If My Dog Has Chronic Kidney Failure, Will He Need a Transplant?
Your dog may be headed for kidney failure but not exhibiting any warning signs. In this interview, Dr. Cathy Alinovi, owner of Healthy PAWsibilities, answers some of the most common questions her pet parents ask her about canine kidney disease.
What is kidney failure?
Dr. Cathy: Kidney failure is either chronic or acute, which means long-term or just started, and is often called kidney insufficiency. Because the kidneys’ job is to filter the blood of toxins normally produced in the body, when the kidneys don’t work optimally, they stop filtering these toxins. These can build up in the blood and lead to vomiting, dehydration, seizures and eventually, death.
What causes kidney failure in dogs?
Dr. Cathy: Kidney failure is “multi-factorial”meaning it has many causes that seem to build up together; so only one factor will not necessarily cause a dog to go into kidney failure. There is a genetic predisposition in some dogs, while some dogs are born with just one kidney, like some humans. However, the major factors involve diet, chemicals, medications, pollution, and other diseases like infection, diabetes and cancer.
How common is it?
Dr. Cathy: Kidney failure does not top the charts of common canine diseases; about 1 in every 100 dogs suffers from kidney failure. However, if you happen to be the owner of that one dog, it can be devastating.
Are there dog breeds with a predisposition to kidney failure?
Dr. Cathy: A few breeds have a slightly increased risk over others: Bulldogs, Lhasa Apsos, German Shepherds, Golden Retrievers, and Newfoundlands.
How many types of kidney failure are there?
Dr. Cathy: Kidney failure is either acute or chronic, and categorization of each type is based on what the bloodwork says and how the patient presents.
Acute Kidney Failure
Acute kidney failure happens suddenly and is often due to something infectious such as leptospira, dehydration, NSAIDs (non-steriodal anti-inflammatories often given for pain), allergic or anaphylactic reactions, and other less common causes.
Chronic Kidney Failure
Chronic kidney failure is a condition that has gone on for a while and some of the causes are similar such as the chronic use of NSAIDs, chronic infection (Lyme), chronic use of medications for allergies or other health conditions, while other times it’s genetic or sometimes it’s just age related. Many humans have kidney issues once they enter their 80s.
What are the symptoms of acute renal failure?
Please refer to the table for my assessment of the most common signs of acute renal failure.
Acute Renal Failure Symptoms
Swelling in the legs
Straining with little to nothing coming out
What are the symptoms of chronic kidney failure?
Dr. Cathy: It is a surprisingly similar list as for acute kidney failure with signs like:
- Weight loss
Other signs could be:
- Drinking and eating less
- Coma and death
How would you diagnose it?
Dr. Cathy: Kidney failure is diagnosed by blood work. High blood levels of BUN, creatinine and phosphorus indicate kidney failure. However, they do not diagnose the cause of the kidney failure.
Western Medicine Diagnosis Protocols
BUN stands for blood urea nitrogen; BUN and creatinine are the breakdown products of protein digestion. Phosphorus is mineral which should be excreted in the urine, along with all the extra BUN and creatinine..
When the kidneys do not function optimally, they lose what they should not and retain what they should not. This means the dog in kidney failure drinks more and urinates more – loses what it should not; and becomes toxic from the by-products of protein digestion – keeps what it shouldn’t.
Here is a crazy thing about blood testing for kidney/renal disease: it’s not until almost 75% of the kidneys are no longer functioning that changes in the bloodwork are noticeable. This means blood tests to screen for kidney diseases are unreliable at early stages of the illness.
Depending on the cause of kidney failure, extra protein in the urine can mean the kidneys are failing and that can be detected earlier than changes in the bloodwork. However, bladder infections and several other health issues can also cause protein in the urine so that test must be interpreted carefully.
Benefit of Traditional Chinese Veterinary Medicine
An interesting thing about Traditional Chinese Veterinary Medicine (TCVM) is kidney insufficiency can be detected long before changes are seen in the blood or urine. As a dog ages, Chinese medicine assumes the kidneys are aging, and this can be measured by astute practitioners of TCVM who diagnose illness with accurate pulse analysis. Therefore, long before a possible kidney failure patient becomes ill, Chinese medicine can detect and treat the condition earlier than conventional western medicine can.
Giving Subcutaneous Fluids to Your Pet
What treatment options are available?
Dr. Cathy: Treatment really depends on the cause and type of the kidney failure. Acute conditions are treated as appropriate with antibiotics for infectious causes, supportive care for antifreeze poisoning, and fluids. Regardless of the type of kidney failure, the treatment always includes fluids: given under the skin, in the vein, or orally if the patient is not vomiting. Once you address the underlying cause, treatment is supportive from there. There are many ways to support kidney function: diet (see below), medication, herbs and nutraceuticals.
