Kidney Failure in Dogs
Dr Amit Bhardwaj,Veterinary surgeon, Goa.
Even though dogs are a different species, their bodies function very similarly to human bodies. Dogs have kidneys to balance nutrients in their bodies and filter out waste. The kidneys have many functions. They principally act to remove waste products from the blood stream, regulate the levels of certain essential minerals such potassium and sodium, conserve water, and produce urine.
Kidneys also help control blood pressure, increase red blood cell production, and help calcium metabolize.If kidney function is impaired, it can cause a domino effect of health problems for your pet. Know the signs of kidney disease in dogs and what you can do to prevent and treat their condition.
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Causes of Kidney Failure in Dogs
Kidney problems in dogs can be acute or chronic. Acute kidney failure happens quickly over several days, while chronic kidney failure happens slowly over time. Many people think that ‘chronic kidney failure’ or ‘chronic renal failure’ means that the kidneys have stopped working and are not making urine. This is not the case. By definition, chronic renal failure (CRF), or chronic kidney disease (CKD) is the inability of the kidneys to efficiently filter the blood of waste products, not the inability to produce urine. Ironically, most dogs in kidney failure produce large quantities of urine, but the body’s toxic wastes are not being effectively eliminated.
Types
There are two types of kidney disease:
- Acute
- This is sudden onset renal failure
- With prompt treatment, the failure can be resolved before it becomes long term
- Recovery depends upon how much damage was done to the kidneys
- If left untreated, acute kidney disease can quickly become fatal
- Chronic
- This is the most common disease in older dogs
- Unfortunately, by the time your pet shows symptoms, the damage is often irreversible
- Early management can slow the progression
- Upon diagnosis, chronic kidney disease will be classified as stage I through IV
Causes of Acute Kidney Failure
Acute kidney problems are most frequently attributed to your dog ingesting a toxin. It may be a chemical like antifreeze, household cleaners, or bad food.
Problems also occur due to a urinary obstruction in your pet’s body. When blood flow decreases, it leaves your dog’s kidneys less oxygenated and more prone to infection.
Kidney issues may also result from:
- Severe dehydration
- Heat strokes
- Snake Bites
- Leptospirosis (a bacterial infection)
Causes of Chronic Kidney Failure
Chronic kidney disease is most common in older dogs, and the exact cause is often difficult to pinpoint because of its slow onset. Early symptoms of chronic kidney disease are easily overlooked or dismissed because they are mild in nature.
Dental disease is a leading cause of chronic kidney failure in older dogs. Bacteria build up on your dog’s teeth and enter the digestive system when eating and drinking. While your dog’s kidneys are designed to filter waste, bacteria can lessen kidney function over time.
Common causes of kidney failure in Dogs
Any disease that impacts the kidneys may cause the kidneys to fail, such as:
Congenital Disease: This category is comprised of hereditary conditions and underlying illnesses – everything from cysts to agenesis (being born missing one or both kidneys).
Dental Disease: Advanced dental disease can result from the buildup of bacteria on teeth and gums. The bacteria accumulates here, then enters the bloodstream to attack multiple organs, causing irreversible damage to kidneys, along with the liver and heart.
Bacterial Infections: Drinking or swimming in contaminated water is a hazard, as the system becomes susceptible to bacterial infections including leptospirosis. This can result in inflamed kidneys and renal cells being killed.
Toxicosis: If the kidneys are poisoned, this can cause cells within the kidneys to become damaged. This can happen if your dog consumes drugs or poisons (including substances or foods that are toxic to them).
Geriatric Degeneration: Cells within the kidneys may break down and die as your dog ages, which can lead to kidney disease.
Symptoms of kidney failure
- Significant weight loss
- Vomiting
- Pale gums
- Drunken behavior or uncoordinated movement such as stumbling
- Breath that smells like chemicals
- Significant decrease in appetite
- Increase or decrease in water consumption
- Increase or decrease in volume of urine
- Ulcers in the mouth
- Blood in urine
- Lethargy
- Intestinal seizures
How Can Kidney Failure Be Prevented?
