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Chronic Renal Failure In Senior Cats and Dogs
Written by Richard Sandore, MD
Produced and edited by Well Beings - Senior Cat & Dog Products. © 2005 WellBeings.com
Reproduced with permission.
The Functions of the Kidneys
The 2 kidneys are remarkable organs that assist in keeping the body in
metabolic balance and maintaining blood count as well as eliminating waste
products from the blood. The functions of the kidneys include: 1)
Regulating the amount of fluid in the blood, 2) Maintaining blood
concentration in the correct range, 3) Eliminating waste products the body
produces from the metabolization of food, 4) Keeping the concentration of
salts in the blood normal, and 5) Producing a chemical called
Erythropoietin which stimulates the production of red blood cells and
prevents anemia.
What is Chronic Renal Failure?
Chronic Renal Failure is a slow loss of kidney function. It is
distinguished from acute renal failure, which is a very rapid loss of
kidney function. The decrease in kidney function in CRF occurs over years
as opposed to acute renal failure, which has a time course of days to
weeks. Because the decrease in kidney function in CRF takes place over a
long period, severe, irreversible damage has usually occurred by the time
pets are symptomatic and the disease is diagnosed.
How Do the Kidneys Work?
Think of the kidneys as the worlds most incredible and effective
filtration system. In the kidneys blood flows through millions of tiny
masses of capillaries called Glomeruli. Practically everything in the
blood except blood cells-water, proteins, and salts-is removed from the
blood and collected in millions of long tubes that run through the
kidneys. As the filtered solution flows through these tubes what the body
needs is reabsorbed into the blood. The rest, waste products, continue
traveling through the tubes, are collected in the center part of the
kidney, and become urine. The urine then flows from each kidney through
the ureter to the bladder where it is stored until it is expelled.
What Goes Wrong in Renal Failure?
In renal failure the kidneys' ability to filter blood is diminished.
Consequently, dilute urine containing much of what the body needs, and
little of the body's waste products is produced and excreted.
The Causes of Chronic Renal Failure
There are many causes of CRF, unfortunately, in the majority of cases the
exact cause is never determined. Known causes of CRF include: 1)
Hereditary conditions that result in abnormal kidneys, 2) Damage to the
kidneys from injury, 3) Infections, both bacterial and fungal, 4) Toxins
produced from bacteria or fungi during an infection, or ingested toxins,
like antifreeze, 5) Obstruction to urine outflow which causes damage to
the kidney from the backup of urine, 6) Medications (side-effects and
overdoses), 7) Autoimmune diseases, and 8) Cancer. (High protein diets do
not cause renal failure. This is a myth that has been around for some
time, and has been proven untrue.)
The Signs of Chronic Renal Failure
Most of the signs of renal failure are general and nonspecific. They
include dull coat, general fatigue, apathy, and tiredness, and lack of
appetite. Increased thirst and increased urination are two of the most
common signs and should be red flags prompting investigation. It may seem
strange that increased urination is a sign of kidney failure, but
remember, the urine that is produced is not concentrated, rather, it is
much more dilute than it should be.
How is CRF Diagnosed?
Your holistic veterinarian will do a complete history and physical exam,
however, the diagnosis is made from testing your companion's urine and
blood.
Urine Tests
Urine is tested to determine its concentration and the amount of protein
and glucose it contains. Specific gravity is a measure of the
concentration of urine, and the higher the number, the more concentrated
the urine. A normal specific gravity for a dog's urine is 1.020 to 1.040,
and for a cat, 1.025 to 1.050. In renal failure the specific gravity is
generally 1.008 (or lower) to 1.012.
Protein and glucose are usually not found in any amount in urine. In renal
failure large amounts of both are present. Other abnormalities of the
urine like the presence of blood cells or chemical crystals can give clues
to the cause of the renal failure.
Blood Tests
Blood is tested for the presence of Blood Urea Nitrogen (BUN) and
Creatinine. Electrolyte levels and a blood count may also be done. BUN and
Creatinine are normal metabolic waste products that are excreted in urine.
A normal BUN level is less than 25 mg/dL to 30 mg/dL, but in renal failure
it can be over 90 mg/dL. Similarly, Creatinine is usually present at a
level less than 1 mg/dL, but is frequently over 8 mg/dL in advanced
disease. A blood count will show anemia with advanced disease and levels
of electrolytes like sodium and potassium may be abnormal.
Treating Chronic Renal Failure
Unfortunately, little can be done to restore lost kidney function. While
dialysis of the blood and kidney transplant is common in humans, they are
less reliable options for animals and place a heavy financial burden on
owners, and are incredibly stressful for pets. Fortunately, many things
can be done to assist the kidneys and augment the remaining function to
allow our companions an active and high quality life.
Diet
In the past it was thought a low protein diet was necessary for dogs and
cats with renal failure. Today it is generally agreed that a low protein
diet does not help, and can actually be harmful because your dog or cat's
protein requirements may not be met leading to malnutrition. Most people
believe a diet with a normal amount of high quality, easily digestible
protein is most beneficial. A diet of primarily raw, organic meat like
chicken or turkey is an excellent choice for cats and beneficial for dogs
as well. Dr. Pitcairn's Guide to Natural Health for Dogs and Cats, by
Richard Pitcairn, DVM, and Susan Pitcairn (ISBN 075962432) is an excellent
resource that discusses the importance of a raw food diet, and offers
recipes, including ones for animals with renal disease.
