Written by: Alexa Waltz

The kidneys are extremely important players in the game of keeping the bodies of humans and animals healthy. Like humans, dogs are born with two kidneys that are primarily responsible for excreting wastes and toxins from the bloodstream and maintaining fluid and electrolyte balances within the body. Kidney disease goes by many other names like “renal failure”, “renal insufficiency”, “kidney damage”, “kidney insufficiency”, “kidney injury”, and “kidney failure”. All of these names imply that the kidneys are struggling to carry out their normal functions to some degree. Kidney disease can also be further described as “acute” (happening suddenly or quickly) or “chronic” (happening slowly over time).

So many questions revolve around the diagnosis of kidney failure in dogs, and it can be very scary and confusing for pet parents. How can I tell if my dog has kidney disease? What would cause my dog’s kidneys to fail? How does kidney disease affect the long-term health of my dog? Recognizing what the kidneys do for the body is key to understanding, diagnosing, and treating kidney disease.   

What Do the Kidneys Do?

Everyone knows at least one important thing about the kidneys: they make urine! The kidneys are made up of millions of little tiny cellular units called nephrons. As blood flows through the kidneys, each nephron is designed to regulate what stays in and what is filtered out of the blood and into the urine – be it waste products from metabolism, toxins, electrolytes, and water. The healthy nephron uses a system of highly specialized cellular channels, pumps, gates, gradients, sensors, receptors, and hormones to filter unnecessary materials from the blood without losing what is valuable – it is really an incredible process! For example, during times of dehydration in dogs, healthy kidneys will conserve water in the bloodstream and produce very concentrated urine (a dark yellow color) and in times of hydration, they will excrete that excess fluid and make a very dilute urine (a light yellow/clear color).

However, the kidneys do much more than just make pee! In fact, the healthy function of other organs hinges on the kidneys keeping everything balanced. Here is a brief summary of how the kidneys are incredible workhorses for the body:

–   Maintain blood pressure

–   Filter wastes and toxins

–   Conserve or excrete water

–   Regulate blood electrolyte and mineral levels (especially sodium, potassium, phosphorus, and calcium)

–   Synthesize erythropoietin to stimulate red blood cell production

–   Conserve important blood proteins

–   Maintain blood pH balance

How Do Kidneys Become Damaged?

Being the fragile filter of the body, unfortunately, the kidneys are in a highly vulnerable position and can be damaged by a variety of different types of medical problems. Here is a list of the most common causes of acute (sudden) and chronic (slowly over time) kidney failure:

–   Ingesting Toxins (grapes, antifreeze, over-the-counter human NSAIDS like Ibuprofen)

–  Infections and Inflammation (Lyme disease, leptospirosis, pancreatitis)

–   Dehydration, Heatstroke

–   Aging (kidneys “wear out” over time)

–   High blood pressure

–   Kidney stones

–   Diabetes (Link: diabetes)

–  Periodontal disease (Link: periodontal disease)

–   Genetic and developmental abnormalities

–   Cancer

The kidneys have significant reserve and are excellent at compensating, even as some nephrons wear out or become damaged and nonfunctional. In fact, changes in your dog’s lab work won’t be apparent until at least 2/3 of those millions of nephrons become compromised! Unfortunately, when damaged beyond repair, the kidney is an organ that does not regenerate itself. This is why it’s essential to start treatment for kidney disease and investigate the underlying cause of kidney damage as soon as a problem is detected.

Acute Renal Failure happens very quickly – usually over a matter of hours to days — with the sudden loss of kidney function. Infections, toxin ingestion, and severe dehydration/heat stroke are often causes of acute renal failure. With appropriate emergency treatment, acute kidney failure may be reversible! Aggressive treatment may help the kidneys regain some or all of their function again depending on the cause and the treatment received. Without treatment, acute renal failure can be fatal.  

Chronic Renal Disease, or chronic renal failure, is a more gradual process taking place over months and years. This means that over a long period of time at least ⅔ of the kidney’s nephrons have become damaged beyond repair. The kidney loses the ability to filter waste products, concentrate the urine, regulate blood pressure, balance electrolytes and minerals, and stimulate the production of red blood cells. They may also be leaking protein into the urine because those specialized filters just do not work anymore. Kidney function greatly affects other organs too, like the heart, GI tract, and eyes, so depending on the actions taken to support the failing kidneys, dogs can have a variety of concurrent issues arise. 

How Can We Tell if the Kidneys Are Damaged?

Physical Symptoms

Refilling that water bowl more than normal? If your dog is drinking more and in turn having to pee more, this is a commonly recognized symptom of chronic kidney disease. Increased thirst and urination closely resemble the symptoms of diabetes as well, which is another serious health condition. Along with changes in water consumption and urination, keep an eye out for weight loss, decreased appetite, low energy, weakness, vomiting, and diarrhea too.

