QUESTION: My 10-year-old male cat, Socks, has been diagnosed with chronic renal failure. The whole family is devastated. Please can you suggest some holistic options to help.
ANSWER: The kidneys are responsible for removing waste products and excess water from the bloodstream in the form of urine. Any condition that stops them from working properly is classed as kidney or renal disease. This can be acute, where there is an abrupt drop in kidney function, or chronic, where the condition progresses over time.
Acute kidney injury can be caused by accidents that injure the kidneys; eating something toxic to cats like lilies, grapes or antifreeze; infections such as leptospirosis; other conditions like pancreatitis or cancer; and the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Potential causes of chronic kidney disease include aging, high blood pressure, diabetes, urinary tract infections, polycystic kidney disease, kidney stones and cancer. But often the cause is unknown (idiopathic).
Chronic kidney disease can affect animals of any age, although it's most common in cats over nine years old and dogs over seven. If chronic kidney disease is left undiagnosed and untreated, it is not possible to repair the kidney.
Symptoms of acute kidney injury include excessive thirst, loss of appetite, difficulty urinating, dehydration, bad breath, diarrhea and vomiting. Neurological signs like seizures and tremors may point to antifreeze (ethylene glycol) poisoning. Symptoms usually come on suddenly—your pet can be fine one day and then really sick the next.
Signs of chronic renal failure include poor appetite, weight loss, increased urination and thirst, vomiting, bad breath and blood in the feces, although they usually don't show up until the later stages of the disease.
After taking a full history and exam, your vet will palpate the kidneys to check their size. In general, the kidneys are painful and enlarged in acute cases but small and shrunken in chronic cases. The vet will also run blood tests to check levels of urea, creatinine and phosphorus and examine your pet's urine.
Ultrasound and x-rays, with both plain and contrast radiography, may be necessary to rule out kidney stones, obstruction, cysts and tumors.
Early recognition is crucial to the successful treatment of acute kidney injury, so it is important to seek veterinary help sooner rather than later. If the poison is known, specific antidotes can be given. However, in most cases it's not, and sometimes it is too late to make the pet vomit or give treatment (antidotes need to be given within three hours).
The mainstay of treatment is supportive care with an intravenous drip, anti-nausea drugs, pain relief and supplying the correct nutrition.
In cases of chronic kidney failure, after initial hospitalization, your pet can go home on a prescription diet. In cats, drugs to treat high blood pressure such as ACE inhibitors may be prescribed. ACE inhibitors have been proven to delay the progression of chronic kidney insufficiency in cats, provided they are also on an appropriate diet.
Phosphate binders may need to be added to the diet to reduce phosphate intake, which comes from protein. Restricting protein intake is therefore crucial. Drugs may be also be prescribed to reduce the protein lost in your cat's urine, as this is associated with a shorter life span.
Additionally, your vet may teach you to administer fluids to your pet subcutaneously (under the skin) so you can flush the kidneys regularly at home.
There are also many things you can try at home to help support your pet's kidneys and slow down their decline in function.
Diet. The biggest challenge in pets with chronic kidney failure like Socks is getting them to eat. My book You Can Heal Your Pet has lots of tips for dealing with appetite loss, but good general appetite stimulators include a hard-boiled egg moistened with clam juice, cooked sweet potatoes or yams and asparagus steamed in water. Add them to any food.
As for the diet itself, this should be a prescription diet specifically designed for kidney disease management, such as those by Hill's (Prescription Diet k/d) or Royal Canin (Renal). Alternatively, you can feed Socks a homemade diet providing it meets the following requirements:
• Must be tasty
• Must be low in phosphorus
• Must contain a low amount of high-quality protein like eggs (see box, right, for an egg-based recipe you can feed your pet), chicken and sardines
• Must be high in omega-3 fatty acids, vitamin B and antioxidants
• Must contain no more than moderate amounts of salt
• Must be high energy, with calories from non-protein sources such as brown rice, basmati rice and millet
See my book You Can Heal Your Pet for more information on how to feed your pet a home-cooked diet.
Supplements. A variety of supplements are useful for pets with kidney disease, including:
Essential fatty acids. EPA and DHA in the form of fish oil or marine oils are proven to support kidney function. Cold-pressed linseed oil is also a good source of omega-3 and omega-6 fats.
