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Kidney / Renal Disease

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  Overview

Kidney or renal failure (or renal insufficiency in its earlier stages) is a chronic condition that affects many cats and dogs. While kidney failure is more common in older pets, younger pets may also be susceptible to this condition. Clinical signs of kidney failure typically do not manifest until a significant percentage (more than 80%) of the kidneys have failed. Renal failure affects many body systems and results in:
- Mineral imbalances- serum (blood) phosphorus is often elevated, calcium may be elevated as well.
- Electrolyte imbalance- sodium and potassium may be out of proportion, leading to dehydration and heart problems.
- Hormonal imbalances- impaired kidneys result in decreased production of erythropoetitin, the hormone that stimulates red blood cell production. This leads to anemia.

Clinical Symptoms
Renal failure is diagnosed by a veterinarian via blood and urine tests. Common symptoms which could indicate that your pet has kidney failure include: bad breath, increased urination, anorexia, increased thirst, vomiting, lethargy, weakness, and loss of coordination.

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 proactive treatment may enable your pet to live with this condition for many years and maintain a good quality of life. If you suspect that your pet has kidney failure, consult with your veterinarian and obtain blood and urine tests to get a definitive diagnosis. Information on this website, or any other website, is not a substitute for veterinary care.

The most common treatments for kidney failure are (in order of most common to least 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). Sodium Chloride or Normosol-R is sometimes substituted for LRS when hypercalcemia (high calcium) is an issue. Fluids are very heavy and can often be purchased more cost-effectively from local suppliers. Some fluids come in 2 different types of bags- DEHP bags and DEHP-Free bags.

- Phosphorus restriction- Phosphorus levels often get dangerously high (hyperphosphatemia) as the kidneys fail and can no longer remove excess phosphorus from the bloodstream. If the phosphorus levels are not too high, blood levels may return to the normal range by simply restricting dietary intake of phosphorus. Purina NF, Hill's k/d, and Royal Canin Renal LP are examples of prescription kidney diets. In other cases, medications called phosphorus binders may be necessary. Please note that ThrivingPets.com does not carry any foods, prescription or otherwise.

- Phosphorus binders- There are two main types of phosphorus binders on the market- calcium-based and aluminum-based. Aluminum-based binders offer some distinct advantages over calcium-based binders. Aluminum-based binders are more effective and will not elevate blood calcium levels the way their calcium-based counterparts may. Aluminum hydroxide is the most effective and least expensive phosphorus binder available according to experts such as Dr. Larry Nagode from Ohio State University, School of Veterinary medicine. Other binders include Renagel, Epakitin and Fosrenol.

- Acid-Reducers & Anti-Nausea medications- Many kidney failure patients lose their appetite with this condition. One or more acid-blockers such as Pepcid/Famotidine, Ranitidine/Zantac, and Omeprazole(Prilosec), anti-nausea medications such as Ondansetron/Zofran, Cerenia, and Metoclopramide/Reglan, and pro-biotics such as Azodyl may be helpful in treating GI upset and helping your pet regain its appetite. Slippery Elm Bark is a natural alternative that coats the lining of the stomach to protect it from stomach acid and ease your pet's discomfort.

- Vitamin B complex- As the disease progresses many pets become anemic. Anemic pets benefit from vitamin B complex with Iron such as Nutrived or Pet-Tinic. In more advanced cases Procrit, Epogen or Aranesp may be used to treat anemia along with vitamin B & Iron supplements.

- Potassium supplementation- Potassium is water soluble and tends to get depleted in kidney failure patients that are getting fluids or drinking and urinating excessively, this condition is called hypokalemia. Potassium may also be elevated (Hyperkalemia), but this is less common. Potassium supplements include- powder, gel, or tablets for Renakare or Tumil-K, Renal K+ powder, pure Potassium Gluconate powder, and Potassium Chloride injectible that can be mixed with subQ fluids.

- 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- for cats- Amlodipine/Norvasc, for dogs- Benazepril/Fortekor and Enalapril/Enacard.

- 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, creating an imbalance in your pets calcium and phosphorus. Calcitriol is an important treatment that can be very beneficial particularly in early stage patients.