AskVet Tip: Acute kidney failure can cause your dog to feel very sick and also suddenly decrease its urine production. This happens because the kidney tissue has been so severely injured that the kidneys have basically “closed up shop” and are not working at all! This is an extremely dangerous and life-threatening situation that needs immediate emergency care. Chronic end-stage kidney failure, when the kidneys have very little functional capacity left, may be accompanied by bad/sweet breath and vomiting blood or black flecks of digested blood. This is due to the buildup of harmful toxins in the bloodstream that cause ulcers in the mouth, stomach, and intestines. Your dog also may have lost a significant amount of weight and may not be eating much at all.

Blood and Urine Testing, Imaging, and Blood Pressure Readings

Sometimes kidney insufficiency is detected on lab work well before any of the above physical signs develop, and early detection is a great thing! This is one of the many reasons that a blood test and urine test are recommended routinely for dogs and cats even if they are not showing signs of being sick – to catch diseases early in their progression! This way, we can initiate some protective treatment early to preserve kidney function for as long as possible.

If you suspect your dog may be showing signs of kidney disease, your vet will perform a physical exam first, looking for signs of dehydration, checking bladder size, heart and respiratory rate, etc. Next, they will likely recommend a urinalysis (urine test) and blood testing as this is the best way to check on how her internal organs are functioning. The urine tests will show if there is infection or inflammation present, if the kidneys are concentrating the urine appropriately, and if there is any other evidence of kidney damage in the urine sample. The blood tests will have several kidney function markers (BUN, Creatinine, SDMA) that become elevated when nephrons are damaged and not filtering correctly. Protein levels, blood electrolytes like sodium and potassium, and mineral levels of calcium and phosphorus are also important in determining the degree of kidney damage. Anemia, or low red blood cell count, is an important observation too. Additional testing to further examine aspects of the blood or urine may also be recommended for your dog depending on the screening test results. X-rays and ultrasound of the kidneys and abdominal organs also help to examine the kidney size and appearance, check for stones in the urinary tract, visualize tumors, and scan for abnormalities in other organs. 

Lastly, measuring a dog’s blood pressure is also very important. Kidney disease can cause high blood pressure AND high blood pressure can further damage the kidneys! It is essential to obtain as much information as possible in order to tailor your dog’s treatments to preserve kidney function. 

AskVet Tip: Kidney disease is graded on a scale from 1-4, 1 being mild and 4 being severe disease. The results of diagnostic testing help to put the puzzle pieces together and determine the stage of kidney disease. At that time, the doctor and pet parent discuss the prognosis, treatments, and long-term expectations together. 

What About Long-Term Health?

The diagnosis of kidney disease does not necessarily mean doom and gloom for your dog! Your dog’s journey with kidney disease highly depends on the stage, initial cause, degree of damage, progression, and treatments. If the issue is detected very early and protective measures are put in place, it is possible for dogs to stabilize and live for many years without showing outward signs of having an issue.

It is important that dogs diagnosed with kidney disease follow up with their veterinarian every 6-12 months as recommended. This allows their vet to keep a close eye on any progression of kidney damage, and to determine when to tweak your dog’s therapy or add further treatments. It is very possible for dogs with kidney disease to live happy and comfortable lives!

Our AskVet Veterinarians are available to discuss all of your pet’s needs 24 hours a day, 7 days a week. Whether you have an immediate need or are looking to improve your pet’s overall wellbeing, just sign into your account, and one of our friendly and knowledgeable veterinary experts will attend to your needs, no appointment required!

 

Written by:

Alexa Waltz, DVM

Dr. Waltz was raised near the beaches of Southern California but has spent her adult life living all over the beautiful United States while serving in the military and as a military spouse. She left California for the first time to pursue a career as a veterinarian at Louisiana State University School of Veterinary Medicine and graduated as a Doctor of Veterinary Medicine in 2006. She was accepted into the US Army Health Professionals Scholarship Program during vet school and upon graduation spent her military years as a veterinarian in San Diego working for the US Marine Corps and US Navy Military Working Dog programs as well as caring for pets of service members. After her military service, she became a civilian veterinarian and continued as a small animal general practitioner at clinics in California, Rhode Island, Colorado, and Maryland. Dr Waltz loves to see her “in person” patients just as much as communicating with and assisting pet parents virtually on AskVet. Dr Waltz is also a Mom to 3 humans, 2 guinea pigs, and 1 Australian Shepherd and in her spare time she loves traveling, adventures, exercising, and doing just about anything out in nature!

 

 

If your pet is experiencing symptoms like separation anxiety, arthritis pain, vomiting, or allergies, you may be wondering about “alternative” treatments for your pet. The most effective and well-studied holistic therapy for pets is acupuncture – which can improve your pet’s quality of life and overall health!

Many pet owners have questions about acupuncture. What is it? How does it work? Is there any scientific benefit to acupuncture? What is involved in a typical acupuncture session?

Read on for answers to all of these questions.

History of Acupuncture

Acupuncture is one of five parts of Traditional Chinese Medicine (TCM). The practice of acupuncture on people and horses began approximately 3,000 years ago in China. Treating pet dogs and cats with acupuncture began approximately 100 years ago – which is still much longer than we have been using many of our Western therapies!

