Navigating Chronic Kidney Disease in Dogs: Signs, Diagnosis, and Treatment

Kidney diseaseChronic kidney diseaseAcute kidney disease

6 Oct

The kidneys play a crucial role in your dog’s overall health, performing essential functions like filtering the blood, removing toxins, regulating blood pressure, and maintaining fluid balance. These bean-shaped organs are part of the urinary system, producing concentrated urine to efficiently eliminate toxins. Approximately 25% of your dog’s cardiac output flows through the kidneys, making them vital for health. When kidney function is compromised, it can negatively impact several bodily systems.

Beyond waste removal, the kidneys also regulate pH levels, reabsorb essential nutrients, and manage the excretion of substances like urea nitrogen, creatinine, phosphorus, and SDMA. These organs produce important hormones involved in red blood cell production and acid-base balance. Inside each kidney, about 200,000 nephrons—tiny filtering units—perform these vital functions. When these nephrons are damaged, kidney function deteriorates, potentially leading to kidney failure.

What causes kidney disease?

Kidney disease in dogs is generally classified into two main categories: acute renal failure (ARF) and chronic renal failure (CRF). Both types have unique causes, symptoms, and treatment options.

Acute Renal Failure (ARF)

Acute renal failure occurs suddenly and presents severe symptoms like vomiting, lethargy, and loss of appetite. Dogs with ARF may produce little to no urine, especially if there is a urinary obstruction. ARF is a medical emergency that requires immediate veterinary care and can be life-threatening.

Common causes of ARF are often linked to nephrotoxins—substances that damage the kidneys. These include certain medications (like some antibiotics and NSAIDs), antifreeze, and foods like grapes or raisins. Although Easter lilies primarily affect cats, they are a good example of how certain plants can also cause renal failure in dogs. Impaired blood flow to the kidneys can also trigger acute kidney failure.

Veterinary treatment for ARF often includes intravenous fluids and, in some cases, homeopathic remedies. Early diagnosis significantly increases the chances of recovery, but if left untreated, ARF can lead to chronic conditions that are more difficult to manage.

Chronic Renal Failure (CRF)

Chronic renal failure is a gradual decline in kidney function, more commonly seen in older dogs. Contributing factors include infections, high blood pressure, kidney trauma, and kidney stones. Although controversial, some experts suggest that certain vaccines may contribute to kidney issues, especially in cats. Additionally, a poor-quality diet lacking essential nutrients can also play a role in the development of CRF.

Managing CRF involves early diagnosis, ongoing veterinary care, and a species-appropriate diet. Avoiding highly processed commercial pet foods is key, as these often lack the nutrients necessary for optimal kidney function.

Chronic Kidney Disease prevalence In certain breeds

Chronic kidney disease (CKD) is more common in certain breeds, like Cavalier King Charles Spaniels and Cocker Spaniels. These breeds are genetically predisposed to kidney issues, and as the disease progresses, the kidneys lose their ability to filter toxins and maintain water balance in the body. A 2013 UK study highlighted the increased prevalence of CKD in both Cavalier King Charles Spaniels and Cocker Spaniels.

For Cavaliers, a complicating factor is the tendency to develop cardio-renal syndrome (CRS) , where heart and kidney diseases exacerbate each other. This often results from mitral valve disease (MVD)—common in the breed—and the use of diuretics, which can reduce blood flow to the kidneys. Monitoring both heart and kidney health is essential, as medications for one condition can negatively impact the other.

There are five forms of CRS, ranging from acute to chronic, and the severity varies depending on the underlying causes. It’s especially important for Cavaliers to have both heart and kidney health monitored regularly, as these systems are interdependent, and medications for one can inadvertently affect the other.

Stages of Chronic Kidney Disease (CKD) in Dogs

The International Renal Interest Society (IRIS) has classified CKD in dogs into four stages, based on blood test results, particularly creatinine and SDMA levels, which indicate kidney function.

• Stage 1 (Early CKD): Creatinine levels are below 125 μmol/L (1.4 mg/dL), and SDMA levels are under 18 μg/dL. Dogs in this stage may not show symptoms, but abnormal urine concentration or kidney imaging can indicate early CKD.

