Caring for the Coughing Cat with Asthma

Posted on November 10, 2024 by felinepurrspective_u3q4o6

A cat receives medication for asthma using a inhalation chamber.

Does your cat cough? Are you waiting for a hairball to appear? If this is a frequent occurrence – say daily, a few times a week, even just once a month – it may be time to pay your veterinarian a visit.

A phlegmy, wet, productive cough often accompanies viral or bacterial infections. A hacking cough, where your cat crouches down during the coughing episode is typical of feline asthma.

the coughing cat with asthma

Feline asthma is an allergic response to something in the environment. Untreated, asthma can result in changes in the lungs that block air flow. The coughing cat with asthma who is not being treated can end up at the ER, breathing through her mouth (very un-catlike), panting and using her abdominal muscles to help push the air out (Reference 1).

Although the asthma cough is described as “coughing up” a hairball, remember that hairballs are hair that is ingested by the cat as she grooms. Hairballs are swallowed and end up in the stomach. The cat must vomit them up. This is a different motion than the pushing done by the abdominal muscles to clear the lungs of air during an asthma attack.

the vet visit

Be prepared to describe your cat’s cough:

Is the cough wet or dry?
How frequent is the cough?
How long has your cat been coughing?

diagnostics (Reference 2)

After taking a detailed history and performing an examination, your vet will recommend some diagnostics to help rule out other diseases that share similar clinical symptoms with asthma. These include heartworm disease, bronchitis, and viral, parasitic and bacterial infections.

Blood work to assess major organ function
Chest x-rays
Fecal assays and heartworm testing

Occasionally, additional testing is needed.

Bronchoscopy – a specialist will examine the cat’s airways with a small camera
Samples of bacteria and cells in the airways can be collected during the bronchoscopy

treatment for feline asthma

If your vet is able to rule out viral, bacterial or parasitic infections, the next step is to initiate treatment for feline asthma. Treatment aims to help the coughing cat with asthma breathe better by reducing the inflammation and constriction in her airways. Untreated asthma can result in structural changes in the airways (Reference 1, 2).

The go-to therapy includes:

oral corticosteroids such as prednisolone
inhaled steroids that your cat can breathe in
bronchodilators to decrease airway constriction. These can be given by injection (terbutaline) or by inhaler (albuterol).

Steroid therapy is lifelong for the coughing cat with asthma. Typically, your cat will start on oral steroids. If her cough responds to oral steroids, your vet will most likely recommend transitioning your cat to inhaled steroids, given by a metered dose inhaler.

benefits of inhaled steroids for cats with asthma

Although cats in general tolerate oral steroid therapy well, there are side effects to long-term administration:

increased thirst and urination
increased risk of infections
weight gain
muscle wasting
diabetes

Taken by the oral route, medications are processed by the GI tract before entering the bloodstream and then going to the lungs. Inhaled steroids are delivered directly to your cat’s lungs; very little steroid enters the bloodstream, and side-effects are greatly reduced.

ADMINiSTRATION OF INHALANTS TO CATS

Unlike humans, who can place an inhaler between their lips, and breathe the medication in, the coughing cat with asthma, like young human children, must inhale the medication from a chamber.

The chamber is a cylinder with a port for the metered dose inhaler on one end and a valve with a soft, silicone mask on the other. The inhaler is actuated, the medication sprays into the chamber, mixing with the air in the chamber. The cat can then breathe in the air/steroid mixture via the mask. A valve keeps the medication in the chamber until the cat takes a breath.

Per Trudell Animal Health (Aerokat), the medication is available in the chamber for 30 seconds. The cat must take 7-10 breaths to empty the chamber and get his medication.

training a cat to use an inhalant chamber

Training a cat to use one of these chambers is a multi-step process that may take a month or more. The oral steroid medication will overlap this training period. Visit “Teach Any Cat Aerokat” for a 5 step training program.

Environmental changes

Feline asthma is thought to be an allergic reaction to inhaled allergens. Treatment with steroids is the first step, but you can also keep your cat more comfortable by minimizing her exposure to irritants such as smoke, aerosols, and dust. Consider using HEPA air purifiers and humidifiers indoors (Reference 1, 2).

Feline asthma is a diagnosis of exclusion. Once viral, parasitic or bacterial infections are found to be unlikely, treatment with corticosteroids and bronchodilators can begin. These are lifelong treatments but the prognosis for a treated feline asthmatic is good.

references

Garrity S, Lee-Fowler T, Reinero C. Feline asthma and heartworm disease: Clinical features, diagnostics and therapeutics. Journal of Feline Medicine and Surgery. 2019;21(9):825-834. doi:10.1177/1098612X18823348
Deininger K., “Understanding Feline Asthma”. Veterinary Health Center, University of Missouri. Uploaded 10/2016. https://vhc.missouri.edu/wp-content/uploads/2016/10/feline_asthma.pdf, viewed 11/2024.

Moving with your cat

Posted on March 16, 2024March 16, 2024 by felinepurrspective_u3q4o6

“Moving with Your Cat” was originally published 9-26-21. This newer version has been updated and contains additional information.

Moving to a new home is stressful even when everything goes right! Imagine how confusing moving is to our cats – the boxes are fun when empty but soon they fill up with things and your cat can no longer jump in.

From the Feline Purrspective…

The bed you used to siesta on gets bagged up and taken away by strange humans. Your world seems to be coming to an end. Will you have enough to eat? Will you be safe from predators? Where can you hide?

Cats are territorial animals. An outdoor cat’s home range is the maximum area he roams and hunts in. Within the home range is a smaller area that the cat will actively defend – his territory. Inside this defended area is a smaller area called the “core territory”, where the cat can rest, has shelter, and feels safe from predators and other cats. Moving with your cat removes him from his core territory – the house or apartment he lives in.

How can we communicate safety and security to our cats when we move? Somehow, we cat owners have to provide what our cats need even though we are no longer “at home”.

What our cats need:

Resources : food, water, litter box, shelter
Safe access to resources
Belonging: territory
Human interaction: predictable
Playtime: predatory behavior

Moving with Your Cat

Getting ready

Resources: Stock up on your cat’s preferred litter and food – if you are traveling by air, perhaps you can ship some of this to your new address.
Safe access to resources: Create a “safe place” for your cat. When moving with your cat, this will most likely be her carrier. Make sure your cat is comfortable in her “home away from home”. In the weeks leading up to the move, leave it out for her to explore and nap in. Consider feeding her meals in it.
Set up a “mobile” territory: A lot of cat communication is by smell. Cats have some of the best noses -with 30 genetic variants of the V1R receptor protein in their vomeronasal organs, they are able to discriminate between a wide variety of smells (Reference 1). So, avoid laundering cat blankets or quilts that your cat sleeps on – the familiar scent of home can help reassure your cat of his territory when he is on the move.
Predictable, positive human interaction: Try to maintain daily feeding and grooming routines as you travel.
Predatory play: Don’t forget play time – try to set some time aside to play with your cat when traveling.

