Update: Help!! FaFa may have kidney disease !

My family noticed that my cat FaFa eat little recently. They are buzzing me about giving me the old dry kibble to FaFa since she is hungry. I am annoyed by this idea since I think dry kibble are unhealthy. Perhaps I am irrational since FaFa have been eating dry kibble all of her life without problem before the diabetic outbreak of the male cats in my home, Monkey and PenPen. I strictly forbid dry food for all cats in my home. It is hard for me to give them those low quality and probably unethical dry kibble again after I am informed.

The reason that FaFa does not eat much is probably due to I buy a new Can food that was beef few days ago. Before that they eat Chicken with Venison Can food and they have no problem with it.

I notice that FaFa in past few days:
1. Vomit some odorless liquid without much content more frequently like once per day.
2. I do not find behavior changes. She is as usual, likes to come to my room for affection, and energetically play with toys. (I just played with her one hour ago)
3. Lost 0.6 pounds, her weight was very stable at 7 lb, now she is 6.4 lb

A moment ago I fed her the old Chicken with Venison can food. She ate small amount of it, probably 10g to 20g. I think that is less than her normal.

What should I do? I have time to observe and look after her. Also, I have ordered the Chicken and Venison can food already.

29/5/2020 Update:
FaFa ate some dry food, and start to eat, but not a lot.

Blood work of FaFa was done, the vet say FaFa may have kidney disease (does it help to post the blood work?). I am slightly devastated and feel helpless. This year is the low point of my life and it has been hard on me. Worse is that my father may get diabetes.

What can I do? I did not talk to the vet directly since I was not available. I do not even know if it is curable. FaFa looks stressed out by the 3 hour stay in the clinic. The vet also prescript some royal canin prescription wet food and tells me to only eat that. FaFa is willing to eat some.

Next step is collect FaFa urine to have examination. Luckily that FaFa's behavior is still normal and seems that there is no suffering. Also, thanks god Monkey and PenPen is improving. PenPen's leg become more normal.

30/5/2020 Update:
FaFa has lost his interest of playing with toys. She keeps meowing me seemingly for food and sense of safety. She does not eat most of the food. I have 2 types of can and she does not eat any. I am feeding her Royal Canin prescription renal with Tuna, she eats some but she does not always like to eat even she is hungry (Why prescript fish product?) Please see the link:

https://www.royalcanin.com/nz/cats/products/vet-products/renal-with-tuna-cig-wet

Composition: meat and animal derivatives (chicken, pork), cereals, fish and fish derivatives (tuna 4%), oils and fats, derivatives of vegetable origin, minerals, various sugars. Additives (per kg): Nutritional additives: vitamin D3: 240 IU, E1 (Iron): 4 mg, E2 (Iodine): 0.17 mg, E4 (Copper): 1.3 mg, E5 (Manganese): 1.2 mg, E6 (Zinc): 12 mg - Technological additives: Clinoptilolite of sedimentary origin: 0.2 g. Analytical constituents: Protein: 6.6% - Fat content: 6% - Crude ash: 1% - Crude fiber: 1.2% - Moisture: 80% - Calcium: 0.12% - Phosphorus: 0.08% - Potassium: 0.15% - Sodium: 0.08% - Magnesium: 0.015% - Chloride: 0.13% - Sulphur: 0.13% - Vitamin D (total): 400 IU/Kg - Hydroxyproline: 0.07% - Essential fatty acids: 2.02% - EPA and DHA: 0.04%. Urine alkalinizing substances: potassium citrate - calcium carbonate. Metabolisable energy: 471.5 kcal.

In 3 brands of dry food she only eat one, and that thanks god! Strange is that FaFa likes human food, such as beef, salmon steak, as she always like. I always want her to eat, but I afraid the phosphorus and protein protein would be too high

@Bron and Sheba (GA) @Nan & Amber (GA) @jt and trouble (GA)

 

I would do exactly what you are doing Peter. Give FaFa whatever she WILL eat. See if that triggers her eating gene and go from there. IF she again turns down the food maybe trip to the vet is in order. sigh...I am so sorry 3 of your kitties have issues. sigh
Hopefully FaFa is just being picky.
jeanne

 

By saying whatever, do you include dry kibble?