• Stage 2 (Mild CKD): Creatinine levels rise to 125-250 μmol/L (1.4-2.8 mg/dL), and SDMA levels range from 18-35 μg/dL. Early signs of kidney dysfunction, like mild azotemia, may appear. Regular monitoring and early intervention can slow disease progression.

• Stage 3 (Moderate CKD): Creatinine levels increase to 250-440 μmol/L (2.9-5.0 mg/dL), and SDMA levels range between 36-54 μg/dL. Dogs may begin showing symptoms such as increased thirst and urination. Managing symptoms and slowing progression is crucial at this stage.

• Stage 4 (Severe CKD): Creatinine levels exceed 440 μmol/L (5.0 mg/dL), and SDMA levels are above 54 μg/dL. At this stage, dogs often experience uremia, which can lead to nausea, vomiting, and lethargy. Treatment focuses on managing symptoms and maintaining the dog’s quality of life.

Symptoms of acute and severe kidney disease in dogs

Recognizing the symptoms of acute and severe kidney disease in dogs is crucial for timely intervention. Acute kidney disease (AKD) often appears suddenly, presenting severe signs, while chronic kidney disease (CKD) tends to develop gradually over time, making early detection difficult. Understanding the signs of both forms can significantly improve treatment outcomes and overall well-being for affected dogs.

Acute Kidney Disease (AKD)

AKD is a sudden onset condition that can lead to life-threatening complications if not addressed promptly. Symptoms typically include:

• Vomiting and Nausea: Accumulation of toxins in the bloodstream can trigger frequent vomiting, one of the first signs of AKD.

• Lethargy: Dogs may show extreme fatigue and an unwillingness to engage in normal activities.

• Loss of Appetite: Many dogs refuse to eat, which leads to rapid weight loss and further weakening of the body.

• Increased Thirst and Urination: Dogs may drink excessively (polydipsia) or, in severe cases, produce very little urine, indicating a problem with kidney filtration.

• Dehydration: Symptoms such as dry gums, sunken eyes, and a loss of skin elasticity are indicators of dehydration, often exacerbated by vomiting and reduced fluid intake.

• Oral Ulcers: Sores in the mouth can appear due to increased toxin levels in the blood, particularly urea.

• Abdominal Pain: Some dogs show signs of discomfort, such as whining, restlessness, or reluctance to be touched around the abdominal area, due to kidney inflammation.

Given the rapid onset of symptoms, AKD requires immediate veterinary attention to avoid irreversible damage to the kidneys. Conditions like toxin exposure, infections, or urinary blockages can rapidly deteriorate kidney function.

Chronic Kidney Disease (CKD)

CKD progresses over time, often without obvious symptoms until significant kidney damage has occurred. Common signs of CKD include:

• Weight Loss: A gradual decline in body weight due to muscle wasting and a reduction in nutrient absorption.

• Increased Thirst and Urination: Dogs with CKD often drink and urinate more, compensating for the kidneys’ declining ability to filter toxins.

• Poor Coat Condition: The dog’s fur may appear dry or lacklustre, often a result of poor nutrition and overall health.

• Vomiting and Nausea: Similar to AKD, frequent vomiting can occur, especially after meals, as the kidneys struggle to filter waste products.

• Decreased Appetite: Dogs may lose interest in food, leading to further weight loss and nutritional deficiencies.

• Bad Breath: A common symptom of CKD is the development of an ammonia-like odour in the breath due to waste buildup in the blood.

• Fatigue and Weakness: Affected dogs may show signs of lethargy, lack of stamina, and overall weakness as the disease progresses.

Though CKD is not curable, early diagnosis allows for better management of symptoms and can significantly improve a dog’s quality of life. Veterinary care typically focuses on slowing disease progression and alleviating discomfort through a combination of medication, dietary changes, and regular monitoring.

What is the standard western veterinary approach to treating CKD in dogs?

