Continual Kidney Illness (CKD) in cats
Chances are high, if a cat lives lengthy sufficient, he’ll get kidney illness. 81% of cats over the age of 15 have persistent kidney illness (CKD).[1]
The kidneys are type of the Swiss military knives of all of the physique organs. They carry out a wide range of life-sustaining chores, and none of us – not cats, canine, people, nor every other animals who’ve kidneys – can survive with out them.
What do the kidneys do? Why do the kidneys fail? What remedies can be found to cats with persistent kidney illness at this time? I attempt to reply these questions and extra on this publish.
Even in case you are fortunate sufficient to have a cat with wholesome kidneys at this time, it’s nonetheless price studying about this illness. In case your cat is graced with an extended life, you’ll possible face CKD ultimately.
And whilst you can’t fully get rid of the chance of kidney illness in cats, there are issues you are able to do to scale back her possibilities of getting this illness, or to catch CKD early. Information and early remedy can enhance your cat’s size and high quality of life.
Learn on.
The kidneys are two bean-shaped organs which can be positioned close to a cat’s rib cage, one on all sides of the backbone.
Contemplating how a lot these organs do, it’s laborious to consider how tiny they’re. Every cat kidney is simply about an inch-and-a-quarter to an inch-and-a-half lengthy.[2]
Kidneys filter a cat’s blood
Probably the most vital jobs that kidneys do is clear waste merchandise from the blood and switch them into urine, which will get peed out of the physique.
How does blood get so “soiled” that it wants cleansing?
When a cat eats, his physique takes all of the vitamins from the meals, and turns them into power.[3] All of the stuff that’s left over, which is now within the cat’s blood and bowels, is waste. If waste is allowed to construct up within the blood, it will probably grow to be poisonous.
Blood is continually circulating by way of the kidneys. Blood that must be cleaned, enters a kidney by way of the renal artery. It strikes by way of progressively smaller blood vessels till it reaches the nephrons, that are the kidney’s tiny filters.
The waste that’s filtered out by the nephrons turns into urine. Urine drains into a group channel and exits the kidney by way of the ureter, which leads straight to the bladder (and ultimately, the litter field). The newly filtered blood returns again to the physique.
The kidneys filter all of the blood in a cat’s physique many instances a day. We truly don’t know what number of instances cats’ blood passes by way of their kidneys, however in people, our total blood provide passes by way of our kidneys roughly 300 instances a day.[4]
Kidneys additionally assist maintain a cat’s physique “balanced”
A cat’s kidneys assist keep homeostasis within the physique. Homeostasis simply means “the established order.” Kidneys assist make it possible for physique methods don’t get out of whack.
For instance: kidneys management the steadiness of water within the physique, so there isn’t an excessive amount of or too little. They management the acidity of the blood, in order that it stays as near impartial as doable.
Kidneys handle blood strain by sending out hormones to regulate the contraction of blood vessels. They maintain electrolytes – important minerals that do the whole lot from ensuring the guts capabilities correctly, to conserving a cat’s tooth sturdy – in steadiness.
Kidneys additionally stimulate a cat’s bones to make pink blood cells, and activate Vitamin D in order that it may be utilized by a cat’s physique.[5]
CKD isn’t truly a illness. It’s extra of an outline of what’s going on in a cat’s physique when the kidneys lose their means to totally operate from another illness, harm, or growing older.[6]
Plenty of issues can occur to a cat that finally impression his kidneys. Cats will be born with kidneys that didn’t type correctly within the womb, impacting their means to do their job over a cat’s lifetime.
A single occasion, like a poisoning or a automotive accident, can injure a cat’s kidneys.
An sickness can harm the kidneys, too, and inhibit their means to carry out the best way they’re imagined to. Even sure medication prescribed by your veterinarian to deal with or diagnose an sickness have the potential trigger kidney hurt.
Any one in all these items can result in the continued, progressive deterioration within the kidneys that we describe as “persistent kidney illness.”
Listed here are among the frequent issues that may result in CKD in cats:
Congenital ailments
Some cats are born with malformed kidneys. Polycystic kidney illness, an inherited illness which is frequent in longhaired cats, is one instance of a congenital kidney illness.
Amyloidosis, by which irregular proteins are deposited on varied tissues and organs, together with the kidneys, can also be an inherited, congenital illness.