Other things to consider when moving with your cat:

Is your cat microchipped in case he escapes?
Consider a calming supplement such as Zylkene, Calming Care. It is best if you start these several weeks before moving.
Have copies of your cat’s medical records. Locate a cat-friendly practice in the new neighborhood.
Do you need a health certificate for travel?
Consider getting your cat accustomed to wearing a harness and leash. Even if not fully leashed trained, a harnessed cat can be more easily handled in an airport or at a rest stop if you have to change out soiled pads in the carrier.
Consider asking your vet for calming medication for travel.
Multi-cat homes: Identify the social groups in your home before moving. This can help you when introducing your cats to their new territory.

moving day

Although some cats travel well together, it is usually a good idea to have separate carriers for each cat in case some random event frightens one of the cats, resulting in a cat fight.

You may want to keep your cat(s) in their own room with their carriers while furniture, etc is being moved – you don’t want them to escape!

Arriving at your new home…

Establish a “safe place” for each cat or social group: Choose a room with a door you can close, that does not have places where your cat can hide (under the bed, behind a bookcase) and you can’t get him. Use one of your smaller moving boxes as a hiding space – put a comfy bed or blanket in this box.
The “safe” room should contain all your cat’s essential resources – food, litter box, water, scratching post.
Use pheromone diffusers in the “safe place”. You may also want to have them throughout the new house or apartment.
A gradual introduction to the new house is best for most cats. Pay attention to your cat’s body language – if she seems scared or frightened, allow her to stay in the “safe room”. Once she seems curious about the world outside her safe place, allow her to explore the rest of the house – you may want to accompany her (a harness/leash can be handy) on her first forays into the new space.
Maintain feeding and play/grooming routines as best as you can.

In a multi-cat homes, you may want to use a protocol similar to introducing cats. Assess how the different social groups are adjusting before allowing free access to everything. A move can disrupt the social order, giving a dominant cat an opportunity to pick on a more timid cat.

Moving with your cat is an adventure…

When your cat arrives at his or her new home, he/she must establish a “new” territory. We can facilitate this process by:

ensuring that your cat has familiar items with her – the food and litter she is accustomed to, beds/blankets that have her scent on them, and a carrier she is comfortable in
allowing him to establish a new “core” territory first in a “safe” room
allowing her to choose when she is ready to leave her “safe” place to explore the rest of the house.

Moving is stressful for us and for our cats. Make sure to monitor your cat(s) for sickness behaviors. Reduced appetite, vomiting, or diarrhea can be signs of stress-related issues. Consult a veterinarian if these problems don’t resolve in a day or two or if your cat does not eat for more than 24-48 hours.

references

Kristyn R. Vitale Shreve, Monique A.R. Udell, Stress, security, and scent: The influence of chemical signals on the social lives of domestic cats and implications for applied settings, Applied Animal Behaviour Science, Volume 187, 2017, pp. 69-76, ISSN 0168-1591, https://doi.org/10.1016/j.applanim.2016.11.011

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Managing the Painful Cat: Recognizing pain and Giving Care

Posted on March 10, 2024March 10, 2024 by felinepurrspective_u3q4o6

Pain is a response to injury and illness. It motivates an animal to protect the wounded part of the body or to slow down to allow the immune system to work. But at a certain point, pain may not be functional – for example, if an animal is too painful to eat. Managing the painful cat must reduce pain without inducing dysphoria – a state of unease and dissatisfaction (Meriam-Webster).

Cats are not only predators, they are also prey for larger carnivores like coyotes. A predator will target a weak or injured prey animal so it is important that prey animals hide their pain, so they don’t become some else’s snack. How do we recognize pain in a cat? How do we manage the painful cat?

Managing the Painful Cat

Managing the painful cat requires that:

We recognize the pain and its severity.
The veterinary team formulates a treatment plan, which includes pain medications and supportive treatments.
The cat owner implements the plan, monitoring the cat’s pain and response to treatment.

Pain can divided into “acute” pain and “chronic” pain.

Acute pain (Reference 1):

rapid onset
short duration (3 months or less)

“Chronic” pain (Reference 1)

occurs along with a chronic health condition
longer duration

We will focus on “acute” pain in this article.

Some causes of “acute” pain are:

surgeries: spay, neuter, dental extractions
illness such as pancreatitis, infections
bite wounds from a cat fight

How do you know if your cat is in pain?

Changes in behavior, posture, and temperament may be indicators of pain or illness. Some examples are:

Changes in behavior

decreased appetite
decreased grooming
urinating or defecating outside the litter box
sleeping in unusual places

Changes in posture

hunched or crouching
changes in gait: walking stiffly, limping

Changes in Temperament

a typically friendly cat does not greet you and hides under the bed
the cat is aggressive toward people or other animals

If you notice such changes, a visit to your vet is in order. Your vet may prescribe therapeutic and pain medication, suggest environmental changes and other supporting therapies such as warm or cold compresses. During the treatment and recovery period, it is important to monitor your cat and note her response to therapy:

behavioral changes: is there improvement
pain assessment

The Feline Grimace Scale (FGS) provides cat owners with a way of assessing acute pain. The FGS focuses on 5 features of the cat’s face: position of the ears, shape of the eyes, shape of the muzzle, attitude of the whiskers, and position of the head. The user assigns each feature a score of 0 (no pain), 1 (moderate pain), or 2 (obvious pain) for a maximum of 10 points. A score of 4 indicates that the cat is painful. To use the FGS, see https://www.felinegrimacescale.com/

Effective pain management enhances healing and will help the cat return to its daily activities faster. Be sure to give medication as directed by your veterinarian. If you have difficulties administering medication or following other instructions, contact the vet clinic immediately for alternative ways of giving medication or other methods of providing supporting therapy. If you feel your cat is in pain in spite of the prescribed treatments, contact your veterinary team – perhaps another medication or therapy will be more effective.

“ It is reasonable to assume that anything that would cause us pain, will also cause pain in cats
and be just as distressing for them” (Reference 2)

Managing the painful cat not only involves giving prescribed medication and treatments in a timely way, it also includes keeping the patient physically comfortable. Environmental modifications can help the painful cat return to the comfort of his daily routine.

Environmental Modifications to Help the Painful Cat Recover (Reference 2)

Restrict outdoor access and activity as directed by your vet
Provide options for quiet rest, ensuring the bed is in easy reach
Essential resources – food, water, litter box and bed – must be close by. The recovering cat may not want to move very far.
Encourage your cat to eat by offering palatable foods and warming them when appropriate, per your veterinarian’s instructions.
Keep other pets and children away if they are likely to disturb the cat or, for example, disturb a bandage.

managing the painful cat: A Case History

In the autumn of 2021, I was taking my cat Gus on short hikes on a nearby mountain trail. One hike, he startled, I lost hold of the leash and he disappeared up the trail. After 2 hours of walking up and down the trail, calling for him, he appeared, without harness and leash, moving stiffly. I carefully put him in his backpack and took him to the vet clinic for an exam and x-rays.

The exam indicated that he had a lot of inflammation in his lumbar spine and was reactive to palpation of that area. X-rays did not show any injury to his skeleton.

We tried NSAID therapy, oral opioids and gabapentin, but there was little improvement in 3 days. Gus was so painful that he would growl when changing positions.