Kidney disease doesn’t have to be a problem for your dog. Keep your dog safe by taking preventative measures to ensure they don’t have access to household chemicals and cleaners.It is important to keep in mind that dogs are chewers by nature, so keeping chemicals in a closed cabinet isn’t enough. You may also have false assurance that “child-proof” seals will keep your dog safe, but they won’t. Dogs can easily chew through plastic bottles and drink dangerous chemicals. Make sure bottles are kept in locked cabinets or up high where dogs cannot reach them.
Avoid Exposure to Medications and Other Harmful Substances
In addition to keeping your dog away from dangerous household cleaners and chemicals, it may also be important to avoid having your pet near medications, food, and other substances.
These could include:
- Raisins
- Prescription and over-the-counter drugs, like ibuprofen
- Grapes
- Contaminated water sources
Dental Hygiene
Since chronic kidney disease can occur from poor dental hygiene, keeping your dog’s teeth clean is crucial for long-term health. Talk to your vet about how often you should have your dog’s teeth cleaned and ask about food and treats that may help with dental hygiene in dogs.
How Is Kidney Disease Treated?
The treatment of chronic kidney disease depends on the results of blood tests, and specific treatments are aimed at resolving specific abnormalities. In some cases, the kidneys are damaged beyond repair before diagnosis and medical treatment is ineffective. However, with early diagnosis and aggressive treatment, many dogs will live a normal lifestyle for many months or years.
Treatment usually occurs in two phases, first flushing the kidneys and removing the accumulated toxins from the blood, and then providing treatments to manage the disease and delay its progression.
What is involved in the first phase of treatment?
In the first phase, high doses of intravenous fluids are given to ‘flush out’ the kidneys and bloodstream. This flushing process is called diuresis and helps mildly damaged kidney cells to function again by removing the toxic metabolites and creating a healthier environment for healing.
If enough functional kidney cells remain, they may be able to adequately meet the body’s needs for filtration and waste removal. Fluid therapy includes replacement of various electrolytes, especially potassium. Other important aspects of initial treatment include proper nutrition and medication to control vomiting and diarrhea if present. Your dog will often begin to feel better soon after this stage of treatment is begun.
What can I expect from this first phase of treatment?
There are three possible outcomes from the first phase of treatment:
- The kidneys will resume functioning and continue to function for a few weeks to a few years.
- The kidneys will resume functioning during treatment but fail again as soon as treatment stops, usually within three to fourteen days.
- Kidney function will not return.
Unfortunately, there are no reliable tests that will predict the outcome. Each case should be treated aggressively and monitored closely. Even dogs that have severe kidney failure may respond favorably to treatment and resume a normal quality of life after treatment.
If the first phase of treatment is successful, what happens next?
The second phase of treatment is to help keep the kidneys functioning as long and normally as possible. This is usually accomplished with one or more of the following, depending on your pet’s condition:
A special diet – Nutrition is one of the cornerstones in the effective treatment of dogs with chronic kidney failure. The ideal diet for a dog in the advanced stages of kidney failure is lower in protein, low in phosphorus, and is not acidified. This type of diet helps reduce the amount of protein wastes or metabolic toxins that may make your pet feel sick and lethargic. In advanced kidney disease, a decreased protein diet will also decrease the workload on the kidneys.
Nutritionists have developed commercial therapeutic diets that are designed for treating various stages of chronic kidney disease. Your veterinarian will recommend the most appropriate diet, containing the necessary quantity and quality of nutrients for your dog.
A phosphate binder – Phosphorus is removed from the body by the kidneys. Once the filtration process is impaired, phosphorous begins to accumulate in the blood. Elevated blood phosphorus levels also contribute to lethargy and poor appetite. Certain drugs will bind excess phosphates in the intestinal tract so they are not absorbed into the bloodstream, resulting in lower blood levels of phosphorus.
