Kidney Disease in Cats 101

Overview of chronic kidney disease
Chronic renal failure, also known as kidney disease, is a common problem in cats. One in three cats will develop chronic renal failure during her lifetime. Your cat’s kidneys are critical for normal bodily functions, such as the removal of toxic metabolic waste products from the blood, and regulation of bodily fluids and hormones. What does chronic kidney disease mean? "Chronic” means long-lasting; therefore, chronic renal failure simply means that there is a decline in the kidneys’ ability to function over a long period of time. Because the kidneys impact other areas of the body, the changes that occur as a result of chronic kidney disease impact many other bodily systems, as well.

Symptoms of chronic kidney disease

  • Increased output of urine--With indoor cats, you may notice “flooding” of the litter box
  • Increased thirst
  • Vomiting
  • Weight loss
  • Incontinence (uncontrolled urination)
  • Bad breath with a peculiar chemical odor
  • Lethargy

If you notice ANY of these symptoms in your cat, you should contact your veterinarian ASAP! They are indicators of many serious diseases and conditions. Your veterinarian can perform tests that will identify why your dear friend is sick. Catching any problems before they become severe will increase your pet’s overall quality of life!

Diagnosis of chronic kidney disease
The tests your veterinarian may choose to run include:

  • Urine tests
  • Chemistry tests
  • A complete blood count
  • Electrolyte tests
  • Radiographs (x-rays)

Other tests may be recommended, depending on your cat’s particular situation.

Treatment of chronic kidney disease
Your veterinarian will discuss treatment options that are tailored to your pet’s needs, as each case is unique.

Treatment may include:

  • Fluid therapy to rehydrate and normalize electrolyte and acid-base levels
  • Nutritional therapy, including a high-quality restricted diet
  • Drug therapy for possible underlying conditions like anemia
  • Medications to lower blood phosphorus levels, if increased

Prevention of progressive chronic kidney disease
Being a vigilant pet owner and taking your pet for routine checkups is the key to the prevention of progressive chronic kidney disease. If you suspect your cat has any of the common signs of renal failure, contact your veterinarian immediately. To learn more about kidney disease, watch this video on why early diagnosis of kidney disease is a good thing.

Next, click here for a closer look at chronic kidney disease in cats.

If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.

Feline Kidney Disease - pets

Chronic kidney disease is defined as kidney disease that has been present for months to years. Chronic renal disease (CRD), chronic renal failure (CRF), and chronic renal insufficiency refer to the same condition.

CKD is not a single disease. There are many different causes of CKD but by the time the animal shows signs of kidney disease the cause may no longer be apparent. Some potential causes of CRF include:

  • congenital malformation of the kidneys (birth defects)
  • chronic bacterial infection of the kidneys with or without kidney stones (pyelonephritis)
  • high blood pressure (hypertension)
  • diseases associated with the immune system (e.g. glomerulonephritis, systemic lupus))
  • acute kidney disease, for example poisoning with antifreeze, that damages the kidneys can lead to CKD

Often the cause of CKD is unknown.

Structure of the kidneys

The microscopic unit of the kidney is called the nephron. Each kidney contains thousands of nephrons. When the pet is young and healthy not all nephrons are working all of the time some nephrons are held in reserve. As the animal ages or if the kidneys are damaged, some nephrons die and other resting nephrons take over the work of those that die. Eventually all the remaining nephrons are working. When there are no extra nephrons remaining and kidney damage continues the pet will start showing signs of CKD. Because of this stepwise loss of nephrons the kidneys are able to "hide" the fact that they are damaged until the damage is severe. When 2/3 of the nephrons have been lost the pet is no longer able to conserve water and the pet passes larger amounts of dilute urine. By the time a pet has an elevation in the waste product creatinine in its blood, 75% of the nephrons in both kidneys have been lost.

What do the kidneys do?

When blood flows through the kidneys, the kidneys act as a complex filter that removes from blood wastes that are generated from break down of food, old cells, toxins or poisons and many drugs that are given for treatment of other diseases. The wastes are removed with water as urine. Waste products than can be measured in the blood include creatinine and urea nitrogen but there are many other waste products that are not measured by blood tests. The kidneys also acts as a filter to keep "good" substances in the blood. The kidneys regulate the amount of water in the blood by excreting extra water and retaining water to prevent dehydration by varying the amount of urine that is produced. The kidneys help regulate blood pressure by saving or eliminating sodium based on how much sodium the pet is eating. The kidneys help regulate calcium and vitamin D which keep bones strong. The kidneys produce a substance that helps with the creation of new red blood cells. Because the kidneys have so many functions, when the kidneys are not working normally, there are many signs that the pet may show.