The next visit was to the neurologist in Denver for an MRI which showed inflammation but no obvious nerve damage. We added a steroid to his therapy; I also gave him twice daily red light therapy. Gus began to improve and recovered fully after 6 weeks.

environmental modifications

Gus was set up in the master bath with the doors closed to keep other cats from entering
A litter box with a low entrance was provided
A bed made of blankets was placed on the floor
A bowl of water was next to the bed

giving medications

A decreased appetite precluded Gus voluntarily taking a pain medication in a treat
Medication was administered using a squeeze up treat (see “How to Give Your Cat a Bitter Pill“)

the efficacy of pain medication and an environment conducive to healing

Although the “tincture of time” was an important factor in Gus’s recovery, alleviating pain and discomfort accelerated healing. The addition of prednisolone (a steroid) to the therapy helped reduce swelling in Gus’s spine – he began to move about more easily the day following his first prednisolone dose. The steroid also stimulated his appetite and having a bed on the floor with easily accessed litter box nearby encouraged elimination.

In the weeks that followed the hiking accident, Gus gained mobility although steps to access high places were still needed. At first, Gus was not able to hold his tail up but he recovered fully in the weeks that followed.

Managing the painful cat requires recognition of pain and a treatment plan from the veterinarian. After that point, the cat’s care is in the hands of his owner who must monitor him for pain, ensure that he eats and eliminates, and provide him with an environment conducive to healing.

references

Steagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S. 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. Journal of Feline Medicine and Surgery. 2022;24(1):4-30. doi:10.1177/1098612X211066268
Recognising and Managing Acute Pain in Cats:Information for Owners/Caregivers. https://icatcare.org/app/uploads/2022/02/Cat-Carer-Guide_Acute-pain.pdf viewed 3/2024

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What do cats need?

Posted on February 17, 2024February 18, 2024 by felinepurrspective_u3q4o6

What do cats need to be healthy and happy? Whether you are a new cat owner or someone who has owned a number of cats, this is a question that needs some careful thought.

Your cat is not human; he/she is a different species. After all, if you were going to have a tiger as part of your household, you would need to learn something about how tigers live in the wild to set up an appropriate habitat. Zoos have found that providing an environment that allows animals to engage in behavior typical of their species reduces mental and physical health problems.

This post was originally published on 7/4/2021. It has been rewritten and updated with new references on 2/17/24.

What do cats need – Healthy Feline Environments

Let’s start with ourselves. Many philosophers and psychologists have come up with answers to what humans need for a happy and fulfilled life. One of the simpler models is that proposed by the psychologist Abraham Maslow in 1943 (Reference 1).

Needs and motivation

Maslow postulated that people are motivated by five types of needs (Reference 1):

Physical needs (food, water)
Safety
Love/belonging
esteem
self-fulfillment (be all that you can be)

As an individual satisfies needs in one of these categories, he is motivated to tackle the next level.

What motivates behavior at the most basic level is the need to survive. We need to eat and drink to stay alive.
Having satisfied these needs, the next step is to ensure that we will continue to have food and water. We need shelter and a job.
Once fed and secure, we can address the need to be part of society – to belong to a group.
The next level of needs is esteem: we need to value ourselves and feel that other people value us.
We are now at the top of the pyramid. We can work on reaching self-imposed goals: maybe become a writer or artist, nurture extended family, or climb mountains.

There is flexibility in this hierarchy- some needs are met at the same time; for some individuals, reaching your full potential may be more important than the esteem of others.

Let’s apply this thinking to cats. We’ll start with the wild cats – those secretive, un-owned cats that populate neighborhoods and barns.

what do cats need? wild cats

A wild cat’s needs begin with having prey to eat.
Once fed, he will find a safe place where he can sleep, eat and retreat from danger – like a den.
He must establish his territory where he can hunt regularly and have access to food.
A well-fed wildcat who hunts successfully has good prospects for mating.
As far as Nature is concerned, the wildcat has reached his or her full potential once he or she has ensured that there will be another generation to hunt and mate, continuing the species.

When food is plentiful, some cats will group together in colonies near the food source. The colony forms around breeding females with some unrelated male cats in the colony that help with kitten care and protection. A colony fulfills safety and belonging for a wild cat.

what do cats need? Domestic cats

Things are a bit different for the cat who lives with humans. Hunting and establishing a territory have become separate from getting enough food; our house cats are spayed and neutered, so do not have a drive to mate and reproduce. We can construct a hierarchy showing what do cats need for the cats that live with us.

the 5 pillars of a healthy feline environment

The American Association of Feline Practitioners (AAFP) list five things that make a healthy environment for a cat (Reference 2).

A safe place
Multiple and separated key environmental resources
Opportunity for play and predatory behavior
Positive, consistent and predictable human-cat social interaction
An environment that respects the cat’s sense of smell and other senses

We can assemble these needs into a pyramid diagram:

At the bottom of the pyramid are the needs for survival: food, water, and litter boxes.
The next level ensures that these essential resources are available to each cat to use safely, without fear of competition or interference from other cats, pets or humans. The cat owner should provide multiple and separated feeding, watering stations and litter boxes.
One of the AAFP requirements is an environment that respects the cat’s sense of smell and other senses. Such an environment is the cat’s territory. Cats will mark walls and furniture in the home with facial pheromones and scratching posts with pheromones released when scratching. Your cat belongs to his territory.

Thinking about cats as aloof and independent would most likely consider the cat’s needs are met at this point.

the cat-human bond

Our cats share basic physiological needs with their wild relatives. But the domestic cat has chosen a different path and has some different needs because of his bond with his human caregiver. The two final levels of the pyramid are 4) positive and predictable human interaction and 5) the opportunity for predatory play.

Human Interaction: To truly feel safe and secure in her territory, a housecat needs to know how the humans in the house will behave: when will she be fed? Will they approach quietly and greet her? Will they swoop down on her and pick her up when she least expects it and hold her dangling in the air?
Predatory Play: The need to hunt defines who your cat is – this is what he was born to do. We need to provide our cats with an opportunity to hunt – whether it is fishing kibble out of a food puzzle or chasing a stuffed mouse at the end of a wand toy.

These last two needs bring us to the heart of the cat-human bond.

Positive and predictable interactions allow us to communicate with our cats; predatory play helps us recognize the cat’s nature as a born hunter and allows us to share this essential part of his life.

We are one of the “5 Pillars of a Healthy Feline Environment”.

In return for helping our cats satisfy their needs, we humans enjoy the pleasure of our cats’ company, better heart health and reduced stress and anxiety.

references

Mcleod, Saul. Maslow’s Hierarchy of Needs. Simply Psychology. Updated January 24, 2024. Viewed 2/2024. https://www.simplypsychology.org/maslow.html
Taylor S, St Denis K, Collins S, et al. 2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines. Journal of Feline Medicine and Surgery. 2022;24(11):1133-1163. doi:10.1177/1098612X221128763

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Managing Aggression in the Multi-Cat Home

Posted on December 17, 2023December 17, 2023 by felinepurrspective_u3q4o6

Cats staring — The direct stare is not a friendly behavior.

