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Diagnosis and Management of Canine Kidney Failure

Summary:

" Canine kidney failure (renal failure) can develop immediately, over months or years. It can occur suddenly, referred to as acute kidney failure, or over time, a condition referred to as chronic kidney failure (CKD). When a renal disease lasts for more than 3 months it is considered to be chronic. All breeds, sexes and ages can be effected.The kidneys remove waste and toxins from the blood. When the kidneys aren't working, these accumulate in the body, causing problems such as increased urination and thirst.

Causes of acute or sudden kidney failure include dehydration, poisoning or a blockage and are reversible in some cases.  The chronic form of the disease has an unknown cause (although damage to the renal tubes is suspected) and is not reversible, resulting in death in months or up to four years. Dietary change is the only affordable treatment that has been shown to slow down the  progression of the chronic form of the disease. Dialysis, or as a last resort, kidney transplantation can save the patient, although the costs can be prohibitive for most owners (see below). "


Dog Kidney Disease Symptoms, Diagnosis and Treatment


Renal Failure in Dogs Overview

Canine kidney disease is diagnosed when the kidneys are not removing toxins from the bloodstream as well as they should. If toxins build to dangerous levels it becomes a condition called azotemia. A case is chronic is it lasts for more than 3 years. Other terms for the disorder are renal insufficiency or renal failure. The percentage of dogs with the condition increases with age, with the highest incidence in dogs over 15 years of age.

It is very difficult to treat existing kidney damage once it is discovered.

There are four stages of canine kidney disease determined by tests conducted over several weeks after a patient is hydrated and is coming off of a fast. Dogs in stages 1 and 2 may not show any symptoms.

Stage 1: Toxins in the blood have not reached dangerous levels.

Stage 2: No symptoms, but there are toxins in the blood

Stage 3: When your dog is showing symptoms of kidney disease

Stage 4: Kidney damage is advancing and your dog is showing significant symptoms such as lethargic behavior.


Staging System for Chronic Kidney Disease (2)

There are two types of kidney failure (dog renal failure): the type that happens suddenly (sudden onset kidney failure) and the kind that happens gradually (called chronic kidney failure, called CKD).


Canine kidney failure can be caused by a cancerous lesion such as the lymphosarcoma pictured here


Causes of Acute Dog Kidney Failure (Sudden Onset)

Canine kidney failure that happens suddenly is usually caused by one of the following:

Causes of Chronic Dog Kidney Failure

Chronic Kidney failure can occur slowly over months or years without showing any symptoms. While the exact cause is not known, it is suspected that damage to the renal tubes is the underlying cause. Health problems in dogs that can lead to chronic dog kidney disease include:
  • Kidney dysplasia (defect in the kidney that is not genetic)
  • Inborn kidney defect
  • Diseases that effect the Immune system
  • Parasite Problem - giant kidney worm called Dioctophyme renale
  • Birth defects
  • Bacterial infections
  • High blood pressure

Breeds and the Incidence of Chronic Renal Disease or Failure in Dogs

Across all breeds the incidence of kidney failure is 9 cases per 1,000 dogs.

There are several breeds that have a higher incidence of canine kidney failure due to genetics:
  • Bull Terriers
  • Cairn Terriers
  • German Shepherds
  • English Cocker Spaniels
  • Samoyed
Abnormal kidney growth due to genetics (renal dysplasia) is seen in the following breeds:
  • Shih Tzu
  • Lhasa apso
  • Golden retriever
  • Norwegian elkhound
  • Chow chow
  • Standard Poodle
  • Soft-coated Wheaten terrier
  • Alaskan malamute
  • Miniature Schnauzer
  • Dutch Kooiker

Dog Kidney Failure Symptoms

In most dogs, symptoms appear suddenly. The associated with kidney disease are also common in other diseases. Several body systems are affected including the cardiovascular, endocrine, immune, gastrointestinal and neuromuscular systems.

Symptoms that occur with greater frequency/early signs:

  • Urination due to the body's inability to concentrate urine normally, indicates an approximate 75% reduction in renal function
  • Water consumption increases to combat dehydration caused by increased fluid loss via urination

Other symptoms that indicate more advanced forms of dog renal failure:

  • nocturia (urination at night)
  • digestive system problems
    • constipation
    • diarrhea
    • vomiting
    • nausea
    • anorexia (appetite loss)
  • very bad breath
  • weight Loss
  • fatigue/lethargic behavior
  • high blood pressure
  • acute blindness (related to hypertension)
  • seizures/coma (late stages of disease)

X-Ray of Canine Kidney Failure in Patient Suffering From Frequent Urinary Tract Infections and Uremia (excess waste products in the blood). X-Ray revealed enlargement of the left kidney which was removed in surgery. The patient died several days after surgery even thought one kidney was normal in size and function.(3)

Diagnosis of Dog Renal Failure

Dog kidney disease is diagnosed through routine blood and urine tests. Results of the tests will indicate if a patient even has kidney disease and how far and how fast it is progressing (called a renal evaluation). The average age at diagnosis is 7 years old.

Tests measure if the urine is of the proper consistency, blood urea nitrogen (BUN) levels and creatinine levels. Even kidneys that are functioning as low as 25% of normal might not be a problem.  X-rays and ultrasound tests will indicate the shape of the kidneys.

