Banner 10000032
RENAL PROBLEMS AND CRF CHRONIC RENAL FAILURE IN CATS
Some feline chronic renal disease symptoms to watch for are Excessive urination ,loss of appetitite, excessive thirst, nausea, vomiting, constipation, weight loss, muscle wasting, poor hair coat, weakness, depression, detached retinas, amnonia smelling breath, lack of appetite and over all weakness. Chronic renal failure problems usually associated with older cats. PKD (PKD can be found in younger cats, especially Persians and Siamese.

The kidneys have four functions.

  • Filterswaste products from the body .
  • Regulates electrolytes (potassium, calcium, phosphorus and sodium).
  • Produces erythropoietin, which indirectly helps to produce red blood cells.
  • Produces the enzyme renin which controls blood pressure The Abyssinian, Burmese,Balinese ,Main Coon Siamese, and Russian Blue breeds are more susceptible to chronic renal failure

    recipes for crfRenal Dietary ideas and some commercial food
    A site that lists a place for supplies for CRF
    Am J Cardiol. 2003 Dec 1;92(11):1335-9. : Relation of dietary fat and fiber to elevation of C-reactive protein.
    King DE, Egan BM, Geesey ME.
    Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

    We examined the relation of dietary fiber, fat, and other dietary factors to levels of highly sensitive C-reactive protein (CRP) in 4,900 adult participants in the 1999 to 2000 National Health and Nutrition Examination Survey (NHANES 99-00), which was a cross-sectional study of a nationally representative sample of noninstitutionalized United States residents. After controlling for demographic factors, body mass index, smoking, alcohol consumption, exercise, and total caloric intake, subjects in the third and fourth highest quartiles of fiber consumption had a lower risk of elevated CRP (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.43 to 0.96; OR 0.58, 95% CI 0.38 to 0.88, respectively) compared with the lowest quartile. Saturated fat consumption was modestly associated with elevated CRP (third quartile: OR 1.58, 95% CI 1.02 to 2.44; fourth quartile 1.44, 95% CI 0.80 to 2.58). The findings suggest that inflammation may link dietary fiber and fat to cardiovascular disease.
    Kidney Int. 2003 Dec;64(6):2100-2107. : Dietary flaxseed meal reduces proteinuria and ameliorates nephropathy in an animal model of type II diabetes mellitus.
    Velasquez MT, Bhathena SJ, Ranich T, Schwartz AM, Kardon DE, Ali AA, Haudenschild CC, Hansen CT. Department of Medicine and Department of Pathology, George Washington University Medical Center, Washington D.C.; Phytonutrients Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland; Jerome Holland Laboratories, American Red Cross, Rockville, Maryland; and National Institutes of Health, Animal Genetic Resource, Bethesda, Maryland.

    Click here for JeffersPet.com
    Background. Evidence is emerging that varying the type or source of dietary protein intake can have beneficial effects on chronic renal disease. Consumption of soybean and soy-based food products, as the source of plant protein, can retard the development and progression of chronic renal disease. We studied the obese spontaneously hypertensive/NIH-corpulent (SHR/N-cp) rat, a model of obesity and type II diabetes mellitus that consistently develops nephropathy resembling diabetic nephropathy. We specifically sought to determine whether changing the source of protein intake from animal protein, casein, to plant protein in the form of either soy protein concentrate or flaxseed protein in the diet has a different impact on renal function and nephropathy in this model. Methods. Male obese SHR/N-cp rats were randomly assigned to one of three diets containing either 20% casein, 20% soy protein concentrate, or 20% flaxseed meal. Except for the protein source, all three diets were identical and contained similar amounts of protein, fat, carbohydrates, minerals, and vitamins. All animals were maintained on these diets for 6 months. At the end of the study, blood sampling and 24-hour urine collections were performed for renal functional measurements, and the kidneys were harvested and examined for histologic evaluation. Results. All three groups had similar amounts of food intake and body weight gain and exhibited fasting hyperglycemia and hyperinsulinemia. Plasma glucose levels did not differ among the three groups, but plasma insulin concentration was significantly lower in rats fed flaxseed meal than those fed either casein or soy protein concentrate. Mean plasma creatinine, creatinine clearance, and urinary urea excretion also did not differ significantly between the three groups. By contrast, urinary protein excretion was significantly lower (P < 0.01) in rats fed flaxseed than in rats fed either casein or soy protein concentrate. Morphologic analysis of renal structural lesions showed that the percentage of abnormal glomeruli with mesangial expansion and the tubulointerstitial score (an index of severity of tubulointerstitial damage) were significantly reduced in rats fed flaxmeal compared to those fed casein or soy protein concentrate. Conclusion. We conclude that dietary protein substitution with flaxseed meal reduces proteinuria and glomerular and tubulointerstitial lesions in obese SHR/N-cp rats and that flaxseed meal is more effective than soy protein in reducing proteinuria and renal histologic abnormalities in this model. The reduction in proteinuria and renal injury was independent of the amount of protein intake and glycemic control. Which dietary component(s) present in flaxseed meal is (are) responsible for the renal protective effect remains to be determined.
    Kidney Int. 2003 Dec;64(6):2100-2107. : Dietary flaxseed meal reduces proteinuria and ameliorates nephropathy in an animal model of type II diabetes mellitus.
    Velasquez MT, Bhathena SJ, Ranich T, Schwartz AM, Kardon DE, Ali AA, Haudenschild CC, Hansen CT.
    Department of Medicine and Department of Pathology, George Washington University Medical Center, Washington D.C.; Phytonutrients Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, Maryland; Jerome Holland Laboratories, American Red Cross, Rockville, Maryland; and National Institutes of Health, Animal Genetic Resource, Bethesda, Maryland.