 

If a cat doesn’t eat for a couple of days they can develop hepatic lipidosis, so it’s important to get FaFa to eat, even if that includes some kibble. Sometimes crushing a few pieces and sprinkling it on top of the wet food can encourage them to eat. Here are some other ideas
http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

 

Ye let him have some kibble maybe try mixing it in with the can? either way. She needs to eat.

 

Hi Peter,

does FaFa have any other health issues you know of? I suggest also asking the vet for an anti nausea med like Cerenia or ondansetron. If not those, hopefully there’s an equivalent in Hong Kong. Minnie acts in much the same way with the clear liquid vomit and not wanting to eat, but the med gets her eating after about 30-40 minutes. Also, can you try baby food? Just make sure it has no seasoning like onions. It should be only protein and water and maybe some starch. Here I have Gerber chicken and turkey baby food to entice Minnie to eat when all else fails. Lastly, I’d also try tuna and tuna water. If she eats that, you may be able to use the tuna water on other food like a sauce to get her to eat it

 

The post is updated with bad news

 

Oh no Peter!!! It is just one thing after another!!!

Hang on, people will be here shortly with useful advice-- many people around here have cats with kidney disease. I have not, but one thing that I have picked up is that it is not always a devastating diagnosis. There are stages, and the condition can be managed quite well, especially in early stages.

The lab results will be helpful for people to help you determine the stage of the disease. I'm going to tag @Marje and Gracie for help here, but as I said, there will be many others here who can offer their experience to help you help FaFa.

This is an excellent site for information about managing kidney disease in cats: https://felinecrf.org

 

Thanks Nan. Your words are very comforting. It may not be as serious as I think. I will study the material.

 

(((((Peter))))) we are pulling for FaFa! AND YOU!

 

I wonder, if FaFa's kidney disease is caused by the transition from 100% dry food to 50% commercial food+50% homemade chicken meat, with supplements such as taurine and fish oil. Some suggested that cats with kidney disease should not eat food that is high in protein. The chicken is obviously high in protein without a lot of fat. The cat food is high in protein with moderate amount of fat

 

I would think it would be the opposite. But of course I'm no expert. Sending prayers for FaFa.

 

I think wet food (and extra moisture in general) is supposed to be better for the kidneys?

The main food-related issue I've heard about for kidney disease is phosphorus. Some wet foods are very high in phosphorus, which is bad for advanced kidney disease. At that point, you have to not only avoid high-phosphorus foods, but also add a phosphorus-binder medication. I don't know if a high phosphorus diet can cause kidney disease, though, it may just be bad once you get it.

I really don't think you can blame yourself for this, Peter . Kidney disease is pretty common in older cats.

 

Zoe was diagnosed with first stage kidney disease. I was told to buy the prescription food which costs 45 bucks for 12 cans AND Zoe refused to eat it. What good is script food if a cat wont eat it??? I wound up donating it to a shelter.
I was told to avoid all fish products but was not told about binders.

No Peter this isnt your doing. Older cats are just prone to Kidney issues.

 

blood work attached!

 

It is recommended that cats in the later stages of chronic kidney diseases eat a lower protein diet. FaFa is not there yet.

You have done nothing wrong. Some cats, especially older cats, get kidney disease. CKD usually progresses slowly. It can be managed.

I've had two kidney cats. One was Rover, the diabetic.

The site Nan mentioned above is the go-to site. There is even a CKD forum attached to the site. Like feline diabetes, CKD is a steep learning curve, and extremely overwhelming at first. Breathe. You have time. And let's see what Marje has to say about FaFa's lab report.

And breathe some more.

 

https://felinecrf.org/canned_food_usa.htm

I saw that most low Phosphorus food is high in carbs >30%, do you people think it is appropriate?

