kidney disease dogs stages

Canine Chronic Kidney Disease: Current Diagnostics and Goals for Long-Term Management

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Chronic Kidney Disease (CKD) in Dogs

What Is Chronic Kidney Disease (CKD) in Dogs?

Dogs have two kidneys, which are vital for maintaining lifes day-to-day processes. They have a variety of functions, the foremost of which is to filter and excrete toxins and waste from the body. Other tasks of the kidneys include regulating fluid, mineral, and electrolyte balance; conserving water and protein; maintaining blood pressure; and producing red blood cells.

Many causes are associated with progressive loss of kidney function, and unfortunately, once lost the damage is irreversible. As a result, unfiltered waste products and toxins build up in the bloodstream, leading to a generalized state of nausea and malaise. When left untreated or unmanaged, a dogs quality of life suffers. Early diagnosis and intervention are vital to managing the disease and maintaining your dogs comfort and well-being.

CKD is a progressive disease that has often been present for some time before it is diagnosed. It is typically classified into four stages, based on laboratory values and clinical signs:

• Stage I: No clinical signs are seen.

• Stage II: Some clinical signs are seen.

• Stage III: Many clinical signs are seen, and pets often feel sick.

• Stage IV: The majority of clinical signs are seen, often as an emergency. The quality of life for the pet is poor.

Is Chronic Renal Failure the Same Thing as Chronic Kidney Disease?

Chronic kidney disease (CKD), renal insufficiency, and chronic renal failure (CRF) are different terms often used interchangeably to describe declining kidney healthwhere over time the kidneys become less efficient in their required tasks and the results are life-threatening.

Symptoms of CKD in Dogs

Dogs typically wont experience any symptoms until the kidneys have lost about 75% of their functioning capacity. The higher the stage (meaning the greater the extent of kidney disease present), the more symptoms are exhibited.

Dogs in any stage can experience the following symptoms:

• Anemia (low red blood cell count)

• Changes in urine output, usually increased

• Decreased appetite

• Dehydration

• Increased thirst

• Muscle wasting

• Nausea

• Oral ulcerations (sores in the mouth) and bad breath

• Pale gums

• Poor coat appearance

• Sporadic vomiting

• Vision loss, often attributed to secondary hypertension (high blood pressure)

• Weakness and lethargy

• Weight loss

Causes of CKD in Dogs

Chronic renal failure by definition is a disease that occurs over a period of time; it is an ongoing, progressive, and irreversible process where, for some dogs, the cause remains unknown despite extensive testing.

Often CKD develops after a serious kidney injury such as from a severe infection (e.g., leptospirosis, tick-borne disease, or pyelonephritis), heat stroke, envenomation (from a venomous bite or sting), or the ingestion of toxic substances like antifreeze, NSAIDs (ibuprofen), or certain antibiotics. CKD is also associated with certain types of immune-mediated diseases or cancer.

Dogs breeds commonly prone to CKD include:

How Veterinarians Diagnose CKD in Dogs

A veterinarian will start with a physical exam, bloodwork, and a urinalysis to look specifically at kidney values such as:

• Blood urea nitrogen (BUN): higher values correlated with kidney failure

• Calcium

• Creatinine (CREA): indicator of the kidneys ability to filter wastes from blood

• Electrolytes: sodium, potassium, chloride

• Phosphorous: higher phosphorus levels seen with CKD

• Red blood cell count: low red blood cell counts are often seen secondary to CKD

• Symmetric dimethylarginine (SDMA): an indicator used for early detection of kidney disease

• Urine specific gravity:determines the kidneys concentrating ability; the more concentrated the urine is, the greater the ability of the kidneys to conserve water

Your veterinarian may also recommend additional testing such as:

• A urine protein to creatinine (UPC) ratio to determine how much protein is lost in the urine (termed proteinuria)

• A urine culture, as dogs with CKD are more likely to acquire urinary tract infections

• A blood pressure evaluation, as dogs with CKD often have hypertension (high blood pressure)

• Radiographs or abdominal ultrasound to screen for kidney stones, tumors, or infarcts (areas of dead tissue)

Treatment of CKD in Dogs

CKD is a manageable but incurable diseasesince by the time dog is symptomatic, irreversible damage has already occurred. Recommendations based on the stage of CKD will be tailored to match your dogs needs, with dogs in Stage III or IV warranting greater care and therapy than dogs in Stage I or II. Common therapies for CKD include medications, diet, and fluid therapy, along with treatment for any underlying condition or inciting factors.