It is increasingly common for people to own more than one cat. With more than one cat in the home, conflict between cats of the same household is also increasing.

managing aggression in the multi-cat home

It can be challenging to identify aggressive behavior. Cats play roughly and what looks like play might be a fight in progress. Subtle signs like staring and tail twitching are hard to recognize from across the room – overt behaviors such as chasing, wrestling and vocalizing are more likely to catch our eye and ear and alert us to trouble. [Reference 1]

Things to keep an eye/ear out for:

aggression

vocalizing: growling, hissing, long drawn out meowing
chasing where one cat is the “chaser”
offensive postures: stiffened legs, stiff tail
defensive postures: crouching, tucked head [References 1, 2]

play

Frequent and long-lasting wrestling/chasing
You may hear occasional short, soft meows or chirrups [Reference 2]
Reciprocity – cats take turns being on top or chasing

things in-between

There are interactions that combine both play and aggression but do not result in a fight [Reference 1].

One cat wants to play and the other does not, responding with a swat and hiss to end the play sequence.
Cats of different social groups may need to pass each other. There may be some hissing but body postures are not stiff nor crouching.

interventions – Managing Aggression in the multi-cat home

When you hear yowling/hissing/growling or see stiff or crouching postures, it is time to investigate. Intervention may just consist of opening a door wider so that both cats can pass through. If things are a bit more serious, separate the participants using noise or a barrier. See Managing the Indoor Cat Fight.

It is important to identify the social groups in the house. A few aggressive interactions between cats who sleep snuggled together, groom each other and share resources most likely will not require intervention [Reference 1].

Gus and Marley tolerate each other with the occasional spat.

PLAY can become AGGRESSION

A cat becomes too exuberant and begins to scratch and bite harder.
Reciprocity stops – cats are no longer taking turns.
Hissing, growling increases as the other cat tries to end the play sequence.

Decreasing aggressive play towards other cats

By reducing the desire to play, cats will play less, decreasing the chance that aggressive play happens [Reference 2].

Provide play-time for the whole group at predictable times: scatter toys around the room for the group to interact with; play with the aggressive/energetic cats with a wand toy or other interactive toys.
These more active cats can also benefit from play time away from the other cats in a separate room [Reference 2].

non-play aggression

Play aggression starts with positive, friendly emotions, whereas non-play aggression arises from fear, anxiety, and frustration [Reference 2].

Common scenarios include cats blocking other cats from accessing resources, or trapping another cat in a place that has no escape route. And there are those “bully” cats that “pick on” timid or shy cats, who respond with crouching down and scooting away.

Have plenty of resources spread out through the house (a cat can’t block two places at once).
Have multiple, separated play/resting/observation areas.
Monitor “bottlenecks”: provide places for cats to avoid each other, e.g. a high cat tree near a doorway, offering an escape from another cat passing through.
Enrich the “bully” cat: give him time away from cats not of his social group with access to food puzzles and novel toys.
Enrich the “victim”cat: give him or her time away from the bully and his buddies.
Put a collar with a bell on the “bully” so that other cats know he or she is coming. [Reference 2]

redirected aggression

Something happens that frustrates or frightens a cat, and the cat strikes out at whomever is closest. The cat cannot strike out at the cause of the arousal – it may be out of reach or too risky to confront.

A frequent scenario is a strange cat appearing at a window. The cat indoors cannot engage the stranger and redirects her frustration and anger at another cat nearby. Other triggers include high-pitched or loud noises, unusual odors, or visitors in the house.

Dealing With Redirected Aggression [Reference 2]

Separate the cats and reintroduce gradually.
Desensitize the aggressor cat to whatever stimulated the aggression: if it was a noise – play this sound (or something like it) when the cat is around. Start with a low volume and gradually increase to full volume while offering high value treats.
Visitors in the house: train the cat to go to a safe place when visitors come in.
For more information, see Redirected Aggression in Your Cat – When It Becomes a Problem.

other interventions – managing aggression in the multi-cat home

Medication may be helpful for very timid cats, highly aggressive cats, or to manage redirected aggression where the cat will continue to be exposed to the trigger [Reference 2]. See Dealing with Anxiety and Misbehavior in Your Cat.
If conflict continues, you may need to set up a time-sharing plan and have different social groups use critical areas in shifts. See How Cats Get Along – Timesharing.
Rehoming the aggressor cat with his social group or the victim cat with her social group may be viable alternatives [Reference 2].

Managing aggression in the multi-cat home requires careful observation of how the resident cats interact with each other. Knowledge of the social groups in the home can help in deciding whether intervention is needed. The cat owner must also be willing to respond to problems by adapting the environment, providing opportunities for cognitive enrichment, such as group and individual play time, and separating and reintroducing cats, when necessary.

Managing aggression in the multi-cat home is essential for the health and happiness of the feline and human occupants.

references

Gajdoš-Kmecová, N., Peťková, B., Kottferová, J. et al. An ethological analysis of close-contact inter-cat interactions determining if cats are playing, fighting, or something in between. Sci Rep 13, 92 (2023). https://doi.org/10.1038/s41598-022-26121-1
Ramos D. Common feline problem behaviors: Aggression in multi-cat households. Journal of Feline Medicine and Surgery. 2019;21(3):221-233. doi:10.1177/1098612X19831204

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Managing the Diabetic Cat – Home Monitoring and Emergencies

Posted on November 19, 2023March 11, 2024 by felinepurrspective_u3q4o6

A diabetic cat sports a fabric collar over her glucose sensor.

Managing the diabetic cat

Managing the diabetic cat is a balancing act. The goal is to reduce the clinical signs of diabetes while avoiding complications like low blood sugar.

How do you know if the therapy your veterinarian has chosen for your cat is working? Monitoring the clinical signs of diabetes is a start. (Reference 1). Pay attention to:

Your cat’s attitude and activity level
daily thirst and urination
daily food intake
weekly weight and body condition score

Your veterinarian will want to monitor your cat’s blood and urine regularly but these are “snapshots” (values at a particular time on a particular day). What is happening during a diabetic cat’s day?

monitoring Insulin-based therapies

Insulin-based diabetic therapies focus on the level of glucose in the blood.

Blood sugar is highest before giving one of the twice daily injections of insulin.
After giving insulin, the cells start to take up glucose and the level of glucose in the blood starts to drop
Blood sugar levels out somewhere between the morning and evening doses and starts to increase as insulin wears off
The lowest point in the plot is called the “nadir”; the high points in the morning and evening are called “peaks”

If you sample your diabetic cat’s blood every few hours and plot the blood glucose values on a graph, you will get a picture of how the insulin is working.

The Home Glucose Curve

Because cats are prone to stress hyperglycemia, it is best to measure these curves at home. This can be done using (1) a handheld meter and sampling every few hours or (2) a Continuous Glucose Monitoring system, consisting of an electronic sensor applied to the cat and a device to read the output of the sensor.

Blood Glucose Meter

These are like the meters used by human diabetics. Instead of pricking a fingertip, it is typical to prick the area around the vein that runs along the outside of the ear. The strip in the glucose meter soaks up the blood like a sponge and a current is generated. The strength of the signal is proportional to the blood sugar.

Continuous Glucose Monitoring System

A Freestyle sensor on the back of a cat’s neck

The Freestyle Libre is a continuous glucose monitoring system developed for humans that can be used with cats. The electronic sensor is the size of two stacked US quarters; the sensor can be scanned with a smartphone or dedicated reader device. The sensor samples every minute and stores data for 8 hours before starting to overwrite it. It is important to scan the sensor at least every 8 hours.