Interest in acupuncture (both human and veterinary) in the United States grew significantly in the 1970s, spurring the National Institute of Health (NIH) to sponsor research into the benefits of human acupuncture. Ultimately, the NIH released a consensus statement highlighting the promising future of acupuncture use in human medicine.

What Is Acupuncture?

Simply put, acupuncture is the insertion of tiny, thin needles into specific points on the body called “acupoints.” These acupoints are related to each other and connected by Meridians or Channels, which are located under the skin. These points are thought to be areas that, when punctured, relieve stress or pain.

Several methods are used to stimulate these points:

• Dry needle: This is the use of needle insertion alone, which is the most common form of stimulation.
• Electroacupuncture: This is when the needle is attached to an electrical lead that provides a mild current to further stimulate the meridians.
• Aquapuncture: This is the injection of a liquid (usually vitamin B12) under the skin into the point.
• Moxibustion: This is when you burn the herb Artemesia above the needles to warm them, which provides additional healing properties described in TCM.

Alternative Therapies: How To Get Started

Similar to Conventional Medicine, the success of any Traditional Chinese Veterinary Medicine (TCVM) treatment plan lies in the correct diagnosis. While your family veterinarian may have diagnosed your pet with “arthritis” or “intervertebral disc disease,” a TCVM diagnosis will be based on a more complex classification that includes any outward symptoms.

A TCVM vet might gather information from the animal’s habits, pulse, tongue color, pressure points, and many more physical changes in order to determine a diagnosis. This is called the Bian Zheng or pattern diagnosis. This may explain why one patient responds to conventional treatment while another pet with the exact same symptoms and disease does not!

Based on assessment of your pet’s diagnosis, your TCVM veterinarian then selects “points” for treatment. Some points have local effects – for example, in treating pain related to a torn cruciate ligament in the knee, the acupuncturist may select a specific point named ST35, which is located at the knee next to the tendon of the knee cap. Other points are distant from the site of disease and are selected based on relation to the Meridian that the problem lies along or a relationship with the organ system involved.

Some acupuncture points have specific actions and can be used as symptomatic treatments as well. For example, the acupoint GV14 located where the neck meets the torso on the top of the back is useful for reducing fever.

A nearby acupoint is used to help stop coughing. One of the most studied points is PC6, located on the inner forelimb above the wrist, which is very effective at preventing nausea. (You may be familiar with the wristbands that help with motion sickness in people!)

How Does Acupuncture Work?

The short answer is: there is no short answer! In general, when we discuss how TCVM works, there are two explanations: Western and Eastern.

Eastern

The Eastern explanation is rooted in several principles. The most basic principle is something that may sound familiar: Yin and Yang. Yin and Yang represent the naturally occurring dichotomy in nature. Hot and Cold, Man and Woman, Day and Night, Excess and Deficiency are some examples you may be familiar with, but there are infinitely more!

Each half of a dichotomy is the polar opposite of the other, but one half cannot exist without its opposite. We only know what cold is because we’ve experienced hot, for example! Likewise, there is no night without day. What’s more: nothing is ever 100% Yin or 100% Yang.

Under this philosophy, the interactions and flow between Yin and Yang create harmony and health. Disease then occurs during periods of disharmony.

Another basic principle is the Five Treasures Theory. The Five Treasures are Jing (or congenital essence — basically DNA), Shen (the mind/spirit/psyche), Body Fluid (tears, urine, sweat, saliva, intestinal fluid, etc.), Blood, and lastly, Qi.

You can think of Qi as the electrochemical communications throughout the cells of your body. Qi is what gives life to our bodies, and where there is no Qi, there is no life. No, we’re not discussing philosophy — Qi directly refers to that intangible bioelectric force that animates living beings.

Qi flows through the Meridians in TCVM. Disease or pain occurs when Qi cannot flow properly. Think of when you have a pinched nerve: Your leg becomes painful, tingly, and you can’t move it as well. Alleviating this pinching can then allow your body to restore itself to a state of health. Something similar happens when the flow of Qi is restored.

Western

In Western Medicine, we tend to rely on a process called evidence-based medicine that seeks to prove theories through research. Fortunately, there have been numerous studies proving the effects of acupuncture.

Through this scientific research, we are learning that there are many complex biological mechanisms of action to explain the beneficial effects we see from acupuncture. Acupuncture stimulates a series of interactions between the nervous, immune, and endocrine systems.

It has been proven to :

• Increase blood flow
• Reduce inflammation
• Strengthen the immune system
• Improve muscle relaxation
• Stimulate nerves
• Release stem cells
• Stimulate endogenous opioids (natural painkillers)
• Release serotonin (the “feel good” hormone)

Because of this research, Western science has validated the use of acupuncture as a beneficial treatment for many different types of medical conditions.

What Can Acupuncture Do for Pets?