Medications such as Cerenia, ondansetron, or omeprazole can help aid nausea, vomiting, and lack or loss of appetite. For some dogs with more extensive needs, a feeding tube may be placed. Additionally, appetite stimulants such as capromorelin and mirtazapine may be recommended.

Most vets will prescribe dietary management with a balanced diet that is lower in protein, salt, and phosphorus and is alkalinized to help combat side effects associated with CKD. Recommended diets typically include:

Fluid therapy is essential. Fluids will flush out toxic waste substances that the kidneys should be doing on a routine basis and restore hydration. They can be given intravenously in the hospital or subcutaneously (underneath the skin) at home. Your dog should have access to fresh water at all timesa water fountain can be an especially important item to add to your home.

Recovery and Management of CKD in Dogs

CKD is a serious lifelong condition that requires ongoing care and monitoring as symptoms continue to develop. Dogs with CKD require more frequent veterinary visits and testing than others, and at all stages of CKD, quality of life should be assessed as symptoms change. Be sure to adhere to your veterinarians recheck guidelines and continue all medications and diet as recommended; many will be required for life.

Depending on the circumstances, certain measures can help keep your dog comfortable and offer a good quality of life for as long as possible. Similar treatment and medications to those outlined above also are applicable for long-term management of CKD in dogs, such as:

• Dietary supplements such as Azodyl, a pre/probiotic, that can help decrease waste products not eliminated by the kidneys.

• Other supplements, such as aluminum hydroxide and Epakitinare geared to aid with low potassium and high phosphorus.

• Anti-nausea and anti-emetic (anti-vomiting) medications can be prescribed as needed for dogs who experience intermittent vomiting and lack of appetite.

Unfortunately, given the severity of symptoms often experienced by dogs with Stage III or IV and the extensive amount of care and effort they require, euthanasia may be the best option.

Chronic Kidney Disease (CKD) in Dogs FAQs

How long can a dog live with kidney disease?

CKD is progressive; however, its difficult to anticipate the degree and timing of the progression. Some dogs can live for years with proper veterinary care and management, while others may have to be euthanized shortly after diagnosis.

How fast does kidney disease progress in dogs?

The progression of CKD in dogs varies, taking weeks to years for symptoms to be noticeable. Once known, though, it is estimated that 75% loss of kidney function has already occurred, and the damage is irreversible. Depending on the underlying cause, some dogs will deteriorate much faster than others. Frequent checkups and routine veterinary visits can help detect CKD sooner, which will ensure your dogs comfort and garner an overall better quality of life.

Featured Image: Adobe/Alan

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...

Last Days of Dog with Kidney Failure: What to Expect

What to expect in Last Days of Dog with Kidney Failure? When your dogs kidneys start to fail, you may be surprised at how quickly his health declines. While theres no cure for chronic kidney disease in dogs, you can help your dog maintain his quality of life in the days leading up to his death by being prepared and keeping an eye out for the signs of Canine Kidney Failure (CKD).

This guide will walk you through what you should expect during the last days of your dog with kidney failure, helping both you and your pup prepare for this difficult time together.

What Is Kidney Failure In Dogs?

Kidney failure in dogs, also known as renal failure, is a serious condition that occurs when the kidneys are no longer able to function properly. The kidneys are two bean-shaped organs located near the base of the spine. They are responsible for many important functions, including:

• Filtering waste products from the blood
• Producing urine
• Balancing electrolytes
• Regulating blood pressure
• Producing hormones that help to regulate red blood cell production and calcium metabolism

When the kidneys fail, these important functions are compromised, which can lead to a variety of health problems.