Bacterial infections
A bacterial an infection of the kidneys, often known as pyelonephritis, normally begins out as a decrease urinary tract an infection that works its means as much as the kidneys.[7]
Sure tick-borne bacterial infections, together with Lyme illness, also can trigger kidney failure.[8]
Viral infections
Feline viral infections, together with feline infectious peritonitis (FIP), feline immunodeficiency virus (FIV), and feline leukemia virus (FeLV) can harm the kidneys.
Parasite infections
Some parasites are able to invading the kidneys, together with Capillaria plica, also called the kidney worm.
Toxins
Frequent family toxins – antifreeze, lily crops, human medicines (particularly antibiotics and over-the-counter painkillers like Tylenol and Advil), and mouse or rat poisons – could cause irreparable harm to the kidneys if consumed by a cat.
Different ailments
Hyperthyroidism, which causes hypertension in cats, can harm the kidneys.
Coronary heart failure with low blood strain also can trigger hurt to the kidneys.
Clotting problems, sure cancers, and immune problems can all have an effect on kidney well being.
Harm and sickness
A cat who loses an excessive amount of blood after being hit by automotive, for instance, would endure low blood strain that would impression the kidneys.
Overheating in sizzling climate, or excessive vomiting and diarrhea, can all trigger a speedy drop in physique fluids that may have an effect on the kidneys.
Why accomplish that many cats appear to finish up with kidney illness?
The brief reply is that scientists and veterinarians don’t know (but). However there are two elements that most likely contribute:
Cats have fewer nephrons
Cat kidneys are overbuilt. Cats want solely a small proportion of the nephrons they had been born with to outlive. However, cat kidneys nonetheless don’t have as a lot spare nephron capability as human or canine kidneys.
Cats have about 200,000 nephrons in every kidney, whereas canine have twice that many, and people have one million nephrons in every kidney.[9]
In different phrases, different animals simply have extra nephron wiggle room ought to their kidneys grow to be broken.
Cats don’t drink sufficient water
Continual dehydration could also be a threat issue for kidney illness. The kidneys are hardworking organs and so they want hydration to do their job correctly. Blood valves should be open, waste wants moisture so it may be flushed, and vitamins want to have the ability to stream simply to the kidneys.[10]
Cats are notoriously fussy water-drinkers. I’ve written an entire publish about why cats don’t appear to drink sufficient, and what you are able to do about it.
And it’d simply appear like cats are notably susceptible to kidney illness versus different animals. It’s estimated that greater than 50% of people over the age of 75 endure from kidney illness, too.[11] It’s possible that simply growing older could cause the kidneys of all creatures to ultimately fail.
Kidney illness is usually an issue for mature and senior cats. Kidney illness impacts 30-40% of cats older than 10, and 81% of cats over 15.
Solely 10% of cats youthful than 3 years outdated could have kidney illness.[12]
Sure cat breeds appear to be extra susceptible to inheritable kinds of kidney illness. These cat breeds embrace:
Within the early phases of illness, the kidneys take care of harm by merely producing extra urine. The kidneys lose their means to filter, so that they compensate by flushing waste out with a number of water. Cats will are inclined to drink extra water to make up for all of the moisture that’s being become pee by the kidneys.
One downside is that the newborn will get thrown out with the bathtub water: protein and nutritional vitamins get flushed out, too, together with the waste. The lack of vital vitamins can have an effect on a cat’s urge for food and impression many physique methods.
As soon as two-thirds of the kidneys have failed, there’s a speedy rise in waste within the bloodstream that the kidneys simply can’t sustain with. The kidneys don’t have the flexibility to filter the waste, nor are they capable of merely flush all of it out. That is when cat guardians usually start to note signs of sickness of their cats (see the symptom listing beneath).
Failing kidneys additionally implies that blood strain isn’t being correctly regulated. Hypertension can impression a cat’s eyes, mind, and coronary heart.
When kidneys are unable to do their job, acid builds up within the blood, which impacts the operate of a range organ methods.
Failing kidneys could imply {that a} cat is unable to provide pink blood cells, resulting in anemia, the place there aren’t sufficient pink blood cells to hold oxygen to a cat’s physique tissues.
