kidney failure dog stages

By Isabella Storyclaire

last updated September 16, 2024

Contributions sourced from

What Are the Symptoms of a Dog Dying From Kidney Failure?

If your dog has been diagnosed with this renal disease or you're worried they're showing signs associated with end-stage kidney failure, a lot is probably going through your mind right now. At the forefront might be which stage of kidney disease does your dog fall under, and how can you make them as comfortable as possible? It's advisable to educate yourself about what to expect as your pet's illness progresses. That way, you can give them the best quality of life all the way through their final days.

Dog Kidney Failure Stages

Dogs with kidney failure go through a series of four stages, from diagnosis through the eventual death of the animal. These stages do not necessarily occur within rapid succession. A dog can go through them over the course of a few months or even years. Veterinarians determine the stage your dog is in by testing the urine to look for signs of the deterioration of the kidney's functions and the blood for symmetric dimethylarginine (SDMA) levels.

The Four Stages of Kidney Failure Chart

The canine kidney failure stages are determined by the levels of creatinine and SDMA, as well as the urine-to-protein (UPC) ratio and the animal's systolic blood pressure.

Dog Kidney Failure Stage	Creatinine (in mg/dL)	SDMA (in g/dL)
Stage 1	less than 1.4	less than 18
Stage 2	1.4 to 2.0	18 to 35
Stage 3	2.1 to 5.0	36 to 54
Stage 4	greater than 5.0	greater than 54

Other clinical indications that a dog is in the stages of kidney failure are:

UPC Ratio:
- Nonproteinuric: less than 0.2
- Borderline proteinuric: 0.2 to 0.5
- Proteinuric: greater than 0.5
Systolic blood pressure (in mmHg):
- Normotensive: less than 150
- Borderline hypertensive: 150 to 159
- Hypertensive: 160 to 179
- Severely hypertensive: greater than 180

Symptoms of End-Stage Kidney Failure in Dogs

The most common signs a dog is dying from kidney failure include:

Uremia: The buildup of waste products in the body produces a distinctive ammonia smell that is especially apparent on the breath.
Pale, dry gums: The gums are duller and dry to the touch.
Mouth ulcers: Uremia causes raw mouth ulcers that are painful.
Bloodshot eyes: The whites of the eyes are bloodshot.
Increased thirst: An affected dog drinks water excessively.
Increased urination: The dog will urine large volumes of dilute urine.
Dehydration: Despite more fluid intake, the dog is dehydrated.
Decreased appetite: The dog loses interest in food.
Weight loss: The dog steadily loses weight.
Gradual loss of fat and muscle mass: The weight loss affects both fat and muscle mass and can cause emaciation.
Dull coat that sheds excessively: The lackluster coat constantly sheds and looks unkempt.
Lethargy: The dog has little energy or interest in moving around.
Fatigue: The dog sleeps most of the day and night with only brief periods of wakefulness.
Vomiting: The dog vomits frequently and cannot keep food down.
Anemia: The dog may develop anemia.
High blood pressure: The dog has elevated blood pressure.
Incontinence: A dog cannot control their urination.
Difficulty breathing: The dog has problems breathing normally.
Slowing heart rate: A faster heart rate is generally present with kidney failure, but the heart rate begins to slow down during the end stage of the disease.
Depression: The dog seems sad and does not respond to any of their favorite things.
Low temperature: Dogs in their last days of kidney failure can experience hypothermia or a low body temperature.
Lack of interest in surroundings: The dog is unaware of or disinterested in their surroundings.
Disorientation: The dog acts confused at times.
Loss of balance and coordination: The dog appears clumsy and unsteady on their feet.
Trembling or shaking: The dog has tremors or episodes of shaking.
Seizures: The dog suffers periodic seizures, one of the major signs of end-stage kidney failure.

Keeping Your Pet Comfortable

Watching your pet go through this can be very difficult. However, there are things you can do to help keep your dog comfortable during the final stages of kidney disease.

Spend as much time as possible with your dog. Even being in the same room will be soothing to them.
Make sure your dog's resting area is quiet, warm, and cozy. Provide them with their favorite blanket and toy.
Protect your pet from other pets or people who may be too rough with them. Supervise interactions with children and teach them to be gentle with the dog.
Pet your dog and talk to them frequently.
Change your dog's bedding often and keep them clean and dry. Brush their fur for dry cleaning. Clean their fur with a sponge bath solution of hypoallergenic pet shampoo.
Feed your pet a low-protein dog food appropriate for a kidney failure diet.
If your dog refuses to eat or has trouble eating, ask the veterinarian about other feeding options such as an esophagostomy tube to keep them nourished.
Monitor your dog's temperature and keep them warm with plenty of cozy blankets.

Last Days of a Dog Dying From Kidney Failure

While a dog owner may fear that entering the final stage of kidney failure means their dog's passing away is imminent, it is difficult to predict how long the does has left. In general, you can expect your dog to pass away within three months of moving into stage 4, though some dogs may thrive for up to a year.

It depends on the associated symptoms and other conditions that may arise due to the dog's poor health. Your dog's age is another factor. There's a lot to keep in mind, a lot to hope for, and the reality that you're facing the end of your dog's life.

Fast Fact

Controlling your dog's diet can help during their struggle with renal failure. Carefully discuss nutrition with your dog's veterinarian.

When to Consider Euthanization

When a dog enters end-stage renal failure, your veterinarian may recommend an end-of-life home treatment plan or a hospice program to make your pet's last days comfortable and maintain your pet's quality of life. For end-stage kidney failure, a treatment plan may include dialysis, a stomach tube, intravenous therapy, pain medication, and methods to care for an incontinent pet.

Depending on their symptoms, your dog may not necessarily be in severe pain, but they will be uncomfortable at the least from other symptoms, including frequent vomiting and diarrhea, lethargy and depression, and constant dehydration. Your veterinarian may recommend euthanasia if a dog is suffering, unresponsive to pain management, or too weak to handle necessary life-sustaining treatment.

Dealing With the Loss

It's hard to come to terms with the fact that a pet is dying. Find comfort in the fact that your dog appreciates your loving care in their final days. They know you love them and take comfort in your presence and all that you do to make their life easier.

End-stage renal disease

Overview

End-stage renal disease, also called end-stage kidney disease or kidney failure, occurs when chronic kidney disease the gradual loss of kidney function reaches an advanced state. In end-stage renal disease, your kidneys no longer work as they should to meet your body's needs.

Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When your kidneys lose their filtering abilities, dangerous levels of fluid, electrolytes and wastes can build up in your body.

With end-stage renal disease, you need dialysis or a kidney transplant to stay alive. But you can also choose to opt for conservative care to manage your symptoms aiming for the best quality of life during your remaining time.

One of the important jobs of the kidneys is to clean the blood. As blood moves through the body, it picks up extra fluid, chemicals and waste. The kidneys separate this material from the blood. It's carried out of the body in urine. If the kidneys are unable to do this and the condition is untreated, serious health problems result, with eventual loss of life.

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Symptoms

Early in chronic kidney disease, you might have no signs or symptoms. As chronic kidney disease progresses to end-stage renal disease, signs and symptoms might include:

Nausea
Vomiting
Loss of appetite
Fatigue and weakness
Changes in how much you urinate
Chest pain, if fluid builds up around the lining of the heart
Shortness of breath, if fluid builds up in the lungs
Swelling of feet and ankles
High blood pressure (hypertension) that's difficult to control
Headaches
Difficulty sleeping
Decreased mental sharpness
Muscle twitches and cramps
Persistent itching
Metallic taste

Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys can make up for lost function, signs and symptoms might not appear until irreversible damage has occurred.

When to seek care

Make an appointment with your health care provider if you have signs or symptoms of kidney disease.

If you have a medical condition that increases your risk of kidney disease, your care provider is likely to monitor your kidney function with urine and blood tests and your blood pressure during regular office visits. Ask your provider whether these tests are necessary for you.

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Causes

Healthy kidney vs. diseased kidney

A typical kidney has about 1 million filtering units. Each unit, called a glomerulus, joins a tubule. The tubule collects urine. Conditions such as high blood pressure and diabetes harm kidney function by damaging these filtering units and tubules. The damage causes scarring.

Polycystic kidney

A healthy kidney (left) eliminates waste from the blood and maintains the body's chemical balance. With polycystic kidney disease (right), fluid-filled sacs called cysts develop in the kidneys. The kidneys grow larger and gradually lose the ability to function as they should.

Kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. For some people, kidney damage can continue to progress even after the underlying condition is resolved.

Diseases and conditions that can lead to kidney disease include:

Type 1 or type 2 diabetes
High blood pressure
Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis) an inflammation of the kidney's filtering units (glomeruli)
Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's tubules and surrounding structures
Polycystic kidney disease or other inherited kidney diseases
Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Risk factors

Certain factors increase the risk that chronic kidney disease will progress more quickly to end-stage renal disease, including:

Diabetes with poor blood sugar control
Kidney disease that affects the glomeruli, the structures in the kidneys that filter wastes from the blood
Polycystic kidney disease
High blood pressure
Tobacco use
Black, Hispanic, Asian, Pacific Islander or American Indian heritage
Family history of kidney failure
Older age
Frequent use of medications that could be damaging to the kidney

Complications

Kidney damage, once it occurs, can't be reversed. Potential complications can affect almost any part of your body and can include:

Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening
Heart disease
Weak bones and an increased risk of bone fractures
Anemia
Decreased sex drive, erectile dysfunction or reduced fertility
Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
Decreased immune response, which makes you more vulnerable to infection
Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium)
Pregnancy complications that carry risks for the mother and the developing fetus
Malnutrition
Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival