

 

Did the vet take some urine and run a culture on it to see if there is bacteria/infection?

 

Yes we did a urinalysis, a thyroid test and a blood chemistry. All normal. There is no blood in the urine and he's peeing a large amount. Specific gravity of the urine was normal. No signs that the cat is dehydrated. The vet could not palpate any masses in his abdomen and other than being a little bony on top and paunchy underneath, she thought he looked good for his age. He weighs 13 lbs which is pretty normal for him.

This peeing outside of the box is not new (has been going on for months) and I thought maybe behavioral, until one time the puddle was so large I thought he must have a medical issue so that is why we went to the vet. He does not seem sore and the boxes are various types....none covered but some large, some not so tall. I thought maybe he was not able to pee due to discomfort in his back or something, but he does not even try to go in the boxes when he pees in the room but not in the box. And his activity level is normal and I don't think he has any discomfort normally moving around. I should add I've never witnessed him peeing.

I do have another male (neutered) cat but I have seen him use the litterbox and so I don't think he's the problem. And they've been buddies for many years.

Laurie

 

I think I'd thoroughly clean out the boxes and fill them with Cat Attract litter and see if that helps.

 

I am excited to try the Cat Attract litter. Thanks both of you for the tip!
Laurie

 

But did the vet send it out for a culture?

 

Do you see him pee--is he in the box and maybe arthritis and so not crouching as low, so aiming OUTSIDE Of it, when his feet are in the inside? This is what happened with my Fred. I then put wee wee pads around the outside of the box and changed those since he would get inside but never used the litter...and then later I put baby diapers on him (had to experiment with sizes but they worked fine. Cut an X in the crease for the tail hole. Just have to watch if he walks around a lot that there is no abrasion from the diaper rubbing against his upper thigh/hip area....

 

Given that even the USG was normal, I don't think CKD is your problem. However, CKD is really common in senior cats and not usually detected in bloodwork until over 60%-75% of kidney function is gone, and in a USG until about 50% of function is gone, so starting a kidney friendly diet early helps slow the progression of the disease IF it's there, and if it's not you're still feeding a good, healthy diet so that's just fine. Given his age, I think starting a kidney friendly diet is a good idea. However, I completely disagree with your vet on what constitutes a kidney friendly diet!

There are several commercial foods that are good for both diabetes and CKD. To manage diabetes, you want to feed a low carb canned food, and to manage the kidney disease, you want to feed a high quality, low phosphorus canned food. Many vets simply recommend low protein prescription diets for cats with CKD, because they are by default low in phosphorus. However, it's the quality of protein and phosphorus levels that matter, not the protein values. The low-protein prescription kidney diets have only been shown to be beneficial in end stage renal failure and should not be fed long term. In fact, they cause muscle wasting (the LAST thing you want to do to a senior kitty!) when fed in early stage CKD and are completely inappropriate for an early stage cat. I have no idea what your vet is thinking suggesting a low protein diet at this stage in the game, especially with the diabetes--that is actually going to cause more harm your cat more than the CKD would!

Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50. You're looking for something with less than 10% carbs (for the diabetes) and less than 250 mg/kcal of phosphorus (for the kidneys). The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, and EVO 95% Chicken & Turkey.

If those are out of your price range the next best thing to feed are the low carb Friskie's Special Diet Turkey & Giblets and Salmon flavors. However, I would strongly urge a food without byproducts, and keep in mind that they're still cheaper than the prescription foods and usually about the same as many grocery store brands if bought in large cans or in cases. Studies have shown that the quality of the protein source does make a difference in controlling the disease, and that needs to be considered along side phosphorus content.

Here is a fantastic website with a lot of information about CKD: http://www.felinecrf.org/