In dogs with chronic kidney disease, the kidneys are reduced in size. Symptoms and treatment of kidney failure in dogs

Kidney failure in dogs refers to problems with the kidneys. At the same time, their excretory ability decreases or completely stops, and various harmful and toxic substances begin to accumulate in the body, affecting general state dog health. At an early stage, this pathology is practically not detected, because Rarely does an owner check a pet’s blood and urine at diagnostic intervals.

At risk for development various pathologies kidneys include dogs over 5 years old. This does not take into account various damaging factors at an earlier age.

Dog breeds predisposed to kidney pathologies

• Samoyed dogs;
• German Shepherds;
• Shar-Pei;
• bull terriers;
• Shih Tzu;
• English cocker spaniels;
• golden retrievers.

In renal failure, the destruction of kidney tissue usually occurs, and the remaining cells bear an increased burden of general excretory function. Kidney cells and tissues do not regenerate, so loss of function of this body obvious. If you regularly take blood and urine tests, you should already increased attention to the upper limits of normal indicators - this may be a signal that there is a predisposition to renal failure. Why is it important to get tested? Because outwardly this pathology begins to manifest itself already when 50-70% of the kidneys are affected. In this condition, cure is impossible; you can only organize periodic or regular maintenance therapy.

Pathology occurs in two forms:

• acute;
• chronic.

Signs, symptoms

It should be repeated that insufficient kidney function is an insidious pathology that begins to manifest itself externally even when the original state of the kidneys can no longer be returned. Given the natural general good health of dogs, kidney failure may begin to manifest itself clinically when one kidney fails completely and the other is one-third damaged. Symptoms can appear several at a time, or some individually. You need to be attentive to the condition of your pet.

What are the main symptoms of kidney failure in dogs? First of all, the dog stops being active, lies down more, looks tired and depressed. The amount of urine produced may increase sharply due to the body's loss of ability to retain and absorb fluid. At the same time, the urge to go to the toilet becomes more frequent up to 6-8 times. Such symptoms definitely lead to dehydration and constant thirst. After this, the amount of urine decreases sharply and disappears completely.

The dog's weight decreases due to lack of appetite, periodic vomiting and diarrhea. The mucous membranes become pale, the pulse may increase (normally 70-120 heartbeats) and swelling may appear, starting from the bottom of the paws. In extreme cases, muscle tremors and inflammation in the mouth are added, up to the appearance of ulcers.

We can assume that a dog is in a very bad state when regular convulsions, extensive ulcerative stomatitis, and vomiting appear. undigested food and complete apathy. Most often, after this the dog short time dies through a coma.

Acute form (API)

This form of the disease is characterized by an extremely rapid rate of development and manifestation. clinical signs. In dogs, acute renal failure is a potentially treatable pathology if only the diagnosis was made in a timely manner. Compensatory therapy can bring the kidneys to a state of maximum performance, to the extent possible in a given specific case. The situation is usually complicated by the fact that the primary acute course is very rare; basically, it is an exacerbation of the chronic course, which causes the main harm to the kidneys. It is secondary acute renal failure that is considered incurable.

Depending on the main causes provoking acute renal failure, the pathology is divided into 3 main types:

1. Prerenal (or prerenal). This type appears due to a sharp fall blood pressure in the kidneys, due to which renal blood flow is disrupted (bleeding, dehydration, heat stroke, etc.).
2. Renal (or renal). The condition develops with direct damage to the tissues and cells of the kidneys due to glomerulonephritis, pyelonephritis, drug poisoning, exposure to snake venom, accelerated breakdown of red blood cells and blockage of tubules with hemoglobin, etc.
3. Postrenal (or postrenal). Main role In this type of pathology, a mechanical effect on the urinary tract plays a role - narrowing of the lumen from compression or complete blockage, for example, from urinary stones. It may be due to tumor processes, urolithiasis or enlarged prostate gland in males.

What signs does it show externally?

In acute cases, there is always a clinic, which is distinguished by the clarity of its manifestation. There may be many symptoms at once and obvious, or there may be one or two and blurred:

What can be seen from the analyzes

• the levels of sugar, phosphorus, creatinine and urea will definitely rise in the blood;
• protein and sugar will go off scale in the urine, its specific gravity will decrease, red blood cells, leukocytes and renal epithelial cells will be detected.

You need to immediately take your dog to the veterinarian for help, because... the animal may die.

Chronic form (CRF)

Most often develops in old dogs, over 6 years old. Sometimes the kidneys begin to work worse, regardless of the influence of any factors. The main reason for the development of chronic renal failure usually remains unidentified unless an autopsy is performed.

The causes of chronic deficiency in young dogs are considered to be

• previously formed surge arrester;
• genetic predisposition to kidney pathologies;
• any primary chronic illness kidney

As nephrons (kidney cells) gradually die, their functions are successfully taken over by the remaining unaffected cells. That is why, with chronic renal failure, external symptoms begin to appear very slowly and when most of the kidneys are damaged and cannot be restored.

What becomes noticeable

What can be seen in the analyzes

• increase in blood creatinine and urea;
• signs of anemia in the blood;
• a high content of protein and sugar is detected in the urine, and a drop in specific gravity is noted. There will be no sediment, as with acute renal failure.

Diagnostics

The diagnosis is made strictly comprehensively based on:

• survey of owners about the condition and lifestyle of the dog (history);
• clinical examination doctor;
• laboratory tests of urine and blood (the most important diagnostic components);
• Ultrasound or radiography (used to determine postrenal pathologies).

The most important criteria for making a diagnosis

• fluctuation in the amount of urine when urinating in any direction and obvious thirst;
• external exhaustion and weakness;
• an increase in creatinine, urea, phosphorus in the blood and an increase in its general acidity;
• a sharp jump in the level of protein and sugar (glucose) in the urine.

What can be seen on an ultrasound

• in the acute form of renal pathology, the kidneys will normal sizes or enlarged;
• in chronic renal failure, the kidneys will be significantly reduced.

Prevention of kidney disease in dogs

It is impossible to 100% prevent the development of kidney pathologies in dogs, because, unlike cats, much large quantity reasons provoke this condition. The main emphasis is on annual medical examination ( preventive examination at the veterinarian) for young dogs and every six months for old dogs. In this case, it is necessary to take blood and urine tests, as well as do an ultrasound of the organs. abdominal cavity. With this approach, it is possible to identify not only the very beginning of renal failure, which can still be cured, but also even determine a predisposition to it.

You should also ensure that your pet does not come into contact with any toxic or poisonous substances, including household chemicals.

Food for dogs with kidney failure

Treatment of any form of renal failure must be accompanied by an appropriate diet. You can feed both your own developed diet and ready-made food. industrial production, created specifically for dogs with kidney problems.

Self-feeding should be based on the following rules:

• Moderate to high fat foods. With kidney failure, dogs lack energy, which can easily be replenished by fats. They are not difficult to digest for a weakened body. Saturated fats are found in butter, fatty meats, egg yolks and full-fat yogurts. Vegetable oils are not recommended for kidney pathologies. Homemade diets should be saturated with fats gradually, because... if you give a lot of fatty foods at once, it will provoke upset stools and cause diarrhea.
• Protein foods are acceptable, but in limited quantities and with high quality protein. Experts still do not recommend completely eliminating protein from the diet. Yolks, in addition to fats, contain phosphorus, the amount of which must be reduced in case of renal failure. It is better to give the dog a mixture of 1 whole egg with one white of the second (i.e. there will be 2 whites and 1 yolk). You can also add finely ground shells, which will also inhibit the excessive absorption of phosphorus. Calculation: 1 gram of ground shells per 0.5 kg of any food. An ideal source of easily digestible protein with low content phosphorus is green beef tripe.
• A small amount of carbohydrates with a low amount of phosphorus. Carbohydrates provide calories and nutrients without increasing phosphorus levels. For these purposes, steamed vegetables (white potatoes and yams), round rice (contains the least phosphorus), and semolina are used in the diet.
• Reduce the amount of salt you consume.
• Drink only clean, filtered water in sufficient quantities (hard water contains minerals that put stress on the kidneys).
• Dogs often experience decreased or completely lost appetite. It is necessary to note those products whose smell provokes the animal to consume food.
• Among the additives allowed to be added to food, you can give:
  • salmon oil (not fish oil, but oil) – 1 g/5 kg of weight;
  • coenzyme Q10 – 15 mg/10 kg of weight three times a day;
  • vitamin B in any form;
  • vitamin E – 50 IU/10 kg of weight;
  • vitamin C (do not abuse) – 500 mg/20-22 kg of animal weight;
  • categorically exclude multivitamin complexes, which may contain vitamin D and phosphorus.