Treatment with acupuncture can be performed for virtually any disease! The most well-supported and well-known uses of acupuncture are for pain management and pain relief.

This alternative therapy can help to regulate nervous systems and the musculoskeletal system. Acupuncture can be used to treat skin conditions such as acral lick granulomas, reduce anxieties and other behavioral problems, relieve pain from hip dysplasia, gastrointestinal tract disorders like IBD and vomiting, kidney disease, and cancer.

Additionally, acupuncture can be done concurrently with the conventional therapies for all of these diseases so our pets can benefit from both Western and Eastern Medicine to live longer, healthier, and happier lives.

Conditions That Could Benefit From Acupuncture

There are some conditions that are used more frequently than others when it comes to pet acupuncture. If your dog suffers from the following, they might be a good candidate to try acupuncture treatment:

• Arthritis: Acupuncture helps your dog’s body to release endorphins which can alleviate pain from arthritis. Depending on how well this pain relieving technique works for your dog, your DVM might take them off some pain medications.
• Cancer: Acupuncture stimulates blood flow and naturally improves the body’s ability to heal itself. This can help alleviate pain from cancer treatment or medications used to treat unwanted symptoms.
• Degenerative Joint Disease: If your pet is beginning to struggle with joint mobility, acupuncture might help to support flexibility and decrease tension to help them move better.
• Trauma: If your dog is suffering from pain caused by some sort of trauma, acupuncture can be used to pinpoint the spots that hurt and try to help alleviate chronic pain.
• Metabolic Diseases: Acupuncture is known to help regulate the endocrine system and relieve oxidative stress. This can help to increase blood circulation and help eliminate toxins inside the body.

Before you decide to move forward with acupuncture for your pet, you should always consult with their licensed veterinarian to discuss the benefits and any potential side effects (though there aren’t really any).

Is Acupuncture Safe?

Acupuncture is considered very safe! There are virtually no side effects when acupuncture is performed by a trained professional. The needles are extremely thin (typically smaller than the needles used to give vaccines), sterile, and single-use only for your pet’s comfort and safety.

Some animals notice the prick as the needle is inserted, but most do not mind the process. In fact, quite a few even fall asleep during an acupuncture session! Some animals experience fatigue the day of or the day after their acupuncture treatment, but otherwise, no significant side effects have been detected after years of study.

Do All Veterinarians Perform Acupuncture?

Veterinarians can become trained and certified in acupuncture through several schools, including Chi University, CuraCore, the International Veterinary Acupuncture Society (IVAS), and the Canine Rehabilitation Institute (CRI). The classes can take anywhere from months to years to complete. In addition to acupuncture, some veterinarians become certified in herbal medicine, Tui-Na, and Chinese food therapy to help their patients heal.

If you think your pet may benefit from animal acupuncture therapy, discuss this with your family veterinarian! Since not all veterinarians are trained in veterinary acupuncture treatment, your family veterinarian may refer you to a local practitioner who offers this treatment.

You can also look up practitioners on the websites of the individual acupuncture schools:

Chi University: https://www.tcvm.net/

CuraCore: https://curacore.org/vet/find-a-practitioner/

IVAS: https://www.ivas.org/vets/

CRI: https://www.caninerehabinstitute.com/Find_A_Therapist.html

What To Expect From the Procedure

Before you can be treated with acupuncture, your veterinarian will discuss your treatment options before recommending you to a Certified Veterinary Acupuncturist with training in TCVM. Any information that is beneficial to understanding your pet’s issue will be sent over to the acupuncturist before the consultation, and during the consultation, any concerns should be voiced.

At the consultation, your dog might undergo blood work, lab testing, and x-rays to determine where the issue is. Once the acupuncturist has determined what the issue is and where the best points to be punctured are, you can go forward with the treatment. These sessions will last anywhere between 20 minutes and one hour.

While your dog might notice the prick of the needle as it’s being inserted, afterward, it can be fairly relaxing. Some animals even fall asleep during the procedure, which is totally okay. It should be a relaxing and comforting experience.

After the procedure is over, your dog might be a little sore and tired. You will want to allow them to rest up and drink plenty of water for the next day. Every dog is different and will be treated specifically based on their needs.

Some dogs might need several treatments a week or just a few a month to help keep them feeling healthy and happy. This is something that your acupuncturist will be able to discuss with you before starting the treatment.

Get to the Point With AskVet

No one expects you to be an expert when it comes to acupuncture, let alone for your pet (unless you literally are one). It can be scary to think about sticking needles into your beloved pup, but it’s painless and does a lot of good for your pet’s health and wellness.

Acupuncture is often where people end up when other pain medications and treatment methods aren’t relieving their pet as much as they hoped for. It’s not a “last ditch effort,” but it might not be the first thing you think of. In fact, you might want to bring it up with your vet at your next check-up.

If you have more questions about pet acupuncture, consider signing up with AskVet. Here, pet parents have 24/7 access to Certified Pet Lifestyle Coaches™, who can provide you with answers to any questions you might have – related to acupuncture or not. With this kind of access, you don’t have to worry when you have a question in the middle of the night.

