oh no I dont have any experience with this at all but sending you hugs and lots of love xoxo

Hi Lori...

Well, CKD (chronic kidney disease) is an incurable condition. That part is true. BUT depending on the stage, and a lot of other things, many cats live quite awhile. And even then, staging isn't a guarantee--the old adage is "Treat the Cat Not the Numbers."

Cats can go a long time on decreased renal failure--which is why many of them aren't even diagnosed until they hit that 75% loss level. And even then, unless they crash, it's not often discovered own its own, but rather secondary to something else.

It is certainly more common in elderly cats--which is why you see a lot of cats "dying" from it. I lost one cat to it at a few months shy of 20 years old--and she wasn't ill until she was very, very old. But there are cats who go into renal failure young: my Momo (the cat I have right now) was 8 when he crashed and was diagnosed as stage IV. Some (rare, but some) are even younger...like juveniles.

Until you get to a certain point,assuming they are stable, it is like any other managed, chronic condition... diet, possibly supplements, maybe fluids, etc. There will be an eventual tipping point where you will probably have to decide about continued care (hospice v. active warfare), and how far you will go and what treatment options you will pursue, but hopefully that will be down the line--depending on the cat, it could be YEARS and YEARS from now :-). And, having gone through cancer with other animals...you are more prepared, I think, than many folks.

I will say, though, I have found Momo's situation more difficult than with sam. Whether that's b/c of their ages--Momo was/is young; Sam elderly--or because of the difference in the disease, I don't know. OSA is sort of definitive. It has relatively standard options, and relatively standard paths of treatment and progression (No two cases are the SAME, but there are generalities), while CKD/CRF is all over the board, and there's always "one more thing" and there's just such variety in symptoms v. prognosis, etc.... way more unknowns, I found at least. That has been one of the hardest things to deal with.

Couple of questions--do you know his levels? Some forums will ask for the whole panel, but really Phosphorus, BUN, Creatinine are the biggies. Is he in hospital right now? Or outpatient? Did he crash, or did you just happen to discover it b/c of other things? Have you done a US/films to check for stones? This is one thing we DIDN'T do the first crash, and I wish now we would have, given what happened this winter. Especially with males...if he's obstructing (and then unobstructing) or whatever, and that's causing the renal compromise, your treatment would vary from if the etiology is unknown. And then again depending on the type and location of the stones. It is a many pronged decision tree

A good resource, which you have probably found, is Tanya's CKD page (http://www.felinecrf.org/). There is A LOT of info there...and it could be more than you need right now, but it's helpful. There is a corresponding discussion board (used to be on Yahoo, but since has moved to a platform called "BigTent" the link to join is here: https://www.big.....roups/tckd bear with them, as they JUST moved this week, so there's a bunch of hiccups I don't know if the old Yahoo group is still accessible to new people or not...) where people are very active. Although, I will say, by very, I mean VERY. There are some, ah, crazy cat people there :p But you will find a wide range--some people are way way way at one end of the spectrum as far as treatment, others at the other. So, if you can wade through it, it is helpful. 

A bit of hope and happiness for you...Momo's story has been pretty positive. In a nutshell: In September of 2012, Momo had sudden (or so it seemed) weightloss, anorexia, etc. We didn't think too mkuch of it at first...we had a new kitten who was harrassing him, and eating all his food, we had just been on a lengthy vacation, which always stressed him out, etc. But after a couple of weeks of him getting worse, I got concerned. Took him in to the vet, who gave him a B12 shot and sent him home. This was not our usual vet, and she never even mentioned the possibility of renal failure--even when I asked to run a panel, and maybe if it could be CRF. She said he was too young, most likely, and we shoudl watch and wait. The next AM, he was so lethargic, he was almost catatonic--I called our vet, who was back in the office and brought him in. Had we waited even hours more, he would have died, for sure.

His initial bloodwork was off the charts. As in the levels were too high to register. 24 hours in hospital brought no change. 48 hours, we saw some movement...vet said give him one more day on the IV. Eventually, after four days, he stabilized, and his levels came down enough to bring him home (BUN was in the high 50s/lo 60s). The vet warned us that off the IV and out of the ICU care, he might not stay stable. He had about 10-15% of renal function left.

That first month or so home was bad--getting him to eat was almost impossible. HIs mouth was full of sores, he had GI issues, etc. Getting any food into him--even with B12 and ciproheptadine--was a gut wrenching battle. Overall, he had gone from just shy of 17 lbs down to 9 lbs.

But, eventually, he DID start to eat (THANK YOU FANCY FEAST!), and we were able to transition him to a dry renal food--he wouldn't eat ANY wet food other than FF...which we still supplemented his dry food with. He got 100 mls sub q daily. And, after a year, he was doing so well, we moved to fluids every other day. The vet was surprised, we were happy, everyone's a winner. His levels climbed after he was released, and they stayed high--and the vet considered him stage IV--but he seemed to be fine for well over a year.

In december of 2013, he crashed again. This was rapid (we knew what to look for now). Eventually, we discovered that he had obstructed. Long long saga (and it's all here somewhere, you can read it for the specifics), but basically, he had stones every where you could have stones. One kidney had completely obstructed and died. He had maybe 3% functino in the remaining one. His bladder was blocked...and kept reblocking. So, we couldn't treat the stones b/c he had no kidneys. And teh obstructions were ruining what little kidney he had left (er, not to mention if you don't pee, you'll die...). Off the cath, he was unable to pee on his own. His levels remained sky high--but they did come down to a readable level...but that's where they stayed.

Basically, after almost a week, the vet said...take him home. Say goodbye, and I will come over in the AM. But lo and behold, he DID pee overnight. We had several fits and starts, but then he started peeing again. The vet said he had days, maybe two weeks, and he'd be there when we need us...in the meantime, he put him on pred to keep the pee flowing and to help with inflammation, gave us stone formula food (even tho the bulk of the stones Momo has are not dissolvable), and said "enjoy him."

It's mid-March now. His levels are off the charts. He still is filled with stones--and it isn't a question of IF he reobstructs, but when. We are in hospice care. But we are still here. He gets 175 mls of sub q daily, and 5 mg of pred. He eats as much wet food (laced with Fancy Feast) as we can give him, and he sleeps in the bathroom at night so we can monitor his pee outtake He shouldn't have made it the FIRST time. But he did. This past winter astounded everyone--including the specialists at the ER, our own vet, and everyone else.

We have made it 18 months with a stage IV cat (mind you, some cats survive with high levels...some do not. It is very varied. Momo just happens to be one who is able to get by) who has virtually ZERO kidney function and stones in kidneys/ureter and bladder. He has slowed since the christmas episode--it aged him, for sure. He is now 10 going on 17, but he still is happy and content. And, thanks to my experiences with Sam, I am able to spend our remaining time with him "being more dog," and not worrying about what hasn't happened.

So there you go...a happy story Feel free to ask me anything--I am happy to help in whatever way I can.

The most common supplements people use are phosphate binders, the B12, maybe slippery elm for tummy stuff, etc. I think it sort of depends on what yoru specific "issues" are. We've really not used any, b/c despite his bloodwork, Momo has done fairly well.

As for fluids...some cats benefit from them even if they are only like once every few days or even once a week or so--seems to perk them up and give them a little boost. Help the kidneys out and all that.

The CKD versus CRF... CKD is just the "new" term that folks are using, to A) make it sound less awful :p and B) distinguish between the end stage of the disease and the more manageable parts of it. Technically, it's still failure...but we make it happy by sounding manageable :p So don't let your vet scare you TOO much.

Do be aware, though...treatment options and opinions can vary wildly by vet. Some just say "put them down" right away, others manage, others refer out, etc. Just from talking to people, it seems like we have a better go of it here in the states than in the UK (where many vets don't even support Sub Q fluids), but even then, there can be some old school thoughts out there. <3

It could be, too, that the depression stresses him and makes things worse--so don't rule that out as a compunding factor. If he's a beggar, fatten him up You could try adding something like Nutrical to his daily diet, if he'll eat it. As for the renal food, some cats will eat it...others, not so much. Some will eat the dry and not the wet (momo wouldn't eat the wet renal food--neither one of the brands...but he WOULD eat the dry. One brand. OTOH, he will eat the wet stone food. Go figure...). The most important thing is eating, period. So, if he won't eat any of teh renal health stuff...far better to get him eating whatever it is he'll eat, than nothing.

Karen...I agree. I think that fluids are one of those things that it's almost better off erring on doing than not (unless, of course, you have heart concerns, etc.), if only on a sometimes basis. Dehydration is awful, and can make all kinds of other stuff even worse.

And in the end, food of SOME sort is better than no food (no matter what the ailment is--we had that problem with Sam. Eating only hot dogs and Fancy Feast is better than not eating at all. ).

The Tanya's group is probaby the biggest and most active for Feline CRF/CKD.

How unfair to have two cancers AND renal disease in poor Maggie. And renal failure is worse--or at least different--in dogs. I feel like it's...what? More manageable in cats? At least to a point? More common, maybe? Dunno. What a fighter she was. <3

Def. treat the anemia--b/c that can get you before the renal failure does.

5.6 is high--and IRIS stage IV...but it's not the total picture, and some things could cause an inflated number (infection, for one...but hypertension, kidney stones, etc. are some others--I'd ask to get the all clear on those, as well). And it can change, too. And, not the only number to keep in mind. Phosphorus is one that can make them feel like shit, def. And will kill an appetite. Did he happen to tell you his phosphorus and BUN? And K, as well? (Potassium levels can be one clue to metabolic acidosis, actually, so good to know there...)

Even with that, median survival for stage IV is 4 months (depending on teh studies you read)--and some studies have had cats living for 5+ years. And, like I said, we are at 18 months and counting at stage IV. (We get the levels down a bit, but they just pop back up...we seem to default to around 130 BUN, 5.5-6 creat, and phos in the 11s., which is where we were in mid-January)

Okay...standard caveat about me not being a vet blah blah blah... but kinda I think it's odd that if he is stage IV they are not suggesting fluids--at least for the short term... Fluids also help flush toxins and take a load off of the kidneys--in addition to the hydration. a lot of t imes, if a cat is testing that high, they'll do an IV in hospital, and then send him home with sub qs to try and bring the numbers down.

But there are so many factors, so it's hard to know...remember what I said about this being more frustrating than the osteo??? :p <3