Examples of diets for an adult dog weighing 20 kg (for one meal):

• 200 g semolina porridge with 2 tbsp. heavy cream and 1 tbsp. l. Melted butter;
  • + 200 g chicken meat (red, because it contains less phosphorus);
  • + 50 g beef fat and finely chopped chicken skin;
  • + 70 g of any permitted vitamin and mineral supplements.
• 200 g of steamed vegetables or grains;
  • + 200 g of any fatty red meat;
  • + 1 egg white+ 1 whole egg with yolk;
  • + 30 g of any offal (kidneys, liver, tripe);
  • + 70 g of auxiliary additives: ground shells, salmon oil, coenzyme Q10, approved vitamins.
• 200 porridge of purified sticky rice used for sushi with 1 tbsp. butter;
  • + 1 egg white;
  • + 100 g of a mixture of fatty lamb and boiled yams (another name for “sweet potatoes”);
  • + 75 g of any permitted mineral supplements and vitamins.

Important: a dog can be switched to a regular diet only in case of acute renal failure and only when blood and urine tests are normalized. With chronic renal failure, a special diet will accompany you for the rest of your life!

If it is not possible to prepare special medicinal food for your dog, you can resort to special ready-made food, balanced with all the necessary nutrients and designed specifically for dogs with kidney failure.

• Renal RF14 (RF16) TM Royal Canin(≈1200 rub./2 kg of dry food, 4000 rub./14 kg) – for dogs with chronic renal pathology. Lifetime use is allowed. Do not feed pregnant women, those with problems in the pancreas or those with lipid metabolism disorders.
• Renal Special TM Royal Canin(≈200 rub./410 g of wet food in canned containers) – for dogs with acute renal failure and chronic renal failure. The food belongs to the medicinal group. Used for 2-4 weeks for acute disease and up to 6 months for chronic disease. Prior approval from a veterinarian is required. Do not give to puppies with pancreatitis or fat metabolism disorders.
• Hills Prescription Diet Canine k/d(≈275 rub./370 g canned wet food, 1400 rub./2 kg dry) – therapeutic and preventive food for dogs with any form of renal failure.
• Hills Prescription Diet Canine u/d(≈250 rub./370 g in canned “wet” food, 1250 rub./2 kg of dry food) – medicinal food used for severe forms of kidney dysfunction, which is not only easily digestible, but also additionally removes certain substances from the body toxic substances that the kidneys cannot handle.
• Purina Veterinary Diets NF Kidney Function® Canine Formula(≈150 rub./400 g of wet food, 1250 rub./2 kg of dry food) – special medicinal food for dogs with any kidney pathologies.
• Eukanuba Renal (≈5000 RUR/12 kg of dry food) – therapeutic and dietary food used for feeding dogs with any form of renal failure. Do not use in puppies during the period of active growth, as well as in bitches during pregnancy and nursing puppies.
• Happy Dog Diet Kidneys (≈950 RUR/2.5 kg of dry food or 2400 RUR/7.5 kg) is a comprehensive food for dogs with pathologies of the kidneys, heart and liver.
• Farmina Vet Life Canine Renal (≈1,400 rub./2.5 kg or 4,900 rub./12 kg of dry food) is a balanced food for dogs with acute renal failure or chronic renal failure. The food is medicinal, designed for a limited course of use: 2-4 weeks for acute renal failure and up to 6 months. with chronic renal failure.

Treatment of kidney failure

Treatment of acute renal failure and chronic renal failure in dogs is carried out with approximately the same drugs, with the only difference that in acute pathology it is important to first eliminate the influence of the provoking factor, and in a chronic course - to support the animal’s exhausted vitality.

Important: combinations and sequence of drug administration are determined exclusively by a veterinary specialist! Self-medication is strictly prohibited!

If an acute process is diagnosed early, the dog must be treated. Chronic renal failure is considered an incurable pathology, treatment procedures for which help put the body into a state of compensation, significantly prolonging the relatively normal life of the dog for another for a long time. In this case, most often, treatment and maintenance therapy for chronic renal failure will remain until the end of the pet’s life.

If the cause of renal failure is congenital underdevelopment or any genetic pathology, then it is impossible to completely restore the function of the kidney/kidneys. Only symptomatic therapy is provided.

1. Intensive drip treatment of renal failure is prescribed, aimed at restoring not only water balance, but also electrolyte and acid-base balance. Also, through droppers you can remove the maximum toxic substances, which the kidneys cannot cope with directly. It is important to administer the solutions warm so as not to aggravate the condition of a dog with a low body temperature.
2. Drugs are prescribed that relieve gagging, improve blood counts, normalize biochemical levels in the blood, and eliminate anemia, which is a natural accompaniment of chronic renal failure.
3. You may need careful antibiotic therapy for purulent lesions (the course and duration is determined by the final urine test).
4. Urination is normalized with the help of diuretics and mechanical diversion of urine in case of overflow Bladder(urine is drained by catheter or surgery if mechanical blockage is present).
5. During the acute stage, blood and urine tests are regularly done to monitor the dynamics of the disease or recovery. Ideally, the dog should be left in a hospital during this period.
6. Systemic glucocorticoid therapy to restore water balance and suppress immune responses in autoimmune glomerulonephritis.
7. In cases of urgent need, drugs are administered that lower blood pressure (in the event of the development of renal hypertension - high blood pressure due to impaired kidney function) and normalize the passage of blood through the kidneys.
8. There may be a need for drugs that protect the mucous membranes of the gastrointestinal tract and reduce overall acidity in the stomach.
9. If the condition worsens, hemo- and peritoneal dialysis and plasmapheresis are possible.
10. Tube feeding or parenteral nutrition may be possible if vomiting persists.
11. Strictly monitor the level of phosphorus in the blood, using drugs that bind and remove its free fractions.

List of medications for renal failure

Restorative and rehydrating solutions for infusions

• Ringer-Locke solution with glucose 40%: up to 20 ml/kg of dog’s weight intravenously (under monitoring potassium levels);
• rheosorbilact: 200-400 ml with a dropper once a day (under monitoring the level of potassium in the blood);
• Nelit: 50 ml/kg of animal weight for self-drinking or through a tube;
• recovery cocktails with saline, glucose and ascorbic acid: up to 100 ml/kg (depending on the severity of the condition) intravenously once a day.

Diuretics

• lasix (furosemide): 0.1 ml/kg twice daily into the muscle. If there is no effect, the dose can be increased 2-4 times (with the correct dosage, the effect appears within 30-60 minutes);
• beckons (mannitol) : 1-1.5 g/kg body weight into a vein by slow infusion or with a dropper;
• Lespenephril : 0.5-1 tsp, and in severe cases up to 2-3 tsp. with water orally before meals every other day for a course of 3-4 weeks. Repetition is allowed after a 2-week break.

Protecting the gastrointestinal tract

• omez (omeprazole) : orally 0.5-1.5 mg/kg body weight daily symptomatically, but not longer than 2 months;
• Zantac (ranitidine): subcutaneously or slowly intravenously at a dose of 2 mg/kg or orally at 3.5 mg/kg twice a day at regular intervals (12 hours).

Antiemetics

• papaverine : 0.03-0.12 g per animal symptomatically;
• Cerucal (metoclopramide): 0.5-0.7 ml/kg up to three times a day as needed, no longer than a week;
• Serenia (for dogs only): subcutaneously at a dose of 1-2 ml/kg symptomatically.

Antihypertensive drugs

• enalapril: the maximum effective dose is 0.5 mg/kg, but there should be a gradual approach to it, starting first with 1/3-1/4 dose, depending on the general condition of the dog and the level of hypertension;
• Vazosan (ramipril): the dose is selected individually, starting from 0.125 mg/kg (maximum 0.25 mg/kg) – once a day orally on an empty stomach.

