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By Isabella Storyclaire

last updated September 16, 2024

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Chronic Renal Failure (CRF) in Dogs

What Is Chronic Renal Failure in Dogs?

Chronic renal failure (CRF), renal insufficiency, and chronic kidney disease (CKD) are all medical terms used to describe the same condition. It occurs when the kidneys are unable to perform their required tasks at the same level of efficiency as before.

Dogs have two kidneys located on either side of their abdomen, that play a vital role in filtering waste from the body. Additionally, the kidneys serve to regulate fluid, mineral, and electrolyte balance; conserve water and protein; and play an important role in maintaining blood pressure and red blood cell production by making a hormone called erythropoietin.

Dogs cannot survive without their kidneys, and unfortunately, kidney transplants are yet to be a viable solution. Dialysis (a treatment for failing kidneys including the removal of waste) is often expensive and is extremely rare in dogs. However, early diagnosis and intervention is key to help maintain your dogs quality of life.

Once diagnosed, CRF is then classified into four different stages based on severity of clinical signs and laboratory values:

Stage I: Clinical signs usually not apparent
Stage II: Some clinical signs noted
Stage III: Many clinical signs noted, and pets often feel sick
Stage IV: Majority of clinical signs noted, pets often present as a crisis

Causes of Chronic Renal Failure in Dogs

The term chronic in chronic renal failure means that the process has been ongoing, is progressive, and unfortunately, cannot be reversed. For some dogs, the disease could have occurred after a serious kidney injury such as from a severe infection (i.e., leptospirosis, pyelonephritis) or ingestion of a toxic substance such as anti-freeze, grapes, or raisins, and certain antibiotics.

For others, it could be inherited, such as with glomerular disease (a specific type of renal kidney disease) and amyloidosis (a rare organ disease) as seen in breeds like the Bernese Mountain Dog and Shar-pei.

For others, it could be attributed to underlying immune-mediated diseases, stroke-like events, or even from clotting disorders. In cases for newly diagnosed dogs the underlying cause will likely remain unknown.

Symptoms of Chronic Renal Failure in Dogs

Clinical signs are often related to the severity of the CRF stage, meaning there are additional and more severe signs noted with stages III and IV than there are with stages I and II. Dogs often exhibit symptoms including:

Foul breath
Weight loss
Decreased appetite

Some dogs may show muscle wasting and signs attributed to high blood pressure, such as vision loss and weakness.

How Veterinarians Diagnose Chronic Renal Failure in Dogs

CRF is often diagnosed based on routine blood work and a urinalysis looking specifically at kidney markers such as:

Blood urea nitrogen (BUN): A by-product of protein metabolism, higher values can often indicate kidney failure
Creatinine (CREA): Measures how well kidneys are filtering waste from blood
Phosphorous: Elevated phosphorus levels typically indicate kidney damage
Electrolytes (Sodium, potassium, chloride)
Calcium

Red blood cell count: A low red blood cell count may indicate kidney failure
Symmetric dimethylarginine (SDMA): An additional test to help determine if kidney disease is present; it can be used for early detection of kidney disease
Urine specific gravity: A marker of how diluted or concentrated the urine is. Usually the higher the number, the more concentrated the urine is and the greater ability of the kidney to conserve water.

Your veterinarian will most likely recommend additional diagnostic testing, including:

A urine protein to creatinine (UPC) ratio to quantify how much protein is being lost in the urine
A urine culture, as dogs in CKD are more likely to acquire urinary tract infections
A blood pressure evaluation
Radiographs or abdominal ultrasound to screen for kidney stones or infarcts (areas of dead tissue)

Treatment of Chronic Renal Failure in Dogs

Dogs with CRF are generally older and have other ongoing issues, such as arthritis or liver disease, and so the management of CRF can be challenging. However, CRF can be managed, mostly with the aid of medications, diet, and hydration.

Specific management is geared toward each stage of the disease, with each progressive stage recommendations built upon the previous stage recommendations. Any dog in any stage with an increase in either UPC (urine protein to creatinine ratio) or high blood pressure will most likely be treated with medication.

Throughout your dogs life, any disease process or illness that could affect his hydration should be treated promptly with IV fluids. Other drugs will be prescribed based on the dogs diagnosis since renal metabolism will be affected and can lead to overdosages and/or worsening of the kidney disease.

