Contact Emergency Service

Phone: 561.741.4041
Fax: 561.741.4043

Compassionate Care    (561) 741-4041

Jupiter Pet Emergency & Specialty Center
A New Approach To Emergency Pet Care

Monday - Friday 5PM - 8AM
Saturday & Sunday & Holidays 24 Hours

300 Central Boulevard, Suite A
Jupiter FL 33458

For appointments with the Specialty Services
Monday - Friday 8am - 5pm
call 561.741.4041 
Check us out every other week on PAGE 5!

The Many Faces of Chronic Kidney Disease (CKD) - Does My Dog or Cat Have CKD

Dennis J. Chew, DVM, Dip ACVIM (Internal Medicine)

Professor Emeritus, The Ohio State University College of Veterinary Medicine

CKD affects older animals more so than younger animals, but any aged dog or cat can be affected depending on the underlying cause(s). Cats are diagnosed at least twice as commonly with CKD as are dogs. CKD is characterized by progressive loss of kidney (renal) tissue (scarring and inflammation) and loss of renal functions important in maintaining a healthy life. Unfortunately, you as the owner of the affected dog or cat may not realize that there is a problem brewing until there is advanced disease.  Some patients with CKD progressively lose renal function quickly, yet others do so more slowly. In general, cats with CKD progress much more slowly than do dogs.

In most cases, the underlying cause of CKD remains a mystery in dogs and cats. This is likely a consequence of finding the disease late in its development, at which point extensive scarring makes it difficult or next to impossible to identify what was causing the original injury.  Many dogs and some cats have genetic causes that predispose them to CKD (e.g. renal dysplasia, glomerular basement membrane disease, amyloidosis, and polycystic kidney disease). CKD occurs commonly in mixed breed animals, but when CKD occurs in pure breeds, genetic mechanisms require more consideration.

One of the earliest clinical signs to be observed in dogs with CKD would be excessive thirst and urinating a larger volume. Sometimes this excess urine production is associated with leakage of urine by the animal in the house i.e. accidents.  This can also occur in cats but is not as commonly reported by cat owners. Weight loss and reduced appetite occur as CKD progresses.  Intermittent or persistent vomiting can be observed as CKD further advances. Owners may notice bad breath if uremic toxins are accumulating in the blood. Your veterinarian may note anemia based on pale mucous membranes, dehydration, oral ulcers, small kidneys that can be firm or irregular, and a larger than usual bladder size.  Many animals with CKD also have concurrent cardiac problems – murmurs, arrhythmias, and high blood pressure.  If the blood pressure is high enough, the animal may suffer loss of vision due to retinal detachment.

A blood sample is usually collected to measure serum biochemistry parameters and the status of the animal’s red and white blood cells.  Urine collected by cystocentesis (bladder needle entry) helps evaluate how the kidneys are doing.  Urinalysis is used to determine how concentrated the urine is, whether there is excessive protein in the urine, and whether there are any clues as to the presence of bacterial infection.  It is recommended to culture the urine to confirm the presence of a bacterial infection. We now recommend that all cats and dogs with suspected CKD have the amount of protein measured in their urine by a specific sensitive test called the urinary protein to creatinine in ratio.  The amount of protein in the urine is helpful diagnostically and to fine tune a prognosis for CKD patients. Sometimes special blood tests are needed to more fully know how well or poorly the kidneys are doing. When blood or urine tests suggest a kidney problem, imaging of the kidneys using a combination of radiographs and ultrasound is usually important to determine the anatomic changes that might be occurring in the kidneys. Depending on the stage of the CKD, a renal biopsy may be needed to fully understand the nature of the renal disease and its best treatment.  All suspected and confirmed cases with CKD should have their blood pressure measured every time that they are seen at the veterinary clinic – untreated hypertension predicts numerous bad outcomes for dogs and cats in general, and more so for those with CKD.

The mainstay of initial treatment of CKD is to feed a “renal diet”.  This type of diet has been developed to limit the amount of dietary phosphorus intake as the most important change to the diet.  These diets are usually supplemented with anti-inflammatory omega -3 fatty acids and are somewhat restricted in dietary sodium intake as well. It may be to the CKD patient’s advantage to have an intestinal phosphate binder medication added into the renal food, or even sometimes to the regular food if they will not eat the renal diet. The concept of a “targeted” serum phosphorus value for the CKD patient while on diet and phosphate binders is recommended. Your veterinarian may also prescribe medications to control high blood pressure and to reduce protein loss into the urine.

Depending on how stable your dog or cat is with CKD, follow-up evaluations with your veterinarian or internist are needed every 2 to 4 months to evaluate blood, urine, and blood pressure to optimize treatment which will slow down the otherwise progressive nature  of CKD and reduced life span.  We recommend baseline blood and urine testing as well as blood pressure in dogs and cats over the age of 6 as part of their routine wellness evaluations. The ability to compare laboratory testing results over multiple visits allows a much earlier diagnosis of CKD.