There are some commercial foods, generally only available from
veterinarians, formulated for cats and dogs with CRF. These diets are low
protein formulas often containing poor quality ingredients. In fact, there
are well-documented studies and research that prove that dogs and cats
thrive on diets with levels of protein consistent with a carnivore's
natural prey selection.
Because water balance is so important and animals frequently require more
than they will drink, it is best to feed high-moisture food. Cats
especially need moist food and dry diets should not be fed. Cats will not
naturally drink water to compensate for the lack of moisture in dry food
leading to a constant state of dehydration.
With any diet it is important that the nutrients in the food get absorbed
and assimilated. Animal Essentials All Natural Enzyme and Probiotic Supplement is an
excellent choice to assure all of the nutrients in your companion's food
are getting where they need to be.
Supplements
Omega-3 fatty acids have been shown to be beneficial in CRF and
antioxidants are important, too. Halo offers several quality supplements:
Anitra's Vita-Mineral Supplement, which supplies the water-soluble
vitamins and Dream Coat Essential Fatty Acid Supplement, for Omega 3, 6 and
9's.
Renafood by Standard Process and Renal Essentials by Vetriscience, are
veterinary prescribed supplements that are good renal detoxifiers and
assist in maximizing kidney function.
Kidney Glandulars and Protomorphogens are extracts from the kidney itself,
and assist the body in detoxifying and promote kidney function.
Nausea and Appetite
The abnormally high waste products in the blood cause cats and dogs to
become nauseated, which leads to a decrease in appetite. A decrease of
food intake makes an already bad situation worse. Since cats and dogs eat
by their sense of smell, warming their food slightly will make it more
appealing and help improve their appetite.
Subcutaneous Fluids
Though animals will drink more because their bodies are signaling them
that more fluid is needed to carry away waste products, they frequently
cannot, or do not drink enough. In emergencies fluids must be given
intravenously. Sometimes, in order to maintain an acceptable level of
health, a small amount of fluid must be given daily under the skin. While
this is not something most owners enjoy the thought of doing, it is not as
difficult as it sounds, and animals don't seem to mind as much as we think
they would.
Electrolytes
The blood is filled with many dissolved minerals, called electrolytes.
Many of these may become out of balance in renal failure. Smartwater,
bottled water by Glaceau, found at all major grocery chains can be given
to aid in restoring electrolyte balance.
Phosphate binders are used to decrease the absorption of phosphates which
are normally present in food, and which the kidneys have difficulty with
when they are not functioning properly.
Potassium supplements are sometimes necessary as this element is
frequently lost in the urine.
Anemia
Erythropoietin is the hormone produced by the kidney that stimulates the
production of red blood cells. It is decreased in renal failure and the
reason animals become anemic. Injections 2 to 3 times a week will
dramatically improve anemia. The downside is that the only commercially
available preparations are human and animals can develop a reaction to
them over time. For this reason it is only used once anemia is severe.
Blood Pressure
Blood pressure can increase in advanced disease and sometimes medications
to control the hypertension are necessary.
Stress
Stress in our animal's lives can affect their metabolism and worsen renal
failure. Providing them a stable, consistent environment is extremely
important.
Herbs, Homeopathics and Flower Essences
There are many alternatives to traditional medications to support kidney
function, both as preventatives and once renal failure has occurred.
Herbs useful for strengthening kidney function include goldenrod, juniper,
and parsley. A tea of 1 part each of hawthorn, ginkgo, echinacea,
marshmallow, and dandelion leaf is useful for treating renal failure.
Animals' Apawthecary Senior Blend Herbal Tincture is a tonic for
diminished kidney function, and strengthens the nervous, digestive,
circulatory and immune systems.
There are many Homeopathic remedies useful for CRF. Some are Apis
Mellifica, Arsenicum Album, Bellis Perennis, Cantharis, and Lycopodium.
Combination remedies are also available. Your holistic veterinarian can
prescribe the best remedies for your pets' individual needs.
Flower Essences can also be useful in detoxifying, promoting kidney
function, and reducing stress. There are many wonderful and qualified
Flower Essence practitioners that can help identify the correct essence or
blend for your pet. Visit the World Wide Essence Society to find a
practitioner near you: http://www.essences.com/wwes/resources2.html
Prevention
There are no true preventative measures to assure your companion will not
be affected by renal failure. As with all potential medical conditions,
the best prevention is a species appropriate diet consisting of high
quality protein, essential fatty acids, vitamins, minerals and enzymes.
Exercise, fresh clean water and air and a calm loving environment are also
essential. All the same things we do to keep ourselves happy, healthy and
disease free apply to our pets. In addition, regular visits to your
holistic veterinarian will help identify minor problems before they become
major ones.
Early Warning
There are unfortunately no early warning signs of renal failure. If a
cat's BUN becomes greater than 35 mg/dL and the Creatinine increases to
1.8 mg/dL to 2.0 mg/dL, less than 25% of kidney function is left. The best
early warning is to be a keen observer of your companion, and discuss any
changes in their behavior with your holistic veterinarian.
Quality of Life
The treatment goal of CRF is to provide the best quality of life possible
for our companions under the circumstances of a potentially debilitating
disease. With early detection and the proper care, nutrition, and most of
all, love, our friends can still have magnificent golden years.
Richard Sandore is a medical writer who has practiced allopathic and
alternative medicine. He can be reached at richard(at)richardsandore(dot)com.
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Robbins Pet Care. All Rights Reserved. The products sold by Robbins Pet Care are not intended to be the sole source of treatment or to take the place of expert veterinarian care. Please consult with your veterinarian and ask about using a natural and alternative approach for the treatment of your pet.
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