Additionally, for all stages, fresh water should always be available, drinking should be encouraged, and adequate nutrition should be given daily. Dogs diagnosed with CRF are most likely prescribed a kidney friendly diet, which may include feeding your dog a canned diet of wet food that contains additional water.

Recovery and Prevention of Chronic Renal Failure in Dogs

As chronic renal failure is not curable and often progressive (although the timeline is variable) in nature, dogs diagnosed early on will benefit from nutritional management and consistent veterinary attention, which may include more frequent check-ups and blood work.

Dogs in stages I and II may often be monitored for further progression of signs, and some may be given a prescription diet specifically geared to help the kidney, by limiting the amount of work they must do.

Many dogs can go on to have a decent quality of life for many months to years. Dogs in stages III and IV often require more medical and dietary assistance. If secondary anemia is present, erythropoietin injections can be given at the direction of your veterinarian.

Dietary supplements, and phosphorus binders (to treat high phosphorus levels) may also be given for low potassium. Anti-nausea and anti-emetic (anti-vomiting) medications can also be prescribed for dogs with a poor appetite, vomiting, or nausea. Fluids given either intravenously or underneath the skin can help dehydration. Because of the severity of signs often seen in dogs with stage III and IV, and the amount of care and effort required to support these dogs, some may be humanely euthanized.

Chronic Renal Failure (CRF) In Dogs FAQs

How long can a dog live with kidney failure without treatment?

Left untreated, dogs in kidney failure will die, usually within a few days to a few weeks. Death is often preceded by loss of appetite, dehydration, weight loss, vomiting, and multi-organ failure.

Can dogs recover from chronic renal failure?

There is no cure for CRF. However, if CRF is caught early and managed correctly, most dogs that experience kidney disease can go on to live a relatively normal life with some changes and long-term management.

Can chronic renal failure in dogs be reversed?

While CRF is not reversible, early treatment can provide your pet with a happier, longer, and fuller life. Regular, semi-annual checkups are key to early diagnosis and treatment of the development of chronic renal disease.

Featured Image: iStock.com/Korneeva_Kristina

WRITTEN BY

Michael Kearley, DVM

Veterinarian

Dr. Michael Kearley graduated from the University of Florida College of Veterinary Medicine in 2013. He graduated with a certificate in...

Kidney Failure Symptoms

Symptoms of Kidney Failure

The symptoms for acute and chronic kidney failure may be different and may resemble other conditions or medical problems. Each individual may experience symptoms differently. It is important to consult your physician for a diagnosis.

Acute Kidney Failure Symptoms

Symptoms of acute kidney failure often depend on the underlying condition. Symptoms may include:

Hemorrhage (unusual bleeding)
Fever
Weakness and fatigue
Fatigue
Rash
Diarrhea or bloody diarrhea
Poor appetite
Severe vomiting
Abdominal pain
Back pain
Muscle cramps
No urine output or high urine output
Pale skin
Nosebleeds
Swelling of the tissues
Eye inflammation
An abdominal mass you can feel

Chronic Kidney Failure Symptoms

Symptoms of chronic kidney failure include:

Poor appetite
Vomiting
Bone pain and/or muscle cramps
Headache
Insomnia
Itching and/or dry skin
Easily fatigued
Urine problems:
- High urine output or no urine output
- Recurrent urinary tract infections
- Urinary incontinence
Pale skin
Bad breath
Trouble hearing
An abdominal mass you can feel
Tissue swelling
Poor muscle tone
Change in mental alertness
Metallic taste in mouth

Diagnosing Kidney Failure

If you experience any of these symptoms, see your doctor for an expert diagnosis. We use a variety of diagnostic methods, including blood tests and an ultrasound, to confirm a diagnosis of kidney failure. Learn more about kidney failure diagnosis at Stanford.

Kidney Failure in Dogs: Symptoms, Treatment & Prevention

Jan 17, 2024

Two main types of kidney failure occur in dogs: chronic renal failure and acute renal failure.
Signs of kidney failure in dogs include drinking and urinating excessively, vomiting, weight loss, and lethargy.
Dogs with kidney failure are typically treated with supportive care including hospitalization, fluid support, dog kidney failure diets, and medications to help balance electrolytes.
The main preventative measures for kidney failure in dogs are to avoid toxic substances, give your dog monthly tick preventative, and vaccinate your dog for leptospirosis.

