Last updated Apr 17, 2023
With old age in cats comes age-related health problems. One of these problems is kidney failure, a progressive disease defined by a significant loss of kidney function.
Kidney failure in cats is a big topic, so we’re going to cover a lot of material in this article. We’ll start with some background about the kidneys, then take a deep dive into the nuts and bolts of kidney failure.
Quick Overview: Kidney Failure In Cats
Other Names: Chronic kidney failure, chronic kidney disease, CKD
Common Symptoms: Increased thirst and urination, dehydration, weight loss, decreased appetite, vomiting, sores in the mouth, foul breath, poor quality haircoat.
Diagnosis: Bloodwork and urinalysis, blood pressure, x-rays, ultrasound.
Requires Ongoing Medication: Yes
Vaccine Available: No
Treatment Options: Dietary therapy involving low levels of phosphorus, sodium, and high quality protein. Medications including blood pressure medication, appetite stimulants, and anti-nausea medication. Phosphate binders help to reduce dietary phosphorus intake. Fluids may be given under the skin (subcutaneous fluids) at home if needed to maintain hydration and keep waste products in the bloodstream lower. Hospitalization for intravenous fluids may be needed in some cases. Some supplements may also help.
Home Remedies: None
Kidney Basics
The kidneys are bean-shaped organs responsible for several vital functions, including filtering toxins and waste out of your cat’s bloodstream, producing urine, regulating the blood’s levels of nutrients, and conserving water.
The kidneys are bean-shaped organs inside a cat’s abdomen. They’re not very big, but they pack a powerful punch in maintaining a cat’s health. Here are their major functions: (1) filter toxins and waste products out of the blood; (2) produce urine to get rid of those toxins and waste products; (3) regulate blood levels of essential nutrients, such as calcium and phosphorus; and (4) conserve water.
Different parts of the kidney’s anatomy carry out these functions. For example, nephrons (kidney cells) are responsible for the filtration. The ureters carry urine from the kidneys to the bladder.
Given these essential functions, you can imagine that kidney failure can be a serious blow to a cat’s overall health.
Fortunately, kidneys don’t fail easily. They have lots of reserve capacity, meaning that they can continue functioning relatively well despite suffering some damage.
How Does Kidney Failure Occur?
Kidney failure occurs when at least two-thirds of each kidney is damaged. With this much damage, the kidneys cannot perform their essential functions.
Kidney failure can be acute or chronic.
- Acute kidney failure occurs when the kidneys suddenly stop working. Some of the many causes of acute kidney failure are toxin ingestion (e.g., antifreeze) and shock.
- Chronic kidney failure, also called chronic kidney disease, develops over many years. It usually begins when cats are about six years old and becomes progressively worse as the nephrons slowly die. When more nephrons die than can be replaced, kidney failure becomes apparent.
Chronic kidney failure is much more common than acute kidney failure in cats, so we’ll focus on chronic kidney failure.
What Causes Chronic Kidney Failure?
The exact cause of chronic kidney failure remains unknown. However, many health conditions, such as those listed below, can significantly damage the kidneys over time.
- Kidney cancer
- Kidney stones
- Bacterial infection
- Hypertension (high blood pressure)
- Systemic infection (e.g., bladder, lungs)
- Polycystic kidney disease: fluid-filled cysts that replace a kidney’s normal internal anatomy
What Are the Clinical Signs of Kidney Failure?
Even when the kidneys are failing enough to cause clinical signs, kidney failure may not be the obvious diagnosis. Kidney failure’s clinical signs are non-specific, meaning that they don’t indicate a particular disease.
The clinical signs gradually worsen as kidney failure progresses.
Below are signs of early kidney failure, also called compensated kidney failure:
At this stage, the kidneys compensate for their inability to filter out waste products by producing more urine.
- Increased urination
- Increased thirst
Below are signs of advanced kidney failure, known as uncompensated kidney failure:
At this point, the kidneys can’t compensate for their loss of function. Uremia, which is the life-threatening buildup of toxins and waste in the blood, develops and causes severe clinical signs.
- Reduced appetite
- Weight loss
- Poor coat
- Bad breath
- Vomiting
- Weakness
- Lethargy
- Depression
- Pale gums
- Mouth ulcers
Is your cat displaying any of these symptoms? An at-home saliva test can help you assess your cat’s kidney function to determine whether a trip to the vet is warranted. Learn more about Kidney-Chek here.