Antianemic and normalizing hematopoietic agents

• vitamin B12: 250-1000 mcg/kg (depending on the size of the dog). Administered subcutaneously or intramuscularly. The frequency of administration and duration of the course depend on the patient’s condition;
• recormon : 500-1000 IU/10 kg of dog’s body weight every other day intramuscularly;
• antianemic iron complex– 0.8 ml/10 kg of weight intramuscularly into the thigh or neck area twice with an interval of two days between injections;
• hemobalance: 0.25-1 ml of the drug, depending on the weight of the dog, into the muscle or intravenously twice a week;
• Ursoferan: once subcutaneously or intramuscularly in a dose of 0.5-1 ml per head.

Renoprotectors

• Canephron: for small individuals, 5-10 drops orally, for medium-sized individuals - 10-15, for large individuals - up to 25, 1-2 times a day for a course of up to 1 month. Can be repeated after some break. A drug from a human pharmacy.

Sorbents and antitoxic agents

• Lactusan: individual dosage with a maximum dose of 50 ml per dog every day. Can be taken for life;
• enterosgel: 1-2 tbsp. gel is diluted with water and poured into the dog’s mouth
• sirepar: intravenously or slowly injected into the muscle 2-4 ml once a day until signs of intoxication disappear.

To maintain heart activity

• Riboxin: up to 10 mg/kg into the muscle twice a day at regular intervals for 1.5-2 weeks;
• cocarboxylase: 0.5-1 g per day for 5, 14 or 30 days. Inject into the muscle or intravenously with droppers;
• sulfcamphocaine: single dose - 2 ml intramuscularly or into a vein. It can be administered up to 3 times a day for a month, depending on the severity of the dog’s condition.

Antibiotics

• ciprofloxacin: 0.2 ml/kg into the muscle once a day (the dosage can be divided into two injections) for 5-10 days;
• enrofloxacin: 5-10 mg per kg of live weight 1 time per day for 5-7 days.

Glucocorticoid hormones

• dexamethasone: 0.5-1 ml intramuscularly or along with a slow drip;
• prednisolone: ​​the usual dosage is 1 ml/kg of dog's weight twice a day for 2 weeks. With positive dynamics of treatment, the dosage is slowly reduced. It is prohibited to abruptly cancel or reduce the dose in dogs!
• metypred (methylprednisolone): 1-2 mg/kg twice daily for up to 2 weeks. If it is more than two weeks, then discontinuation should be carried out through a gradual dose reduction.

Phosphorus binders

• ipakitine: 1 g of powder (1 dispensing spoon)/5 kg of dog’s body weight is mixed with food and given twice a day. The course is long - 3-6 months;
• almagel: 1 ml/5-10 kg of weight up to 4 times a day strictly before meals 30 minutes for a course of up to 1 month. If the phosphorus level remains high, the drug should be replaced with another one;
• Renalcin: 5 ml/10 kg of dog’s weight per day until the condition returns to normal and longer. Daily dose can be divided into several steps.

Hemostatic agents

• Vikasol: once a day, 1-2 mg/kg intramuscularly for a maximum of 5 days;
• Dicinone (etamsylate): intramuscularly 10-12 mg/kg; if taken orally, the dosage is doubled and taken up to 4 times a day.

Kidney failure in dogs - an acute or chronic disorder in which the functioning of the organ is reduced or completely stopped. At the same time, toxic substances accumulate in the dog’s body, which leads to a malfunction of the entire body. The risk group includes pets older than 5 years, and even earlier if they have congenital diseases of the urinary system.

Causes

Kidney failure cannot be understood as a single disease. This is a complex of symptoms in dogs that indicate a malfunction in the functioning of an entire system of organs and tissues.

IN Lately The understanding of this pathology has changed greatly; scientists have become aware of new factors that provoke renal failure.

The list of common reasons:

In older dogs, signs of kidney failure may appear due to natural age-related changes in tissues.

Among concomitant diseases most often found:

• interstitial nephritis or inflammatory process in the kidneys, which is non-bacterial in nature;
• underdevelopment of the kidneys;
• malignant and benign neoplasms;
• urolithiasis disease.

Which breeds get sick more often?

It cannot be said that some breeds are more predisposed to the occurrence of kidney failure. No such patterns have been identified.

But some breeds are more susceptible to diseases that can cause kidney problems.

Thus, golden retrievers are susceptible to amyloidosis; polycystic disease is more often found in Cairn Terriers, Beagles, West Highland White Terriers and their mixed breeds.

Stages of development

Dividing renal failure syndrome into stages helps to better understand what pathological processes occur in the dog’s body and directly in the kidneys. Each stage is characterized by its own manifestations.

Compensation

It takes up to 90% of the total time allotted for the development of the disease. The period is characterized by a complete absence of symptoms, the dog looks healthy. Only a timely urine test can indicate a kidney problem.

Latent (hidden) period

Morphological and functional disorders in the kidneys are increasing, but the disease has not yet reached a critical point. A urine test indicates a change in the functioning of the paired organ, but according to the biochemistry of the blood, “everything is clear.” A timely ultrasound will help make a diagnosis.

Decompensation

It is at this stage that the dog owner begins to realize that there is a problem with the pet’s health. The first pronounced symptoms of renal failure appear, urine analysis is poor.

Terminal stage

In essence - final, final. The animal's kidneys have practically failed, and renal coma may develop.

Types of kidney failure

Depending on the reasons for the development of the syndrome, the following types are distinguished:

There are also acute and chronic forms of pathology. AKI or acute renal failure, a severe but reversible disease.

Chronic renal failure (CRF), in contrast to acute form, occurs as a result of prolonged exposure negative factors. As a result, the kidney cells gradually die, and the organ ceases to fully perform its functions.

Symptoms

There is no standard list of symptoms that appear in all dogs without exception. There are many variations possible, which makes diagnosis very difficult.

The dog owner should be wary of:

• decreased appetite, refusal of favorite treats;
• increased thirst and increased urination;
• With the development of the disease, the amount of urine decreases down to AUR ( acute delay urine);
• apathy, lethargy, lack of desire to walk or move;
• muscle weakness.

Kidney problems are characterized by a hunched posture, recurring vomiting, and swelling. Over time, signs of dehydration increase: the skin becomes dry, the coat becomes dull, saliva becomes viscous, and the eyes become sunken.

Kidney failure is accompanied by a violation of nitrogen metabolism, and the dog’s breath begins to smell strongly of urine.

During the examination, the veterinarian notes a slight decrease in temperature, a violation heart rate.

If left untreated, they develop in the terminal stage neurological disorders, there are convulsions, the dog is poorly oriented in space, the state of shock turns into a coma.

Acute form

Characterized by rapid development of symptoms. AKI in dogs is considered a reversible pathology if treatment measures are taken on time. If a diagnosis is made in a timely manner, the doctor will prescribe medications that will help the kidneys compensate for functional disorders and bring the organ to a stable state.

The primary form of acute renal failure is rarely diagnosed; as a rule, the dog owner misses or does not consider it necessary to take the pet to the veterinary clinic on time, believing that “it will pass.” Thus, acute renal failure in the very first case of development is not treated, and in the subsequent acute attack diagnosed as a period of exacerbation chronic form.

Secondary acute renal failure is considered incurable, only supportive therapy!

Causes of acute renal failure:

• exposure to poisons, toxins;
• blood poisoning;
• worms, protozoa and infections;
• increased dehydration;
• heavy blood loss (shock);
• blockage of the urethra with the development of acute urinary retention and subsequent intoxication of the body.

Acute renal failure is characterized by a clear algorithm for the manifestation of symptoms, but they do not necessarily all appear at the same time. A dog may have one or two, but this does not mean that the help of a veterinarian is not required:

1. Sharp oppression. Morning activity gives way to complete apathy in the evening.
2. The dog urinates a lot and often, but as the disease progresses, the amount of urine decreases.
3. Muscle weakness, unsteady gait.
4. Almost complete lack of appetite.
5. Visible swelling, especially in the front legs and abdomen.

A distinctive feature is the rapid increase in symptoms until the development comatose state. Therefore, the owner’s reaction to the pet’s illness should be quick.

During examination, the blood levels of sugar, creatinine, phosphorus, and urea are elevated. There are critical levels of sugar and protein in the urine, the specific gravity is reduced, there are white and red blood cells, and kidney epithelium.

Chronic form

Advanced renal failure is most often diagnosed in dogs after 6 years of age. The real reason CRF is most often discovered only after autopsy.