AskVet’s goal is to provide you with quality care and answers so that you don’t have to spend any more time worrying about your pet than you already have. Plus, we don’t just have answers for cats and dogs — we include care for all (ranging from hamsters to snakes). Join for just $9.99/month and feel a sense of ease the next time you need some reassurance.

 

Sources:

An Historical Review and Perspective on the Impact of Acupuncture on U.S. Medicine and Society | NCBI

About – Traditional Chinese Veterinary Medicine | Chi University

Effect Of Acupuncture On Pain And Quality Of Life In Canine Neurological And Musculoskeletal Diseases | NCBI

 

 

Receiving the news that your dog has kidney disease can be scary and confusing for pet parents. Kidney disease occurs on a spectrum – some cases are an emergency, and your dog may be feeling very sick, vomiting, and acting lethargic.

In other cases, you just may note that the water bowl is empty more often than normal, and your dog is having to urinate frequently. And to complicate things more, kidney disease may be asymptomatic early in its course, only to be discovered via annual blood and urine testing. Every dog’s journey with kidney disease will be highly dependent on the cause, severity, progression, and treatments.

Managing kidney disease hinges on understanding all of the ways that the kidney supports the body. Kidneys are made up of millions of tiny cellular units called nephrons. These little nephrons are the true workhorses of the kidney and perform many essential functions for the body.

There are a variety of medical problems that cause nephrons to become damaged and result in kidney failure in dogs. Unfortunately, once healthy kidneys are permanently damaged, they cannot regenerate healthy tissue.

The kidneys are so good at compensating for damaged nephrons that by the time we start to see evidence of kidney damage on your dog’s lab work, at least 2/3 of the kidney’s functional capacity is already diminished! At that time, it is important that treatment is initiated to preserve as much kidney function as possible.

Let’s talk more about what the kidneys do.

What Do Dog’s Kidneys Do?

The kidneys are responsible for many functions that are crucial to overall health. One such function is removing excess waste, fluids, and toxins. This keeps the body healthy by preventing buildup.

When the kidneys can no longer filter out these substances, it is a sign that they aren’t working properly. Kidneys also control blood pressure and pH levels, help produce red blood cells and support bone health.

So what are the signs of this vital organ failing?

What Are the Clinical Signs of Chronic Kidney Disease?

Some of the most common symptoms include weight loss, decreased appetite, vomiting, increased or decreased urination, and thirst. You might also notice your dog’s gums becoming pale or that their breath has a chemical scent. Additionally, they might have trouble walking or staying balanced.

This wide range of symptoms will likely worsen as the disease progresses.

What Causes Kidney Failure in Dogs?

Now that you know the signs, you might be wondering how your furbaby became ill. Several things can cause kidney failure, ranging from damage to specific parts of the kidneys to ingesting household products that may contain dangerous toxins.

Let’s dive in:

Kidney Damage

There are many ways in which the kidneys could become damaged. Here are a few possible infections and other issues that may have caused your dog’s kidney failure:

• Glomerular Disease: This disease occurs when the part of the kidney responsible for the filtration of waste products, called the glomerulus, becomes inflamed. The inflammation damages surrounding tissues within the kidney, which leads to the development of chronic kidney disease.

In the early stages, your dog may not exhibit symptoms, but it is vital to seek treatment as soon as possible to slow the progression of this illness.

• Nephrolithiasis: Nephrolithiasis is a term used to describe kidney stones. Kidney stones may not be painful initially but can become painful if they result in a blockage or infection.
• Blockage: If kidney stones become fragmented, they can move into the ureter along with urine as it reaches the bladder. The fragments could cause a blockage if they become stuck within the ureter, making it difficult for urine to leave the bladder. Consequently, the kidneys become enlarged and damaged.
• Leptospirosis: This is a treatable bacterial infection that can cause acute kidney injury but may also contribute to chronic kidney disease. Prompt management of this infection is best to ensure a favorable outcome.

Household Products and Toxins

Some products you use in your home can be hazardous for dogs.

A few common household items that may contribute to kidney failure include:

Grapes and Raisins

Grapes and raisins are both poisonous as they stay in the stomach for an extended period of time and aren’t processed correctly within your dog’s gastrointestinal tract.

The exact amount needed to inhibit kidney function is unknown, but you should avoid giving these fruits to your dog altogether to minimize the risk.

Antifreeze

Antifreeze can be found in products such as paint, motor oil, hydraulic brake fluid, and radiator coolant, more commonly referred to as automotive antifreeze.

Cardiac Medications

Some heart medications include beta blockers and calcium channel blockers, both of which are used in human and veterinary medicine to effectively treat high blood pressure and cardiac disease. Poisoning due to these medications can lead to a low heart rate and acute kidney injury.

