Kidney Disease in Cats with Dr. Jean Hofve, DVM

Kidney Disease in Cats with Dr. Jean Hofve, DVM

Originally published – February 12, 2012

Recently, I had the pleasure of talking about Kidney Disease in Cats with Dr. Jean Hofve, DVM. Below is the transcript of our conversation with a few edits to add more information.

A sincere thanks to Dr. Jean for taking the time to talk about kidney disease in cats with me.  Dr. Jean has a page on her site, Little Big Cat, dedicated to this subject as well – Kidney Disease.

You can learn more about cat health by reading Dr. Jean’s book, The Complete Guide to Holistic Cat Care: An Illustrated Handbook.

You can learn more from Jean’s website as well, Little Big Cat.

We’ve now done several interviews with Dr. Jean, feel free to check any of them out:

• Cat Allergies with Dr. Jean
• Food Allergies in Cats with Dr. Jean Hofve
• Litterbox Questions with Dr. Jean
• Obesity in Cats with Dr. Jean Hofve, DVM
• Kidney Disease in Cats with Dr. Jean Hofve, DVM
• Cat Conjunctivitis and Cat Herpes with Dr. Jean Hofve
• Cat Constipation – Causes, Symptoms & Treatment of Constipation with Dr. Jean Hofve

You can listen to our conversation by playing this YouTube video (it’s a stagnant image with audio):

Here is our conversation:

Jenny: What are the different types of kidney disease in cats?

Dr. Jean: Kidney disease can be either acute or chronic. Chronic would be things like glomerulonephritis (chronic inflammation) and kidney stones and things like that. Kidney stones are pretty common in older kitties. Acute would be things like toxins and infections. You can have a toxic insult, like with the melamine in pet food.

That caused a lot of animals to die of kidney failure. It caused acute kidney failure or acute renal failure. Many of those animals that recovered had chronic kidney damage which is probably going to get worse over time. All kitties it seems, practically all of them anyway, do develop renal failure with age. Now, I have theory about that. The theory has to do with the feline distemper (panleukopenia) virus.

And it’s our bad habit of vaccinating cats every year for something they don’t need. And consequently, the virus itself that goes into the vaccine is grown on Crandall-Reese kidney cells, and they are feline kidney cells. So when those viruses are filtered, some of the kitty proteins get in with the vaccine, and then you inject it into the cat, and the cat will make antibodies against it and cause chronic inflammation. With vaccines, the immune system tends to make antibodies to things like red blood cells, and particularly connective tissue. There’s a lot of connective tissue in the kidneys, so you’re setting up a situation where you have each vaccine creating more and more antibodies, which creates more and more inflammation as the antibodies bind with the kidney tissue. So you set up a chronic low-grade inflammation in the kidneys, and if you do that every year, the kidneys can just only take so much of that and leave scar tissue at its wake. If you have enough scar tissue, then you have very little functional kidney tissue left. I believe that most chronic renal failure in cats arises from years of dry food that’s caused chronic dehydration, which is a burden on the kidneys, and/or vaccines that caused prior inflammation.

Jenny: So are there ways to avoid kidney disease in your cat? Obviously, from what you just said I could conclude to avoid the vaccination.

Dr. Jean: Right. Now, panleukopenia will kill a kitten, so I recommend that you get the first couple or two, three distemper vaccines for your kittens. Because it’s a kind of disease that’s very common. It’s a parvo virus, it’s everywhere in the environment, and you can bring it in to your cats on your shoes. I have friends who did not vaccinate and lost 11 cats and all the kittens.

It was because a worker was not careful about changing shoes when she came in. So, you know, vaccinate the kittens for distemper. But after kittenhood, they don’t ever need a booster. That vaccine lasts from eight to fifteen years or more, which is you know, pretty much a cat’s lifetime. If you’re a cat, if you’ve lived a normal life, even if you’ve lived indoors, you’ve been exposed to that parvovirus over and over again. It produces really long-lasting and I suspect lifetime immunity. They’ll never need another distemper shot. Because once they have immunity to it, the chances of ever getting severe disease from it is pretty much nothing.

Jenny: That’s good. I’m so thankful that I have this conversation with you via email before I took Charlie and Trig in. Because I know that my Vet would have scared me into it. I know that I would allow that to happen and when I don’t have a good gut feeling about it, then that’s when I start to question it so I’m glad we’re here.