Western Medicine Approaches
Conventional medications aim to reduce chemical values in the blood. For example, phosphorus tends to become high in the blood of kidney patients, so conventional medicine says to give phosphorus binders to help the body excrete excess phosphorus. The formula is medication for the nausea, medication for the vomiting, medication for the other side effects and lots of fluids. Again, fluids are the key to keeping things flushed out of the system in kidney disease. In extreme cases, when the owner can afford it and lives near a referral center, a canine kidney failure patient can receive dialysis, just like humans.
Nutraceutical medications use herbal medications to help the kidney function better. Cordyceps, astragalus, and rehmannia are all examples of herbs used for centuries to treat kidney function. More specific herbal therapy by herbologists (Traditional Chinese Veterinary or otherwise trained) look at the individual patient, the individual symptoms, and the individual issues and then custom formulate a herbal remedy for the patient. Moreover, as the patient’s symptoms change, so does the therapy.
Acupuncture and Homeopathy
Acupuncture and homeopathy can also help the kidney failure patient. Just as with herbal treatment, a specific work up by an expert will help your dog do better longer. Because alternative treatments are tailored to the patient, there are many different treatments, not just one drug to treat one symptom.
What dietary changes should I make?
Dr. Cathy: There is a big controversy over the answer to this question. Pet food companies have researched low protein diets compared to regular diets and found dogs on low protein diets live longer. However, protein is needed by the body to make muscle.
Problems with Conventional Diets
If your dog isn’t eating protein, it’s eating more carbohydrates and fat, which make your dog fat while he/she loses muscle, which is not what healthy dogs need. In addition, most prescription kidney diets are made with inferior quality ingredients; ingredients no human would eat. These ingredients continue to damage the kidneys through inflammation.
Alternative Dietary Methods
The alternative view is to feed a diet of high quality foods and ingredients; those that are easier for the body to digest, so the body can get the best nutrition possible from the food. As there is a great controversy here, your safest choice is to work with your holistic veterinarian to custom formulate a diet specific for your dog’s needs.
Treating Canine Kidney Disease
Are there ways to prevent kidney failure?
Dr. Cathy: Some things are more obvious: your dog should avoid antifreeze, grapes, raisins, and lilies, all of which can cause kidney failure. Some are less obvious: for some dogs, but not all, jerky treats imported from China can cause kidney failure, as can Trifexis, but this applies to just a few.
The biggest thing you can do for your dog is to minimize use of vaccines and medications and feed high quality foods, preferably not dry. The moisture is removed from dry foods to make them dry and that can be hard on the kidneys. Also, avoid lower quality foods, with more suspect ingredients, including mycotoxins (toxins produced by fungi, which grow in low quality food sources, like corn) that can damage the kidneys.
Will my dog need a kidney transplant?
Dr. Cathy: Kidney transplantation is quite expensive, and a specialty procedure. Few universities and research groups offer kidney transplant as a treatment option for canines.
What's involved in a canine kidney transplant?
Dr. Cathy: First, the dog's owner must find a compatible donor dog. If the donor dog is healthy and has the right blood type, one kidney is removed from him and transplanted into the sick dog. However, in order for the dog in kidney failure to keep and use the kidney well, the dog must be on some expensive immune suppressive medications, just as humans are after a transplant procedure.
While it is a great option for the dog in kidney failure, it is rarely performed at this time. As it is an exceedingly expensive procedure, only a fortunate few are able to pursue this treatment method.
How long will my dog live if he has kidney failure?
Dr. Cathy: Prognosis is predicated on the severity of the failure, how quickly it came on, and the cause. Some patients do well for months to years; other patients deteriorate in a matter of weeks or even days.
Something to keep in mind about the kidneys is they do not simply filter the blood. Kidneys are also responsible for making the hormone (erythropoietin) that stimulates the bone marrow to make red blood cells. Without this hormone, the kidney failure patient becomes anemic as the red blood cells get depleted slowly.
The kidneys are also intricately involved in regulating blood pressure in the body through a complicated pathway called the renin-angiotensin-aldosterone system. The important thing to realize about these two points is that if the kidneys fail, it affects a lot more of the body than just the kidneys; the heart via blood pressure, and blood cells are all affected. A dog in kidney failure has serious issues to worry about.
Early Intervention May Save Your Dog's Life
As you can tell, early detection and prompt treatment are your dog's best keys to a good prognosis if he develops kidney disease. While this can be an insidious disease that slowly overtakes your best friend, regular checkups with your vet, proper nutrition, and consistent, age-appropriate exercise will contribute to keeping your dog in optimal health.
Email interview with Dr. Cathy Alinovi, owner, Healthy PAWsibilities and author of Dinner PAWsible, 11/18/2014
© 2014 Donna Cosmato