The early indicators of CKD are sometimes misattributed to “regular growing older.” They embrace:
- Weight reduction
- Poor coat high quality[13]
Because the kidneys proceed to fail, extra signs of CKD embrace:
- Dangerous breath
- Poor urge for food
- Ingesting extra
- Urinating extra
- Vomiting
- Diarrhea
- Lethargy (drained, missing in power)
- Mouth sores
- Cat seems unkempt (scruffy, ungroomed)
- Fever
- Peeing accidents, or an incapability to urinate
- Decrease again ache
- Swelling within the limbs[14]
Diagnosing CKD will be very difficult. The “downside” (in quotes, as a result of additionally it is a lifesaving present) is that cats have sufficient spare capability of their kidneys that they will lose as much as two-thirds of their kidney operate earlier than it begins to have an effect on their well being. A cat’s kidneys will be quietly failing for months or years earlier than a cat guardian or veterinarian would possibly even discover.
Conventional exams for kidney illness: blood urea nitrogen (BUN) and creatinine, are “late markers” for kidney failure. That implies that they don’t present {that a} cat is sick till CKD is sort of far alongside.
Right now, there’s a comparatively newer check that may decide if early kidney illness is happening. A blood check for SDMA (symmetric dimethylarginine), acts like an early warning system that the kidneys aren’t filtering the blood the best way they need to.[15]
SDMA can detect as little as 25-40% discount in kidney operate, in comparison with 75% lack of kidney operate for the creatinine check, for instance.[16]
The primary concern with this newer check is that there haven’t been any large-scale research in cats on its use. When in a cat’s life ought to veterinarians start providing this check to sufferers? How usually ought to the check be repeated earlier than kidney illness is recognized? What different elements have an effect on SDMA in a cat’s blood? How ought to SDMA check outcomes be analyzed?
And most significantly, we want research to indicate that early intervention improves outcomes for cats with CKD.
We don’t have all of the solutions but.
All exams for kidney illness are on the lookout for larger concentrations of waste and different substances in a cat’s blood and urine that wholesome kidneys can be filtering out. A veterinarian could advocate a couple of check to substantiate the findings of different exams.
Ideally, cat’s blood might be examined a second time, some weeks or months after the primary check (and after fasting), earlier than a vet diagnoses a cat with CKD, as there are numerous abnormal issues, like dehydration, that may present inaccurate readings.
Blood urea nitrogen (BUN)
This check seems for urea nitrogen, a waste product that’s created when a cat’s physique breaks down the protein that she eats. A better BUN may point out kidney failure.
Creatinine (CREA)
Creatinine is a waste product that comes from digesting protein and from the traditional use of muscle tissue. A creatinine check measures how nicely the kidneys are filtering waste from the blood. An excessive amount of creatinine suggests kidney harm.
Electrolytes
It’s the kidneys’ job to maintain electrolytes comparable to sodium, potassium, chloride, bicarbonate, phosphorous, and calcium in steadiness. If electrolytes are unbalanced, it might be an indication that the kidneys aren’t working correctly.
Full Blood Depend (CBC)
A whole blood depend is actually a depend of a cat’s pink and white blood cells and platelets.
The kidneys are chargeable for producing a hormone known as erythropoietin that stimulates the manufacturing of pink blood cells. If the kidneys aren’t capable of produce all of the erythropoietin {that a} cat wants, the red-blood-cell depend could also be low.
If the reason for the kidney illness is an an infection or irritation, a CBC would present a rise in white blood cells.
If the underlying explanation for the kidney illness is a clotting dysfunction (which is uncommon), the platelet depend can be low.
Urinalysis
Urine is a window into kidney operate. A Urine Particular Gravity (USpG) check will present how diluted or concentrated a cat’s urine is. A better quantity implies that the urine is extra concentrated, and is an effective signal that the kidneys are nonetheless capable of preserve water.
A urine sediment check can present if there may be protein, micro organism, blood cells, or kidney cells within the urine. Any a kind of might be a sign of kidney an infection or harm.
A urine tradition can also be vital as a result of cats with CKD usually tend to have urinary tract infections (UTIs).
Different exams
Your vet may advocate X-rays or ultrasounds to search for kidney stones, cysts, or areas of useless tissue.
She or he will possible verify your cat’s blood strain. Hypertension might be each an indication and/or a explanation for kidney harm.