Dr. Jean: I’m glad I’m presenting this information that comforts you. For several years now I’m sure the (veterinary) profession is well aware of it. You know, when go to a conference and you’re getting your continuing education… vets make more money out of dogs. Dogs are bigger. They take bigger pills, they eat bigger bags of food. People are more willing to spend money on dogs. If you’re a vet in a small animal practice, you’re going to probably go to the lectures that are about something that you’re going to be able to use and make money with, and that’s going to be the dog stuff. Most vets aren’t cat people. They don’t “grok” cats. You know what I mean? I have worked primarily with cats. I understand them. I can see, I can feel, I can get into a sort of intuitive kind of level, and “get” what’s going on. Most vets are not that comfortable with cats. And they certainly don’t know this research, even though it’s been out there for many years. You know, it’s just not common knowledge. And there’s always controversy about vaccines. All the experts recommend that you vaccinate no more than every three years, if that, and the data’s very strong in dogs and it’s pretty good in cats, that you don’t need to be revaccinating these guys for these diseases that aren’t a threat. But many vets are still tied to the vaccine income, and the things it says on the label “give it every year”. So they think that presents a great liability, and that it’s the standard of practice. There’s a lot of reasons.

I went to a meeting once where we talked about vaccines and dozens of vets commented, and I thought it was just amazing how many different ways that individual veterinarians found to say “it’s the money.” But that is what it came down to with every single one of them. It came down to the income. That should have started in 1994 when the information about vaccine-associated tumors started to come out, when Macy started to publish about it. And so we’ve had almost 20 years to figure out a way to replace that income with something else. But the older generation of vets will do it their own way, to hell with research, science and uhh forget it! “You know, I’ve always done it this way, and everybody’s done just fine”. The animal that got sick from vaccinations or or got cancer from vaccinations, those people simply don’t go back to that vet. So the vet never sees the real outcome of that policy. There’s no way to keep track of that.

The American Animal Hospital Association just came up with a whole new thing about vaccines, saying, really, we know they last three years, and we know they probably last at least five years. But they refrain from recommending that we get on every five year schedule. Because that is not politically correct.

Jenny: That …I completely agree. I actually take my cats to KC cat clinic so it’s only cats. But..

Dr. Jean: Oh that’s good. Because it’s a cat only clinic, they tend to be a little better about it.

Jenny: What are some signs of kidney disease?

Dr. Jean: Drink a lot, pee a lot syndrome. That’s the number 1. If it’s get bad, they’ll start losing weight. If it gets really bad, you’ll walk into the room and it will smell like a outhouse, because the ammonia in their breath would be so bad. But they’re pretty sick by that time usually.

And you know, it’s the sudden increase in drinking and urinating. Actually urinating comes first if you want to do the chicken-and-egg thing.

Jenny: So if you saw more amounts of, or you saw bigger clump of litter for example, that would be a sign?

Dr. Jean: Yeah, I can tell you what happened with my cat. I had two cats and they had a history… the younger cat had a history of urinary tract infections. But the older one seemed fine. They weren’t losing weight. Nothing was happening. Then all of a sudden, we went from 2 to 3 clumps of litter in a box every day to 8 or 9. And so naturally, I took the younger cat at first because she was my “big ticket item” cat. And if anybody’s going to be sick, it’s going to be her. But it was all fine. I had just run complete bloodwork on the older cat I think in April, because she was in a study. You know when you’re a vet student, every cat or every dog is in a study of some kind. She just had a full blood workup in April. Everything was perfect. This is July and she’s in kidney failure. But she went on another 5 years. She was a tough old broad. It was early kidney failure, she wasn’t concentrating her urine. So you know it could just be overnight like that. So you know, it’s always worth paying attention to what’s in the litter box. That’s your eye on them in your world.

Jenny: Yeah, I certainly never noticed it when Rags had a chronic renal failure. But I did once when they told me to notice it. You know one of the things that’s often searched for in my site is kidney disease cat food. Is there such a thing other than the prescription diet stuff?