CKD is progressive

By the time the pet shows signs of CKD, the damage is severe. There is no cure for CKD. The remaining nephrons are working so hard that with time they will fail as well. CKD is usually fatal in months to years but various treatments can keep the pet comfortable and with a good quality of life for months to years.

Signs of CKD

Because the kidneys perform so many functions, the signs pets with CKD show can vary quite a bit. The signs may be severe or may be subtle and slowly progressive. Despite the chronic nature of the disease, sometimes signs appear suddenly. Some of the more common signs of CKD include:

  • drinking too much (polydipsia) and urinating large volumes of urine (polyuria)
  • the increased volume of urine in the bladder may lead to, or worsen incontinence (leaking urine), especially at night
  • vomiting and/or diarrhea
  • lack of appetite and weight loss
  • general depression related to the elevation of waste products in the blood
  • anemia resulting in pale gums and weakness due to a low blood count
  • overall weakness from low blood potassium

Less common signs include

  • weakened bones can result in bone fractures
  • high blood pressure can lead to sudden blindness
  • itchy skin from calcium and phosphorous depositing in the skin
  • bleeding into the stomach or gut or bruising of skin

Signs you may see if you examine your pet include: dehydration, weight loss, pale gums and ulcers in the mouth.

The signs seen in pets with CKD and the findings on examination are not specific for CKD and may be seen with many other diseases so blood and urine tests are needed to make a diagnosis of CKD.

Diagnostic Tests

Abnormalities that are often seen on diagnostic blood and urine tests include:

  • anemia without signs of a response by the body to the low blood count (non regenerative anemia)
  • increased wastes that are normally removed by the kidneys (blood urea nitrogen [BUN] and creatinine)
  • increased phosphorus
  • calcium is often normal but can be elevated in some pets with CKD and rarely is decreased
  • dilute urine
  • +/- protein or bacteria in the urine

Sometimes bruising occurs where the blood sample was drawn as pets with CKD may have platelets that are less sticky than normal (normal platelets prevent bruising).

A diagnosis of CKD can usually be made based on the signs, physical examination and blood and urine tests but other tests may be performed to look for an underlying cause for the CKD and/or to "stage" the CKD.

Details about Staging

The severity of chronic kidney disease (CKD) can be estimated based on blood waste product elevation and abnormalities in the urine such as the presence of protein. The International Renal Interest Society (IRIS) has developed a method to estimate the stages of CKD. Stages are numbered 1 through 4 where one is the least severe and four is the most severe. The higher the stage number also generally corresponds to the greater number of symptoms seen in the pet. Some treatments are recommended to be started when the pet has a certain stage of CKD.

Other tests that may be performed include

  1. Determination of kidney size using abdominal radiographs (x-rays) or ultrasound
    What might this test show? The kidneys in pets with CRD are usually small reflecting the death of a large number of nephrons. If the kidneys are large then certain causes for the CKD should be considered such as lymphoma (cancer) of the kidneys, or an uncommon disease called amyloidosis. Some pets with signs of kidney disease who have large or normal sized kidneys may have acute kidney failure rather than CKD. The treatment and prognosis for pets with acute kidney disease differs from the treatment and prognosis of pets with CKD.
  2. Kidney biopsy
    What might this test show? A biopsy is not required to make a diagnosis of CKD but the results of a biopsy may show a cause for the CKD. A biopsy is more likely to show specific information when the kidneys are big rather than small. A biopsy can be valuable in pets who develop CKD at a young age or who are of a breed known to develop congenital kidney disease. There may be specific microscopic changes in a kidney biopsy from an animal with congenital kidney disease that may suggest that related animals are also at risk for developing CKD. Knowledge that the cause of CKD is caused by congenital kidney disease does not change the treatment of the affected animal but does provide information for related animals, for example if you should remove them from a breeding program. When a biopsy is planned, usually the biopsy is collected using ultrasound or laparoscopy to see the kidney during the biopsy so that no other organs are damaged during the biopsy.
  3. Bacterial culture
    What might this test show? Bacterial infection is not a common cause of CRD but pets with CKD may develop a bacterial infection as several aspects of the pet's immune system may be less functional when the kidneys are failing. If white blood cells are observed on microscopic examination of the pet's urine, a bacterial culture of the urine should be obtained.
  4. Tests of clotting ability
    What might this test show? If a pet is going to under go kidney biopsy, tests may be performed in advance to evaluate the ability to stop the bleeding from the biopsy site.

