Find out about Kidney emergencies

Case file…
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,).

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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