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

• Acute kidney failure develops suddenly, often within hours or days. It can be caused by a variety of factors, such as poisoning, infection, or trauma.
• Chronic kidney disease develops slowly over time, often months or years. It is the most common type of kidney failure in dogs, and it is often caused by aging or underlying health conditions, such as diabetes or high blood pressure.

Causes Of Kidney Failure In Dogs

There are many potential causes of kidney failure in dogs, and they can be broadly categorized into four main groups:

1. Toxins and Poisons

• Ingestion of household toxins: Antifreeze, ethylene glycol, and rodenticides are some of the most common household toxins that can cause kidney failure in dogs. These substances are highly toxic to the kidneys and can cause rapid and severe damage.

• Certain human medications: Some human medications, such as ibuprofen, acetaminophen, and aspirin, can be toxic to dogs kidneys, even in small doses.
• Certain plants and foods: Grapes, raisins, lilies, and mushrooms are all examples of plants and foods that can be toxic to dogs kidneys.

2. Infections

• Bacterial infections: Infections of the bladder, kidneys, or prostate can spread to the kidneys and cause damage.
• Leptospirosis: This bacterial disease can be contracted through contact with contaminated water or soil.
• Lyme disease: This tick-borne disease can damage the kidneys in some dogs.

3. Blockages and Obstructions

Kidney stones: Stones can form in the kidneys and block the flow of urine, which can lead to kidney damage. Tumors: Tumors in the bladder, urethra, or prostate can block the flow of urine and damage the kidneys. Congestive heart failure: This condition can cause fluid to build up in the abdomen and around the kidneys, which can impair their function.

4. Immune System Disorders

• Glomerulonephritis: This is an autoimmune disease that attacks the glomeruli, which are the tiny filtering units in the kidneys.
• Amyloidosis: This is a condition in which abnormal proteins build up in the kidneys and interfere with their function.

Inherited Causes:

In some cases, kidney failure in dogs can be caused by a genetic predisposition. Certain breeds of dogs are more prone to kidney disease than others, such as the Cavalier King Charles Spaniel, Shih Tzu, and Pug.

It is important to note that this is not an exhaustive list of all the causes of kidney failure in dogs. If you are concerned about your dogs health, it is always best to consult with a veterinarian.

Last Days Of Dog With Kidney Failure Treatment

Treatment Options in the Last Days:

While there is no cure for kidney failure, there are treatments that can help to manage the symptoms and make your dogs last days more comfortable. These may include:

• Fluid therapy: Subcutaneous fluids or intravenous fluids can help to keep your dog hydrated and flush toxins from their system.
• Pain medication: If your dog is in pain, your veterinarian can prescribe pain medication to help keep them comfortable.
• Anti-nausea medication: This can help to control vomiting and nausea.
• Appetite stimulants: In some cases, appetite stimulants can help to encourage your dog to eat.
• Nutritional support: Providing your dog with a high-quality, easily digestible diet can help to ensure that they are getting the nutrients they need.

Making the Difficult Decision:

The decision of when to euthanize a dog with kidney failure is a personal one that should be made in consultation with your veterinarian. There is no right or wrong answer, and the decision will ultimately depend on what is best for your dog and your family. Some factors to consider may include:

• Your dogs quality of life
• Their level of pain and suffering
• Their ability to eat and drink
• Their ability to move around and interact with their surroundings

If you are struggling with the decision of whether or not to euthanize your dog, it is important to talk to your veterinarian. They can help you to understand the pros and cons of each option and make the best decision for your dog.

The Initial Symptoms of Kidney Failure in Dogs

One of the initial symptoms of kidney failure in dogs is an increase in water consumption and urination. You may also notice your dog has lost their appetite and is losing weight. Your dog may seem lethargic and have decreased energy levels.

As the disease progresses, your dog may vomit, have diarrhea, and develop bad breath. In the final stages of kidney failure, your dogs body is gradually filling up with toxins. You may gradually start to see signs a dog is dying from kidney failure.

