Chronic Renal Failure Pt. 2: Treatment, and Managing the Symptoms of CRF

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We hear from readers looking for help with CRF issues all the time. This is part two of a three part series from The Cat Doctor on the diagnosis and treatment of this all too common condition in cats.


by Lori Horwedel, client educator at The Cat Doctor, Philadelphia, PA.

In part two of our series on Chronic Renal Failure, we’re discussing some of the treatments used to manage the symptoms associated with CRF.

Ali is an adorable 21 year old kitty who has been living with CRF for several years

.Your cat has just been diagnosed with kidney disease, and you’re worried and a little overwhelmed by the changes your veterinarian has suggested. (See Part 1: Chronic Renal Failure in Cats: Causes, Symptoms and Diagnosis). Perhaps you’ve been told your cat needs a special diet. Maybe she needs medications, or even fluids. Today, we’re going to list some of the more commonly prescribed treatments associated with kidney disease and explain why they’re used.

Diet: There are several prescription diets on the market today that area tailored to cats with CRF. Kidney-friendly diets will have lower levels of protein to ease the workload of the kidneys, as well as decreased levels of phosphorus and sodium. They will also often contain increased levels of Omega 3 fatty acids, amino acids, and B vitamins to make up for vitamins and minerals lost from excessive urination.


Phosphorus binders: As the kidneys lose their ability to excrete phosphorus, it becomes important to limit the levels your cat takes in through his diet. In addition to dietary measures, oral medications might be used to bind to extra phosphorus in the kidney to aid in secretion. Phosphorus binders must be given immediately before, after, or with food so they can help the kidney excrete excess phosphorus in food. Common drug names are Sucralfate, Carafate, and Amphogel.


Appetite stimulants can cause increased activity and vocalization

Nausea medications: Cats with renal disease can experience nausea as a results of the buildup of toxins in their systems. Anti-nausea medications such as Pepcid (Famotidine), Zantac (Ranitidine), Cerenia, and Anzemet (Dolasetron) can help reduce nausea and therefore increase appetite and provide a better quality of life.
Appetite stimulants: Because of the nausea associated with renal disease, some cats will refuse food.  Appetite stimulants such as Cyproheptadine and Mirtazipine can make anorexic cats feel hungry. Mirtazipine also has the added benefit of reducing nausea. Both Cyproheptadine and Mirtazipine can cause some behavioral changes in kitties such as increased activity and vocalization.


Amlodipine: As we mentioned in the first installment of this series, cats with kidney disease often become hypertensive because they kidneys play a key role in regulating blood pressure. Amlodipine (a generic of Norvasc) is a blood pressure medication that is commonly prescribed to cats with renal insufficiency. Amlodipine is not metabolized through the kidneys, making it safe for cats with compromised kidney function.
Epogen: As kidney function decreases, the kidneys lose their ability to create erithropoiten, the hormone that controls the production of red blood cells. Epogen is a hormone injection given to severely anemic cats to stimulate the manufacturing of red blood cells.


Potassium: Cats with renal disease will often experience some weakness when their potassium levels become low. Potassium supplements can improve their mobility and quality of life significantly. These can come in pill form, powder form (both pill and powder form are marketed under the name Tumil-K), or even be added to a fluid bag.


Fluids: Subcutaneous (given under the skin) fluids can be given to help the kidneys filter out toxins and keep the cat hydrated. In acute renal failure cats, intravenous (commonly called “IV”) fluids are often given during hospitalization to stabilize their condition, followed by regular subcutaneous fluids at home to maintain their kidney function. While injecting your cat with fluids at home might seem daunting, it is fairly easy to do once a comfort level is achieved. Most cats tolerate the administration of fluids well, especially if given positive reinforcement during the treatment.

This segment of the series was an overview of some of the common treatments for cats with kidney disease. In the final installment, we will post step-by-step instructions on administering injections and subcutaneous fluids!


The Cat Doctor is a full service medical and surgical facility exclusively for cats. Established in 1983, in the Art Museum area of  Philadelphia, the hospital has served the Philadelphia community well for over twenty years, providing excellent comprehensive and compassionate care.

The Cat Doctor works with local rescues and animal welfare organizations, and is well known to readers who followed the case of Clark Kent. In cooperation with rescue group City Kitties, The Cat Doctor cared for Clark after he was found, cold, wet, abandoned and near death, and provided photos and updates for his thousands of supporters and well-wishers.

The practice also maintains an active Facebook page, where visiting cats and staff mascot and blood donor kitty Diamond get their pictures and updates posted regularly.

This article is reprinted with permission from their website, where it is posted here.

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