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K is for ...

KIDNEY DISEASE (See also URINARY TRACT DISEASE & SUBCUTANEOUS FLUIDS):
Feline Chronic Renal Failure Information Center http://www.felinecrf.com
A comprehensive resource for those with cats diagnosed with chronic renal failure.
Tanya's Feline Chronic Renal Failure Information Centre http://www.felinecrf.org
Diesese symptoms, diagnosis, treatments and how to cope with it. Also information on the effect of diet, giving fluids, and links to additional information.

 


Nadia's CRF Page - Kerry's website about her CRF Kitty Nadia
Tanya's CRF Website - Helen's website about her experiences with Tanya. Holistic and Conventional support information
* CRF E-Mail Support List - Over 3,200 members support each other on this list. * Requires Yahoo registration
Linda's Feline CRF Hints - CRF Hints from an experienced owner
David Jacobson's On-Line Supplies Guide - An excellent resource for finding Lactated Ringers, needles, veno sets & phosphate binders
Chronic Renal Failure - Bengal Cat Club
Chronic Renal Failure - Marvista Veterinary Hospital
Kidney Failure in Cats - Dr. Petra Drake, DVM
Feline Kidney Disease - Long Beach Animal Hospital
Chronic Renal Failure - Excellent article from Waltham’s with diagrams
Kidney Disease - Dr. Mike Richards
Watch for Kidney Failure - University of Illinois, College of Veterinary Medicine
Kidney Copes With Chronic Renal Failure
Early Signs of Kidney Disease - Drs. Foster & Smith
Encouraging Cats To Drink More Water - Good article from Drs. Foster & Smith
Kidney Disease in Older Cats - Jean C. Hofve, DVM From Holisticat
Feline Nephrology & Urology Website - Excellent links on all aspects of Feline Kidney disorders
Kidney Disease: Polycystic Kidney Disease
Polycystic Kidney Disease - By Colleen Power
Kidney Disease in the Cat - Feline Advisory Bureau of the UK
Kidney Function & Disease - Excellant article from Chick Newman, DVM, PhD
Canine and Feline Nephrology and Urology - Personal Home page of Dr. Katherine M. James
The Urinary System - Merck Veterinary Manual
Chronic Renal Failure - Dr. Roger Ross, DVM
Chronic Renal Failure - The Pet Place
Management of Chronic Renal Disease - Client Information Brochure from UC Davis Vet School
Kidney Disease In Dogs And Cats - Ron Hines DVM PhD
Kidney Failure-General Considerations - Columbia Animal Hospital
Kidney Failure In Cats - Columbia Animal Hospital
Kidney Failure in the Cat and Dog - The Pet Center. Excellent!!!
Renal Failure - New thoughts on protein from the American Association of Feline Practioners
Feline Kidney - High phosphate & acidification may play a role in development of renal failure

Calcitriol:

Calcitriol Reference Guide - THE Calcitriol Reference site. Contains Dr. Larry Nagode's articles, compounding sources, dosage protocol, Owner's Orientation & other Veterinarian comments. This is the site to print out articles for discussion with your vet.
Current Guidelines for Managing Feline Renal Failure - 2001 WSVA Congress
* Calcitriol Links - Understanding the role of Hyperparathyroidism and it's implications in kidney failure. * Requires Yahoo registration
* Calcitriol E-Mail list - Dr. Larry Nagode frequents this list and is willing to help any owner and/or vet with Calcitriol information. * Requires Yahoo registration.
* Dr. Larry Nagode - Message #1123.* Requires Yahoo registration.
* Dr. Larry Nagode E-List Replies - Downloadable file of all Dr. Nagode's replies to the Calictriol e-mail list.* Requires Yahoo registration.
* Feline Phosphate Management E-Mail List - Managing Phosphorous levels in CRF cats. Use this list in conjunction with the Calcitriol list.* Requires Yahoo registration.
Calcitriol - Discussion from the 2001 Small Animal Veterinary Conference
Calcitriol - from Marvista Vet
Calcitriol Treatment - Island Pharmacy
Secondary Hyperthyroidism & Effects of Phosphorous & Protein Restriction - Waltham's - PDF FILE: Open in new window!
Supression of Parathyroid Levels - Washington State University. Excellent explanation, a bit technical.
Calcitriol Treatment at Home - See section 5 under Ongoing Treatment
Calcium Inbalances

Questioning the Low Protein Diet for Kidney patients:

The importance of feeding your cat high protein, high fat & low carbohydrate diets is just emerging with new research. There has never been any conclusive evidence that protein causes kidney damage. In fact, feeding low protein diets to CRF cats may actually contribute to muscle wasting and weakness. Cats are carnivores and require high levels of protein in their diets. Feeding low protein diets may actually "starve" them, and the theory is they break down their own muscle tissue to supplement their protein requirements.