Home fluid therapy – Once your dog is stabilized, you can give maintenance levels of fluids under the skin (subcutaneously) to your dog at home. This serves to prevent dehydration, helps continually flush toxins from the kidneys and provides additional levels of electrolytes. This is done from twice daily to once weekly, depending on the degree of your dog’s kidney failure. Most dogs do best when they receive a small amount of fluids on a daily basis. Once the dog becomes stable, the frequency of treatment may be decreased. Although home fluid therapy might not sound like something you can do, you will be surprised at how easy the technique is and how well most dogs tolerate it. For detailed instructions on this procedure, see handout “Subcutaneous Fluid Administration in Dogs”.
Therapy for protein in the urine (proteinuria) – Dogs with protein in the urine have increased risk of progression of CKD. Angiotensin converting enzyme inhibitors (blood pressure medications) will help to lower pressure in the kidneys, therefore lessening the degree of proteinuria.
A drug to regulate the parathyroid gland and calcium levels – Calcium and phosphorus must remain at about a two-to-one (2:1) ratio in the blood. The increase in blood phosphorus level secondary to kidney failure stimulates the parathyroid gland to increase the blood calcium level by removing it from bones. This can be helpful for the sake of the normalizing calcium to phosphorus ratio, but it can make the bones brittle and easily broken. Calcitriol can be used to reduce the function of the parathyroid gland and to increase calcium absorption from the intestinal tract. This medication is needed if there is evidence of abnormal function of the parathyroid gland.
A drug to stimulate the bone marrow to produce new red blood cells – The kidneys produce a hormone (erythropoietin) that stimulates the bone marrow to make red blood cells. Therefore, many dogs in kidney failure will be unable to produce erythropoietin and have anemia or a low red blood cell count. Synthetic erythropoietin may stimulate the bone marrow to make red blood cells and correct the anemia in most dogs. Unfortunately for some dogs, the drug cannot be used long term because the immune system recognizes the drug as ’foreign’ and will make antibodies against it. This treatment may be recommended if your dog has persistent anemia.
While damage from acute kidney problems is more easily treated, damage to your dog’s organs from chronic kidney disease is irreversible unless caught early. Since some damage is irreversible, preventative measures listed above are essential for your dog.If kidney disease or kidney failure is diagnosed in your dog, treatment will depend on the severity of his condition. Your vet will begin by addressing issues related to underlying conditions like chemical poisoning, dehydration, or infection.
Your dog’s treatment plan may also include:
- Medicines that encourage production of urine
- Fluid therapy via an IV
- Addition of electrolytes to balance out blood levels
- Medicine to reduce vomiting
- Medication to ease gastrointestinal problems
- Dialysis
- Recommendations for changes in diet
- Medicine for anemia
- Management of blood pressure
What Foods are Good for Dogs With Kidney Disease?
While you may be tempted to create a DIY home-cooked diet for your dog, that may not be best. Dog food has the correct balance of nutrients your dog needs to stay healthy. You may be tempted to feed your dog from your plate, but some foods can hurt your dog and/or contribute to kidney issues, like:
- Alcohol
- Chocolate, coffee, and caffeine
- Coconut
- Grapes and raisins
- Macadamia and other nuts
- Milk and dairy
- Onions, garlic, chives
- Raw or undercooked meat and eggs
- Salty/processed snack foods
- Xylitol
- Yeast dough
What Happens if Kidney Disease Goes Untreated?
Kidney problems in dogs that go untreated can be life-threatening. If you suspect your dog has kidney failure, don’t try to self-diagnose and treat the condition at home.
Kidney problems often lead to life-threatening conditions that require immediate hospitalization and treatment. If left untreated, end-stage kidney failure may occur, leading to a fatal outcome.
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