Year: 2023

Managing Aggression in the Multi-Cat Home

Posted on 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

  1. 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
  2. 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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Social Groups of Cats in The Multi-Cat Home

Posted on by felinepurrspective_u3q4o6
Gus greets Miso

Social Groups of cats in the multi-cat home

This post was originally published 8/29/20. This newer version has been edited to incorporate new material and references.

If there is plenty of food around, free-roaming cats tend to form groups called colonies. The core of the cat colony are the females, typically a mother, her sisters, and her daughters. These females share the care of the kittens – they nurse each others’ kittens and even help each other give birth.

Male kittens are driven off by their mothers at maturity to avoid inbreeding. They can become solitary hunters like their wildcat ancestors or become attached to an unrelated colony if accepted by the females.

Smaller social groups of cats often form within the larger social group of the cat colony.   These groups of 2 or more cats typically

  • sleep snuggled together
  • groom each other
  • rub against each other
  • “play fight”.

These cats are comfortable sharing resources: food, water, litter boxes, sleeping and resting places.  Often these are cats that grew up together but that is not always the case. 

social groups of cats indoors -managing the multi-cat home

In the multi-cat home, some cats also prefer to stay together. Identifying the social groups of cats in the home can aid in allocating resources and reduce conflict among the resident cats [Reference 1].

Identifying the social groups of cats

Members of the same social group mayCat sharing a basket

  • sleep snuggled together
  • groom each
  • rub against each other
  • engage in mutual social play.

There are no hard and fast rules to affiliation: some cats will not snuggle together, but will groom each other and play together.

A Multi-Cat Household and its Social Groups

There are 3 social groups in this 4 cat household.

Social Group 1

Athena forms her own social group.  She is a 15 year old spayed female. She recognizes her housemates but prefers to spend time by herself or with her owners.

Social Group 2

Marley (14 yr neutered male) will hang out with 4 year old Zelda. They will rest together and  “share” snacks. They will occasionally “play fight”.

Social Group 3

Zelda and Gus (3 yr old neutered male) groom each other’s heads and play together occasionally.

Gus and Zelda also go on walks together with their owners.

Allocating resources in the multi-cat home to reduce conflict

One of the keys to harmony in the multi-cat home is to provide multiple resources and spread them throughout the house.  The goal is to ensure that all cats have access to litter boxes, food and water without having to compete with another cat. Here is a simple diagram showing the location of litter boxes on the second floor of a multi-story home [Reference 1].

When locating resources, watch for “bottlenecks” such hallway doors where cats may have to pass each other. Try and place litter boxes, water stations… away from these areas.

House map cat resources
A simple sketch of your house can help with locating litter boxes.

tips for managing resources in the multi-cat home

  • # litter boxes =  # social groups + 1
  • Feed cats individually and out of sight of each other.
  • Have daily play time for each cat
  • Have multiple sleeping, resting places – have secluded and elevated choices

monitoring interactions between cats to manage conflict

Once the social groups in the house are identified, it important for the cat owner to monitor how the cats are getting along and intervene, if necessary, to prevent conflict [Reference 1].

  • A cat fight can result in injuries to the fighting cats and the humans who try and manage the fight.
  • Aggression does not need to cause physical injury – psychological stress resulting from one cat guarding resources from another can result in illness and undesirable behaviors such as house-soiling.

signs of conflict – signs of play

It is important to be aware of potential conflict in the multi-cat home.  Signs of conflict not only include chasing, running away, howling and hissing, but also more subtle, seemingly harmless behaviors such as staring and blocking doorways.  To make things more confusing, chasing and running away can be play behaviors! For more information, visit “How Do Your Cats Get Along – Conflict Behaviors”.

 Cats are socially flexible and can form social groups with unrelated cats, although the strength and intensity of these social bonds can vary.  A few aggressive interactions between cats who sleep snuggled together, groom each other and share resources may not point to a deterioration in their relationship [Reference 2].  However, cats whose affiliation is weaker and whose inter-cat interactions are frequently punctuated with hissing and growling may warrant a call to your veterinarian or a cat behaviorist. 

