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Overview
Kidney or renal failure (also commonly known as kidney or renal insufficiency in its earlier stages) is a chronic conditions that affects many cats and dogs. While kidney failure is more common in older pets, younger pets may also be suseptible to this condition. Clinical signs of kidney failure don't typically manifest until a significant percentage of the kidneys have failed. Renal failure affects many body systems and results in:
- A build-up of toxins in the blood- phosphorus is often elevated, calcium may be elevated as well
- Electrolyte imbalance- sodium and potassium are off, often leading to dehydration
- Hormonal imbalances- impaired kidneys can't produce erythropoetitin, the hormone that stimulates red blood cell production
Clinical Symptons
Renal failure is diagnosed by a veterinarian via blood and urine tests. Here are some common symptons that could indicate your pet has kidney failure that pet owners should watch for:
- Bad breath
- Anorexia
- Increased thirst
- Vomiting
- Lethargy
- Weakness
- Loss of coordination
- Increased urination
Blood Tests
Blood test results can be difficult to interpret without medical training, so you should consult your veterinarian to thoroughly review you pet's labs. Below is a list of the most critical values for kidney patients:
- BUN
- Creatinine / CREA
- Phosphorus / PHOS / P / Pi
- Calcium / Ca
- Potassium / Potas / K
- Hematocrit / HCT
- Parathyroid Hormone / PTH
Treatment
Although kidney failure is incurable, early detection and aggressive treatment may enable your pet to live with this condition for many years. If you suspect your pet has kidney failure
the first thing you should do is consult your veterinarian and do the blood and urine tests to get a definitive diagnosis. Information on this website, or any other website for that matter, is not a substitute for veterinary care. The most common treatments for kidney failure are (in order of most common to less common):
- Fluid therapy- Administration of IV or subcutaneous (subQ) fluids can be very beneficial to dehydrated pets. The fluid most often used to treat pets with kidney failure is Lactated Ringers Solution (LRS). Normosol-R is sometimes substituted for LRS when hypercalcemia (high calcium) is an issue.
- Phosphorus restriction- Phosphorus levels often get dangerously high (hyperphosphatemia) as the kidneys fail and can no longer perform this function. If the phosphorus levels are not too high, blood levels may return to the normal range by simply restricting dietary intake of phosphorus. Examples of prescription kidney diets are Purina NF and Hill's k/d. In other
cases, medications called phosphorus binders may be required.
- Phosphorus binders- There are 2 main types of phosphorus binders on the market- calcium-based and aluminum-based. Aluminum-based binders offer a couple of key advantages over calcium-based binders- aluminum-based binders are more effective and they won't elevate blood calcium levels the way their calcium-based counterparts will. Aluminum hydroxide is the most effective and least expensive phosphorus binder available. Other binders include Epakitin and Renagel.
- Potassium supplementation- Potassium is water soluble and tends to get depleted (hypokalemia) in kidney failure patients that are getting fluids or drinking and urinating excessively. Potassium may also be elevated (Hyperkalemia), but this is much more uncommon. Potassium supplements include- Renakare powder, gel and tablets, Tumil-K powder, gel and tablets, pure Potassium Gluconate powder, and Potassium Chloride injectible that can be mixed with subQ fluids.
- GI support- Many kidney failure patients find that they lose their appetitie with this condition. One or more of acid-blockers such as Pepcid/Famotidine, anti-nausea medications such as Reglan or Ondansetron/Zofran, and pro-biotics such as Azodyl may be helpful in treating GI upset and help get your pet to eat.
- Vitamin B supplements- As the condition progresses many pets become anemic. Anemic pets should be supported with a vitamin B complex with iron such as Nutrived Vitamin B Complex with Iron. In more advanved cases Erythropoeitin/Procrit/Epogen may be used to treat anemia.
- Blood pressure medications- Many pets with renal failure also have, or develop, high blood pressure (hypertension). Hypertension is typically treated with one or more of the following medications- Norvasc/Amlodipine, Benazepril, Enacard/Enalapril.
- Calcitriol- Calcitriol is an activated vitamin D that helps the body regulate the absorption and storage of calcium and phosphorus in the blood stream and bones. Vitamin D cannot be used by the body until it is processed and altered by the liver and kidneys. When the kidneys are impaired vitamin D cannot be activated or used, throwing off your pets calcium and phosphorus balancing system. Calcitriol is an important treatment that is not used nearly enough.
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