Therapeutic Management of Chronic Renal Failure in a Dogs : Causes, Symptoms & Treatment

Therapeutic Management of Chronic Renal Failure in a Dogs : Causes, Symptoms & Treatment

 Kidney disease is considered a silent killer in dogs and cats as there are rarely any early symptoms and by the time it is detected, there are chances that the disease has already progressed and become irreversible. Your canine child, may however, be displaying certain subtle signs that you must may attention to. Any unexplained vomiting or bad breath issues should not be ignored. It is important to get regular check-ups done as dogs get older to nip the kidney disease in the bud.

Renal failure (also referred to as kidney failure) can be caused by many conditions that negatively affect the health and functioning of the kidneys and its related organs.A healthy dog’s kidneys work to regulate hydration, release hormones required to produce red blood cells, remove toxins and maintain a normal balance of electrolytes. If a dog experiences kidney failure, the kidneys no longer perform these functions efficiently.

While kidney problems can be concerning for any pet owner, don’t lose hope if your veterinarian has diagnosed your pup with a kidney issue that may lead to kidney failure. Depending on the circumstances, there may be measures you and your veterinarian can take to prolong your pet’s life.

What is kidney/ renal failure in dogs?

The inability of the kidneys to remove waste products from the blood is kidney failure. Acute kidney failure in dogs is a real and dangerous possibility. The bodies of animals produce toxins all day, every day, and the toxins circulate to the kidneys to be dissolved in water, filtered out and excreted through urination. Kidney (renal) failure occurs when a dog’s kidneys are no longer able to remove waste and concentrate urine. The build-up of toxins produces the signs and symptoms of poisoning – called uremic poisoning.

Kidney failure can appear suddenly (acute kidney failure) or come on gradually over months (chronic kidney failure).

Healthy kidneys make highly concentrated urine, meaning a large amount of toxins can be handled and excreted in a relatively small amount of water. A failing kidney, by contrast, needs more and more water to excrete the same amount of toxins. A dog in kidney failure will drink increasing quantities of water, until eventually he simply can’t drink enough and toxin levels in his bloodstream begin to rise and he begins to show signs of illness or poisoning.

NOTE:  These signs will now show until 75 percent of functioning kidney tissue is destroyed. Thus, a considerable amount of damage occurs before the signs are noticed. It is critical to check for renal failure at the first signs of change in urination behaviour of the dog.

There are two types of renal failure in dogs:

Acute Renal Failure

Most commonly associated with toxins or infections, acute renal failure causes kidney function to suddenly decline (in hours or days).

Chronic Renal Failure

This type of kidney failure involves more gradual loss of kidney function (over weeks, months or years). Degeneration associated with geriatric decline is often to blame. While all kidneys have a natural lifespan, some dogs’ kidneys will, unfortunately, deteriorate more quickly than others.

Causes of Kidney Failure

Any disease that impacts the kidneys can cause kidney failure. These conditions include:

Geriatric Degeneration

Cells in ageing kidneys often decline and die. This is the most common cause of kidney

disease in dogs.

Congenital Disease

From abnormal development and cysts to agenesis (being born without one or both kidneys) there are a number of inherited conditions that can lead to abnormal kidney function.

Bacterial Infections

These can be transmitted by swimming in or drinking contaminated water. This type of infection can cause the kidneys to become inflamed and renal cells to be destroyed.

Toxicosis

Also referred to as kidney poisoning, toxicosis can damage the kidneys’ cells and happens when your dog ingests poisons (such as chocolate or antifreeze) or drugs (such as ibuprofen or acetaminophen). These are just some of the many common household items that should be kept out of the reach of your dog’s curious paws.

Any condition that causes the kidneys to stop functioning properly is referred to as kidney or renal disease in dogs, and may vary significantly in severity. While damage is in progress, there is still functional tissue left. Renal failure is far more serious, as the kidneys have stopped working altogether.

Stages of Renal Failure in Dogs

The elevation of blood waste product and abnormalities in urine, including the presence of protein, can indicate the severity of chronic kidney disease.

According to the International Renal Interest Society (IRIS), stages of chronic renal disease are numbered 1 through 4 (with four being the most severe). The higher the stage number, the more symptoms you’ll often see in your pet. It’s best if some treatments are started when the pet is at a specific stage of chronic kidney disease.

Median survival time for dogs in Stage 1 is more than 400 days, while Stage 2 ranged from 200 to 400 days and Stage 3 ranged from 110 to 200 days.

End-Stage Renal Disease in Dogs

Chronic kidney disease is progressive, and there is no cure. By the time an animal shows signs of the disease, damage is severe. The nephrons (microscopic units in the kidneys) that remain are working hard to compensate for the nephrons lost to damage or age. In time, these remaining nephrons will also fail.

As the disease progresses prognosis worsens and survival time decreases with each stage. Median survival time for Stage 4 kidney disease ranges from 14 to 80 days, according to IRIS.