Treatment of CRF

The severity of the pet's signs will determine what treatments are needed. Not all treatments presented below may be needed or appropriate for each pet with a diagnosis of CKD. Treatments may also be started incrementally (a few treatments are started and then based on patient response, additional treatments may be added later). The information below is not meant to be a substitute for veterinary care.

Pets with severe signs may be hospitalized for fluid and intravenous drug treatment to reduce the amount of waste products in their body. Many pets with CKD will feel better in response to treatment with IV fluids but if the kidney disease is extremely severe the pet may not respond to treatment.

Those pets who are still eating and not showing severe signs are treated with a variety of treatments, often introducing treatments incrementally as new signs develop. The treatment approach is often called "conservative" compared to more aggressive treatments such as hospitalization for fluid therapy, dialysis or kidney transplantation. Remember that CKD is not a disease that can be cured. Treatments are designed to reduce the work the kidneys need to perform, to replace substances that may be too low (such as potassium) and to reduce wastes that accumulate such as urea (generated by the body from proteins) and phosphorus. The initial response to conservative therapy may be relatively slow, taking weeks to months to see a response.

Feeding of a kidney diet is usually recommended. Kidney diets contain less protein compared to other diets and the protein is high in quality. It is protein in the diet that is converted to waste products that the kidneys must remove in the urine. The higher the quality of the protein in the diet, the less wastes created for the kidneys to eliminate. Low quality protein requires the kidneys remove more wastes. which makes them work harder. Egg and meat contain higher quality protein cereal grain protein is of lower quality which leads to more wastes for the kidneys to eliminate. Protein is used by the body to repair cells and tissues that are continually regenerating, so a pet needs some protein in their diet. By feeding a low quantity, but high quality protein diet that contains an appropriate amount of fats and carbohydrates, the pet's body can use the protein for replacing the cells and tissues and use the fat and carbohydrates for energy. Kidney diets also contain a lower amount of phosphorus. Phosphorus accumulates in the blood when the kidneys are diseased. Kidney diets control the amount of other substances that may be too high or too low in patients with CKD such as salt, potassium, magnesium and B vitamins. There are differences in the kidney diets for dogs and cats. When making diet changes it is often beneficial to gradually introduce the new diet by adding increasing amounts of the new diet while reducing the amount of the current diet over 1 to 2 weeks. The pet is more likely to accept a new diet when it is introduced gradually and it is less stressful to the kidneys to gradually adapt to changes in the diet.

Protein restricted diets are less palatable than higher protein diets. Pets with CKD that are still eating are more likely to accept a change in diet to a protein restricted diet than are pets who are very ill and refusing most foods. Protein restricted diets are more expensive than higher protein diets.

There are many pet food companies that sell kidney diets. Homemade diets can be fed but it is best to work with your veterinarian to formulate a diet that is balanced.

Diet effect

It is generally agreed that feeding renal failure diets to dogs and cats with kidney disease improves their quality of live and may minimize the progression of the disease resulting in a longer life span. Studies that evaluate the effect of dietary changes on quality and quantity of life typically use commercial diets that differ in their composition of protein, phosphorus, sodium and lipids compared to maintenance diets so that positive effects are not attributable to a single component of the diet but rather to a "diet effect".

A randomized, double masked, clinical study in 38 dogs with spontaneous stage 3 or 4 kidney disease, half of which were fed a kidney failure diet and the other half a maintenance diet, published in JAVMA in 2002, demonstrated improved quality and increased quantity of life in the group fed the renal failure diet.

