can a dog recover from kidney failure

Can Dog Recover from Kidney Failure?

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What is Kidney Disease?

Kidney diseasecan be referred to as kidney failure, insufficiency, dysfunction, or disease. However you word it, it means the kidneys arent able to do all the hard work they should be doing, making the dog sick.

The main role of the kidneys is to filter out toxins in the bloodstream. When the kidneys arent working, those toxins and waste products build up in the blood. This condition is known as azotemia.

This disease is classified into two categories, chronic and acute. Chronic disease is a progressive process in which the function is lost over time. It often takes months or even years before the dog develops clinical signs. Chronic disease can be caused by an inherited abnormality at birth or with age, which is more common. Chronic disease is most commonly found in cats but can also be diagnosed in dogs. Dogs are more commonly diagnosed with acute kidney injury. This is where there has been a sudden injury to the kidneys, causing them to be unable to function. The most common causes are toxins such as certain medications (NSAIDs), grapes/raisins, ethylene glycol (antifreeze), or an infection such as leptospirosis or Lyme disease.

Clinical Signs

A dog with this disease may lose weight, stop eating or eat less, vomit, have diarrhea, show muscle wasting, drink more water than normal, urinate more than normal, have a decreased energy level, be anemic, or have ulcers in the stomach or mouth.

Diagnosis

A veterinarian can diagnose disease through a combination of tests such as a physical exam, bloodwork, urinalysis, radiographs, ultrasound, and blood pressure.

Dog Kidney Failure Stages

TheInternational Renal Interest Society (IRIS)has developed guidelines to help us better understand chronic disease, the diagnosis of this disease, the stages of this disease, and the best course of treatment and management based on the stage. These stages are based on blood creatinine levels, the SDMA test, blood pressure, and proteinuria (protein in the urine).

According to the IRIS guidelines, there are 4 stages of chronic disease.

Stage 1

Chronic kidney disease occurs when the blood creatinine is less than 1.4 mg/dl, and the SDMA level is 14-18mg/dl. There is minimal protein in the urine, and the dog usually has normal blood pressure in this stage. This stage is often referred to as pre-failure; typically, the dog isnt symptomatic.

Stage 2

Chronic kidney disease occurs when the blood creatinine is between 1.4-2.8mg/dl, and the SDMA level is 18-35mg/dl. These dogs may leak protein into their urine and experience slightly high blood pressure. Dogs with stage 2 disease have mild failure and dont typically show clinical signs.

Stage 3

Chronic disease occurs when the blood creatinine is between 2.9-5.0mg/dl, and the SDMA level is 36-54mg/dl. These dogs often have protein in their urine and elevated blood pressure. They are in moderate kidney failure and start showing signs of sickness.

Stage 4

Chronic disease occurs when the blood creatinine exceeds 5.0 mg/dl, and the SDMA level exceeds 54mg/dl. These dogs have more protein in their urine and elevated blood pressure, and they are in severe failure and often very sick.

According to IRIS guidelines, there are5 stages of acute kidney injury.[2]Acute injury. However, overall is a sudden and severe form of the disease, and it can vary in how powerful based on the insult. Some dogs can do well and recover with quick and effective treatment. Others develop chronic disease stages, while others fail quickly and die suddenly.

The acute injury stages are more difficult to define but are characterized by varying levels of increased blood creatinine levels and decreased urine production, often leading to anuria or no urine production. In the early stages, dogs will respond to replacement fluids through an IV, while in the later stages, dogs are not responsive to replacement fluids.

How to treat Kidney Disease in Dogs?

Once a dog is in stages 3 or 4 of kidney failure, about 70%-75% of the function is already lost, and in most cases, is gone for good. Because chronic disease cant be cured, treatment is aimed at supportive care and treating failures secondary effects. Some common secondary issues dogs can suffer from with kidney disease include anemia, hyperphosphatemia (increased phosphorus levels in the bloodstream), hypokalemia (low potassium blood levels), dehydration, nausea or vomiting, urinary tract infections, and anorexia. By addressing these concerns, this dogs can buy some time and live out a more comfortable and happy life.

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Chronic Kidney Disease Treatment

Treatment guidelines for chronic kidney disease are based on the IRIS guidelines.^[3]

Stage 1:

• Use drugs with side effects concerning the kidneys with caution. These include NSAIDs (Non-steroidal anti-inflammatory drugs) and some antibiotics.
• Increased fluid intake to correct dehydration and to prevent dehydration. This includes keeping several sources of freshwater available at all times, adding water to food, or feeding more of a wet food diet than dry.
• Treat underlying urinary tract infections if present.
• Monitor bloodwork changes and trends with regular bloodwork and urine tests.
• Treat secondary effects of kidney disease. Most dogs arent clinically ill at this stage, but they may have changes such as high blood pressure, high blood phosphorus, or protein leaking into the urine.