Symptoms of Renal Disease & Renal Failure in Dogs

As noted above, chronic kidney disease is kidney disease that has been present for months or years. Signs of chronic disease in dogs can vary from subtle and slowly progressive to severe. They may sometimes appear suddenly and commonly include:

• Drinking too much and producing large volumes of urine
• General depression associated with elevation of waste products in blood
• Overall weakness caused by low potassium in the blood
• Increased volume of urine in the bladder

By the time a dog experiences renal failure, the disease has advanced and you may notice such signs as:

• Blood in urine
• Lethargy
• Pale gums
• Ulcers in the mouth
• Intestinal seizures
• Significant weight loss
• Drunken behavior or uncoordinated movement such as stumbling
• Significant decrease in appetite
• Breath that smells like chemicals
• Vomiting

By the time a dog experiences renal failure, the disease has advanced and you may notice Your vet can examine your dog to determine whether kidney issues or other problems such as diabetes mellitus are causing the symptoms. Factors to be considered may include the type of renal failure your dog may be experiencing, the extend of loss of function in the kidneys, progression of the condition and its underlying causes.

Treatment & Prognosis for Renal Failure in Dogs

Your veterinarian will perform diagnostic blood and urine tests to detect the presence of any abnormalities. While a diagnosis of renal disease or failure can usually be made based on physical examination, in addition to the blood and urine tests. Other tests may also be performed to check for underlying causes for renal disease and/or to discover which stage of renal disease your dog is experiencing.

Severity of symptoms will determine appropriate treatments, which may include IV fluids, though if the disease is extremely severe your pooch may not respond to treatment. Aggressive treatments may include hospitalization for fluid therapy, dialysis or a kidney transplant.

Keep in mind that chronic renal disease cannot be cured. Prognosis is associated with severity of disease. As your dog progresses through stages of renal disease, survival time is likely to grow shorter.

The treatments are intended to reduce the work the kidneys are required to perform, to replace substances such as potassium and to reduce accumulating wastes. Your dog’s initial response to conservative therapy may be relatively slow — it may take weeks or months to see progress. Your vet may also suggest changes in diet to improve your pet’s quality of life and potentially limit the progression of disease, leading to a longer lifespan.

 Detection/signs of kidney failure

One of the first things you should notice is if the dog drinks and urinates more often. It’s a cycle of more water intake to flush toxins and more urination causing subsequent dehydration and thirst.

As kidney function declines and urine can’t be concentrated the dog retains ammonia, nitrogen, acids, and other chemical wastes in her blood and tissues. The degree of uremia is determined by measuring serum blood urea nitrogen (BUN), creatinine, and electrolytes. This stage is called uremia and comes as the last stage of acute renal failure in dogs.

Initial signs of uremia:

Uremia is the final stage of kidney failure, and indicates renal failure in dogs. The early signs of uremia include complete loss of energy, bad or foul-smelling breath and many other symptoms such as:

•   Apathy and depression
•   Loss of appetite and weight
•   Dogs at this stage now urinate less than normal
•   Ulcers may be present in the mouth.
• An ammonia like odour to the breath – best way to detect is smell the mouth or press a finger to the gums and smell the finger

Signs of advance uremia

•   As renal failure progresses it may cause edema – typically retention of water in the limbs & abdomen
•   Vomiting, diarrhea, and gastrointestinal bleeding
• At the end stages of kidney failure, the dog will have continuous seizures and falls into a coma

What should you do if you suspect kidney failure?

If you detect excessive drinking of water/ thirst in the dog and unusually high urination and/or loss of weight immediately get a blood test done. Kidney failure shows prominently in the blood chemistry as toxin levels (creatinine and nitrogen) rise.

Causes of kidney failure

Causes of acute kidney failure include

•   Poisoning
•   Tick fever & other bacterial/ viral infections especially in blood
•   Leptospirosis
•   Rupture of the bladder or urethra
•   Shock, with inadequate blood flow to the kidneys
• Congestive heart failure with low blood pressure and reduced blood flow to the kidneys

Acute failure and but mild enough may be completely reversible.

Causes of chronic kidney failure include

Chronic renal failure is one of the most common diseases seen in older dogs,  along-with arthritis and cancer. Many pet owners mistakenly think that as long as their dog is peeing a lot – often more than he did in his younger years, in fact – his kidneys are still working well. In fact, the opposite is true. So be very sensitive to urination habits in older dogs. Chronic failure is caused by Nephritis or Nephrosis.

• Nephritis is inflammation of the kidneys and is most often caused by auto-immune disorders that affect the major organs but may also be caused by infections & toxins.
• Nephrosis is any degenerative disease of the renal tubules and will severely compromise renal function

For chronic renal failure, there is no cure – the focus is on disease management for the rest of life.

Diagnosis  of Kidney failure in dogs 

Usually, in the case of kidney failure, the veterinarian will perform certain tests such as the urinalysis and a blood chemistry analysis. The urinalysis is to test kidney function. If there is an excess of protein in urine, it could be one of the symptoms of kidney failure in dogs.

Treating Kidney Failure

Tests and monitoring

• Dogs with kidney failure require periodic monitoring (once a month) of blood chemistry to detect changes in kidney function that may require medical intervention.

