Thank you Antonia,
First, I appreciate your clarification of Opal's heart situation since it was quite unclear why a diuretic would even be a concern here. Since there is no underlying heart issues in her history, the use of diuretics is not something we'd need to worry about here at all. Instead, we can focus on the health issues at hand.
Now to start, we have to consider that we are likely looking at a range of interrelated issues relating to her kidneys. As kidney disease progresses, we will see a depression in kidney filtration. This translates to increased urinary dilution and thus volume -- which leads to an older cat suddenly having to go more often and accidents often result (since they aren’t used to having to go so frequently and old joints often aren’t keen to get up to do so more frequently). So, while we can see urinary accidents of the elderly cat for a range of reasons (ie arthritis, other organ or metabolic issues, bladder stones, bladder tumors, urinary sphincter troubles, etc), in Opal's case it is most likely to be related to those struggling kidneys.
Furthermore, as these kidneys struggle to filter, we will not just see more fluid loss
but also see an increase in the levels of toxins/metabolic wastes (ie urea, creatnine, phosphorus, etc) in her blood stream. As this happens, we will see these cats develop nausea, vomiting, and most commonly appetite loss related to uremic gastritis of the stomach and uremic oral ulcers. So, while dental disease and other health issues could play a role in her appetite decline, again in this situation this is highly likely to be a side effect of her kidney disease progressing.
Therefore, in this situation, we can see each of these signs related to the above issues. Still in Opal's situation, it is very likely that these signs are linked to her kidneys struggling. Therefore, it would be ideal to have a discussion with her vet about potentially starting further kidney support measures here. At the same time, they can examine her and just make sure that none of those other above mentioned concerns are also affecting her (and address them if they are). If those are clear, then her vet can dispense kidney supportive treatment like Semintra (More Info) or Fortekor. Both will help the kidneys filter better to reduce toxin build up in her blood (and thus address the trigger for her appetite loss) and aid fluid reuptake to normalize her urine output (to prevent dehydration but also likely settle her accidents). As well, depending on their exam findings and whether they recheck her blood values, phosphate bingers (ie Renalzin) may also be a good step for her. And if we are seeing appetite decline due to high urea levels affecting her stomach, then you may want your vet to trial her on an antacid or anti-nausea therapy (ie Cimedtidine, Pepcid (LINK) or Zantac (LINK)) to settle her stomach +/- kidney relief pain relief (ie Bupenorphine) if uremic ulcers are found.
Overall, feline urinary accidents at rest and appetite decline in the elderly cat can be triggered by a range of issues. Still with Opal's combination of signs, her age, and her known kidney struggles; we do have to be very suspicious that these signs are all related to this organ. Therefore, it would be best to have a wee check up with her vet (to rule out other concerns since there is no rule to say they can have one thing wrong at a time) and confirm if those kidneys are our culprit. And if they are as we suspect, then it would be worth considering kidney support medication to see if you can settle this for her to get her eating better and halting these accidents.
I hope this information is helpful.
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All the best,
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