# Feline CRF Q&A



## Shoshana89 (Jul 19, 2011)

Thursday of last week I noticed Livia, my 13yr persian, was very lethargic. It's so freaking hot out I was lethargic too so I didn't think too much of it. Thursday night she seemed a tab uninterested in much of anything so I made a mental note. Friday morning she was downright near death so I rushed her to an ER vet. Her ran blood/UA tests and came back in and announced Livia has CRF-Chronic Renal Failure. He said it's terminal but there are things we can try to make her more comfortable and prolong her life. He gave her sub-Q fluids that say gave me special food and scheduled her to come back in saturday for more fluids, which I did. Livia instantly perked up. Yesterday Livia was up and down the stairs, scratching my great grandmothers antique rocker, jumping onto furniture and demanding her "special" food whenever the mood struck her. I am NOT ungrateful she is feeling so much better I am however extremely confused. Her mobility in her hind legs have completely returned. I would assume she would still be displaying some signs of weakness there but idk. (Although I have no proclaimed myself an honorary Vet after all my research!) Two yrs ago livia had a benign tumor removed from her shoulder by a vet I absolutely have a ton of confidence in but I moved 2 1/2 hrs away from the vet for grad school. I called him yesterday afternoon bc I was so confused and frustrated. He answered his OWN phone at the clinic and spoke to me for about 20mins even though it's been 2 yrs. (I love him and if anyone needs a cat dr in Indianapolis PLEASE ask me for his name and go see him) He said Livia's blood/UA 2 yrs ago were perfectly normal and if she has CRF she most likely would have been showing signs 2 yrs ago but perhaps not. He threw out a lot of different possibilites and I'm driving to see him tomorrow afternoon. Even if he confirms the CRF I think he'll do a better job at helping Livia (and me). I'm wondering what improvements, experiences, etc others have had with CRF others have had especially if you've seen a near complete disappearance of the leg lack of mobility.


----------



## Shoshana89 (Jul 19, 2011)

*Follow-up*

Yesterday Livia had her appt with her cat-only vet. He rechecked her blood/UA and there was a marked improvement from her initial ER results. In fact if you were to only look at her results from yesterday they appear as a cat that is starting the normal kidney decline of an elderly cat. The vet was very shocked at her results from yesterday when comparing the results from nearly a week ago. He believes Livia had developed an aortic clot which traveled out and landed and erupted in her legs. This can not be definite because the ER vet did not perform certain test when he did her bloodwork. It is, however, the medical theory that makes the most sense given her test results from yesterday. By all accounts Livia should not have made it. Additionally she really shouldn't have recovered as well. The official diagnosis after all of this is now "renal insufficency". He estimated, by her UA, her kidneys have lost 80% of their functionality so we're now on a course to maintain the 20%.
The financial tally is now at $1345.00 since last Friday. I nearly threw my own clot when I got yesterdays bill. Going forward I'll be giving her IV fluid therapy at home 3xs a week, continuing with her special food and a daily antibiotic. Does anyone have any suggestions? Things that have worked better? I'm open to anything...even just venting your own stories. Sadly i can not pay you for your advice...i'm now broke lol


----------



## laurief (Jun 22, 2008)

Shoshana89 said:


> Going forward I'll be giving her IV fluid therapy at home 3xs a week, continuing with her special food and a daily antibiotic. Does anyone have any suggestions? Things that have worked better?


Just to clarify, you're going to be giving her subQ fluids at home, not IV. SubQ is administered under the skin. IV is administered directly into a vein. Given the most recent blood test results that you shared with me privately, I would be giving fluids daily if she were my cat. Her elevated TP indicates that she is still dehydrated. Getting her properly hydrated may bring her renal values down a bit more, and proper hydration is key to maintaining a CRF cat's renal and overall health. How much fluid did your vet tell you to give her at each administration, and how much does Livia currently weigh?

Why did the vet prescribe antibiotic, and which antibiotic was prescribed?

Are you scheduled for more follow-up bloodwork? If not, you should plan on going in for another blood panel in 3 months if she continues to act normal and happy ... sooner if she acts ill again.

Laurie


----------



## Shoshana89 (Jul 19, 2011)

He gave her Convenia. Yes I meant sub-q fluids at home. I'm getting the IV therapy/Sub-Q confused. She is scheduled to return in 1 month to get her bloodwork checked. I called him today to ask about the frequency for the fluids and he assured me 3xs a week is plenty. I'm doubting him though because you've been so adament in your experiences. Everytime I used the tern CRF he said "renal insufficiency" back to me. I'm thinking I may need to take her to yet another vet...I don't know.


----------



## laurief (Jun 22, 2008)

Why did he give her an antibiotic? I assume he suspects some sort of infection?

