Kidney failure cat

Question
Hi Dr. Gifford,

I have a twelve year old cat who last November was diagnosed in "severe, significant" kidney failure but with sub-q fluids and a special diet (including potassium powder in his food) he has done quite well.  He has recently started drooling and pawing at his mouth and, while I can't see any, I assume there are sores in his mouth.  He is otherwise healthy and eating just fine.  Are these sores ever treated, say with steroids and/or antibiotics, or is this the end for him?  I hate to put him to sleep while he still seems to have so much life in him and I'm willing to try to keep him happy and healthy for a while longer.

Answer
When cats are suffering from kidney failure they develop uremia or a build up of toxins that would otherwise be excreted in the urine if kidneys were functioning properly. This uremia can cause oral ulcerations to develop which are quite painful. My concern is that if these sores are developing, the kidney failure may not be as well controlled as we would hope. What are your kitty's current kidney blood values? Particularly BUN, Creat, Phosphorus and Potassium? How much SQ fluids are you giving daily? Has your kitty had his blood pressure checked?

Improving his uremia by increasing his fluids may help the oral ulcers resolve faster. Also, antibiotics will help. Lastly, make sure it is not actually a tooth abscess or oral tumor that is causing the discomfort. Have your vet check his mouth to make sure we know what we are treating.

Dr. G.