The next post will look at identifying aggressive behaviors in more detail and what interventions are available to the cat owner.

references

  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
  2. 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

 

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Managing the Diabetic Cat – Home Monitoring and Emergencies

Posted on 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…

  1. measure blood glucose (BG)
  2. 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)
  3. recheck BG in 15 minutes
  4. if glucose rises, continue to offer food and check glucose until the value is in a normal range
  5. notify your veterinarian
  6. 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

  1. 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
  2. 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
  3. 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 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

  1. determine how many calories your cat is eating
  2. reduce current calories by 10-20%
  3. 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

  1. 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
  2. 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
  3. (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 )
  4. 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 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

  1. 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
  2.  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)
  3. 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
  4. American Association of Feline Practitioners, Diabetes Educational Toolkit, https://catvets.com/diabetes-toolkit/troubleshooting, viewed 11/2023

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Cats Communicate by Smell – Semiochemicals in Cat Communication

Posted on by felinepurrspective_u3q4o6

Cats have many more odor sensitive cells in their noses than we humans do. They also have a vomeronasal organ (VNO) in the roofs of their mouths to process odors. Cats communicate by smell.

cats communicate by smell

This post was originally published May 2, 2021 and has been updated to reflect new content.

For a cat, odors can be associated with a particular place or individual animal, identifying that place or animal.

Another way cats communicate by smell is through semiochemicals. Odors can contain semiochemicals, molecules that carry “messages” from one organism to another. The organism receiving the “message” responds with a change in physiology or behavior. For example, there are insect traps that use hormones that simulate the type of scent produced by the female insect. Male insects are lured into the traps, preventing them from mating.

Semiochemicals that carry “messages” between members of the same species are called pheromones. For cats, pheromones are used to mark territorial boundaries, advertise that a cat is ready to mate, or send greetings. Lactating mother cats also produce a blend of “appeasing” pheromones,  that make kittens feel safe and reassured when their mothers are nearby.

Cats release pheromones from glands in their bodies. These glands can be found in…

  • the lips
  • the cheeks
  • the pads of the feet
  • at the base of the tail
  • the area surrounding the teats in females.
Glands producing pheromones
Locations of the glands that produce pheromones in the cat.

 

Cats communicate by smell -pheromones

When your cat rubs his cheeks against furniture or that corner wall, he deposits pheromones there. Researchers have separated secretions from the sebaceous glands in your cat’s face into 5 pheromone-containing fractions. The “F3 fraction” is thought to be a friendly greeting, marking the area as safe.

Cat Appeasing Pheromone (CAP) is released when the mother cat nurses her kittens. It is a message to the kittens that they are safe and secure – after all, mom is there!

Cats also release pheromones when they scratch, marking territory with another pheromone, FIS or feline interdigital semiochemical. The cat making the scratch marks also leaves behind his own individual scent, giving the next cat who comes along an idea of who left the pheromone message. As time goes on, the pheromones/scents decay. This change in pheromones/scents  notifies the incoming cat when the previous cat was there.

using pheromones to communicate with your cat

It is not surprising that synthetic versions of the F3 fraction of the facial pheromones and CAP have been made with the intention of calming cats and reducing conflict in multi-cat households. These products are available as diffusers or sprays.

Facial Pheromones F3 Fraction

  • Diffuser: place in areas you want your cat to identify as safe and secure, for example, sleeping areas.  You may not need to use the diffusers all the time – after all, your cat or cats are most likely marking these areas themselves. However, the diffuser could give an added boost in times of increased stress, such as home renovation.
  • F3 spray can help with  urine marking. Clean the marked spots with enzyme cleaners (eg. Tide), followed by rubbing alcohol. When dry, spray the spot with one of the F3 sprays.
  • The F3 spray is also useful to discourage scratching. Try spraying the area you DON’T want scratched with the F3 spray and place a scratching post nearby.
  • BSerene spray features the F3 fraction combined with catnip oil to promote calm behavior.

Cat Appeasing Pheromone

  • Diffuser
  • This product can be useful in multi-cat households when introducing a new cat. Place the diffuser in the common areas where all the cats will congregate.
  • You may not need to use this diffuser all the time but it can give a boost during times of stress, for example, when one cat returns from a veterinary visit.
  • The BSerene brand offers a diffuser that contains both F3 and CAP.

A product called Feliscratch contained a synthetic version of FIS. Feliscratch was applied to the scratching post to encourage cats to use it.  This product has recently been pulled off the market due to flagging sales.

No Feliscratch?

  • Make scratchers appealing with treats or catnip
  • If your cat will knead a small fleece blanket, it is possible that this blanket may have FIS deposited on it.
  • Placing the blanket near a new scratching post may attract your cat to the scratcher.

Feliway Optimum – one size fits all?

Feliway Optimum is the result of computer simulation and features a single product designed to address urine spraying, scratching, fear, and inter-cat conflict. It is a proprietary blend of specific pheromones that bind to receptors in the VNO in cats. It comes in a diffuser (Reference 1).

 

How effective are pheromones in communicating messages to cats?