In young dogs, chronic renal failure develops due to:

• lack of treatment for acute forms of the disease;
• hereditary kidney diseases;
• chronic pathologies affecting kidney function.

When kidney cells die gradually, their function is taken over by the remaining healthy cells. That is why the first signs of the disease are visible only to a specialist. The fewer living cells remain, the more the symptoms increase, but at this time it is difficult to help the dog, since a large area of ​​the kidneys is affected.

Symptoms of chronic renal failure:

• lethargy, apathy;
• the urge to urinate, but with a small amount of urine;
• severe thirst, the pet drinks a lot of water;
• signs of dehydration;
• pungent odor of urine from the mouth;
• low (less than 37 degrees) body temperature, bradycardia;
• vomit.

The problem is also indicated by the dog’s appearance: weight loss, dull fur, and increasing signs of anemia. The examination reveals high levels of creatinine and urea in the blood, the specific gravity of urine drops, there is a lot of protein and sugar in the urine, but, as with acute renal failure, no sediment is observed.

Diagnostics

The veterinarian carefully studies the dog’s life history, the conditions of its detention, diet, previous diseases, injuries, etc. After the inspection is carried out laboratory analysis urine and blood. X-rays and ultrasound help identify postrenal pathologies (urolithiasis, obstruction, etc.).

The doctor accurately diagnoses based on the following signs:

1. The amount of urine and its fluctuations in the direction of increase/decrease, thirst, exhaustion, weakness.
2. Increased creatinine, phosphorus, urea, high acidity of urine.
3. A sharp increase in glucose and protein in the urine.

On ultrasound during acute renal failure, the kidneys are not externally changed, their contours remain within normal limits. With chronic renal failure, the paired organ is reduced and deformed.

Treatment

Kidney problems in animals are one of the most pressing topics for veterinarians; there is still no uniform treatment regimen. However, a positive prognosis is only possible if the dog owner contacts a veterinary clinic in a timely manner.

In the acute form, the factor that provoked the kidney damage is first eliminated.

With chronic renal failure, all efforts are devoted to maintaining the functioning of the remaining healthy parts of the kidneys; it is impossible to restore damaged nephrons. Therapy for the chronic form is lifelong.

If there is a congenital genetic pathology - renal failure in puppies - it is impossible to restore the functioning of the organ; the doctor prescribes supportive and symptomatic treatment, which helps the dog to exist in a relatively stable state.

Possible ways of the treatment process:

• droppers. Restore water-electrolyte and acid-base balance, remove toxins and poisons;
• prescription of antiemetics;
• it is important to eliminate anemia, which almost always accompanies chronic renal failure;
• in the presence of purulent processes, antibiotics are given;
• elimination of poor urine flow (diuretics, catheter, surgery).

During an exacerbation, it is important to regularly take blood and urine tests to monitor the progression of the disease and the effectiveness of the treatment. Veterinarians recommend placing the dog in a hospital for this period.

During treatment, an appointment may be required. hormonal drugs, ASD, agents that regulate water balance, normalize blood pressure, eliminate problems in the gastrointestinal tract, etc.

The more advanced the kidney problems, the longer it will take to treat. Pet owners need to be prepared for significant expenses, but what does money mean compared to the health of their beloved animal!

Prevention

It is impossible to completely exclude the development of renal failure in a pet; too many factors provoke the pathology. Therefore, it is recommended to be examined by a veterinarian 1-2 times a year, take tests, do an ultrasound and other manipulations as indicated. This will allow you to promptly identify the onset of kidney problems and eliminate them before the disease becomes irreversible.

Diet

Diet in this case is mandatory. If there is the slightest deviation in the functioning of the dog’s kidneys, food with a moderate or reduced content of protein and phosphorus is recommended. For a dog with chronic renal failure, eggs and fresh meat are allowed, but fish, bones, offal sets, and cheese are completely excluded from the diet.

Veterinarians recommend increasing the amount of fatty foods. Give it to your pet butter(but not margarine, not spread containing palm oil), yolk, fatty meat, yogurt. Fish fat, vegetable oils contraindicated.

About 40-50% of a dog's diet should be carbohydrates (semolina, rice, white potatoes, yams).

You also need to reduce salt intake and give your pet only purified drinking water.

After treatment, transfer to a regular feeding diet is allowed only if urine and blood levels are normal. With long-term renal failure, the diet will be lifelong.

There are ready-made foods designed specifically for dogs with kidney problems. They are prescribed by a veterinarian.

Sample list:

1. Happy Dog Diet Kidneys. For dogs with combined pathologies of internal organs.
2. Renal RF14 (RF16) TM Royal Canin. For life. Do not use during pregnancy, pancreatic disease, or poor fat metabolism.
3. Farmina Vet Life Canine Renal. Balanced food, medicinal.
4. Hills Prescription Diet Canine k/d. Treatment and prophylaxis.
5. Eukanuba Renal. Therapeutic and dietary. There are restrictions on admission.
6. Hills Prescription Diet Canine u/d.
7. Renal Special TM Royal Canin. Medicinal.

It is important to note that dietary ready-made food is not cheap; you will have to pay from 500 rubles per kilogram.

Medicines

Sample list of medications used for renal failure. Prescribed only by a veterinarian; self-prescription is completely excluded:

• solutions to restore water-salt balance: Ringer-Locke with glucose, Reosorbilact, Nelit, cocktail (glucose, ascorbic acid, saline solution).
• diuretics: Furosemide, Lespenefril.
• to protect the gastrointestinal tract: Zantac, Omez.
• eliminating vomiting: Serenia, Cerucal, Papaverine.
• blood pressure lowering: Vazosan, Enalapril.
• for good blood counts: Hemobalance, vit. B12, Ursoferan.
• antibiotics: Ciprofloxacin.
• sorbents: Enterosgel, Lactusan.
• for cardiac activity: Riboxin, Sulfcamphocaine.
• hormones: Metypred, Prednisolone.

They also take medications that bind phosphorus (Renalcin) and hemostatic agents (Vikasol).

The list of medications changes depending on what exactly is revealed during the examination and what treatment a particular dog needs.

Forecast

If acute renal failure in its very first manifestation is diagnosed immediately, then the prognosis is favorable to cautious, mainly due to the rapid development of the pathological condition and the cause of the effect on the kidneys. In case of chronic course and maintenance treatment – ​​cautious, in the absence of therapy – unfavorable. Exacerbation of chronic renal failure is always considered as an unfavorable prognosis.

BASIC POINTS

• Chronic renal failure (CRF) is the most commonly diagnosed kidney disease in dogs.
• Clinical signs of the disease appear only after at least 67% of the renal parenchyma ceases to function.
• Diagnosis of the early stages of renal dysfunction allows for the timely use of protection techniques, incl. transfer the animal to a special diet and prescribe appropriate drug therapy in order to slow down the development of further damage to these organs, speed up recovery and improve the animal’s quality of life.
• The plasma clearance test for exogenous creatinine can be used in routine veterinary practice.

Chronic renal failure (CRF) is the most commonly diagnosed kidney disease in dogs. It develops as a result of the progressive and irreversible loss of functioning nephrons. Clinical signs of renal failure begin to appear when 67-75% of the renal parenchyma ceases to perform its function. Polyuria and polydipsia are usually the first signs of kidney disease, but they very often go unnoticed for a long time. It is generally accepted that a decrease in urine specific gravity and azotemia (i.e., excess creatinine and/or urea concentrations permissible norm) occurs only after failure of at least 67% and 75% of the renal parenchyma, respectively (Fig. 1). Therefore, chronic renal failure is usually diagnosed at relatively late stages of kidney disease. Over the past 20 years, significant advances have been made in diet therapy and drug treatment of chronic renal failure, but the problem of its early diagnosis is still relevant. Establishing impaired renal function at the very beginning of the disease makes it possible to use means to protect these organs from further damage, incl. prescribe a special diet or drug therapy. This will slow down the development of kidney disease, shorten the recovery period and improve the quality of life of sick animals. This publication describes a number of strategic approaches to identifying renal dysfunction in dogs with subclinical ESRD.

Figure 1. Consequences of kidney disease and the development of uremic syndrome with it.