    Background. Evidence is emerging that varying the type or source of dietary protein intake can have beneficial effects on chronic renal disease. Consumption of soybean and soy-based food products, as the source of plant protein, can retard the development and progression of chronic renal disease. We studied the obese spontaneously hypertensive/NIH-corpulent (SHR/N-cp) rat, a model of obesity and type II diabetes mellitus that consistently develops nephropathy resembling diabetic nephropathy. We specifically sought to determine whether changing the source of protein intake from animal protein, casein, to plant protein in the form of either soy protein concentrate or flaxseed protein in the diet has a different impact on renal function and nephropathy in this model. Methods. Male obese SHR/N-cp rats were randomly assigned to one of three diets containing either 20% casein, 20% soy protein concentrate, or 20% flaxseed meal. Except for the protein source, all three diets were identical and contained similar amounts of protein, fat, carbohydrates, minerals, and vitamins. All animals were maintained on these diets for 6 months. At the end of the study, blood sampling and 24-hour urine collections were performed for renal functional measurements, and the kidneys were harvested and examined for histologic evaluation. Results. All three groups had similar amounts of food intake and body weight gain and exhibited fasting hyperglycemia and hyperinsulinemia. Plasma glucose levels did not differ among the three groups, but plasma insulin concentration was significantly lower in rats fed flaxseed meal than those fed either casein or soy protein concentrate. Mean plasma creatinine, creatinine clearance, and urinary urea excretion also did not differ significantly between the three groups. By contrast, urinary protein excretion was significantly lower (P < 0.01) in rats fed flaxseed than in rats fed either casein or soy protein concentrate. Morphologic analysis of renal structural lesions showed that the percentage of abnormal glomeruli with mesangial expansion and the tubulointerstitial score (an index of severity of tubulointerstitial damage) were significantly reduced in rats fed flaxmeal compared to those fed casein or soy protein concentrate. Conclusion. We conclude that dietary protein substitution with flaxseed meal reduces proteinuria and glomerular and tubulointerstitial lesions in obese SHR/N-cp rats and that flaxseed meal is more effective than soy protein in reducing proteinuria and renal histologic abnormalities in this model. The reduction in proteinuria and renal injury was independent of the amount of protein intake and glycemic control. Which dietary component(s) present in flaxseed meal is (are) responsible for the renal protective effect remains to be determined.
    Nippon Jinzo Gakkai Shi. 1989 Jan;31(1):15-24. : [Pathophysiological mechanism of ischemic acute renal failure: protective effect of coenzyme Q10, Ca channel blocker, superoxide dismutase and protease inhibitor against ischemic acute renal failure]
    [Article in Japanese]
    Higuchi C.

    Ischemic insult has been considered a cause of cellular injuries under certain circumstance, such as the disturbance of energy metabolism, the alternation of calcium homeostasis, the production of oxygen radical and the release of lysosomal protease. The present study was designed to clarify the pathophysiological effects of coenzyme Q10 (CoQ10), diltiazem, superoxide dismutase (SOD) and urinastatin on the development and progression of ischemic acute renal failure (IARF) of the rat. At 24 hours after reflow following 45 minutes ischemia, serum urea nitrogen, creatinine and fractional excretion of sodium were 99.3 mg/dl, 3.14 mg/dl, 5.95% respectively, in non-treated IARF rats. Renal ATP content was reduced to 0.91 micrograms/mg. prot. from 10.59 micrograms/mg. prot. at 10 minutes after ischemic insult, and remained at almost the same level throughout the entire 45 minutes ischemia. Although the subsequent blood reflow resulted in the recovery of ATP content, it was up to 50% of normal level at 24 hours after reflow following 45 minutes ischemia. During the ischemic period, the pathological changes were mild, whereas, after reflow, tissue involvement was mainly localized in the S3 segment of the proximal tubule. Major alteration were the loss of brush border, high amplitude swelling of mitochondria with matrical densities and fragmentation of the epithelial cell. At 24 hours after reflow, it was observed that renal function was superior in IARF rats treated with CoQ10, diltiazem, SOD and urinastatin. The treated rats also had higher ATP contents and showed less pathological changes than non-treated rats. Among these inhibitory agents, diltiazem exerted the most reliable effect. From these results, it was concluded that IARF was obviously caused by such pathophysiological mechanisms as mentioned above. Especially, Ca influx into the cells is one of the most important factors on pathogenesis of IARF
    Bratisl Lek Listy. 2000;101(9):490-4. : [Malondialdehyde and selected antioxidant plasma levels in conservatively treated patients with kidney diseases]
    [Article in Slovak]
    Gazdikova K, Gvozdjakova A, Kucharska J, Spustova V, Braunova Z, Dzurik R.
    Institute of Preventive and Clinical Medicine, Limbova 14, SK-833 01 Bratislava 37, Slovakia.
    gazdikova@upkm.sk

    Oxidation stress and decreased antioxidative capacity participate in the progression and complications of renal diseases such as hyperlipoproteinemia or cardiovascular diseases. Many data have been collected on oxidation stress in dialysed patients, however a shortage of information is evident in conservatively treated patients. STUDY AIMS: To determine the blood and/or plasma levels of MDA and the selected antioxidants, i.e. Coenzyme Q10 (CoQ), alpha-tocoferol, beta-carotene in conservatively treated patients with kidney diseases. PATIENTS AND METHODS: Fifty five patients (45 with interstitial nephritis and 10 with glomerulonephritis) were included. They were divided into 3 subgroups on the basis of their clearance of creatinine (Ckr). Only validated methods have been exploited for the determination of variables. RESULTS: MDA plasma levels were increased (5.37 +/- 0.10, reference range (rr.) < 4.5 mumol/l) with the highest levels in patients treated by immunosuppression. CoQ plasma (0.35 +/- 0.04, rr. 0.4-1.0 mumol/l) and blood (0.30 +/- 0.03 mol/l) were decreased, notably in patients with interstitial nephritis. No correlation with Ckr was apparent. alpha-tocopherol plasma levels (42.1 +/- 3.04, rr. 15-40 mumol/l) were increased, but the concentrations increased further with the decreasing kidney function. beta-carotene plasma (2.14 +/- 0.39, rr. > 0.8 mumol/l) were in reference range but decreased with the decrease of kidney function. CONCLUSIONS: CoQ plasma levels are decreased and MDA levels increased in conservatively treated kidney disease patients even in just slightly decreased renal function. beta-carotene levels decrease only in advanced renal failure. These changes could participate in kidney disease progression and it is suggested that their correction opens the possibility of progression inhibition. (Tab. 3, Ref. 27.)
    Am J Kidney Dis. 2003 Jul;42(1):44-52. : Relationship between C-reactive protein, albumin, and cardiovascular disease in patients with chronic kidney disease.
    Menon V, Wang X, Greene T, Beck GJ, Kusek JW, Marcovina SM, Levey AS, Sarnak MJ.

