Chronic Kidney Disease in Dogs and Cats

Chronic  Kidney Disease (or CKD) is diagnosed with lab tests that are performed by your Veterinarian.  CKD occurs when the kidneys are not able to do their job of removing waste products from the body as effectively as they should. These waste products accumulate in the blood and cause symptoms including increased thirst and urination, loss of appetite, vomiting, and weight loss.

Classification:

CKD is classified on a scale of four according to guidelines provided by the International Renal Interest Society (IRIS).  The higher the number, the more advanced the disease. Blood tests, urine tests, and a blood pressure measurement are required for staging. Staging CKD allows us to create the most effective treatment plan and allows us to come up with the most accurate prognosis. Our goal is to diagnose the problem early and to slow the progression of the disease.

Diagnosis:

Blood Tests:

With stage 2-4 CKD, kidney values are elevated in the blood. This elevation means that we have likely lost about 75% of the kidneys normal function.  Obviously we would like to try to diagnose kidney disease as early as possible; stage 1 or 2. So, weight loss, increased thirst and urination, decreased appetite, or any other signs of illness should be taken seriously, and blood tests and urine tests should be run as early as possible.

Urine Tests:

A decrease in the urine concentrating ability of the kidney typically happens earlier in kidney disease than bloodwork changes, and an increase in urinary protein happens even sooner. Therefore, when kidney disease is suspected, urine samples are the most valuable specimens we can collect. We look for protein, concentrating ability, and signs of infection or other disease.

How do we collect urine you ask? Your veterinarian can either collect the urine with ultrasound guidance, or you can collect urine from a litter box filled with non absorbing litter (like Styrofoam packing material).

Protein in the urine can exacerbate an existing kidney problems. The protein in the urine is also the result of a kidney problem. Looking for protein in the urine is critical whenever kidney disease is suspected. We look for urine on a special urine test strip, and we send samples out for more specific analysis. Treatment of urinary protein is with diet and medication.

The earlier we diagnose the disease, the more likely it is that we can help.

Blood Pressure:

Blood pressure elevations can damage the kidneys, and they can be the result of having kidney disease. If high blood pressure is diagnosed, it is critical to control it. Measuring blood pressure in a dog or cat is similar to measuring your blood pressure. We use a pressurized cuff and a special amplifier to hear the pulse. We have reliable medications to lower blood pressure.

Cause of Kidney Disease:

The cause of CKD is not always apparent. Infections including kidney infections, Lyme disease and Leptospirosis are possible causes. Vaccinating for Lyme disease and Leptospirosis and controlling tick exposure can help to prevent these diseases. Genetic s are frequently the cause, especially in cats

Treatment:

Treatment involves;  controlling blood pressure, decreasing urinary protein, restricting and/or binding dietary phosphorous, increasing water intake, controlling gastrointestinal upset, and limiting other toxins. Special kidney diets and supplementation of omega three fatty acids are among the earliest and most effective treatments.

Monitoring:

The Androscoggin Animal Hospital develops an individual plan for each patient.  Once the disease is staged and stable, you should have a recheck examination with your Veterinarian at least every 3- 6 months. This allows us to identify problems and to adjust our treatment plan accordingly to maximize quality of life.  These exams will include the following tests:

1.    A blood test. This allows us to look at kidney function including; kidney values, electrolytes (sodium, potassium, chloride, and phosphorous) and red cell number.

2.    A Urinalysis. This allows us to look at the concentration of the urine, to look for excessive protein in the urine, and to look for evidence of infection.  Treatment may be started or medications adjusted based on these results.

3.    A UPC  test on the urine (Urine Protein Creatinine ratio) If there is protein identified on the initial Urinalysis. Controlling protein loss has been shown to improve survival and quality of life.

4.    A Blood Pressure screening. CKD can be accompanied by high blood pressure. This can worsen the kidney disease, and can cause blindness, neurologic symptoms, and discomfort. We have very effective medications for controlling blood pressure.

In addition to these 4 recommendations, we may recommend performing the following additional tests every 3-6 months:

1.    A Urine Culture to rule out infection.  A urinalysis may make us suspicious, but only a culture can let us know for sure that there is no infection. Infections can cause additional kidney damage if they go undetected.

2.    A blood test for Parathyroid Hormone levels.  In some cases these levels are increased. Over time this elevation can cause bone problems, loss of appetite, and a worsening of kidney disease. Early detection and intervention has been shown to improve quality of life and survival.

With these tests, and working together with you, we can develop a treatment plan to help have a good quality of life while managing a serious disease.