Diet

•   Restrict salt intake – this helps prevent/ delay demand hypertension.
•   Protein is poorly metabolised by dogs with kidney failure and increases kidney load. It’s best to put the dog on a renal diet. Dogs with weak kidneys can be thrown into uremia by feeding them more protein than they can handle.
• It is extremely important to provide fresh water at all times. The dog must be able to take in enough water to compensate for her large urine output. Some dogs will need occasional boosts to their fluid intake.

Treatment

The veterinarian should carefully monitor the blood levels, potassium levels and state of blood flow to the kidneys. If things have reached a critical place, intravenal medication will have to be transferred to remove toxins, and reducing phosphorus in the kidneys.

Two things need to be remembered – one is fluid therapy, and that the other is that half the battle is managing it in real time.

• On detection of renal failure, the No 1 priority is to give enough fluid to flush out as much of toxic accumulation as possible – and it works very well in acute kidney failure. Depending on the size and blood chemistry 3-6 bottles (300ml) of R/L may be given for the initial 5-7 days and continued thereafter.
• Restricting phosphorus intake is the other priority. Medications to lower phosphorus levels are required along with dietary adjustments.
• If the disease is the result of irreversible kidney tissue damage, in many cases renal function will stabilize for weeks, months or years at a time. And while the disease will progress and kidney function will continue to deteriorate, the dogs symptoms can be minimized with supportive treatment. After the initial fluid support dogs go into a treatment that includes

1)     Azodyl/Ipakitine/Rubinal (proprietary drugs) + Renal food formulations

2)  You may want to explore human grade renal medication to keep up kidney function – these includes supplements, nutrition, hormones to compensate for lost kidney function (this can be recommended to you if you request us)

• Blood transfusions to supply fresh blood that the dog may need. This has to be done carefully since new blood may itself increase kidney load but may be the best option in critical stages.

While some vets debate the efficacy of this treatment for at least 70% of the dogs in our care that were already critical we’ve been able to arrest symptoms for anything upto 6 months or more and give the dog a quality of life in this period.

Diet and nutrition in cases of kidney failure 

You will have to pay a lot more attention to maintaining your dog’s diet in the case of kidney failure. Consult with the veterinarian about a solid diet plan. Your dog will need healthy fatty acids such as Omega-3. Sodium is beneficial to bringing imbalances under control. Amino acids are very healthy for dogs as well.

Prevention of kidney failure

• Many situations of acute renal failure can be prevented by ensuring dogs are kept safely away from toxic substances, heavy metals, rat poison and other pesticides, common household medicines
• Any dog with a bacterial infection, urinary obstruction or other illness that could lead to compromised kidney function should receive proper treatment, the sooner the better.
• Limiting drugs that your pet is subjected to throughout her life will reduce the amount of toxins her liver and kidneys must process. Kidney failure in elderly dogs is usually the result of worn out organs. The less stress on your pet’s kidneys, the longer they’ll do their job effectively.

Palliative care for dogs with kidney failure 

If your dog is in pain and is sick, there are some things you can do to help a little bit. For one, try and keep fresh food and water available for your dog. Sometimes, if your dog isn’t hungry, warm the food ever so slightly and hand-feed the dog.

Frequently Asked Questions (FAQ)

1. What causes dog kidney failure?

Acute kidney failure in dogs is caused due to poisoning/ toxic ingestion, bacterial and viral infections in blood, bladder issues and heart diseases. Chronic kidney failure is caused by Nephritis (inflammation of the kidneys) or Nephrosis (degenerative disease of the renal tubules).

2. What are the symptoms of end stage kidney failure in dogs?

Symptoms of a kidney failure in dogs, especially in its last stage implies that 2/3 of the renal tissue has been destroyed. The visible symptoms of this include loss of appetite, increased water consumption, lethargy, diarrhea, vomiting and foul breath. In this stage, the blood toxin levels increase immensely and are very difficult to control.

3. Can a dog recover from kidney failure?

Detecting early signs of kidney failure in dogs clubbed with aggressive treatment processes yields positive results. Reversal of an acute renal failure is not possible but fluid therapy treatment and medications will slow down the process considerably, allowing your canine to lead a normal life. Be very careful of the dog’s diet to support the process and lower their salt and potassium intake.

4. Does dialysis work for dogs?

Dialysis is very beneficial for dog kidney failure treatment, especially in acute failure cases. There is a 50% chance that the dog will recover post the treatment, in absence of any underlying renal conditions. Like humans, they need to be taken for dialysis 3 times a week to relieve the symptoms of uremia.

5. How much does dialysis cost in India?

Dog dialysis in India can cost an average of Rs.15,000 per month. The high cost is due to the longevity and the frequency of the treatment that requires lifelong dialysis thrice every week. In addition, there can be supportive costs for medication and maintenance of the procedure. Very few vet hospitals in India have these facilities.

Compiled  & Shared by- Team, LITD (Livestock Institute of Training & Development)

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Reference-On Request.