Non-Steroidal Anti-Inflammatory Medications

It is not safe to give your dog over-the-counter medication meant for humans without first receiving guidance from your veterinarian upon consultation since many human medications are harmful to animals. This includes non-steroidal anti-inflammatory medications such as Advil and Motrin. These can cause intestinal ulcers and acute kidney injury.

Vitamin D3

Vitamin D3 is extremely harmful to dogs, and they could rapidly develop an acute kidney injury if this vitamin is ingested. Vitamin D3 can raise calcium and phosphorus levels, otherwise referred to as hypercalcemia and hyperphosphatemia. Consequently, the body’s soft tissues within the heart, kidneys, and GI tract will harden.

Several items in your home contain vitamin D3, including rat poison, prescription vitamins, multivitamins, and omega fatty acid supplements.

Chronic Kidney Disease and Age

The age at which dogs could develop chronic kidney disease varies based on age and size.

Large dogs might show early signs of CKD as young as seven years of age because they tend to have a shorter life span than smaller breeds. In contrast, small dogs live longer and may not show signs of CKD until they are around ten to 14 years of age.

How Is CKD Diagnosed?

To diagnose CKD, your vet may conduct several tests, including three different blood tests, as well as urine testing, radiography, ultrasonography, and testing for infectious diseases.

Here’s what you can expect:

• Radiography: This test uses X-rays to examine your dog for tumors or kidney stones. It might also help detect other health problems.

• Ultrasonography: Ultrasounds are safer than radiographs because they use sound waves instead of radiation. However, both tests are essential: ultrasounds take images of the body’s tissue differently than radiographs.

• Blood Urea Nitrogen: The BUN test is a blood test that is usually incorporated into blood panels. Elevated results are only shown on this test when kidney function has decreased by 60 to 70 percent, making it highly effective at uncovering kidney problems.

• Blood Creatinine: Similar to the BUN test, the blood creatinine test will only show elevated results at 60 to 70 percent decreased kidney function. Creatinine is an amino acid in muscle protein. Both tests are influenced by factors unrelated to kidney function, such as exercise, diet, and muscle mass. For this reason, these tests can provide an accurate diagnosis after the disease has progressed, but a final blood test is needed to diagnose CKD in its early stages.

• SDMA Test: Symmetric dimethylarginine tests for an amino acid called arginine. SDMA levels elevate well before BUN and creatinine, helping detect kidney failure early on. Your dog could be tested for phosphorus and calcium levels in their blood.

• Urinalysis: Testing urine can provide information about the status of the kidneys that may not have been apparent in blood testing. This includes the detection of protein loss within urine, the presence of bladder stones, bleeding, and inflammation.

What’s the Outlook? The Future for Dogs With Kidney Disease

CKD is progressive, but proper treatment can allow dogs to live for months to even years with the diagnosis while still having a good quality of life. Starting treatment as soon as possible can help them live longer.

Geriatric Degeneration

As your dog ages, they could develop health issues, including CKD. We’ll discuss a few of them and their symptoms below.

Degenerative Joint Disease

This disease is also known as Osteoarthritis. Dogs can develop arthritis in old age, just like humans. Typically, this affects the function of any weight-bearing joints such as the knees and hips, which erodes the body’s cartilage over time. Osteoarthritis is progressive, but treatment can help ease your dog’s pain while slowing progression.

Dementia

Older dogs may begin to show signs of cognitive dysfunction, including dementia. You’ll want to see your veterinarian for an official diagnosis if you notice your dog doing things like pacing, having accidents, appearing confused or lost, or withdrawing from the family. Dementia cannot be cured, but your vet can prescribe medications or supplements that might make these symptoms more manageable.

Blindness

Dogs can lose their vision as they get older, and while there is no way to reverse it, their other senses can help them adapt. It is best not to rearrange your furniture so that they won’t be confused about their surroundings at home and keep them on a leash when you take them outside.

Diabetes

Canine diabetes is a frequent concern in elderly dogs and can present itself in one of two ways. The first and most common is insulin-deficient diabetes. This occurs when the pancreas is not functioning properly, preventing the body from producing enough insulin.

The second form is insulin-resistant diabetes, during which insulin is produced but is not used properly within the body. Diabetes can lead to abnormal blood chemistry, resulting in damage to organs, including the kidneys. If your dog has diabetes, they may experience weight loss, increased appetite and urination, and increased thirst.

Symptoms of End-Stage Renal Disease in Dogs

When your dog enters the end stages of kidney failure, their symptoms may worsen. Some of these could be similar to ones they experienced in prior stages of CKD, while others were not present before the final stages.

Review a few of them below:

• Uremia: When waste productsbuild up in the body, this gives your dog’s breath a strong ammonia scent

• Mouth Ulcers: Uremia could cause painful ulcers in your dog’s mouth.

• Dull and shedding coat: Your dog might begin to shed more than usual, and their coat may appear unkempt.

• Bloodshot eyes: During the final stages, the eyes may seem bloodshot.

• Loss of body fat and muscle mass: The weight loss brought on by kidney failure can cause them to appear emaciated as they lose both muscle mass and body fat.

