What to Ask, What to Test, and What to Know After a Diagnosis
A diagnosis of kidney disease can feel overwhelming for cat parents. Often, the conversation quickly turns to prescription diets, fluids, and lab numbers – without much explanation of what those numbers truly mean or what other options may exist.
Integrative veterinarian Dr. Randy Aronson encourages a more complete, thoughtful approach to kidney disease in cats – one that focuses on early detection, inflammation, nutrition, and long-term monitoring, not just managing lab values.
This guide outlines what cat parents should understand, ask for, and track after a kidney disease diagnosis.
Step 1: Understand the Tests That Matter
Kidney disease should never be evaluated with bloodwork alone.
Key blood markers (general reference ranges may vary by lab):
- Creatinine: ~0.8–2.4 mg/dL
- BUN (Blood Urea Nitrogen): ~16–36 mg/dL
- SDMA: <14 µg/dL
While these values are important, Dr. Randy emphasizes that trends over time matter more than a single number. A gradual rise – even within the “normal” range – can signal early kidney stress.
Why Urinalysis Is Essential
One of the most common gaps Dr. Randy sees is kidney disease being discussed without a urinalysis.
Urinalysis provides information bloodwork alone cannot.
Key urine markers to ask about:
- Urine Specific Gravity (USG):
- Normal: >1.035
- Decreased concentration: <1.020
This shows how well the kidneys are concentrating urine.
- Urine Protein-to-Creatinine Ratio (UPC):
- Normal: <0.2
- Borderline: 0.2–0.4
- Concerning: >0.4
Protein loss through urine can accelerate kidney damage.
- Urine sediment or culture:
Urinary tract infections are common in kidney cats and can worsen disease if missed.
Two cats with the same creatinine level may be in very different stages of kidney disease depending on what their urine shows.
Step 2: Rethinking Prescription Kidney Diets
Dr. Randy does not routinely recommend prescription kidney diets.
His reasoning is straightforward: read the ingredient label.
Many prescription diets rely heavily on corn, wheat, or other highly processed carbohydrates. He believes kidney disease is closely tied to chronic inflammation, and highly processed, carbohydrate-heavy diets may contribute to that burden.
Rather than feeding to lab numbers alone, he focuses on reducing inflammation while supporting real nutrition.
Step 3: Protein Isn’t the Enemy – Nitrogen Is
A common message cat parents hear is that protein must be drastically restricted.
Dr. Randy reframes this idea. Cats need protein. The challenge is managing nitrogen waste, a byproduct of protein metabolism.
To support kidney cats while maintaining nutrition, he uses targeted tools based on lab trends and disease stage:
Support options he uses:
- Porus One or Azodyl
Used when creatinine, BUN, or SDMA begin trending upward to help bind nitrogen waste in the gut. - AminAvast
Used to support kidney blood flow and filtration (glomerular filtration rate). - Phosphorus binders (such as Naraquin)
Added when phosphorus begins to rise or as disease progresses, helping reduce nausea, appetite loss, and kidney stress.
This approach allows many cats – especially in early to mid-stage kidney disease – to continue eating more biologically appropriate diets while reducing metabolic strain.
Step 4: Monitor Trends and Adjust Over Time
Kidney disease is not static.
Dr. Randy recommends:
- Bloodwork and urinalysis every six months
- Watching directional trends, not just cutoffs
- Adjusting nutrition and support as the cat’s condition evolves
A slow upward creep in values often matters more than a single “high” result.
The Takeaway for Cat Parents
A kidney disease diagnosis does not mean there’s nothing else you can do.
It means it’s time to:
- Ask for complete testing
- Understand what lab values truly represent
- Read ingredient labels critically
- Focus on inflammation and whole-body support
With informed testing, thoughtful nutrition, and ongoing monitoring, many cats with kidney disease can maintain comfort, vitality, and quality of life far longer than expected.
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