KIDNEY/RENAL PROBLEMS IN DOGS: CARE & MANAGEMENT

KIDNEY/RENAL PROBLEMS IN DOGS: CARE & MANAGEMENT

Dr.Santosh Giri,V.O, AHD, GHAZIPUR,UP

 

Kidneys are very busy organs that have lots of responsibilities to keep your dog healthy, from removing toxins to maintaining their blood pressure and helping to create new red blood cells.

Just like human kidneys, your dog’s kidneys balance certain substances in the blood and filter out the body’s wastes as urine. They maintain normal concentrations of salt and water in the body. Kidneys also help control blood pressure, aid in calcium metabolism and sustain phosphorous levels. Additionally, they manufacture a hormone that encourages red-blood cell production. When kidneys don’t function properly, toxins build up in the blood and a dog will become ill.

How the kidneys function————-

When the body uses nutrients from food to produce energy, it also produces waste products. Blood containing these waste products, as well as water and minerals, flows to the kidney to be removed in the urine.

An important role of the kidney is to remove excess phosphorus from the blood. In the kidney, the blood is transported down a series of tubules called nephrons, where some of the water, and any useful nutrients, are re-absorbed from the tubules back into the bloodstream. The urine formed is then stored in the bladder until the dog urinates, when it flows to the outside through the urethra.

The proteins your dog eats as part of his diet are broken down into smaller units called amino acids, which are used by the body for growth, replacement of old cells, and regulation of body functions. In effect, they are the building blocks of protein. There are 20 different amino acids that can be re-assembled by the body into, for example, hormones, muscle tissue, and cell wall components. Amino acids that aren’t needed are converted into urea, a waste product excreted by the kidneys in the dog’s urine.

The kidney also plays a critical role in maintaining water balance and hydration in the body, by regulating the amount of water re-absorbed in the kidney tubules.

Chronic kidney disease is defined as kidney disease that has been present for months to years. Chronic renal disease (CRD), chronic renal failure (CRF), and chronic renal insufficiency refer to the same condition.

 

Identifying Kidney Failure in Dogs—-

 

Kidney failure (also known as renal failure) is the end result of any one of a large number of diseases that can affect the kidneys and related organs. Technically, it occurs when the kidneys can no longer efficiently perform their function, which is to filter out toxins, maintain a normal electrolyte balance, regulate hydration, and secrete hormones needed for the production of red blood cells.

There are two broad types of kidney failure in dogs:

• Acute renal failure:When kidney function suddenly declines (in hours or days), the process is referred to as acute. Acute renal failure in dogs is most commonly associated with infections and toxins.
• Chronic renal failure:When the loss of function is more gradual (over weeks, months or years), it’s called chronic renal failure. The most common cause of chronic renal failure in dogs is degeneration associated with geriatric decline. All kidneys have their own natural lifespan, but some dogs’ kidneys deteriorate more quickly than others.

One of the most notable differences between acute and chronic kidney failure is that acute kidney failure is reversible if treated early and aggressively, whereas chronic kidney failure can only be managed.

 Diagnosing kidney disease in dogs

When diagnosing kidney disease in dogs, your vet will start by testing a sample of pee to see if your dog’s urine is being concentrated, whether protein is being lost in their urine and if they have any other problems, like an underlying infection. They might also take a blood test to check for specific kidney function, to get an idea of your dog’s overall health and to see if the build-up of toxins has affected any of their other organs.