Not often, a vet could advocate a kidney biopsy to seek out out the kind of illness that your cat is affected by.
How is urine collected from a cat for a urinalysis?
You possibly can’t precisely ask a cat to pee in a cup, are you able to?
There are 3 ways of accumulating urine from a cat:
Non-absorbent litter
Your vet could advocate utilizing a non-absorbent cat litter in your cat’s typical field. The pee will simply settle within the backside of the litter pan, and you may tip the field so that each one the urine collects in a nook. You possibly can then suck up a pattern with a syringe or eye dropper.
If that doesn’t work, your vet will have the ability to extract urine out of your cat utilizing:
Catheterization
Catheterization includes inserting a small tube into the cat’s urethra (the opening the place the pee comes out) up into the bladder. Cats will should be sedated for this process.
Catheterization could cause some irritation to the urethra, and also can introduce micro organism from the skin world into your cat’s bladder. However it’s much less invasive than cystocentesis (beneath).
Cystocentesis
Cystocentesis includes inserting a really wonderful needle by way of your cat’s stomach wall into her bladder.
Whereas this process is taken into account secure and produces the “cleanest” urine pattern, not all cats will lie nonetheless for the process. So, this check may require sedation. Cystocentesis additionally requires a comparatively full bladder, and will necessitate using an ultrasound to find the pee throughout the bladder.
There’s a system that each one vets use to measure the development of kidney illness in cats. It’s known as the IRIS system, which stands for The Worldwide Renal Curiosity Society.
Staging kidney illness primarily based on a system like IRIS is helpful. Realizing the place a cat “is” in a progressive sickness like CKD, will help information the remedy plan.
The IRIS system breaks kidney illness down into 4 phases:
Stage I
On this earliest illness stage, a cat has no signs. His BUN and creatinine exams are regular. It’s uncommon to diagnose a cat with CKD at this stage as a result of there aren’t any outward indicators of sickness, and no change in his lab values. However CKD, caught at Stage I, has the perfect likelihood for profitable remedy.[17]
Typically CKD in Stage I is found by a vet merely palpating (feeling) the kidneys or seeing the kidneys on an X-ray or ultrasound. Typically a vet will discover {that a} cat’s blood creatinine is rising over time, even when it’s nonetheless within the regular vary. Protein that retains displaying up in urine will be one other signal.[18]
Cats in Stage I and II are usually handled with a prescription cat-food food regimen and monitored.
Stage II
Some cats could have began to drink extra and pee extra at Stage II. Your vet can see adjustments in your cat’s blood work and urinalysis that point out adjustments occurring within the kidneys.
Your vet will most likely wish to discontinue any drug that your cat is taking that might be dangerous to the kidneys (if doable). She or he will attempt to determine and deal with any infections that might be inflicting lack of kidney operate.
Stage III
Cats in Stage III usually seem sick. There may be extra waste within the blood work. Cats in Stage III (and in addition IV, beneath), will be given erythropoietin injections to assist with anemia. They are often given dietary supplements to assist with low potassium, and phosphorous binders to deal with excessive phosphorous.
Medicine that scale back nausea and vomiting will help a cat with a poor urge for food, or one who’s vomiting steadily. Fluids will be given intravenously or underneath a cat’s pores and skin, to assist with dehydration. You possibly can study to present your cat these medicines and fluids at dwelling.
Stage IV
Stage IV is the ultimate stage of renal failure when cats are sometimes in disaster.
What’s a prescription kidney food regimen?
Prescription kidney diets are designed with much less protein, phosphorus, and sodium than conventional cat meals to assist scale back the quantity of waste within the bloodstream {that a} cat’s kidneys should course of.
Prescription kidney diets are sometimes larger in water-soluable nutritional vitamins, fiber, and antioxidants to assist enhance a cat’s high quality of life.
Nevertheless, many cats are fussy about consuming their therapeutic diets. Not consuming, even for a really brief time frame, could cause a deadly liver illness in cats known as hepatic lipidosis.
Transition slowly out of your cat’s favourite meals to the brand new prescription food regimen. Heat the meals to make it extra engaging. Add vet-approved toppers, just like the juice from a can of tuna, or presumably bone broth. Regardless that prescription cat meals is dear, you might have to attempt totally different manufacturers to see if there may be one your cat likes.