 

Thank you people for your comforting words. I feel somewhat better after knowing it is not likely to be my fault.

 

We love you and your "crew" Peter.

 

I'm new here but I just wanted to say that my first baby, Oreo, developed CKD. It is wonderful that you guys caught it so early. It definitely wasn't your fault at all, it is sadly common for many older kitties. Oreo still lived to be 19 years old and did very well will with his diet and Sub-Q fluids which is for the later stages. I'm wishing you and your sweetie all of the best and I also wholly recommend that website linked above, they are angels for putting such incredible resources together.

 

Am I blind? I don't see any bloodwork. There's a special place on the spreadsheet for Labs

No...you need low carb/low phosphorus which means under 10% carb, under 250mg phos. Unfortunately, there aren't a lot of foods that are both but here's the current list of low carb/low phos foods

 

It is attached in my first post. Yes, I will try to fine some. Unluckily the vet seemingly recommend high carb dry k/d prescription food, which I cannot make sense of. I can see he is genuine, however that can be an issue.

 

Glad that it is seemingly early. FaFa has lost his interest of playing with toys. She keeps meowing me seemingly for food and sense of safety. She does not eat most of the food. I have 2 types of can and she does not eat any. I am feeding her Royal Canin prescription renal with Tuna, she eats some but she does not always like to eat even she is hungry (Why prescript fish product?) Please see the link:

https://www.royalcanin.com/nz/cats/products/vet-products/renal-with-tuna-cig-wet

Composition: meat and animal derivatives (chicken, pork), cereals, fish and fish derivatives (tuna 4%), oils and fats, derivatives of vegetable origin, minerals, various sugars. Additives (per kg): Nutritional additives: vitamin D3: 240 IU, E1 (Iron): 4 mg, E2 (Iodine): 0.17 mg, E4 (Copper): 1.3 mg, E5 (Manganese): 1.2 mg, E6 (Zinc): 12 mg - Technological additives: Clinoptilolite of sedimentary origin: 0.2 g. Analytical constituents: Protein: 6.6% - Fat content: 6% - Crude ash: 1% - Crude fiber: 1.2% - Moisture: 80% - Calcium: 0.12% - Phosphorus: 0.08% - Potassium: 0.15% - Sodium: 0.08% - Magnesium: 0.015% - Chloride: 0.13% - Sulphur: 0.13% - Vitamin D (total): 400 IU/Kg - Hydroxyproline: 0.07% - Essential fatty acids: 2.02% - EPA and DHA: 0.04%. Urine alkalinizing substances: potassium citrate - calcium carbonate. Metabolisable energy: 471.5 kcal.

In 3 brands of dry food she only eat one, and that thanks god! Strange is that FaFa likes human food, such as beef, salmon steak, as she always like. I always want her to eat, but I afraid the phosphorus and protein protein would be too high

 

I am wondering, due to recent big change of all cats due to diabetic outbreak of Monkey and PenPen, I am thinking the stress may trigger FaFa Kidney problem. I also think the recent change from Chicken and venison can to Beef can stressed out FaFa. I need to try to ensure low stress for FaFa

 

30/5/2020 Update:
FaFa has lost his interest of playing with toys. She keeps meowing me seemingly for food and sense of safety. She does not eat most of the food. I have 2 types of can and she does not eat any. I am feeding her Royal Canin prescription renal with Tuna, she eats some but she does not always like to eat even she is hungry (Why prescript fish product?) Please see the link:

https://www.royalcanin.com/nz/cats/products/vet-products/renal-with-tuna-cig-wet

Composition: meat and animal derivatives (chicken, pork), cereals, fish and fish derivatives (tuna 4%), oils and fats, derivatives of vegetable origin, minerals, various sugars. Additives (per kg): Nutritional additives: vitamin D3: 240 IU, E1 (Iron): 4 mg, E2 (Iodine): 0.17 mg, E4 (Copper): 1.3 mg, E5 (Manganese): 1.2 mg, E6 (Zinc): 12 mg - Technological additives: Clinoptilolite of sedimentary origin: 0.2 g. Analytical constituents: Protein: 6.6% - Fat content: 6% - Crude ash: 1% - Crude fiber: 1.2% - Moisture: 80% - Calcium: 0.12% - Phosphorus: 0.08% - Potassium: 0.15% - Sodium: 0.08% - Magnesium: 0.015% - Chloride: 0.13% - Sulphur: 0.13% - Vitamin D (total): 400 IU/Kg - Hydroxyproline: 0.07% - Essential fatty acids: 2.02% - EPA and DHA: 0.04%. Urine alkalinizing substances: potassium citrate - calcium carbonate. Metabolisable energy: 471.5 kcal.

In 3 brands of dry food she only eat one, and that thanks god! Strange is that FaFa likes human food, such as beef, salmon steak, as she always like. I always want her to eat, but I afraid the phosphorus and protein protein would be too high

 

This is high carb and very low protein. The more important thing for CKD at earlier stages is good quality protein so if he likes chicken, you can increase the good quality protein by adding some extra chicken to his meals or egg whites which are high in protein, low in phosphorus.

You might want to ask your vet about trying an appetite stimulant. I'm not sure what all is available in Hong Kong, but what is used mostly here is Mirtazapine (only for cats) or Cyproheptadine (which is a human allergy medication)

It's important that he eat so try to find something that he'll eat. If it's higher in carbs, you may need to make sure he's fed separately from the diabetic's so they don't get into it.

He may benefit from sub-q fluids too. The more water you can get into him, the more it can keep the kidneys flushed out and delay them from getting any worse (and may improve them)

 

Peter when was the last time you looked at FaFa's teeth? I think a dental should be ruled out. (just in case) smell her breath?
This might be simplistic but should be ruled out.

Also agree subq's may be necessary.
Sending prayers ad positives for FaFa
j

 

Thank you for all your love for FaFa . Fortunately, the vet has finished urine test and FaFa has stage two kidney disease but not very serious, also he does not prescript any medicine, except antibodies because of FuFu's urine has little bit of blood. He told me to have next appointment 1 month later. I may not understand all the things he told me since in that phone call he mentioned a lot of veterinarian terms and science as if I am his colleague, I am sure his average patient will understand not more than 1%. I guess he sees as one of his "very sophisticated" client. . Thanks FDMB.

I understand fully the actions he suggests me to take:
1. Have the toilet very clean so that FaFa is willing to pee. To prevent kidney problem.
2. Eat Royal Canin k/d wet and dry food. (I have some doubt. It is true that they have very low phosphorous and and some ingredient food for kidney, but dry when kidney function is bad? Animal by product? 30% carb? Extremely expensive? )
3. Observe FaFa's behavior, nothing is more important that FaFa feeling well.
4. Give her Rameron to stimulate her appetite, and give antibiotics.

Strange thing is that FaFa's BG is complete normal but little bit of sugar in urine is detected. The vet say that may be marginally diabetic, but he is not sure and thinks that we do not need to do anything now.

Regarding to dental issue, yes FaFa has stones on his teeth that the vet said he considers to cleanse FaFa's teeth. (I do not know the correct English terms) I observed that FaFa has some trouble eating. Luckily her breath is odorless. (as always, FaFa smells very clean)

Actions I want to take:
1. In short term, FaFa needs to eat to gain weight and feel good. So at current stage I have FaFa try many kinds of wet food, I brought salmon and seafood can since FaFa always like salmon. The only things I need to limit is the phosphorus need to be as low as possible (lower than 0.2%), preferably designed for CKD cat. Btw, I have not learn how to determine if phosphorus is below 250 mg. One thing I worry is that as you people have said fish should be avoided, I also worry that FaFa may get addicted. Also large predatory fishes like salmon may have too much heavy metal in the meat.

Today, I bought some Japanese branded wet food specifically for kidney problem, it is about 51% protein, 32% carb, and 16% fat. I guess Japanese company cannot be too bad or unethical, and it cannot hurt to try new food for FaFa. Good news is FaFa is happily willing to eat seafood can such as Salmon. She eats a lot and stop meowing all the time. She feels a lot better. (And I feel a lot better too). I bought a lot of other kinds of food too, hope FaFa would like them.