Conventional treatments for CKD focus on managing symptoms and slowing disease progression. Key components of traditional care include:

• Low-Protein Diets: Designed to reduce blood urea nitrogen (BUN) and creatinine levels. However, reducing dietary protein may impair kidney function since proper filtration is linked to protein intake.

• Sodium Restrictions: To manage hypertension and prevent fluid retention.

• Medications: Adjustments to diuretics and ACE inhibitors are made based on kidney function and hydration levels.

• Regular Blood Tests: Monitoring kidney function is essential for long-term management.

The September 2015 Consensus Statement from veterinary cardiologists and nephrologists provides key management strategies:

1. Address elevated blood pressure following IRIS guidelines.

2. Regularly monitor and adjust medications like diuretics and ACE inhibitors.

3. Nutritional management, focusing on sodium and phosphate reduction while maintaining adequate protein levels.

Supporting Kidney Health Through Nutrition

Diet is one of the most powerful tools in managing CKD. A balanced, species-appropriate diet that limits phosphorus and sodium, while carefully managing protein intake, is key to supporting kidney function and slowing disease progression it is the only treatment that has been shown to effectively prolong survival and improve quality of life.

Too much phosphorus can further damage the kidneys, and excessive sodium can lead to high blood pressure and fluid retention. Finding the right protein balance is critical—too little can result in muscle wasting, but too much can overwork the kidneys.

Incorporating antioxidant-rich foods like blueberries, spinach, and kale into your dog’s diet can help combat oxidative stress, which is often associated with CKD.

Including organ meats in your dog’s diet—about 10-25%—is incredibly beneficial, especially when it comes to feeding kidneys. Feeding kidneys to dogs with CKD can help supply the specific nutrients and enzymes necessary for repairing and maintaining kidney tissues. Glandular supplements (UK) that containing kidney tissue can be a substitute when fresh organ meats are not available. Glandular supplements (USA/CAD) can still provide the vital nutrients your dog needs to promote overall organ health and support their kidneys specifically.

Omega-3 fatty acids, particularly from fish oil, have anti-inflammatory properties that can benefit kidney health. Additionally, bone broth, given in moderation, can provide extra hydration and essential nutrients.

When considering dietary changes, it’s essential to consult a holistic veterinarian or qualified canine nutritionist who understands the needs of a dog with CKD. With the right nutritional approach, you can significantly improve your dog’s quality of life and help manage the progression of CKD.

Phosphorus and Protein: What You Need to Know

One of the main goals of managing CKD is controlling phosphorus intake. As the kidneys lose their ability to filter phosphorus, it builds up in the bloodstream, leading to further damage. Slightly restricting phosphorus can slow down the progression of CKD. Foods high in phosphorus, such as raw bones, organ meats, dairy, and egg yolks, should be fed in moderation rather than eliminated entirely.

Protein restriction is another area of common misunderstanding. Recent research indicates that moderate amounts of high-quality protein are better for dogs with CKD, helping maintain muscle mass and overall health. Monitoring your dog’s blood test results, particularly urea and nitrogen levels, is key to finding the right balance for your dog’s unique needs.

Sodium, Potassium, and Magnesium Considerations

Sodium restriction is often recommended for dogs with CKD, but it’s important not to cut it out completely. Sodium plays essential roles in the body, and a moderate amount from natural and healthier sources like Himalayan salt can be beneficial. However, balancing sodium with other electrolytes like potassium and magnesium is crucial, as too much of these can strain the kidneys.

Dry Food for Dogs with CKD: Why It’s Not the Best Choice

Managing chronic kidney disease (CKD) in dogs requires a well-thought-out diet that supports kidney function and helps slow the disease’s progression. Diet is perhaps the most significant factor that can influence a dog’s quality of life with CKD, and when it comes to choosing between fresh, whole food and dry kibble, the choice is clear—dry food simply doesn’t measure up.

Below are the 3 main reasons why dry food is not recommended for dogs with CKD:

• Dehydration: Kibble is low in moisture, and maintaining hydration is critical for kidney health. Dry food can exacerbate dehydration, forcing the kidneys to work harder.