However first discuss to your vet in case your cat will not be consuming. There could also be different choices, like including a phosphorous binder to his favourite meals as a substitute of utilizing the prescription food regimen, in case your cat is refusing to eat her particular meals.
No. Continual kidney illness can solely be handled, not cured. Any harm to the kidneys can’t be reversed.
That doesn’t imply there isn’t something veterinary science can do! There are many instruments in your vet’s toolbox that may assist lengthen and enhance your cat’s high quality of life:
Antibiotics
Antibiotics can be utilized deal with infections which have precipitated kidney illness or are the results of kidney illness. Cats with CKD are inclined to develop bladder infections extra steadily.
Potassium dietary supplements
Cats with CKD are inclined to lose potassium of their urine, which ends up in muscle weak spot, stiffness, and a poor coat high quality. Low potassium also can make CKD worse.
B nutritional vitamins
When the kidneys can not focus urine, water-soluble nutritional vitamins, like B12, get washed out in a cat’s pee. Supplementing with further B nutritional vitamins will be very useful.
Blood-pressure reducing medication
Hypertension will be attributable to CKD, and also can trigger extra harm to kidneys. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium-channel blockers (CCBs), are medicines that may assist do the job the kidneys are not capable of do.
Anti-nausea and anti-vomiting medication, and urge for food stimulants
Cats who’re nauseous and vomiting usually don’t have any urge for food. These medicines will help a cat regain curiosity in his meals.
Anemia medicines
Many cats with CKD aren’t capable of produce sufficient pink blood cells of their bone marrow. Erythropoietin-replacement remedy will help stimulate the manufacturing of pink blood cells.
Medicines for proteinuria
Proteinuria is the lack of protein within the urine that may be a hallmark of CKD. Proteinuria also can harm kidneys additional if it isn’t handled.
Phosphate binders
Phosphate binders, normally added to meals, will help “mop up” extra phosphate within the blood that’s attributable to CKD.
Fluids
Within the later phases of CKD, cats can’t drink sufficient to take care of wholesome hydration. Fluids can enhance their high quality of life.
Dialysis, extra formally often known as hemodialysis, is a mechanical means of purifying the blood.
Dialysis is a remedy alternative for people experiencing acute or persistent kidney failure. An individual who requires dialysis will want it for the remainder of their lives, or till they’re able to get a kidney transplant.
A cat present process dialysis would have a catheter positioned in her jugular vein and her blood can be circulated by way of machine with a filter to take away the poisonous waste that the kidneys can not filter. Dialysis normally takes 5 to 6 hours per session and requires two to a few classes per week, all underneath normal anesthesia.
It may be troublesome to discover a heart that gives dialysis for animals, and particularly for cats. Additionally it is extraordinarily costly.
However extra importantly, dialysis will be very laborious on a cat’s physique, and can most definitely impression a cat’s high quality of life. For these causes, it isn’t normally advisable for cats who’ve persistent kidney illness.
Most causes of persistent kidney illness are usually not preventable.
What you are able to do is restrict your cat’s publicity to kidney-damaging issues, like lilies, human medicines, family cleaners, and antifreeze. Block entry to your storage, and lock up harmful substances.
You possibly can maintain your cat updated on vaccines, and heartworm and flea-control medicines. Doing so will assist forestall many bacterial and viral causes of kidney illness.
Restrict your cat’s publicity to different cats who would possibly unfold sickness to your cat. One of the best ways to do this is to maintain your cat indoors.
Cats are amazingly resilient. Cats with as little as 5% kidney operate can survive for a surprisingly very long time.[19]
Many cats, particularly these recognized with CKD within the early phases, with way of life adjustments and long-term administration of the illness, can go on to dwell a traditional lifespan.[20]
Normally, CKD tends to progress slowly, and a few cats reply very nicely to remedy. In case your cat has been recognized with CKD, she should have years of lively life left with remedy.
It may be laborious to know when the tip is close to for a cat within the closing stage of a illness like CKD. What are the indicators {that a} cat is close to loss of life? How do I do know if my cat is struggling? What’s the proper factor to do?
This extensively researched web site, created by a lady who had three cats with CKD, does an unbelievable job of answering a few of these tougher questions.
