Canine renal failure is most often seen in older dogs, although it can affect dogs of any age. Renal failure occurs when the kidneys become diseased and begin to lose their ability to function properly. Many strategies can be used to slow the progression of the disease and a combination of medications together with dietary modifications are usually most effective. Proper treatment of kidney failure can not only slow the progression of disease but also increase the quality of life for the dog.
Feed a renal diet low in phosphorus, sodium and protein. Commercial diets formulated for kidney disease are an option. A home-cooked diet is also an option but should be formulated with the aid of a veterinary nutrition expert to ensure that the diet is complete and balanced to meet the needs of the dog.
Start fluid therapy if the dog is clinically dehydrated or showing symptoms of vomiting, lack of appetite or depression. Administer fluids subcutaneously (under the skin). Repeat the fluids periodically as needed to control symptoms.
Monitor the blood phosphorus levels periodically. Adjust the levels of phosphorus in the food accordingly. One advantage of feeding a home-cooked diet is the ease with which the diet can be adjusted to meet changing medical needs. However, commercial diets with varying degrees of phosphorus restriction are also available. As blood phosphorus levels increase, choose foods with lower phosphorus levels.
Administer phosphate binders such as aluminum hydroxide if dietary modification alone is unable to control phosphorus levels. Phosphate binders should be added if feeding a phosphorus restricted diet has not resulted in adequate lowered blood phosphorus levels in six to eight weeks.
Measure the blood potassium levels. If elevated, feed a diet with restricted potassium levels. If the blood potassium levels are decreased, supplement the diet with potassium. Again, commercially available foods provide an option or a home-cooked diet can be formulated.
Measure the blood bicarbonate and/or total carbon dioxide concentrations. If these levels are low, metabolic acidosis exists. Treat with sodium bicarbonate or potassium citrate.
Measure the amount of protein loss in the urine by performing a urinalysis and a protein:creatinine ratio on the urine. If protein is found on the urinalysis and the protein:creatinine ratio is elevated in the absence of blood in the urine or urinary tract infections, protein loss is confirmed and can be quantified. If protein loss is confirmed, begin administering ACE-inhibitors such as enalapril or benazepril.
Measure the blood pressure. If blood pressure is elevated, treat with ACE-inhibitors if they are not already being given. If ACE-inhibitors do not control the blood pressure adequately alone, add amlodipine to the treatment regime.
Measure the hematocrit (the ratio of red blood cells to white blood cells). If the hematocrit is less than 20 percent, use erythropoietin to treat the anemia.
Begin treatment with calcitriol once phosphorus levels are normal. Calcium levels should also be measured and calcitriol should not be administered if the values are increased.
Kidney failure causes gastric uremia which damages the gastrointestinal tract. Reduce gastric acid produced in the stomach by giving ranitidine or famotidine. Protect the gastrointestinal mucosa (the lining of the stomach and intestines) with sucralfate.
Give anti-emetic medications such as maropitant or metoclopramide as needed to control vomiting. These medications will need to be given by injection if the dog is vomiting and unable to hold down oral medications.