Stage 2:

• All the same steps as in Stage 1.
• Start a specific diet.

There are several high-quality commercial prescription kidney diets that your veterinarian can recommend. These include restricted protein content but with high-quality protein sources and restricted phosphorus and sodium levels. And it is best to offer canned or wet food to increase water intake.

Stage 3

• All the same steps as in Stage 1 and Stage 2.
• Phosphorus should be restricted in the diet, but if phosphorus is high, a phosphorus binding medication may be required to get the levels down in the blood.
• Treat secondary illness. Dogs can start feeling sick in this stage and those secondary effects will need to be treated: treat anemia with supplements and medications as recommended by your veterinarian; control vomiting with anti-nausea medications and gastrointestinal ulcers with antacids;anorexia and a decreased appetite can be supported with appetite stimulants; dehydration can be corrected with intravenous fluids or with regular subcutaneous fluid therapy.
• Supplements to support kidney function and overall health can be helpful: immune supplements, fish oil/fatty acid supplements, pre and probiotics

Stage 4:

• All the same steps as in Stages 1, 2, and 3.
• Continue treating secondary effects and illnesses.
• Continue supplements.
• Continue diet therapy. A feeding tube may be needing depending on how little the dog is eating.

Acute Kidney Injury Treatment

Acute kidney injury is a very sudden and serious condition that requires urgent treatment and still only has about a 50 percent survival rate.

If the cause of the kidney injury is known, such as a specific virus, bacteria, or toxin, specific therapy can be initiated. Dogs with injury are typically hospitalized for 24-hour monitoring and treatments and started on intravenous fluid therapy and various medications as needed. Their fluid intake and output (urination) is monitored carefully, and they are provided with high quality nutritional support.

The same types of supplements can be used for acute kidney injury as those mentioned for chronic kidney disease.

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Frequently Asked Questions

The survival time for a dog with kidney failure depends on the underlying cause, what stage of failure they are on, if it is a chronic or acute kidney disease, and their other secondary illnesses or symptoms. Early stages of chronic kidney disease have survival times of around a year while later stages have survival times around a few months. With successful treatment and supportive care, dogs can live longer with kidney disease.

Kidney failure cannot be reversed. Typically, once there is an insult to the kidneys or diagnostic tests show decreased kidney function, there has been permanent damage.

While kidney failure cannot be reversed or cured, it can be supported, and a dog can live out a good quality of life in many cases.

Kidney failure in dogs can be painful depending on the type of injury, insult, or disease that causing kidney failure. It is always difficult to determine pain in dogs, as they cannot speak to us, but we can tell if they are uncomfortable or sick. Your veterinarian can help you keep your canine friend as comfortable as possible while fighting kidney failure.

Article Sources:

1. Brooks, Wendy.Kidney Failure in Dogs and Cats: Where to Begin. 1 Jan. 2001,veterinarypartner.vin.com/default.aspx?pid=19239&id=4951452.
2. IRIS Staging of CKD.IRIS, International Renal Interest Society,iris-kidney.com/pdf/IRIS_Staging_of_CKD_modified_2019.pdf
3. Diagnosing, Staging, and Treating Chronic Kidney Disease in Dogs and Cats.IRIS, International Renal Interest Society,iris-kidney.com/pdf/IRIS_Pocket_Guide_to_CKD.pdf.
4. Grading of Acute Kidney Injury.IRIS, International Renal Interest Society,iris-kidney.com/pdf/4_ldc-revised-grading-of-acute-kidney-injury.pdf
5. Brown, Scott. Renal Dysfunction in Small Animals Urinary System Merck Veterinary Manual.Merck Veterinary Manual, 1 Oct. 2013,merckvetmanual.com/urinary-system/noninfectious-diseases-of-the-urinary-system-in-small-animals/renal-dysfunction-in-small-animals
6. Brown, Scott. Noninfectious Diseases of the Urinary System in Dogs Dog Owners Merck Veterinary Manual.Merck Veterinary Manual, 1 June 2018,https://www.merckvetmanual.com/dog-owners/kidney-and-urinary-tract-disorders-of-dogs/noninfectious-diseases-of-the-urinary-system-in-dogs
7. Chronic Kidney Disease and Failure.VetMed,vetmed.wsu.edu/outreach/Pet-Health-Topics/categories/diseases/chronic-kidney-disease-and-failure
8. Foster, JD, et al. Canine Chronic Kidney Disease | Diagnostics & Goals for Long-Term Management.Todays Veterinary Practice, 22 Oct. 2019,todaysveterinarypractice.com/canine-chronic-kidney-diseasecurrent-diagnostics-goals-long-term-management/

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Kidney Failure in Dogs

Types of Kidney Failure in Dogs

There are two types of kidney failure in dogs - acute kidney failure and chronic kidney failure.