A veterinarian will look for many of the aforementioned symptoms, reduced body temperature and changes to the shape of the kidneys (enlarged, small). Signs of acute renal failure in particular are enlarged kidneys and a short time span for symptoms.

Before reaching a specific diagnosis, diseases with similar symptoms need to be ruled out such as a urinary tract infection.

Treatment

Treatment options for canine kidney disease usually depends on the severity of the condition (stage that the disease is in) and the underlying cause. Patients that have toxins in the blood at critical levels will be treated to address fluid and electrolyte deficiency (called a uremic crisis).

Dogs in stage 3 or 4 kidney failure are monitored every 1 to 3 months. If only one of the two kidneys is diseased, just one kidney can be removed, a procedure called a nefrectomy.

Cost of Treatment

The cost of canine kidney disease treatment can vary based on the progression of the problem. This can range from several hundred dollars a month for supportive care to thousands of dollars for dialysis or transplantation.

Prescription Medications

Medications such as antihypertensive agents with specific intrarenal effects such as ACE inhibitors have had a positive impact on renal diseases.
  • Famotidine: to address nausea and lack of appetite
  • Aluminum Carbonite: to correct hyperphosphatemia (excessive phosphates in the blood)
  • Amlopidine: for hypertension (high blood pressure)
  • ACE inhibitor (benazepril/enalapril): to address proteinuria (excess proteins in the urine)

Acute Kidney Disease Treatment

For actute forms of the diseaes, the first step is to eliminate anything that may be causing the kidney disease such as:

  • Medications - that may be damaging the kidneys (eg; the antibiotic gentamicin).

  • Stress - the introduction of new pets and changes in your dogs environment, also extreme weather such as heat or cold

The kidney's could be helped by:

  • Drinking more water; make water available throughout the day
  • Antacids (tagamet or zantac for canine)
  • Natural Medicine: there are several herbal ingredients that can address some of the issues associated with kidney health. Herbs such as burdock (for digestion and blood sugar regulation), dandelion (helps with fluid balance and is a good vitamin source) and cleavers (lymphatic cleanser). is made specifically for this purpose and is worth further research and discussion with your veterinarian.

If the kidney disease is reversible then your veterinarian may recommend an expensive treatment option such as dialysis. This is used in cases such as It is possible for dog's to receive a kidney transplant.

Chronic Kidney Disease Treatment

The veterinarian will address any symptoms with the condition possibly stabilizing for weeks or months at a time.  The veterinarian cannot stop the deterioration of the kidneys, however, the condition of the patient can be improved with care.

Treatment for canine kidney disease can include:

  • fluid therapy for dehydration
  • a switch to a special kidney diet (see below)

Dog Dialysis in cases for Chronic and Acute Kidney Disease

Hemodialysis for canine kidney failure is available to treat acute and chronic cases of the disease. In this procedure a cather is iattached to the dog while the dialysis machine removes toxins from the blood (dogs need to tolerate having a catheter attached). The cost of care is estimated to be between $20,000 to $25,000 for the initial 2 to 3 weeks of treatment, Owners also need to live near the dialysis center.

For chronic kidney disease a dog would need lifetime dialysis, resulting in even higher costs. For acute kidney failure, dialysis can make more sense since the treatment is short term.

Dog Kidney Transplants

Several veterinary hospitals can perform kidney transplants in dogs. Unfortunately survival rates in 50% of patients are 2 months or less.(1) Transplants can cost as much as $15,000, preceeded by dialysis and other forms of supportive care (before and after) that can bring the total to $100,000 (U.S.).

Post surger medications such as rejection prevention medications are required for the life of the dog and will cost more in larger breeds.

Dog Kidney Disease Diet

Recent research studies show that dietary change to a commercial food made for kidney or renal problems can both improve your dog's quality of life and extend the number of years your dog can live with the disease. The diets work by decreasing phosphorus levels and by suupplementing the diet with omega 3 fatty acids. The results is longer survival times, although researchers have not identified the specific part of the diet that is leadeing to the improvements in lifespan. See our

More Information on Kidney Failure and Dogs

(PDF Download)(4)
(PDF Download)(5)

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References for Canine Kidney Failure

(1) Dog Watch, Cornell University School of Veterinary Medicine

(2)

(3) Washington State University School of Veterinary Medicine

(4) Chronic Kidney Disease (CKD) in Dogs & Cats - Staging and Management Strategies
Dennis J. Chew, DVM Diplomate ACVIM (Internal Medicine)
The Ohio State University College of Veterinary Medicine
Columbus, Ohio, USA

(5) Acute Renal Failure: Prevention, Diagnosis and Management
Scott A. Brown, VMD, PhD, DACVIM
University of Georgia


Bartless, Paul C; Van Buren, James W; Bartlett, Andrew D; Zhou, Chun

Merck/Merial Manual for Pet Health

Medical Management of Chronic Kidney Disease
Scott Brown, VMD, PhD, DACVIM and Cathy Brown, VDN, PhD, DACVP
Department of Small Animal Medicine and Surgery
College of Veterinary Medicine
University of Georgia

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