Information and training of animal owners, identification of risk factors

CRF is frequently reported in dogs. Therefore, every dog ​​owner should be informed about chronic renal failure, its prevention, manifestations of diagnostic significance, as well as factors contributing to the development of this pathology. Special attention should be considered for dog breeds that show a predisposition to kidney disease. It is important to reassure breeders that renal dysfunction can occur even in clinically healthy dogs. Owners should be advised to regularly monitor their pets so that they can judge whether the disease is progressing or not, and promptly seek help from specialists for further examinations. Well-informed breeders can provide very important information about the water and food consumed by their pets, as well as changes in the animals’ body weight.

Risk factors associated with the development of CRF in dogs are poorly understood, but, apparently, this pathology most often manifests itself in adult animals of this species: 45% of dogs with CRF are over 10 years of age. This does not mean at all that any adult dog can get sick, but it does suggest the need to determine the concentration of creatinine in the blood plasma and specific gravity of urine (SUD) in animals as the most important indicators of the health of aging animals. Hereditary nephropathies have been reported in some dog breeds (Table 1), although their incidence remains unknown. These inherited diseases can develop in puppies, young dogs, adults and aging dogs. If you suspect that dogs of such breeds have kidney dysfunction, it is necessary to collect anamnestic data regarding whether a similar disease has occurred in animals of this line (parents, littermates, other relatives). CRF can cause different reasons, and the establishment of any of these etiological factors (for example, according to anamnestic data that the animal has had piroplasmosis, hypertension, etc. in the past) (Fig. 2) should serve as a reason for kidney research.

Figure 2. Causes of acquired chronic renal failure

Regularly assess the animal's water intake, urine output, appetite and body weight

Polyuria and polydipsia, resulting from the loss of the ability to concentrate urine, are not specific to chronic renal failure, but they are considered its early clinical manifestations. It can be difficult for owners to determine the amount of urine their dogs excrete. For precise definition this indicator, the animal is hospitalized and placed in a metabolic chamber for a day (usually this is resorted to for experimental purposes, and not for routine diagnostic examinations). Before placing the animal in the chamber and before releasing it from it, they ensure that it performs the act of urination. Adult dog excretes urine during the day in a volume approximately equal to 20-40 ml/kg of body weight (in puppies this figure is higher).

Assessing a dog's water intake is much easier, especially when the animal's access to water is controlled. Owners of dogs belonging to the group increased risk According to chronic renal failure, it is recommended to annually monitor the water consumption of your pets. This indicator is considered normal if it does not exceed 100 ml/kg body weight. The amount of water animals drink daily is variable, as it depends on a number of factors, including. physical activity, air temperature, type of diet, etc. Therefore, measuring the volume of water consumed by the dog is carried out for 3-4 days in a row. To avoid subjectivity when determining this indicator, the dog owner needs to weigh a bowl of water 2 times a day (with an interval of 24 hours).

A slight decrease in appetite and body weight, although not specific to chronic renal failure, often accompanies this pathology. Daily feed consumption is assessed by weighing it each time it is given to the animal. When changing the diet, the animal's appetite may change depending on how much new food attractive to him. Weighing animals is less subjective, but this procedure should be carried out regularly and on the same scales.

Indirect assessment of renal function based on the results of repeated studies of blood plasma and urine

This article discusses the possibility of diagnosing chronic renal failure only in those animals in which this pathology is asymptomatic or manifests mild clinical signs. The best markers of kidney function in this situation are creatinine and urine specific gravity.

Plasma creatinine concentration

Creatinine is constantly formed in muscles as a result of creatine metabolism. It is excreted from the body only in the urine, being completely filtered in the kidneys through the glomeruli and only to a small extent undergoing secretion in renal tubules. Plasma creatinine concentration is considered the best indirect indicator of renal function, although the accuracy of its determination is influenced by many factors.

In this regard, one cannot discount the influence of various factors operating before and during the analysis. Blood samples for this test should be taken from animals on an empty stomach (a 12-hour overnight fast is sufficient). Most foods contain some amount of creatinine, so after consuming them, dogs may experience higher levels of creatinine in their blood. permissible level what causes nonspecific indications test. Physical exercise does not lead to a significant change in plasma creatinine concentration in dogs. The concentration of creatinine in the blood plasma is better determined by the enzyme method rather than the Jaffe method, since the readings of the latter are influenced by an increased (> 50 μmol/L) concentration of bilirubin in the blood.

Figure 3. The relationship between plasma creatinine concentration and glomerular filtration rate (GFR) is graphically expressed by a curved line. This indicates an early stage of renal dysfunction, manifested by a decrease in GFR and a corresponding slight change in the concentration of creatinine in the blood plasma. In contrast, in dogs with severe renal failure, significant fluctuations in plasma creatinine concentrations are noted against a background of rather limited fluctuations in GFR.

It is believed that an increase in plasma creatinine concentration indicates a decrease functional state kidneys The relationship between this indicator and GFR is graphically depicted by a curve (Fig. 3). Meanwhile, the concentration of creatinine in blood plasma depends on a combination of factors such as the formation, distribution and excretion of creatinine from the body. This means that this indicator may be increased in dogs with developed muscles or those suffering from dehydration. In animals with renal failure, endogenous creatinine production is reduced (2). Consequently, increased concentration Plasma creatinine does not necessarily correlate with GFR, since creatinine formation may also be reduced as a result of decreased muscle mass. Dehydration can lead to a decrease in the volume of distribution of creatinine, which is dependent on the total body water supply. However, dehydration usually occurs only in the later stages of chronic kidney disease.

A once-determined concentration of creatinine in the patient’s blood plasma is usually compared with the maximum permissible value of this indicator. If the concentration of creatinine in the animal’s blood is higher than the latter, then the presence of kidney pathology is assumed, and if it is below the permissible level, then the animal is considered healthy. But in a number of situations this approach is incorrect. Literature data on the acceptable value of this indicator are very variable (Fig. 4), which is partly due to the characteristics of the dog populations in which blood testing was carried out, its dependence on age, breed and a number of other factors. In dogs different breeds and animals of different ages The normal concentration of creatinine in the blood varies. For example, it is higher in adult dogs compared to puppies, as well as in dog breeds with more developed muscles. Therefore, one should interpret very carefully a slight excess of this indicator from the norm. Impaired renal function can also occur in cases where the concentration of creatinine in the blood plasma remains within normal limits.

Figure 4. Various acceptable values ​​for plasma creatinine t in dogs (according to veterinary guidelines or obtained from Reflotron, Kodak and Vettest analyzers). There are significant differences between data obtained from different sources, which may be due to differences in control samples or analytical methods

However, even the results of a single determination of the concentration of creatinine in the blood plasma provides valuable diagnostic information, on the basis of which the International Renal Interest Society recently proposed a classification of stages of chronic renal failure in dogs and cats based on the value of of this indicator (Table 2).

A much more accurate indication is provided by serial determination of the dog's plasma creatinine concentration over a period of time (for example, one year). At the same time, it is important to standardize the testing conditions in order to ensure that to avoid the influence of factors that complicate the interpretation of the results. For example, each time blood should be taken from the dog on an empty stomach, the same testing method should be used, and the animal’s body condition should not change throughout the entire period of the study. Blood plasma samples are stored frozen until testing (at a stable temperature not exceeding -20°C). When the time comes for testing the next blood plasma sample, the one taken the previous time is thawed and examined simultaneously with the last one. This allows us to establish a “critical change” of the determined indicator, which represents the minimum difference between two successive levels of creatinine concentration in the blood plasma and reflects biologically significant changes in kidney function in healthy dogs; the “critical change” is 35 µmol/l (i.e. 0.4 mg/ dl).

If significant changes in the concentration of creatinine in the blood plasma unexpectedly appear in a dog, their connection with the animal’s health state is checked by repeated testing, which allows us to eliminate diagnostic errors (Fig. 5).

Figure 5. Dispersion of creatinine content in blood plasma due to analytical errors. Dog plasma samples were tested twice in a blinded manner in the same laboratory. Very large discrepancies in the results of testing one sample were obtained - 0.7 (62 µmol/l) and 2.1 mg/dl (186 µmol/l). These observations indicate the need to retest serum samples when unexpectedly high or low readings are obtained compared to previous plasma results from the same animal.

