Has your pet been diagnosed with Kidney Disease?
For Frequently Asked Questions Click for the Morris Animal Foundation's FAQ Sheet on Kidney Disease.
For a quick overview visit the ASPCA Kidney Disease Webpage
Looking for answers on what this diagnosis means for you and your pet? This is the place to find out more about this diagnosis and how we support and treat cats and dogs with this common condition.
Hill's Atlas of Veterinary Clinical Anatomy
A good place to start is at our website's VeterinaryPartner Library. To help you find the information it provides quickly, we are providing this link to Veterinary Partner's Chronic Kidney (Renal) Disese Center. The Center will then link you to an entire collection of articles on the different therapies that help our kidney failure patients.
We recommend starting with the article from the Kidney Disease Center called, Kidney Disease: Where to Begin. This article will explain the vocabulary of this disease. It will also discuss the various blood tests that we use to evaluate kidney disease. It is a good handout to have handy when your veterinarian is calling you with blood test results.
The Morris Animal Foundation has produced a FREE and On-Demand Webinar for Caregivers of pets with kidney disease! It explains causes, symptoms, and treatments. You can watch it by simply registering at the link.
You may hear us talk about your pet's urine concentration or specific gravity. You may ask what is the significance of urine concentration? Urine is a solution containing "stuff", various waste products and toxins, cleared by the kidney and that need to be excreted from the body. Urine concentration or specific gravity reflects how much "stuff" is in the urine or the concentration of these excreted waste products. The more "stuff", or the greater the concentration of these products in the urine, the higher the specific gravity will be. Pure water serves as a baseline, it has a specific gravity of 1.000.
The specific gravity of urine is measured to also determine the kidney's ability to concentrate or dilute the urine to maintain the body's hydration status. When water is scarce or the body wants to prevent dehyration, the kidneys work to retain as much fluid in the body as possible. So the kidneys resorb as much water passing through them as possible, but the kidneys still allow waste products and toxins to be excreted into the urine as usual. The concentration of the waste products is therefore is increased in the urine and specific gravity rises.
In patients with loss of kidney function, the concentration of waste products and toxins able to be excreated is decreased. In addition, the poorly functioning kidney is often unable to retain needed fluid in the body and excessive water is lost into the urine. The end result is that the urine concentration and specific gravity are decreased
In normal animals, urine specific gravity can vary greatly and will depend on fluid intake. In dogs normal can vary from 1.001 to 1.075, but most dogs will be above 1.020 a large part of the time and should be over 1.035 if not drinking much or dehydrated. Healthy cats tend to have consistently well concentrated urine, usually above 1.040. Cats as a species are not typically big water drinkers so their urine tends to be more concentrated.
Animals with chronic kidney disease will have dilute urine and decreased specific gravity because they are not excreting "stuff" or toxic waste well and they are also not able to retain body fluids. Much fluid is lost into the urine, and fewer toxins are able to be excreted, so urine concentration declines.
Dilute urine loses its strong yellow color and appears pale. The excessive loss of fluid and increased urine volume will stimulate thirst so pets with chronic kidney disease often have increased thirst in addition to increased volumes of urine. This is called polyuria and polydipsia or PU/PD.
Still confused about Urine Concentration and Specific Gravity? Click to read about Let's Get Specific about Urine.
Although we see kidney disease in both our canine and feline patients, it is especially common in cats. A great video resource, that provides a nice overview of feline kidney disease, is provided by the Veterinary School at Cornell University. Click this link to Cornell's Video on Feline Chronic Kidney Disease to learn more! It contains a great demonstration on a common treatment called subcutaneous fluid therapy. Even dog owners may find this video helpful.
Subcutaneous Fluid Therapy...You want me to poke what? Click the link for a helpful tutorial on how to give Subcutaneous (SubQ fluids)
Chronic Kidney Disease & Failure from Washington State University This veterinary school website from Washington State University provides a nice overview of kidney disease in an easily understandable format for pet owners.
International Cat Care Information on Kidney Disease This site gives the European view for owner's treating kidney disease in cats.
IRIS STAGING of Kidney Disease The International Renal Interest Society (IRIS) staging is a way to determine the severity level and prognosis for a patient with kidney disease. The staging is based on several lab parameters such as urine concentration, Blood values for kidney function (BUN and Creatitine), urine protein, and blood pressure.
One of the earliest therapies we try for our kidney disease patients is dietary therapy. The following handout from the Kidney Failure Center will explain more about the Dietary Therapy of Renal Failure.
We often recommend veterinary prescription kidney diets. Below are some examples. There are diets for both cats and dogs. Which is the best one? The answer is the one your pet likes best! Often finding the right one for your pet takes patience, encouragement, tincture of time, and some trial and error. It is important for pets with kidney disease to continue to eat well! Transitions to new diets may need to be gradual. We do not want any patient to go on a hunger strike! In general, we encourage feeding as much canned food as possible vs. dry food. This will help support hydration that is desperately needed in kidney failure patients.
The prescription diet manufacturers are great about backing their products. If your pet will not eat a diet after giving it a reasonable trial period, it can be returned for a refund on your Deer Run Animal Hospital account. The refund then can be used to try a different flavor or brand of kidney diet.