The idea of managing cat behavior using pheromones is appealing. There are no pills to give and you can treat all your cats at once. However, studies aimed at determining whether these products work or not have mixed results (Reference 2).

How receptive an individual cat is to pheromone signals may depend upon her experience (Reference 2).  A free-roaming cat or cat who is a member of a multi-cat household will use pheromone signals more than an indoor cat who lives alone.  A kitten bottle-fed by humans will not be exposed to CAP like kittens nursed by a feline mother.

In my own experience, cats with a feral background respond more strongly to the pheromone products than cats raised in a human household.

You can think of pheromones as those signs in the library asking you to KEEP QUIET or the NO SMOKING signs – there is always someone who is talking or smoking. Compliance is never 100%.

Since cats communicate by smell, synthetic cat pheromones allow us to add some basic messages when we are trying to change a cat’s behavior. Do these products work? The efficacy of these products may depend on the experience of the individual cat.  Consequently, pheromones are best used in conjunction with other behavior modifications.

references

  1. De Jaeger, Xavier & Meppiel, Laurianne & Endersby, Sarah & Sparkes, Andrew. (2021). An Initial Open-Label Study of a Novel Pheromone Complex for Use in Cats. Open Journal of Veterinary Medicine. 11. 105-116. 10.4236/ojvm.2020.113006.
  2. Zhang Lingna, Bian Zhaowei, Liu Qingshen, Deng Baichuan. Dealing With Stress in Cats: What Is New About the Olfactory Strategy?. Frontiersin.org/articles/10.3389/fvets.2022.928943, DOI=10.3389/fvets.2022.928943 

 

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Introducing a New Cat into the Multi-cat Home

Posted on by felinepurrspective_u3q4o6

Introducing a new cat to an established group of resident cats can be challenging. Most experts recommend a slow, gradual introduction, similar to how wild cat colonies accept new members.

introducing a new cat

Wild cats recognize members of their own colony. Unfamiliar cats will be greeted with aggression if they try to approach and enter the group. This is not to say that non-members don’t join the colony from time to time. If these “outsiders” are persistent in their attempts to join the group, they may be accepted after a gradual process that involves many interactions (Reference 1).

I am in the process of introducing a new cat to my household. The introduction process is still ongoing but here is my progress so far.

Miso is 2 year old male domestic shorthair who had been frequenting the porch where my veterinarian employer leaves food out for the community cats. Miso behaved more like a stray cat and tried to get into the house. So, he was coaxed into a carrier, neutered and had dental treatment at the veterinary clinic where I work.

Miso is friendly toward humans and other cats. Although he is quite a bit younger than my cats, I thought it was worth a try to bring him into my group.

At the time of the introduction, there were 4 cats in my household and two social groups:

  1. Athena, aged 18 years, forms her own social group. She tolerates the other cats but does not snuggle, groom or otherwise interact with them.
  2. Marley, a 17 year old neutered male, 7 year old Gus, and 7 year old Zelda form the second social group. Zelda and Marley will snuggle together particularly when it is cold. Gus and Zelda allogroom; Gus and Zelda also groom Marley.

Getting Ready

 

Introducing a new cat starts with scent exchange. A few weeks before I brought Miso home, I brought home a blanket he slept on and left it in the kitchen area. All four cats carefully smelled it and there was some hissing but that waned over a week.

I made a barricade of closet shelving to close off the downstairs from my resident cats and set up a room downstairs for Miso to stay in with a litter box, scratching posts and food station.

 

Week 1

Miso is calm and confident and asks to go out of his room. He goes out into the catio downstairs. We set up a system of time-sharing the catio, allowing Zelda and Athena to occupy it in the morning while Miso is closed in his room. Miso has the catio in the afternoon.  At night, Miso is closed in his room.

Miso chooses to eat at the top of the stairs next to the barricade. The other cats are fed out of sight in the kitchen.

At the end of the week, I apply a mousse shampoo to Miso and wash his bedding, thinking that he might smell like the vet clinic.  I also put a multi-cat pheromone diffuser downstairs and 4 more on the upstairs floor.

Week 2 – Zelda gets sick

Zelda has diarrhea which I think may be due to the stress of having a new roommate.  The diarrhea  resolves with a few days of probiotics.  

The resident cats frequently hiss while passing Miso at the barricade but they now ignore him and continue on their way. We start to allow Miso upstairs while the other cats are in the catio.

At the end of the week, we allow Miso to have free run of the downstairs and not be closed in his room at night. The barricade is still up.

