Browsing tag: Kidney disease

Are your cat’s kidneys crock? – The signs of kidney failure

Kidney failure is very common in cats, between 20% and 50% over the age of 15 will suffer to some degree.  Unfortunately, it is often missed until it becomes advanced because the early symptoms are subtle and our feline friends are very good at hiding illness.  However, the sooner it is caught the better

In most cases the cause for the kidney’s failing is unknown, it is just a gradual dying off of the tissue, particularly in elderly cats.  If younger animals are diagnosed with the problem then can be a more obvious cause but it doesn’t often change the treatment plan.

The kidneys are the filtering organs for the blood.  They remove all the waste products and toxins, sending them out in the urine.  When they start to malfunction they become less efficient, these by-products stay in the body and, as they are effectively poisons, make the animal feel unwell and mildly nauseous. They are often mildly dehydrated, so it is not unlike a permanent hangover.

Feeling sick understandably means affected cats have poor appetites and to survive the body has to break down its own tissue.  Unfortunately, this creates very high levels of toxic metabolites, which stay in the blood stream, make the cat feel worse, so they eat even less and so the vicious cycle continues.  The toxins themselves also directly damage the kidneys, further exacerbating the problem.

The big challenge with kidney disease is that the organs will have been dying long before any signs, either in the cat or on tests, are seen.  Animals have far more kidney tissue than they need and it is only when approximately 70% is destroyed, is there any sign of the problem.  Also, the organ is non-regenerative, so once it’s gone, it’s gone.

I describe it to my clients that it’s like a snowball rolling down a hill.  Once we discover the problem it has already picked up significant momentum.  We cannot stop it but we can slow it down.  This is why it is so important to catch it as early as possible.

"The early signs of renal disease are vague..."

“The early signs of renal disease are vague…”

The early signs of renal disease are vague; slow, gradual weight loss which is often missed; being quiet in themselves and sleeping more, which can easily be written off as ‘just old age’ and occasional vomiting.  Unless vets and owners are actively looking for problems; for example regularly weighing older cats or doing simple urine tests or blood analysis, it is easy to miss until it is more advanced and the pet is obviously poorly.

The mainstay of treatment for kidney failure is a change in diet.  Prescription foods for renal disease are designed to treat several aspects of the problem at once and studies have shown that cats who eat them, will live longer.

These diets are easily digestible, so produce fewer toxic left-overs than normal cat food; they are supplemented with ingredients which help the remaining kidney tissue to function as best it can and contain vitamins and minerals that affected cats are often deficient in.

Although these foods are very palatable and with time and patience most cats will accept them, some elderly felines are very stuck in their ways!  A good appetite is vital in renal patients so for them, and for some more badly affected pets, there are supplements that can be added to their usual food which have similar, positive effects.

Another treatment which I use regularly is the administration of fluid under the skin.  Although renal patients drink copious amounts, they are chronically dehydrated. Subcutaneous fluids really help to combat this, helping them feel better and therefore eat better.

Also, kidney disease is often both a cause and consequence of high blood pressure, another very common problem in older cats.  Again a vicious cycle is in action; the higher the blood pressure, the poorer the kidney function and poor kidney function very often leads to high blood pressure.  All feline renal patients should have their blood pressure regularly checked and treated if it is raised.

Chronic renal failure is one of the most commonly diagnosed illnesses in older cats and all owners should be on the lookout for the early symptoms.  My one tip is to weigh your cats regularly, as often the first sign of this, and many other diseases, is insidious weight loss.

If you are concerned about your pets, have a chat to your vet.  Kidney problems are easily identified with simple, non-invasive urine and blood tests and the sooner it is caught the better!  Affected cats, with the correct treatment and care, can live for years after diagnosis!

Cat Henstridge BVSc MRCVS – Read more of her blogs at www.catthevet.com

If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.

Ask a vet online-‘my cat has suddenly lost weight, she was fine a few weeks ago’

Question from Gemma Loopylou Moorey:

I has my cat suddenly lost weight I can even fill her ribs now she was fine a few weeks ago. Even her mood is changed she meows loudly when I talk to her in a bad mood way

Answer from Shanika Winters online vet:

Hi Gemma and thank you for your question regarding your cats sudden weight loss and change of temperament.  I will discuss in my answer some possible cause for the changes you have noticed in your pet.  I would advise that you take your cat to see your vet as soon as possible.

