Renal Failure, Acute (Feline)

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Feline acute renal failure (ARF) is a condition that is described as the sudden decline in kidney function that typically occurs over a period of hours to days. Veterinary care is required.

Common name: Feline acute kidney failure
Scientific names: Feline acute renal failure, Acute tubular necrosis, Acute uremia, Lower nephron nephrosis, Vasomotor nephropathy

Diagnosis

Signalment
All cats are susceptible to developing the disease. There is no specific breed that may be affected. Older cats are at a greater risk because of decreased urine-concentrating ability. Outside roaming cats are also at a greater risk.

Incidence/prevalence
Incidence may be increased during the winter and fall months due to the increased potential for exposure to antifreeze that contains ethylene glycol.

Geographic distribution
No known geographical distribution.

Clinical signs (primary, most to least frequent, scientific term, synonyms)
Anorexia (not eating), Vomiting, Acute onset of diarrhea, Depression, Dehydration, Abdominal palpation pain, Oral ulcerations.

Clinical signs (secondary, most to least frequent, scientific term, synonyms)
Some cats have decreased urine output, Fever.

Causes (scientific, common term)
Toxins, Systemic disease, Hemodynamic/hypoperfusion problems

Organ systems affected (most to least affected)
Kidney, Gastrointestinal.

Diagnostic tests
Complete blood count, Chemistry panel and electrolytes, Urinalysis, Differential Diagnosis, Chronic renal failure, Liver failure, Diabetes, Hyperthyroidism, Pancreatitis.

Overview

Feline acute renal failure (ARF) is a condition that is described as the sudden decline in kidney function that typically occurs over a period of hours to days.

The kidneys have a very important role in filtering the blood. Any type of damage made to the kidneys can result in an increase in toxins in the bloodstream. This increase in blood toxins usually shows up in the blood work as an increase in BUN and creatinine levels. Clinical signs in cats are usually nonspecific unless there was a known exposure to a nephrotoxin.

There are generally three causes for acute renal failure in cats, including nephrotoxins, hemodynamic/hypoperfusion problems and systemic disease. An example of a nephrotoxin is ethylene glycol antifreeze. Unfortunately, cats do not require a large dose of antifreeze to develop ARF. A hemodynamic/hypoperfusion problem would include dehydration or underlying heart disease. Hyperthyroidism and diabetes are examples of systemic diseases that may lead to ARF if they are not controlled.

It is important to differentiate between acute and chronic renal failure because ARF is a potentially reversible condition that requires very aggressive treatment.

Treatment

Home Care
No known home care would be sufficient to treat for ARF.

Professional Care
The objective of treating ARF is to decrease any additional damage to the kidneys, promote the production of urine and counteract any effects from the increase in toxins in the blood.

Veterinary treatment is required. Initial management involves obtaining baseline blood work and urinalysis and intravenous fluids, monitoring urine output; abdominal radiographs/ultrasound and treating any effects from the increase in toxins in the blood.

In order to decrease any further damage to the kidneys, aggressive fluid treatment is needed. The production of urine is promoted by the use of diuretics. Typical signs include nausea, vomiting and inappetence. These signs are treated with anti-vomiting medicines and nutritional support.

Action
Follow-up blood work is needed to evaluate the kidney's function. Blood work is repeated on a daily basis for the first 5 to 7 days or until the values (BUN blood urea and nitrogen, and creatinine levels) start to decline. The cat is kept on IV fluids until an improvement in kidney values is seen. Treatment may continue for 2 to 3 weeks beyond resolution of signs.

Because of the extent of treatment and the guarded prognosis, pet parents need to be aware of the dangers of nephrotoxins like ethylene glycol. Also, older cats are susceptible to kidney effects associated with dehydration or a systemic disease. It is very important to have yearly geriatric exams done on older cats and have plenty of fresh water available at all times.

Outcome
In general, the prognosis of ARF depends on four factors, including the severity of renal dysfunction, response to the treatment, the extent of kidney damage and the ability to manage other effects, such as stomach upset, including vomiting.
References/Additional Readings

Ettinger, S.J.; Feldman, E.C. Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat, 4th ed. Philadelphia: W.B. Saunders Company, 1995; 1720-1733.

Birchard, S.J., Sherding, R.G. Saunders Manual of Small Animal Practice, 2nd ed. Philadelphia: W.B. Saunders Company, 2000; 913-919.
Author

Hope J. Serrato-Lopez, DVM
Editor

Steven Hansen, DVM, MS, MBA

DABVT, DABT

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