Acute Kidney Injury In Dogs

The term ‘kidney injury’ represents a broad spectrum of acute or sudden kidney damage, ranging from a mild disease that is undetectable clinically to acute renal failure that is deadly.

Kidney injury is the outcome of any one of the several conditions that can affect the kidneys and related organs. Physiologically, it occurs when the kidneys can no longer efficiently perform their function, which is to remove wastes and extra fluids, maintain a healthy balance of electrolytes, control acid balance regulate hydration, control blood pressure, etc.

Kidney problems can be broadly classified into acute or chronic. Acute kidney failure happens suddenly (in hours or days), while chronic kidney failure happens gradually over time. For this reason, chronic kidney failure is also called ‘end-stage renal disease’.

For renal damage occurring over a short period of time (hours to days), the acute kidney injury (AKI) term has replaced the historical term acute renal failure. This is considered to better portray the duration of the different phases of injury and pathophysiologic changes.

Kidney injury symptoms:

• Decreased urine output (occasionally normal)
• Breath that smells like chemicals
• Internal bleeding
• Fluid retention of the face, legs, and ankles (edema)
• Uncoordinated movement such as stumbling
• Seizures
• Fatigue/weakness
• Nausea
• High blood pressure

The treatment of kidney injury varies depending on the underlying cause, the dog's overall condition, and the severity of symptoms.

Sometimes, AKI dogs require hospitalization and intensive care to recover.

Aggressive treatments may include hospitalization for a kidney transplant, dialysis, Temporary Feeding Tube, or intravenous (IV) fluids.

For milder cases - Antibiotics, fluid therapy, and other medications

Kidney injury in dogs - Treatment protocol focuses on slowing the disease progression, and severity and improving the quality of life for the pet.

Peritoneal Dialysis: A tube is placed directly into the peritoneum in the abdomen, then the fluid is pushed into this membrane (acts as a natural filter) and dissolved substances are later drained out.

Kidney dialysis (Hemodialysis) is required for:

• Critical electrolyte abnormalities
• No underlying cause is found but severely elevated kidney values
• Lack of urine production
• Over hydration as a result of fluid administration

Treatment of appetite changes, blood pressure alterations, anemia, fluid imbalances, electrolyte disturbances, gastrointestinal problems, and nausea is typically necessary.

Dog owners should consult with their veterinarian as soon as they notice the symptoms as some conditions can be very serious (and possibly fatal).

Keep dogs away from household chemicals such as antifreeze and other cleaners.

Dogs can easily poke their nose through plastic bottles and ensure bottles are kept up high or in locked cabinets where dogs cannot reach them.

Keep raisins, Grapes, prescription and OTC drugs, like ibuprofen out of reach of dogs.

Clear away contaminated water sources

Talk to your vet about your dog’s dental hygiene and how often you should have your dog’s teeth cleaned

Vaccination against infectious diseases (like leptospirosis) can prove highly effective to prevent acute kidney failure

There is no breed disposition.

Causes:

Infections

• Pyelonephritis
• Leptospirosis infection
• Lyme disease
• Primary bacterial kidney infection

Toxicity

• Anti-freeze ingestion
• Amyloidosis
• Severe blood pressure changes (low or high)
• Nephrolithiasis
• Kidney blockage (ureteral obstruction with hydronephrosis)
• Medications such as cardiac and anti-inflammatory medications
• Damage to kidney tubules (tubulointerstitial disease)
• Certain foods such as grapes/raisins in dogs
• Severe pancreatitis (inflammation of the pancreas gland)

Stages of kidney injury:

The International Renal Interest Society (IRIS): kidney injury is often progressive and stages of chronic renal failure are numbered 1 to 4 (with increasing severity).

There are higher chances of morbidity and mortality at stages 3 and 4.

Mortality:

Median survival time for dogs:

Stage 1: >more than 400 days

Stage 2: 200 to 400 days

Stage 3: 110 to 200 days.

Diagnosis:

• Inflammatory or infectious disease testing (in certain cases)
• SDMA test: SDMA (a naturally occurring biological indicator for kidney function)
• IRIS (The International Renal Interest Society) staging system - urine protein: creatinine ratio [UPC)
• Urine testing (urinalysis and urine culture)
• Abdominal ultrasound
• Blood work evaluation

Prognosis:

Many instances of acute kidney injury can be reversed depending on the cause and with prompt treatment.

The stage or severity of the disease determines the prognosis.

In some dogs, medical management will offer much-needed healing time for kidneys and in other cases, dogs may recover but develop permanent damage that is clinically significant leading to chronic kidney diseases.

What is more important to consider is that the degree of elevation in kidney values does not always connect with the outcome. With prompt care, many dogs that originally had significant dysfunction can have good outcomes.

Contact your vet right away, if you notice any of the following:

• Fluid retention of the face, legs, and ankles (edema)
• Decreased or no urine output often

Foods to avoid:

• Pretzels, chips, and crackers
• Coconut
• Chocolate, coffee, and caffeine
• Grapes, purines, and raisins
• Dairy, eggs
• Salty/processed snack foods like canned and packaged snacks)
• Macadamia and other nuts
• Onions, garlic, chives
• Raw, processed, or undercooked meat
• Yeast dough
• Xylitol

Special diet for kidney diseases:

Lower in protein, reduced amounts of sodium and phosphorus, with increased levels of omega-3 fatty acids, potassium, and high-alkaline foods

Protein: 14-20%, 35 g/1000 kcal of high-quality protein

Sodium: ≤ 0.3%

Phosphorus: 0.2 - 0.5%

Potassium: 1.1- 2-3%

Omega-3 fatty acids: 1 g of EPA and DHA per 1000 kcal of diet = 25 mg/kg of DHA combined with 40 mg/kg EPA q24h

High alkaline foods:

• Green Leafy Vegetables
• Root vegetables
• Almonds
• Cucumber Beets, Avocado, Figs, and Apricots

Kidney injuries in dogs that go untreated are deadly. When you suspect any kidney-related issues with your dog, don’t try to treat the condition with any conventional home remedies.

Discuss with your vet to provide you with a practical prognosis for your pet's recovery after a complete examination and testing.