This week's column:
My cat has been diagnosed with chronic renal failure. Is there any chance her condition will improve?

Dear Sinéad, Siouxsie and Thomas:
I'd like to get some information on treating a cat in kidney failure. Our cat (11 years old) has been though a one week treatment of fluids twice a day (which resulted in fluid in her lungs and labored breathing) with the hope that she'll start to drink and eat independently. Unfortunately, she hasn't and the vet has advised that we euthanize her. Her creatinine measured 10 prior to the treatment, indicating an elevated level of toxins in her body. She's still getting around independently and not overtly showing any signs of distress, though she's mostly lying down for long periods.

Is there any hope that she will rally? If not, what is the progression of the disease (signs of increasing distress, etc.)? Are there medications that would make her transition comfortable or is it best to have her euthanized?

I've started giving her Rescue Remedy, 2 drops in 6 oz water, administered with an oral syringe. She drank 2 syringes easily -- though slowly -- and already her breathing has become less labored. I intend to repeat this dosage at intervals of every 2 hours. Am I giving her enough? Too much? Should I continue administering it this way or I've
read that I can put 2 drops on my fingers and rub it into the skin of her ear flap. Are there any other essences that I should be giving her?

I would appreciate your soonest reply as the treatment has been stopped and we're not sure what to expect or how to respond.

Thank you,

Sinéad: Well, Frances, as your vet has probably told you, chronic renal failure is a terminal illness. The amount of time it takes for a cat in chronic renal failure (CRF) to reach the point of "too much suffering" varies from cat to cat.

Siouxsie: For the benefit of our other readers, we'll start by explaining what the kidneys do and what renal failure is. The kidneys filter the blood and eliminate waste products generated by cell division by producing urine, which is then stored in the bladder and eliminated through the urethra. The kidneys also regulate the electrolytes (minerals the body needs to function properly) in the blood. They do this through about 200,000 tiny filters called nephrons. When these nephrons begin to die, the kidneys lose their ability to filter waste products out of the blood. The result of this is a buildup of toxins in the body that makes your cat feel sick and, in extreme cases, can poison the body's other organs so that they stop working too.

Thomas: There are two types of renal (kidney) failure: acute and chronic. Acute (sudden onset) renal failure is usually brought on by ingesting something toxic such as ethylene glycol antifreeze or NSAID drugs like aspirin or acetaminophen. Chronic (long-term) renal failure can be brought on by an episode of acute renal failure or by progressive deterioration in kidney function.

Sinéad: One way a veterinarian can tell whether a cat is suffering from acute renal failure or a crisis point in chronic renal failure is by the amount of urine produced. In acute renal failure, a cat will suddenly stop urinating. However, a primary symptom of chronic renal failure is increased urination.

Siouxsie: A cat only needs 30 percent of its kidney capacity to function normally, so by the time a cat actually shows symptoms of CRF, almost three-quarters of the nephrons are no longer working. Because of this, treatment needs to begin as soon as symptoms of CRF appear.

Thomas: CRF symptoms include excessive urination, increased thirst, nausea and gagging, a smell of ammonia on the breath, drooling, dehydration, constipation, loss of appetite (and resulting weight loss), depression, poor hair coat, and lethargy.

Sinéad: CRF is diagnosed by means of a blood test and a urinalysis. The blood test measures levels of creatinine and blood urea nitrogen (waste products eliminated through the kidneys), as well as other enzymes. It will also allow the vet to do a "blood count" -- to see if the number of red and white blood cells is within the normal range. A high white blood cell count could indicate infection, and a low red blood cell count could indicate anemia. A urinalysis is a test of the cat's urine to see if there is excessive protein, sugar, or other types of waste products in it.

Siouxsie: What causes CRF? The common contributing factors are age, genetics, environment, and disease. However, research has begun to show a connection between CRF and high blood pressure, low potassium levels, acidified diets, dental disease and possibly treatment for hyperthyroidism (because the drugs used to treat hyperthyroidism can harm the kidneys).

Thomas: As we said earlier, the prognosis in CRF varies widely from cat to cat, and it depends a lot on how much kidney function is left. The fact that your kitty is responding to Rescue Remedy is a good sign, we think. You can probably give it to her once a day rather than every two hours, although do continue giving her all the water she'll take.

Sinéad: We recommend that you not use essential oils on your cat at all. The active ingredients in some essential oils are toxic to cats, and any cat with kidney function problems should have minimal exposure to toxins of any kind. When you give your cat water, make sure it is spring water or, if you use city water, run it through a pitcher filter to get the chlorine, fluoride and other chemicals out.

Siouxsie: You can use flower essences, but we recommend rubbing them into the skin of your cat's ear flap rather than having her ingest them. Flower essences are a form of "energy medicine," so they don't need to be eaten to do their job. We recommend the use of flower essences to treat the emotional effects of chronic disease (Anaflora's Calm Kitty and Return to Joy, or Green Hope Farm's Anxiety, Recovery or Senior Citizen) and to help your cat accept her new state of being. They can also help animals make the transition out of their bodies (Green Hope's Transition) when the time has come.