2. In long term, follow Dr. Lisa's method to CKD, that is 60% fat, 40% protein, and 0% carb. Add fish oil, as long as FaFa likes it. Today I read that the will of a cat should always be honored, if she don't want to eat the "health food" or to be treated, I need to respect that.

3. Search for appetite stimulant, a better water fountain (I am going to have commercial white ceramic fountain and my own DIY).

4. Add water into the food and blend it. It seems FaFa like licking to eat.

5. Sub-Q fluid? I do not have any idea, I think I need to discuss with vet

 

The sub q's are for later stages of of kidney failure (I think) I do know that most fish of ANY kind has high phosphorus. Sadly that is Zoes favorite food also. Shes in stage 1 failure .
Good that FaFa likes the added water. Thats VERY good!
Love the idea of a DIY fountain. How clever
Unfortunately the honoring the cats wishes are thrust upon us. We know they wont eat that prescription diet. Spend 40 dollars for 12 cans of food! Zoe ate exactly one can and refused it after that. What good is prescription diet food if the cat wont eat it???

My last comment is about that DRY food. I'm sorry, I dont know how they cant see, that dry food takes away water...It just dont make sense. I will never feed dry to any cat ever. I get a lot of slack from others when I say that because they believe dry is good for the teeth. I cant convince anyone that statement is just a lie.

Peter I am so impressed with your dedication.
jeanne

 

Your cats ckd is only stage 2. Nothing to worry about yet. Number one thing is keeping her hydrated. Find foods under 1% phosphorus. If she won't eat the low phosphorus /low carb food, you could feed higher phosphorus food but add a phosphorous binder to the food such as aluminum hydroxide. Not sure exactly what is available to you in Hong Kong. My cat is also ckd and diabetic. I feed weruva foods and add extra water to them. They are 0.57-.97% phosphorus. She was diagnosed early stage 2 ckd just over a year ago. As of January she was about the same. Just had bloodwork done last week so hopefully she's still doing good in that department. You can see her levels in my labs tab of my spreadsheet.

I have a good friend who moved to Hong Kong about 7 years ago. Stay safe.

 

The Remeron is an appetite stimulant....it's Mirtazapine

 

Update: FaFa actively play with toys. Great recovery.

 

Awwwwwwww!!!!

So cute! And so glad she's feeling better!!!!!

 

Awwwwwwwwwwwwwwww Thank you Peter! Hee hee FaFa is so cute.

 

Is phosphorous binder prescription medicine? Should I ask the vet? This vet is ethical that he tends to help clients to pay only what's necessary to save money. But I do not mind to pay more/

 

You do not need a script for phos binders. That said, I have no link to share on hand. I know others here buy it online. Shoot for all I know you might find it on Amazon
Good luck!
j

 

First try to let the cat eat the low phosphorus food. The phosphorus binder has side effects.

 

Attached is the list of food for cats with CKD. See if you could find some in Hongkong.

 

It's not perscription but you only need it if the phosphorus level is over like 6, so it would depend on what the labs show. Your cat is at 5.5. I would try just finding a lower phosphorus food first.

 

That is from Weruva official webstie. I am feeding FaFa this and she loves it. I think the phos content is acceptable but not the best.

I do not trust dry food too, I have not found any research that can strongly prove that carbs has high value to cats. Perhaps marginally beneficial to prevent some disease for some cats, but insufficient to say dry food is appropriate to cats.

 

There is a great ckd forum on Facebook called Cats with Chronic Renal Failure

 

Thanks for your reminder regarding to the safety of Hong Kong. Hong Kong is still very safe compare to many countries as long as one does not provoke others.

