Feline chronic kidney disease: can we move from treatment to prevention?

Chronic kidney disease (CKD) is arguably the most common disease of older domestic cats. Recent research has focused on treatment options and prognostic variables. Specifically, the roles of dietary protein, hypertension and proteinuria as potential causes of a progressive decline in kidney function have been evaluated. The value of prescription kidney diets and the prognostic value of proteinuria have been confirmed. However, in contrast to dogs, rodents and people, significant proteinuria is uncommon in the cat and hypertension is not a prognostic indicator. Despite significant progress, the cause of CKD in the overwhelming majority of cats remains unknown and fundamental questions remain unanswered. Treatment of feline CKD is limited to non-specific options until some of the causes and pathophysiological mechanisms that result in chronic tubulointerstitial nephritis are identified.