A sudden loss of a significant amount of weight can be very dangerous for your cat, regardless of the cause of the weight loss in the first place such changes can lead to organs failing and your cat being in need of emergency veterinary care.

An average cat weighs between 4 and 6 kg so even a change of a few 100g of weight is significant on such a small animal.  Ideally your vet will weigh your cat each time they are seen; it is easy to keep track of your cat’s weight at home too, weigh your cat carrier empty and then with your cat inside and the difference is your cat’s weight.  This should be easier than trying to convince your cat to stand on weighing scales.  Some owners may be able to weigh themselves and then again when holding their cat if the cat carrier causes stress.

The fact that you have described that you can feel your cats ribs and you could not before suggest a lot of weight has been lost.

You have mentioned that your cat seems to meow as if in a bad mood, this is what we would call a change of temperament.  Changes to a cat’s temperament can be due to many stresses or changes to their home, environments, routine, companion animals or due to pain/illness.

What will happen when I take my cat to the vet?

Your vet will ask you lots of questions about your cat’s general state, what time scale the changes have happened over and if you can think of anything that may have led to the weight loss and temperament change such as moving home, new pet/family member and or exposure to chemicals such as rat/mouse poisons.

Your vet will then perform a full clinical examination of your pet including recording its weight.  If the physical examination and the details you have given your vet are not enough to confirm a diagnosis then your vet may advise further test most likely blood tests and or x-rays to work out what is happening with your cat.

What will the blood tests and x-rays tell us?

Blood tests usually consist of routine haematology, biochemistry, and or specific disease test.

Haematology looks at your cat’s red blood cells, white blood cells and platelets.  These give an indication of whether your pet is fighting an infection, anaemic (low in iron) or has abnormal cells or parasites present.

Biochemistry looks at the chemicals in your cat’s blood and gives an indication of how the major body organs are functioning.  Significant changes can suggest for example liver or kidney disease.

Specific disease tests include looking for viruses such as FeLV (feline leukaemia virus), FIV (feline immunodeficiency virus) and increased levels of thyroid hormone (Hyperthyroidism).

X-rays are often done of the chest and abdomen( tummy) two views of each at 90 degrees in order to look for any obvious abnormalities such as enlarged or shrunken organs or unexpected tissues ( infection or tumours).

Some practices may also offer ultrasound scans and or MRI (magnetic resonance imaging) scans to help make a diagnosis.

Biopsies may need to be taken, this is when small or large pieces of tissue are removed from your cat (under anaesthetic if appropriate) and sent to a laboratory for analysis.

What happens next?

Hopefully all the information your vet has found out will lead to a diagnosis and then treatment plan for your pet.  From the information you have given in your question some of the possible disease that come to mind are Kidney failure, hyperthyroidism and or a severe infection.

Kidney disease can be treated by increasing your cat’s fluid intake, reduced protein diets, anabolic steroids( body building) and various medications to reduce the components in your pet’s that are difficult for the kidneys to deal with .

Hyperthyroidism can be treated medically with tablets to reduce thyroid hormone production, surgically by removal of thyroid gland tumours or by radiation therapy to destroy the thyroid gland tumour tissue.

Severe infections can be treated by use of appropriate and in some cases several antibiotics at the same time, and supportive intravenous fluid therapy.

I hope that this answer has helped you to understand some possible causes for your cat’s condition and why a full examination from your vet with or without further tests is most likely to help lead to a diagnosis and treatment plan for your cat.

Shanika Winters MRCVS (online vet)

If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.

Colic: Part 1: Diagnosis and Workup

Horse colic examination and anatomy
When talking about colic, it’s important to have some idea of what the various parts of the equine gut are… So, here we go:
Stomach – quite small, and hidden away deep up in the ribcage.
Small intestine - this is very long, but quite narrow (perhaps 1 or 2 inches across). It is all coiled up throughout the abdomen.
Large intestine – this is divided into three parts:
The Caecum is a large sac perhaps four or five feet long, pointing forward, and can be heard on the right flank. Generally, it makes a loud gurgling noise every 20 to 30 seconds in a normal, healthy horse.
The Large Colon makes up a double U shape, lying on the bottom of the abdomen. It can be up to a foot across, but at each end is a sharp 180-degree bend; the bend near the pelvis (the pelvic flexure) is especially narrow.
The Small Colon runs from the large colon down to the rectum, along the top of the abdominal space.