  • The median interval before development of a uremic crisis was twice as long in the group fed the renal diet
  • Dogs fed the renal diet survived at least 13 months longer (average 593 vs 188 days)
  • Owners of dogs fed the renal diet reported significantly higher quality of life scores for their dogs

The results of a study of cats with naturally occurring stable chronic renal failure fed a diet restricted in phosphorus and protein compared to cats with CKD fed a maintenance diet reported a median survival of 633 days for 29 cats fed the renal diet compared to 264 days for 21 cats fed a regular diet. The groups were not randomly determined but based on cat & owners willingness to change to the renal diet.

In a study published in JAVMA in 2006, 45 client-owned cats with spontaneous stage 2 or 3 CKD were randomly assigned to an adult maintenance diet (23 cats) or a renal diet (22 cats) and evaluated for up to 24 months. Findings included:

  • Significant differences: BUN lower and blood bicarbonate higher in the renal diet group
  • No Significant differences
    body weight
    urine protein-to-creatinine ratio
    parathyroid hormone concentrations.
  • 26% of cats fed the maintenance diet had uremic episodes (26%), compared with 0% cats fed the renal diet
  • At the conclusion of the study, 5 (21.7%) cats in the maintenance diet group had died from renal causes and there were no renal-related deaths in the renal diet group.
  • There were no significant differences in quality of life as perceived by owners responding to a questionnaire.
  • Owners impressions of cats willingness to consume the diets did not differ between groups


Because pets with kidney disease cannot conserve water by making concentrated urine, their water intake is very important to prevent dehydration. Make sure they always have plenty of fresh water available. If the pet is not eating well, or is vomiting, then s(he) may not be drinking enough and may get dehydrated. Pets can be encouraged to drink by giving them flavored broths in addition to plain water. The broth should be low in sodium and its best to discuss with your veterinarian other ingredients in the broth to make sure it doesn't contain substances that will make the kidneys work harder.

Water soluble vitamins like B and C are lost in greater amounts when the pet is urinating greater amounts. Kidney diets contain increased amounts of water soluble vitamins so additional vitamins do not need to be given unless a homemade diet is being fed.


Lack of appetite and increased loss of potassium in urine may result in low body potassium (hypokalemia). Cats with CKD are more likely to have low body potassium than are dogs. Cats with low potassium may develop painful muscles. Both cats and dogs may be weak when potassium is low. Cat kidney diets contain higher levels of potassium so additional supplementation is probably not needed unless the cat shows signs of muscle pain. Potassium gluconate or citrate can be given by mouth if potassium supplementation is needed. Potassium chloride is acidifying and is not recommended.

Phosphorus, calcium and PTH

Pets with CKD usually have increased blood phosphorus. In health, phosphorus and calcium are controlled by a hormone called parathyroid hormone (PTH). PTH works with vitamin D on the intestine, kidney and bone to keep calcium and phosphorus normal. As the kidneys fail the amount of PTH in the body is elevated and the amount of vitamin D is reduced. Elevated PTH itself may be responsible for some of the signs shown by pets with CKD. PTH draws calcium and phosphorus from the bones which can weaken bones which can lead to bone fracture.

Kidney diets typically contain reduced phosphorus and an appropriate amount of calcium but if phosphorus remains elevated when the pet is eating a kidney diet then phosphorus can be tied up in the intestinal tract so it can be eliminated in the stool. Intestinal phosphate binding agents include aluminum carbonate, aluminum hydroxide, aluminum oxide, calcium citrate, calcium acetate and calcium carbonate and sevelamer hydrochloride. Phosphate binding agents which contain calcium should not be used until blood phosphorus is normal to prevent calcium and phosphorus from combining and precipitating in tissues including the kidneys. It is not usually necessary to give additional calcium but if a pet has low blood calcium, the phosphorus should be normalized before giving calcium. Even when blood phosphorus is normalized, PTH levels are still higher than normal. The administration of low doses of vitamin D (1, 25 dihydroxycholecalciferol [calcitriol]) will suppress PTH and possibly slow the rate of progression of kidney deterioration.

It is not 100% agreed that giving your pet calcitriol will slow the deterioration of the kidneys.


Some pets with CKD will have an acid blood pH. Kidney diets are designed to counteract the acidosis but very sick animals that are hospitalized may need addition treatment to correct the acidosis.


Diseased kidneys are less efficient at regulating sodium and sodium in turn helps control blood volume and pressure. Excess sodium can lead to water retention and not enough sodium can lead to dehydration. When changing diets that contain different amounts of sodium (kidney diets usually have less sodium than regular diets) make the change gradually over several weeks. Use caution when giving your pet table scraps or treats that may be high in sodium.

