MY PET HAS CHRONIC RENAL FAILURE!

Now what?By Jacquelyn H. Burns, DVM

© Jacquelyn H. Burns 2012All rights reserved

What is Chronic Renal Failure?

Kidney damage that is cumulative enough to cause Patient to not feel as well as he or she should

Weight loss A consequence of decreased appetite

Probably due to nausea/queasiness Loss of function

Production of dilute urine (lots and lots of urine!) Patient drinks more water to compensate for this

Buildup of waste products in blood stream Gastrointestinal irritation/ulceration

Probable cause of decreased appetite Anemia

Does it hurt?

No, but patients often feel tired, queasy or nauseated and maybe just disinterested in life

What Causes It?

Acquired Toxins

Anti-freeze (ethylene glycol) Certain toxic plants

Recurrent untreated conditions Urinary tract infections/disease Other chronic diseases Glomerulonephritis

Age-related? While I tell my clients “Old age is not a disease,” the majority of

the chronic renal failure (CRF) patients are middle-aged and older. An insult here/an insult there, over time, can damage and scar the kidneys, leading to loss of function. Older pets are more likely to have accumulated damage causing loss of functional kidney tissue.

Congenital Some breeds are more prone to it than others

“Old Age is not a disease!”

While we tell clients “Old age is not a disease,” the majority of the chronic renal failure (CRF) patients are middle-aged and older. An insult here/an insult there, over time, can damage and scar the kidneys, leading to loss of function. Older pets are more likely to have accumulated damage causing loss of functional kidney tissue.

Insult here, insult there? “Insults” can result from blood

clots, infections, trauma, shock, toxins and drugs, and diseases affecting other organs

Cells that are “insulted” badly enough die and are replaced by scar tissue

Kidneys have an enormous “reserve capacity” Up to 75% of functional tissue called

nephrons can be lost and the kidneys still manage to keep up with their work

Once 76% or more of the nephrons are damaged, the kidneys begin to get behind in their work

Guy walks into a bar…

I don’t get no respec

t

Crossing the 76% ThresholdOwners start to notice

signs of disease Toxins build up in the blood stream

Which lead to gastrointestinal irritation Which cause heartburn, nausea, lethargy

Which cause patient to eat less Which cause the patient to lose weight

• Kidneys can dilute the filtered blood, but not re-concentrate• Leads to dilute urine

• Leads to drinking more/urinating larger volume

All sorts of other trickle down problems occur…that simply

lead to more problems Hypertension retains more fluidheart

has to work harder Protein loss in urine low blood

proteinpatient feels badpatient eats poorly

Lack of erythropoitinanemiapatient feels badpatient eats poorly

Electrolyte inbalances, ugh! Don’t get me started!!! High phosphorouslow calcium

Signs of CRF Appetite loss or disinterest in food

Sometimes anorexia Weight loss Increased thirst/increased interest in water

Having to fill the water bowl up more often Increased urine volume

More urine volume Bigger puddles More saturated litter box/having to change more often

Urinating in house or on bedding Lethargy/listlessness Vomiting

Physical Exam Findings

Weight loss or low body condition score Sometimes pale mucous membranes

Lining of eyes Lining of mouth Noses on fair-skinned pets

Sometimes kidneys palpate abnormally Most often small, hard and lumpy—pitted and

scarred Sometimes swollen

Sometimes halitosis, thick saliva, oral ulcers

Laboratory Findings

Urinalysis Proteinuria

Protein:Creatinine ratio test may be needed to assess.

Low urine specific gravity This means the urine is very dilute

Blood Tests High Creatinine and BUN (blood urea nitrogen) High phosphorous High potassium Anemia

Low hematocrit

Diagnostic Imaging

Kidneys can be evaluated by various kinds of diagnostic imaging X-rays Ultrasound

Bottom Line Diagnostic Test?

Renal biopsy

Though it often doesn’t change the outcome, a renal biopsy is the most definitive test to assess cause of and prognosis for kidney disease.

Regardless of the cause, the outcome is often not good. Disease cannot be cured but managed. Management is

for life. Goal of therapy is a longer life and improved

quality of life.

OK, so how do we “manage” kidney disease?

???????

Prescription Diet KD

Pretty simple. KD=Kidney Diet Low protein content=lower workload for

kidneys Less nitrogenous waste products to be filtered

out Increased fat content

Fat increases calories Fat increases palatability!

Reduced levels of Sodium Potassium Phosphorous

Azodyl

Not a drug but a nutraceutical Contains microbes that “digest”

nitrogenous waste products in the gastrointestinal tract

Fewer waste products in G-I tract mean less to be absorbed and filtered by the kidneys Goal to keep Creatinine and BUN low(er)

Special precautions Refrigerate For best results, give capsules whole

EpakitinEE-puh-KY-ten

Also a nutraceutical Phosphorous in the G-I tract binds to it

Reduces absorption of phosphorous in gut Makes for lower phosphorous blood levels

Made from ground up crustacean shells Powdered and palatable

What cat doesn’t like the taste of shrimp and crab?

Not added to our treatment regimen until phosphorous blood levels are increased

Nausea. It’s there. Often pets, especially cats, don’t vomit, they

simply don’t eat. Much of the time, this means there is nausea.

These drugs are given “as needed.”

Sucralfate, an gastro-intestinal protectant Binds to irritated stomach and intestinal lining Decreases heartburn, queasiness, nausea

Pepcid AC, an antacid Reduces gastric acid secretions Decreases heartburn, queasiness, nausea

Reglan, an anti-emetic Decreases nausea, vomiting

Blood Pressure Regulation

Anti-hypertensives are helpful in many cases, particularly in patients with Glomerulonephritis, an inflammatory process that adversely affects the kidneys and causes protein loss via the urine

Maintenance (at home) Fluids!

I saved the fluids for last. People are often intimidated by the idea of administering fluids at home. It can be scary, but most people can learn to do it. If not, sometimes they bring the pet in 2 to 3 times weekly for fluid administration by our technicians

Subcutaneous Fluids

Most often are prescribed for cats

Needle is placed under the loose skin on the shoulder/neck area

Fluids run by gravity Take 5 to 10 minutes

to do Usually done 2 to 3

times weekly

Training Our technicians can

show you how to do this at home.

Requires: A bag of LRS An IV Line 18 or 20 gauge

hypodermic needles

USE A FRESH, UNUSED NEEDLE EACH TIME. The IV line is multi-use if you are very clean with it.

Monitoring

Regular checkups to include BUN, Creatinine, Phosphorous, Calcium, Sodium and Potassium Intervals between checkups to be determined by

your veterinarian. Of these, we are most concerned with creatinine

and phosphorous Numbers matter, but only insofar as the

patient feels well. We want our pets to feel well enough to eat, play and love with gusto, no matter how low or high their creatinine is.

This material:

This material is intended to help veterinary clients understand chronic kidney disease and how it affects their pet, as well as one veterinary practice’s general approach to treatment. Each patient is an individual and must be assessed and treated by his or her own veterinarian, according to that veterinarian's clinical judgment and that patient’s unique needs.

For proper diagnosis and treatment, see your veterinarian. ( preferably with a cup of urine in your hand )

Slide Presentation Courtesy of

Jacquelyn H. Burns, DVM Holmes Veterinary Hospital 1001 Church Street Laurens, SC 29360 www.holmesvethospital.com

All rights reserved Copyright © 2012 by Jacquelyn H. Burns, DVM