Thomas: Generally the most effective treatment for CRF involves subcutaneous fluids and nutritional support in the form of a low-protein diet with easily absorbed vitamins. You will want to buy or make a food that has the best possible quality of ingredients (human-quality meat, for example) and preferably organically raised grains and natural preservatives such as Vitamin E oil. Your veterinarian will guide you on what foods are best for your cat.

Sinéad: We think you and your cat would benefit from a consultation with a holistic veterinarian. Holistic vets generally have focused a lot of their training on nutritional support for health and for management of chronic illnesses. We have a couple of cat and dog friends with CRF who have benefited from the care of a holistic vet.

Siouxsie: Dr. Richard Pitcairn, in his book Natural Health for Dogs and Cats, has listed some herbal and homeopathic remedies that can help strengthen animals' kidneys. Give one to two drops of Alfalfa (Medicago sativa), three times a day, during the initial crisis. Once you see an improvement, reduce to once a day or as needed. You could give alfalfa tablets instead if you wish, one tablet a day crushed up and mixed with kitty's food.

Thomas: You can also use Marsh mallow (Althaea officinalis). Prepare an infusion by adding 2 tablespoons of the flowers or leaves to 1 cup of boiling water. Let steep five minutes. Twice a day, give kitty 1/2 teaspoon of this mixture. You can mix it with food or feed it to her with the water you're syringing into her. Continue giving this remedy for several weeks and then taper off to twice a week.

Sinéad: The homeopathic remedy Nux vomica 30C is useful to treat occasional bouts of uremia. It will help with the symptoms of toxicity, especially nausea, vomiting and feeling generally ill. Crush two pellets into a powder and place it on her tongue. Give no food for 60 minutes before or after the treatment. You only need to administer this treatment once. If after a month there's no improvement, try a different remedy.

Siouxsie: Natrum muriaticum 6X will help with the body's use of water. It is indicated for the cat that is very thirsty and prefers to lie on cool surfaces. Give one pellet, once a day, on the tongue or down the throat, for four weeks. Do not give food for 10 minutes before or after treatment.

Thomas: Sepia 6C is helpful for the cat that has mostly stomach symptoms -- nausea, vomiting or loss of appetite. Give one pellet, once a day, on the tongue or down the throat, for four weeks. Do not give food for 10 minutes before or after treatment.

Sinéad: Pulsatilla 6C is indicated for the cat that shows no sign of thirst (in spite of the kidney disease) and prefers to lie on cool surfaces. Give one pellet, once a day, on the tongue or down the throat, for four weeks. Do not give food for 10 minutes before or after treatment.

Siouxsie: Dr. Pitcairn also recommends vigorously brushing the coat and skin to help the body eliminate toxins through the skin. Provide regular mild exercise and exposure to fresh air and sunshine. Always allow easy access to a litterbox and make lots of pure water available for drinking at all times.

Thomas: You may be able to entice your kitty to start eating again by warming her food. We've talked about this and other appetite-stimulating tricks in this column.

Sinéad: These treatments should help you support your cat's kidney function, and they may in fact help her to feel better and increase her quality of life. Eventually, however, you're going to have to make the decision you're dreading. How will you know it's the right time? First of all, your cat's symptoms will increase in severity -- she won't be able to eat or even drink without gagging and possibly vomiting. She'll develop ulcers in her mouth and start looking listless in spite of all the supportive therapy you're doing.

Siouxsie: And you'll have a strong sense that your kitty is ready to leave her body. All of us have had an animal friend who's given us "that look" before, and as much as it pains us to do so, we know it's the most loving and courageous choice we can make for our companion.

Thomas: We wish we had a firmer answer for you about how you can tell when it's time to let your cat go. We certainly think it's possible that your cat could rally -- cats can live a long time even if they do have CRF -- but we think that if she isn't at least starting to eat again within a week, you're going to need to take your vet's advice to euthanize under serious consideration.

Sinéad: In the meantime, we've found some other online resources about feline CRF that could be very helpful to you. The Feline CRF Information Center was started in 1996 by a couple whose beloved cat was diagnosed with CRF. They are lay people, just like you, and the site contains tons of information about CRF and its treatment in language that non-veterinarians can understand.

Siouxsie: Judy's World: Living with a CRF Cat is another site full of information and support for people whose cats are suffering from CRF. Again, this is a lay person's site, so be aware that your vet is going to be the best authority on CRF management and treatment.

Thomas: And here's a page of kidney disease information links from the cats forum.

Sinéad: We hope this information helps you and your cat, Frances. Purrs to both of you, and please let us know how it goes.

Got a question? Need some advice? E-mail us at None of the material in this column is meant to be a substitute for regular veterinary care.