High blood pressure (hypertension)

Many pets with CKD have high blood pressure. High blood pressure can contribute to further decline of kidney function and can occasionally lead to sudden blindness from retinal detachment. Ideally blood pressure should be measured by your veterinarian and hypertension confirmed before giving drugs to treat high blood pressure but measuring true blood pressure in dogs and cats can be difficult. If the pet has an elevation in blood pressure it may be due to the excitement of being examined or due to CKD. The calmer you are able to keep your pet during examination, the more reliable the readings for blood pressure. There are several drugs that may be used to manage high blood pressure including enalapril, benazepril, or amlodipine (and others). Enalapril and benazepril are in a class of drugs called ACE inhibitors and are sometimes used in pets with CKD that have abnormal amounts of protein in their urine even when blood pressure is normal.


The kidneys play a role in producing a hormone called erythropoietin which stimulates the production of new red blood cells. Red blood cells live about a hundred days so new cells are continually being made. Less erythropoietin is made in pets with CKD leading to anemia. The packed cell volume (PVC) (also called hematocrit) is the percentage of blood cells compared to fluid in whole blood. When the PCV is

25% in dogs, anemia may contribute to lack of activity and weakness.

Anemia can be treated by blood transfusion or by the administration of human erythropoietin. Erythropoietin is very effective in increasing PCV but because human erythropoietin is not exactly the same as dog and cat erythropoietin, over time, the pet may form antibodies that cause the medication to become ineffective. Canine and feline erythropoietin are currently being studied.


Certain types of fats (polyunsaturated omega 3 fatty acids) may slow the decline in kidney function are are often present in kidney diets.

Subcutaneous Fluids

Some cats and dogs with kidney disease may not drink enough to prevent becoming dehydrated and may benefit from the administration of intermittent SC fluids. If your veterinarian feels your pet may benefit from giving subcutaneous fluids.

Lack of Appetite

The accumulation of wastes in the body often decreases appetite. A goal of several of the above treatments is to reduce the amount of wastes in the blood. If the pet remains off food despite above treatments you might try different brands of renal failure diets, warming the food or adding odiferous toppings to entice the pet to eat.


Increased levels of waste products cause the pet to vomit. Your veterinarian may recommend medications that reduce nausea or act directly on brain centers to reduce the urge to vomit.

Drugs used to treat other diseases

Because the kidneys are responsible for elimination of many drugs, make sure that your veterinarian is aware of any other medications you are giving your pet as these may accumulate in the body to toxic levels if the kidneys cannot eliminate them.


If the urine shows signs of infection or if a urine culture grows bacteria then antibiotics may be administered. If a urinary tract infection is involving the kidneys, the period of treatment is much longer than a infection of the bladder.

Avoiding Stress

You are in the best position to judge what is stressful to your pet. When a pet is stressed they may drink and eat less than normal. Reduced water intake is detrimental to diseased kidneys. When possible, keep your pet calm. That might mean for example: having an in-home pet sitter if your pet is stressed by boarding, removing the pet from the household during a party or limiting contact with other animals if these situations appear to be a source of stress for your pet. Extremes in heat or cold are stresses. Certain drugs such as prednisone/cortisone make the kidneys work harder.

Kidney Transplantation

There has been progress made in transplantation of kidneys, more for cats than for dogs.

See for a list of facilities that currently offer transplanation.

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Feline Kidney Disease: Yes, There's Hope!

Feline kidney disease is something every cat owner will experience if their cat lives long enough without succumbing from another disease. Most cats do not show an obvious decline in kidney function until they are well into their teens. Some less fortunate kitties have problems with kidney function, even feline kidney failure, much earlier in life.

Watch the following video to see just how long a cat can live in spite of having kidney problems. You'll be amazed.

As you can see from the above video, a diagnosis of feline kidney disease doesn’t have to mean disaster. If you find out your cat has declining kidneys, there are many actions you can take to extend his life. These treatments range from a simple change in diet or giving medication to learning to give fluids under the skin at home to the real extreme, a feline kidney transplant.

Here's How YOU Can Directly Ask Your Questions!