Sensor life can range from a few days to 2 weeks. The sensor can be placed on the back of the neck, behind the shoulder, or on the flank. A 2″ x 2″ area is clipped and cleaned for sensor application.

A plot of the average of glucose reading recorded during a two week period.

Monitoring glucose allows your veterinarian to adjust the insulin dose or change the type of insulin to best regulate your cat. The goals of insulin therapy are (Reference 1):

Peak Glucose values of 180-250 mg/dL
Nadir Glucose values of 80-144 mg/dL

managing the diabetic cat – emergencies

HYPOGLYCEMIA
Low blood sugar can be life threatening when blood glucose drops to < 40 mg/dL. You may notice your cat is tired, unresponsive, disoriented and anxious.

What triggers hypoglycemia in the managed feline diabetic?

insulin dose is too high relative to food intake
too much insulin is given
your cat is in remission

If your cat’s glucose in the blood is normal, there is no glucose in the urine, and his fructosamine is in normal range, your veterinarian will start to gradually reduce the insulin dose until insulin is discontinued. If blood glucose values remain in the normal range and there is no glucose in the urine for 2- 4 weeks once insulin has been stopped, your cat is in remission!

If you suspect low blood sugar…

measure blood glucose (BG)
BG less than 80 mg/dL – feed the cat or give up to 1 tablespoon corn syrup by mouth (1 tbsp = 15 mls – you don’t need to give this all at once)
recheck BG in 15 minutes
if glucose rises, continue to offer food and check glucose until the value is in a normal range
notify your veterinarian
if your cat is unconscious, rub some syrup on his gums or inside his cheek, measure BG, and go the the ER!

DIABETIC KETOACIDOSIS

Diabetic cats have an abnormal glucose metabolism and their bodies may break down fats for energy, resulting in ketones in the bloodstream. Too high a level of ketones makes the blood acidic, causing cells to function abnormally. This is more likely to happen:

in newly diagnosed diabetics and poorly regulated diabetics
when there are illnesses such as infections, tumors, dental disease (Reference 2)

Watch for…

Loss of appetite
Lethargy and depression
Vomiting/diarrhea
dehydration
difficulty breathing
a sweet smell to the cat’s breath

This is a true emergency – high levels of ketones in the blood and urine combined with the blood and other body fluids becoming acidic can be fatal. Treatment starts with IV fluids to correct dehydration and electrolyte imbalances and administration of insulin to restore glucose as the main source of energy.

Managing the diabetic cat: non-insulin based therapies

Blood glucose curves are part of the recommended monitoring process for cats receiving oral non-insulin therapy but they do not have as important a role as monitoring a cat on insulin. Cats receiving the oral therapies are not prone to low blood sugar and the blood glucose curve will not have the characteristic shape of a cat receiving insulin. Glucose readings are simply averaged. It is more important to monitor ketones as these cats may be more prone to develop DKA.

Ketones can be monitored using “urine dipsticks”. The cat’s urine is collected using non-absorbent litter or a litter tray with a sieve bottom. Urine is collected with a syringe and dropped on the urine test strip (Reference 1). The makers of Senvelgo, a oral liquid non-insulin drug, recommend checking ketones this way every 1-3 days in the first 14 days of therapy.

Urine dipsticks detect acetoacetic acid and are not very sensitive. Hand-held meters that detect levels of beta-hydroxybutyrate in the blood provide a more sensitive measure of ketones. Blood can be collected from the ear vein of the cat and level of ketones measured similar to the blood glucose meters described above. Abott’s Precision Xtra meter has been validated for use in cats (Reference 3). Perhaps, as non-insulin therapies become more common, monitoring of ketones in the blood will become part of managing the diabetic cat at home.

With appropriate treatment, the diabetic cat can have a life expectancy similar to cats without diabetes. The key to managing the diabetic cat is early diagnosis, weight control, regular exams and labwork, and home monitoring of clinical signs, glucose and ketones.

references

ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats. Sparkes, A. (chairman), Journal of Feline Medicine and Surgery (2015) 17, 235-250
Rudloff E. Diabetic ketoacidosis in the cat: Recognition and essential treatment. Journal of Feline Medicine and Surgery. 2017;19(11):1167-1174. doi:10.1177/1098612X17735762
Weingart C, Lotz F, Kohn B. Validation of a portable hand-held whole-blood ketone meter for use in cats. Vet Clin Pathol. 2012 Mar;41(1):114-8. doi: 10.1111/j.1939-165X.2011.00389.x. Epub 2012 Jan 17. PMID: 22250845.

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Treating Diabetes in Cats – Insulin and Non-Insulin Therapies

Posted on November 12, 2023March 11, 2024 by felinepurrspective_u3q4o6

Insulin injections can be given under the skin in the loose skin over the shoulders.

Diabetes is a condition where there is persistently high levels of glucose in the blood and urine. In healthy cats, insulin, a hormone produced by the beta cells in the pancreas, signals the cells in the body to take up glucose, reducing the glucose in the blood and urine. Diabetic cats are similar to human Type 2 diabetics – they are insulin resistant and have beta cells that are not functioning normally. What treatments are available for these cats?

treating diabetes in cats

One way to treat diabetes in cats is to supplement the insulin the cat is still producing with twice daily injections of insulin. There is not a commercially available feline insulin. Fortunately, production of anti-insulin antibodies does not appear to be a significant problem in cats and we can turn to the synthetic insulins made for the human market or a product derived from pig insulin, developed for dogs (Reference 1).

Practitioners typically reach for the longer-acting insulins listed below to manage feline diabetics (Reference 1)

Glargine (brands:Lantus, Basaglar) is given twice daily. It is available in a 100 Units (U)/ml solution. It does not need to mixed before use and should be clear, not cloudy.
Protamine Zinc Insulin (PZI) is also given twice daily. It comes in a 40 Units (U)/ml suspension which should be rolled or inverted gently to suspend it before using.

Vetsulin is derived from porcine insulin and has a shorter duration of action compared to glargine and PZI. It is not as well tolerated by cats as glargine and PZI. It should be shaken prior to use and be uniformly white in color. It is available in a 40 Units U/ml suspension.

treating diabetes in cats with insulin

Insulin is given by syringe under the skin (subcutaneously) every 12 hours. It is best to stick to the every 12 hour schedule but if this is not possible, you can administer it within 2 hours before or 2 hours after the 12 hour mark. Skip the dose if you are out of this window (Reference 1).

Insulin Syringes

U-100 syringes are used with Glargine insulin.
U-40 syringes are used with PZI and Vetsulin.
Syringes with 0.5” needles are recommended – shorter needles may not always go far enough through the skin.

Giving Insulin Injections

The injection can be given in the loose skin near the shoulder blade or hip.
Rotate injection sites to avoid build up of scar tissue and for better absorption of the drug.
There are many good videos on giving subcutaneous injections. Take a look at the “Caring for your Diabetic Cat” video on the “Health Topics” page at Cornell Feline Health Center.

Insulin can be given in the loose skin over the shoulders and hips.