Week 3 – A Behavior Change for Gus

Miso was trained to harness and leash when at the vet clinic. I officially bring Miso upstairs on a leash and we have our first friendly interaction with the residents – Miso and Gus touch noses and there is no hissing.

Gus greets Miso

Miso is assigned a feeding station (a cat carrier) to eat in and is fed with the other cats. I get a little push back from Gus, who refuses to eat at his feeding station.  I offer him his food on his cat tree which he accepts.

Miso starts doing the evening food puzzle and treat toss with Zelda and Marley. Again, Gus prefers not to participate and does his food puzzles on his cat tree. The barricade is opened during the day near the end of the week.

 

Week 4 – Aggression from Athena

Athena swats Miso and we separate them temporarily, closing Athena in the bedroom. I put a broom near the door way with the water fountain so that I can herd Miso away in case he blocks Athena on her way to water.

There is still plenty of hissing going on but everyone’s body language is neutral. There are still 4 multi-cat pheromone diffusers on the upper floor.  Miso is allowed out in the catio with the other cats.  Everyone keeps their distance.

At the end of the week, Miso is allowed upstairs at night and chooses an empty carrier to sleep in.

Although the cats are sharing common areas now, the process of introducing a new cat is far from over. It will take many more months before all the cats are accustomed to the new resident and the changes in the daily routines.

Introducing a new cat into an established household is stressful for the incoming cat as well as the residents. Even with a gradual introduction, stress-induced illness, changes in routine, and displays of aggression are not uncommon. It is important to monitor the body language of all the cats, accommodate changes in behavior and be ready to separate cats if there is a scuffle.

references

  1. Crowell-Davis SL, Curtis TM, Knowles RJ. Social organization in the cat: a modern understanding. J Feline Med Surg. 2004 Feb;6(1):19-28. doi: 10.1016/j.jfms.2003.09.013. PMID: 15123163.

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Diets for Managing CKD in Cats

Posted on by felinepurrspective_u3q4o6

canned cat food meal feeding

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

from “Helping Your Cat Transition to a Therapeutic Kidney Food”, Hill’s Pet Nutrition/Clinician’s Brief, Educational Concepts, LLC © 2022

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

  1. 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]
  2. Phosphorus: Fact Sheet for Health Professionals, https://ods.od.nih.gov/factsheets/Phosphorus-HealthProfessional/, viewed 9/2023.
  3. Cave, N. and Wall, M. Protein restriction for cats with chronic kidney disease, Vet Focus, Issue # 30.1, © 6/25/20
  4. 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.
  5. 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

Managing the Cat with Chronic Kidney Disease

Posted on by felinepurrspective_u3q4o6
HDO BP cat
A cat relaxes in his basket during a home blood pressure check. Regular blood pressure checks are essential to monitoring chronic kidney disease.

Chronic Kidney Disease (CKD) in cats is progressive and not curable but there are strategies we can undertake to improve the quality of life of our “kidney” cats and possibly give them some more time with us. Here is a checklist for managing the cat with chronic kidney disease:

  1. Keep Kitty hydrated
  2. Feed a diet that will lessen the stress on the kidneys
  3. Maintain appetite
  4. Manage high blood pressure
  5. Treat anemia if necessary
  6. Treat urinary tract infections

Managing the cat with chronic kidney disease

hydration

Kidney failure is tied to the “death” of nephrons that filter the blood. The remaining nephrons compensate by increasing filtration. Dehydration decreases renal blood flow putting more stress on the remaining nephrons. Keeping the “kidney” cat hydrated helps maintain electrolyte concentrations and dilute the waste products the kidneys are struggling to filter out.

Increasing Voluntary Water Intake

  • Have a variety of water sources and fountains in the home to encourage water intake.
  • Consider feeding a wet diet – many canned foods contain about 80% water.
  • Try water from tuna, water used to poach chicken or fish (offer alone, add to the water bowl, or try frozen in an ice cube tray and added to the water bowl). 

Hydration supplements like Purina’s Hydra Care are designed to maximize the amount of water cats take in while drinking. Nutrient enriched water is more viscous, clings to the cat’s barbed tongue, and increases the water consumed with each lap of the tongue.

Subcutaneous Fluids

This refers to giving fluids under the skin, not in a vein. It is done using a bag of sterile fluids, an IV line and a needle. This is a strategy often employed in IRIS stages 3 and 4 of kidney disease.  This can be done in the veterinary clinic or at home, once you and your cat are comfortable with the process.

Kidney-friendly diets

As the kidneys fail, they are no longer as efficient at filtering the waste products of protein metabolism. Phosphorus in the form of phosphates tends to build up in the body while potassium levels may drop.