Feline Kidney Transplants

Granted, very few cat owners opt to have their cat go through the process of receiving a new kidney. However, some do. I will never forget the first feline kidney transplant the University of Pennsylvania School of Medicine performed. It had special meaning for me because their first recipient was one of my own patients from my cat hospital.

I had managed the cat’s kidney disease for quite some time before he went for surgery. It was important for him to become more stable before the transplant. I am happy to say the surgery was a success. The kitty lived many more years and developed other diseases, including feline hyperthyroidism and cat diabetes, which his loving parents continued to treat and the cat lived to a ripe old age.

Much more common is medical management through dietary changes, medication and administration of fluids at home. Periodic blood work is necessary to monitor the need to adjust dosages and add or discontinue medications and adjust fluid therapy.

I personally have had many of my own cats develop kidney disease and in all cases, they lived several years after the initial diagnosis. You can do as much for your own cat as I did for mine. You don’t have to be a veterinarian to care for a feline kidney disease patient at home.

Symptoms of Feline Kidney Disease

If your cat develops kidney disease, the first symptoms you will probably see are increased thirst and increased urination. Any time you observe this in your cat, regardless of age, it’s time for a trip to the veterinarian where your cat will HAVE to have blood work and a urinalysis. There are a few different cat diseases that cause an increase in thirst and urination only an analysis of your cat’s blood will let your veterinarian know which disease is causing your kitty’s symptoms.

Other Symptoms (but don’t wait until you see these!)

If the condition is chronic, a cat with kidney disease can develop anemia. This can lead to

High Blood Pressure in Cat Kidney Disease

Without getting too technical, I need to advise you that the kidneys play a very important role in blood pressure. Therefore, many cats with kidney disease develop high blood pressure.

Unfortunately, high blood pressure in cats is similar to high blood pressure in people and is a silent enemy. Over my many years of practice, I have seen all too often that the first sign of high blood pressure observed by cat owners is blindness in their cats. This is another reason to make sure your cat has regular veterinary visits even if he looks healthy to you. If early changes in kidney function are detected and blood pressure is measured, blindness can be avoided.

Laboratory Changes in Cat Kidney Disease

It is important to note that the first laboratory indication of feline kidney disease onset will be a decrease in the specific gravity of the urine. In other words, your cat’s urine will be “thinner”, more like water. This occurs before there are changes in the blood. Often, however, by the time you notice the signs of increased thirst and urination and take your cat to the vet, this early stage will have progressed to one in which there are changes in the blood.

If the feline kidney disease is not too advanced, the only blood abnormalities will be an increase in creatinine and an increase in BUN. If the elevations are slight and all other tests are normal, that is good news and may only require monitoring or a dietary change. However, further diagnostics are recommended even at this stage in order to look for possible underlying causes of the change in kidney function in the hopes of halting the underlying cause.

Additional Diagnostics

These diagnostics can include a complete urinalysis including a culture of the urine, radiographs of the kidneys (x-rays), ultrasound of the kidneys, and blood pressure measurement. Your veterinarian may also recommend a needle biopsy of the kidneys which can often be done with no or mild sedation. These tests are necessary to be able to distinguish between such things as feline kidney infection (pyelonephritis), kidney stones, cancer of the kidneys, feline polycystic kidney disease, FIP (feline infectious peritonitis), feline amyloidosis (deposits of a protein called amyloid in the kidneys), glomerulonephritis (an inflammatory disease), hydronephrosis (caused by an obstruction to the normal flow of urine), chronic interstitial nephritis, and a few other rare genetic disorders.

Chronic interstitial nephritis is the most commonly diagnosed condition the kidneys are small and normal kidney tissue has become scar tissue. However, this may be the most common of the feline kidney diseases simply because all the other diseases, if untreated, lead to this condition. It is, therefore, very important to diagnose feline kidney disease as early as possible and look for underlying causes that may be treatable before the condition becomes chronic and irreversible or unmanageable.

A proper diagnosis is important, as always, so that the appropriate treatment can be prescribed. If there is inflammation, anti-inflammatories may be indicated whereas if there is infection, anti-inflammatories can be harmful and instead, antibiotics are needed. If there is cancer, removal of one kidney may be an option or chemotherapy. If hydronephrosis is occurring due to an obstruction from a stone or other problem, then it may be possible to remove or alter the obstruction. You can see how knowing what condition needs to be treated is so important for determining the treatment.