Try to make giving injections as pleasant as possible. Establish a routine. It can help to have dedicated place to give treatments, for example, a soft blanket on one side of the sofa. If there is a treat or food your cat likes, be sure to offer this during or after the injection.

Diet and the Diabetic Cat

Insulin resistance has been linked to obesity in cats. If your diabetic cat is obese, losing weight can help manage his diabetes and possibly reduce his insulin dose.

If your cat has lost weight due to diabetes, start insulin therapy before starting a weight loss program. Once your cat is stable and you have established your “diabetic” routine, implement your weight loss plan (Reference 2).

Plan for weight loss

determine how many calories your cat is eating
reduce current calories by 10-20%
monitor weight and body condition score (BCS)

Diets for Diabetic Cats

a high protein, low carbohydrate diet is recommended
canned foods are recommended due to their higher water content and lower carbohydrate content
many obese cats have low BCS in spite of excess body fat and high protein may be needed to maintain lean body mass

There are therapeutic diets targeted at treating diabetes in cats. Purina DM and Hill’s m/d feature high protein and low carbohydrates. If your cat does not care for high protein/low carb diets, consider a high protein, low fat, moderate fiber and moderate carbohydrate diet such as Hill’s w/d food, designed to address glucose balance as well as weight loss and urinary care.

For cats with concurrent diseases, you will have to choose which condition is better treated by diet. For example, if your cat has kidney disease and diabetes, it may be wise to feed a kidney diet and manage the diabetes by adjusting insulin dose or type of insulin.

treating diabetes in cats – “non-insulin” therapies

Recently, the FDA approved two drugs given orally for diabetic cats: Bexacat (12/2022) and Senvelgo (8/2023). Bexacat is a once daily tablet; Senvelgo is a liquid given once daily with food or directly into the cat’s mouth.

Both these drugs (SGLT2 inhibitors) work by blocking the reabsorption of glucose by the kidneys. Instead of being returned to the bloodstream, glucose is excreted in the urine, lowering blood sugar without insulin. High levels of blood glucose have been tied to beta cell dysfunction – SGLT2 inhibitors lower blood sugar and are thought to promote growth of new beta cells (Reference 3).

These drugs work best for treating diabetes in cats who have been recently diagnosed and have NOT had previous insulin treatment. At this time, Bexacat and Senvelgo are NOT recommended for cats…(Reference 4)

13 years or older
with pancreatitis or a history of pancreatitis
with kidney disease or other concurrent disease
having suffered a condition known as ketoacidosis.

Candidates should be healthy, with the exception of being diabetic (Reference 4).

Treating diabetes in cats has traditionally focused on giving insulin injections and feeding a high protein, low carbohydrate diet. Experts recommend using the long-acting insulins for cats. The injections are given twice daily. Recently, new oral therapies have been made available that offer once-a-day dosing and the potential of regenerating pancreatic cells.

In the next post, we will look at how we can monitor insulin and non-insulin therapies to ensure our diabetic cats’ health and safety.

references

ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats. Sparkes, A. (chairman), Journal of Feline Medicine and Surgery (2015) 17, 235-250
Clark M, Hoenig M. Feline comorbidities: Pathophysiology and management of the obese diabetic cat. Journal of Feline Medicine and Surgery. 2021;23(7):639-648. doi:10.1177/1098612X211021540
(Nakamura A. Effects of Sodium-Glucose Co-Transporter-2 Inhibitors on Pancreatic β-Cell Mass and Function. International Journal of Molecular Sciences. 2022; 23(9):5104. https://doi.org/10.3390/ijms23095104 )
AAHA publications NEWStat® 2023-1 New oral diabetes medication for cats requires careful case selection Singler, Emily 1/13/23. https://www.aaha.org/publications/newstat/articles/2023-1/new-oral-diabetes-medication-for-cats-requires-careful-case-selection/ viewed 11/23.

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Diabetes in Cats – What is it? How is it diagnosed?

Posted on November 5, 2023March 11, 2024 by felinepurrspective_u3q4o6

This diabetic cat is walking on his ankles. This is called a plantigrade stance.

Diabetes is a condition where there is persistent high glucose (sugar) in the blood and the urine. Like humans, cat can develop diabetes. Which cats are at risk for diabetes? How do you diagnose diabetes in a cat?

Two previous posts addressed diseases that we tend to see in older cats, chronic kidney disease and hyperthyroidism. This post completes the trio by looking at feline diabetes.

diabetes in cats

Why do high levels of glucose occur in the blood and urine? Uptake of glucose by the muscle and fat cells in the body is dependent upon the hormone insulin. Insulin, produced by the “beta” cells in the pancreas, signals these cells to take up glucose. If the beta cells fail to produce enough insulin, these cells will not receive glucose, and, consequently, will not have energy for cellular functions. The glucose in the blood stream is then filtered out into the urine.

clinical signs of diabetes

Clinical signs of diabetes (Reference 1) are similar to those of hyperthyroidism and chronic kidney disease.

increased thirst and urination
weight loss
increased appetite

In some cases of uncontrolled diabetes, a cat will start walking on his ankles, referred to as a “plantigrade stance”. Cats often recover a normal gait after several months of treatment for diabetes. Some practitioners use oral methylcobalamin, a form of vitamin B12, to help speed up recovery (Reference 2).

the feline diabetic

Most feline diabetics are similar to type 2 human diabetics: they have insulin resistance and beta cells that are not functioning normally.

when muscle and fat cells become resistant to insulin, more insulin is needed to maintain glucose uptake.
beta cells in the pancreas respond by producing more insulin.
high levels of insulin trigger the liver to store glucose as glycogen instead of releasing it into the bloodstream (the cat is still able to get glucose from the GI tract).
eventually, the beta cells cannot continue “hyper-secreting” insulin and fail, resulting in high levels of glucose in the blood, not in the cells. (Reference 3)

diabetes in cats – who is at risk?

obese cats
cats over 7 years old
cats that are not very active
male and neutered cats
cats receiving steroids such as prednisolone

Obese cats are 2-4 times more likely to develop diabetes mellitus. Obesity leads to insulin resistance in the muscle and fat cells. However, many overweight cats never develop diabetes. They will have normal blood glucose values as long as the beta cells can produce enough insulin to suppress glucose production in the liver.

diagnosing diabetes in cats

Persistent high glucose levels in the blood (hyperglycemia) and urine (glycosuria) accompanied by one or more of the clinical signs above support a diagnosis of diabetes mellitus. A thorough history needs to be taken and a complete physical examination done. Diagnostic blood work will include routine chemistries, a complete blood count, urinalysis, urine culture or bacterial assay, and T4 measurement.

Why measure T4?
Excess thyroid hormone increases glucose production in the liver. If a cat is hyperthyroid, the hyperthyroidism needs to be managed in order to control the blood sugar.

One of the challenges to diagnosing diabetes in cats in the veterinary clinic is stress hyperglycemia. A cat’s blood glucose values can become falsely elevated due to the stress of the car ride, the exam and other factors. If the blood glucose is high enough, glucose spills over in the urine, also causing a false positive. Options to rule out stress hyperglycemia include (Reference 4):

repeating the lab work on a subsequent visit with the patient on pre-visit sedation
collecting a urine sample at home
measuring blood glucose at home
adding a serum fructosamine to the blood panel

Fructosamine measures the average of the blood glucose over the two weeks preceding the sample collection and consequently should not be affected by stress hyperglycemia. Fructosamine may not be accurate if the cat became diabetic within the past two weeks or if the cat has uncontrolled hyperthyroidism (Reference 1)

Once your cat is diagnosed with diabetes, what happens next?

