By Ann Hohenhaus, DVM

Cat with Vet

An annual visit to your cat’s veterinarian will result in blood tests being submitted to a veterinary laboratory to test for a variety of diseases such as hyperthyroidism and chronic kidney disease. To the typical cat owner, a diagnosis of kidney disease sounds ominous, but it’s not always as bad as it sounds. Take for example my nephew cat BeeDee. He had a rough start in life, abandoned as a kitten at The Animal Medical Center following a head trauma incident. My sister adopted him and he lived a good life, twenty-one years to be exact, despite having been diagnosed with chronic kidney disease at age eighteen.

Kidney disease: The diagnosis

Estimates suggest one to three percent of cats will develop kidney disease during their lifetime and one in twelve geriatric cats has kidney disease. The diagnosis of chronic kidney disease in a cat like BeeDee is based on elevations in two blood tests: blood urea nitrogen, commonly abbreviated BUN, and creatinine plus evaluation of urine-specific gravity. In chronic kidney disease, the urine-specific gravity is neither concentrated nor dilute; it falls in a middle range known as isothenuric because the impaired kidneys no longer have the ability to concentrate or dilute the urine. Creatinine and BUN can be elevated in disorders other than chronic kidney disease such as a kidney infection or dehydration. Taking a urine sample from your cat to his annual examination will win you a gold star from your veterinarian and allow the urine to be tested to determine if chronic kidney disease is likely. For suggestions on how to collect feline urine, click here.

Severity scoring

The International Renal Interest Society (IRIS) developed guidelines to grade the severity of chronic kidney disease in cats and dogs. The IRIS guidelines rank kidney disease from stage I to stage IV as the creatinine increases. Since as many as twenty percent of cats with chronic kidney disease have hypertension, your cat’s veterinarian will recommend blood pressure monitoring. Blood pressure, urine protein level, and organ damage from hypertension all play a role in IRIS staging. As your cat’s stage increases, so does the need for treatment.

A low score wins!

A study of 211 cats with chronic kidney disease, performed at The AMC, showed IRIS stage based only on creatinine levels in the blood correlated with the cat’s longevity. Cats diagnosed with Stage IIb had a creatinine >2.3 mg/dl, stage III greater than 2.8 mg/dl and stage IV greater than 5 mg/dl. Those cats with IRIS stage II kidney disease survived on average over 1000 days, stage III cats nearly 800 days and stage IV cats only about 100 days.

If your cat’s diagnosis is low IRIS stage chronic kidney disease, try not to worry. Treatment can help keep your cat around for years to come. I can’t guarantee your cat will do as well as my nephew cat and live to the ripe old age of 21 – but you never know!

17 responses to “Grading system helps form prognosis for cats with kidney failure”

  1. Charlotte R Wolfe says:

    My older cat is now producing a lot of urine. Needs lots of water in the morning, better afternoon, but very tired.
    Wants me with him a lot more.

    • Linda Rudolph says:

      I buried a neighbor’s 13 year old cat two days ago after we made that very difficult decision. By the time I saw her, Chloe was very thin (7 lbs), extremely lethargic, and drinking a liter of water daily as well as urinating out that amount, or more. The day we decided was when she only arose from her bed for water, and some food.
      What I’m getting to is that it’s not just the quantity of a life that matters. The quality is so much more important. When I saw her struggling to get up to drink more and more water, and walking like a 100 year old woman, I knew I had to get a professional opinion.
      She wasn’t my kitty, but she definitely stole my heart in the few weeks I fostered her. The people who handed her over had her since she was a kitten. They claimed to love her–and I believe the young daughter did–yet they failed to mention anything about her being ill. I was only told she hadn’t been to a vet recently so her shots were not up to date.
      When I first saw her I would’ve sworn I was looking at a cat of at LEAST 20 or more years of age! Her short fur was matted and looked dirty and dull. (This is one of the signs of kidney failure.) Her face looked stressed, and I’m sure she was. She was sick, in a new environment, and for 13 years she thought she’d have someone to love her and care for her, then her home is suddenly gone. Poor baby.
      Thinking she was diabetic at first, I switched her to a high protein diet and she responded almost immediately. But after a week or so the symptoms returned.
      I asked the vet to check her blood sugar just in case, but it was normal. She, the vet, thinks it may have been a couple of things ailing her besides the kidneys failing. I think that the crappy cat food some of these companies put out should be outlawed. Shame on them for continuing to sell the same garbage while increasing the costs to the consumers.
      Anyway, I made the decision for the ones who would not. Realize that we only grieve for ourselves. The one who’s passed is no longer in any pain. So when we selfishly hang onto our loved ones, human or animal, we’re only serving ourselves. Always put yourself in your pet’s place. How would you feel? What would you want done?
      So,as I held her head in my hand and spoke softly in her ear about how all this was going to end very soon and how she’d be a kitten again, running in the grass in the sunshine, the doctor gave her the injections. She was gone almost immediately, but through my tears, I swear I saw a look of calm…and relief(?) on her face. That was very difficult but I’m glad she’s not suffering anymore.
      I’ve been doing TNR for about seven years now and I’ve gone through that with a number of other animals. But each one is unique. Each touches you in a different way. Chloe touched my heart like only a few others. She may have even gotten to my soul, if there is such a thing (and I believe there is).
      Sadly, by the time cats display the symptoms you described, anywhere from 75% to 90% of kidney function is gone. There ARE treatments, but the cat’s age, state of being, and cost all need to be looked at in a realistic way. A friend helps with that type of decision. And I ALWAYS ask the vet what they would do if the pet was their own. Watch their face. Men try to hide it more than vets who are women. But that day when I asked, her look said it all. At her stage she probably wouldn’t live through the treatment.
      I’m not trying to bring you down. I’m just sharing my thoughts and experiences in the hopes that it might help you make your decision a little easier. My heart goes out to you and, especially, to your kitty. Whatever you decide, I’m sure it’ll be the right decision. In the meantime, do your crying and say your goodbyes (without actually saying that word). And spend as much time with your pet as you can. Always remember the good times and tell him or her about them while you still can. They LOVE that!!
      Again good luck. I wish you both the best.