Signs Of Renal Failure in Dogs

1. One of the first signs that your dog may have renal failure is an increase in thirst and urination. You may notice your dog spending more time at the water bowl and making more trips outside to relieve himself.
2. A decrease in appetite is another common sign of renal failure in dogs. Your dog may lose interest in his food or stop eating altogether.
3. Weight loss is another sign that something may be wrong, as dogs with renal failure often consume fewer calories than they burn.
4. Pale gums are another common symptom, as kidneys play a role in producing red blood cells. If your dogs gums are pale, it could be a sign of anemia or other problems with his blood cells. Anemia can cause lethargy, weakness, fainting, and chronic infections.
5. Vomiting may also be a sign of kidney disease. Renal failure affects the bodys ability to filter out toxins so dogs with kidney disease cant always keep their stomach contents down when they get sick.
6. Older dogs often show these symptoms before younger ones do because theres a chance theyre suffering from both kidney disease and arthritis at the same time. Signs of arthritis include limping on one side or difficulty getting up off the floor without help from you or another person.

Recognizing The Decline

The final stages of canine kidney failure are very difficult for both the dog and the owner. As the toxins build up in the dogs body, it will start to experience a decline in its health. Recognizing the signs that your dog is dying is important so that you can make the decision to euthanize them. Some common signs include fever, difficulty breathing, vomiting, diarrhea or constipation.

Read More: How Much Does it Cost to Euthanize a Dog at Home

Dogs who have experienced fever may also show seizures or paralysis. They may also seem disoriented and uncoordinated as their limbs stop working correctly. These symptoms are often accompanied by an increased heart rate and rapid breathing. If you notice any of these symptoms, it is important to contact your veterinarian immediately because there may be something else going on besides just renal failure that needs attention as well.

Read More: Dog Kidney Failure When To Euthanize Your Dog

Hospitalization

Your dog may need to be hospitalized in the final stages of kidney failure. This is because their body will slowly start to fill up with toxins. hospitalization will help to keep your dog comfortable and will also allow them to receive more intensive Treatment Guidelines for Chronic Kidney Disease in Dogs and Cats.

During this time, you may notice that your dogs appetite decreases and they begin to lose weight. You may also notice that they drink less water and urinate less often. As the toxins build up in their body, they may start to experience nausea and vomiting. In the final stages, your dog may become lethargic and sleepy. They may also experience seizures or muscle twitching.

Shortness of breath

One of the most common signs that a dog is dying from kidney failure is shortness of breath. This is because the kidneys are responsible for filtering toxins out of the blood, and when theyre not functioning properly, those toxins build up and cause respiratory distress. If your dog is having trouble breathing, its important to take them to the vet immediately. In the meantime, here are some things you can do to help your dog feel more comfortable in their final days.

Try to keep them cool this will prevent overheating which leads to fluid accumulation in the lungs (pulmonary edema). It also prevents dehydration and weight loss which can make a dog more uncomfortable.

Give them water or electrolyte-rich fluids such as coconut water or Pedialyte in order to prevent dehydration. Its also important to provide medications if your dog has any allergies or other medical conditions that require medication in order for them to be as comfortable as possible in their final days.

Loss of appetite and vomiting

One of the initial signs that your dog is entering the final stages of kidney failure is a loss of appetite. Your dog may stop eating altogether or may only pick at their food. They may also start vomiting. As their body starts to fill up with toxins, they may experience nausea and will no longer have an appetite. This can lead to weight loss and weakness. You may also notice that your dog is drinking less water than usual.

Depression

As your dogs kidney function declines, this can lead to depression, as your dog may not feel well and may not have the energy to do things they once enjoyed. You may notice your dog sleeping more, or they may stop eating as much.

In the final stages of kidney failure, your dog may experience severe kidney pain and may go into shock. As their organs start to shut down, they will become increasingly weak and sleepy. Ultimately, death from kidney failure is a peaceful process, and your dog will drift off into a deep sleep from which they will not wake up.

Read More: How to Euthanize a Dog with Over the Counter Drugs

Diarrhea and Bloody Urine

One of the most common signs that a dog is in the final stages of kidney failure is diarrhea and bloody urine. This is because the kidneys are no longer able to filter out toxins from the blood, causing them to be excreted through diarrhea.

Bloody urine may also be caused by dehydration, which is common in dogs with kidney failure. As the body becomes more and more dehydrated, the blood becomes thicker and can start to form clots. This can lead to bloody urine. If you notice any of these signs, its important to take your dog to the vet immediately.

