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Chronic Kidney Disease

Advice about treating and managing Chronic Kidney Disease

Chronic kidney disease is a common condition in cats and to a lesser extent dogs. The cause of the disease is usually unknown but the end result is a gradual reduction in the amount of the kidney that is able to excrete waste products. The first signs of the disease are apparent when 60% of the functioning kidney is lost, these are usually mild, unnoticeable signs that are only apparent on blood or urine tests. When 70% of the kidney is lost the build up of toxins in the blood will cause the animal to become ill and show signs of kidney failure. There is no cure for kidney disease but if picked up early we can support remaining kidney function and prolong the life of the kidney. It is a good idea if you have an elderly pet over the age of 8 in dogs or 10 in cats to bring a urine sample to your annual health check and vaccination, so we can regularly monitor the concentration of your pet’s urine and therefore check its kidney function.

Signs of kidney disease to watch out for in your pet:

  • Increased drinking
  • Increased urinating
  • Intermittently off food
  • Vomiting
  • Weight loss
  • Sudden blindness in cats
  • Dull unkempt coat

The consequences of kidney disease are:

  • A build-up of toxins in the blood which will make your pet off colour
  • Protein loss in the urine which is seen as a loss of muscle
  • High blood pressure which can cause blindness
  • Ulcers in the mouth and stomach which affect appetite and cause sickness
  • Anaemia which will cause lethargy and an unwillingness to exercise

Investigations

The first thing we will do to investigate kidney disease is to take a blood sample and collect a urine sample. Once kidney disease has been confirmed we will then do several tests to stage your pet’s kidney disease using the IRIS system from 1 to 4 with various sub stages. This allows us to evaluate the severity of the kidney disease and target our treatment most effectively. To enable us to stage your pets kidney disease we will take additional blood tests, run extra urine tests and measure your pets blood pressure. It is likely that your pet will be hospitalised as a day patient in order for us to do this.

Treatment

1. Diet – The most important component of treating kidney disease is diet. An animal with kidney disease is unable to remove phosphate from the blood stream so it builds up causing nausea and vomiting. A kidney diet is formulated to be very low in phosphate. We recommend the Royal Canin Renal diet which comes as a kibble for cats, as wet pouches in Beef, chicken or tuna in gravy, or as a small tin, or Royal Canin Renal diet for dogs which comes in tins, pouches or as a dry kibble. Also contains only small amounts of high quality protein which helps prevent build-up of protein metabolites in the blood. If your pet isn’t keen on the diet please persevere, try warming up the food or hand feeding and we can also use appetite stimulants in these cases.

2. Phosphate binders – If your pet won’t eat the renal diet then it is better they eat something rather than nothing! In this case we add a phosphate binder to the food to reduce the dietary intake of phosphate. This may also need to be used if your pet’s phosphate levels can’t be managed by diet alone.

3. Anti-hypertensive drugs – e.g. amlodipine or an ace-inhibitor, will be used if your pet has high blood pressure. An ace-inhibitor will also be used if your pet has excess protein in their urine.

4. Fluids – water intake should be maximised at home to help continually flush the kidneys. Therefore the wet diets are better and extra water can be added to the food. Some owners will administer subcutaneous fluids at home and if your animal becomes very sick we may consider a period of intravenous fluids to flush out the kidneys.

5. Potassium supplementation – This is used in some kidney cases if the potassium is low.

6. Anabolic steroid and Vitamin B injection – This injection is used if your pet is anaemic to boost red blood cell production and also to boost appetite and demeanour.

Long term management

Your pet will need a check-up at least every 6 months to monitor blood parameters, urine samples and blood pressure. You are also entitled to a free nurse clinic every 3 months to monitor your pet’s weight and overall health. If you have any concerns about your pet in the meantime, especially if you notice any changes in drinking or urinating then please contact us at the clinic.

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