      • Erin Nutt says:

        Hello Linda,

        I made the very hard decision to put my cat, Roamie, down yesterday. I liked your comment the most and it was reassuring to me that I made the best decision for Roamie. She had gone through 3 rounds of IV fluids in the last year and half and she was on prescription food as well; but In the last 2 weeks I had Seen her struggle to walk and play with me. She started sleeping in my closet and I would would have to pick her up and move her to my bed. In the last few days she was restless and gave me looks that I had never seen before. She was my beautiful and sassy cat but she was declining fast. When I made the decision to put her down her kidneys were only at 25% working and she weighed 5lbs.

        I was with her and hugged and cuddled her until her last breath. Kidney Disease is a terrible thing for a cat and although it was manageable in the early stages, it really took a toll on her in the end.

        Thank you for sharing your thoughts.

  2. Ann-Marie W says:

    We too are going through this CRF with our lovely little kitty. She needs plenty of good natural foods, vitamins and lots of attention to her water supply, loving time in our laps, massages and did I say loving nurture. Wish the Vet would have stressed the importance of the supplements earlier for the this is hard on the family budget to help her on this journey. It is so special to be able to help this Sweetheart when she needs our help and support.

  3. Marsha Deliso says:

    MY cat has CRF, I used willard water additive in the cats bottled water. Used Milk Thistle herb 200 ml divided into 2 doses daily.. Supplemented with omega 3 with vitamin D, and liquid form Sundown B complex with B 12- 1/2 dropper.
    Used cooked eggs, cooked turkey and cooked liver for nutritional value along with canned cat food when she would eat it { Wellness brand} Mix Milk thistle with chicken or turkey baby food. I spent $1000 at vet, tried antibiotics and special diet with slight results. When my cat worsened stopped eating and drinking- I went to natural medicine-Herbs etc My cat is anemic so I have my cat Momma 2 on Pet-Tinic or Pet tab sIron Plus. My cat is doing much better now. Do your own Research- Favorite site thistle

    • Alissa D says:

      You wrote that you prepare protein for your cat eggs, turkey, liver) – i was told that cats with kidney failure/disease require diets very low in protein. Were you not given that same information?

      i’m feedling my beloved cat food specific to renal failure (Royal Canin). My cat wasn’t eating very much prior to his diagosis (and had lost 1.8 lbs in 15 months). He is eating approximately the same amount and maybe a little more now, which is good since I have heard and been told that some cats don’t like the special low-protein renal failure food. I have already seen a decrease in his urine output after 5 days on the food. My hope is that as his kidneys continue to work less hard to process protein, that he will start eating more and gain back some of the weight he lost.

      For me, the most difficult part is feeding my two cats separately, and my older boy, multiple times during the day.

      • Debby says:

        Thank you for explaining more about the protein problem. I’ll have the results tomorrow for my precious boy. We’ve lost one some years back to this so I’m hoping his thyroid medicine just needs adjusting. I can hope. It’s good to know the “whys”.