Acute kidney failure occurs when there is a sudden decline in kidney function (within hours or days) as a result of toxin exposure (such as antifreeze, raisins, grapes, and some human medications) and bacterial infection.

On the other hand, chronic kidney failure involves a gradual but progressive loss of kidney function. The problem can take weeks, months, or years to develop. Age-related issues are the topmost reasons for kidney failure in dogs. Deterioration of organ structure and function inevitably occur from years of wear and tear.

The size of the dog has been found to influence the age of onset of chronic kidney disease. Early signs of kidney disease in smaller dog breeds may be exhibited when theyre about 10-14 years of age. On the other hand, larger breeds, which are known to have shorter life spans than their smaller counterparts, may develop kidney failure as early as seven years old.

Acute Kidney Failure in Dogs

Signs of Acute Kidney Failure

Dogs with acute kidney failure typically show signs of severe lethargy, vomiting, and reduced appetite. They may be drinking and urinating a lot or not at all.

Causes of Acute Kidney Failure

• One of the most common causes of acute kidney failure in dogs is ingestion of toxins, such as antifreeze, rodenticides, or some human medications (such as ibuprofen). Dogs are such curious creatures and this trait can increase their risks for toxin exposures.
• Infection with a bacterial organism called Leptospirosis can lead to kidney failure in pets and people.
• Various drugs can also cause kidney failure in certain pets.
• Severe infections or illnesses like sepsis or pancreatitis can also lead to acute kidney failure.
• Obstruction of the urinary tract caused by kidney stones or bladder stones that restricts urine flow.
• Anything that decreases the flow of blood through the kidneys, including dehydration, heatstroke, bee stings, or snake bites.

Treatment of Acute Kidney Failure

Acute kidney failure is a serious condition. Aggressive and quick treatment to support the kidneys and manage the underlying cause can be lifesaving. Treatment typically consists of hospitalizing your dog and keeping them on IV fluids, administering anti-nausea medications, administering antibiotics if needed, and ensuring they receive proper nutrition. The treatment may take days to weeks. Rechecking blood work and urine tests will help your vet monitor your dogs response to treatment.

Acute kidney failure can be fatal in over half the cases, even with treatment. Approximately 20% will recover and have chronic kidney disease as a result of the damage and 20% will recover and regain normal kidney function.

Chronic Kidney Failure in Dogs

Older cats are more prone to developing chronic kidney failure compared to dogs, but dogs can also develop this condition. Since this is a slow, progressive process, your dog may not show symptoms immediately. You may notice weight loss or muscle mass loss even though your dog is eating well. You might also notice your dog drinking and urinating more than usual. Its important to note that diabetes can cause similar symptoms.

Diagnosing Chronic Kidney Failure

Early stages of chronic kidney disease can be diagnosed with routine yearly blood work and urine tests before clinical symptoms even develop. If your vet suspects kidney failure, they will recommend basic blood work, urinalysis (urine test), and blood pressure measurements to help diagnose kidney failure, stage the kidney failure, and discuss proper treatments and supportive care.

Kidney failure is staged in 4 levels, with Stage 1 being the mildest and Stage 4 being the most severe.

Treatment for Chronic Kidney Failure

Once your vet has diagnosed and staged your dogs kidney failure, treatment will be discussed. Options can range from medications that lower blood pressure, treatment to reduce protein loss in the urine, intravenous or subcutaneous fluids, potassium replacement, medications to help improve red blood cell levels, and dietary changes.

There are a variety of prescription kidney supportive diets available. These diets can help your dog feel better and live longer, often for years, depending on the stage of kidney failure your dog is experiencing. Since some dogs can be picky eaters, you may need to try a variety of diets to find one they enjoy, so dont be discouraged if they refuse a few types!

Encouraging your dog to drink more water will also help support the kidneys. Canned foods contain more fluids compared to dry kibble, so feeding your dog canned food and eliminating the kibble may be recommended. Adding water or low sodium chicken broth (avoid onions and garlic) to the food can also encourage more water intake. Having multiple water bowls around the house will make it easier for your senior dog to take a drink when they want to.

Home Care for Dogs with Kidney Failure

If your dog has been diagnosed with chronic kidney disease, here are some ways to help your dog have a better and longer life:

• Prescribed medications should be administered exactly as instructed by your veterinarian.

• Keep a close eye on your dogs diet and food intake. If your pet is on a prescription diet, avoid feeding extra treats or snacks.

• Divide your dogs daily ration into several smaller meals given at regular intervals throughout the day.

• Fresh food should always be offered during each mealtime.

• Fresh clean water should be available to the dog at all times.

• If your dog has a poor appetite, try warming the food to just below body temperature. Warming can enhance the taste and flavor of the food and encourage your pet to eat.

• Regular monitoring is very important. Dont skip your pets appointments with your veterinarian for follow-up exams and lab work

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