 

Diagnostic Tests

Abnormalities that are often seen on diagnostic blood and urine tests include:

• anemia without signs of a response by the body to the low blood count (non regenerative anemia)
• increased wastes that are normally removed by the kidneys (blood urea nitrogen [BUN] and creatinine)
• increased phosphorus
• calcium is often normal but can be elevated in some pets with CKD and rarely is decreased
• dilute urine
• +/- protein or bacteria in the urine

 

The Causes of Kidney Failure

Kidney failure is ultimately caused by any disease affecting the kidneys. These include:

• Bacterial infections, like leptospirosis, which the Centers for Disease Control and Preventionreports can be transmitted by drinking or swimming in contaminated water. This infection can lead to inflammation of the kidneys and consequent destruction of renal cells.
• Toxicosis,or kidney poisoning, leads to damage of the kidneys’ cells. It occurs when your dog ingests drugs (like ibuprofen) or poisons (like antifreeze or grapes).
• Congenital disease: Inherited conditions can lead to abnormal kidney function.
• Geriatric degeneration:When kidneys get old, their cells can decline and die. This is, by far, the most common cause of kidney disease in dogs.

 

Symptoms of Kidney Failure

The most common signs of kidney failure in dogs include:

 

• Change in water consumption
• Change in volume of urine produced
• Depressionand listlessness
• Loss or decreased appetite
• Chemical odor of breath
• Vomiting
• Weight loss
• Blood in urine
• Mouth ulcers
• Pale gums
• Stumbling, acting drunk

 

The severity of clinical signs associated with kidney disease can vary depending on the presentation (acute or chronic), the extent to which the loss of kidney function has progressed and the underlying cause. only vet can determine whether these signs point to a kidney problem or another issue, like diabetes mellitus.

Treating Kidney Failure in Dogs——-

 

It is important to identify kidney failure and begin treatment in its earliest stage. Your veterinarian can determine if kidney disease is present and start appropriate treatment. Depending on whether the problem is acute or chronic, treatment may include the following:

 

• Drugs that encourage urine production
• Fluid therapy
• Management of blood electrolyte abnormalities
• Monitoring of urinary output
• Control of vomiting
• Medication for gastrointestinal problems
• Dialysis
• Dietary management
• Correction of anemia
• Management of high blood pressure
• Therapy for any specific underlying causes identified (example: antifreeze toxicity, infection)

 

The treatment of kidney failure varies depending on the underlying cause and the canine patient’s overall condition. Dogs that are severely ill from acute kidney failure may need hospitalization and intensive care to recover. For milder cases, antibiotics, fluids, and other medications given on an outpatient basis can prove effective. Dialysis is even a possibility for a lucky few whose pet parents can afford the high cost of treatment.

In the case of chronic renal failure in dogs, treatment generally focuses on slowing the progression of disease and improving quality of life for the patient. Treatment of anemia, blood pressure alterations, electrolyte disturbances, fluid imbalances, nausea, and appetite changes is typically necessary. Most of these signs are managed through diet changes and medication. Pets can sometimes experience a good quality of life for years after a kidney failure diagnosis.

Preventing Renal Failure——-

 

Given that chronic renal failure in dogs is most commonly the result of genetically predetermined, age-related degeneration, it’s not considered preventable. Nonetheless, regular physical examinations and wellness screenings can increase your dog’s chances of early diagnosis and treatment.

Acute renal failure, however, is considered preventable in many instances. Vaccination against infectious diseases, like leptospirosis, for example, can prove highly effective. Clearing households of toxins, like antifreeze; being careful with grapes and raisins; and keeping all human medications out of the reach of dogs is also important.

 

Understanding Your Dog’s Risk——-

 

The timing of kidney degeneration is likely linked to a dog’s genetics. Consequently, chronic renal failure in dogs is effectively preprogrammed to occur at a certain age. Nonetheless, no specific breed predisposition is known to exist. Certain kidney diseases that can lead to renal failure in dogs, however, can disproportionately affect specific breeds. These include the following:

• Basenjidogs are especially affected by Fanconi syndrome, which disrupts electrolyte absorption.
• Bernese mountaindogs can suffer a congenital disease of the kidneys called glomerulonephritis.
• Collies, Shetland sheepdogs and German shepherds can be affected by lupus, an autoimmune disease affecting the kidneys and other organs.
• Shar-Peis can suffer a kidney disease known as familial renal amyloidosis.