Confusion at the end stage

At the end stage of kidney failure, your dogs body is gradually filling up with toxins. This can cause confusion and disorientation. You may also notice your dogs appetite decreases and they start to drink less water. As their kidneys begin to shut down, your dog may experience diarrhea, vomiting, and seizures. In the final stages, your dog will become comatose and eventually die.

The Final Stage (death): 15+ hours before death

In the last 15 hours before death, your dog may become very quiet and lethargic. They may also refuse to eat or drink anything. As their body starts to shut down, they may experience seizures or convulsions. Ultimately, they will fall into a coma and die. Dogs who have been in kidney failure for over 6 months are much more likely to be in these final stages, but it can happen at any time during the disease process.

How Can I Make My Dog Comfortable With Kidney Failure?

Making your dog comfortable with kidney failure is crucial during this challenging time. Here are some ways you can help:

Physical Comfort:

• Warm, cozy environment: Provide a comfortable bed or blanket in a quiet, draft-free area. Use heating pads on low settings if your dog tolerates them.
• Easy access to food and water: Ensure fresh, clean water is always available. Place food and water bowls at a convenient height, especially if weakness is present.
• Pain management: Discuss pain medication options with your veterinarian to keep your dog comfortable.
• Gentle massage: Gentle stroking and massage can provide comfort and relaxation. Focus on areas like the legs, chest, and back.
• Support for movement: Help your dog up and down stairs or outside for bathroom breaks if needed. Provide ramps or harnesses for additional support.

Dietary and Fluid Support:

• Prescription kidney diet: Work with your veterinarian to find a balanced, low-protein, and phosphorus-restricted diet suitable for your dogs specific needs.
• Smaller, more frequent meals: Divide daily meals into smaller portions to encourage eating and reduce digestive strain.
• Hydration support: Encourage water intake through fresh water bowls, flavored water, or even ice cubes. Subcutaneous fluids administered by your veterinarian might be necessary in advanced cases.

Emotional and Mental Support:

• Spend quality time with your dog: Talk to them in a soothing voice, offer gentle petting, and engage in familiar activities they enjoy (within their limitations).
• Maintain daily routines: Consistency in their schedule can provide comfort and a sense of security.
• Reduce stress and anxiety: Avoid loud noises, unfamiliar people, or situations that might overwhelm your dog.
• Consider veterinary hospice care: In advanced stages, specialized veterinary hospice care can provide additional comfort and pain management in a home-like setting.

How Do I Know If My Dog Is In Pain From Kidney Failure?

Determining if your dog is in pain from kidney failure can be difficult, as dogs tend to hide their discomfort. However, there are some clues to watch for:

Physical Signs:

• Changes in posture and movement: Your dog may hunch their back, appear stiff or sore, or avoid lying down in certain positions due to discomfort.
• Whining, groaning, or vocalizations: Unusual vocalizations, especially when touched or moved, can indicate pain.
• Decreased activity and playfulness: A noticeable reduction in their usual playful behavior or reluctance to participate in activities they once enjoyed can be a sign of pain.
• Changes in appetite and drinking: Sudden changes in eating or drinking habits, especially decreased appetite or avoidance of water, can be linked to pain or discomfort.
• Excessive licking or biting at specific areas: If your dog excessively licks or bites at their abdomen, back, or other areas, it could be due to pain in those locations.
• Behavioral changes: Increased aggression, withdrawn behavior, or hiding can indicate distress and potential pain.

Additional Observations:

• Facial expressions: Watch for signs of anxiety or discomfort in your dogs facial expressions, such as flattened ears, wide eyes, or a grimace.
• Body language: Changes in tail position, lowered head, or avoiding eye contact can be indicators of discomfort.
• Changes in sleep patterns: Difficulty sleeping or restless sleep patterns can be due to pain or underlying discomfort.

What Not To Give A Dog With Kidney Failure?

