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Henley and Twyford

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Case Notes: Henry and his Scary Episode of Acute Renal Failure (ARF)
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Meet Henry. About 10 years ago this handsome boy decided that living under a hedge was no longer suitable for him so he wandered down the road and found a receptive family as his new home. He did this in a very polite way; rather than breaking and entering to steal food and a warm bed as most stray cats would, he came to the front door of the house and awaited his inevitable invitation.

For the last decade he has become a dearly beloved member of his new family - and for the most part has lived a happy and healthy life with them.

Last September however, his owners noticed he was lethargic, was not eager to eat or drink, and was producing no urine. These are often early warning signs of urethral obstruction in male cats - in itself an emergency situation. What few people realise is that a complete lack of urination is also a common early clinical sign of acute renal failure (ARF). This turned out to be the problem for Henry.

Photo:
Henry

Kidney disease is generally associated with a dramatic increase in urination and drinking - and this is indeed the case with ongoing or chronic renal disease where the organs are unable to concentrate urine - effectively water passes straight from the blood, through the kidney and into the bladder.

When he arrived at our Henley clinic, Henry's bladder was distended with urine and he was feeling very sorry for himself. We hospitalised him to confirm our suspicions of either a urethral obstruction or ARF. Whilst awaiting his blood results the nurses expressed his bladder manually and he then continued to urinate on his own, thus ruling out a complete urinary obstruction. This along with the blood results confirmed our feared suspicions of ARF.

Amazingly, the kidneys receive up to 20% of the entire cardiac output, which increases the delivery of any blood borne toxicant relative to other organ systems. Due to the unique physiological and anatomical features of the kidneys they are very susceptible to the effects of toxicants and ischaemia (reduction of blood flow). There are many causes of ARF, most of which are unavoidable. The ethylene glycol found in many de-icer products at this time of year is extremely harmful to the kidneys but a broad range of other compounds - from pesticides to certain dried fruits - could have been the origin of Henry’s condition. No matter the cause, the end result is always the same: a build up of dangerous toxins (including naturally produced urea) in the blood that should have normally been excreted into the urine. It is frequently fatal.

The goal of treatment is to flush these toxins from the system and give the kidneys supportive care with aggressive intravenous fluid therapy. Also to give prophylactic antibiotic cover for this compromised patient and treat any resulting gastric ulceration, a common complication. Finally, it is important to feed a 'kidney friendly diet' with lower protein and phosphorous content. This was a trick with Henry as he can be a picky eater at the best of times, and we finally had to settle on giving him his favorite food to get him eating ... Beijing Duck!

After 48 hours of treatments and supportive care, it was time to assess his kidneys again. Despite Henry appearing to feel a bit better in himself the results of his follow up blood tests were even more grave than when he presented. This indicated just how early in the disease process his symptoms had been recognised by his owners - and how quickly he was brought to us. It did, however, reveal the possibility that the insult to his kidneys was irreversible.

As he was looking better clinically we gave him the benefit of the doubt and another 36 hours of treatment. This was a crucial and nerve racking time for his family and all the surgery staff looking after Henry. Happily his next blood test showed that the treatment had been effective and his kidneys had recovered from the damage caused. He returned home and has been healthy ever since!

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Macgregor Spinks BVM&S MRCVS

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Henley Vets and Twyford Vets
The Veterinary Centre: 271 Reading Road, Henley-on-Thames, RG9 1EL - Phone 01491 574490
Also at Twycombe Lodge, Loddon Hall Road, Twyford, RG10 9JA - Phone 0118 934 0259