What Causes Kidney Problems in Dogs?

Kidney disease is a common condition seen in dogs of all ages. Two types of kidney failure may occur in dogs.

Chronic Renal Failure

Chronic renal failure is caused by a slow decrease in the function of the kidneys over time and usually occurs in older dogs. As the kidneys age, the cells within the kidneys begin to die and degenerate. This form of kidney failure is usually non-reversible. The main goal of treatment in chronic renal failure is to help prolong the life and improve symptoms associated with the disease.

Acute Renal Failure

Acute kidney failure in dogs can occur within hours after exposure to a toxic substance or an infectious disease. Because the damage occurs quickly, sometimes there is a chance to save the kidneys if treatment is instituted quickly and aggressively.

Some of the most common toxic substances and infectious diseases that may cause kidney failure in dogs include:

Antifreeze
Raisins
Grapes
Advil (ibuprofen)
Overdose of vitamins
Leptospirosis
Lyme disease

Signs of Kidney Problems in Dogs

The main signs of kidney problems in dogs include a sudden change in drinking or urination habits. Dogs that have kidney problems usually drink excessive amounts of water or ask to go out to pee frequently. Anytime you notice a new symptom like this, it is important to contact your veterinarian immediately.

Many clients ask me, is kidney failure in dogs painful? My answer is that many causes of kidney failure do not cause a lot of pain, but your dog probably feels very sick and weak like you feel when you have the flu. That being said, there are some causes and symptoms of kidney disease that can cause pain such as mouth ulcers or kidney pain due to severe infections. The best way to determine if your dog is painful from kidney failure is to ask your veterinarian.

Here is a list of the most common symptoms of kidney failure in dogs:

Increased thirst and urination
Vomiting
Foul odor breath
Decreased appetite or not eating
Weight loss
In severe cases, urine production may decrease or stop completely

Diagnosing Dog Kidney Problems

If your dog has any of the symptoms described above or has eaten any of the toxic substances listed above, you should get your dog to a veterinarian immediately. Your veterinarian can run a urinalysis test and blood work to determine if your dog is in kidney failure. Urine concentration (urine specific gravity), BUN (blood urea nitrogen), and Creatinine are the most common tests to determine if your dog is in kidney failure. Your vet may want to perform additional advanced tests to check for infectious diseases or other underlying causes of kidney failure in your dog.

How Are Kidney Problems Treated?

Initial treatment of kidney failure in dogs includes hospitalization and IV fluid therapy. Your veterinarian will determine what the underlying cause of the kidney disease is and treat it with appropriate medications and therapies. Dogs with kidney failure often must be hospitalized for several days to weeks to become stabilized prior to discharge.

If your veterinarian can stabilize your dog and wean them off of IV fluids without the kidney values rapidly increasing, they will send your dog home on a dog kidney failure diet which is specially formulated to be easy on the kidneys. They may also prescribe your dog oral medications to help reduce the risk of ulcers or to control electrolyte imbalances secondary to kidney failure. In addition, if your dog is moving more slowly and having a harder time moving around because of the kidney disease, consider getting a PawRamp.

The cost of treating kidney failure in dogs can vary depending on what the underlying cause of the kidney failure is and how severe the illness is. Mild forms of kidney disease which are caught early may only incur minor costs. Severe forms of kidney disease in dogs may cost hundreds to upwards of one to two thousand dollars to treat depending on the severity of your dogs disease.

What Happens if Kidney Problems Go Untreated?

If kidney failure goes untreated, your dog will get progressively sicker and eventually pass away. Dogs need their kidneys to function properly to survive. Unfortunately, if no treatment is done, your dog will get more sick over time.

Preventing Kidney Problems in Dogs

The main ways to prevent kidney problems in dogs is to prevent exposure to harmful infectious diseases and toxic substances. Ensure that you keep toxic items like grapes, raisins, antifreeze, and Advil away from your pet as these items are extremely dangerous. I have seen a dog go into kidney failure after eating just a few raisins or a few Advil tablets. To read about other toxic foods for your dog, read this article on Common Household Foods That Are Toxic To Your Dog.

