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further info from Cornell U.

Chronic Kidney Disease

Chronic kidney disease, or CKD, is one of the most prevalent diseases in older cats, affecting up to 40% of cats over the age of 10 and 80% of cats over the age of 15. Healthy kidneys perform many functions in the cat, including filtering the blood, making urine, and helping to regulate blood pressure. CKD refers to the persistent loss of kidney function over time and can have many health consequences. The only known risk factor for the development of CKD in cats is age, so it is very important for all senior cats to be regularly monitored for this disease.

Diagnosis
To evaluate kidney function, veterinarians will most often turn to blood tests and urine analysis (urinalysis) to evaluate the concentrations of waste products and other components that healthy kidneys normally filter or regulate. It is important to note, however, that there is no single test that can give a veterinarian a complete picture of kidney function and prognosis.

Blood tests can determine the concentration of three important waste products normally filtered by the kidneys: blood urea nitrogen (BUN), creatinine, and symmetric dimethyl arginine (SDMA). Azotemia, or an increase in the concentration of these compounds in your cat’s blood, may suggest that his kidneys are not functioning properly, but these values must be interpreted in light of a number of factors. Creatinine has historically been recognized as the most specific indicator of kidney function, but this test has some limitations. Dehydration, for example, can cause BUN and creatinine concentrations to increase in spite of the fact that a cat’s kidneys are functioning normally. Muscle mass also affects creatinine concentrations, so a very thin cat may have normal blood creatinine levels despite decreased kidney function. SDMA concentrations are less affected by dehydration and muscle mass and also rise earlier in the progression of CKD. Creatinine concentrations in the blood do not generally rise until a cat has lost almost 75% of their renal function, while SDMA elevations are detectable when about 40% of kidney function is lost, potentially allowing CKD to be diagnosed sooner.

In a urinalysis, your veterinarian will consider the concentration of the urine (urine specific gravity, or USG), its pH, and the presence of blood cells, bacteria, and other cells that generally should not be found in feline urine, all of which provide important information regarding the health of a cat’s kidneys. A low urine specific gravity, indicating poorly concentrated urine, can be one of the earliest indicators of CKD in the cat, but this will be falsely decreased in a cat who recently received fluids. Urine protein/creatinine ratio, or UPC ratio, tests for protein loss through the kidneys and can be very important in determining the severity of disease. It is also important to culture a urine sample to rule out the possibility of bacterial infection of the urinary tract in suspected cases of CKD. Urine samples may be obtained either by collection from a litter box filled with non-absorbent beads designed for this purpose, by catheterization of the urethra (the opening of the urinary tract to the outside world), or by cystocentesis, a technique that extracts a urine sample by passing a very fine needle through the abdominal wall into the bladder. Cystocentesis is generally considered a safe procedure, and in most cases will provide the most diagnostically useful sample for analysis.

Ideally, a veterinarian will base their interpretation of kidney function on at least two blood and urine samples, obtained within two weeks of one another, from a stable, well-hydrated cat. The concentrations of other blood components, including various electrolytes (like sodium and potassium), phosphorus, red blood cells, and proteins are also important to evaluate in a cat being examined for CKD. Other studies that can be useful in evaluating a cat with suspected CKD include imaging studies such as abdominal ultrasound, radiographs (X-rays), and, in some cases, microscopic evaluation of biopsy samples. Approximately 60% of cats with CKD will also develop hypertension, so measurement of a cat’s blood pressure is an important part of the medical evaluation for this disease.

https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/chronic-kidney-disease