Chronic Feline Kidney Disease

If none of the above causes are found and if your cat has a diagnosis of chronic renal disease, then this is likely to be progressive and eventually can become very debilitating. HOWEVER, it can take a long time and many things can be done to prolong your time with your cat and keep your cat happy and comfortable.

Whether a low protein diet helps chronic kidney disease in cats or not has always been and still is a controversial topic in veterinary medicine. Some say it helps others say it doesn’t. My experience has been that it does. When my own cats have had declining kidneys, I have always changed their diet to one lower in protein.

There are several different prescription diets available from your veterinarian that are described as being feline kidney diets. DO NOT feed your cat one of these diets in the dry form. In fact, do not feed your cat dry food period. Dry food has very little moisture in it. Canned food has much more and every cat with kidney disease needs to consume more water. Eating dry food over the course of a cat’s lifetime may indeed be one of the causative factors in the development of chronic kidney disease in so many cats.

Some of the prescription diets also restrict the protein level far too much, as you can read more about on The most important dietary change you can make for your cat with feline kidney disease is to switch to an all canned food diet if you have not already done so. And, to help encourage drinking, I strongly recommend the use of a cat water fountain, especially the ones seen here, since increasing moisture intake is so critical to kidney health.

Additional Treatment for Feline Kidney Disease

Other treatments for kidney disease in cats depend on the stage of the disease and the symptoms or blood abnormalities that exist. These can include:

- Medications to alleviate ulcers and gastritis

- Medications to decrease elevated phosphorus which is a common problem in kidney disease

- Blood pressure medication

- Vitamins with iron for anemia

- Epogen, a replacement hormone that stimulates red blood cell production


As kidney disease progresses, fluid therapy can become very essential. During times of crisis, the fluids may need to be administered intravenously in the hospital.

On a more chronic basis, cat owners are often taught to give fluids subcutaneously at home. This is a simple procedure that most cats tolerate very well and can extend life by months to years.

Keep in mind that this procedure is not painful for your cat, is not for the purpose of extending the life of a cat that is in pain, and is not difficult to learn to do.

While the administration of SQ fluids at home can be life-saving, I encourage you to understand that this is not an extreme, life support type of treatment, which is the impression some people seem to have until they understand it fully.


I was just told that my 13-year-old cat has early feline kidney disease. Bailey's BUN was 45. What would you recommend for this problem?

I have been feeding her Iams Prohealth Formula. I have a problem with a family member giving pounce treats and I have now asked him to stop. Will I be able to continue the Iams Prohealth or do I need to change her diet?

I have 7 kids ranging from 2 to 13 and we free feed. I want her to live healthy, but I do not have the ability to stop the free feeding due to the other cats in the house. HELP!

First, I want to point out that a BUN of 45 is barely elevated. Also, BUN can be elevated from things other than kidney failure. In addition, the most sensitive indicator of kidney function is not BUN, but creatinine. Did the vet tell you if the creatinine was elevated? Also, did they analyze her urine? The earliest sign of feline kidney disease is a decrease in the specific gravity (concentration) of the urine. That will occur before creatinine and/or BUN becomes elevated.

If these tests were not performed, they should be.

The value of feeding a low protein diet, such as Hill's prescription diet K/D, is somewhat controversial. Most vets, including myself, feel that a low protein diet is indeed beneficial. I have been treating cats with kidney disease for 20 years and my experience has been that those on a low protein diet feel better and live longer than those not eating a low protein diet.

K/D is not the only prescription low protein diet. Iams also has one as does Purina and other companies.

It is very difficult to feed one cat differently than the others when you have a multi-cat household. I have been in that situation myself as have many of my clients.

I have at times fed all my cats the low protein diet if one needed it and the others were not kittens or pregnant or nursing cats. You could also leave dry low protein food down all the time and supplement all except the kitty with feline kidney disease with regular canned food. At that same time, you can give the one with kidney disease low protein canned.

Other cat owners have gone to an all canned food diet so the kidney disease kitty can be fed low protein while the others eat regular, eliminating dry food altogether. This has the added benefit of offering more water due to the high water content of canned food. Increased water intake is beneficial to the urinary tract.

Others, including myself, have postponed any diet change when the kidney insufficiency is in such early stages. You are probably beginning to see there is no one right or wrong answer. It is still not completely known if feeding a low protein diet is helpful at all or if feeding a moderate protein diet is superior to a low protein one.