Hill's Prescription Diet Feline g/d-early kidney disease (prefer canned formulations of all kidney diets for cats)
Hill's Prescription Diet Canine g/d-early kidney disease
Hill's Prescription Diet Feline k/d/-moderate to late kidney disease
Hill's Prescription Diet Canine k/d/-moderate to late kidney disease
Purina Veterinary Diet Feline NF
Purina Veterinary Diets Canine NF
Royal Canin Veterinary Diets Feline Renal LP
Royal Canine Renal Modified Canine (MP)-early kidney disease
Royal Canin Veterinary Diets Canine Renal LP-modertate to late Kidney Disease
To learn more about how to order prescription diets from us, and home delivery options, please go to the Deer Run Animal Hospital Prescription Diet Ordering Information webpage. Or call our front desk staff for more ordering information and assistance.
If your pet does not accept the recommended kidney diet, let your veterinarian know. Not all pets will eat these diets and in these cases your vet will make other recommendations. The dietary goal for kidney disease involves feeding diets low in phosphorus, and these diets are also usually low in protein. Increased potassium and B vitamins are also important as well as low sodium content. For a listing of dietary phophorus content of many popular feline diets click this link:
Tanya's List of Phosphorus Content of Cat Food
Calcitriol Therapy: A treatment for Chronic Kidney Failure in Dogs & Cats is a promising supportive therapy to consider for kidney failure patients. Kidney failure eventually leads to a complication called Renal Secondary Hyperparathyroidism. This problem develops from a fairly complex sequence of events in renal failure patients and involves calcium and phosphorus balance, and a hormone called Parathyroid Hormone or PTH. Excessive levels of PTH build up causing toxicity throughout the body. Phosphorus levels will also increase when this happens. Calcitriol therapy is used to try to prevent this excess of PTH.
Calcitriol: A Therapy for Chronic Kidney Disease
Calcitriol drug therapy works best when started early in kidney disease, so we try to bring up this option as soon as the disease is diagnosed. It works best as prevention of excessive PTH and is less effective if PTH levels are already high. Calcitriol therapy is not for every pet and owner. It requires periodic blood monitoring and some expense. It may lenghthen and improve quality of life for our kidney failure patients, so we strongly recommend considering this treatment.
Calcium and Phosphorus Balance This is a link to a handout with more information on calcium and phosphorus balance.
Some cats get high blood phosphorus levels due to their Kidney Disease. If this happens, a phosphorus binder called Aluminum Hydroxide is usually recommended to be mixed into the diet to prevent absorption of phosphorus from food. Here is a reference to dosing Aluminum Hydroxide
Aluminum Hydroxide Supplementation Handout
Potassium Supplementation is often needed in cats with chronic kidney disease. Low blood potassium levels lead to weakness and hasten the progression of kidney disease. Here are some examples of supplements that are used to raise potassium levels: Renal K and Tumil K. Cats with low potassium can develop severe muscle weakness and may be unable to raise their heads as in the picture below.
High Blood Pressure or Hypertension is another common complication of kidney disease. This link will explain how high blood pressure is monitored and treated. Click to see a video of how we take a cat's blood pressure.
A Doppler blood pressure montior from Veterinary Partner.com
Fluid Therapy is often needed in our kidney failure patients.
If possible we want to use the oral route, click to learn how to make your cat drink more at our Cats & Water Drinking web page.
In severe and acute cases, hospitalization for intravenous fluid therapy may be needed. In more chronic situations, especially in cats and small dogs, Subcutaneous Fluid Therapy may be very beneficial. Watch this video on Feline Subcutaneous fluids and this Subcutaneous Fluid Therapy link both contain videos on how to give pets subcutaneous or Sub Q Fluid therapy at home. Your veterinarian will also be able to help you learn how to give your pet Sub Q Fluid therapy if it is indicated. Many clients learn to do this at home with ease after a little practice! Here is an article that give great instructions on how to give Subcuatneous Fluids...you want me to poke what? The European International Cat Care website has a great handout describing the procedure, but be aware some of their products look slightly different than American products, check them out at this link. Cat Subcutaneous Fluid Administration
Pets, especially cats, can often live for years with kidney failure, when well supported with the various therapies discussed in these handouts and links. There is no cure for kidney disease, but it is often possible to maintain quality of life for years with diligent monitoring and support. Periodic rechecks are important to monitor blood pressure, montior electrolytes, watch for urinary tract infections, monitor rate of progression, and adjust therapy as needed.
Caring for a Cat with Chronic Kidney Disease a great reference and resource for the cat owner by British Feline Specialist, Dr. Sarah Caney. The book can be purchased at this link either in hard copy or a downloadable version!
Feline Chronic Renal Failure Owner Information Center This website is written by an owner of a kitty that had renal failiure. If you are looking for the perspective of other owner's of cats with renal failure, this is a great support site. Most of the information is very accurate even though it is written by a cat owner without a veterinary education. You will learn that being the caregiver of a cat with renal failure is like getting a mini medical education!
Tanya's Comprehensive Guide To Feline Chronic Kidney Disease another great website by an owner of cats with kidney disease. Has great information and support.