If your dog has kidney failure, its crucial to be mindful of their diet and avoid anything that might worsen their condition. Here are some things you should not give a dog with kidney failure:

Food and Treats:

• High protein foods: Excessive protein places strain on the kidneys as they struggle to remove waste products. Opt for low-protein kidney-specific diets recommended by your veterinarian.
• High phosphorus foods: Excess phosphorus can exacerbate kidney damage. Avoid dairy products, meat bones, processed meats, and commercial treats high in phosphorus.
• High sodium foods: Sodium can contribute to high blood pressure and worsen kidney function. Steer clear of salty foods like cured meats, cheese, and human snacks.
• Toxic foods: Grapes, raisins, onions, mushrooms, and chocolate are all toxic to dogs and can worsen kidney failure.
• Fatty foods: High-fat foods can be difficult for dogs with kidney disease to digest and may cause nausea or vomiting.

Medications and Supplements:

• Over-the-counter medications: Many over-the-counter pain relievers and anti-inflammatory medications can be harmful to dogs with kidney disease. Always consult your veterinarian before giving your dog any medication.
• Herbal supplements: Some herbal supplements can interact with medications your dog is already taking or have adverse effects on their kidneys. Consult your veterinarian before giving your dog any supplements.

Conclusion

If you notice any of these symptoms in your dog, it is important to see a veterinarian right away. Early diagnosis and treatment of kidney failure is essential for improving the chances of a successful outcome.

Treatment for kidney failure in dogs will vary depending on the underlying cause and the severity of the condition. In some cases, treatment may be able to reverse the damage to the kidneys. However, in many cases, the goal of treatment is to manage the symptoms and slow the progression of the disease.

If you have any questions about kidney failure in dogs, please talk to your veterinarian. They can provide you with more information about the condition and help you develop a treatment plan for your dog.

FAQs

How long does end stage kidney failure last in dogs?

Median survival time for Stage 4 kidney disease (considered end-stage) ranges from 14 to 80 days, according to IRIS guidelines.Some dogs with aggressive treatment and supportive care may even manage for several months or even a year.Unfortunately, some dogs may deteriorate and succumb to the disease much faster, within days or even weeks.

Can a dog die naturally from kidney failure?

Yes, unfortunately, dogs can die naturally from kidney failure. Its a serious condition that progresses as the kidneys lose their ability to function properly, leading to the buildup of toxins in the body. This can eventually lead to organ failure and death.

When should I put my dog to sleep with kidney failure?

The decision of when to euthanize a dog with kidney failure is a deeply personal and difficult one, and there is no single right answer. Its a complex process that requires careful consideration of your dogs individual situation, their quality of life, and your own emotional well-being.

Do dogs cry with kidney failure?

Dogs with kidney failure typically do not cry in the same way humans do due to emotional distress. Tears in humans are triggered by a complex combination of emotional and physical factors, including the release of hormones and neurotransmitters. While dogs can produce tears, they primarily serve lubrication and eye health functions, not emotional expression.However, some dogs with kidney failure may exhibit vocalizations that could be misinterpreted as crying. These vocalizations can include:Whimpering: This can be a sign of pain or discomfort, which is common in advanced stages of kidney failure.Howling: This can be a sign of anxiety or distress, which can also occur in dogs with kidney disease.Moaning or groaning: These sounds can also indicate pain or discomfort.

Can you save a dog with kidney failure?

Unfortunately, saving a dog with kidney failure is not always possible, as it depends on various factors like:Stage of the disease: Early diagnosis and treatment offer better chances of managing symptoms and prolonging life. In advanced stages, saving the dog might be challenging or even impossible.Underlying cause: Some causes, like acute kidney failure due to toxins, may have better treatment options and recovery potential than chronic kidney disease caused by age or genetics.Severity of damage: The degree of kidney damage plays a crucial role. If significant damage has already occurred, full recovery might not be achievable, but managing symptoms and improving quality of life is still possible.Response to treatment: Some dogs respond well to medications, dietary changes, and other supportive care, allowing them to live comfortably for months or even years. Others may not respond as well, limiting the potential for saving them in the traditional sense.

Do dogs with kidney failure smell?

Dogs with kidney failure may sometimes develop a distinct odor, but its not a universal symptom and can vary depending on the stage and severity of the disease