Cat with kidney disease and heart failure

Hi doctor,

My cat has had kidney disease for one year, and doing fairly well with Fortekor, Rubenol. Just before Christmas he was diagnosed with cardiomyopathy based on echocardiogram. The vet prescribed monotildiem and prilactone.  As the cat already had the Fortekor, I didn't administer the monotildiem because it seemed like a lot of medicine all together. I did give him the diuretic but was afraid of the effects on the kidneys.  I also started him on Azodyl, which I bought when I was in the US over Christmas (I live in France and no Azodyl available here).

In the past couple of weeks, the cat developed a heavy breath that he never had before.  I took him to the vet on Saturday and the vet suspected water on the lungs, but an x-ray showed no evidence of this.  He also had the highest kidney labs so far -- the urea and creatinine I put in the specs.  The vet thinks it could be due to the lower blood flow from the heart problems.  She stopped the diuretic and replaced with beta blocked prescription, which I started today.

I do wonder if the cat has anemia but the vet has not tested for this.  In addition to the heavy breathing he has been sleeping more than usual an generally seems weak.

My question is if you agree with the treatments for kidney and heart problems, and if the heart problems can be the cause of the increased lab values, as the vet thinks.

Thanks.  

[Aleda M Cheng, D.V.M., C.V.A]

I am sorry that you cat has so many problems!

Your vet has a daunting task.  Trying to balance all of your cats medication is very difficult.

I really can't tell you if the increased Urea and Creatinine are caused by the heart medication since kidney disease has no difficultly in escalating and progressing all by itself over time.  I believe that your vet was correct in taking your cat off of the diuretic since it is difficult to keep the kidneys perfused adequately while on a diuretic.  

However, I do believe that your vet is doing an excellent job in trying to maintain the medication balance.  

There are a couple of things that may help as additions to your cat's protocol.  One is the medication Vetmedin for heart disease.  I know that it is available in the UK, but don't know if it is available in France.  Please ask your vet about this.  The other is a very common Chinese herbal formula: Eight Righteous.  Eight Righteous is an important herbal formula for kidney disease and has excellent results.  It is available for purchase online at many sites.  The dose for an average cat is 3 teapills twice daily.  Teapills are very tiny pills.  

In the past erythropoietin was used for the anemia associated with chronic renal failure, but since the erythropoietin was a human based product many cats developed anti-bodies to the product which caused even worsening anemia.  Alternatives are currently being sought.