Fighting Cat Kidney Disease With Surgery...

“More cats than ever lead longer, healthier lives after a kidney transplant”

by Arden Moore

Orange Julius, an orange-and-white tabby, has been beating the odds his whole life.

He barely survived his birth: OJ was the runt of a litter delivered by a stray that wandered into a San Antonio, Texas, backyard during a nasty thunderstorm in the spring of 1989. Animal lovers Nancy and Paul Norris rescued OJ and welcomed him into their home where dogs, frogs, a hamster and turtles resided, as well.

A year later, OJ licked antifreeze drippings of the garage floor. The ethylene glycol in the antifreeze caused rapid crystallization in his kidneys. Within 24 hours, the Norris' flew him to the University of California at Davis, the only place in the United States at the time where feline kidney transplants were performed. He was dangerously near death.

"This cat had been through a lot since birth and was very much part of our family. We couldn't just sit back and do nothing and let him die," Nancy Norris says.

Ten years later, OJ's playful and mellow manner belies his rough beginnings. At 11 years old and a solid 14 pounds, OJ has the distinction of being the country's longest-surviving feline kidney transplant patient.

"OJ is very friendly and very outgoing. When people come to our house, he walks right up to greet them. He loves for you to rub his stomach," Norris says. "We feel blessed to have him in our life."

When a Kidney Fails

Thanks to advances in anesthesiology, surgical procedures and medications, more and more cats facing acute or chronic kidney disease are living long, healthy lives after a transplant.

In cats — as well as people — the pair of kidneys works as the body's filters to cleanse the blood of waste products. They take in blood, filter it and produce urine for excretion. They also help regulate blood pressure and calcium in the body. When the kidney's fail, toxins are released in the body, and if untreated, death occurs.

Veterinarians and researchers still do not know definitely what causes kidney problems in cats. But they have identified certain environmental factors that can cause kidney damage, even death to your cat: antifreeze, windshield wiper fluid, Easter lilies, tiger lilies, stargazer lilies and day lilies.

If your cat is diagnosed with kidney damage, your veterinarian's first course of action is to prescribe medications and administer fluids to restore hydration, electrolyte balance and acid-base balance.

A dialysis, to filter toxins from the failing kidneys, can also be performed at a university, but this only prolongs a cat's life. Dialysis can improve a cat's survival rate while waiting for a kidney transplant. And in fact, it is common for cats to undergo three or four such treatments prior to the surgery. A kidney transplant is the only way to save your cat from acute or chronic renal failure.

Even older cats (8 and up) are good transplant candidates if they don't have any other medical problem such as diabetes or a heart condition. The oldest cat given a transplant by Dr. Aronson was 15 years old; for Dr. Gregory, it was a 16-year-old cat.

Surgery Saves Lives

At least nine veterinary hospitals and centers in the United States have surgeons capable of performing this delicate operation. "In the beginning, the success rate was about 65 percent survival after the first year, but now, we're up to about 90 percent," says Clare Gregory, DVM, a pioneer in feline transplantation surgeries and a professor or surgery and radiological sciences at the University of California at Davis. He led the surgical team that performed the kidney transplant on OJ.

A kidney transplant is an expensive, last-resort effort to save a cat's life. Typically, the procedure requires four hours of surgery and costs between $4,000 and $5,000. Owners must agree to adopt the donor cat, which is a healthy but homeless cat from the local animal shelter or veterinary hospital.

"Essentially, you get the chance to save not one, but two cats' lives," says Lillian Aronson, DVM, who trained with Dr. Gregory at UC Davis and now directs the kidney transplant program at the University of Pennsylvania's College of Veterinary Medicine in Philadelphia.

A healthy kidney is removed from the donor cat and transplanted to the recipient cat within one hour to minimize the time the organ is without a blood supply. During this microsurgical procedure, the ureter from the donor kidney is connected to the recipient's bladder and the new kidney is attached to the recipient's blood vessels.

The surprising news for many cat owners is the failing kidneys remain in the sick cat. The new kidney is simply situated in the lower abdomen next to the bladder.

The recipient cat lives with three kidneys, the donor cat with one.
"I tell my patients that it's the same number of kidneys per household, just redistributed," Dr. Aronson says.

Actually, the two original kidneys — though weak — are vital to a cat's chance for survival. "Sometimes, the new kidney doesn't work right away and we need the older kidneys, which are still functioning to some degree," Dr. Aronson says. "We only go back in at a later time to remove the native kidneys if they've developed infection or tumors, but that's rare. There is plenty of room in the abdomen for three kidneys in a cat."

Future Research and Hope

After spending more than a decade perfecting kidney transplant, Dr. Gregory and his UC Davis colleagues are ready to tackle the bigger challenge; pinpointing the cause behind this sneaky disease in an effort to find a cure. They are currently raising money in hope of opening the nation's first dialysis/transplantation center. They hope to achieve this goal by late next year. Researchers there would study and treat renal failure in companion animals.

"We are doing more transplants than ever, but we still don't know most of the time what's causing the renal failure, other than acute cases like antifreeze ingestion. It's like looking at a barn after it's burned down and not knowing if lightning or someone with a match started the fire," Dr. Gregory says.
"We can save many more animals' lives if we have the support to research possible dietary and genetic influences behind the disease," Dr. Gregory says.
The success of publicized kidney transplants reassured Susie Lorden of Sacramento, Calif., her 9-year-old black cat would survive a transplant operation. Adopted as a stray kitten when it darted under her moving car, Damian was an adventure-seeker who loved care rides and taking evening neighborhood strolls on a leash with Lorden. When she noticed Damian excessively lapping up bowls of water, Lorden took him to his veterinarian who delivered shocking news: kidney failure.

"The vet basically told meall I could do was give Damian fluids, low-protein foods and make him comfortable, but that hew was going to die — and die soon," Lorden says.

But Lorden did some research and discovered a Web site called the Feline CRF Information Center, which alerted her to the veterinary clinics in the country at which kidney transplants were performed. She immediately dialed UC Davis and made an appointment for Damian.

The surgery was successful. Today, Damian again strolls in the neighborhood (albeit now leashed in a baby stroller), begs for cat treats and tolerates Nike, his donor cat housemate. Although Damian must take immune and antirejection drugs daily, he's gained back the 5 pounds he lost when first diagnosed with kidney failure.

"He's back to his wonderful old self," Lorden says. "Looking at him now, you'd never realize how bad off he was."

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