The most important consideration about diet for a cat with chronic feline kidney disease and any cat, for that matter, is to feed canned food only. Dry food is so deficient in water and is too high in carbohydrates for any cat and will be particularly damaging for a cat with kidney disease.

Discuss these issues with your vet, make sure all the tests have been run that I mentioned, provide fresh water at all times, and take your kitty for frequent rechecks. As kidney function changes over time, certain medications may be added that are very useful as well as other dietary changes or supplements and possibly fluid supplementation at home.

Best of luck with everything. Thank you for raising this very important question.

What Other Cat Lovers Have Said About Feline Kidney Disease

Click below to see questions or stories about diabetes from other cat lovers.

My cat has stopped eating food but still drinks water and a bit of milk. He also has kidney failure.
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Kidney Disease in Cats- Your Ultimate Guide

What is Cat Kidney Disease?

Your cat’s kidneys help him or her stay healthy by managing your cat’s blood pressure, stimulating red blood cell production, removing waste from the blood, and making important hormones. Kidney disease hinders these important functions and can negatively impact your cat’s wellbeing. Cat kidney disease takes form in two distinct ways:

Acute Renal Failure

This sudden onset kidney disease can happen very suddenly to cats of all ages as a result of poisons, shock, or trauma.

Chronic Kidney Disease (CKD)

This slow progression towards kidney failure is found in middle-aged and senior cats, as their kidney function deteriorates over time.

How to Spot Kidney Disease in Cats

Kidney failure—especially CDK, which develops slowly over time—is not always immediately detectable. But paying attention to the warning signs can help you gauge your kitty’s health along the way.

Some warning signs include:

  • Frequent urination or urinating where they shouldn’t
  • Dehydration and/or excessive water drinking
  • Weight loss
  • Vomit, diarrhea, or urine containing blood
  • Cloudy urine
  • Foul breath, mouth ulcers, or an unhealthy brown tongue
  • Weakness or lethargy

What Causes Kidney Disease in Cats?

The acute and chronic versions of kidney disease have drastically different causes, but both are the end result of damage to and dysfunction of the nephrons—the tiny tubes that comprise the kidney’s filtering system.

In Acute Renal Failure, the nephron damage happens very quickly due to ingestion of a poison or chemical, heart failure, bacterial infection, etc. The remaining healthy nephrons are unable to compensate for the sudden loss of function, which precipitates total kidney failure.

With Chronic Kidney Disease, on the other hand, the damage builds up slowly, until too many nephrons stop working and the kidneys lose function altogether. This is often the result of slowly developing conditions, such as an autoimmune disorder—in which a cat’s body attacks its own healthy organs— or kidney cysts—which slowly grow to destroy the tissue.

How to Prevent Kidney Disease in Cats?

There are ways to help slow or mitigate the potential onset of this condition and keep your cat as healthy as possible for all nine lives:

Proper Diet

Feed your cat moisture-rich, balanced and healthy meals.


Supply your cat with a constant stream of fresh drinking water.

Healthy Lifestyle

Help your cat maintain a healthy weight to avoid obesity and diabetes, which can be linked to kidney failure.

Standard Check-Ups

Bring your kitty to the vet twice a year.

Stay Vigilant

Use PrettyLitter’s smart technology to check for blood and monitor your cat’s pH balance.

Kidney Failure In Cats: Causes, Signs, Treatments & Prevention

Brittany Leitner Mar 05, 2021 в—Џ 7 min read

Whether you’re dealing with a loved one or family pet, the words “kidney failure” can sound alarming. Kidneys are vital to help flush out toxins in the body and help restore the body’s fluid balance, and it’s no different for your cat.

However, in cats, kidney failure is much more common and can have serious effects on their quality of life. California veterinarian Dr. Rachel Mar points out that chronic kidney disease can be difficult to notice in cats, but routine trips to the vet can help make a difference in catching it early. If you’re concerned about this happening to your cat, there are a few things you can do to watch out for kidney failure, tend to your cat after a diagnosis, and increase your cat’s quality of life and extend their lifespan after being diagnosed. Here’s everything you need to know about kidney failure in cats.

Watch the video: Supplement For Cats With Kidney Disease. 3 Tips For CKD Feline Health u0026 Kidney Restore, Help Now!

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