CHRONIC KIDNEY DISEASE
Chronic kidney disease (CKD) is kidney disease that has been present for months to years.
The functions of the kidneys include: eliminating waste products of metabolism; maintaining the normal amount and composition of body fluids (water, salt, potassium, phosphorus, pH, others); producing several hormones, including hormones that are involved in blood cell production, influence blood pressure, and manage calcium and phosphorus metabolism.
CKD can occur at any age, but is more common in older pets.
The disease(s) that damages the normal kidneys and begins the processes that lead to CKD may be infection, immune-mediated disease, congenital disease, toxicity, and many others.
We have a very high suspicion that chronic inflammation associated with periodontal disease is a very significant pre-disposing factor for chronic kidney disease.
Almost always, at the time of diagnosis of CKD, the initial disease that caused the problem cannot be determined.
Dogs and cats with early or mild CKD may have no signs of illness.
When signs first appear they include increased drinking and urinating, decreased appetite, and weight loss.
In advanced CKD symptoms include continued inappetance and weight loss, lethargy, and weakness. Uncommonly, there can be persistent vomiting, diarrhea and even seizures. These signs are due to a metabolic condition called uremia.
The pet's medical history and physical exam are often enough for us to have a strong suspicion of CKD. In order to provide appropriate, patient-specific care, additional diagnostic tests are needed.
At YVC, we evaluate the structure and function of the urinary tract with:
- a blood profile
- a urine profile
- an ultrasound exam
- blood pressure measurement
With the results of these tests we establish the diagnosis, prepare a treatment plan specific for the pet, and give the owner a prognosis.
Three blood tests, BUN (blood urea nitrogen), creatinine, and SDMA, along with the urine test, are most useful for detecting kidney disease in its earliest stages. By the time any of these tests are slightly abnormal, however, it is likely that the pet has already lost 75% of their kidney function.
CKD is progressive and irreversible; the damaged kidneys cannot be returned to normal; therefore, treatment for CKD is not an attempt at curing the problem, but an attempt at relieving the symptoms and slowing the progress of the disease.
Treatment options include:
- Dietary therapy, with particular attention to management of protein, phosphorus, omega-3 fatty acids, and potassium. There are several excellent specialty diets for managment of CKD. We have found that, while it is best to feed them exclusively, they still help significantly if they are only part of the pet's food intake. We have also found that switching between CKD diets, or simultaneously feeding more than one kidney diet, are effective strategies. CKD diets are also complete and balanced, and are high quality maintenance food for most healthy cats that do not have CKD; in homes with multiple cats where it is easier to feed all of the cats the same food it is usually a great option of feed them all CKD diet.
- Fluid therapy by encouraging water consumption (Please see our YVCipedia article "Encouraging Water Consumption".)
- Fluid therapy in the form of regular subcutaneous (under the skin) fluid injections, which often can be administered by the owner at home
- Dental care, in particular, annual, or more frequent, dental cleaning
- Medication for nausea and vomiting
- Medication to stimulate appetite
- Medication for high blood pressure
- Medications for mineral and electrolyte imbalances
- Medication to promote blood flow to the kidneys
- Treatment of anemia
- Calcitriol (the active form of vitamin D)
Needs vary from one pet with CKD to another, and from the owners of one pet to another. The needs of any particular pet change over time. We create an initial treatment plan and revise it, based on re-evaluations, to meet the specific needs of each CKD patient.
If we diagnose CKD when there are no symptoms, or the pet's problems are mild to moderate, the possibility of good quality of life for months to years is very good.
If we diagnose CKD when the pet's problems are moderate to severe the outcome varies from pet to pet too much to accurately predict. In these circumstances, we have found the response to the first few days to weeks of treatment to be a reliable indicator of the ultimate outcome.
Yarmouth Veterinary Center