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Find out about Kidney emergencies

Now a days it is common to see dogs brought into pet clinic complaining that dog is drinking too much water and urinating excessively and also vomiting food. The pet parents complain that these dogs want to be let outside more frequently during the day and may urinate on household furniture as well. These may be the first observable signs of acute renal failure (ARF) that appear suddenly, but there are many other signs that appear preceding this which most often go unnoticed even by the most attentive pet parents. Here’s more info on ARF.

Case file…

Dr Suranjan Sarkar

Dr Suranjan Sarkar

Recently, I had a patient – a Cocker Spaniel – with complaints of drinking water frequently, eating very less food and vomiting afterwards. I enquired about his history and was told by the pet parent that the dog has been sick for about one month, but the problem of vomiting started about six months back. As I further queried, I came to know that it all started six months back when the dog received treatment from a very popular local quack in Ranchi for skin disease, probably scabies. The skin condition got better but the dog started vomiting everything he was fed. On examination, I found that the dog was not urinating properly and in less quantity. The dog felt pain whenever the belly area was palpated. I suggested haematological and biochemical test. Test results showed serum creatinine 4.7 and blood urea 102.00. This was way high. After two months of treatment along with renal diet, the dog is nearly normal with serum creatinine 1.3.

Dogs at risk

While dogs of any age are prone to kidney disease, it is most often seen in elderly dogs. Large breed, free-roaming dogs seem to be predisposed to this condition, probably due to their increased access to poisonous plants, chemicals, snakes, insects, micro-organisms and other nephrotoxins (things that damage the kidneys). Systemic illness, dehydration, low blood pressure (hypotension), advancing age and administration of certain drugs can also put dogs at an increased risk of developing ARF. In Indian condition, it is very often seen during summer months when dogs suffering from dehydration show signs of ARF. There are breed predisposition also. Certain breeds who are more prone to kidney disease are Samoyed, Bull Terrier, Cairn Terrier and German Shepherd.

Signs and symptoms

In ARF, there is decline in kidney function. Kidney is a very important organ of body and among others; it is responsible to regulate blood pressure, blood sugar, blood volume, water composition of the blood, pH level and produces red blood cells and certain hormones. The symptoms mainly depend upon degree of losses in kidney function and upon body’s way to compensate those losses, so one or more symptoms listed below may be noticed in dogs with ARF.

  • Vomiting
  • Lethargy
  • Dullness
  • Diarrhoea
  • Constipation
  • Weight loss
  • Increased thirst
  • Lack of appetite
  • Blood in urine
  • Dehydration
  • Fever
  • Oral ulcers
  • Dull and dry coat
  • Paleness of mucous membrane
  • Acute blindness due to high blood pressure
  • Seizures and comas
  • Increase in frequency and amount of urination
  • Bad breath from buildup of blood urea nitrogen in blood
  • Brownish discoloration of tongue surface

Causes of ARF

There are many causes of renal failure in dogs, some of which are listed below.

Anitimicrobials, NSAIDS: Indiscriminate use of antibiotics are damaging to kidneys. Aminoglycoseds are most nephrotoxic, so prolonged use of these drugs should be avoided. Similarly renal disease in dogs has been associated with administration of NSAIDS such as Aspirin, Carprofen, Flunixin Meglumine, Naproxen, Phenylbutazone and Ibuprofen.

It is very often seen that when dogs fall sick due to some reason, pet parents tend to give them over the counter drugs or contact quacks instead of contacting qualified vets. These practices encourage indiscriminate use of antibiotics and NSAIDS without knowing the side effects of those drugs.

Vitamin D: Dogs and cats who consume vitamin D3 contained in rodenticide formulation accidentally may develop ARF. In addition, toxicosis can also occur from feeding formulation containing excessive Vitamin D.

Foods: Certain plants such as lilies, grapes and resins are nephrotoxic and can cause ARF.

Other diseases: Infectious disease like Leptospirosis is a cause of ARF, so dogs should be vaccinated against endemic strains of leptospira. Other diseases such as Lyme disease and Pyelonephritis also cause ARF in dogs.

Word of caution: If leptospirosis may be the cause of ARF, the pet parent should handle urine extremely careful, because the causative micro-organism is zoonotic – which means that it can infect humans as well as dogs.

Diagnosing ARF

The signs and symptoms listed above may also be found in many other disease conditions, so blood and urine are sent to pathological labs for testing. The test results in dogs with ARF may reveal elevated blood urea nitrogen (BUN), creatinine and phosphorus levels, abnormally low urine specific gravity and maybe evidence of a urinary tract infection or obstruction. High levels of circulating BUN, creatinine and phosphorus are caused by the kidney’s inability to properly filter toxic waste products from the blood and flush them out in urine. Low urine-specific gravity means that the kidneys aren’t able to reabsorb water and concentrate urine normally, which makes it overly dilute, contributing to the dog’s dehydration, despite a high water intake.

Treating ARF

Treatment of kidney failure in dogs occurs in two phases. The first phase is to restart the normal functioning of kidneys. Large quantities of intravenous fluids are given to flush out the kidneys. This flushing process, called diuresis, helps to stimulate the kidney cells to function again. If enough functional kidney cells remain, they may be able to adequately meet the body’s needs for waste removal. Fluid therapy includes replacement of various electrolytes, especially potassium. Drugs are given to control vomiting and diarrhoea and also for gastric ulcers. Underlying cause should be treated; for example, antibiotic therapy in cases caused by bacterial infection.