 

While kidney disease can be a scary diagnosis, many dogs and cats can live comfortably for years with kidney disease if it is caught early enough and treated appropriately. While most drugs used to treat pets with kidney disease are only meant to reduce symptoms, feeding the right diet can have dramatic effects on survival – studies have shown that pets that eat diets designed for kidney disease can live twice as long as those who eat more typical diets.

The nutritional changes that need to be made depend on the severity of the kidney disease, but in general, pets with kidney disease should be fed diets reduced in phosphorus, protein, and sodium and supplemented with omega-3 fatty acids from fish oil. The most important of these nutrients for most dogs and cats is phosphorus. It is important to feed a low phosphorus diet to keep the pet’s blood phosphorus low, which is thought to slow the progression of kidney disease and improve survival.

As the kidneys are responsible for getting rid of the waste products from protein in the diet, diets for pets with kidney disease have lower amounts of protein to minimize the buildup of waste products in the blood as the kidneys fail, which can make your pet feel quite sick. If your dog or cat has protein loss in his or her urine, then a low protein diet is particularly important because lower protein diets reduce the protein loss, which can improve survival time.  In addition to feeding a lower protein diet, you also need to avoid giving high protein treats such as meat, jerky treats, cheese, rawhides, pig ears, etc.

High salt (sodium) diets may increase blood pressure and may worsen kidney damage, so diets designed for pets with kidney disease are low in sodium. You should also avoid feeding high salt treats such as cheese, bread, deli meat, and many commercial dog and cat treats. Keeping to foods and treats that have less than 1 mg sodium per Calorie (kcal) is generally a good start. Low sodium treats include fruits and vegetables (but be sure to avoid grapes, raisins, onions, and garlic!)

There is some evidence that omega-3 fatty acids from fish oil may have benefits for cats and dogs with kidney disease, so many diets for pets with kidney disease contain added fish oil, or fish oil is added as a supplement if the diet doesn’t already have it.  Talk to your veterinarian about whether fish oil is right for your pet and, if so, about optimal dose and a brand that has high quality control.

Diets designed for kidney disease are also designed to be non-acidifying whereas many dog foods and most cat foods are designed to be acidifying. Pets with kidney disease often become too acidic, so it is important that the diet be designed to help counteract this issue.

Dietary management of dogs with chronic kidney failure————-

While it’s not possible to repair damage to the kidney tubules, you can help the remaining kidney tubules work more efficiently by feeding your dog the correct diet. This will help to reduce the clinical signs by preventing the accumulation of waste products in the blood; and it will help to slow down the progression of disease.

Feeding your dog a diet that’s lower in protein than normal will help reduce the buildup of unwanted waste products such as urea. But it’s important to not reduce the level of protein too much, or your dog won’t get enough protein for cell replacement and body regulation.

You should also reduce the level of phosphorus in your dog’s diet. Specially designed low-phosphorous diets are available from your vet. When the kidney is unable to remove phosphorus from the blood, a series of chemical processes leads to the loss of function of more kidney tubules.

Since dogs with kidney disease sometimes have poor appetites, they need to eat enough to stay at a normal weight; losing weight—particularly muscle tissue—can put added stress on their kidneys. An ideal diet will have a high concentration of calories, yet still be low in protein and phosphorus.

