Treating Chronic Renal Failure in Dogs
Although I’ve been dealing with chronic renal failure in dogs and cats since starting my veterinary career, this past winter, I starting managing it in my own dog, Luna. She’s an older dog that I’ve had for 13 years. One morning in February, she peed a large puddle on the floor inside, something she had never done. I thought that maybe she was just becoming a little bit senile and losing housetraining, but I brought her into the clinic so that I could check her out. I sent out a lab panel and found out she was azotemic, which means that the kidney markers on her bloodwork were too high.
Unfortunately, by the time we see kidney values increase in the blood, much of the working function of the kidneys is already compromised. With chronic renal failure, the kidneys will not recover, and we don’t have medications that can fix them. Some referral clinics can do dialysis, but it’s quite expensive and not really a viable option in most cases. So we are left with doing the best we can to maintain the remaining kidney function for as long as possible.
We typically use the International Renal Interest Society (IRIS) staging system to help guide our diagnostics and treatment recommendations. The mainstay of helping the kidneys is hydration, so we can try adding water to food, providing fluids underneath the skin, or having pets stay in the hospital for intravenous fluid therapy. Processing protein is an issue for the kidneys so we are typically using low-protein diets. Phosphorous buildup, potassium loss, hypertension, urinary tract infections, anemia, and nausea are all problems that we can see with kidney disease.
Cats are especially prone to kidney disease, and it seems that most cats living into old age will have some degree of kidney dysfunction. It is often a slowly progressive disease, so they might feel well for years. Often the first thing we will notice are increased drinking or bigger urine clumps in the litter box.
In pets with known renal disease, we try to monitor blood values, urine, and blood pressure every 3–6 months. We want to do the best we can to keep our pets feeling well for as long as we can.
Luckily, my own dog is actually doing pretty well at about three months in. She’s on antibiotics for a urinary tract infection right now, and she eats a prescription kidney diet. Her appetite is good, and she’s adamant about getting a daily walk. In the next couple of weeks, she’s due in for some repeat lab work, so I can see where she’s at. Stay tuned for updates!
