Tanya

 

TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

24 July 2000 - 24 July 2020

Twenty years online!

(Not tax deductible since I am a private individual)

 

 

 

 

CANINE KIDNEY DISEASE

 

ON THIS PAGE:


Stages


Treatments


Support


More Information


 

 

HOME


Site Overview


Just Diagnosed? What You Need to Know First


Search This Site


 

WHAT IS CKD?


What Happens in CKD


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES: PROLONGING LIFE


Phosphorus Control


Hypertension

(High Blood Pressure)


Proteinuria


Anaemia


Potassium Imbalances


Pyelonephritis (Kidney Infections) and Urinary Tract Infections NEW


Metabolic Acidosis


Kidney Stones


 

KEY ISSUES: HELPING YOUR CAT FEEL BETTER


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The B Vitamins (Including Methylcobalamin)


Constipation


 

CAT FOOD DATA


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


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


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.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


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


 

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)


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


 

DIET & NUTRITION


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


 

FLUID THERAPY


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


Dialysis


 

RELATED DISEASES


Heart Problems


Hyperthyroidism


Diabetes


Polycystic Kidney Disease (PKD)


Pancreatitis


Dental Problems


Anaesthesia


 

OBTAINING SUPPLIES CHEAPLY


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Canada


 

SAYING GOODBYE


The Final Hours


Other People's Losses


Coping with Your Loss


 

MISCELLANEOUS


Prevention


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


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SITEOWNER (HELEN)


My Three CKD Cats: Tanya, Thomas and Ollie


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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.

 

Staging should only occur after diagnosis. Before making a firm diagnosis of CKD, two blood test readings from a stable dog who is not dehydrated (dehydration can make the numbers look a lot higher than they really are) are required. Ideally the readings should be taken after fasting, though that is not always the best choice for a CKD dog. In practice, most vets will make the diagnosis based on bloodwork taken once during your initial visit, but remember, this is not optimum. And if your dog is in crisis, perhaps severely dehydrated and on a drip at the vet's, the blood test readings will not be accurate, so do not panic.

 

IRIS staging of CKD (2019) International Renal Interest Society) 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 dog'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 2.8

Creatinine between

125 and 250

 

66 - 75%

Stage 3

Creatinine between

2.9 and 5.0

Creatinine between

251 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 What Happens in CKD). 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).

 

IRIS Staging: SDMA


The staging system also looks at SDMA, which is a newer test introduced by Idexx in 2015/2016. This test appears to be able to detect CKD earlier than the traditional bloodtests (see Early Detection), in some cases it may be able to detect CKD when perhaps only 40% of kidney function has been lost.

 

Stage of Disease

Creatinine

SDMA Measurement

Comments

Stage 1

Below 1.4 mg/dl

Below 125 µmol/L

Below 18

If SDMA is increasing or is consisently above 14, CKD may be present.

Stage 2

1.4 - 2.8 mg/dl

125 - 250 µmol/L

18 - 35

This is considered by IRIS to be mildly increased.

Stage 3

2.9 - 5.0 mg/dl

251 - 440 µmol/L

36 - 54

 

Stage 4

Over 5 mg/dl

Over 440 µmol/L

Over 54

 

 

For dogs with persistently elevated SDMA readings, IRIS staging of CKD (2019) International Renal Interest Society suggests changes in the stage of CKD the dog is deemed to be in as follows:

 

Creatinine Level

Current IRIS Staging

Based on Creatinine Levels

SDMA Measurement

Revised

IRIS Staging

Below 1.4 mg/dl

Below 125 µmol/L

Stage 1

Over 18

Stage 2

1.4 - 2.8 mg/dl

126 - 249 µmol/L

Stage 2

Over 35

Stage 3

2.9 - 5.0 mg/dl

250 - 440 µmol/L

Stage 3

Over 54

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


 

IRIS staging of CKD (2019) 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


IRIS staging of CKD (modified 2019) (2019) 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 140

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

 

Some dog breeds, such as sight hounds, tend to have higher blood pressure naturally. For these breeds, IRIS recommends using breed-specific reference ranges if possible.

 


Treatments


 

Treatment recommendations for CKD in dogs (2019) International Renal Interest Society has some treatment suggestions for CKD dogs.

 

Dietary guidelines for dogs with chronic kidney disease (2018) Rollins AW Today's Veterinary Practice Jul/Aug 2018 discusses dietary issues for CKD dogs

 


Support


 

K9Kidneys is a group for those with a dog with CKD.

 

K9 Kidney Diet is a group which discusses the role of diet in CKD dogs.

 


More Information


 

PetCoach has an overview of kidney disease in dogs.

 

Canine chronic kidney disease: current diagnostics and plan 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: 13 July 2020

 

Links on this page last checked: 13 July 2020

   

*****

 

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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