TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 

CANINE KIDNEY DISEASE

 

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DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


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Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


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Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


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Nutritional Requirements of CKD Cats


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Home > Miscellaneous > Canine Kidney Disease

 


Overview


 

I have no personal experience with kidney disease in dogs, but I sometimes get asked about it, so below I explain the IRIS staging system for CKD in dogs and provide links to further information and support groups.

 


IRIS Staging System


 

When your dog is first diagnosed, you may immediatrely wonder how serious it is. Many vets now take the test results and categorise them according to the system provided by the International Renal Interest Society. This divides CKD into four stages; so if your vet tells you, for example, that your dog is in Stage 2, s/he is probably referring to the IRIS staging system.

 

The IRIS staging system (2015) looks at three things in this order:

  • blood tests

  • proteinuria (levels of protein in the urine)

  • hypertension (high blood pressure)

IRIS Staging System: Blood Tests


The IRIS staging system begins by looking at the cat's creatinine levels (creatinine is a measure of kidney function). Here are the four stages, together with my estimate of the likely percentage of function lost at each stage:

 

Stage of Disease

Blood Values:

US Measurements (mg/dl)

Blood Values:

International Measurements (µmol/L)

Approx. Level of Kidney Function Lost

Stage 1

Creatinine below 1.4

Creatinine below 125

 0 - 65%

Stage 2

Creatinine between

1.4 and 2.0

Creatinine between

125 and180

 

66 - 75%

Stage 3

Creatinine between

2.1 and 5.0

Creatinine between

181 and 440

 

76 - 90%

Stage 4

Creatinine over 5.0

Creatinine over 440

Over 90%

 

Obviously, not every dog with creatinine below 1.4 mg/dl (US) or below 125 µmol/L (international) has CKD! The problem is that when measuring creatinine, you cannot detect CKD until at least 66% of function has been lost, because before that there are usually no symptoms (see below). Therefore for dogs in Stage 1 who do have CKD, bloodwork values are usually within the normal range, and kidney problems would only be suspected if an anatomical or functional abnormality had been detected, or if the SDMA test result indicates a problem (see immediately below).

 

Following the introduction of the SDMA test, which is thought to be able to detect CKD when only 40% of kidney function has been lost, IRIS guidelines state the following:

 

SDMA Test Measurement Current IRIS Staging IRIS Staging

Over 14 ug/dl

Stage 1 Stage 1

Over 25 ug/dl

Stage 2 but with a low body condition score Treat as if in Stage 3
Over 45 ug/dl Stage 3 but with a low body condition score Treat as if in Stage 4

 

In all cases, two readings in a stable dog (who is not dehydrated - this can make the numbers look a lot higher than they really are), ideally after fasting (though that is not always the best choice for a CKD patient), are required before making a firm diagnosis of CKD. In practice, most vets will make the diagnosis based on bloodwork taken once during your initial visit.

 

IRIS Staging System: Proteinuria


The International Renal Interest Society then recommends sub-staging based on whether proteinuria is present.

 

Healthy dogs only have tiny amounts of protein in their urine because their kidneys do not allow the protein to leak through. In CKD dogs, this mechanism can be faulty and excess levels of protein in the urine, known as proteinuria but sometimes referred to as microalbuminuria, may occur.

 

The usual way to determine if a dog has proteinuria is via the urine protein:creatinine ratio (UPC). Three urine samples should be collected over a mimimum period of two weeks before a conclusion is drawn.

 

Urine Protein: Creatinine Ratio

Proteinuria Status

Below 0.2

Non Proteinuric (NP)

Between 0.2 and 0.5

Borderline Proteinuric (BP)

Over 0.5

Proteinuric (P)

 

There is a correlation between the severity of proteinuria in cats and the prognosis, though I don't know if the same applies to dogs. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria (2006) Syme HM, Markwell PJ, Pfeiffer D & Elliott J Journal of Veterinary Internal Medicine 20 pp528–535 found that cats with a urine protein:creatinine ratio below 0.5 survived almost three times as long as cats with a urine protein:creatinine ratio of over 0.5.

 

However, don't panic if your dog's level is over 0.4 because the UPC ratio is not always accurate - for example, blood in the urine, infection or inflammation may give a false positive result. Hypertension may worsen proteinuria, so getting blood pressure under control may lead to an improvement in the UPC ratio. Even if your dog's UPC ratio is indeed high, it may gradually reduce with treatment.

 

IRIS Staging System: Hypertension


The International Renal Interest Society then recommends substaging based on whether hypertension is present. It considers a cat's blood pressure in terms of how likely it is that damage to organs such as the eyes will be caused:

 

Average Systolic Blood Pressure Measurement (mmHg)

Risk  of Damage

to Organs

BP Substage

Treatment Plan

Under 150

Minimal

Normotension

No treatment necessary

150 - 159

Mild

Borderline hypertension

Treatment is not normally necessary. However, it may be appropriate to begin or increase blood pressure medications if ocular or neurological signs are present

160 - 179

Moderate

Hypertension

Begin or increase blood pressure medications

Over 180

Severe

Severe hypertension

Begin or increase blood pressure medications

 


Treatments


 

The International Renal Interest Society has some treatment suggestions for CKD dogs.

 


Support


 

K9 Kidneys Support Group is a group for those with a dog with CKD.

K9 Kidney Diet Group is a group about diet in CKD dogs.

 


More Information


Pet Education has an overview of kidney disease in dogs.

Kidney Disease in Dogs has comprehensive information in layman's language from a lady with a CKD dog, but sadly she died in 2007 so the website may not be too up to date.

Canine chronic kidney disease: current diagnostics and goals for long-term management (2013) Foster JD Today's Veterinary Practice 3(5) pp21-26 has a detailed overview of CKD in dogs.

 

 

 

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This page last updated: 16 March 2017

 

Links on this page last checked: 16 March 2017

   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

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