For those of you who are reading this post as a follow-up to my previous post on kidney failure I appreciate your return. For those of you just now joining, please take a look back on my previous post for the ins and outs of the diagnosis and unfortunate consequences of kidney failure.
If your pet has been diagnosed with kidney failure you may be asking yourself what can be done. During this post I hope to give some insight into the treatments possible for some of the problems encountered if your has been diagnosed with kidney failure.
What can we do:
Kidney failure can occur as either chronic or acute. During an acute case, the animal usually has severe clinical signs and changes in behavior that occurred suddenly such as, depression, vomiting, fever, loss of appetite, and changes in the amount of urination. In these cases, your pet will likely be hospitalized for intensive treatment. If he/she survives the initial crisis, the chances for full recovery of kidney function will depend on how badly the organs are damaged,and the underlying cause. The goal of treatment during an acute condition is to provide supportive care while the kidneys recover. It can take anywhere from several days to a few weeks to determine whether these patients will recover, and to what extent.
Treatment of chronic renal failure will need to address many of the clinical signs as well as the abnormalities revealed during diagnostics. IV fluid therapy may be performed initially in the veterinary hospital, along with systemic antibiotics, and medications to decrease nausea and vomiting. Once a patient is stabilized, long-term management can be discussed. The severity of the pet’s signs will determine necessary treatments. Not all of the treatments presented below may be appropriate for each pet. Starting treatments incrementally allows us to evaluate the response, before adding additional treatments later.
Feeding of a kidney supportive diet is usually recommended for a multitude of reasons. These diets contain higher quality protein than traditional diets allowing for a reduction in the quantity of protein in the diet. Protein is essential for replacement of cells and tissues, unfortunately the breakdown of protein is one of the key contributors in waste products that must be removed by the kidneys. Using high quality protein results in fewer toxins created for the kidneys to eliminate which reduces stress on the kidneys. A combination of fats and carbohydrates in these diets can be used exclusively for energy, sparing the minimal quantity of protein for tissue repair. Kidney diets also contain a lower amount of phosphorus and sodium. By regulating the sodium in the diet, your pet will have an easier time maintaining the appropriate balance of the fluids he/she takes in to the body. Phosphorous is a mineral frequently found in excess in our kidney failure patients. This increase in phosphorus can have numerous consequences such as vitamin D deficiency, and impact hormones responsible for regulating calcium.When making diet changes it is beneficial to gradually introduce the new diet by adding increasing amounts of the new diet while reducing the amount of the current diet over 5-7 days. The pet is more likely to accept a new diet when it is introduced gradually and it is less stressful to the kidneys and gut as well
- Fluid Therapy
Because pets with kidney disease cannot conserve water, encouraging water intake is very important to prevent dehydration. Make sure your pet always has plenty of fresh water available. Reluctant pets can be encouraged to drink by flavoring normal drinking water with no sodium broth. Some cats and dogs with kidney disease may not drink enough to prevent becoming dehydrated and may benefit from the administration of intermittent subcutaneous fluids (fluids given underneath the skin). This is traditionally a low-stress procedure that can be done at home with the potential for a big return on your pet’s quality of life.
As discussed in my previous post, low potassium or hypokalemia may be seen in a chronic renal failure patient. If this happens your pet’s muscles may become weak or painful. If over time we notice your pet developing this condition, potassium supplementation can be given by mouth if needed.
- High blood pressure (hypertension)
Many pets in kidney failure have high blood pressure. High blood pressure can contribute to further decline of kidney function and can occasionally lead to sudden blindness from retinal detachment. Unfortunately measuring true blood pressure in dogs and cats can be difficult due to the excitement a visit to the vet can produce resulting in false elevation of pressure. The calmer you are able to keep your pet during the examination, the more reliable the readings for blood pressure. There are several drugs that may be used to manage high blood pressure and some of these can also be used to help the body retain necessary protein if we see frequent loss of protein in your pet’s urine.
If your pet is suffering from anemia as a result of chronic kidney failure, we will continue to assess the packed cell volume or hematocrit over time. These readings give us the percentage of blood cells compared to fluid in whole blood. When the PCV is ~20% in cats and ~ 25% in dogs, anemia may contribute to lack of activity and weakness. Severe anemia can be addressed with blood transfusions, however since the concern in kidney failure patients is the ability to produce red blood cells this is only a temporary fix.
- Lack of Appetite
The accumulation of wastes in the body often decreases appetite. A goal of several of the above treatments is to reduce the amount of waste in the blood. If the pet remains off food despite above treatments you are welcome to try different brands of renal failure diets, warming the food or adding water or no-sodium broth to entice the pet to eat. Certain medications can be tried to reduce any symptoms of nausea and encourage appetite in these patients. Of course if your pet refuses to eat any or the prescription diets this will result in bigger problems than keeping him/her on a traditional diet. Please discuss your concerns with your veterinarian if your pet is refusing to eat for more than 24 hours.
As with most things in life, prevention is easier than treatment and kidney disease is no
exception. Not all kidney disease can be prevented, however there are many things that
can be done to minimize the amount of damage that is done to the kidneys over time and identify problems early. These include 1.Feeding your pet a high quality diet recommended by your veterinarian 2. Practicing good preventative medicine by scheduling wellness visits and staying up to date on vaccinations 3. Keeping your pet at a healthy weight 4. Giving all medications as prescribed by your veterinarian 5. Alerting your veterinarian if you notice any change in your pet’s behavior.
Remember: Following instructions and working closely with your veterinarian during your pet’s treatment for any illness will give your pet a better quality of life for as long as possible.