 

Diet———-

 

Feeding of a kidney diet is usually recommended. Kidney diets contain less protein compared to other diets and the protein is high in quality. It is protein in the diet that is converted to waste products that the kidneys must remove in the urine. The higher the quality of the protein in the diet, the less wastes created for the kidneys to eliminate. Low quality protein requires the kidneys remove more wastes. which makes them work harder. Egg and meat contain higher quality protein; cereal grain protein is of lower quality which leads to more wastes for the kidneys to eliminate. Protein is used by the body to repair cells and tissues that are continually regenerating, so a pet needs some protein in their diet. By feeding a low quantity, but high quality protein diet that contains an appropriate amount of fats and carbohydrates, the pet’s body can use the protein for replacing the cells and tissues and use the fat and carbohydrates for energy. Kidney diets also contain a lower amount of phosphorus. Phosphorus accumulates in the blood when the kidneys are diseased. Kidney diets control the amount of other substances that may be too high or too low in patients with CKD such as salt, potassium, magnesium and B vitamins. There are differences in the kidney diets for dogs and cats. When making diet changes it is often beneficial to gradually introduce the new diet by adding increasing amounts of the new diet while reducing the amount of the current diet over 1 to 2 weeks. The pet is more likely to accept a new diet when it is introduced gradually and it is less stressful to the kidneys to gradually adapt to changes in the diet.

Protein restricted diets are less palatable than higher protein diets. Pets with CKD that are still eating are more likely to accept a change in diet to a protein restricted diet than are pets who are very ill and refusing most foods. Protein restricted diets are more expensive than higher protein diets.

There are many pet food companies that sell kidney diets. Homemade diets can be fed but it is best to work with your veterinarian to formulate a diet that is balanced.

 

Diets for dogs with kidney failure

A special diet can reduce signs of kidney failure in dogs and slow the progress of the disease. Your vet may suggest a carefully balanced prescription kidney diet for dogs. This food will have been formulated to meet your dog’s special needs and should always be your first choice if recommended.

Unfortunately, these special diets aren’t always the tastiest as they’re made to very strict recipes, so your dog might not guzzle it up with as much gusto as they do with their usual food. Bear in mind that a dog’s sense of smell and taste is around 200,000 times more sensitive than ours, so they’re bound to notice the difference! That said, don’t give up on your prescription diet just because your dog seems disinterested at first – with a bit of perseverance, they’ll come around in the end.

Introduce their new diet slowly

When feeding a dog with kidney problems, take things slowly, introducing their new diet gradually so they can learn to adapt to the blander flavours and different textures. Unless your vet says otherwise, start by blending a little of the new diet thoroughly into your dog’s original food. Then, each day, increase the quantity of the new diet by very small amounts, reducing the amount of their original diet proportionately. Ask your vet about portion sizes for the prescription diet, or use the guidelines on the packaging, because it won’t necessarily be the same as you’re used to feeding your dog.

Feed little and often

While your dog’s getting used to their new feeding routine try offering them smaller meals more regularly rather than one or two larger meals. You’ll need to avoid giving them treats when they’re on their special diet anyway, so more regular feeding might help fill those gaps.

Warm their food up to make it more palatable

You can also try to make their new diet more palatable by slightly warming wet food in a microwave to release aromas and soften its texture. If your dog is used to wet food but the prescription diet is dry, try soaking the kibbles briefly in warm water to soften them.

The changeover process can take anything from two to six weeks to complete, but it’s worth the extra time and effort to keep your furry friend as fit and healthy as possible. With a good quality diet and plenty of water, you and your dog should be able to carry on enjoying a healthy, happy life together.

 

Looking after dogs with chronic kidney failure—————-

Here are a few other ways you can help your dog that has chronic kidney failure:

• If your dog has been prescribed drugs, administer them exactly as advised.
• If your dog has been prescribed a low phosphorus diet, feed it to him exactly as advised. Avoid feeding extra snacks.
• Feed your dog small meals, often, rather than giving him one or two large meals in a day.
• Offer fresh food at each feeding.
• Make sure your dog always has access to clean, fresh water.
• Sometimes, dogs that have chronic kidney failure don’t feel like eating. For them, it may help to warm food to just below body temperature, and to try hand feeding for the first few days of a new diet.

 

Chronic kidney failure is a very serious disease, so if you suspect that your senior dog has this condition get him to the veterinarian as soon as possible.

Reference-On request