How Is Kidney Failure Diagnosed?
Your veterinarian can diagnose your cat with kidney failure through bloodwork and urinalysis.
Because kidney failure affects older cats, the clinical signs listed above may be mistaken for normal old-age changes.
Diagnostic testing for kidney failure primarily involves bloodwork and a urinalysis.
Several changes on the bloodwork suggest kidney failure:
- Increased blood urea nitrogen (BUN) and creatinine levels: BUN and creatinine are waste products that normal-functioning kidneys easily eliminate.
- Reduced potassium
- Elevated phosphorus
- Anemia (low red blood cell count)
A relatively new blood test that measures a substance called SDMA helps to diagnose kidney failure even earlier than can be done with routine bloodwork.
On a urinalysis, dilute urine would suggest kidney failure, especially if the bloodwork shows elevated BUN and creatinine. Protein may also be present in the urine.
Because hypertension can cause kidney failure, a veterinarian may also take a cat’s blood pressure to help confirm a kidney failure diagnosis.
What Are the Stages of Kidney Failure?
An official staging system, developed by the International Renal Interest Society (IRIS), assigns a stage to chronic kidney failure according to fasting blood creatinine levels. There are also sub-stages, which consider blood pressure and protein in the urine.
The main stages are 1 (least severe) to 4 (most severe). Your cat’s stage of kidney failure will guide treatment.
You can find the most recent IRIS staging guidelines here.
How Is Kidney Failure Treated?
While not curable, kidney failure in cats is treated using a range of therapies, with most aiming to reduce the kidneys’ workload, minimize waste products in the blood, replace lost nutrients, and manage clinical signs. Subcutaneous fluids are often administered to cats who have become dehydrated.
Chronic kidney failure is not curable. Treatment goals include reducing the kidneys’ workload, minimizing waste products from the blood, replacing lost nutrients, and managing clinical signs.
Treatments can generally be grouped into dietary changes and medications. Be aware that not every cat in kidney failure will need every available treatment.
Dietary Changes
The ideal kidney diet is low in protein, phosphorus, and sodium. A low-protein diet is needed to reduce the kidneys’ workload, but the protein must be of high quality. Phosphorus must be kept low because it can accumulate in the blood when the kidneys are failing. Low sodium is necessary because hypertension can worsen kidney function.
Water
Cats in kidney failure need easy access to plenty of fresh water to prevent dehydration. However, kidney failure can make a cat feel lousy and not in the mood to drink water. Adding some flavor to the water, such as some low-sodium flavored broth, can entice a cat to drink.
For cats with severe chronic kidney failure, daily subcutaneous fluids may be necessary to maintain adequate hydration. Don’t worry—giving subcutaneous fluids to your cat is easy to do and is comfortable for your cat.
Supplements
In kidney failure, nutrients such as potassium and vitamins B and C are lost through the urine and need to be supplemented back into the diet. They can be given as daily supplements or included in the kidney diet.
Other supplements include antioxidants and fatty acids to reduce further kidney damage.
Your veterinarian will determine which supplements your cat will need and instruct you on how to add them to your cat’s diet.
Medications
An array of medications helps to manage kidney failure in cats. For example, anti-vomiting medications may be needed to control a cat’s vomiting.
Phosphate binders attach to phosphate in the intestine and prevent it from getting absorbed into the bloodstream.
Erythropoietin, which stimulates red blood cell production, improves anemia.
Blood pressure medications reduce blood pressure and improve blood flow through the kidneys.
As with your cat’s diet, your veterinarian will determine which additional medications your cat will need.
What’s the Prognosis for Kidney Failure?
If you’ve seen your cat vomiting, you need to identify the cause and then care for them accordingly.
The prognosis depends on the severity of kidney failure. Kidney failure will progressively worsen, but the treatments listed above can slow down the progression and give your cat a good quality of life even as their kidneys aren’t working so well.
Bringing It Together
Kidney failure is a complicated but manageable disease in older cats. If your cat is in kidney failure, work with your veterinarian and do your best to care for your cat.
Frequently Asked Questions
What are the symptoms of end-stage kidney failure in cats?
The symptoms of end-stage kidney failure reflect the kidneys’ inability to compensate for significant damage and loss of function. These symptoms include vomiting, weakness, depression, weight loss, and bad breath.
How long does a cat live with kidney failure?
This depends on the stage of kidney failure. A cat may live several years with early-stage kidney failure, but less than that if the kidney failure is advanced.
Is kidney failure painful in cats?
That can depend on the underlying cause of kidney failure. For example, antifreeze toxicity can lead to a painful swelling of the kidneys.
Is kidney failure reversible?
The kidneys can withstand a lot of damage before they start to fail. However, once kidney failure sets in, there’s little chance for the kidneys to recover. Therefore, kidney failure is not reversible.
That is a lot of good information. Fortunately, my cats don’t have that issue but it is good to know what to look for.
It’s a too good information, First time i read cats have Hypertension,ckidney ancer and kidney stones issues too like human.
I believe our kitty is at the very end of renal failure. He no longer eat no matter what we give him, even though a syringe.He’s
always on my cushion so I have moved to a different place. He lays around all day doing nothing. He’s lost a lot of weight as well. We feel he has no quality of life left. He was diagnosed 1 1/2 years ago. He is 17 and think it’s time. Any thoughts would be greatly appreciated.
Hi Kelly,
I’m so sorry to hear about your cat. Quality of life is a big consideration when a pet has become very ill. I suggest that you talk with your veterinarian about your cat’s declining quality of life. Unfortunately, it’s never easy to talk about the end of a pet’s life. Your veterinarian would be the best person to talk to because they know your cat so well and can help you make a decision. Remember that it is your decision to make; your vet is simply there to help guide you through the decision-making process.
I am just another person with a cat with kidney failure. When is enough, enough. I have this problem with my cat who is 16 years old.
I am not feeding my cat fancy foods or prescription foods. He is pick y and will not eat them. So I hydrate my cat with water under the skin every other day. It is starting to get on my nerves. If I miss a day. My cats starts hiding in a dark space. and will not eat. So I do not miss a day. I give my cat Cerenia once in awhile, when I can not stand to see him eating grass outdoors. I am getting close to throwing in the towel. I love my cat very much. I will not sit around while toxins are building up in his blood stream , from failing kidneys. I hate taking my cats in for euthanizing. WIthin 2 years , i have taken two of my cats in to be euthanized. Both had cancer. U think I am cruel.
Cancer is a painfull disease. I will not put a cat through cancer treatments. There is all kinds of things out there, if U want to extend the lilfe of your cat. If U are financially wealthy. U can do it. Money does not cover misery and suffering and the cats quality of life. Death is a kindness and the way out.
I agree — you definitely have to weigh costs (not just financially) of any treatment against the benefits that might be gained. With some things (like many cancers and chronic diseases), the “cost” of the cure (if there IS one and even if it were FREE) is often simply not worth the degradation to the animal’s overall quality of life due to the stress from frequent vet visits, painful procedures and/or negative side effects of medications or treatments. Certainly the age and overall general health of the animal play a HUGE role when weighing the cost/benefit of any given treatment, as well as the expected prognosis afterward. But far more frequently we find ourselves faced with these situations and decisions when we have a senior pet, who may also be dealing with other issues simply related to aging (arthritis, for example) that affect their resilience and make recovery more difficult, or unrealistic. It is a hard, hard thing to let them go, but better for them (and ultimately for US) to allow them to pass on with peace and as little pain and suffering as possible. To that end, I STRONGLY recommend looking into finding a vet in your area that offers at-home euthanasia — it is an absolute BLESSING for both you and your pet! I have done this with all 3 of my senior dogs when it became time to make that difficult decision because I wanted them to be able to feel relaxed, comfortable, and able to be in their own home surrounded by love and familiar/favorite things and people when they passed. And I will happily do it again for my senior cat should it become necessary for him. The cost is typically VERY reasonable, only a little bit more than what the vet charges to do it at their office in order to cover their transportation costs, but SO worth it! Some local vets offer this as an option, and some do not. However, there are now quite an array of mobile vet services around, all of whom I’ve found offer this (at least in my area — although can’t for the life of me imagine that a mobile vet WOULDN’T). Certainly ask your regular vet if that is an option, but if not, a quick internet search for “mobile vet euthanasia” or “at-home pet euthanasia” in your area should help you find one. I have also found a quality of life “calculator” (so-to-speak) for pets online that is set up as a questionnaire with a rating scale that you can use to help you determine when it is time to let them go, so maybe that would help you with your initial question of “when is enough enough”? Blessings to you and your kitty!
