Kidney disease: Let me start by saying “Ugh!” Kidney disease can be tough to manage and difficult to predict. But don’t fear! There is lots we can do to MANAGE this disease and manage is the key word. We will start by going into what kidney disease is and how we diagnose it.
This is a very basic picture of a kidney. It’s job in dogs/cats is the same as in people. The blood from around the body goes into the kidneys with excess waste products, the kidneys filter them out and then the blood is pumped out of the kidneys. The waste goes down the ureter into the bladder to be stored until the bladder is emptied. The kidneys will also either pull water out of the blood or leave water in the blood depending on how hydrated or dehydrated our pets are. This is a very basic description of what the kidney does, there are other more complicated jobs it has but we will stick with the basics.
This is a not so happy kidney. This is a kidney that is very unhealthy. So what is kidney disease? Simply put, the kidneys stop doing their job. They no longer care if the urine is dilute or concentrated and they don’t filter out the waste well at all. The toxins(waste) begin to build up in the pet’s system making them feel sick. When they begin feeling sick, they will have a decreased appetite and likely vomit multiple times. Since the kidneys don’t work as well and the pet has trouble holding down fluids, the pets will become dehydrated very quickly. We need to diagnose the kidney disease as soon as possible to manage it as well as possible to keep the kidneys healthy for as long as we can.
Diagnostics: These are some of the tests we will run that will help us diagnose kidney disease. The standard blood work for kidney disease is the same standard blood work we run for most animals that come in sick. We run a CBC(to look at red/white blood cells), Chemistry(to look at liver/kidney/electrolyte values) and a urinalysis(to look at the urine). These give us a very good baseline to begin and can tell us if we have kidney disease or not. A very important part of this is the fact that the “kidney values” will not increase until we have 75% kidney damage. That 75% is never coming back. The remaining percent, however, can build up to take up the slack. This means that “normal kidney values” does not guarantee that we do not have any kidney disease. It is very important to have all three of these tests. We CAN NOT diagnose kidney disease without looking at the pet’s urine.
Once we have the blood work back and we see that pet has kidney disease, there is some additional tests we may sometimes run. We will check the pet’s blood pressure(yes, we can check that on your pet). Kidney disease will cause the blood pressure to increase and this can cause more damage to the kidneys if we don’t control it. High blood pressure can also cause sudden blindness. We may also send out a urine protein:creatinine ratio to see how much protein the pet is loosing through the kidneys.
Treatment: Once we have the diagnosis of kidney disease we will begin discussing treatment. There are quite a few things to do and it depends on how sick the pet is. If a pet is extremely dehydrated and sick, the first thing we will discuss is going to be IV fluids. These are fluids directly into the pet’s veins with an intravenous catheter. For kidney disease, nothing is better than putting the fluids right into the veins of the patient. Depending how the pet responds this could take anywhere from a day to a week on IV fluids.
If we catch the disease early enough, we can have the owners manage the pet at home. We do this a few different ways. The first way is by changing the pet’s diet. We need them to be on a “kidney diet.” The diet is specifically made to help manage kidney disease. It is low in protein(protein is what builds up in the system and makes the pet feel sick/nauseous) and is low in phosphorous(phosphorous will cause calcium to travel to the kidneys and damage them). There are other things about the diet but these two are the biggest part of it. There are a few different kidney diets and some come in many different flavors to make sure the pet continues to eat. One of the most difficult things to manage with kidney disease is keeping the pet eating.
The next thing we will discuss is giving sub cue fluids at home. These are fluids under the skin of the pet and are NOT IV fluids. This works well because the pet can not vomit up the fluids and they absorb in a little under a day or so. This is better than the pet drinking fluid but it is not as good as IV fluids. It is, however, easy to do at home and we can teach most people how to do this. Animals with kidney disease get dehydrated very quickly and if they are not drinking enough, sub cue fluids will help to keep them hydrated. We will typically have the owners give fluids every other day to a couple times a week depending on the pet.
Prognosis: This is the most frustrating part. There is no good way to tell how a pet is going to respond to managing of the disease. If a pet comes in looking very sick and the values are really high, then that is usually a poorer prognosis. The difficult part is when an animal just begins to feel sick or on a routine check up we find kidney disease. We have no way of predicting how that disease will progress. The best we can do is initiate treatment and see how the pet responds. Typically if we can go for about 3 months with no major issues, then the prognosis is better. The pet, however, will likely succumb to the kidney disease or have to be euthanized due to the disease. If the pet is stable, an attempt should be made to manage the disease and see how the pet responds. Some pets just need a change in diet and some medications to control the blood pressure. Some animals do well with the disease and some worsen quickly. We just have to give them a chance and see which one they will be.
Kidney disease can be scary up front but there are multiple things we can do to try and control it. If you have pets, especially cats, you will eventually have to deal with this disease. Just because the last cat might have died quickly from it doesn’t mean your next cat will. With a little treatment we can give them a good remaining quality of life.