Page 347 - Problem-Based Feline Medicine

18 – THE THIN, INAPPETENT CAT 339

treatment. This anemia is usually reversible when Prevention
therapy is discontinued. For this reason rHuEPO
Since the majority of cases of chronic renal failure are
should not be initiated too early in the course of
of unknown primary cause, there are currently no pre-
progressive CRF.
ventative recommendations.
Treatment of systemic hypertension.
Avoid any potential renal insults, particularly in cats
● Treatment is usually carried out on a trial basis,
with pre-existing comprise of renal function or renal
monitoring for a decrease in blood pressure without
perfusion. For example, avoid using NSAIDs in dehy-
adverse effects or the development of hypotension.
drated cats, and use intravenous fluids prior to induc-
Generally a period of about 2 weeks is sufficient to
tion of anesthesia and during surgery, to maintain renal
document a response. If severe clinical signs are
perfusion in elderly cats and cats with compromised
present, therapy may need to be more aggressive.
renal function. Remember that minor renal insults may
● Classically, a staged therapeutic response is recom-
summate to cause clinically significant renal damage.
mended, starting with dietary sodium restriction,
● Promptly and appropriately treat conditions causing
followed by the use of various pharmacological
decreased renal perfusion including dehydration,
agents.
shock and hypotension associated with anesthesia
The current treatment of choice for the cat is and surgery.
amlodipine besylate. An initial dose of 0.625 mg/cat
Pre-renal and post-renal azotaemia, if not corrected,
PO q 24 h is recommended and may be increased cau-
may lead to renal damage and renal failure.
tiously if the response is poor, to 1.25 mg daily.
Combination therapy is required in some cases, with
the addition of an ACE inhibitor or beta blocker.
FELINE IMMUNODEFICIENCY VIRUS
Treatment of proteinuria involves protein restriction (FIV)***
to maintain a BUN of ≤ 29 mmol/L (80 mg/dl) and use
of an ACE inhibitor to reduce glomerular pressure. Classical signs
Treatment of anorexia associated with chronic renal ● Middle-aged to older cats, particularly
failure. entire males and feral cats.
● Anorexia is usually associated with moderate to ● Clinical signs variable, often vague.
severe uremia, and contributes to further uremia by ● Weight loss, inappetence.
resulting in catabolism of tissue protein for energy. ● Pyrexia, lymphadenopathy.
● Change food gradually over 1–2 weeks in a renal ● Immunosuppression (cat flu, diarrhea,
diet, and increase palatability by warming to just neoplasia).
below body temperature. ● Gingivitis/stomatitis.

Reduce gastric hyperacidity from hypergastrinemia.
● H2-receptor antagonists such as famotidine (0.5–1 Pathogenesis
mg/kg PO q 24 hours).
Feline immunodeficiency virus (FIV) is a lym-
● Gastric mucosal protectant, sucralfate (250 mg/cat
photrophic lentivirus, which causes an acquired
q 8–12 hours, on an empty stomach).
immunodeficiency syndrome (AIDS) in cats.
Modify doses of drugs if excreted by kidneys. ● FIV is morphologically and biochemically similar
to human immunodeficiency virus (HIV), however
it is antigenically distinct and the viruses are
Prognosis species specific.

Chronic renal failure tends to be progressive and the Infectious virus is found in the saliva of FIV-positive
long-term prognosis is poor, although with careful cats and transmission occurs primarily though inocula-
management some cats will live for years. tion of the virus through saliva or blood.