Dr. Jean: Yeah. The thing about the kidney cat food is that the only study that’s every really shown a benefit was done by the company who made the food. In my experience, those foods, if you start them on those diets too early, you’re going to have problems. When I was in vet school, they said, “don’t start them on k/d until the kidney function has really declined, and you really start to need the restricted phosphorous. Because those diets, they’re so low on protein, they don’t really give enough protein for ongoing body maintenance so this cat tend to lose weight and body condition. Most cats don’t like it and don’t eat enough, on top of the reduced nutrition. You know, one study showed, it increased length of life and pure complications, and you know that’s fine if you want to do that. My philosophy is that if somebody says to me, “Jean, I can let, you can live 10 years longer if you just give up the Ben and Jerry’s.” And I would say, “Stick your 10 years and give me the ice cream!” You know, I like to see them happy to eat, so I give them what they like to eat. The higher protein food also have more fat so it maintains your body weight better. You know, it just depends on the food-motivation of the cat… do they really get a lot of joy out eating their whatever high protein food? You know I just have a problem taking that away from them, and making their life longer, but boring and less enjoyable. A lot of people (and most vets) wouldn’t agree with me, but that’s my philosophy.

Jenny: Can you explain in layman’s terms, what kidney failure means or what’s the process and what your understanding is of how it makes the cat feel?

Dr. Jean: Well the process is, that kidney cells die off overtime and are replaced with scar tissue. And the kidneys have a huge capacity and you can lose, by the tiniest show of symptoms, 75% of your functional tissue. It’s like when you come to the end of the rope… that means there’s no more rope. And if you keep going, you will fall. So these guys have come to the end of their reserved capacity, and now we have symptoms and because the kidneys are responsible for retaining water and certain ions and excreting other things, it’s very active tissue. For instance, there’s a hormone produced in the kidneys that helps the bone marrow to produce more red blood cells, so when the kidneys are failing, they get anemic because that signal is not being sent anymore. Sowhat happens is that they drink more water, but they can’t take in enough water to make up for the losses. Cats eating canned or homemade take in a lot more water than the cat that’s eating dry food, but either way they lose fluid overall and become dehydrated.

So the kidneys are extremely unhappy because they can’t hold on to enough water. So then cats get thirsty and drink, but can never make up for what the kidneys are losing. And also, they’re losing proteins, you’re losing important things in the urine. And so they start to lose weight because they’re breaking down tissue to try and supply some of the things that the kidneys would have normally held back in and recycled. So it’s a bad cycle. When the kidneys are also not excreting ammonia and other toxins for you, well those now start to build up in the blood. And one time I moved behind a dairy, and they had an ammonia leak. It was one o’clock in the morning and it was summer, I woke up, and it was like somebody took an icepick and shoved it to my eye. It gave me an instantaneous severe headache. I had that ammonia go into my bloodstream. These guys have a lot of circulating ammonia, and that gives them a headache. And they’re nauseous. They don’t want to eat, so they cannibalize their own tissue to try and maintain themselves. You know if you don’t do anything, it’s a very fast downward spiral.

Now the things that I like to do for these guys… Now there’s quite a few drugs nowadays, all these things to control the calcium/phosphorous balance, and to manage the anaemia, and the high blood pressure. But the one thing that is more important than anything else is subcutaneous fluids. So learn how to give fluids and give up.

I just had somebody write me this morning, “Well, I’m giving my cat fluids once a week.” That’s like, yeah, that would be like if you have chronic pain, you take an aspirin once a week. C’mon dude! Pay attention. They need the fluid. And supplementing fluids does a host of wonderful things, including that flushes ammonia and other toxins out through the kidneys, so it brings those levels down. Dehydration causes headache all by itself, and it causes nausea. So, you know if you can correct the dehydration, you’ve got 90% of the problem licked.

Now, when cats are on a lot of fluids you have to worry about supplementing potassium. In vet school I worked in the pharmacy. Every bag of fluids that went out was spiked with potassium. Because all those fluids are made for humans, and humans tend to get too much potassium, so all fluids are too low potassium. To make the potassium even back to normal, you have to add it. So you know I’m the only vet that I know that does that because I work for the pharmacy! Well there is one other person who worked in the pharmacy after me, and she’s also a vet. But she’s the only other one.

You know, nothing’s without complications.

Jenny: Right. That’s interesting about the potassium. I definitely wish that I would have known that when Rags was alive.