Suggested dosage: 40 mg/kg EPA plus 25 mg/kg DHA daily for both cats and dogs
B vitamins. Cats with kidney disease tend to excrete large volumes of water-soluble vitamins like B vitamins, so supplementing with these vitamins can help. Vitamin B12 may be given as an injection (speak to your vet), or try a B complex vitamin.
Suggested dosage: 30 to 50 mg vitamin B complex, depending on your pet's size
Whole-food supplements. Canine Renal Support and Feline Renal Support from Standard Process are great foundational supplements. They're only available via health professionals in the US, though; contact Standard Process (www.standardprocess.com) for details.
Suggested dosage: Follow label instructions
Probiotics. These friendly bacteria can be beneficial for pets with kidney problems. A product called Azodyl by Vetoquinol (available on Amazon) is designed for pets with kidney disease as it traps toxins in the GI tract and relieves the kidneys from the job of filtering them.
Suggested dosage: Follow label instructions
Milk thistle. Widely available online, milk thistle supplements can help protect kidney cells from damage. In the UK, try Dorwest Herbs (www.dorwest.com), and in the US, NHV Natural Pet (www.nhvnaturalpetproducts.com).
Suggested dosage: Choose a pet-friendly formula and follow instructions on the label
Kelp or seaweed powder is rich in minerals and a good supplement for pets with kidney disease. In the UK, try Dorwest Herbs (www.dorwest.com) and in the US, Wholistic Pet Organics (www.wholisticpetorganics.com).
Suggested dosage: Give a pinch to cats and small dogs and ½ tsp to larger dogs
Chinese herbs. Traditional Chinese veterinary medicine (TCVM) can achieve excellent results for kidney disease, and using Chinese herbs under the guidance of a TCVM practitioner can be life changing.
Astragalus, dong quai, Ginkgo biloba, rhubarb and rehmannia are very popular Chinese herbs for kidney disease. And cordyceps, a mushroom commonly used in Chinese medicine, has been proven to improve kidney function by reducing renal scarring. A TCVM-trained vet can prescribe the most suitable herbal formula for your cat.
Alternatively, you could try Kidney Support Gold by Pet Wellbeing (available on Amazon), which contains cordyceps, rehmannia, dong quai and astragalus.
Acupressure. Acupressure is another traditional Chinese technique that might benefit Socks, and it's something you can do yourself at home. The following two acupressure points can be stimulated daily:
ST 36: Stomach 36 is located behind or lateral to the tibial crest on the outer side of the back leg, just below the knee in a depression in the middle of the muscle, where the lower leg (tibia) joins the knee. Stimulating this point can help with stomach or gastrointestinal upset as well as exhaustion and poor appetite. Hold this point for 30 seconds.
KI 3: Known as "Great Creek," this point strengthens the kidney and is located on the inside of each back leg, just above the ankle at the midpoint between the Achilles tendon and the protuberance of the ankle bone (medial malleolus). Hold this point for 15 seconds.
See my book You Can Heal Your Pet for full instruction on how to give acupressure to your pet.
Homeopathy. According to Dr Francis Hunter, Mercurius Solubilis 30c can help with chronic kidney failure.
Suggested dosage: 3-4 times daily for a few days at first. Then use 3 times a day for 5-7 days once a month
Every part of an egg is highly nutritious for dogs and cats, including the eggshell. Eggs are a high-quality protein source and rich in vitamins A, B2, B12 and D, plus iodine, selenium and phosphorus. They are an excellent healthy snack to feed and add to homemade recipes. Most dogs love egg recipes, but cats can be fussy, and you may need to experiment to see which recipe is best for Socks. I have found this one very cat friendly.
Chive feline treats
1 small bunch of chives, finely chopped
¾ cup (115 g) self-rising flour
1 free range egg
4 oz (120 g) can of sardines in sunflower oil (use all of the oil from the can)
1) Preheat oven to 375°F/190°C. Grease a 8 × 11 inch (20 × 29 cm) baking sheet.
2) Mix together all the ingredients in a large bowl to form a soft dough. Spread mixture ½ inch (1 cm) deep on the baking tray. Bake for 25-30 minutes until just firm.
3) Remove from the oven and let cool. Cut into bite-sized squares.
4) Keep in an airtight container in the fridge for up to five days, or freeze for up to one month.