More Information




Site Overview

Just Diagnosed? What You Need to Know First

Search This Site



What Happens in CKD

Causes of CKD

How Bad is It?

Is There Any Hope?

Acute Kidney Injury



Phosphorus Control


(High Blood Pressure)



Potassium Imbalances

Pyelonephritis (Kidney Infections) and Urinary Tract Infections NEW

Metabolic Acidosis

Kidney Stones



Nausea, Vomiting, Appetite Loss and Excess Stomach Acid

Maintaining Hydration

The B Vitamins (Including Methylcobalamin)




Ways of Assessing Food Content, Including What is Dry Matter Analysis

How to Use the Food Data Tables

USA Canned Food Data

USA Dry Food Data

USA Cat Food Brands: Helpfulness Ratings

USA Cat Food Brands: Contact Details

USA Food Data Book

UK Canned Food Data

UK Dry Food Data

UK Cat Food Brands: Helpfulness Ratings

UK Cat Food Brands:

Contact Details



Coping with CKD

Tanya's Support Group

Success Stories



Important: Crashing

Alphabetical List of Symptoms and Treatments

Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)

Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)

Phosphorus and Calcium Imbalances

Miscellaneous Symptoms (Pain, Hiding Etc.)



Early Detection

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

Urinalysis (Urine Tests)

Other Tests: Ultrasound, Biopsy, X-rays etc.

Renomegaly (Enlarged Kidneys)

Which Tests to Have and Frequency of Testing

Factors that Affect Test Results

Normal Ranges

International and US Measuring Systems



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)

Phosphorus Binders

Steroids, Stem Cell Transplants and Kidney Transplants

Antibiotics and Painkillers

Holistic Treatments (Including Slippery Elm Bark)

ESAs (Aranesp, Epogen etc.) for Severe Anaemia

General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations

Tips on Medicating Your Cat

Obtaining Supplies Cheaply in the UK, USA and Canada

Working with Your Vet and Recordkeeping



Nutritional Requirements of CKD Cats

The B Vitamins (Including Methylcobalamin)

What to Feed (and What to Avoid)

Persuading Your Cat to Eat

2007 Food Recall USA



Oral Fluids

Intravenous Fluids

Subcutaneous Fluids

Tips on Giving Subcutaneous Fluids

How to Give Subcutaneous Fluids with a Giving Set

How to Give Subcutaneous Fluids with a Syringe

Subcutaneous Fluids - Winning Your Vet's Support




Heart Problems



Polycystic Kidney Disease (PKD)


Dental Problems





USA Online

USA Local (Fluids)




The Final Hours

Other People's Losses

Coping with Your Loss




Feline CKD Research, Including Participation Opportunities

CKD Research in Other Species

Share This Site: A Notice for Your Vet's Bulletin Board or Your Local Pet Shop

Canine Kidney Disease

Other Illnesses (Cancer, Liver) and Behavioural Problems

Diese Webseite auf Deutsch



My Three CKD Cats: Tanya, Thomas and Ollie

My Multi Ailment Cat, Harpsie

Find Me on Facebook

Follow Me on Twitter

Contact Me

Home > Miscellaneous > Canine Kidney Disease




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



No treatment necessary

150 - 159


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



Begin or increase blood pressure medications

Over 180


Severe hypertension

Begin or increase blood pressure medications




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




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.




Back to Page Index


This page last updated: 16 March 2017


Links on this page last checked: 16 March 2017






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.



Copyright © Tanya's Feline CKD Website 2000-2017. All rights reserved.


This site was created using Microsoft software, and therefore it is best viewed in Internet Explorer. I know it doesn't always display too well in other browsers, but I'm not an IT expert so I'm afraid I don't know how to change that. I would love it to display perfectly everywhere, but my focus is on making the information available. When I get time, I'll try to improve how it displays in other browsers.


You may print out one copy of each section of this site for your own information and/or one copy to give to your vet, but this site may not otherwise be reproduced or reprinted, on the internet or elsewhere, without the permission of the site owner, who can be contacted via the Contact Me page.


This site is a labour of love on my part. Please do not steal from me by taking credit for my work.

If you wish to link to this site, please feel free to do so. Please make it clear that this is a link and not your own work. I would appreciate being informed of your link.