Urine Specific Gravity (USG)

UMR is the ratio of the mass of a certain volume of urine to the mass of the same volume of clean water at the same temperature. SLM is determined using a refractometer. Changes can occur as early as initial stage renal failure. However, BMR, which is highly variable even in healthy dogs, can vary depending on the animal's water consumption and diet. The SPM also varies from day to day, from one sample to the next. With normal body hydration, the BMR usually ranges from 1.015 to 1.045, but can decrease to 1.001 or increase to 1.075. If the BMR rises above the level of 1.030, the dog begins to actively reabsorb water from the renal tubules and collecting ducts of the kidneys. When the SMR decreases below 1.008, the animal begins to resorption of salts from the filtrate located in the renal tubules. In both cases, the kidneys compensate for the mentioned changes. When determining the SMR, the degree of hydration of the animal’s body is taken into account: the SMR is too low (<1,030) на фоне обезвоживания организма указывает на первичную дисфункцию почек или другие причины, повлекшие за собой снижение концентрирования мочи. Однако возможна и такая ситуация, когда при обезвоживании организма у собаки с субклиническим нарушением функции почек УПМ оказывается выше 1.030. Из-за вариабельности УПМ однократно выявленные изменения этого показателя не обязательно указывают на полиурию, но критериями последней служит персистентное значение УПМ в пределах от 1,008 до 1,029. Сопутствующая азотемия дает больше оснований подозревать наличие заболевания почек, но не позволяет поставить окончательный диагноз.

Other indicators

Plasma urea (or "blood urea nitrogen") concentration is also important in diagnosing clinical chronic renal failure. A number of researchers believe that this indicator correlates better with the clinical signs of the latter than the concentration of creatinine in the blood plasma. However, the concentration of creatinine in the blood plasma appears to better reflect the decrease in GFR than the urea content in the blood, which is due to the presence of many extrarenal factors that can influence the value of the latter indicator. Such factors include feeding and fasting, metabolic activity of the liver, dehydration, etc. Therefore, the concentration of creatinine in the blood plasma is of greater importance for diagnosing the early stage of renal dysfunction and the latter in subclinical cases.

Electrolyte disturbances (hyperphosphatemia, hypokalemia, hypocalcemia) are noted during periods of significant impairment of renal function, but they are absent in the early subclinical stages.

Proteinuria can develop at any stage of chronic renal failure. and its intensity is largely determined by the etiology of the disease. If proteinuria is detected, it is necessary to conduct additional studies to determine the cause of the disease. However, in many animals with chronic renal failure, proteinuria is mild.

Testing the kidneys' ability to concentrate urine

With chronic renal failure, the ability of the kidneys to concentrate urine decreases, but other factors also influence the value of the UMR, including. treatment with diuretics and glucocorticoids, glucosuria, not diabetes, imbalance of basic electrolytes. A test based on limiting the dog to water allows one to evaluate the concentrating activity of the kidneys during polyuria or polydipsia without identifying their causes. It should not be used to examine dogs suffering from dehydration and/or azotemia, because its implementation in such cases is associated with the risk of harm to the health of the animals and since dehydration in patients with low BMR itself serves as confirmation of the loss of the kidneys’ ability to concentrate urine. This test can be carried out in two versions (Table 4). However, its sensitivity in diagnosing early stage chronic renal failure has not been documented.

Direct method for determining GFR

GFR is currently considered the best direct indicator of kidney function. Over the past 30 years, many new methods for determining this indicator have been proposed and tested, based on determining the clearance of certain markers in urine and blood plasma from the corresponding marker.

Urine and blood plasma clearance, limitations of use

Determination of inulin clearance in urine is considered a reference method for assessing GFR. The calculation is simple, and to carry it out you only need to know three indicators: the volume of urine excreted by the animal over a certain period, as well as the concentration of the marker in the urine and blood plasma. Despite the diagnostically valuable information provided, tests to determine urine clearance are rarely used in veterinary practice, because they are time-consuming and labor-intensive. In addition, it is necessary to collect urine at a certain time, and in the process of frequent catheterization the risk of injury and infection increases urinary tract animals. When the dog is in a metabolic chamber, urine collection can be limited to 24 hours, but it is necessary to repeatedly wash the chamber to maximize the collection of marker, the remains of which during subsequent tests may cause incorrect determination of clearance.

For these reasons, tests designed to determine plasma clearance (especially those involving a single intravenous marker) are considered an alternative to corresponding urine tests in cases where urinary excretion of the marker is negligible. The main advantage of the test, in which GFR is determined by its clearance from blood plasma after a single intravenous injection of a marker, is that only one blood sample is required to obtain the result. Radiocontrast agents (for example, iohexol and iothalamate), inulin, various radiolabeled substrates, and creatinine are used as markers. These tests have a number of limitations. For example, radiolabeled nucleotides cannot be used in routine diagnostic practice due to safety reasons and legal restrictions. Detection of most of the available markers is difficult, expensive, or simply not available in a regular veterinary clinic. The iohexol test requires a fairly large volume of blood plasma (3-4 ml, i.e. approximately 8 ml of blood), which is too much for dogs small breeds. This marker is detected by a specific fluorescent glow in X-rays. Finally, determining plasma clearance, which is the ratio of the dose of a marker administered to an animal and the area under the curve of its plasma concentration (AUC) over time, requires complex calculations (data modeling using exponential equations), which discourages practicing veterinarians from its use.

Plasma clearance test for exogenous creatinine (TCPEC)

TCPEC was recently developed and tested in dogs in comparison with known methods for assessing GFR (tests to determine the clearance of inulin and endogenous creatinine in urine, blood plasma from iothalamate). Plasma and urine clearance of creatinine corresponds to GFR in dogs. With its help, it is possible to diagnose subclinical renal dysfunction in this type of animal. The main advantage of TCPEC is the ability to determine the baseline plasma creatinine concentration, which provides a direct estimate of GFR independent of the volume of distribution and endogenous production of creatinine.

Main stages of TKPEC

> Determination of the fasting baseline (initial) concentration of creatinine in the blood plasma before the test.
> Intravenous administration of a certain amount of creatinine.
> Determination of creatinine concentration in blood plasma.

Calculation of blood plasma clearance.

Main advantages of TKPEC:

> The test can be performed in routine veterinary practice because it is simple, easy to perform (intravenous marker and blood sample) and requires little time.
> To obtain a result, only 1 ml of blood is needed, which makes it possible, if necessary, to repeatedly take a blood sample from small breed dogs or puppies, and, in addition, limits the number of manipulations performed on the animal.
> Creatinine is safe: an increase in its concentration in the blood plasma of sufferers CRF in dogs after intravenous administration up to 8000 µmol/l (90 mg/dl) does not lead to unwanted side effects.
> There is no need to resort to the services of specialized laboratories, because the concentration of creatinine in blood plasma can be quickly determined using a conventional veterinary biochemical analyzer.
> Test results are received immediately after it is administered.
> Determination of creatinine clearance does not require complex calculations
> TKPEC does not require large financial costs.

There are no commercial creatinine preparations - you have to prepare them yourself, although preparations are underway for the production of this reagent.
- The last blood sample must be taken from dogs for testing no later than 6 hours after the administration of creatinine. Therefore, the dog has to be hospitalized for the whole day during the test.
- Borders normal values The GFR for dogs has not been definitively determined. Currently, the maximum acceptable value for this indicator is considered to be 1.5 ml/kg/min, but the results of further studies may make adjustments.

Conclusion

The fight against chronic renal failure is one of the main problems in ensuring the health of small domestic animals. Currently her early diagnosis difficult, since in the initial stages of chronic renal failure it is asymptomatic. However, a number of steps can be taken in this direction useful actions: informing pet owners about this pathology, regular examination of their pets, including determining changes in BMR and creatinine concentration in their blood plasma over time, as well as assessing GFR (if necessary). The main hope is that early diagnosis of chronic renal failure will help timely begin to treat the sick animal and transfer it to a special diet, which will both prolong the patient’s life and improve its quality.

Gervais P. Lefebvre
Herve P. Lefebvre, DVM, PhD, Dipl ECVPT, Professor of Physiology
Jean-Pierre Bron
Jean-Pierre Braun, DVM, PhD, Dipl ECVCP, Professor of Biochemistry, Physiology and Therapeutics, Department of Pathophysiology and Experimental Toxicology, National Veterinary School of Toulouse, France
A. David J. Watson
A. David J. Watson, BVSc, PhD, FRCVS, FAAVPT, MACVSc, Dipl ECVPT,
Associate Professor of Veterinary Medicine, Faculty of Veterinary Sciences, University of Sydney, Australia

What is acute renal failure and why does it occur?