All I can say is you will know when enough is enough I would see if you have a vet that will come to your home and put your baby to rest it’s alot calmer and relaxing fir your furbaby and you they can go to heaven in there favorite bed spot lap it’s just nicer not much more money then taking to vet my friend paid 300 that’s less then the vets where I go just an idea…give my love along with your love to your beautifull furbaby…take care of eachother
My cat is 13 year old Maine Coon with less than 25% kidney function. He howls a lot when getting ready to drink his water.
He drinks a great deal and urinates many times a day.
His appetite is still good but I’m concerned he may be in pain.
Hi Sheldon,
Cats often vocalize when they are in pain or have discomfort. However, pain is not typically associated with kidney failure. I recommend notifying your veterinarian about the behavior. It could be that your cat has some underlying pain that hasn’t yet been diagnosed.
My cat has been diagnosed with kidney failure. He had one seizure 3 days ago. Is that a symptom of kidney failure and will he have more.
Nancy
Hi Nancy,
Seizures can occur with kidney failure. They can occur because, as kidney function worsens, toxins build up in the blood (‘toxemia’). Toxemia could eventually lead to neurologic problems, such as seizures. There’s not a good way to know for sure whether your cat will have more seizures. If you have not done so already, let your vet know that your cat has had a seizure. Your vet will be able to provide the best way to move forward, which may include additional medical therapy.
Can we get the suppliments ourselves or does it have to be through a vet? My cat is 18 and I just can’t put her through the stress of taking her to the vets office.
Hi Pam,
It’s understandable that you don’t want to increase your cat’s stress with a vet visit. I recommend calling your vet and asking them which specific supplements your cat needs, and which brand of supplement that they recommend. Your vet can also instruct you on how much of each supplement to give your cat, and how to administer it. If you want to purchase the supplements online, go to trustworthy websites, such as Chewy.
My cat is at least17 years old.He was diagnosed about 54years ago. He was a stray who showed up one cold winter day.He was pretty fat had been neutered an am just assuming had been vaccinated.He wss super thirsty ANF needed or demanded moving water from the tap.I took him for a check up and we made it. Barely thru that. I didn’t take hi back much.Worst visit he was in kidney failure.so make sure begets plenty of water his appetite is hood.his belly is very big and he has lost a lot of his teeth but for an old cat with issues he is pretty good.Taking him yo the vet usually results in me bleeding and crying I am 75 and just want to know if you think my Perry is in pain or misery He is an amazing cat except at the vets.
Hi Joy,
From your description, I’m not able to say definitively if Perry is in pain or misery. Because it seems that visits to the vet could be causing Perry a lot of stress, you could try to find ways to make the visits less stressful. For example, you could make the car ride to the vet comfortable, such as by making sure Perry is secure in his crate and playing calming music in the car. At the vet’s office, your vet could try different things to keep Perry’s stress level down. I recommend talking to your vet before your next visit to come up with a plan make the visit more pleasant for you and Perry.
I adopted my 5-year-old cat, who has FIV, from a rescue two months ago. He was on the street before the rescue found him. A recent blood test revealed that his kidneys are functioning at only 25% capacity. His creatinine and BUN levels were off the charts. He was in the hospital on IV fluids for 3 days and a subsequent blood test showed his levels had “improved.” Now that he’s off the IV, however, his appetite and energy have again decreased. He refuses to eat the canned Royal Canin kidney food; he does eat a bit of the dry. To the best of my knowledge, he hasn’t ingested any toxins. I know kidney failure is incurable and irreversible. The vet doesn’t know why a young cat would get kidney disease and wants to perform an ultrasound to find out if it’s congenital or if it’s cancer. What else could an ultrasound tell us? Is there any point to his having one if he isn’t going to get any better?
