Last month we discussed some of the causes of kidney problems, diagnostic tests that needed to be run to determine the cause, supplements that help support kidney function, and the importance of diet during both the growing years and throughout the lifetime of the dog to promote healthy kidneys and organs.
Should you find out your dog's renal problem is genetic or congenital, or if the damage is from an outside source that has progressed too far along to be helped, the next step is to examine maintenance, diet and treatment options that will provide quality of life for your dog.
Kidney issues are generally labeled either "acute" (caused by external sources that can be remedied or managed) or "chronic" (progressive without a cure or permanent treatment).
If your dog is given a diagnosis of chronic renal failure AND you have already researched your dog's history for possible reasons AND you have run the diagnostic tests that were suggested in the March 2012 B-Naturals Newsletter, it is time to look at management and monitoring renal disease progression.
This would start with having your veterinarian run periodic blood work to monitor BUN, creatinine and phosphorus blood levels. The BUN (Blood Urea Nitrogen) level addresses dehydration and how efficiently the kidneys can filter fluids. Creatinine is a by-product of muscle metabolism and increased levels indicate renal issues are present. Increases in Phosphorus indicate the loss of the kidney's ability to process this mineral.
Generally, if BUN is over 80, creatinine is over 3 and the phosphorus levels rises outside of normal limits, it MAY be time to decrease phosphorus in the diet. Many recommendations state to reduce protein at this time, but that is not correct. Proteins are high in phosphorus, but it is not necessary to reduce protein in order to reduce the phosphorus intake. Further, the kidneys, as well as the heart, lungs and liver, need good quality, animal-based protein to survive and thrive. So reduced protein overall is counter-productive and can create more harm to your dog's organ function over time. However, as these blood levels rise, dogs can have discomfort as they try to process the phosphorus, so some dogs may get relief if they are fed a phosphorus-reduced diet. Reducing phosphorus or protein does NOT spare the kidneys, but reducing phosphorus may help with pain due to the kidney's inability to process normal amounts of phosphorus.
I had a Rottweiler named The Bean, who was born in 2002. His symptoms started with a raging urinary tract infection (UTI) that was very difficult to treat. Subsequent sonograms showed the infection had not only spread to his kidneys but also that his kidneys were malformed. With this information in hand, I immediately began to research everything I could about kidney problems, kidney disease, treatment and prognosis. At the time this information was discovered, I was also told he probably would not live past six months.
From my research, I learned that much of the information available on canine kidney disease was outdated. Furthermore, the studies that were done to determine diet needs for dogs were performed on rats. Rats are omnivores and they have entirely different nutritional needs than dogs, as they are carnivores.
I also discovered there were options available, however, most were not widely known to most veterinarians unless they were specialists in renal issues or simply interested in the subject. The Bean was also diagnosed with glomerulonephritis (inflammation in the kidneys and protein loss in the urine). Standard treatment was to withhold protein for this issue, however there were a couple of newer sources available that said to give MORE protein to make up for the loss.
Therefore, in spite of the recommendations I was given to reduce protein, and in spite of Bean's BUN, creatinine and phosphorus levels slowly rising, I opted to continue feeding him raw diet.
My veterinarian was surprised to see that Bean kept trucking along. I monitored his blood work every 6-8 weeks. I made sure I gave Bean plenty off Omega 3 fish oil by giving him 1000 mgs per 10 lbs of body weight daily, which is the maximum medicinal dose. This is because the Omega 3 found in fish oil is known to help fight inflammation and is renal protective. I also gave him 2 mgs of CoQ10 per pound of body weight daily as it is thought to help keep creatinine levels down. Additionally, I gave him B vitamins , which also help kidney function, vitamin C , vitamin E , Berte’s Ultra Probiotics and Food Science All-Zyme .
Bean's condition slowly worsened over the next few years. Eventually I tried to feed him a low phosphorus diet, but he would not eat it. It was frustrating and challenging. He did get pancreatitis and anemia a few times, which is typical as renal issues increase the potential for both of these issues. I administered dog plasma intravenously which would bring him out of these conditions, but it was expensive. However, we used that method twice and the results were successful.