• Low bioavailability of protein: Dry food often contains denatured or cross-linked proteins, making them more challenging for the body to break down. This forces the kidneys to filter harder, increasing the strain on them.

• High sodium and starch content: Many dry foods are high in sodium and starch, which can worsen kidney issues. Sodium can lead to high blood pressure and fluid retention, while excessive starch is inflammatory and unnecessary.

Here’s what to focus on instead when feeding a dog with CKD:

• Feed fresh, unprocessed food

• Keep the diet low in phosphorus levels (0.2% – 1% dry matter)

• feed high quality protein with Moderate protein levels

• feed kidneys as 10-25% of your dogs diet.

• keep your dog hydrated with fresh and filtered water.

• control the amount of Treats/chews given - include the within the daily calorie intake

• Avoid table scraps

What About Prescription Diets for Kidney Disease?

While many veterinarians recommend prescription diets for CKD, it’s important to be aware of their limitations. These diets, particularly dry formulas, are often low in moisture, high in processed, low quality ingredients, and filled with additives that can further strain the kidneys. They also tend to be low in protein, despite mounting evidence that a moderate, high-quality protein diet is better for managing CKD.

Low Sodium

Reducing sodium in your dog’s diet is not only unnecessary but can actually cause harm. Low sodium levels can lead to tissue dehydration, which further stresses the kidneys. Instead, your dog needs balanced trace minerals and salt to help their body maintain proper hydration and electrolyte balance.

High Carbohydrates

Many prescription kidney diets are designed to help dogs gain weight, but they do so using low-quality ingredients like high carbohydrates and poor fats. These “junk” ingredients can lead to weight gain but not in a healthy way. What your dog really needs is high-quality protein to preserve muscle mass and support overall health, especially when managing kidney disease.

Low Moisture

Dogs with kidney disease are prone to dehydration, which makes moisture in their diet essential. While canned kidney diets contain more water, kibble is typically only 10-15% moisture, compared to fresh food diets, which can contain up to 85%. Ensuring your dog’s food is moisture-rich is vital to supporting their hydration and kidney function.

Omega-3 Fatty Acids

While omega-3 fatty acids can support kidney health, they can easily become rancid in processed foods, reducing their effectiveness and potentially causing harm. It’s better to add fresh and more potent forms of omega-3 supplements to your dog’s diet just before feeding, ensuring th. e fats remain beneficial.

Artificial Additives

Commercial and prescription diets are often loaded with preservatives, artificial colors, and synthetic vitamins. These additives are unnecessary and must be processed by the kidneys, adding additional strain to already compromised organs. Opt for a diet free from artificial ingredients to lessen the burden on your dog’s kidneys.

By focusing on real, nutrient-dense food, you can better support your dog’s kidney health naturally.

The Role of Treats in a CKD Diet

Dogs with CKD can still enjoy treats, but they should meet the dietary criteria for phosphorus, protein, and sodium, and not exceed daily caloric intake. Fresh, low-phosphorus treats are the best option, ensuring they don’t interfere with the overall diet plan.

Herbs, Supplements, and Superfoods for Managing CKD in Dogs

When managing chronic kidney disease, incorporating specific herbs, supplements, and superfoods can naturally support kidney function and overall well-being.

While these natural remedies can’t cure CKD, they complement traditional treatments and help slow disease progression. Always consult with a holistic veterinarian before introducing any new supplements or herbs to ensure they align with your dog’s health needs.

1. Omega-3 Fatty Acids

Omega-3 fatty acids, especially from green lipped mussel and algae oil, are well-known for their anti-inflammatory benefits. They can reduce kidney inflammation, improve cardiovascular health, and help manage proteinuria, a common issue in CKD.

2. Antioxidant-Rich Superfoods

Foods like blueberries, kale, and spinach are rich in antioxidants, which reduce oxidative stress on the kidneys. Spinach, while high in nutrients, should be carefully prepared due to its oxalate content—boiling can reduce soluble oxalates by up to 87%. This helps reduce kidney stone risk and ensures the nutritional benefits are retained without the oxalate burden.