What volume of fluids did he prescribe per administration? How much does Livia weigh?

CRF or renal insufficiency is just a matter of semantics. There is no specific or consistent definition that I know of to differentiate the two. Perhaps that vet just isn't prepared to commit to the "chronic" designation of her renal problems yet, and he may be correct. It's still possible that she may continue to improve and recover if, in fact, she suffered an acute renal failure.

Laurie


----------



## Muzby (Jan 9, 2008)

Just a quick question I feel everyone could learn from:

If the vet tells you 3x a week, and an experienced CRFmommy says daily... I see the conundrum. However, to my thinking, there is no "overdose" for subQ? So even doing it daily, won't necessarily HARM the cat, and could only HELP if anything, correct?


----------



## laurief (Jun 22, 2008)

No, that is NOT correct! I nearly killed one of my CRF cats by overhydrating him. He was drowning internally because he wasn't absorbing fluids as quickly as he should have been. He was seriously dehydrated at diagnosis, and my vet told me to administer 300 ml of fluids a day for five days to rehydrate him. After the third administration, he went into respiratory distress (open-mouth breathing), and I had to rush him to the vet to save him. His chest cavity was full of unabsorbed fluid, and he could barely breathe. We used diuretics to remove the excess fluid, and he pulled through. I had to be VERY careful how much fluid I gave him after that, though.

Generally speaking, the "typical" dose of fluids given to CRF cats who receive fluids daily is 100 ml. That amount is variable, though, depending on the cat's size, CRF stage, cardiac health, ability to maintain hydration through oral intake of water, and other factors. Many vets have clients administer larger volumes of fluids less frequently as a matter of convenience for the owners, but that is not in the cat's best interest. It's best to maintain as even hydration in the cat as possible, and the best way to do that is to admin daily. So if, for example, your vet prescribes 150 ml every other day, it's actually better for the cat if you admin 75 ml daily, instead, to maintain more level hydration. This is why I have asked you how much fluid your vet prescribed per admin 3xs weekly and how much Livia weighs.

Believe me, you don't ever want to see Livia gasping to breathe the way my Bitsy did when I overhydrated him. That's certainly something I never want to see again.

Laurie


----------



## Beckie210789 (May 9, 2011)

I had a cat who jaundiced on me, and ended up with hepatic lipidosis. She was prescribed 100 cc of lactated ringers twice a day. She started coughing a lot after each dose, and breathing heavy. I called my vet, and they were pretty non chalant about it, saying that she was just upset about having the fluids administered, but a friend of mine, who is a vet tech, called me that evening to catch up and I asked her about the coughing. She said that if you give them too much fluids, too often, it can lead to fluid build up around the heart and lungs, and she urged me to back her off to 50cc twice daily instead. I did, and the coughing went away, as well as the heavy breathing. I called my vet the next day with the findings, and again, they weren't concerned. My cat was only 9 lbs though, so not a large cat by any means.


----------



## laurief (Jun 22, 2008)

Oops! I didn't realize that last post was written by Muzby instead of Shoshana. Sorry about that. My reply still applies, though.

Laurie


----------



## Muzby (Jan 9, 2008)

Learn something new every day!  Thanks ladies.


----------



## Shoshana89 (Jul 19, 2011)

He perscribed 100 m/l 3xs a week. He did the antibiotic because he said frequently a cat "crashing" from either CRF or ARF frequently is masking an underlying infection in the kidneys from the lack of filtration. I spoke with the after hours vet last night and he made the gentle hush toned suggestion I may be over reasearching...


----------



## laurief (Jun 22, 2008)

There's no such thing as over-researching. There are, however, such things as confusion, misunderstanding, and over-reaction. It's important to verify the credibility of the sources of your information AND the sources of your sources' information (and so forth). For instance, my experiences with my own CRF cats may not bear any relevancy at all to what happens with anyone else's CRF cats, so you need to keep all information in perspective and question EVERYTHING. This is especially true when dealing with living individuals, each one of whom is different, and an inexact science like medicine. It'd be great if there was just one effective course of treatment for each disease that worked the same way in all individuals affected with that disease, but it doesn't work that way. Physical bodies are different. Diseases are different. The way each individual body reacts and responds to the same disease and its treatments is different. This is why you will get so many seemingly contradictory diagnostic and treatment recommendations from different vets (not to mention from experienced lay-people such as myself). I personally believe research and information are the only paths to knowledge and rational decision-making, but at the end of the day, you still need to sift through it all and decide which information makes the most sense and how to best apply it to your situation. When dealing with an ailing beloved, that's not an easy thing to do. I know. I am constantly questioning and rethinking the decisions I make daily about the care of each of my animals who have chronic medical conditions.

Laurie


----------