• Dehydration: Although kidney failure causes increased thirst, it also causes frequent urination, leaving your dog constantly dehydrated.

• Dry and pale gums: The gums could become pale and extremely dry due to the lack of fluids in your dog’s body.

• Fatigue and lethargy: Your dog’s energy levels may decrease, causing them to sleep more and become less active.

• Slow heart rate and trouble breathing: During prior stages, the heart rate may increase, but it becomes slower in the final stages. However, blood pressure could become elevated. Difficulty breathing could also arise.

• Anemia: Anemia is the lack of healthy red blood cells in the body, resulting in reduced oxygen flow to the organs.

• Tremors and shaking: Your dog might experience shaking, tremors, and loss of balance.

• Seizures: Recurrent seizures are a major indication that your dog is in the final stages of kidney failure.

• Depression and disorientation: Your dog may seem confused and lose interest in things they usually enjoy.

Acute or Chronic?

Acute Kidney Failure (acute renal failure) occurs when there is a sudden injury to the kidney tissue due to causes like toxin ingestion or infections like Lyme or Leptospirosis. This damage occurs quickly over minutes, hours, and days. Acute Kidney Failure is an emergency needing immediate treatment.

If the damage happens more slowly over time due to unknown reasons and old age, it is referred to as Chronic Kidney Failure (chronic renal failure). Treatment for this type of kidney disease involves long-term management to prevent progression and further loss of those important nephrons.

End-stage chronic kidney failure occurs when the damage is in such an advanced state that other body systems are also affected, and the condition of the dog is very poor overall.

Treatment of acute and chronic kidney failure are similar yet different since one happens on a much faster timeline than the other! How do we tell the difference between acute and chronic?

Using information from the pet parent about recent changes in your dog that you have observed at home, physical exam findings, blood and urine test results, blood pressure readings, and other diagnostic options like x-ray and abdominal ultrasound, your veterinarian can distinguish which type of kidney issue your dog is experiencing.

When a kidney injury is diagnosed, the goals of treatment are to address the original cause of the damage, restore as much kidney function as possible, and slow the damage and further loss of function. Some treatments also directly target the buildup of certain wastes in the bloodstream, aid in hydration, and maintain electrolyte balances.

How Is Acute Kidney Failure Treated?

The kidneys are very fragile and can be rapidly and severely injured by infections, toxins (grapes, raisins, antifreeze), and severe dehydration (heat stroke and shock). Without treatment, acute kidney failure is life-threatening. If the kidneys experience this sudden injury, the sooner treatment is received, the better the outcome!

Severely ill dogs can be expected to be hospitalized for several days. In some cases, acute kidney failure can be reversed; the kidneys can be jump-started again to resume their responsibilities.

In other cases, treatment is ineffective or not initiated in time, and the kidneys will suffer a degree of permanent damage.

Possible Treatment Plans for Acute Kidney Failure in Dogs

If your dog is diagnosed with acute kidney failure, here are some treatments that may be offered:

• Treatment for the primary disease causing the acute kidney failure (such as antibiotics for an infection of the kidneys)
• Intravenous (IV) Fluids: used to restore electrolytes and hydration and help the kidneys continue to flush out the wastes and toxins from the bloodstream.
• Urinary Catheterization: measuring the urine output is key in monitoring how the kidneys are rebounding and responding to treatment.
• Medications: Antibiotics, anti-nausea medications, gastro protectants, appetite stimulants, blood pressure medications, cardiac support, and pain medications if your dog is painful
• Temporary Feeding Tube: Many dogs feel lousy and do not want to eat. A feeding tube can help deliver nutrition directly to their stomach until they are ready to eat on their own.
• Monitoring: Bodyweight, urine output, electrocardiogram, blood pressure, temperature, and urine and blood testing will assist your veterinarian in closely monitoring your dog’s status.

Are There Renal Replacement Therapies for Dogs?

AskVet Tip: Unfortunately, treatments called “renal replacement therapies” (aka dialysis and kidney transplants) are not widely available options to treat kidney failure in animals. Some veterinary hospitals do have dialysis capabilities, but at this time, it is not routinely used and is very expensive.

For more information, refer to your veterinarian for dialysis options at referral centers and large veterinary hospitals in your area.

Acute kidney failure is a very serious and potentially fatal condition. Prognosis often depends on the initial cause of the kidney injury and how quickly appropriate treatment is begun.

Some dogs will beat the odds and have an excellent response to treatment, resuming their regular healthy lives! Unfortunately, other dogs will suffer permanent damage to the kidneys and live with some level of chronic renal failure, requiring ongoing care for the rest of their lives.

Treatment Options for Chronic Kidney Disease

Chronic kidney disease has a much slower progression and often takes place over months and years rather than hours and days. Since chronic kidney disease occurs from mild to severe, the International Renal Interest Society (IRIS) created a standard set of guidelines for treating chronic kidney disease based on the classified stage.

What Are the Four Stages of IRIS?