The next post will address the treatments available to the diabetic cat and how the chosen therapy must be monitored.

references

Sparkes, A (chairman), ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats, Journal of Feline Medicine and Surgery (2015) 17, 235-250
Sereno, R. Managing complications in diabetic cats, DVM 360:article 5/1/2011. https://www.dvm360.com/view/managing-complications-diabetic-cats (viewed 11/2023)
Clark M, Hoenig M. Feline comorbidities: Pathophysiology and management of the obese diabetic cat. Journal of Feline Medicine and Surgery. 2021;23(7):639-648. doi:10.1177/1098612X211021540
American Association of Feline Practitioners, Diabetes Educational Toolkit, https://catvets.com/diabetes-toolkit/troubleshooting, viewed 11/2023

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Diets for Managing CKD in Cats

Posted on October 1, 2023March 11, 2024 by felinepurrspective_u3q4o6

Diet is a key therapy for cats with chronic kidney disease (CKD). Diets for managing CKD in cats aim to (Reference 1):

lessen the clinical signs of CKD
slow the progression of the disease
provide adequate nutrition

Diets for managing ckd in cats

The goal of diets for managing CKD in cats is to reduce the amount of uremic waste products while providing adequate nutrition. There are a number of commercially available diets that are formulated to do this. These foods feature (Reference 1):

reduced phosphorus
restricted amounts of high-quality protein
higher calories
reduced sodium
potassium supplementation
B vitamins and fatty acids

Phosphorus

Phosphorus is needed for the growth, maintenance, and repair of all tissues and cells, and for the production of the genetic building blocks, DNA and RNA. Phosphorus is also needed to help balance and use other vitamins and minerals, including vitamin D, iodine, magnesium, and zinc (Reference 2).

As kidney disease progresses, the ability of the kidneys to excrete phosphorus declines. To reduce stress on the kidneys, diets for managing CKD in cats aim to reduce the amount of phosphorus and balance the ratio of calcium to phosphorus. Too much phosphorus and not enough calcium can lead to kidney and bone damage (Reference 1). Commercial kidney diets are formulated to maintain an appropriate ratio of calcium to phosphorus.

protein in diets for managing cats with ckd

Since protein contributes significantly to phosphorus content, kidney diets restrict the amount of protein. Less protein means less uremic waste products. Emphasis is placed on formulating these diets with “high quality” protein. High quality proteins are a “complete package” and provide the cat with all the amino acids he or she needs. Thus, the protein used is highly bioavailable and generates less uremic waste products (Reference 1).

There are concerns that reduced protein diets predispose cats to weight loss and loss of lean muscle mass. Some recent studies suggest that senior cats may require more protein than younger cats to maintain lean body mass (LBM) (Reference 1).

Some practitioners advocate feeding higher protein diets to cats suffering with CKD to maintain the LBM. This may not be the answer to maintain LBM – increased protein in the cat’s diet means more uremic waste, making the cat feel nauseated and not inclined to eat. Ultimately, the cat will be eating less and calorie reduction will lead to muscle wasting as the cat’s body uses his own muscles for nutrition (Reference 3).

More on Lean Body Mass…

A recent study in 2019 (Reference 4) found a correlation between consumption of essential amino acids (essential amino acids must be consumed in the diet) and LBM. Cats with CKD Stages 1 and 2 were fed either a control kidney diet or a higher calorie “test” kidney diet that included higher amounts of essential amino acids and carnitine, an amino acid derivative that plays a role in energy production in the body.

The cats eating the lower calorie control diet lost LBM whereas the other group of cats eating the “test” diet maintained their LBM. Researchers observed that the cats on the control diet did not eat enough food to get adequate amounts of essential amino acids. They found that essential amino acid intake, not total dietary protein, correlated with maintaining LBM.

Although offering reduced protein, most commercial kidney diets make sure that more than sufficient amounts of the essential amino acids are available. The challenge is to get cats with CKD to eat enough of the diets.

Other Supplements

Commercial diets for managing CKD in cats also supplement:

Potassium, an electrolyte essential to the function of muscles and nerves
B vitamins – these water soluble vitamins can be depleted as the cat drinks more water and urinates more
Fatty acids – fatty acids found in fish oils are thought to reduce inflammation and decrease protein in the urine

Starting a kidney Diet

Renal diets are typically recommended for cats in IRIS Stages 2, 3, and 4. Occasionally a reduced protein diet may be prescribed for a Stage 1 cat who has persistent protein in her urine. Many practitioners like to introduce therapeutic diets when the cat is in IRIS Stage 2, because the cat should still be feeling well and more likely to accept the new diet (Reference 3).

The best time to switch to a kidney diet is when your cat is eating her regular cat food well and is feeling well. Wait to introduce the new diet if…

Your cat has just come back from the hospital
You have visitors or are doing home remodeling
Your cat is not eating her regular food well
Your cat is vomiting or having diarrhea

Introduce the new diet gradually, over several weeks (Reference 1)


Week 1	Week 2	Week 3	Week 4
Offer 25% of the new diet and 75% of the current food	Offer 50% of the new diet and 50% of the current food	Offer 75% of new diet and 25% of the current food	Offer 100% of the new diet

Make sure to offer the appropriate amount of calories to your cat – the new renal diet will most likely be more caloric than the your cat’s current food and you will not need to feed as much.

tips for transitioning to a kidney diet

Choose a food similar to the one your cat is eating already – wet or dry? fish or chicken?
Offer the new food in a separate bowl alongside the regular food
Make sure to offer fresh food
Use a “topper” to encourage your cat to try the new food – fish flakes or a favorite treat
Try gently warming wet foods – the stronger smell may make the food more appealing
Meal feed your cat – small, frequent meals gives your cat more chances to try the new food
Avoid mixing medications into the new food – use a small amount of another food or pureed treat to give the medications

If you are struggling with a finicky cat, talk to your vet. If your cat is healthy, ask if you can do a trial of mirataz to stimulate his appetite and facilitate the transition to the new food.

Alternatives to a commercial kidney diet

Use a phosphorus binder in the food your cat will eat. Consult your veterinarian for the appropriate dose.
Home cooked diets are an option but should be formulated by a veterinary nutritionist. Nutritionists affiliated with websites such as balance.it will work with your vet to formulate a recipe for your cat.

Studies have shown that diets for managing CKD in cats can increase longevity, help control uremia and maintain phosphorus concentrations. While some have concerns about the protein restriction in these diets, kidney diets have been shown to maintain LBM providing the cat eats enough food to get sufficient nutrition.