It’s something all horse owners dread – colic. However, colic is a symptom, not a disease in its own right, and has a wide range of different causes. This is the first in a three-part series where I’ll be looking at colic in horses – its diagnosis and treatment, and what happens if your horse has to be referred for surgery.

Put simply, all colic is, is abdominal pain. However, before you’re tempted to dismiss it as a stomach ache, it’s worth remembering that the horse’s intestines are as complicated as a major chemical factory! Anything that causes disruption to their function is potentially life-threatening.

Occasionally, colic pain comes from a non-intestinal source, e.g. Liver disease (think ragwort poisoning, or liver fluke), or a kidney issue. In mares, it can also be caused by certain disorders of the reproductive tract. However, the vast majority are due to disease, damage or malfunction of the intestines.

If you call your vet and tell them that your horse has colic, they’ll treat it as an emergency, because it can be. They’ll generally take a bit of history from you, a quick description of what the horse is doing at the moment, and then they’ll head out to examine the horse. Most vets will also give instructions for what to do while you’re waiting; it’s important to do what they say, not what someone else on the yard suggests. This is because they may have an idea what sort of colic your horse has, and will try to tailor their instructions to the specific case. For example, some forms of colic respond well to being trotted around on the lunge; however, that can worsen other types.

When they arrive, the vet will want to establish three things:
Firstly, does the horse actually have colic? I’ve been called out to “colic” cases that proved to be laminitis; to a mare foaling down; once even to a tired (but perfectly healthy) horse sleeping in his stable!
Secondly, assuming it is a colic, is it a Medical or a Surgical Colic? (I’ll talk more about this distinction in a minute).
Third and finally, can they make a specific diagnosis of what kind of colic it is?

Every vet will have their own routine, but my workup goes something like this:

What’s the horse’s behaviour like? Is he alert, or dull and unresponsive? Is he thrashing about, or just looking at his flanks occasionally? Generally, a quieter horse is likely to have a milder colic, unless he or she is so toxic that they are depressed or spaced out. One exception is that some spasmodic colics are incredibly painful – however, the pain usually comes in waves.

Are there any droppings in the stable? Hard, dry lumps of faeces is suggestive of an impaction, or blockage; while very runny faeces or diarrhoea may suggest colic secondary to an infection, e.g. Salmonella.

Then I’ll start my examination:

Mucous membranes (gums are usually most accessible and reliable) – what colour are they, what is the refill time, are they tacky?
The normal colour is described as being “salmon pink”, and if you press with a finger for a moment, the colour should fade to white, then return within 2 seconds. They should also be nice and moist to the touch. If they are red, or purple, or the colour doesn’t fade, it is highly suggestive of toxic shock (like septicaemia). This is a marker of a really, really severe injury to the gut wall, that’s allowing bacterial toxins to enter the circulation. If the refill time is greater than 2 seconds, or the membranes are tacky or dry, it suggests dehydration and/or shock.

Heart rate - how fast, is the rhythm good? As a (very rough and ready!) general rule, a heart rate under 60 beats per minute implies a Medical colic, while over 80 suggests a Surgical case. If there’s an abnormality in the rhythm, it can mean heart disease as well, or severe toxic shock.

Gut sounds - what do the guts sound like in all 4 quadrants?
This is where you’ll see your vet putting a stethoscope to the horse’s flanks, listening to the guts. The normal, healthy gut makes a wide range of bubbling, gurgling noises (the sort that anywhere else you would associate with really cheap plumbing!). The bottom left is the left Large Colon, bottom right is the right Large Colon and perhaps some Caecum, the top right is the base of the Caecum, and the top left is mainly small intestine. This is one of the most useful tests we can do – reduced sounds mean the guts are “slowing down” – this can mean an impaction or blockage, but it can also mean a serious disease e.g. a twisted gut. Increased sounds is generally a good sign, as it usually means a Spasmodic colic.