    BACKGROUND: C-Reactive protein (CRP) level is elevated in kidney failure and may be related to malnutrition and cardiovascular disease (CVD). Data are limited regarding relationships between CRP levels and glomerular filtration rate (GFR), nutritional indices, and CVD in patients with earlier stages of kidney disease. METHODS: CRP was assayed from samples from the Modification of Diet in Renal Disease (MDRD) Study (n = 801). CRP distributions were compared between the MDRD Study and National Health and Nutrition Examination Survey (NHANES; 1999 to 2000). Associations between CRP level and GFR, nutritional indices, serum albumin levels, and CVD risk factors were examined in the MDRD Study. RESULTS: Geometric means of CRP, adjusted for age and sex, were similar in NHANES (0.23 mg/dL) and the MDRD Study (0.22 mg/dL). In the MDRD Study, CRP level was related directly to measures of body fat and CVD risk factors, inversely with serum albumin level and energy intake, and unrelated to GFR. In multivariable analysis adjusting for other determinants of serum albumin level, high CRP level (>0.6 mg/dL) was associated with a 0.07-g/dL (0.7-g/L; 95% confidence interval [CI], 0.03 to 0.12) lower mean serum albumin level. After adjusting for traditional CVD risk factors, the odds of CVD were 1.73 (95% CI, 1.07 to 2.78) times greater in subjects with a high CRP level. CONCLUSION: GFR level does not appear to influence CRP level in the earlier stages of chronic kidney disease. CRP levels are independently associated with serum albumin level and CVD prevalence. Inflammation may be involved in the pathophysiological state of malnutrition and CVD in the earlier stages of predominantly nondiabetic kidney disease.
    J Vet Pharmacol Ther. 2003 Aug;26(4):283-290. : RENAL AND CARDIOVASCULAR DRUGS.
    Flournoy WS, Wohl JS, Albrecht-Schmitt TJ, Schwartz DD.
    Walter Reed Army Institute of Research, Washington, DC, USA; Department of Clinical Sciences and Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, AL, USA.

    The presence of dopamine (DA) receptors in feline kidneys is a matter of contention. Radioligand binding and Western blotting studies were employed to determine whether DA receptors are present in feline kidneys. The pharmacologic profile of the selective D1-receptor antagonist [3H]-SCH 23390 was studied in renal cortical membrane preparations from cats by conducting saturation binding isotherm and competitive binding experiments. [3H]-SCH 23390 bound to feline renal cortical membranes in a manner consistent with labeling of a D1-like receptor. The binding profile revealed a single site D1-like or D1 receptor in the feline renal cortex with a Kd = 7.8 +/- 1.0 nmol/L and Bmax = 76.5 +/- 19.5 fmol/mg. Competitive binding studies for [3H]-SCH 23390 against unlabeled agonists yielded the following Ki values and rank order of competition: SKF38393 (Ki = 0.47 +/- 0.26 microm) > fenoldopam (Ki = 3.12 +/- 1.1 microm) > DA (Ki = 933.1 +/- 1.6 microm). Competitive binding studies for [3H]-SCH-23390 against unlabeled antagonists yielded the following rank order of competition: SCH 23390 (Ki = 1.97 +/- 0.81 microm) > spiperone (Ki = 3.79 +/- 0.79) > metoclopramide (Ki = 4.26 +/- 2.4 microm). Western blot analysis with anti-DA D1 receptor antibodies detected a single band with Mr of 74 kDa corresponding to a D1 DA receptor. These results suggest that a putative D1-like or D1 receptor exists in feline kidneys different from those previously identified in rat, dog or human kidneys
    J Small Anim Pract. 2003 Jun;44(6):261-8. : Acid-base balance of cats with chronic renal failure: effect of deterioration in renal function.
    Elliott J, Syme HM, Markwell PJ.
    Royal Veterinary College, Royal College Street, London NW1 0TU.

    In a previous cross-sectional study of feline chronic renal failure (CRF), metabolic acidosis was identified in 52.6 per cent of animals with severe renal failure (plasma creatinine concentration >400 micromol/litre). The aim of this longitudinal study was to determine whether metabolic acidosis preceded or accompanied a deterioration in renal function in cats with CRF. Data were analysed from 55 cats with CRF that had been followed longitudinally for at least four months. Twenty-one cases showed deterioration in renal function over the period of the study, as evidenced by significant rises in their plasma creatinine concentrations and decreases in bodyweight. In five of the 21 cases, acidaemia accompanied the deterioration in renal function. Only one of these cats had evidence of metabolic acidosis before renal function deterioration. One other case developed metabolic acidosis without a rise in plasma creatinine concentration. These data suggest that biochemical evidence of metabolic acidosis does not generally occur until late in the course of feline CRF. J Vet Med Sci. 2003 Apr;65(4):545-8. : Evaluation of feline serum amyloid A (SAA) as an inflammatory marker.
    Sasaki K, Ma Z, Khatlani TS, Okuda M, Inokuma H, Onishi T.
    Laboratory of Veterinary Internal Medicine, Faculty of Agriculture, Yamaguchi University, Yoshida, Japan.

    1-800-PetMeds  -  Save $5
    The concentration of feline serum amyloid A (fSAA) was determined by a direct enzyme-linked immunosorbent assay (ELISA) by using fSAA specific monoclonal antibodies, to evaluate the fSAA as an inflammatory marker in cats. The mean concentration +/- standard deviation of fSAA was found to be 0.60 +/- 1.06 microg/m l and 33.65 +/- 67.59 microg/ml in serum samples from normal cats (n=45) and cats (n=312) with various diseases and disorders, respectively. A significant difference (p<0.001) was found between the two groups. It was also found that the concentration of fSAA begins to increase rapidly at approximately 3-6 hr after spay, and increases up to significantly high levels in some disorders, like injury, renal failure, infectious diseases, etc.
    J Small Anim Pract. 2003 Feb;44(2):65-70. : Assessment of acid-base status of cats with naturally occurring chronic renal failure.
    Elliott J, Syme HM, Reubens E, Markwell PJ.
    Royal Veterinary College, Royal College Street, London NW1 0TU.