        • Linda M says:

          Hi, the big issue here is that the Royal Canin food is not so palpable and most cats don’t like it. It’s hard to find a canned renal diet that is appealing to them. I’ve turned to making their food and adding vitamins & a prosperous binder to handle the protein. Also, liver is a good source and I also use turkey. Making the food is also ten times cheaper since the special diet foods are expensive and in fact, not that special in addition to the apparent bad taste since a majority of them don’t like it. My next kitties will be on a home diet since I think the canned food, even high quality organic is not great. They cook it in the can – how can that be a good thing. Also there is a reason why so many cats are getting renal failure and I for one think it’s diet related to canned, mass produced food that has who knows what in it. You’d be sick too if you ate this way. I have my best boy can in end stage renal failure now and doing home treatments. He is not going to live a lot longer but he’s comfortable so far and still eating, drinking & using the box despite his stage of disease.

          • Geraldine P. says:

            Hi Linda, I am treating my 21 year old cat with CRF. He is presently taking Azodyl 2x a day as well as Methimazole 2x a day for his thyroid. I would love to find out what vitamins and phosphorous binder you use for your cats diet. If you could share a typical meal recipe I would be so grateful. Thank you!

      • Frank F says:

        Consider SureFlap automatic feeders. They’re not cheap at around $150 each but they open when your pet is close using their embedded microchips or a chip hung on a collar. They close when the cat moves away. You can train multiple cats for the same feeder or buy each a feeder and never worry about them eating each other’s food or medication.
        My $0.02

  4. Allan says:

    I adopted a twelve year old part Siamese male cat with stage two renal failure and did not know about raw meat diets until he was stage three. We were both unknowingly exposed to an extreme level of carbon monoxide for a long time and during this time Koko stopped eating and drinking water for 5 days I finally realized that his kidneys were shutting down and jumped on the web to find a solution. The third site visited said that spirulina was excellent for cleaning cats kidneys. I raced to Walmart and got some capsules and a plastic needle less syringe
    . Then I mixed some purified water with enough spirulina to make a mixture not to runny or to pasty but something that would leave the syringe and yet not splatter down his throat and into his lungs by squirting the mixture on the side of the roof of his mouth so the tong would wipe it down his throat…and it worked. After doing this 3 times in 4 hours Koko came looking to eat. He put on the weight he had lost although not the muscle at this time he was 18 and still very active. Next I put him on the TC Feline(.com) raw meat chicken diet and he improved amazingly. His fur thickened and became very shinny, he had more energy and his old attitude back….wanna box? I kept giving the spirulina for several months and should not have stopped.

    • Peter Sps says:

      My 13 year old long hair cat stop eating. I got her to the vet and, as suspected, it was renal disease.
      Much better after day two of 150 ml under the skin. But I will try the spirulina, as I also take lots of vitamin supplements.

      Thanks to all contributors to this subject.

  5. Jason says:

    Meera has been in stage II for 4 years now. Her blood panel yesterday was the best we’ve seen since her until diagnosis.

    Since diagnosis she takes Calcitriol twice a week. She also takes a B12/rehemmnia root supplement daily. A year ago I decided to get out a head of it. Most people dont start fluids till stage three but I started her early as she doesn’t drink enough even with a fountain. She gets 100ml three times a week with a potassium additive. Once a week she gets a shot of B12. Her values this year are better than the year before. It was terrifying to start fluids but I’m happy i started early as my hope is keeping everything optimal will allow what’s left of her kidneys to avoid any further damage.

    Her diagnosed creatinine levels 4 years ago was 2.6
    As of yesterday she is sitting at a 1.8

    She eats high quality wet food. My vet feels too many cats waste away on kidney diets and the ability to retain body mass is a key factor in determining long term prognosis.

  6. Toni C says:

    My 16.5 year old tripped cat was recently diagnosed with stage 2 KD. He’s been eating raw since he areas three due to colitis. Raw cured it in a months time when no meds did.
    I tried the renal support food and he refused it. My vets response was to keep him on raw, really no choice here. He has perked up being back on raw. His quality of life is good now so that is the best I can expect.

  7. The information about the Grading system helps form prognosis for cats with kidney failure. It has been a great help in understanding what BeeDee is going through and how to best care for him. The grading system takes the guess work out of interpreting lab results, giving us valuable information about his condition and helping us make informed decisions on treatment.

  8. Heather says:

    It’s a tough roller coaster when you have a cat with kidney disease but I had a cat that lived for 7 years with it and her quality of life was great until the last 6-7months.

    I strongly suggest giving sub q fluids (lactated ringer) it’s not as hard as it sounds and it really makes them feel better and live longer. Also the low protein kidney diet foods from the vet help too. Also the website is very helpful

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