I discovered this web page, entitled “The Ultimate Hours,” particularly useful. It outlines the indicators and signs that may accompany a cat with CKD close to the tip, and supplies steering as you navigate the troublesome choices that include loving a cat.
Tanya’s Complete Information to Feline Continual Kidney Illness
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Daybreak LaFontaine is a lifelong animal lover who all the time appears to have a bit of pet hair in her keyboard. Her weblog, Kitty Contemplations, helps cat guardians higher perceive and take care of the particular beings they share their lives and houses with. Her cat-products enterprise, Cat within the Field, sells stunning, well-made, and award-winning merchandise that she designed to satisfy the organic wants of cats.
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FOOTNOTES
[1] Weir, Malcolm Weir, et al. “Continual Kidney Illness in Cats: VCA Animal Hospitals.” Vca, vcahospitals.com/know-your-pet/kidney-failure-chronic-in-cats. Accessed 4 Oct. 2024.
[2] “Kidney Measurement.” Kidney Measurement – an Overview | ScienceDirect Matters, www.sciencedirect.com/matters/immunology-and-microbiology/kidney-size. Accessed 4 Oct. 2024.
[3] “Overview of Kidney Issues.” College of Rochester Medical Heart, www.urmc.rochester.edu/encyclopedia/content material.aspx?contenttypeid=85&contentid=P08231. Accessed 7 Oct. 2024.
[4] “Understanding Kidneys, Information and Features.” ERA, 10 Oct. 2023, www.era-online.org/publications/understanding-kidneys/.
[5] Kearley, Michael. “Kidney Illness in Cats.” PetMD, 9 Could 2022, www.petmd.com/cat/situations/urinary/kidney-disease-cats.
[6] “Continual Kidney Illness.” Cornell College School of Veterinary Medication, www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/chronic-kidney-disease. Accessed 3 Oct. 2024.
[7] “Pyelonephritis in Cats: VCA Animal Hospitals.” Vca, vcahospitals.com/know-your-pet/pyelonephritis-bacterial-infection-of-the-kidney-in-cats. Accessed 8 Oct. 2024.
[8] “Ticks and Your Cat.” Cornell College School of Veterinary Medication, www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/ticks-and-your-cat. Accessed 8 Oct. 2024.
[9] Sharon M. Gwaltney-Brant, Chapter 18 – Renal toxicity, Editor(s): Ramesh C. Gupta, Veterinary Toxicology (Second Version), Educational Press, 2012, Pages 264-277, ISBN 9780123859266,https://doi.org/10.1016/B978-0-12-385926-6.00018-1. https://www.sciencedirect.com/science/article/pii/B9780123859266000181
[10] “Not Simply 4 Paws Animal Hospital: Veterinarian in Canyon Lake, CA.” Not Simply 4 Paws Animal Hospital | Veterinarian in Canyon Lake, CA, notjust4pawsanimalhospital.com/dehydration-and-kidney-failure. Accessed 8 Oct. 2024.
[11] “Getting old and Kidney Illness.” Nationwide Kidney Basis, 12 Aug. 2024, www.kidney.org/aging-and-kidney-disease.
[12] Weir, Malcolm Weir, et al.
[13] ibid.
[14] Kearley, Michael. “Kidney Illness in Cats.” PetMD, 9 Could 2022, www.petmd.com/cat/situations/urinary/kidney-disease-cats.
[15] “Renal Amyloidosis.” Cornell College School of Veterinary Medication, www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/renal-amyloidosis. Accessed 4 Oct. 2024.
[16] “SDMA in Cats: How Helpful Is It and When to Use It.” Exploring SDMA Significance and Optimum Software in Feline Diagnostics, www.moichor.com/blog-post/sdma-in-cats-how-useful-is-it-and-when-to-use-it. Accessed 8 Oct. 2024.
[17] Case, Jamie, and Barri J. Morrison. “Kidney Failure in Cats: Signs, Phases and Causes.” PetMD, 29 July 2024, www.petmd.com/cat/situations/urinary/kidney-failure-in-cats.
[18] “Testing for Kidney Illness: VCA Animal Hospitals.” Vca, vcahospitals.com/know-your-pet/kidney-disease-testing. Accessed 9 Oct. 2024.
[19] Case, Jamie, and Barri J. Morrison..
[20] Kearley, Michael. “Kidney Illness in Cats.”.