    Metabolic acidosis is reported to be a common complication of feline chronic renal failure (CRF) but acid-base status of feline patients with this disease is rarely assessed by general practitioners. A cross-sectional study involving 59 cases of naturally occurring feline CRF was conducted to determine the prevalence of acid-base disturbances. Cases were categorised on the basis of their plasma creatinine concentrations as mild, moderate or severe. A group of 27 clinically healthy, age-matched cats was assessed for comparison. A low venous blood pH (<7.270) was found in 10 of the 19 severe cases (52.6 per cent), three of the 20 moderate cases (15 per cent) and none of the 20 mild cases. Acidaemia was associated with an increased anion gap contributed to by both low plasma bicarbonate and low chloride ion concentrations. Biochemical analysis of urine samples showed urine pH to decrease with increasing severity of renal failure. Urinary loss of bicarbonate was not associated with the occurrence of acidaemia and there was a tendency for urinary ammonium ion excretion to decrease as the severity of renal failure increased. Cats with naturally occurring CRF do not show plasma biochemical evidence of acid-base disturbances until the disease is advanced.
    Vet Clin North Am Small Anim Pract. 2003 Jan;33(1):119-34. : Renal cytology.
    Borjesson DL.
    Department of Veterinary Diagnostic Medicine, University of Minnesota, 1333 Gortner Avenue, St. Paul, MN 55108, USA.
    borje002@umn.edu

    FNA of renal tissue is a rapid and noninvasive diagnostic tool that can be optimized by a thorough understanding of renal diseases, anatomy, and the ultrasonographic appearance of lesions likely to exfoliate for cytology. Signalment, history, and ancillary laboratory tests can narrow the list of differential diagnoses and help to determine whether cytologic evaluation will be sufficient or whether tissue architecture is needed for a definitive diagnosis. Renal cytology is particularly useful for the diagnosis of inflammation and neoplasia, including abscesses, FIP, mycotic infections, lymphoma, carcinoma, and metastatic neoplasia.
    Prev Vet Med. 2002 Sep 10;55(1):1-15. : Diet and lifestyle variables as risk factors for chronic renal failure in pet cats.
    Hughes KL, Slater MR, Geller S, Burkholder WJ, Fitzgerald C.
    Department of Veterinary Anatomy and Public Health, College of Veterinary Medicine, Texas A&M University, College Station 77843-4458, USA.
    A case-control study examining diet and lifestyle variables to generate hypotheses of potential risk factors for chronic renal failure in pet cats was conducted in five private practices in Texas, USA and at the Texas A&M University Veterinary Medical Teaching Hospital. A telephone questionnaire was used to gather information from owners of 38 cats newly diagnosed with CRF between December 1994 and 1995 and from owners of 56 control cats. Factor analysis was used to determine whether composite variables should be constructed to summarize the nutritional predictors adequately. The composite variables and other lifestyle variables were analyzed with logistic-regression. Three final exploratory models were developed: ad libitum feeding with fiber; ad libitum with Factor-2 (a composite variable composed of fiber, magnesium, protein, sodium and ash); and fiber alone. Ad libitum feeding and increased ash intake were associated with increased odds of CRF; increased dietary fiber, magnesium, protein and sodium were associated with decreased odds of CRF.
    J Am Vet Med Assoc. 2002 Jun 15;220(12):1799-804. Related Articles, Links Prevalence of systolic hypertension in cats with chronic renal failure at initial evaluation. Syme HM, Barber PJ, Markwell PJ, Elliott J. Department of Veterinary Basic Science, Royal Veterinary College, London, UK.
    OBJECTIVE: To determine prevalence of systolic hypertension and associated risk factors in cats with chronic renal failure evaluated in first-opinion practice. DESIGN: Prospective study. ANIMALS: 103 cats with chronic renal failure. PROCEDURE: Systolic arterial blood pressure (SABP) was measured with a noninvasive Doppler technique, and cats that had SABP > 175 mm Hg on 2 occasions or that had SABP > 175 mm Hg and compatible ocular lesions were classified as hypertensive. Information from the history (previous treatment for hyperthyroidism, age), physical examination (sex, body weight), routine plasma biochemical analyses (creatinine, cholesterol, potassium, sodium, chloride, and calcium concentrations), and thyroid status were evaluated as potential risk factors for systolic hypertension. Variables associated with systolic hypertension were evaluated by use of logistic regression. RESULTS: 20 (19.4%; 95% confidence interval, 13 to 28%) cats had systolic hypertension. Plasma potassium concentration was significantly and inversely associated with systolic hypertension. CONCLUSIONS AND CLINICAL RELEVANCE: Prevalence of systolic hypertension, although clinically important, was lower than that reported previously. The cause of the inverse association between systolic hypertension and plasma potassium concentration is not yet known. Am J Vet Res. 2002 Jun;63(6):833-9. Related Articles, Links Effects of the calcium channel antagonist amlodipine in cats with surgically induced hypertensive renal insufficiency. Mathur S, Syme H, Brown CA, Elliot J, Moore PA, Newell MA, Munday JS, Cartier LM, Sheldon SE, Brown SA. Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens 30605, USA.
    OBJECTIVE: To determine whether amlodipine besylate decreases systemic arterial blood pressure (BP) and reduces the prevalence of complications in cats with induced hypertensive renal insufficiency. ANIMALS: 20 cats with partial nephrectomy. PROCEDURE: Following reduction in renal mass, 10 cats were administered 0.25 mg of amlodipine/kg, PO, q 24 h (group A). Ten cats served as a control group (group C). Systolic BP (SBP), diastolic BP (DBP), and mean BP (MBP), physical activity, and pulse rate were measured continuously for 36 days by use of radiotelemetric devices. RESULTS: Compared with values for clinically normal cats, SBP, DBP, and MBP were significantly increased in cats of group C. Cats in group A had significant reductions in SBP, DBP, and MBP, compared with values for cats in group C. Albuminuria but not urine protein-to-creatinine ratio was significantly correlated (R2 = 0.317) with SBP in hypertensive cats. Prevalence of ocular lesions attributable to systemic hypertension in group C (7 cats) was greater than that observed in group A (2). Two cats in group C were euthanatized on day 16 because of nuerologic complications attributed to systemic hypertension. One normotensive cat in group A was euthanatized because of purulent enteritis of unknown cause on day 27. CONCLUSIONS AND CLINICAL RELEVANCE: Amlodipine had an antihypertensive effect in cats with coexistent systemic hypertension and renal insufficiency. Its use may improve the prognosis for cats with systemic hypertension by decreasing the risk of ocular injury or neurologic complications induced by high BP.
    J Vet Intern Med. 2002 May-Jun;16(3):217-21. Related Articles, Links Comment in: J Vet Intern Med. 2002 May-Jun;16(3):215-6. Prevalence and incidence of serum magnesium abnormalities in hospitalized cats. Toll J, Erb H, Birnbaum N, Schermerhorn T. Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
    Total serum magnesium concentration ([Mg2+]s) was prospectively determined for 57 cats admitted to the intensive care unit (ICU) of the Cornell University Hospital for Animals. Data were collected and analyzed to determine the following: prevalence and incidence of [Mg2+] abnormalities, medical disorders associated with altered [Mg2+]s, association of altered [Mg2+]s with other electrolyte abnormalities, length of hospitalization for cats with abnormalities of [Mg2+]s versus those with normal [Mg2+]s, and survival of cats with abnormal [Mg2+)s versus those with normal [Mg2+]s. The point prevalence of magnesium abnormalities was 26%, the period prevalence was 46%, and the cumulative incidence was 23%. Hypermagnesemia was associated with abnormalities of serum potassium (P = .04) and phosphate (P = .01) concentrations. Abnormalities of [Mg2+]s were not associated with abnormal serum concentrations of Na+, Ca2+, or Cl-. On admission. hypomagnesemia was detected in cats with gastrointestinal, endocrine, and other disorders; hypermagnesemia was detected only in cats with renal disease, obstructive uropathy, or neoplastic disease. The median hospital stay for cats that developed abnormal [Mg2+]s after admission was longer than for cats that remained normomagnesemic (5 versus 4 days, respectively; P = .03). Despite the longer hospital stay, the survival of these cats was lower than that of normomagnesemic cats (54 versus 77%; P = .05). When all cats were considered, the survival of cats with abnormal [Mg2+]s also was decreased compared with normomagnesemic cats (62 versus 81%; P = .05). We conclude that abnormalities of [Mg2+]s may affect morbidity and mortality of affected cats.
    Prev Vet Med. 2002 Sep 10;55(1):1-15. : Diet and lifestyle variables as risk factors for chronic renal failure in pet cats.
    Hughes KL, Slater MR, Geller S, Burkholder WJ, Fitzgerald C.
    Department of Veterinary Anatomy and Public Health, College of Veterinary Medicine, Texas A&M University, College Station 77843-4458, USA.