The IRIS has 4 stages – stage one being very mild disease and stage 4 being severe end-stage disease. IRIS staging is based on a complete assessment of kidney function, which includes blood and urine test results and blood pressure measurement. (You may hear your veterinarian discuss blood values such as creatinine, BUN, SDMA, and urine protein creatinine ratio!)

With mild kidney disease, only a few treatments may be needed to aid the nephron with filtration, maintain hydration, lower blood pressure, and balance electrolytes.

With advanced kidney disease, the filtering power of the nephron is greatly diminished, causing wastes and toxins to build up in the bloodstream affecting the function of other organs around the body.

Possible Treatments for IRIS

The following are some commonly recommended treatments for dogs with IRIS Stages 1-4 kidney disease in order to improve or maintain kidney function and quality of life for as long as possible:

• Treat any primary disease-causing or complicating condition (such as high blood pressure)
• “Renal diet”: Prescription diets with decreased protein and restricted phosphorus and sodium content to help support struggling kidneys and reduce the amount of work they have to do (Hill’s K/D and K/D Early Support, Purina Pro Plan NF and NF Early Care, Royal Canin Renal Support and Early Renal Support)
• Supplements: Phosphorus binders (Epikatin, Aluminum Hydroxide), vitamin D supplements (calcitriol), potassiumsupplements, probiotics (Azodyl), omega-3 fatty acid supplements (fish oil)
• Medications: Blood pressure medications (enalapril, telmisartan, amlodipine), anti-nausea medications (cerenia, ondansetron), appetite stimulants (mirtazapine, entyce), antacids (omeprazole, famotidine)
• Intravenous or Subcutaneous Fluids: Maintain hydration and correct electrolyte imbalances. IV fluids can be given in the hospital and fluids under the skin (subcutaneous, or “SQ” fluids) can be given at home.
• Erythropoietin: Injectable erythropoietin may become necessary if the red cell count becomes too low.
• Feeding tube: Sick dogs sometimes do not want to eat, so a feeding tube can provide nutrition directly into the stomach for a period of time until he starts to feel better

How Can Kidney Failure Be Prevented?

The best thing you can do to reduce the chances of canine kidney failure is to schedule regular vet visits. This makes it less likely that they will develop any conditions you would be unaware of. When they are examined by your vet often, routine tests such as blood work and urine tests may detect early signs of kidney disease and other illnesses.

Your dog’s diet is another aspect of preventing kidney disease is keeping your dog on a healthy diet. Adding probiotics can support good bacteria that are already in their system. Feeding your dog high-quality food with protein as the main ingredient can help support kidney function.

Providing your dog with clean drinking water will also lessen the bacteria they consume. If your dog is susceptible to kidney problems or other issues, your vet might recommend specific foods to support kidney health.

You should always talk to your vet when navigating a CKD diagnosis, as they can assist you in coming up with a treatment plan that best suits your dog.

Goals of Treatment

The goals of treatment are to address any disease responsible for damaging the kidneys in the first place, support the remaining kidney function, and address any fluid, electrolyte, and mineral imbalances that arise due to the compromised kidneys.

Pet parents can take an active role in helping their pups by closely adhering to treatment plans and following up with the recommended recheck appointments and blood/urine tests.

The response to treatment can vary widely between dogs – some kidney function can improve with the above treatments allowing dogs to live an active and happy life for many years.

Other dogs may progress quickly and develop debilitating issues resulting in a poorer quality of life. Keeping your dog feeling good for as long as possible is the outcome we all strive for!

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Sources:

Kidney Failure in Dogs – Signs & Symptom | Rossmoyne Animal Emergency Trauma Center | Mechanicsburg.

Kidney Failure in Dogs | Kirrawee Vet Hospital | NSW

Renal Failure in Dogs: Causes, Symptoms & Treatment | Flat Rock Emergency Vet

Hypercalcemia in Dogs and Cats – Endocrine System | Merck Veterinary Manual

Hyperphosphatemia in Animals – Metabolic Disorders | Merck Veterinary Manual

 

Written by:

Alexa Waltz, DVM

Dr. Waltz was raised near the beaches of Southern California but has spent her adult life living all over the beautiful United States while serving in the military and as a military spouse. She left California for the first time to pursue a career as a veterinarian at Louisiana State University School of Veterinary Medicine and graduated as a Doctor of Veterinary Medicine in 2006. She was accepted into the US Army Health Professionals Scholarship Program during vet school and upon graduation spent her military years as a veterinarian in San Diego working for the US Marine Corps and US Navy Military Working Dog programs as well as caring for pets of service members. After her military service, she became a civilian veterinarian and continued as a small animal general practitioner at clinics in California, Rhode Island, Colorado, and Maryland. Dr Waltz loves to see her “in person” patients just as much as communicating with and assisting pet parents virtually on AskVet. Dr Waltz is also a Mom to 3 humans, 2 guinea pigs, and 1 Australian Shepherd and in her spare time she loves traveling, adventures, exercising, and doing just about anything out in nature!