Dr. Jean: Yeah, and you know, it used to be that there was an issue with the potassium and it was actually discovered by one of teachers and one of my professors at vet school. He was Marty Fettman. He was the first veterinarian in space! That was a big deal in old days, back in the day. They found that k/d, the food k/d, was causing cats to become hypokaemic which is low potassium. Because it just didn’t have enough potassium and it didn’t make up for what they lose in the urine. So now, k/d has more potassium and some of the others do too.

I would say, if you’re going to feed a kidney diet, only feed the wet version. The dry version, is just you know, you’re slapping yourself upside the head by making them more dehydrated at the same time you’re trying to combat dehydration! Because the dry food sucks the moisture out of them. So you’re gonna lose that one. So the cat food’s extremely important.

Jenny: Well my mom’s cat, Murphy, had been on kidney food dry for a long time before she took him off dry food altogether and put him on a wet food only.

When Rags was in chronic kidney failure -I gave him lactated Ringers, it was once a day and then it became twice a day because they didn’t want… I’m not gonna be able to say this right but basically my memory of it was too much fluid in failing kidneys could really hurt him so that’s why they broke it down to twice a day eventually.

Dr. Jean: The area where you inject fluids (scruff of the neck) does not have a great blood supply so it has a limited capacity to absorb fluids. So if you give a 5 pound cat 200 ccs of fluids, it’s just gonna drain down to his legs and not absorb it. So you give smaller amounts more frequently. I don’t recommend lactator Ringers though. It really needs to to be Normasol or Plasmalyte or similar fluids. Ringers has lactic acid in it. And these cans are already too acidic. Acid is a big problem and the last thing you want to do is add more acid. And lactate is lactic acid.

Jenny: Then another thing that was added that I had to shoot into the bag was B12. What do you think about…

Dr. Jean: I usually just put B complex, and C, and potassium. The Bs tend to get washed out with water. They tend to get washed out with fluids, so yeah.

Jenny: Those were kind of all of my questions, do you have anything to add to this that maybe I forgot to ask?

Dr. Jean: Omega 3 fatty acids and probiotics are really, really important for these guys.

Jenny: When you say these guys, you mean kidney failure cats or all cats?

Dr. Jean: Well, all cats. Especially kidney failure. Because Omega 3s have been shown to improve their status and self-probiotics. Now there’s a particular brand of probiotics called Azodyl. That’s the one they did the studies on. One of our readers just told me that they can’t get it and they can’t figure out where to go. But I think any probiotic in the store would be just fine. Because the probiotics help… a lot of the urine toxins are manufactured by the bacteria in the colon. Proteins are broken down there. For some reason, I can’t remember what the logic was but stabilizing and balancing that population, it definitely had a huge beneficial effect in terms of keeping the numbers down. By keeping the numbers down, what you’re doing is you’re proving how the cat feels. The numbers are themselves critical. It just that, that’s how you know.

Dr. Jean: They’re like, how do I know if the cat’s in pain, or how will I know if it’s time. The first thing I will say is, “You’ll know.” Sometimes, you have to, sometimes you go to the vet and they’ll say “Well you know, this doesn’t look good.” and every single person I’ve ever said that said, “Oh, yeah I kind of had that feeling.” Every single one. So nobody doesn’t every really know.
Kidney failure isn’t really painful until you start getting headaches because of the ammonia. Most of the stuff can be managed. When they quit grooming and they quit wanting to be petted, and they just hide…it’s quality of life issue. Dying of kidney disease is pretty horrific. So most of these guys would need a little help.

The other this is that felines CRF website have incredibly detailed information and they refer to each other back and forth all the time so…

Jenny: and that’s felinescrf.com?

Dr. Jean:  And they’ve just got so much information. All the details and all the meds. You know I’m retired so I don’t keep up on the details. If I were still in practice, I’d be using some of these medications, because I want to make the cat feel better for as long as possible without going overboard. I wouldn’t recommend the kidney transplant and all that kind of stuff. WHY? You’re gonna buy a little time but in the meantime you’re gonna put the cat to the horrific surgery with a long recovery… two cats for this surgery, and recovery and stuff. So what? For another 6 months or a year? For some people that’s gonna be worth it. But my whole philosophy is kinda minimalist. My cats have taught me that. They taught me that they didn’t want extraordinary effort.