    A case-control study examining diet and lifestyle variables to generate hypotheses of potential risk factors for chronic renal failure in pet cats was conducted in five private practices in Texas, USA and at the Texas A&M University Veterinary Medical Teaching Hospital. A telephone questionnaire was used to gather information from owners of 38 cats newly diagnosed with CRF between December 1994 and 1995 and from owners of 56 control cats. Factor analysis was used to determine whether composite variables should be constructed to summarize the nutritional predictors adequately. The composite variables and other lifestyle variables were analyzed with logistic-regression. Three final exploratory models were developed: ad libitum feeding with fiber; ad libitum with Factor-2 (a composite variable composed of fiber, magnesium, protein, sodium and ash); and fiber alone. Ad libitum feeding and increased ash intake were associated with increased odds of CRF; increased dietary fiber, magnesium, protein and sodium were associated with decreased odds of CRF.
    Kidney Transplantation as a Treatment for Chronic Renal Failure in Cats: General Information and Specifics about Feline Renal Transplantation at the University of Wisconsin
    Survival of cats with naturally occurring chronic renal failure: effect of dietary management
    . Elliott J, Rawlings JM, Markwell PJ, Barber PJ
    Royal Veterinary College, London.
    J Small Anim Pract 2000 Jun;41(6):235-42

    Fifty cats with naturally occurring stable chronic renal failure (CRF) were entered into a prospective study on the effect of feeding a veterinary diet restricted in phosphorus and protein with or without an intestinal phosphate binding agent on their survival from initial diagnosis. Twenty-nine cats accepted the veterinary diet, whereas compliance (due to limited intake by the cats or owner resistance to diet change) was not achieved in the remaining 21. At diagnosis, both groups of cats were matched in terms of age, bodyweight, plasma creatinine, phosphate, potassium and parathyroid hormone (PTH) concentrations, packed cell volume and urine specific gravity. Feeding the veterinary diet was associated with a reduction in plasma phosphate and urea concentrations and prevented the increase in plasma PTH concentrations seen in cats not receiving the diet. Cats fed the veterinary diet survived for longer when compared with those that were not (median survival times of 633 versus 264 days). These data suggest that feeding a diet specifically formulated to meet the needs of cats with CRF, together with phosphate binding drugs if required, controls hyperphosphataemia and secondary renal hyperparathyroidism, and is associated with an increased survival time


    Iams
    Eukanuba Veterinary Diets Nutritional Kidney Formula Multi-Stage Renal (Iams) diet for cats in all stages of chronic renal failure. Features the exclusive Nitrogen Trap Fiber System. Allows for the feeding of optimal protein levels and provides outstanding palatability and maintained body weight. Helps cats by repartitioning the nitrogen created by protein metabolism for the urine to the feces. Comprised of beet pulp, gum arabic, and fructooligosaccharides (FOS), increases the animal's fecal nitrogen excretion by up to 34 percent. A proven fiber system that reduces reliance on the kidney for nitrogen waste excretion. Results in a stronger, healthier animal. Contains a 28-percent protein level, designed to meet the cat's protein requirements. This protein level helps cats maintain body weight, muscle mass and organ function. Cats exhibit physical signs of improvement in appearance and activity levels after three weeks of eating the formula. Available in a 5.5-pound bag, the diet is a moderate protein formula that helps nutritionally slow the progression of kidney dysfunction while working to maintain proper blood urea nitrogen (BUN) levels. It also fulfills the cat's nutrient and energy requirements. Contact: Iam's
    Nadia's CRF Site
    J Feline Med Surg. 2000 Jun;2(2):75-82. : Dietary management of feline chronic renal failure: where are we now? In what direction are we headed?
    Polzin DJ, Osborne CA, Ross S, Jacob F.
    College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA.

    Dietary modification is of primary importance in managing cats with chronic renal failure. Diets designed for cats with chronic renal failure are typically formulated to be pH neutral and contain reduced quantities of protein, phosphorus and sodium and an increased quantity of potassium. These changes in diet formulation are designed to ameliorate clinical signs of renal failure by adapting dietary intakes to meet the limited ability of failing kidneys to adapt to the normal range of dietary intakes. Important recent clinical trials support the therapeutic value of dietary therapy in cats with chronic renal failure. Copyright 2000 European Society of Feline Medicine
    J Nutr. 2002 Mar;132(3):456-60. : Net protein oxidation is adapted to dietary protein intake in domestic cats (Felis silvestris catus).
    Russell K, Murgatroyd PR, Batt RM.
    Waltham Centre for Pet Nutrition, Waltham on the Wolds, Melton Mowbray, Leics LE14 4RT, UK.
    kim.russell@eu.effem.com