Commercial renal diets for kidney cats feature reduced phosphorus and restricted amounts of high-quality protein, an increased calorie density, sodium restriction, potassium supplementation, supplementation with B vitamins, anti oxidants and omega-3 fatty acids (Reference 1). There have been a number of studies done addressing the effectiveness of these diets – the results show that cats suffering from CKD lived longer when fed a renal diet (Reference 2).

Phosphorus Binders

For some cats in advanced stages of CKD, a renal diet may not reduce phosphorus enough; other cats simply refuse to consume a renal diet. For these cats, adding a “binding agent” to the food can help reduce the amount of phosphorus that is available for the cat to metabolize. Supplements that “bind” with the phosphates in the food form a nonabsorbable compound eliminated in the stool.   “Phosphorus binders” include (Reference 1):

  • Aluminum hydroxide
  • Calcium carbonate
  • Calcium acetate
  • Sevalamer (a hydrogel of poly-allylamine, free of aluminum and calcium)

 appetite and nausea

A “kidney” cat can suffer from nausea and vomiting due to the buildup of uremic toxins in the bloodstream. The cat consequently doesn’t eat well resulting in dehydration and weight loss. Reduced potassium levels and anemia due to CKD also contribute to a reduced appetite (Reference 1).

Medical Management

Managing the cat with chronic kidney disease also includes managing nausea and vomiting. Drugs that target nausea and vomiting include maropitant (Cerenia) and ondansetron. These are typically available in oral tablets.

There is another drug that is often the first choice of many practitioners. Mirtazapine is an antidepressant drug that not only controls nausea and vomiting, it also stimulates appetite.

  • available in a transdermal gel (Mirataz) as well as tablets
  • the transdermal form is FDA approved for use in cats
  • the transdermal gel is applied once daily and the dose is easily adjusted
  • side effects are vocalizing and increased activity.

If a cat is too nauseous or unwell to maintain food intake, a feeding tube should be considered.

high blood pressure

Increased filtration rate in the remaining nephrons and activation of the renin-angiotensin system can lead to high blood pressure in cats with CKD. Systolic blood pressures over 160 mm Hg require treatment to prevent damage to the cat’s eyes, heart and kidneys. In particular, the leakage of proteins into the urine (proteinuria) can be reduced once high blood pressure is managed (Reference 1).

Amlodipine is the most commonly used drug to reduce cats’ blood pressure. It is a calcium channel blocker that is available in tablets that can be taken once or twice daily. Amlodipine typically reaches therapeutic levels in 7-10 days.  Managing the cat with chronic kidney disease should include a blood pressure check every 3-6 months.

anemia

One of the kidney’s functions is to produce the hormone erythropoietin. Erythropoietin triggers cells in the bone marrow to make more red blood cells. Failing kidneys may not generate enough erythropoietin and anemia (low levels of red blood cells) can result.

Fewer red blood cells means less hemoglobin. Less hemoglobin means less oxygen is getting moved around the body. Anemia can result in weakness and tiredness. 

If the fraction of red blood cells in the blood drops below 20%, many practitioners will supplement the cat with a man-made analog of erythropoietin. The most commonly used drug is darbepoetin; it is given as an injection under the skin. Injections of iron supplements often accompany the darbepoetin injections in the initial stages of therapy (Reference 1).

A new treatment (2023) is available for anemia in cats with CKD.  Varenzin -CA1 is a once daily oral liquid medication made specifically for cats.  Varenzin-CA1 is designed to stimulate the cat’s body to make its own erythropoetin.

Urinary tract infections (UTI)

With increasingly dilute urine seen in cats with CKD, UTI’s are more common. Most of these UTI’s do not have clinical signs such as frequent urination or blood in the urine. Urinalysis should be part of the CKD cat’s checkup. White blood cells found in a centrifuged urine sample are indications for a bacterial culture and treatment. Treatment can be based on sensitivity testing and a kidney friendly antibiotic chosen.

Managing the cat with chronic kidney disease requires attention to multiple factors. Treating dehydration, nausea, high blood pressure and anemia can keep the “kidney” cat comfortable and slow the progression of the disease. A critical part of managing the cat with chronic kidney disease is feeding an appropriate diet. The next post will look at the science behind the commercial renal diets and alternatives to them.

references

  1. Sparkes, A. (panel chair), ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease, Journal of Feline Medicine and Surgery (2016) 18, 219–239.
  2. 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]

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Chronic Kidney Disease in Cats

Posted on 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

  1. 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
  2. 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
  3. 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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