3. Astragalus & Rehmannia

These traditional Chinese herbs support kidney function, with astragalus improving blood flow to the kidneys and reducing proteinuria, and rehmannia offering anti-inflammatory benefits. You’ll need help from a Traditional Chinese Veterinary Medicine (TCVM) practitioner to tell you which combination and dosage is best for your individual dog.

4. Milk Thistle & Bentonite Clay

Milk thistle supports liver detoxification, which is vital when kidney function declines, while bentonite clay may help remove toxins from the gut, giving the kidneys a break from processing these harmful compounds.

5. B-Complex Vitamins

B vitamins, especially those lost in urine due to CKD, are essential for energy, metabolism, and overall vitality. Supplementing with a B-complex can help replenish these nutrients and support red blood cell production.

6. Turmeric & Coenzyme Q10

Turmeric, thanks to its active compound curcumin, and CoQ10 both offer anti-inflammatory and antioxidant benefits, protecting kidney cells from further damage.

7. Pink Himalayan Salt

Switching to cleaner salts like genuine Pink Himalayan salt can be beneficial for dogs with CKD, as it contains trace minerals and is less processed than table salt. However, sodium levels must still be carefully managed to avoid exacerbating high blood pressure.

8. Probiotics

Maintaining gut health through probiotics can support the kidneys by aiding in the removal of toxins, preventing their absorption into the bloodstream.

9.Dandelion, parsley and urva-ursiall

Dandelion, parsley, and uva-ursi are known for their kidney-supporting properties due to their natural diuretic and anti-inflammatory effects. Dandelion is rich in potassium, which helps flush out excess fluids and supports kidney filtration. Parsley aids in reducing water retention and may help eliminate toxins through the urine, making it beneficial for urinary tract health. Uva-ursi has antimicrobial properties and supports the kidneys by reducing inflammation and promoting urine production, helping to prevent infections.

10.Cordyceps mushrooms

Cordyceps mushrooms are a potent natural remedy for supporting kidney health in dogs with Chronic Kidney Disease (CKD). Known for their adaptogenic properties, cordyceps help reduce oxidative stress and inflammation, which are key contributors to kidney damage. They can also improve kidney function by increasing renal blood flow and supporting the kidneys’ filtration ability. Additionally, cordyceps have been shown to enhance energy levels and overall vitality, which is especially beneficial for dogs with CKD who often experience fatigue and muscle wasting.

Research has also indicated that cordyceps may reduce proteinuria (excessive protein in urine), a common issue in CKD, and improve kidney biomarkers such as blood urea nitrogen (BUN) and creatinine levels. When supplementing with cordyceps, ensure you’re using high-quality products and adjust dosage according to your dog’s weight, as supplements are often labeled for humans.

Important Note

When adding herbs to your dog’s food, use fresh, chopped herbs and add a pinch per 10 lbs of body weight, with up to 1 tablespoon for dogs weighing 100 lbs or more. When using dried herbs, capsules, or tinctures, remember that the dosage on the label is usually for a 150 lb human, so adjust the amount based on your dog’s weight.

Incorporating these natural remedies, alongside traditional treatments and a kidney-friendly diet, offers a holistic approach to managing CKD in dogs. Always consult with your vet before adding new supplements, especially for dogs with existing kidney issues.

Probiotic strains beneficial for CKD

Below is a list of specific probiotic strains that you can include in your dogs CKD regime, along with a brief summary of their benefits for kidney health and related studies:

1. Lactobacillus casei:

This strain is beneficial for kidney health as it helps reduce the production of uremic toxins, such as urea, which accumulate in dogs with CKD. By reducing the levels of these toxins, Lactobacillus casei may alleviate the strain on the kidneys, helping to slow the progression of kidney disease.

Study: Ranganathan, N., et al. (2010) demonstrated that Lactobacillus casei can reduce blood urea levels, improving gut health and reducing the buildup of harmful compounds in the bloodstream of CKD patients.