Acute renal failure(AKI) is a severe pathological condition that involves impaired excretory function of the kidneys. This process develops rapidly, is usually reversible, and is accompanied by sudden changes in acid-base, water and electrolyte balance, and a decrease in renal excretion various substances from the body and, as a result, their accumulation.

The causes of such changes are a sharp decrease in blood flow to the kidneys, damage to the kidney tissue and/or disturbances in the outflow of urine from the kidneys. In other words, acute renal failure occurs:

• Prerenal(“prerenal”) - develops with a sharp drop in blood pressure and disruption of intrarenal blood circulation, due to shock of various origins (bleeding, poisoning, infections, heat stroke), dehydration, heart failure.
• Renal(“renal”) – develops when bacterial infections kidneys (pyelonephritis), inflammatory kidney diseases (acute glomerulonephritis, interstitial nephritis) and system-wide infectious diseases(leptospirosis). The cause of the development of acute renal failure can be the effect on the tissue structures of the kidneys of various toxic substances (ethylene glycol, salts of heavy metals, aniline), drugs (aminoglycosides, chemotherapy drugs, radiocontrast agents, non-steroidal anti-inflammatory drugs and some other drugs), snake venom. Renal renal failure can be caused by blockage of the renal tubules with hemoglobin from destroyed red blood cells during their massive hemolysis, for example, with piroplasmosis or as a result of diseases accompanied by the development of disseminated intravascular coagulation (poisoning with hemolytic poison, severe forms sepsis).
• Postrenal(“postrenal”) – develops when there is blockage or compression of the urinary tract (ureters, bladder or urethra), due to urolithiasis, tumors, enlarged prostate gland in males and other reasons.

In addition to the excretory function, the kidneys perform a number of other functions in the body - they regulate the composition of blood and other body fluids, participate in water-salt metabolism, the metabolism of proteins and carbohydrates, and synthesize biologically active substances that regulate blood pressure levels and the process of hematopoiesis. Therefore, renal failure (especially chronic) leads to additional disorders, such as a drop in hemoglobin levels, disorders of hormone-dependent functions and calcium metabolism.

Fluid and electrolyte imbalances, as well as the accumulation of metabolic products in the blood, give rise to complications from the cardiovascular and nervous systems, leads to gastrointestinal disorders and bleeding, as well as immunosuppression.

How does acute renal failure manifest?

Clinical signs of acute renal failure are nonspecific: general depression, change in urine volume (decreased urine volume, up to complete cessation of urination), weakness, vomiting, diarrhea, decreased appetite or lack thereof, increased pulse rate, swelling, pallor or redness of the mucous membranes. The severity of clinical manifestations can vary from minor disorders, invisible to the owner, to the most severe disorders.
If any such symptoms are detected, the animal should be taken to the clinic immediately.

Which patients most often have acute renal failure?

Patients at increased risk include those with kidney disease, severe trauma, or systemic disease(pancreatitis, diabetes mellitus, cardiovascular diseases, liver diseases). Additional risk factors include dehydration, electrolyte imbalance, low or high blood pressure, fever, and sepsis.

How does a doctor diagnose acute renal failure?

The diagnosis of acute renal failure is made on the basis of information provided by the animal owner (history), examination, and most importantly, the results of laboratory tests. An important symptom is a decrease in the amount of urine excreted by the animal (oliguria) or its complete absence (anuria). Upon examination, all or some of the following signs may be detected: the smell of urine in the exhaled air, pale mucous membranes, weakness, signs of dehydration, low temperature. The kidneys may be enlarged and painful. According to laboratory tests, there is a rapid development of azotemia, that is, an increase in the content of urea and creatinine in the blood (they are the main indicators of kidney function). In addition, phosphorus levels and blood acidity usually increase. A urine test reveals the presence of protein and glucose, as well as casts and renal epithelial cells in the sediment; the appearance of salt crystals and red blood cells is also possible. In addition, X-ray diagnostics are used, including with the introduction of special substances into the blood (for example, to exclude kidney stones, determine their size, the level of blood supply to the kidneys and other pathologies), ultrasound diagnostics and, in some cases, kidney biopsy.

Treatment

Treatment of patients with acute renal failure should be comprehensive and aimed at eliminating the cause, stimulating diuresis, correcting fluid and electrolyte imbalances, acid-base disorders, removing accumulated toxins from the body, and eliminating systemic complications. These patients require intensive therapy in an inpatient department of the clinic.

First of all, doctors try to eliminate the cause that caused the development of acute renal failure (shock, bleeding, dehydration, infection, cardiac dysfunction, etc.), which can itself help restore diuresis. If postrenal renal failure is established, it is necessary to ensure the free flow of urine as soon as possible (introduction urinary catheter, pumping urine with a syringe through abdominal wall, or using surgery). In parallel, measures are being taken to restore the adequate process of formation and excretion of urine (drugs are prescribed that improve intrarenal blood flow, microcirculation in the kidney tissues, diuretics that are administered intravenously, strictly dosed using intravenous dispensers under the constant supervision of the attending physician).

To correct water-electrolyte balance and acid-base disorders, infusion therapy is necessary. The choice of treatment tactics depends on the nature of the underlying and concomitant diseases, the degree of kidney damage and the general condition of the patient. Infusion therapy usually continue until the urea and creatinine levels reach normal level, adequate diuresis will be established and the general condition of the patient will stabilize.

During the treatment period, it is necessary to constantly monitor vital signs. important functions body of a sick animal: assess its clinical condition, volume of urine excreted per hour, urea and creatinine levels, electrolytes and blood gases, red blood indicators - hematocrit, hemoglobin, red blood cell count, color index blood (to monitor the development of anemia), as well as other laboratory indicators.

A complication of kidney failure may be an increase in potassium ions in the blood, which can lead to muscle weakness and heart rhythm disturbances. A common complication renal failure is vomiting. Its cause may be the effect of toxins on the central nervous system and/or peptic ulcer of the gastrointestinal tract. To prevent this complication, drugs that protect the gastrointestinal mucosa and antiemetic drugs are used.

In the event of the development of irreversible pathological changes in the renal tissue, when renal function is not restored in in full, acute renal failure passes into the chronic stage, which gradually develops and is characterized by progressive irreversible damage to the renal parenchyma. The end stage of chronic renal failure is acute renal failure, but it is irreversible and the prognosis in this case is unfavorable.

For patients with severe, intractable electrolyte and other disturbances, as well as for patients with end-stage chronic renal failure, peritoneal dialysis is indicated. This procedure is performed only in a clinical setting. To carry out dialysis, drains are installed in the animal's abdominal cavity under general anesthesia, through which a special liquid is injected and left in the abdominal cavity for a certain time. During this period, harmful substances pass from the body into this fluid, and an exchange of electrolytes and water occurs. Fluid is then removed from the abdominal cavity. The process is repeated periodically.

Despite timely medical care and adequate treatment, patients often die from acute renal failure due to the development of irreversible, incompatible with life, disturbances in the functioning of the body.

Nutrition

Animals with renal failure must receive nutrients. If the animal feeds on its own, then all that is necessary is to feed it with special medicinal dietary food. A diet for kidney failure is characterized by a reduced content of protein, phosphorus and sodium in the dog's diet.

If there is no appetite, but there is no vomiting, then they resort to feeding through a tube. If vomiting is present, then use parenteral nutrition (intravenous administration of solutions of amino acids, lipids and glucose).

The complex excretory function of the kidneys classifies almost any pathology of the paired organ as severe and life-threatening for the pet. The impossibility or difficulty of removing toxic substances from the body’s blood leads to self-poisoning. Kidney failure is not a separate developing disease, but a whole complex of symptoms. In veterinary practice, acute and chronic forms of the disease are distinguished.

Read in this article

Causes of kidney failure

Kidney failure in dogs has multiple etiologies. Veterinary specialists, based on many years of therapeutic practice, identify the following main causes of renal pathology:

According to the observation of veterinary specialists, representatives of such breeds as bull terrier, cocker spaniel, shih tzu, Doberman pinscher, German shepherd, Golden retriever, pinscher.

