Acute Renal (Kidney) Failure in Cats

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Overview of Acute Kidney Failure in Cats

Acute kidney failure (acute renal failure or ARF) is characterized by an abrupt decline in kidney function that leads to changes in the chemistry of the body including alterations in fluid and mineral balance. The changes that arise as a result of ARF affect almost every body system.

Below is an overview of Acute Renal (Kidney) Failure in Cats followed by in-depth information about the diagnosis and treatment of this serious condition. 

The kidneys filter blood, remove the waste products of metabolism, and eliminate them in the urine. The kidneys also regulate the volume and composition of body fluids (including mineral concentrations and acid base balance), and produce hormones that stimulate the production of red blood cells (erythropoietin) and regulate calcium balance (calcitriol).

Acute kidney failure can be caused by toxic injury to the kidneys, decreased blood flow and oxygen delivery to the kidneys, infections, obstruction of the kidneys and prevention of urine elimination caused by a ruptured bladder.

The recent recognition of kidney failure is not necessarily the same as acute renal failure, since some animals with chronic kidney failure tolerate it for some time before symptoms are apparent.

There is no specific breed predilection but older animals are thought to be at greater risk for acute kidney failure. Acute kidney failure is more common in the fall and winter due to pet exposure to anti-freeze which contains ethylene glycol. Cats that are allowed to roam outside without supervision potentially have increased exposure to ethylene glycol.

The symptoms of ARF, although often severe, are not specific. Even with intensive management, ARF is a very serious disorder and often is fatal.

What to Watch For

  • Disorientation
  • Incoordination
  • Decreased urine production
  • Straining to urinate
  • Loss of appetite
  • Lethargy
  • Vomiting
  • Weakness
  • Changes in water consumption and urination
  • Diagnosis of Acute Renal Failure in Cats

    Your veterinarian will take a complete medical history specifically questioning exposure to ethylene glycol (anti-freeze), recent surgery or anesthesia (possibly causing decreased blood flow to the kidneys), exposure to drugs toxic to the kidneys (aminoglycoside group of antibiotics and non-steroidal anti-inflammatory drugs) and previous illnesses. The following diagnostic tests may also be necessary to recognize acute kidney failure and exclude other diseases. Tests may include:

  • Complete physical examination
  • Serum biochemistry tests
  • Urinalysis
  • Complete blood count
  • X-rays of the abdomen
  • Culture of the urine
  • Ultrasound examination
  • Kidney biopsy
  • Ethylene glycol test
  • Blood tests for certain infections
  • Treatment of Acute Renal (Kidney) Failure in Cats

    ARF is a life-threatening serious condition that requires hospitalization and intensive treatment. Treatment consists of identification and correction of life-threatening problems while searching for the underlying cause of ARF. Treatment for ARF may include one or more of the following:

  • Induce vomiting
  • Intravenous fluids
  • Drugs that encourage urine production
  • Management of blood electrolyte abnormalities
  • Monitor urinary output
  • Control of vomiting
  • Management of anemia
  • Peritoneal dialysis or hemodialysis
  • Treatment with 4-methylpyrazole (Antizol®) or ethanol
  • Home Care

    Acute renal failure is a life-threatening condition and there is no effective home treatment. If you suspect your pet has this condition, or if you even suspect your pet may have consumed even a small amount of anti-freeze, you should call your veterinarian immediately. Your veterinarian may instruct you to induce vomiting before bringing your pet to the hospital.

    Administer any medications prescribed by your veterinarian. Follow-up examinations and laboratory tests are important to assess your pet’s response to treatment. Allow free access to fresh clean water.

    Preventative Care

    Avoid exposure to ethylene glycol (anti-freeze), and avoid exposure to drugs known to be toxic to the kidney (e.g. aminoglycoside antibiotics and non-steroidal anti-inflammatory drugs). Don’t allow cats to roam outside unattended.

    In-depth Information on Acute Renal (Kidney) Failure in Cats

    Acute renal failure (ARF) is a life-threatening disorder that can affect cats of any age.

    Acute renal failure may be caused by decreased blood flow to the kidneys (called ischemia) or exposure to certain drugs or chemicals that are toxic to the kidneys.

  • Low blood flow to the kidneys may occur during anesthesia and surgery, and some drugs such as the non-steroidal anti-inflammatory agents like ibuprofen may also cause ARF by reducing blood flow to certain parts of the kidneys. Other causes of reduced blood flow to the kidneys include severe dehydration, shock, poor heart function, heat stroke and overwhelming infection (sepsis).
  • Many toxins can damage the kidneys and lead to ARF. Probably most important is ethylene glycol, which is the active ingredient of anti-freeze. Some antibiotics, especially a class of injectable antibiotics known as aminoglycosides, can cause damage to the tubules of the kidney and ARF. High blood calcium concentration likewise can damage the kidneys. Heavy metals (e.g. lead, arsenic), contrast dyes used for certain X-ray procedures, and some anesthetics also can damage the kidneys. An important toxin that specifically affects the kidneys of cats is the Easter Lily. Cats should never be allowed access to this group of plants. Some older drugs used to treat heartworms (thiacetarsamide) and fungal infections (amphotericin B) also are toxic to the kidneys.
  • Acute bacterial infection of the kidneys (called pyelonephritis) also can produce ARF.
  • Rare causes of ARF include glomerulonephritis (acute inflammation of the microscopic filtering devices of the kidney called glomeruli), glomerular amyloidosis (deposition of an insoluble type of protein in the kidney), disseminated intravascular coagulation (a body-wide clotting disorder), obstruction by blood clots of the arteries going to the kidneys, and hemolytic-uremic syndrome (liver and kidney failure caused by a specific strain of the bacteria E. coli).
  • Urinary obstruction is a type of reversible ARF that is treated by relieving the obstruction.

    The most common causes of death during treatment of ARF are high blood potassium concentration, acid-base disturbances, very high concentrations of waste products in the blood that do not improve with fluid therapy and excessive administration of fluids with fluid accumulation in the lungs.

    Animals unable to produce urine despite medical treatment have little chance for survival without peritoneal dialysis (infusion and removal of fluid into the abdominal cavity to remove waste products from the body). Hemodialysis can be performed in animals but is only available at selected referral hospitals and is very costly.

    The prognosis for recovery of kidney function in ARF depends on the severity of the kidney damage, the underlying cause of ARF and supportive treatment.

    Other medical problems can lead to symptoms similar to those encountered in ARF. A thorough medical evaluation is needed to diagnose ARF including laboratory testing and diagnostic imaging (X-rays or ultrasound). Warning signs that owners may see in pets with ARF include complete loss of appetite, marked lethargy, and vomiting. Unfortunately, these symptoms are very non-specific and may be caused by many other disease conditions. If is important to consult your veterinarian promptly.

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