Dry food is between 35-50% carbohydrates while canned food is generally around 10%. Canned food is better for urinary tract health because of the higer water content. High carb, dry food diets are being linked to the epidemic development of feline diabetes. These articles are MUST READS for new information on proper diets for carnivores:

The "Catkins Diet" - American Veterinary Medical Association
What's Really In Pet Food - Animal Protection Institute
Cutting Carbs for Diabetic Cats - Vetcentric
The Dry Food Cat Crisis - Feline Future
Dry Food & Kidney Stones - Implication of dry food related urinary tract disease
Focusing On Protein - The Pet Center
Contrasting Grain-based and Meat-based Diets Fed To Dogs and Cats - The Pet Center
Dry Cat Food Nutritional Information - Protein, Fat & Carbohydrate Percentages of Name Brand Dry Cat Food
Canned Cat Food Nutritional Information - Protein, Fat & Carbohydrate Percentages of Name Brand Canned Cat Food

With respect to renal failure, recent research suggests it may actually be the lower phosphorous content of prescription diet foods that slows the progression of renal failure, rather than the lower protein. A couple of quotes to think about:

From the Veterinary Infomation Network, September 2003:

"CRI Management: General Suggestions (Including Information On Protein Restriction) An effect of protein restriction on the progression of CRF has been looked for for YEARS and no effect was found until a couple of studies recently. These studies need to be run in larger numbers of animals, in a randomized, controlled study. And it remains to be determined whether protein restriction itself, or phosphorus restriction, is providing the benefit. A low protein diet is a low phosphorus diet, and controlling hyperparathyroidism prolongs survival in CRF. Veterinarians (and most veterinary nephrologists) continue with the mantra that "protein is bad" but this is wrong, was wrong, and will always be wrong. Every benefit that folks have seen, over these many years from protein restriction, was really due to the phosphorus restriction. Even though pet food manufactureres cannot practically (inexpensively) separate protein from phosphorus in their food sources, pet owners can (and should) -- simply by adding in cooked egg whites to an otherwise protein and phosphorus restricted diet. Egg whites contain no cells, so no cell membranes loaded with phosphorus, so they have very very low levels of phosphorus."
VIN Archives

From Southpaws Veterinary Clinic:

"Many patients are initially diagnosed with CRF when already in a protein malnourished state and negative nitrogen balance (significant weight loss and poor body condition, poor haircoat, hypoalbuminemia). The clinical signs of protein malnutrition suggest that catabolism has been chronic, sustained for possibly months before these signs become detectable. This state develops because protein depletion forces body proteins to be catabolized to meet regular nutritional needs."
Do chronic renal failure (CRF) patients need low protein diets?

Presentation, Small Animal Veterinary Association,
2001

"Restriction of dietary protein has been recommended for patients with CRF based primarily on the premise that protein catabolites, retained because of excretory failure, contribute to uraemic signs. The potential risks of protein restriction in the cat’s diet are, however, considerably greater than for the dog. The cat is unable to down-regulate hepatic enzyme activity associated with protein catabolism even when dietary protein intake is low,(18) thus it is particularly at risk of protein malnutrition.

Conclusions:
It is not clear how the data from the studies of induced renal failure relate to the observations from cats with naturally occurring disease that are discussed in the section on phosphate restriction. If comparisons can be drawn, the data suggest that phosphate restriction may have been more important than protein restriction in the increased life span that was observed in the clinical cases; nevertheless, protein restriction may also have been of value in the uraemic cats. Whilst further studies may help in understanding the underlying mechanisms, management of cats with naturally occurring CRF using a phosphate and protein restricted diet, in combination with oral phosphorus binding agents in those cats where control of hyperphosphataemia and RHPTH was not achieved by diet alone, resulted in more than doubling of average survival time from the commencement of treatment. "
Recent Advances in the Dietary Management of Chronic Renal Failure in Cats

Delmar R. Finco, DVM, PhD

"The conflicting results from the two studies of cats will require further study for resolution. The negative results from the second study indicate that protein restriction in cats with renal disease remains to be proven as an effective maneuver for ameliorating progression of renal disease"
Effects of Dietary Protein Intake on Renal Functions - (WARNING! Pdf document. Right click to open in separate window)

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