But despite that grim picture, feline kidney failure is a treatable disease. And while many animal diseases can be treated if the owner has enough money and is willing to spend it, what's usually needed to treat feline kidney failure is not huge amounts of money, but the willingness and ability to give the cat that care at home.

"I've seen even very sick cats, cats who needed hospitalization in the beginning, do really well on home care with an owner who was willing to give it a try," said Dr. Patty Khuly, a Miami veterinarian and noted animal health blogger. "What makes the difference in how well a cat with kidney failure does is not how sick they are, or how bad their kidney values are on a blood test. It's the attitude of the owner."

The fear and insecurity many owners feel arise because advanced stages of the disease can require frequent medication and daily injections of subcutaneous fluids -- fluids administered with a needle under the skin of the cat. There aren't many cat owners who have confidence in their ability to hold a cat in place for several minutes, slip a needle under her skin and inject between 100 and 200 milliliters of fluid, every single day for the rest of the cat's life.

After all, most of us find just giving a cat a pill extremely daunting.

But those fluids are critical to a cat in kidney failure. To understand why, it's helpful to know just what happens when a cat's kidneys fail.

Kidney failure basics

The kidneys are made up of structural units called "nephrons," which filter toxins out of the bloodstream and flush them from the body with the urine. Every cat is born with far more nephrons than she'll need for a normal lifetime, but when disease, toxic exposures, drugs or other causes damage the kidneys, nephrons are destroyed.

The body has no ability to make new nephrons, and as more and more of them go offline, the kidneys' ability to filter toxins from the blood is diminished. Fewer nephrons are doing more work, and like a toilet being used more often than before, the flushing process requires more water all the time.

The kidneys start signaling to the cat to drink more water, which in turn leads to more urine. At this stage, very observant owners will sometimes catch the disease early, but these symptoms are easy to miss, particularly with indoor/outdoor cats or those who live in multi-cat households, where just who is drinking and urinating in what quantities isn't clear.

That fact is particularly unfortunate because this stage can persist for months or years, and can often be prolonged with nothing more than a specially formulated diet and regular check-ups at the vet to monitor the progress of the disease.

In later stages, however, affected cats start to suffer from loss of appetite, nausea, vomiting and weight loss. They can deteriorate rapidly, often sending their owners to the veterinarian in a panic with little hope that their pets can be saved. Simply giving the cat subcutaneous fluids to augment those she can drink on her own can add years to the life of a cat in kidney failure, so helping a cat owner overcome fear and uncertainty about the process can make a huge difference.

Getting through it, getting help

Dottie Zammetti, whose black cat, Munchkin, had recently been treated for cancer, feared the animal would not survive when chemotherapy drugs caused the cat's kidneys to fail.

"Munchkin went downhill very fast," Zammetti told me. "She needed intensive fluid therapy and drugs to lower her calcium levels, drugs for nausea and vomiting, and drugs to treat low red blood cells."

After Munchkin's veterinarian got her stabilized, the home care began. "I gave her subcutaneous fluids," Zammetti said. "It took a while for us to adjust to that process, but after around a week and a half, she just accepted it as part of our routine."

And as sick as Munchkin was at first, after two weeks of treatment, she settled into two years of feeling well.

Zammetti got help from an online support group for owners of cats in kidney failure. "They were a wealth of information," she said. "I found out where to get better needles that made administering the fluids much easier, and tips for making it less stressful on Munchkin, like giving her a treat after the fluids."

The group also steered Zammetti towards less expensive sources of necessary supplies, such as subcutaneous fluids.

"The people in the groups helped keep me going, because when I felt like I didn't see an end to it [the cat's illness], they would give me the helpful advice to get me through that rough period," she said.

Beyond home care

At the 2006 American Board of Veterinary Practitioner's Symposium, veterinary internal medicine specialist Dr. Alice Wolf told her audience that chronic, progressive kidney failure in cats "can be successfully managed for years if it is detected early and managed appropriately."

But at some point, those years are going to run out. What can you do then? And are there options beyond basic home care and veterinary monitoring that might give your cat an edge in fighting the disease?

There's no single big new therapy currently in use or even on the horizon. What is new is that many veterinarians are becoming more skilled at treating feline kidney failure, and they're using both new and old medications to manage symptoms and buy the cat more time.

"Nausea is a big problem in these cats, and a lot of people focus too much on the fluids and don't take on issues like the appetite," said Dr. Khuly. "There are many drugs that can treat nausea, control vomiting and stimulate the appetite."

There are drugs that can control other symptoms of kidney failure, including incorrect levels of calcium, phosphorus and potassium in the blood, low red blood cells and blood pressure problems, as well.

It's also possible to give a cat a kidney transplant, although the cost is exorbitant and it's the rare pet owner who will even consider it.

The cat must be in fairly good health to receive a kidney transplant, and so it's only worth considering in the early stages of disease. Additionally, all veterinary feline kidney transplant programs require the owner to adopt the donor cat, which means you come into the center with one cat and go home with two.

Nor is a transplant a panacea. Fewer than half the cats live another three years, and the cat will have to be on medication to prevent organ rejection, just like human transplant patients are.

For most cat owners, Khuly says, the takeaway message is that a diagnosis of kidney failure doesn't have to be a death sentence for your cat, and it isn't going to break the bank or require heroic measures.

"Many of these cats who are on the brink of death can be brought back with supportive care at home," she said. "Not only brought back for days or weeks or months, but years. You just don't know unless you try."

Additional resources on feline kidney failure

Feline kidney failure information

Feline Chronic Renal Failure support group

Feline Chronic Renal Failure Information Center

Tanya's Feline Chronic Renal Failure Information Centre