    Cats have a requirement for dietary protein two to three times that of omnivores and herbivores. This was reported to be due to the hepatic catabolic enzymes of this species being set to a permanently high level and, therefore, showing little adaptation to low dietary protein. A major mechanism for adapting to dietary protein in other species is amino acid oxidation (hereafter referred to as protein oxidation), and the objective of this study was to determine whether protein oxidation in cats was correlated with protein intake. Net protein and net fat oxidation in six adult cats were studied directly from gas exchanges using indirect calorimetry, after feeding moderate protein (MP; 35% energy) and high protein (HP; 52% energy) diets. Protein oxidation was significantly higher (P < 0.05) when cats were fed the HP diet (28.4 plus minus 0.7 mg/min) rather than the MP diet (20.4 plus minus 0.8 mg/min). Fat oxidation was significantly higher (P < 0.05) when cats consumed the MP diet (9.0 plus minus 0.7 mg/min) rather than the HP diet (4.7 plus minus 0.5 mg/min). Protein oxidation was significantly correlated (linear regression, R(2) = 46.0, P < 0.05) with protein intake such that the mean ratio of 18-h oxidation: 18-h intake was 1.2 on both diets. Fat oxidation was significantly correlated (linear regression, R(2) = 18.9, P < 0.05) with fat intake such that the mean ratio of 18-h fat oxidation: 18-h fat intake was 1.1 (MP) and 0.9 (HP). This study demonstrated that cats adapt net protein oxidation at these levels of protein intake, and the reason for the high dietary protein requirement of this species is, therefore, unclear.
    Br J Nutr. 2003 Jan;89(1):29-37. : Whole-body protein turnover of a carnivore, Felis silvestris catus.
    Russell K, Lobley GE, Millward DJ.
    Waltham Centre for Pet Nutrition, Melton Mowbray LE14 4RT, UK. kim.russell@eu.effem.com

    The cat (Felis silvestris catus) has a higher dietary protein requirement than omnivores and herbivores, thought to be due to metabolic inflexibility. An aspect of metabolic flexibility was examined with studies of whole-body protein turnover at two levels of dietary protein energy, moderate protein (MP; 20 %) and high protein (HP; 70 %), in five adult cats in a crossover design. Following a 14 d pre-feed period, a single intravenous dose of [15N]glycine was administered and cumulative excretion of the isotope in urine and faeces determined over 48 h. N flux increased (P<0.005) with dietary protein, being 56 (se 5) mmol N/kg body weight (BW) per d for cats fed the MP diet and 146 (se 8) mmol N/kg BW per d for cats fed the HP diet. Protein synthesis was higher (P<0.05) on the HP diet (75 (se 10) mmol N/kg BW per d; 6.6 (se 1) g protein/kg BW per d) than the MP diet (38 (se 5) mmol N/kg BW per d; 3.4 (se 0.4) g protein/kg BW per d). Protein breakdown was higher (P<0.05) on the HP diet (72 (se 8) mmol N/kg BW per d; 6.3 (se 0.7) g protein/kg BW per d) than the MP diet (44 (se 3) mmol N/kg BW per d; 3.9 (se 0.3) g protein/kg BW per d). Compared with other species the rate of whole-body protein synthesis in the well-nourished cat (9.7 (se 1.3) g protein/kg BW0.75 per d) is at the lower end of the range. These results show that feline protein turnover adapts to dietary protein as has been shown in other species and demonstrates metabolic flexibility. Further work is required to determine exactly why cats have such a high protein requirement.
    J Small Anim Pract. 2003 Feb;44(2):65-70. : Assessment of acid-base status of cats with naturally occurring chronic renal failure.
    Elliott J, Syme HM, Reubens E, Markwell PJ.
    Royal Veterinary College, Royal College Street, London NW1 0TU.

    Metabolic acidosis is reported to be a common complication of feline chronic renal failure (CRF) but acid-base status of feline patients with this disease is rarely assessed by general practitioners. A cross-sectional study involving 59 cases of naturally occurring feline CRF was conducted to determine the prevalence of acid-base disturbances. Cases were categorised on the basis of their plasma creatinine concentrations as mild, moderate or severe. A group of 27 clinically healthy, age-matched cats was assessed for comparison. A low venous blood pH (<7.270) was found in 10 of the 19 severe cases (52.6 per cent), three of the 20 moderate cases (15 per cent) and none of the 20 mild cases. Acidaemia was associated with an increased anion gap contributed to by both low plasma bicarbonate and low chloride ion concentrations. Biochemical analysis of urine samples showed urine pH to decrease with increasing severity of renal failure. Urinary loss of bicarbonate was not associated with the occurrence of acidaemia and there was a tendency for urinary ammonium ion excretion to decrease as the severity of renal failure increased. Cats with naturally occurring CRF do not show plasma biochemical evidence of acid-base disturbances until the disease is advanced.
    J Am Vet Med Assoc. 2002 Jun 15;220(12):1799-804. : Prevalence of systolic hypertension in cats with chronic renal failure at initial evaluation.
    Syme HM, Barber PJ, Markwell PJ, Elliott J.
    Department of Veterinary Basic Science, Royal Veterinary College, London, UK.

    OBJECTIVE: To determine prevalence of systolic hypertension and associated risk factors in cats with chronic renal failure evaluated in first-opinion practice. DESIGN: Prospective study. ANIMALS: 103 cats with chronic renal failure. PROCEDURE: Systolic arterial blood pressure (SABP) was measured with a noninvasive Doppler technique, and cats that had SABP > 175 mm Hg on 2 occasions or that had SABP > 175 mm Hg and compatible ocular lesions were classified as hypertensive. Information from the history (previous treatment for hyperthyroidism, age), physical examination (sex, body weight), routine plasma biochemical analyses (creatinine, cholesterol, potassium, sodium, chloride, and calcium concentrations), and thyroid status were evaluated as potential risk factors for systolic hypertension. Variables associated with systolic hypertension were evaluated by use of logistic regression. RESULTS: 20 (19.4%; 95% confidence interval, 13 to 28%) cats had systolic hypertension. Plasma potassium concentration was significantly and inversely associated with systolic hypertension. CONCLUSIONS AND CLINICAL RELEVANCE: Prevalence of systolic hypertension, although clinically important, was lower than that reported previously. The cause of the inverse association between systolic hypertension and plasma potassium concentration is not yet known.
    Eur Heart J. 2003 Mar;24(5):412-20. : Comment in: Eur Heart J. 2003 Mar;24(5):381-3.
    Accelerated decline and prognostic impact of renal function after myocardial infarction and the benefits of ACE inhibition: the CATS randomized trial.
    Hillege HL, van Gilst WH, van Veldhuisen DJ, Navis G, Grobbee DE, de Graeff PA, de Zeeuw D; CATS Randomized Trial.
    Department of Cardiology/Thoraxcenter, University Hospital Groningen, Hanzeplein 1, 9700 Groningen, The Netherlands.
    h.hillege@tcc.azg.nl

    AIMS: Information regarding the cardiorenal axis in patients after a myocardial infarction (MI) is limited. We examined the change in renal function after a first MI, the protective effect of angiotensin converting enzyme (ACE) inhibition and the prognostic value of baseline renal function. METHODS AND RESULTS: The study population consisted of 298 patients with a first anterior wall MI who were randomized to the ACE inhibitor captopril or placebo after completion of streptokinase infusion. Renal function, by means of glomerular filtration rate (GFR), was calculated using the Cockroft-Gault equation (GFR(c)). In the placebo group, renal function (GFR(c)) declined by 5.5 min(-1)within 1 year, vs only 0.5 ml min(-1)in the ACE inhibitor group (P<0.05). This beneficial effect of captopril was most pronounced in patients with the most compromised renal function at baseline. The incidence of chronic heart failure (CHF) within 1 year increased significantly with decreasing GFR(c)(divided into tertiles: 24.0, 28.9, and 41.2%; P<0.01). The risk-ratio for GFR(c)<81 ml min(-1)vs >103 mL min(-1)was 1.86 (95% CI 1.11-3.13; P=0.019). CONCLUSIONS: Renal function markedly deteriorates after a first MI, but is significantly preserved by ACE inhibition. Furthermore, an impaired baseline renal function adds to the prognostic risk of developing CHF in patients after a first anterior MI.
    J Am Vet Med Assoc. 2002 Jan 1;220(1):49-52, 36. : Acute renal failure caused by lily ingestion in six cats.
    Langston CE.
    Bobst Hospital, the Animal Medical Center, 510 E 62nd St, New York, NY 10021, USA.

    Acute renal failure was diagnosed in 6 cats that had ingested Easter lily or tiger lily plants. All 6 were treated medically; 2 underwent hemodialysis. Three cats survived the acute episode, and although they had chronic renal failure, they survived for more than 1.5 years. Two cats died despite aggressive medical management, including hemodialysis. One cat was euthanatized shortly after the diagnosis was made. Three of the cats were oliguric or anuric at the time of initial examination, and all 3 died. None of the 3 cats that survived had oliguria or anuria. Various members of the lily family (Liliaceae) can cause nephrotoxicosis in cats, but the toxic principle is not known. Although the prognosis for full recovery of cats with lily toxicosis is poor, long-term survival is possible with supportive care. The prognosis appears to be better for cats with nonoliguric renal failure.
    J Vet Pharmacol Ther. 2002 Oct;25(5):371-8. : Effect of renal insufficiency on the pharmacokinetics and pharmacodynamics of benazepril in cats.
    King JN, Strehlau G, Wernsing J, Brown SA.
    Novartis Animal Health Inc., Basel, Switzerland.
    jonathan.king@ah.novartis.com

    The effect of renal insufficiency was studied on the pharmacokinetics (PK) and pharmacodynamics (PD) of the angiotensin-converting enzyme (ACE) inhibitor benazepril in cats. The active metabolite of benazepril, benazeprilat, is eliminated principally ( approximately 85%) via biliary excretion in cats. A total of 20 control animals and 32 cats with moderate renal insufficiency induced by partial nephrectomy were used. Assessments were made at steady state after treatment with placebo or benazepril (0.25-2 mg/kg) once daily for a minimum of 10 days. The PK endpoint was the AUC (0-->24 h) of total plasma benazeprilat. The PD endpoints were systolic, diastolic and mean blood pressures (respectively SBP, DBP and MBP) measured by telemetry, and plasma ACE activity, assessed by an ex vivo assay. Renal function was assessed by glomerular filtration rate (GFR), measured by inulin clearance, and plasma creatinine concentrations (1/PCr). As compared with control animals, the renal insufficient cats had a 78% reduction in GFR (0.57 +/- 0.41 mL/min kg), increased plasma creatinine (2.7 +/- 1.0 mg/dL), urea (44.0 +/- 11.9 mg/dL) and ACE activity, and moderately increased blood pressure (SBP 171.8 +/- 5.1 mmHg) (all parameters P < 0.05). Renal insufficient cats receiving benazepril had significantly (P < 0.05) lower SBP, DBP, MBP and ACE, and higher GFR values as compared with placebo-treated animals. There were no significant differences in SBP, DBP, MBP, benazeprilat or ACE values according to the degree of renal insufficiency in cats receiving benazepril. It is concluded that no dose adjustment of benazepril is necessary in cats with moderate renal insufficiency.
    Am J Vet Res. 2002 Jun;63(6):833-9. : Effects of the calcium channel antagonist amlodipine in cats with surgically induced hypertensive renal insufficiency.
    Mathur S, Syme H, Brown CA, Elliot J, Moore PA, Newell MA, Munday JS, Cartier LM, Sheldon SE, Brown SA.
    Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens 30605, USA.

    OBJECTIVE: To determine whether amlodipine besylate decreases systemic arterial blood pressure (BP) and reduces the prevalence of complications in cats with induced hypertensive renal insufficiency. ANIMALS: 20 cats with partial nephrectomy. PROCEDURE: Following reduction in renal mass, 10 cats were administered 0.25 mg of amlodipine/kg, PO, q 24 h (group A). Ten cats served as a control group (group C). Systolic BP (SBP), diastolic BP (DBP), and mean BP (MBP), physical activity, and pulse rate were measured continuously for 36 days by use of radiotelemetric devices. RESULTS: Compared with values for clinically normal cats, SBP, DBP, and MBP were significantly increased in cats of group C. Cats in group A had significant reductions in SBP, DBP, and MBP, compared with values for cats in group C. Albuminuria but not urine protein-to-creatinine ratio was significantly correlated (R2 = 0.317) with SBP in hypertensive cats. Prevalence of ocular lesions attributable to systemic hypertension in group C (7 cats) was greater than that observed in group A (2). Two cats in group C were euthanatized on day 16 because of nuerologic complications attributed to systemic hypertension. One normotensive cat in group A was euthanatized because of purulent enteritis of unknown cause on day 27. CONCLUSIONS AND CLINICAL RELEVANCE: Amlodipine had an antihypertensive effect in cats with coexistent systemic hypertension and renal insufficiency. Its use may improve the prognosis for cats with systemic hypertension by decreasing the risk of ocular injury or neurologic complications induced by high BP.
    Dealing with Chronic renal failure....and loss

    This was forwarded to me an email and I was told that although the original writer was unknown it should be all right to include the wisdom on this webpage
    This could be useful for future reference to those of you prepared to go the extra mile for your cat/s/dog/s. It helped me to find that others suffer the same guilt, doubts, exhaustion, etc. Ella is on a bit of an uphill at the moment but is holding her own - long may she do so, the angelcat! 'bye Lorna Emotional Roller Coaster

    The progression of feline CRF has been compared to an emotional roller coaster ride by those who have gone through it, and, indeed it is. As time goes on, the sloping hills become steeper and closer together. There are up days and down days. Taking care of a CRF cat can be emotionally stressful, extremely frustrating and time-consuming for all involved. Your cupboards may be full of food your cat won't eat. You may wonder how much you are hurting the cat by giving sub-Q fluids. When the time comes for medication and then even more medication, you may agonize over how much more the cat can possibly bear. Our experience with Avatar has taught us that cats can, indeed, put up with quite a bit. After two and a half years of sub-Q fluids and two years of three pills twice a day and the loss of more than a third of his body weight, he remained the lovable, affectionate cat he had always been. In spite of your best efforts, your cat may become withdrawn and depressed. The first few times this happened to Avatar, we tried to steel ourselves for the worst. Each time, though, he bounced back (at least part way) and stayed at the new 'plateau' for weeks or even months. Each crisis plunged us into gloom. Each minor recovery elated us. Watching Avatar groom himself for a few minutes after recovering from one of his bad spells brightened our whole week. At first we considered each additional month as a gift, then each week and finally each day. Our efforts were focused on quality of time rather than quantity. Emotional Exhaustion

    The effects of caring for a CRF cat will eventually hit and you may feel exhausted and, occasionally, even angry at the cat. These are normal feelings. A caregiver's life is not easy. Be sure to take some time for yourself. Social Ostracism

    Friends and relatives may insinuate that you are quite mad to have chosen such a course of action. Only a true cat person will understand completely. The loss of respect from those who are judgmental is a small thing. The love you receive from your cat is unconditional and will more than compensate for any small-minded opinions from others. Financial Impact

    The financial impact can be substantial if the cat is able to maintain a reasonable quality of life for a long period of time. This is particularly true if you have sub-Q injections done at the veterinarian's office (as we did) rather than doing them yourself. Medication can also be expensive. If you are financially able to afford the expense, then it is well worth continuing on. We put off buying a new car for more than a year. If you examine the situation, you come to the realization that your money is buying life. What else could be so precious? Loss of Mobility-Curtailment of Activities

    Caring for a CRF cat can mean no extended periods of time away from home at all unless arrangements are made with a competent person to care for your cat while you're gone. When the condition is advanced, the cat will require some sort of special attention almost every day. This is not meant to imply that caring for a CRF cat is a constant vigil, but regular sub-Q fluids or regular medication regimens definitely limit your freedom of action. Since CRF cats urinate frequently and in greater volume, the litter box must be changed more often. If you must go away, you will have to make arrangements for someone to administer the sub-Q fluids and/or medications in your absence. This is not a casual cat-sitting situation. Check with the technicians at your veterinarian's office. Perhaps one of them would like to earn some extra money on the side and be willing to come to your home daily, if necessary, to care for your cat while you're away. The Burden of Making the Final Decision

    Eventually, either you or your cat will have to decide that the time has come to put an end to your efforts to prolong the cat's life. Since most cats in CRF rarely show signs of agony, or even severe discomfort until the very end, trying to judge the way the cat feels will become a constant preoccupation. You can expect to project your own anxiety onto the cat and try to read the cat's actions and expressions through the filter of your own distress. Most people who have made that final decision say that the cat let them know when the time had come. They are unable to explain exactly how this worked. In any case, the close relationship between a CRF cat and his caregiver does lead to a level of communication that is more profound than the usual cat-human interaction. As a caregiver, you will become attuned to tiny variations in the cat's attitude and health, so it is not unreasonable to assume that you will know when further efforts will be more deleterious than helpful. Although you may anticipate an enormous amount of guilt over making the final decision, you should keep in mind that some people have, in retrospect, experienced guilt at having prolonged an uncomfortable existence for too long. If your efforts on your cat's behalf are based on love, it's unlikely that you will make a serious error in judgment when the final decision must be made. There is no quantifiable measurement of the optimum time to end a life. It will be tough enough just to make the decision without agonizing over it after the fact. With Avatar, we tried to set markers to take the burden of making the final decision away from us. For example, we told ourselves that when his weight dwindled to a certain point or when he became too weak to jump onto his favorite perch, the decision would be made for us. In the end, though, the burden fell entirely on us. After closely watching the progression of his CRF for so long, we knew that Avatar would not be able to weather another crisis. The choice became one of waiting until he was suffering or acting to prevent that suffering. We opted for the latter. Saying Good-bye

    Talk with your veterinarian in advance about euthanasia so that you are fully informed and can make decisions early. It is a difficult choice, but one that must be made when your cat is in end-stage CRF. When the time actually comes, you will be emotionally overwhelmed and that's not a good time to try to make rational decisions. Your veterinarian will explain what options are available. You may or may not want to be present during the procedure. If you do, some veterinarians will consent to come to your home. Ask your veterinarian about giving a tranquilizer to the cat prior to the intravenous injection to reduce stress. Dispositions

    Funeral rituals are for the benefit of the living. This holds true for the loss of any loved one. Doing right by the deceased is a way of getting your own life in order and dealing with the loss. You will need to decide on either cremation or burial. In the first case, you must also decide if you want a private cremation (your cat only) or a communal cremation (several pets) and make your wishes known to your veterinarian. Private cremation is slightly more expensive but ensures that you will have your own cat's cremains returned to you, if you so desire. If you decide to have your cat buried, know in advance where pet cemeteries are located in your area and gather information on memorial stones and pet coffins. As with communal cremation, a communal burial may also be a suitable alternative. Cremains may also be buried. You also may decide to have a favorite toy or blanket buried or cremated with your cat. Grief

    The loss of a beloved cat can be devastating and the deep pain and grief may last a long time. No one can take the hurt away for you. But celebrating your cat's life may help. Remember your cat with a memorial garden. A photo collage can be comforting. Write down memories of the good times you had with your cat. Have a portrait done of your cat from a favorite photograph. Make a scrapbook full of memories and pictures of your cat. If your cat has been buried in a pet cemetery, visit occasionally. A number of pet-loss hotlines are available for counseling and support. Click here to find links to pet loss pages and Rainbow Bridge. Seek out friends who have gone through the same thing and can understand and sympathize. Although no cat can ever replace yours, eventually you may want to have another join your home and this is probably the best therapy of all.