CHRONIC KIDNEY DISEASE (RENAL FAILURE)
There are several names for this very common degenerative disease of the kidneys in both dogs and cats - chronic renal failure, chronic renal disease, chronic renal insufficiency, and most recently, chronic kidney disease (CKD). This condition is one of the most common old age changes we see in our feline population, and there are researchers continuing to ask the question why. It is considerably less common in dogs, but we do see it in our canine companions as well.
Sadly, by the time the pet shows signs of CKD, the damage is severe. Additionally, CKD is progressive, and there is no true cure. In spite of that, we are frequently able to give our patients months to years of good quality life. Because the kidneys perform so many functions, the signs we see in pets with CKD can vary quite a bit. The signs may be severe or may be subtle and slowly progressive. Despite the chronic nature of the disease, sometimes signs appear suddenly, when the disease hits a tipping point. The most common signs include some combination of the following: excessive drinking and excessive urination, intermittent vomiting and lack of appetite, general depression secondary to the build-up of waste products usually cleared by the kidneys, weakness secondary to anemia and/or low blood potassium. Since the signs seen in pets with CKD and the findings on examination are not specific for CKD, blood and urine tests are needed to make a definitive diagnosis of CKD. When these tests are performed, we will find some combination of anemia, increased BUN and creatinine (wastes that are normally removed by the kidneys), increased phosphorous in the blood, dilute urine, and possibly protein or bacteria in the urine. Once the initial diagnosis is made, we sometimes perform other tests to look for an underlying cause for the CKD and/or to "stage" the CKD.
The severity of the pet's signs will determine what treatments are needed. Treatments may be started incrementally (a few treatments are started and then based on patient response, additional treatments may be added later). A pet with severe signs may be hospitalized for fluid and intravenous drug treatment to reduce the amount of waste products in his body. Many pets with CKD will feel better in response to treatment with IV fluids but if the kidney disease is extremely severe the pet may not respond to treatment.
Those pets who are still eating and not showing severe signs are treated with a variety of treatments, often introducing treatments incrementally as new signs develop. The treatment approach is often called "conservative" compared to more aggressive treatments such as hospitalization for intravenous fluid therapy. Remember that CKD is not a disease that can be cured. Treatments are designed to reduce the work the kidneys need to perform, to replace substances that may be too low (such as potassium) and to reduce wastes that accumulate such as urea (generated by the body from protein metabolism) and phosphorus.
Although chronic kidney disease is a serious condition that is not curable, we can often give your pet a significant amount of good quality time after the diagnosis is made.