The second phase of treatment aims to keep the kidney functioning as long as possible. This is achieved by feeding dogs a diet low in phosphorous and protein and not acidified. There are various commercially available renal diets for dogs which will help prolong the life of kidney by putting less stress to kidney some of these are Hills k/d, Royal Canin renal LP and Purina NF.

(Dr Suranjan Sarkar, global1693@gmail.com  runs Complete Dog Care at Ranchi, which is truly a complete pet corner where available medical facilities, grooming, pet food, accessories and others,).


Facebook

Q. I have a nine-year-old dog who is facing the problem of kidney failure. What should I do? Is kidney transplant possible?
– Sudhir, Gurgaon

“Kidney failure is a tough thing to handle, both for pet parents and the pets. I’m glad you are willing to go to such great lengths to try and save your dog. However, a kidney transplant is not a viable option. For example, you can’t transplant just any other dog’s kidney into yours. It has to be matched at the antigenic level. Finding such a dog will mean having to test quite a few. This is very expensive and I don’t think anyone is doing this in India.

The next is the surgery itself. But he will have to be put on immunosuppressive drugs for the remainder of his life to prevent transplant rejection. Which means, even a small stomach bug could kill him. Considering all of these things, I repeat, kidney transplants are not a viable option in dogs.”
– Dr Kadambari Venkatraman, Olive’s Pet Clinic, Hyderabad

“The best alternative option is haemodialysis, which is available at selected places Madras Veterinary College or Bombay Veterinary College. Once he is stabilised, he can be placed on the renal diet and required medications that may help to prolong his life up to three years (depending on degree of kidney function left).”
– Dr K G Umesh (MVSc, MSc (UK)), Regional Associate for South Asia, WALTHAM

“Kidney transplantation is a final option but in Indian standard it is not possible at all. You can go for alternative option of dialysis.”
– Dr Shivaji H Talekar, New Hope Hospital, Mumbai

“Unfortunately there are a few institutions doing it with very low success rate (about 30 percent).
– Dr RM Bhardwaj, member (co-opted), Animal Welfare Board of India

Health

Key Kidney Knowledge

Looking after your pet’s health is probably the most important gift that you can give them. Some diseases like chronic kidney disease (CKD) and kidney failure build up over a long period of time and very often pet parents are not even aware that their pet is affected.

Chronic kidney disease (CKD): CKD is the most common kidney disease in dogs and cats. Regardless of the cause, CKD is characterised by progressive damage to kidney. It destroys small functional units of the kidney called ‘nephrons’ and reduces the filtration rate from 30 percent to 50 percent of normal.

Basically this is auto-maintained process. As there is damage to some of the nephrons and they become non-functional, other nephrons have to take burden to purify the blood. At some point of time, a stage comes when these nephrons exhaust with their capacity to purify the blood and again they become non-functional and process continues. It’s progression to end stage i.e. renal failure proceeds at relatively constant rate. If measures are not taken in due time, improvement in the kidney function is quite difficult because compensatory and adaptive changes to sustain the kidney have already occurred.

Kidney failure: Kidney failure occurs when 75 percent or more of the nephron population becomes non-functional. Kidney failure is a condition that can have many causes, but the final outcome is more or less same. Whatever may be the underlying disease, the main damage is always done to nephrons. Kidney itself has a great reserve capacity and continues to function normally until more than two thirds of its functional units i.e. nephrons are destroyed. This is a major reason why dogs and cats are often presented to veterinary surgeon quite late in disease process. That’s why external signs simply do not exist in early stages!

Kidney failure can affect dogs and cats at any age, but it is more common in middle aged or older animals. The incidence of chronic kidney failure increases with age. It is thought that cats and dogs aged seven or older are more at risk of developing the condition. According to research, around 10 percent of cats and dogs suffer from kidney failure at this age. Numbers are probably greater for animals who are still in the pre-clinical phase of disease, not showing any external signs of a problem. As the problem can progress quite slowly, signs are often ignored as they occur gradually and are easy to miss in early stages.

Tips for pet parents

Observe your pet carefully; it may go a long way in ensuring his healthy life.

  • Urination: You should track changes in volume and frequency to urination. Many a time your dog is incontinent because he is urinating in the house when in reality he is urinating more frequently (polyuria) and not allowed outdoors frequent enough.
  • Water intake: Water intake is more easily detected than urination. Water intake should not exceed 80-90 ml/kg per day and 40-45 ml/kg per day in cats, though it may vary depending on season, physical condition and diet.
  • Other signs: Some signs like weight loss, dehydration, oral ulceration, vomiting, diarrhoea and loose teeth may be observed.
  • Regular tests: If your cat or dog is aged seven or older, even if none of the external signs are present, ask your vet about specific testing for kidney problems.
  • Treatments: There are a range of possible options your vet might consider. Changing to a prescription renal diet, adding in dietary supplements and sometimes, in the later stages, using some prescription medication (with prior consultation of your vet).

(Dr Ajay Pore is product executive–Companion Animals, Vetoquinol India Animal Health Private Limited, Mumbai).