2. Bifidobacterium longum:

Known for supporting gut barrier integrity and reducing gut-derived toxins, Bifidobacterium longum may be beneficial in reducing inflammation, a common issue in dogs with CKD. It also helps minimize the production of nephrotoxic compounds, which further supports kidney health.

Study: Research by Guida, B., et al. (2014) highlighted that Bifidobacterium longum could lower systemic inflammation and prevent the accumulation of harmful metabolites in CKD.

3. Lactobacillus acidophilus:

Lactobacillus acidophilus is widely used for its gut health benefits, specifically its ability to maintain microbial balance and reduce oxidative stress, which can exacerbate kidney disease. By promoting a healthy gut environment, this strain may help reduce the impact of kidney-damaging toxins.

Study: Anders, H. J., et al. (2016) explored the role of probiotics in modulating oxidative stress and inflammation, with Lactobacillus acidophilus showing positive effects on kidney function in CKD.

4. Lactobacillus plantarum:

Lactobacillus plantarum has been shown to enhance the removal of toxins like indoxyl sulfate, which is produced in the gut and is harmful to kidney function. By decreasing these toxins, it may help to slow the progression of CKD in dogs.

Study: Research by Vaziri, N. D., et al. (2013) demonstrated the ability of Lactobacillus plantarum to reduce uremic toxin levels, thereby supporting kidney health in individuals with CKD.

5. Streptococcus thermophilus:

This strain has been shown to support the reduction of uremic toxins by enhancing gut microbial health. It is often included in renal-targeted formulations, combined with other strains to aid in the management of kidney disease by lowering harmful metabolites and improving gastrointestinal function.

Study: Research conducted by Patel, C., et al. (2012) found that Streptococcus thermophilus, along with other probiotic strains, could reduce serum urea levels and improve the health of CKD patients.

6. Bacillus coagulans

Bacillus coagulans is a resilient probiotic that can survive stomach acid and reach the intestines, where it exerts its benefits. It has been shown to modulate the immune response and reduce inflammation, which is particularly useful for managing CKD in dogs.

Study: A study by Ranganathan, N., et al. (2009) indicated that Bacillus coagulans supplementation in CKD patients resulted in a decrease in inflammatory markers, which is critical in reducing the progression of kidney disease.

These probiotic strains show promise in managing CKD by improving gut health, reducing inflammation, and lowering the production of nephrotoxic compounds. Each of these probiotics has a unique mechanism of action, and incorporating them into a dog’s health plan may complement traditional therapies for CKD.

Homeopathy for CKD

Several homeopathic remedies can help manage Chronic Kidney Disease (CKD) in dogs by supporting kidney function and relieving symptoms. Berberis vulgaris is commonly used to alleviate discomfort related to kidney stones and promote healthy kidney function. Apis mellifica may help reduce swelling and fluid retention, while Serum Anguillae is often recommended for severe kidney conditions due to its ability to support detoxification. Arsenicum album can also be beneficial in cases where dogs experience gastrointestinal upset or dehydration, which are common in CKD.

While homeopathic remedies aim to support the body’s natural healing processes, they should be used alongside veterinary care. Research into the efficacy of these remedies for kidney disease in animals remains limited, but some holistic practitioners advocate their use based on clinical experience. For further information, you can explore this resource on holistic treatments for CKD in pets .

Final Thoughts

While there is no cure for CKD, effective management can slow the disease’s progression and improve your dog’s quality of life. Western treatment typically focuses on reducing symptoms, supporting kidney function, and addressing complications. However, a Holistic approach is key to supporting dogs with CKD. Understanding how chronic kidney disease progresses and the critical role the kidneys play is essential in helping your dog manage this condition. By focusing on the right nutrition and treatments, you can make a significant difference in their quality of life.

If your dog has CKD, prioritising a fresh, species-appropriate diet is one of the most effective ways to support kidney function. Steering clear of dry food and working with a holistic veterinarian or appropriately canine nutritionist to create a balanced, kidney-friendly diet will ensure your dog’s nutritional needs are met. While CKD is a serious diagnosis, with the right diet and care, your dog can still enjoy a longer, healthier life.