New research is focusing on the connection between the kidneys and the GI tract, particularly the uremic toxins that originate in the gut. Prebiotic and probiotic treatments in CKD cats are being investigated to see if improving the health of the microorganisms living in the gut can reduce blood concentrations of gut-derived uremic toxins. (Reference 5)

references

Quimby, J. and Ross, S., Diets for Cats with Chronic Kidney Disease (CKD) [updated 2022]. http://www.iris-kidney.com/education/protein_restriction_feline_ckd.html [viewed 9/2023]
Phosphorus: Fact Sheet for Health Professionals, https://ods.od.nih.gov/factsheets/Phosphorus-HealthProfessional/, viewed 9/2023.
Hall JA, Fritsch DA, Jewell DE, Burris PA, Gross KL. Cats with IRIS stage 1 and 2 chronic kidney disease maintain body weight and lean muscle mass when fed food having increased caloric density, and enhanced concentrations of carnitine and essential amino acids. Vet Rec. 2019 Feb 9;184(6):190. doi: 10.1136/vr.104865. Epub 2018 Dec 4. PMID: 30514741; PMCID: PMC6589452.
Summers, S. and Quimby, J., The feline gut-kidney axis: food for thought, Veterinary Focus, Issue #33.1, 5/31/23, https://vetfocus.royalcanin.com/en/scientific/the-feline-gut-kidney-axis-food-for-thought, viewed 9/2023

Chronic Kidney Disease in Cats

Posted on September 17, 2023March 11, 2024 by felinepurrspective_u3q4o6

Cat on Baby Scale — Weight loss is a symptom of kidney disease.

Chronic kidney disease (CKD) is common in older cats. A 2014 study found that 30-40% of cats over age 10 years had CKD. (Reference 1).

chronic kidney disease in cats

Let’s take a closer look at what the kidneys do for our cats.

regulate fluid volume in the body
maintain the pH and electrolyte composition of the body.
make renin, an enzyme that helps maintain blood pressure
make erythropoietin, a hormone that stimulates production of red blood cells
filter the blood removing waste products

Nephrons are the tubular structures in the kidney that filter the blood and produce urine. A cat’s kidney has about 200,000 nephrons (Reference 2).

Over time, nephrons become damaged and are replaced by scar tissue. Renal failure occurs when less than 25% of the nephrons are functional and the remaining nephrons can’t maintain adequate function. The most common cause is an inflammatory process called tubulointerstital nephritis (Reference 3).

The remaining nephrons compensate by increasing filtration rate. The result of this “hyper filtration” is scarring of the tubes in the nephrons and loss of protein into the urine. The “hyperactive” nephrons also release the enzyme renin. Renin triggers the production of the hormone, angiotensin II, that makes heart beat more forcefully and raises the cat’s blood pressure. (Reference 3).

Diagnosing Chronic Kidney Disease in Cats

Clinical Signs of Chronic Kidney Disease

Some clinical signs are similar to those of other chronic diseases such as hyperthyroidism and diabetes. Like those disorders, these signs are usually not present until later in the disease process.

weight loss
increased thirst and urination
rapid pulse and breathing
unkempt hair coat

In addition the “kidney cat” may have

lethargy
weakness
poor appetite
bad breath or ulcers in the mouth (occasionally)

Diagnosing Chronic Kidney Disease in Cats

CKD is typically diagnosed by measuring creatinine and SDMA in the blood and measuring the urine concentration (Reference 1).

Creatinine

Creatinine is a by-product of energy-producing processes in the muscles. A healthy cat’s kidneys filter out most of the creatinine. As kidney disease progresses, the remaining nephrons filter out less creatinine and values of creatinine in the blood rise.

SDMA

SDMA (symmetric dimethylarginine) is a metabolite of arginine, one of the essential amino acids for cats. SDMA is produced from metabolism of proteins and, like creatinine, is filtered out by the kidneys. Unlike creatinine, SDMA is not influenced by the change in muscle mass. SDMA is more sensitive to the increase in the filtration rate as kidney disease progresses. It will increase earlier than creatinine.

Urine Concentration

As remaining nephrons increase filtration to compensate for the loss of nephrons, the cat drinks more fluid and the urine he produces becomes more dilute. As CKD progresses, urine concentration decreases.

the stages of chronic kidney disease

The International Renal Interest Society (IRIS) has formulated a guide to staging CKD in cats, as well as in other animals. There are 4 stages of CKD. The table below summarizes the values for creatine and SDMA seen for cats in the stages of CKD.

Stage	Creatinine (mg/dL)	SDMA (mcg/dL)	Comments
Stage 1	<1.6	<18	Blood values are normal but urine is dilute or kidneys are abnormal on examination or imaging
Stage 2	1.6 – 2.8	18 – 25	Clinical signs are mild or absent
Stage 3	2.9 – 5.0	26 – 38	Clinical signs are present but vary in severity
Stage 4	>5.0	>38	Risk of uremic crisis

Signs of Uremic crisis (end stage kidney failure):

Refusal to eat, vomiting, lethargy, confusion (possibly pacing and restlessness), withdrawn, uncontrolled urination or defecation, ammonia-like odor to the breath, seizures (from https://www.petmd.com/cat/conditions/urinary/kidney-failure-cats). Emergency treatment is needed.

other signs of chronic kidney disease in cats

Even if creatinine and SDMA are within normal limits, high blood pressure and protein in the urine may indicate that a cat has kidney disease. Recall that as nephrons “die”, the remaining nephrons increase filtration to compensate and blood pressure rises. The higher pressure damages the walls of the tubes in the nephrons and protein can leak out into the urine.

High Blood Pressure

Systolic blood pressures under 140 mm Hg are considered normal; SBP 140- 159 is prehypertensive; over 160 is hypertensive and treatment is recommended. (see “Measuring Your Cat’s Blood Pressure: Why and How”)

Protein in the Urine

Protein in the urine can be associated with disease processes such as urinary tract infection. Persistent protein in the urine warrants a closer look and the veterinarian will often choose to run a test to measure the urine protein creatinine ratio (UPCR). UPCR < 0.2 are normal; ratios of 0.2-0.4 are borderline; ratios over 0.4 support a diagnosis of CKD.

Diagnosis of chronic kidney disease can be challenging. Clinical signs are non specific and shared by other chronic diseases such as hyperthyroidism and diabetes. Because the kidneys have so much reserve capacity and our markers do not detect it until nephron death approaches 70-80%, it can be easy to miss some of the more subtle indicators of kidney dysfunction. It is important for our cats to have regular exams to assess their overall condition, lab work, and blood pressure measurement. Kidney disease is progressive and not curable, however, early intervention can slow down the process. In the next post, we discuss treatment of Stage 1 through Stage 4 of chronic kidney disease in cats.

references

Sparkes, A. et al. ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease, Journal of Feline Medicine and Surgery (2016) 18, 219–239, https://journals.sagepub.com/doi/pdf/10.1177/1098612×16631234
Sadeghinezhad, J. and Nyegaard, J. Cat Kidney Glomeruli and Tubules Evaluated by Design-Based Stereology. The Anatomical Record, Volume 302, Issue 10, 18-46-1854, 14 May 2019, https://doi.org/10.1002/ar.24144
Grauer, Gregory, Feline Chronic Kidney Disease, Today’s Veterinary Practice, February 6, 2015, Issue March/April 2015, https://todaysveterinarypractice.com/urology-renal-medicine/feline-chronic-kidney-disease/

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