I haven’t written on kidney disease in quite some time, so this month I want to address some of the common questions regarding this disease.
Question: What is kidney disease (also known as renal disease)?
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Kidney disease is when the kidneys lose their ability to function at 100%. Most often, it is due to inflammation and scarring in the kidneys. Usually the kidneys will function and show no symptoms until two-thirds to three-quarters of their function has been lost.
Question: What are the symptoms of Kidney Disease?
The signs that are seen most often are drinking more water and urinating more frequently, and the urine is often clear or colorless. Later symptoms may include nausea, lack of appetite, weight loss and lethargy.
Question: What causes kidney disease?
There are two types of kidney disease: Acute renal disease and chronic renal disease.
There are several things that can cause acute renal disease. It is caused by an outside influence or injury and the symptoms appear quickly. Some causes can include tick borne disease, leptospirosis, an ongoing urinary tract infection (UTI), certain NSAID medications such as aspirin, Rimadyl, Deramaxx or Metacam, long term antibiotic and steroid use, and heart medications such as Enalapril and Benazepril. These last two drugs are often prescribed in cases of chronic renal disease to help maintain normal blood pressure, so it is important to know that these drugs may damage the kidneys. Please note, OLD AGE is NOT cause renal failure!
If you suddenly start seeing symptoms of renal disease, is very important to test your dog for UTI’s, tick borne disease and leptospirosis as quickly as possible because oftentimes acute renal disease can be treated if detected early enough. Additionally, check all medications your dog is taking for any potential side effects on your dog’s kidneys. Remember, early detection is key in acute renal disease, so test, test, and test!
To understand more about why OLD AGE does NOT cause renal failure, please read more here:
Chronic renal disease, on the other hand, is generally congenital, or inherited. The dog has the disease from birth and their kidneys may be malformed or defective. Symptoms generally show up in the first year of the dog’s life and the disease progresses and continues to worsen with time and must be managed with medications, fluids and attention to the diet.
Question: How do I know if my dog has kidney disease?
Your veterinarian will start with blood tests and a urinalysis. The three main blood levels to look at are BUN, which addresses hydration, creatinine, which addresses renal function, and phosphorus. Dogs in severe renal failure will have elevated phosphorus levels because their damaged kidneys are unable to process phosphorus.
When the BUN level is high, I have seen veterinarians say the dog is in renal failure. However, high BUN levels can also mean stress, illness, dehydration, or they just ate a high protein meal.
IF a dogs BUN level is high AND the creatinine level is high AND the dog is showing signs of weakness and lethargy, the first treatment of choice is IV fluids. Until you know whether the dog has acute (treatable) or chronic renal failure, you want to support the dog’s kidneys until you have time to run some tests (sterile urine culture, tick borne disease blood test, leptospirosis titer). This is even more important if the phosphorus is elevated as well.
The urinalysis will show the specific gravity, which is the ability to concentrate urine or why renal affected dogs often have clear urine and the pH which can help determine if there is a urinary tract infection (alkaline urine can indicate bacteria).
It is also important to review any medications your dog has been recently taken to determine if the use of the medication may have caused the symptoms. Also, did your dog ingest any poisons, such as anti-freeze, weed or insect killers, chocolate or grapes? Does your dog have any gum disease or gum infections? Be pro-active in this search. Tick borne disease is treatable with doxycycline, leptospirosis, which is a bacteria, is killed with two weeks of penicillin drugs, and UTI’s are identified by the sterile culture results, which tells you WHAT bacteria is present and the SPECIFIC antibiotic to use to kill it. Please note UTI’s are “antibiotic” specific and usually require at least 3 weeks of antibiotic use to remove all the bacteria!
Question: What other conditions ‘mimic’ kidney disease?
Some of the diseases listed below have already been covered, but a more complete list is below.
- Urinary Tract Infection (UTI)
- Tick Borne Disease
- Non-Steroidal Anti-Inflammatory Drug (NSAID) use such as aspirin, Rimadyl, Deramaxx, etc.
- Long term Steroid use
- Certain prescription medications (always check side effects of any medications you give to your dog!)
- Addison’s Disease (adrenal disorder)
- Severe Hypothyroidism (leads to poor immune system responses)
- Gum infection or disease
Question: Should I change my dog’s diet? And can diet reverse this problem?
Due to the nature of renal disease, diet changes may be indicated for comfort. When renal disease reaches a certain point and the damage is significant, the kidneys become impaired. At this time, the dog struggles to process nitrates and phosphorus which can cause discomfort and pain. Can diet save or spare the kidneys? Not exactly, but a diet change at a certain point can offer comfort, provide better quality of life and may be able to extend your dog’s life. Generally, a diet change isn’t indicated until the BUN reaches 80 (and stays there or is higher) and the creatinine is at 3 or higher. Even then, it may not be necessary to make a diet change until the phosphorus levels go higher than the normal range. It is important to monitor these levels regularly if your dog has kidney issues OR when you notice a change in your dog such as weight loss, lack of appetite and/or lethargy).
Additionally, when blood levels reach these levels, it is time to consider giving your dog subcutaneous fluids. Sometimes administering these fluids a few times a week is enough, however, this will probably increase as time goes on. Your veterinarian can instruct you on how to do this and they can write you a prescription to get the fluids, lines and needles at Wal-Mart or Costco.
Another consideration when the phosphorus levels rise is to add calcium to the diet because it binds to phosphorus and/or add phosphate binders to the diet. This would also be the time to reduce phosphorus, NOT protein, in the diet, to reduce stress on the kidneys and alleviate any pain. The kidneys need protein to survive and thrive; a protein starving diet can be harmful to the kidneys.
Question: Are there supplements that are helpful for a dog with kidney disease?
B complex vitamins are important for renal function and health. Adding B12 can help with appetite and if you are adding subcutaneous fluids, ask your veterinarian for injectable B vitamins you can add to the ringers’ solution.
Fish oil capsules contain omega-3 fatty acids, which are considered renal protective. Give one per 10 lbs. of body weight daily.
COQ10 is speculated to help keep creatinine levels down. Give 2 to 3 mgs per pound of the dog daily.
Probiotics help keep the good flora and fauna in the dogs system. This helps with both digestion and to keep the immune system strong.
On a personal note, I had a Rottweiler named “Bean” who had congenital malformed kidneys. He was diagnosed with chronic renal disease at 4 months of age. I certainly went to great lengths to keep him healthy and thriving and he lived until just past the age of 5 – four and a half years longer than the veterinarian said he would live. He contracted other opportunistic issues during his illness (this is common with chronic renal disease) including numerous UTI’s and leptospirosis, twice! I gave him subcutaneous fluids throughout most of his life and I used other medications and treatments as well. I shared his story a few years ago in a newsletter I wrote on kidney diets and treatment options. You can read and learn more here:
August is upon us and the heat of summer has finally hit!
Be sure to provide plenty of fresh water for your dogs around the clock
and keep them cool!