 

My cat eats weruva too! Great stuff. This is what she's currently eating.
Weruva slide and serve pate foods Family Food (.97 phosphorus and 0 carb). Also Jeopurrdy Chicken (0.97 P 6.1 carb)

Weruva Steak Frites (0.57 phosphorus 7.5 carb although I take out any big pieces of potatoes to try to limit the carbs just a bit)

weruva Fowl Ball chicken and turkey (0.89phosphorus 0 carb).

Weruva LA isla Bonita - phosphorus 0.77 carb 4.5
Glam and punk 1% carb, 0.93 phosphorous.

Weruva paw lickin chicken 3.3 carb 0.82 p and
Press your lunch 5.9 carb. 0.82 phosphorous

Bff play Laugh Out Loud chicken and lamb 7.7 carb, 0.82 phosphorous

 

Thanks, I just searched and applied.

 

I agree about the dry Peter!

 

Thanks for your detailed information. May I ask, in Salmon (Pretty in Pink) protein provides 71.6% of calories. Fat provides 28.9%. Is protein too much for CKD? Should fat be 60%?

 

I think it is too much. I won't feed my cat with CKD higher than 40% protein.

 

Look at the dry matter chart. Low protien is only needed when they are in late stages.

 

@PH&MonkeyPenPenFaFaTiger

Peter: sorry for the delay but I’ve been off the board a few days.

It is very fortunate you have caught this early. I would definitely avoid the dry food if you can and you need to be sure you are feeding canned food that is the lowest phosphorus levels that FaFa will eat. Of course, we don’t want her starving herself so if dry is all she will eat, so be it, but it is really best for the CKD for her to eat canned or balanced raw food that is lower in phosphorus.

I see Tanya’s was linked for you so I would start by reading about phosphorus and anemia. She does not need a binder until her P level is over 6 so focus on the foods that are lower in P. Right now, her hematocrit is good but as it approaches 30, you will want to start B vitamins as discussed on Tanya’s under “Anemia”.

It’s important to check the urine to see if she has protein in it. If she does, they need to run a urine protein:creatinine ratio because proteinuria is common in CKD cats and controlling it, along with phosphorus and anemia, are the keys to longevity. She also needs to have her blood pressure checked every time you take her in. With my CKD cats, I usually had them in to see the vet every 3 months. If she gets close to anemia, you have to weigh taking the blood and the value you get out of it against the anemia. But, as long as she is not approaching 30% on the hematocrit, keeping an eye on the blood allows you to make adjustments if the P goes up, if Ca goes up, and if the creatinine goes up. Subq fluids are not started until the creatinine is above 3.5. Also, her potassium is a trending a bit low right now; it should be above 4 so you might want to talk to the vet about when/if to start potassium supplementation. Do not do this without a vet!

Right now, the food she needs is a good quality protein and I would not feed low protein. I would focus on good quality protein even up to 60% if you need to in order to keep the P lower.

 

ok I was trying to like your post (i mark them that way to make sure I read them and I get a "You do not have permission to view this page???

 

lol i can post here but not view here

 

My reply was moved into my post ...

 

ty lol Thats a first for me.

 

Thanks for your help! I am studying it. The Tenya page said that strong evidence that therapeutic diet is superior than normal cat food that is low phos and protein. Should I buy only the "prescription" cat food? Can I homemade a better cat food? Since prescription cat food are not easy to find, high cost, and have > 30% carbs, and contain undesirable ingredients such as by-product

 

Hi Peter, I’m sorry FaFa has early kidney disease. Sheba had early kidney disease and I fed her a home made diet.
I will attach a link for you which discusses it.
http://www.felinediabetes.com/FDMB/threads/home-prepared-diet-of-crd-cats.150441/

 

Thanks, I need to learn about it. My plan of giving semi raw meat according to Dr. Lisa's recipe has been delayed since FaFa's condition.

 

Btw, should I give Methyl-B12 to FaFa? I heard that it can also help CKD.

 

wow I didnt know that. Interesting

 

I give my cat half a zobaline a few times a week to keep her HCT up. Can't hurt. I Don't give a whole one because her kidneys are already working hard and I don't want to stress them with the extra vitamins to filter.