In addition to protecting against toxic substances, you can also protect against infectious diseases that may cause kidney problems. Leptospirosis can cause kidney failure in dogs, so I recommend that most pets get a leptospirosis vaccine to prevent this disease. Lyme disease can cause kidney failure, so I highly recommend placing your dog on a monthly tick preventative like Nexgard which has shown to be effective at preventing Lyme disease if given regularly. If you are interested in learning more about my favorite recommendations for flea and tick preventatives and Lyme disease in dogs, be sure to check out these articles on How To Remove a Tick From Your Dog and How To Spot Fleas on Dogs.

Top Picks for Maintaining Your Dogs Digestive Wellness

Prioritize your dogs digestive health with our top picks, carefully curated to maintain a balanced and thriving digestive system. From probiotics that promote beneficial gut bacteria to digestive enzymes aiding in nutrient absorption, these selected products offer a comprehensive approach to supporting your dogs digestive wellness.

Our Score

These functional soft chew supplements feature a base of pumpkin and papayatwo sources of enzymesplus probiotics for digestion, bowel and immune support.
Contains DE111, a bacillus subtilis that supports digestive function and a strong immune system.
These chewables contain six probioticsDE111, Lactobacillus acidophilus, L. plantarum, L. brevis, L. fermentum and L. lactisto promote proper gut flora and function.
May provide relief from occasional gastric distress, including constipation, indigestion, gas and bloating.
Paw-fect for small, medium and large breed dogs.

Our Score

These functional soft chew supplements feature a base of pumpkin and papayatwo sources of enzymesplus probiotics for digestion, bowel and immune support.
Contains DE111, a bacillus subtilis that supports digestive function and a strong immune system.
These chewables contain six probioticsDE111, Lactobacillus acidophilus, L. plantarum, L. brevis, L. fermentum and L. lactisto promote proper gut flora and function.
May provide relief from occasional gastric distress, including constipation, indigestion, gas and bloating.
Paw-fect for small, medium and large breed dogs.

9.4

This veterinarian-recommended dog probiotic helps support digestive health and manage the symptoms of diarrhea.
Recommended for the dietary management of puppies and adult dogs with diarrhea.

Be prepared the next time your dog has an upset stomach by keeping Purina Pro Plan Veterinary Supplements FortiFlora Dog Probiotic Supplement close at hand. Designed to manage the symptoms of dog diarrhea, this digestive care dog food powder supplement contains special probiotics for dogs, plus healthy antioxidants for added immune support. FortiFlora dog digestive health supplements supply dogs with a guaranteed level of live microorganisms to benefit beneficial intestinal microflora and help quell a variety of digestive issues. A proprietary microencapsulation process helps enhance the stability of the probiotics in each sachet, aiding their survival until they can reach your dogs intestinal tract. This formula is appropriate for use in both puppies and adult dogs, and it can also be helpful for treating excessive gas. Dont let your best friend suffer tummy upsets any longer than he has tolet this vet-recommended supplement swoop in and save the day!

9.4

Sprinkle on dry kibble as a food topper mix with water for a broth, paw-feet alternative to probiotic chews.
Created by vet nutritionists to provide maximum digestive health.
Promotes skin health, and effectively controls yeast overgrowth, so your best pal stays comfortable and itch-free.
Made with all-natural ingredients for a powerful probiotic and prebiotic digestive supplement.
Supports overall gut health, is used as a preventive probiotic for diarrhea, serves every day.

9.4

Formulated to support and balance the digestive tract.
Great for dogs with sensitive stomachs and digestive issues caused by stress, antibiotics, a weakened immune system or dietary issues.
Features a special blend of probiotics, including veterinary-strength PB6, which helps support good bacteria in the gut and promotes a balanced and healthy GI tract and normal stool quality.
PB6 technology enables beneficial bacteria to travel through the complete GI tract for optimal stomach and intestinal balance.
Bite-size chew that you can feed like a treat.

When to See A Vet

It is important to see a vet anytime your pet has a new symptom especially vomiting, lethargy, or changes in drinking and urination habits. In addition, if your dog has eaten something toxic like grapes, raisins, antifreeze, or Advil, you should visit an emergency veterinarian immediately. Early and aggressive treatment improves the prognosis for your dog surviving.