Finally, I’d want to take the temperature (a horse with a fever is likely to have another disease, e.g. Salmonella, that is the underlying cause of the colic), and then, if at all possible, do a rectal exam. People get very excited about this, and it’s one of the standard jokes about vets, but I’d like to go on record and say that I doubt anyone actually enjoys rectalling a horse! Apart from anything else, it’s dangerous to the vet, and uncomfortable to the horse… However, it can provide more information than almost any other test. What we’re feeling for is anything unusual: is the large colon a normal size and texture? How about the Caecum? Can you feel the small intestine? Usually, the small intestine is almost impossible to feel – it just slithers out of the way. If, however, you can feel thick, swollen loops of intestines (they feel a bit like black pudding, or really thick, soft sausages, if you’re interested!), it is an indication of a complete blockage in the small intestine, which needs emergency colic surgery. On the other hand, if you feel a doughy, squishy mass in the colon, that means the horse has an impaction.

Sometimes, if there is doubt about whether food is passing from the stomach or not, the vet will pass a stomach tube and see how full the stomach is. This looks really easy in theory – you pass a tube up the horse’s nose, he swallows it, and then you syphon out the stomach. If you get lots, it’s too full, if not, it’s fine. However, not all horses are quite so easy! Some horses are really difficult to get to swallow the tube, and it can take several attempts to make sure it’s not in the windpipe (which would be a disaster). Also, the equine stomach is, as one equine surgeon I know once put it, “a fantastic organ – it can be completely dilated (full), and you’ll get nothing out of it until you move the tube half an inch, then it all comes spurting out”. However, if there’s any doubt, it can be a great tool to ensure that there isn’t a rapidly life- threatening blockage; it can also be emergency first aid to prevent the horse’s stomach rupturing in a severe surgical colic.

The vet will also sometimes take blood samples – we tend to hold onto these in case they’re needed, but the main things we’re looking for are:
1) Evidence of dehydration – the blood tests will allow us to quantify the degree of dehydration, making it easier to plan a course of treatment.
2) Evidence of infection – if the white cell count is significantly abnormal, it suggests there may be something else causing the colic that we might need to look into.
3) Liver and kidney function – sometimes liver or kidney disease can present as colic
4) MOST IMPORTANTLY – Fibrinogen levels. Fibrinogen is a substance that can be used to assess inflammation and tissue damage – a high Fib level in a colic case is very suggestive that the gut integrity is damaged, and that surgical intervention may be needed.

There’s one other sample that can be very useful, especially as a “rule out” test if the clinical findings are contradictory or unclear. This is a peritoneal tap. This test carries some risk, but sometimes it’s the best way to find out what’s going on inside the abdomen. The belly of the horse is clipped, and prepared so make it as sterile as possible – we don’t want to risk introducing infection. The area is numbed with local anaesthetic, and then either a small incision is made with a scalpel and a blunt cannula inserted or (more usually) a small sterile needle is VERY CAREFULY inserted through the abdominal wall. The fluid that comes out is collected in a sterile sample pot for examination. The risk, of course, is that damage is done to the intestines; however, we’re very careful to avoid them as far as possible, and instead to collect the fluid that surrounds the intestines, the peritoneal fluid. In the lab, the numbers of cells can be counted to assess if there’s infection in the belly (peritonitis); however, in the field we can tell three things:
1) The tap fluid is clear (you can read text through it) yellowish – this suggests that the abdomen is basically OK, and means that in the absence of any other findings, the case can be managed medically.
2) The tap is cloudy, reddish or umber in colour - this means severe damage to the gut walls and/or peritonitis (infection in the abdominal cavity). This horse needs urgent referral for investigation at a hospital.
3) The tap contains gut contents (green or brown, lumpy) – sadly, this means that the intestines have ruptured; the horse is highly unlikely to survive. Alternatively, this may mean that the needle has gone into a part of the intestines, so if I get this, I’ll usually repeat the tap a few inches away, to make sure. If the needle has damaged the intestine, it’s not a disaster, but it is something to be avoided if possible.

So, using all the information from our history and workup, the vet has to decide if the colic is Medical or Surgical.

The terms are more or less self-explanatory: a medical colic can be managed with drugs, while a surgical colic needs emergency surgery.

As a rule of thumb, 9/10 colics are medical, and can almost always be managed on the yard. In my next blog, I’ll be looking at these Medical colics, their causes and treatment.

If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.

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