I began giving him subcutaneous fluids every other day when he was about two and a half years old. This continued until the last year of his life, when I had to increase the doses to a full liter of subcutaneous fluids daily. And yes, I ended up doing this myself at home. I did not ever think I would be able to do this on my own, but it administering these fluids became second nature to me.
Bean eventually became anemic the last year of his illness and I used oxyglobin intravenously once, which was expensive, but it helped increase his iron levels and give him energy. He also received darbepoetin intravenously every two weeks, which was also costly, but worth it as it helped keep his red blood cell count at normal levels.
Bean lived a very good and pampered life, but most importantly, he had a high quality of life! He lived to be 5 years old, which was an accomplishment that amazed most of the veterinarians who were involved in his life. Most of the things I did with The Bean the veterinarians said could not be done or would not work. But in the end, we all learned a lot from this experience.
What I have talked about are a few choices for end stage treatment of renal disease. I will admit they were expensive and time consuming, so for some, other choices may have to be made. I would also like to add that I also checked into a kidney transplant for Bean, but discovered dogs do not react well to the medications used for organ rejection and The Bean's quality of life would have only extended a year or so. As a result, I did not pursue this option. Should anyone be interested, the University of Madison in Wisconsin is working on this.
Lastly, I would like to offer some diet information that is important for supporting the kidneys. I will cover the highlights here, but more information is detailed in my book, "Raw and Natural Nutrition for Dogs" .
First, I was never able to get The Bean to eat a low phosphorus diet! However, it is certainly worth a try to offer this diet to your dog to bring comfort when they are showing signs of distress, which is usually when BUN levels are over 80, creatinine is over 3, and phosphorus levels are elevated. The symptoms of distress are usually shown with nausea, refusing to eat, and subsequent weight loss. The trick is to keep the protein levels high but the phosphorus levels low to sustain and maintain kidney health.
There are several factors involved in making a diet low in phosphorus. One is to use high fat meats because they are high in calories, but the meats must also be low in phosphorus. Another issue is to stop using raw bones, as they are high phosphorus. If feeding a cooked diet, use low phosphorus carbohydrates to reduce phosphorus levels.
For a raw diet, you can remove the bone and add calcium carbonate or calcium citrate for the calcium. Calcium is needed because it binds to the phosphorus and blocks some of the uptake. Use fattier cuts of meat, such as lamb, pork, canned fish, (salmon, mackerel, sardines), dark meat chicken and high fat dairy choices such as yogurt and cottage cheese. You may need to add some low phosphorus carbohydrates for fiber to firm stools, which is addressed in the next paragraph.
In cooked diets, you still use meats that are higher in fat, such as fatty hamburger, pork, lamb, and canned fish and you can add eggs and whole milk dairy products. Fiber is needed in diets with no bone, but it is necessary to use low phosphorus carbohydrate choices. Some good food choices include preparing cooked cream of wheat, sticky rice (such as rice used in sushi), rice noodles, plain malt-o-meal or white potatoes. You can also season these with butter to increase calories. Be sure to mash cooked vegetables well before serving. You can make these diets atabout 75% animal-based proteins (eggs, meat, dairy) and 25% low phosphorus carbohydrates. If the dog is uncomfortable, you can increase this to 40% carbohydrates, but if you reduce protein further, is can result in protein starvation.
In some cases, I mentioned pancreatitis could develop. Should that occur, the fat content must be reduced. While lower fat diets are needed to deal with the pancreatitis, lower fat diets do not provide the support the kidneys need in dogs with renal issues. My book also includes diets for pancreatitis.
If I had another dog with chronic renal issues, I would choose to feed a normal diet for as long as possible. I also believe in feeding a sick dog what they will eat. After all, a dog WANTING to eat, and CHOOSING to eat what they like, is worth more than it's weight in gold! Dogs live to eat and enjoy their food. I would give Bean supplements, but if he was feeling down or fussy, I did not try to push them on him on those days.
The Bean lived four and a half longer than any veterinarian predicted he would live. I give credit to his longevity and quality of life on his diet of high quality protein, subcutaneous fluids when needed, monitoring his blood work and doing frequent sterile urine cultures to keep infection from his urinary tract.
If anyone has specific questions on any of the treatment options I used for the Bean, please feel free to me privately for more information at firstname.lastname@example.org.