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Kidney Disease

 

 

 

 

When we talk about kidney disease in the dog or cat we could be referring to many things.  Some dogs develop acute (sudden onset) kidney failure like people often do.  When we see acute kidney failure in dogs and cats it is almost always due to a toxin like antifreeze poisoning.  What we usually deal with in animals, however, is what we call “chronic (long term) renal (kidney) failure”.  This can be secondary to acute renal failure, infections, or toxins, but is usually an age related degenerative problem in which the kidneys quit functioning well.  In fact, we often never know for sure what the underlying initiating cause of chronic renal failure was in an individual case.  In this article we will deal primarily with chronic renal failure, since this is what we  see 95% of the time.

 

It is interesting that we have an excess of kidney tissue in our body.  That is why we can give away a kidney to someone and not miss it.  It is no different in dogs and cats.  In fact, you have to get down to the point where 2/3 (66%) of the kidney tissue is non-functional before you get any symptoms at all!  In chronic renal failure you have two main problems that cause symptoms:

 

1)      Water consumption/urine production:  When most people think of kidney “failure” they think of the kidneys shutting down and not producing urine.  However, in chronic renal failure, just the opposite occurs.  When 66% of the kidney tissue is functionally gone, the remaining kidney tissue cannot conserve water.  So, your pet begins to produce large volumes of dilute urine.  This in turn results in a large increase in water consumption.  In fact, this is why most kidney failure patients are presented to us – the owner notices this increase in thirst and urine production.

 

2)      Toxin build-up in the blood:  Once the kidney tissue is 75% gone, the kidneys lose the ability to adequately filter the blood.  Because of that, toxins that are normally eliminated in the urine begin to build up in the blood.  These toxins are mainly the by-products of protein digestion and high levels of these toxins will cause your pet to feel bad, lose their appetite and develop gastrointestinal signs such as vomiting and diarrhea.

 

When your pet develops chronic renal failure you need to understand that it is NOT CUREABLE – in other words, we cannot fix the problem.  However, we can do much to relieve the symptoms and give your pet a good quality of life for some time.  Diagnosis and treatment consists of the following:

 

When we initially diagnose chronic renal failure in dogs or cats it is CRITICAL that we do a thorough workup to assess the situation.  We need to do a urinalysis, blood work, urine culture, and other testing such as blood pressure measurement to make SURE that we indeed to have chronic renal failure.  This is VERY IMPORTANT since there a some diseases that look very similar to this problem yet are much more easily treated and carry a much better long term prognosis.  Once the diagnosis of chronic renal failure is made we use several things in treatment which may include the following:

  • Fluid therapy:  Since chronic renal failure animals cannot conserve water with their kidneys they will produce a lot of urine no matter how much they drink.  Therefore, if they quit drinking for any reason they can quickly dehydrate, which causes the toxin levels in their blood to shoot up very high.  When a pet comes in with chronic renal failure and is dehydrated it is imperative that we place them on IV fluids for a period of time.  This will rehydrate them, and flush the toxins out of their blood.  If we don’t do this, we will have no chance of getting your pet back on their feet.  Once hydration returns to normal, most pets will begin drinking enough to remain hydrated on their own.  We do have the ability in cats to place an indwelling catheter under their skin over the back that can be used by the owner at home to administer fluids on a regular basis when needed.  This has been helpful in many animals and allows many more months of life in severely affected animals.  It is important that you encourage your pet to drink lots of water with this disease and never leave them long periods without water.  If they quit drinking, remember, they will dehydrate quickly and we should see them as soon as possible. 
  • Diet change:  It is critical that we change your pet to a low but high quality protein diet such as NF or KD.  We have these diets available and they come either canned or dry.  These diets produce much fewer of the toxins that build up with kidney failure.  Since these toxins are responsible for the illness, lethargy, and GI signs that accompany chronic renal failure, the diet change is one of the most critical things to implement in these patients.  Studies have shown that animals with chronic renal failure can live 3 times longer if fed the proper diet compared to staying on regular dog or cat food.
  • Medication:  We start most animals with chronic renal failure on various medications.  They may include:
    • Rocotrol:  This drug blocks the production of a hormone that elevates in kidney disease.  The elevated hormone causes changes that are detrimental to your pet.  By using this product daily on the food, we can greatly slow the progression of kidney disease.
    • Cimetidine:  One of the side effects of toxin buildup in the blood in animals with kidney disease is the development of tiny stomach ulcers.  This is responsible for many of the intestinal signs (vomiting/diarrhea) that can develop with kidney failure.  Use of cimetidine to block the development of these ulcers is very beneficial. 
    • Potassium:  Cats with kidney disease often develop very low levels of potassium in their bodies.  This results in weakness, lack of appetite, and a general sick feeling.  By supplementing potassium we can greatly improve the quality of life for any cat with kidney disease.  Unfortunately, potassium is very unpalatable for most cats.  The good news is that it is available in a chewable liver flavored tablet that most cats eat – or at least will eat crumbled up on their food.
    • Antibiotics:  We routinely culture the urine in pets with chronic renal disease.  Infection, which is common, is treated with antibiotics when needed. 
    • Blood pressure medication:  This is especially important in cats, which commonly develop dangerously high blood pressure secondary to kidney disease.  However, dogs can have blood pressure problems as well.  We recommend any animal that has chronic renal failure have its blood pressure checked.  If elevated, we need to implement medication to reduce the blood pressure to a low and safe level. High blood pressure – left untreated – causes the kidney failure to progress to death much quicker than it would if we kept it under control. 
    • Phosphorus binders: After we have the correct diet in place and other medications such as rocotrol on board, some dogs or cats still develop have too much phosphorus in their blood.  In these animals we need to use medication to get the level down if at all possible. 
    • Medication for anemia:  Since the kidney produces a hormone that stimulates the bone marrow to make blood, some dogs and cats with chronic renal failure become anemic.  When this becomes an issue we do have options for stimulating the bone marrow.
    • Medication to control acid/base levels:  Many cats and dogs have blood that is too acidic – even on the correct diet.  This leads to many other problems and should be controlled.  If we discover this on monitoring blood work once your pet is stabilized on diet, etc., we will consider treatment to correct it.
  • Monitoring:  It is critical to monitor your pet’s progress with blood work on a regular basis.  We will recommend basic kidney rechecks every 3 months.  We will get an accurate body weight, do a thorough physical exam and check the blood for those things that show us the status of the kidney disease.  We may also check the blood pressure.  Cost for these procedures is $60 - $100 dollars plus any medications that are needed.    This will allow us to make necessary changes to prolong and improve the quality of your pet’s life.

 

In short, chronic renal disease is often treatable by various modes.  If you feed the proper diet, watch hydration level, and use the drugs that are needed to maintain health, your pet can live a quality life for a long time after diagnosis. 

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