There is also an age-related dynamics of the pathology. In dogs over 8 years of age, kidney failure develops 2 times more often than in young pets under 1 year of age.

Stages of the disease

In veterinary practice, renal failure syndrome develops in the following stages:

• Latent. During this phase, the owner, as a rule, does not observe obvious clinical signs. In rare cases, general weakness, increased fatigue, and lethargy are detected. Clinical researches urine and blood tests carried out during this phase can reveal characteristic changes in parameters in the underlying pathology.
• Compensated deficiency phase. The stage is characterized by the clinical manifestation of problems with the excretory system. The owner is watching increased thirst in the dog and frequent urination. At this point, 50–55% of nephrons die. The level of urea in the blood can reach 20 mmol/l, the creatinine level can reach 200 µmol/l.
• Stage of decompensated insufficiency. The number of disabled structural and functional units of the kidneys reaches 80%. The animal has not only problems with urination, but also general symptoms: loss of appetite, vomiting, constipation, weight loss. Blood tests record a persistent increase in urea and creatinine, which indicates a serious disorder of protein metabolism in the body.
• Terminal. During this stage, the ability of the nephrons to filter blood is reduced to a minimum. The kidney function coefficient decreases to 15%, that is, the death of nephrons is 85%. The blood is sharply disturbed electrolyte balance, uremic intoxication develops. The animal has damage to the respiratory, cardiovascular and nervous systems. Pathological processes at this stage of nephropathology are irreversible.

With timely attention from the owner and proper comprehensive treatment, the animal can completely regain its kidney filtering capacity. The terminal stage usually ends with the death of the pet.

Acute and chronic forms

Acute renal failure has lightning-fast development and is usually observed immediately after treatment primary disease. With a timely diagnosis and complex therapy pathological process in acute cases, the course is reversible and is accompanied by restoration of the filtering capacity of nephrons.

In veterinary practice, specialists encounter the chronic form of the disease more often than with acute manifestation pathology. As a rule, by the time of manifestation clinical picture Most of the nephrons are removed from the functional state, and it is not possible to restore them.

Symptoms in dogs

The manifestation of clinical signs of impaired excretory function in a pet becomes obvious only at the stage of compensated insufficiency. Before this phase, the disease can only be suspected based on the results of a clinical blood test.

Veterinary specialists note that the symptoms of the disease do not always have characteristic signs, which makes timely diagnosis difficult. The owner should pay attention to the following symptoms in his four-legged friend:

• Decreased appetite. The dog is reluctant to approach the bowl and is picky. The portion of food eaten decreases.
• Increased. A sick animal drinks a lot and often.
• The owner notes frequent urination in the pet. In the initial stage of the disease, urine volumes are normal. With the development of pathology, there is a decrease in the amount of urine excreted, up to complete absence urination. In some cases, the owner discovers puddles of urine on the floor.
• Depressed, lethargic, apathetic state. The dog often lies down and spends a lot of time half asleep. Reluctant to go for walks and does not take part in games. The dog has muscle weakness. The animal is hunched over and moves reluctantly.

• Nausea, frequent vomiting.
• Visible mucous membranes are anemic.
• A sick animal has swelling in the chest area, anterior and hind limbs, in the abdominal area.
• Signs of dehydration: dryness skin, dull fur, viscous saliva, sunken eyeball.
• Violation of nitrogen metabolism leads to an unpleasant ammonia odor from the oral cavity.
• In some cases, dogs experience indigestion in the form of diarrhea.
• Body temperature is usually slightly reduced. The dog has a heart rhythm disorder.

Diagnostic methods

Taking an anamnesis allows the veterinarian to suspect the development of renal failure after an infectious or non-infectious disease of the excretory system. During a clinical examination, edema, dehydration, and signs of heart failure may be detected. An important diagnostic component is laboratory analysis of blood and urine.

An increase in urea and creatinine indicates a serious violation of the filtering ability of nephrons and a violation of nitrogen metabolism in the pet’s body.

Normally, the urea level in dogs is 3.5 - 9.2 mmol/l, and the creatinine concentration is 26 - 120 µmol/l. With moderate renal failure, the urea level in the blood of a sick animal reaches 28 mmol/l, and in the terminal phase – 50 and higher.

The concentration of creatinine in the stage of compensated deficiency increases to 400 µmol/l, in the terminal stage – 600 µmol/l. Such high values indicate a complete cessation of the filtration function of the kidneys, poisoning of the body with nitrogenous metabolic products and mean death for the pet.

In addition to protein metabolism indicators, mineral metabolism also changes in the blood. In the chronic form of the disease, an increase in the concentration of phosphorus in the blood is observed, while the calcium content decreases. Low hemocrit values ​​during the disease indicate a disturbance in the process of erythropoiesis in the body of a sick dog. Protein and sugar are found in the urine.

Ultrasound diagnostics allows you to assess the size of the kidneys. As a rule, in the case of the development of an acute form of the disease, upon examination, the doctor discovers an enlargement of the organ, and with the development of chronic kidney failure, the kidneys decrease in size. Postrenal pathologies, for example, can be identified when x-ray examination.

Ultrasound examination

Treatment of a four-legged friend

Does not exist in veterinary practice fundamental difference tactics for treating acute and chronic renal failure. In both cases, the same treatment regimens are used. In the acute form, therapy is aimed at eliminating the provoking factor. With the development of chronic deficiency, therapeutic forces are compensatory in nature and are aimed at improving the pet’s quality of life and prolonging it.

An approximate treatment regimen prescribed for a sick animal is as follows:

• Infusion therapy to eliminate dehydration and normalize electrolyte and acid-base balance. Intravenous drips help reduce the load on the kidneys and promote detoxification of the body. For this purpose they use saline solutions, Ringer's solution, Polyglucin, Reogluman, Reosorbilact, etc.
• Normalization of the urinary process. A sick dog is prescribed diuretics: Furasemide, Mannitol, Lespenefril. In some cases, the veterinarian uses mechanical diversion of urine by installing a catheter.
• In cases of purulent infection, a sick dog is prescribed antibacterial agents of the cephalosporin series.
• Severe vomiting is stopped with antiemetics, for example, Cerucal, Papaverine, Enterosgel.
• At high rates phosphorus in the blood must be bound. For this purpose, Almagel, Maalox, Aludrox are used. A good effect was noted when potassium acetate was used to bind phosphorus and increase calcium in the blood.
• The presence of symptoms of anemia is eliminated with the help of vitamin B12, Ferroglucin, Ursoferan.
• With kidney failure, the heart also suffers. To normalize myocardial function, a sick dog is prescribed Cordiamin, Riboxin, and Cocarboxylase.
• If the disease is caused by autoimmune processes in the kidneys, systemic glucocorticoid therapy is successfully used in veterinary practice.

Blood purification using hemodialysis or peritoneal dialysis allows you to quickly and effectively rid the body of toxins. Specialized veterinary clinics have in their arsenal high-tech devices for hemodialysis in animals. In their absence, the sick pet can undergo peritoneal dialysis.

The essence of the manipulation comes down to washing the peritoneum, which has a high ability to absorb liquid, through special holes with medicinal solutions.

For information on the symptoms, diagnosis and treatment of kidney failure in dogs, watch this video:

Dietary nutrition for pathology

The therapeutic diet for renal failure has a minimal protein content. The bulk of a sick pet's diet should consist of fats and carbohydrates. Products must contain a minimum amount of phosphorus; salt is completely excluded. Veterinary specialists, as a rule, recommend that during treatment the pet be switched to medicated food, specially designed for problems with the excretory system.

Prognosis for renal failure

The development of an acute form of the disease has more favorable consequences for the animal, subject to timely diagnosis and adequate treatment. This is due to the fact that the detection of clinical signs occurs at a time when the main part of the nephrons has not yet died.

In the chronic form of the disease, the prognosis is cautious. If signs of the terminal stage are detected in an animal, the outcome for the animal is unfavorable.

Kidney failure in dogs is a severe pathology of the excretory system, accompanied by disruption of nitrogen metabolism and the functions of other organs. Veterinary specialists give a cautious prognosis when the chronic form of the disease develops. Treatment is aimed at detoxifying the body, restoring the filtering capacity of the kidneys, and prescribing symptomatic therapy. In some cases, a lifelong therapeutic diet is prescribed.

Useful video

About the diet for chronic renal failure, watch this video: