Dear Dr. Dog: My veterinarian just informed me that my dear old Lab has kidney problems and I’m very worried. What can I do to keep my dog with me as long as possible despite kidney disease?
Although kidney disease is less common in dogs than cats, it does occur. This article discusses how you can optimize your dog’s kidney health, recognize signs of problems, and treat disease now that it has occurred.
The liver and the kidneys are largely responsible for the excretion of waste and for detoxification. The main function of the kidneys is to maintain hydration, filter the blood, and remove unwanted toxins, as well as maintaining proper electrolyte and pH balance. In addition to these critical functions, the kidneys stimulate the bone marrow to produce red blood cells. (This explains why patients who are in kidney failure are often anemic.)
Maintaining Kidney Health
The most important way to maintain healthy kidney function in dogs is to provide a plentiful source of clean drinking water at all times. Without water, the kidneys cannot effectively filter the blood, which leads to a buildup of toxins. Prolonged dehydration can lead to kidney damage and/or failure.
Nutrition is also critically important in kidney health. While there is no single food that is right for all dogs, most dogs thrive on foods that approach their evolutionary diets. Dogs are omnivores by nature, designed to eat a variety of plant- and animal-based foods. Wolves, coyotes, and wild dogs eat small animals (often whole) and also graze on grasses, berries, etc. They do not eat large amounts of carbohydrates like grains. Therefore, to keep your dog healthy, provide a well balanced raw diet and/or a grain-free canned diet. Grain-free kibble is also an acceptable option.
The Causes of Kidney Disease
There are a number of reasons why a dog may develop kidney insufficiency or failure. Some dogs are born with congenital problems that either directly or indirectly affect kidney function. Renal dysplasia (malformed kidneys) can occur, as well as a condition called renal amyloidosis, wherein a material called amyloid gets deposited over time, eventually leading to kidney damage and failure. Amyloidosis is most commonly seen in Shar Pei dogs.
Infection is another potential cause of kidney damage in dogs. Severe kidney infections, called pyelonephritis, can lead to death of kidney cells and a decrease in overall renal function. One bacterial disease in particular, leptospirosis, is known to cause kidney and/or liver damage in dogs. Leptospirosis infection in dogs can be difficult to treat and is sometimes fatal. A vaccination for leptospirosis is available for dogs and I recommend it for many of my canine patients.
Mechanics of Kidney Disease
Most cases of chronic renal insufficiency (CRI) or chronic renal failure (CRF) do not have a known causative agent. CRI and CRF usually occur in older dogs. Unfortunately, clinical signs usually are not present unless the dog has lost at least 60-75% of kidney function. This is why when a dog (or cat) begins to show signs of kidney problems, it is serious. By this time, they have very little in reserve.
When dog kidneys lose function, they can no longer concentrate urine. This means their urine is very dilute and they tend to lose a lot of water when they urinate, so they tend to drink more to compensate for the water losses. This process leads to the classic symptoms of drinking more water and urinating more, which is generally when pet owners realize there is a problem.
Animals in an acute kidney crisis often have stopped eating and drinking and generally feel terrible. Veterinarians treat this through a combination of fluid therapy (usually intravenous) and medications to help with GI upset and to improve appetite. Once patients are feeling better and are eating again, they often can be cared for at home.
Treating Kidney Disease
Chronic kidney disease is a bit tricky to manage. The patient generally has less than 25% of normal kidney function and there is no known way to stimulate regeneration of kidney cells. Therefore, the goal of treatment is to optimize the patient’s remaining kidney tissue.
With almost all kidney issues, maintaining hydration is the primary goal. Dehydration is very bad on the kidneys. Depending on the severity of the case, some animals will need to receive supplemental fluids in the form of subcutaneous (injected under the skin) fluids to supplement the water they drink. These animals must have constant access to clean water and be fed canned diets (wet food contains more water). We sometimes recommend that people add water or low-sodium chicken broth to canned food to improve appetite and water consumption as well.
Loss of appetite often occurs with kidney problems, which can worsen when a prescription diet is recommended. Prescription food for kidney problems generally is not very palatable and many animals refuse it. It is crucial that animals with kidney disease eat well, so never mind the prescription diet if your dog doesn’t like it.
Hydration and appetite aside, dogs with kidney disease may have alterations of their blood phosphorus, potassium, and water-soluble vitamin balance. Many of these issues can be addressed through nutritional supplements and/or medications. Correcting these imbalances can improve appetite, energy, and overall quality of life.
Alternative Medicine
Unfortunately, Western medicine has a fairly limited repertoire when it comes to treating kidney insufficiency and/or failure. Integrating complementary and alternative medicine into the treatment plan can really help dogs with kidney issues. Nutritional supplementation, acupuncture, probiotics, and herbal therapy are often very effective at supporting the immune system, optimizing blood flow and kidney function, and supporting other organs, in particular the liver. The liver is the body’s other main organ of detoxification, so improving its function is an excellent way to ease the load on the kidneys.
As with any disease, the treatment plan for a dog with kidney problems should be tailored to the individual. Don’t hesitate to ask your veterinarian questions as you develop an effective plan for managing your dog’s kidney disease.
Best of health in 2011 to you and your animal companions!
Gary Richter has been a veterinarian in the East Bay for 12 years. He is the owner and medical director of Montclair Veterinary Hospital as well as Holistic Veterinary Care, a facility dedicated to providing alternative and complementary health options for pets. Dr. Richter lives in Oakland with his wife, daughter, and several pets.
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