Hi Katherine,
I’m sorry to hear about your cat. An abdominal ultrasound can be used to see if there are any visible abnormalities with the kidneys, such as smaller-than-normal size, mineralization (calcium buildup, for example), and damage to the soft tissue inside the kidneys. Although your cat won’t necessarily get better because of the ultrasound, your vet may be able to adjust your cat’s treatment management according to how the kidneys look on the ultrasound. I think that it would be worth it to have the ultrasound performed to, quite literally, get a better look at the kidneys and more fully understand your cat’s kidney disease.
Hi, my Exotic Persian 15yrs old has been diagnosed with Kidney failure they did not give me the readings of the tests just that the levels were very high.
I see that one lady’s cat tends to Howl, well, mine howls a lot even to the point that she woke me up four nights in a row last week between 3 and 5 in the morning, not appreciated by me.
Tonight she attacked my other cat, Persian 12 years old, up until then she might have given her a flick with her paw but never attacked her, this concerns me because I am to receive a new kitten at the end of this month and the last thing I want to happen is for her to attack it and possibly do serious harm.
We have tried the Urinary foods and she will not eat it, even just a small amount in with her normal foods.
I dont know what to do, if the howling is a sign that she is in pain then she must be in pain every day because she howls every day.
I truly would appreciate some advice.
Hello Jan, thank you for stopping by. I’m not sure if it was a mistype, but if your cat is in kidney failure, she should be on a renal diet—not a urinary food. You can see a few of your options in our article on the best cat food for kidney disease. Other than that, it sounds like your cat may be stressed, but looking at this comment alone, I can’t say why your cat has been howling or swatting your other cat. I would do an assessment of everything that has changed in your 15-year-old’s life and environment recently that could be contributing to these behavioral changes, as the diagnosis of kidney failure may not be the only contributor or a contributor at all.
Thankyou, yes we did have another change of address, the Vet did all the tests and this is her diagnosis. Going to try a different change of food (Kidney) and we will see how she gets on.
Thankyou for replying.
Regards
My cat smokiegirl9 will be 19 in October and the vet says has kidney disease will a potassium supplement her kidneys even a little a she isn’t going to the bathroom because she is not eating alot I was thinking about giving her some water through a syringe they have her on a gel that I put inside her to try and stimulate her to eat I dont know what else to do any suggestions would be appreciated
Hello Judith,
Talk to your vet first before giving your cat any type of supplement. Cats with kidney disease require a strict diet to keep their kidneys from working too hard, so adding a potassium supplement could put extra work on your cat’s kidneys and worsen the kidney disease. Regarding giving your cat water through a syringe, talk with your vet about that as well. Cats with kidney disease must stay well hydrated, and there are different ways of doing that, such as subcutaneous fluids. Overall, because kidney disease is complex, it will be important for you to work closely with your vet to monitor your cat’s health and make adjustments to their treatment; do not make any adjustments before talking with your vet.
My 16 year old cat has been diagnosed with kidney disease. He had a dental appointment and we were told the anesthesia may speed up the disease. His mouth was bothering him, so we decided to take the risk. We knew the symptoms would accelerate, but were not prepared for his difficulty standing up. He has an excellent appetite, so nothing has really changed except his rear legs appearing weak. I will call my vet monday, but was hoping for some information sooner. thank you
Hi Tracy,
I’m not sure if there is a connection between your cat’s recent dental procedure and the rear limb weakness. I hope that your vet can provide you with more information as to why your cat developed this weakness after the procedure.
My 16 year old cat has been diagnosed with kidney disease. He had a dental appointment and we were told the anesthesia may speed up the disease. His mouth was bothering him, so we decided to take the risk. We knew the symptoms would accelerate, but were not prepared for his difficulty standing up. He has an excellent appetite, so nothing has really changed except his rear legs appearing weak. I will call my vet monday, but was hoping for some information sooner. thank you
Hi there, sorry that I wasn’t able to get to you before your appointment on Monday. This is a complex issue, and it’s very difficult to evaluate the causes of your cat’s leg weakness without in-person veterinary analysis. I hope that you got some answers—hopefully good news!—at the vet’s appointment.
My cat was diagnosed with kidney failure 22 November 2021 he was 4years old and few months and was put to sleep no other treatment was offered he stopped eating only drank milk and water was sleeping all the time walking really weak the veterans told me his kidney were large in size and his body temperature was really low so they said it’s best to put the injection so slowly his organs shut down and he will not wake up I wish they offered him treatment so he had couple more years to live
I’m sorry to hear that you lost your cat to kidney failure at such a young age. Take care.
Hi our cat is only 18 months old and we were just told she has kidney failure. The vet is hydrating her and will discuss more with us tomorrow. Do you think there is any chance of recovery. She has all the symptoms of kidney failure listed above except I haven’t seen that she has vomited. Thank you.
Hi Mairi,
Given the information that you have provided, it would be difficult to say whether your cat has a chance of recovery. Your vet will likely be monitoring your cat closely today and will be able to provide you with more detailed information tomorrow. Kidney failure is progressive, but there are various treatment options that can reduce the kidneys’ workload and help them function at least a little better.
My thanks for this very informative article. My Cat was diagnosed with kidney failure this afternoon and severe anemia. This reinforces what the vet shared with me and answers/explains information from the vet I was too overwhelmed to take in and process. Back there tomorrow for more fluids and blood work. Tough decisions to make!
You’re welcome! I’m glad that the information presented in the article was helpful to you.
My
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ShouldIconsidereuthenasia?
Hi Lora, it’s hard to say based on this comment alone. You may appreciate this article on deciding when it’s the right time to euthanize your cat. You can also consult your veterinarian for an expert opinion.
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RenalDiet
I have a Birman who just turned 10, and started lose weight and appetite was not normal. The vet took blood test and showed he is anemic, and his kidneys seem swollen. Ultrasound showed fluid spots by kidneys. I still get him to eat but seems like it’s constant little trips to food bowl, eating little at a time, but meows a lot by his bowl. He drinks water and still uses litter box. He is not playful and isn’t himself but still in main rooms with us.
Vet feels we should maybe go to bigger hospital like a university to have him tested, due to them not having the more modern equipment. We are torn whether to take him and spend big money we can’t really afford if it is kidneys issues that cant be reversed. Is 10 considered old or is there a chance he could still live several years?
Of course, I’m not a vet, and this is not a diagnosis or individual prognosis, but from what you’ve described, it sounds like there is still hope for improving your cat’s health, and I imagine he could see several more years. I would recommend seeing if you can get some affordable testing done and look into treatment for this condition. Wishing you all the best.
Kitty has been diagnosed about a year ago and I’ve given him supplements mostly with the dietary changes. He’s not really digging the new diet so much so he’s eating less, but, he eats. So, he’s losing weight and he has sleepy days. Anyone interested in the supplement, I leave a link here (it works well):
https://www.chewy.com/liquid-vet-kidney-bladder-support/dp/206901
Thank you for sharing, Bryan.
👋. I have a 15 1/2 Purebred Bengal who suffers from Chronic Kidney Failure. We’ve done everything possible. She developed a UTI last week and received one of two shots, the second of which she gets this coming Monday. She only wants to eat wet. Sleeps all day long. Not much appetite.
We are keeping her as comfortable as we can, and love her to pieces.
She is my shadow and it will be most difficult when the time comes.
My cat was recently diagnosed with very early stage kidney disease. Basically 2 kidney function values in his last exam came just above normal range. So I’ve been recommended to get prescription based food as described above. Makes sense. But I don’t want to just sign up to whatever garbage brand of cheap animal feed (not food) they happen to be sponsored by to push on patients. I just recently found a good brand of high quality food that my cat actually likes (RAWZ) so this really sucks because it will be very hard to go through the changing food process again. So basically my question is, given that cost is not a factor for me, what’s the best kidney function food I can get for my cat that has the necessary protein phosphorus and sodium levels that he needs for his kidneys while also being high quality, healthy and species appropriate? (Note: My cat *DESPISES* pate. He will not touch it, and I of course never feed dry food)
Thanks in advance for any advice
Hi Jason,
There are several high-quality prescription (and non-prescription) kidney diets from which you can choose for your cat. To guide your selection, Cats.com has an article on cat foods for kidney disease (https://cats.com/best-cat-food-for-kidney-disease). Given that your cat does not like pate, you can bypass the foods in the article that have the pate formulation. If any of the foods appeal to you, discuss them with your vet to determine which one would best suit your cat’s individual health needs, given the stage of your cat’s kidney disease.