Kidney Disease in Dalmatians

The Dalmatian = Club of=20 America
Kidney Disorders = in=20 Dalmatians

Urinary = System: The=20 Kidneys - Basics=20

Study Group on Kidney & Liver Disorders =
Health=20 & Research Committee
Dalmatian Club of = America=20

This page by Former Director = James E.=20 Seltzer, Ph.D.

This site is intended to be = informative=20 only. If your dog is suffering from a health = problem,
diagnosis=20 and treatment should be based upon consultation with your=20 veterinarian.

Organization of the Urinary = System

Among the body=92s principal organs, two = hard-working kidneys=20 control the balance of water, acids/bases, and electrolytes. = In=20 addition, they detect, filter, remove and finally pass on = for=20 excretion toxic wastes from the body. The kidneys also help = regulate=20 blood pressure, help regulate the calcium and phosphorus = metabolism,=20 and produce a hormone that stimulates red-blood-cell = production=20 called erythropoiten. The kidneys are bean-shaped structures = a few=20 inches long in an adult Dalmatian and somewhat narrower in = width=20 than in length. In adult dogs, normal kidney weight may vary = from=20 one-half to one percent of body weight =96 about a half = pound in a=20 Dalmatian. Yet from 10 to 20% of the total blood flow from = the heart=20 passes through these relatively small organs. For an average = adult=20 Dalmatian they will process almost 200 gallons of blood each = day, of=20 which all is recycled except for a small fraction that is = converted=20 to urine. From the kidneys, urine passes through small = muscular=20 tubes called ureters which empty into the bladder. The = bladder is a=20 balloon-like structure bound with muscle. It is a storage = site for=20 urine until it can be eliminated from the body. When the = bladder=20 empties, urine flows down the urethra to exit from the body. =

When Things go=20 Wrong =

Kidney disease is=20 any destructive process within the kidney. Kidney disease is = not=20 limited to any particular age or breed, but is one of the = most=20 common medical problems of older dogs and is a leading cause = of=20 death. Depending on the study, kidney failure is the second = or the=20 third leading cause of death in dogs after heart disease = and/or=20 cancer. Furthermore, autopsies done on older dogs reveal=20 abnormalities in as many as 85% of all kidneys examined in = dogs over=20 the age of five. Kidney disease may have many different = causes,=20 including inherited defects, infections and toxic = substances.=20 Frequently, the cause cannot be determined, but with careful = examination and testing, the severity of the disease can be=20 evaluated and a treatment protocol can be established.=20

The kidneys have=20 great reserve capacity, but if kidney disease destroys the = kidney's=20 ability to perform properly, waste materials accumulate in = the blood=20 and signs of actual kidney failure are likely to appear. = Signs=20 associated with kidney failure are:

Increased=20 thirst (Polydipsia)
Increased=20 urine volume (Polyuria)
Weight loss=20
Weakness and=20 exercise intolerance
Tendency to=20 bleed or bruise easily
Dehydration=20 (To test for this, gently pull the skin away from your = dog=92s=20 middle. If the skin does not immediately spring back, the = dog may=20 be dehydrated.)
Stiff-legged=20 gait and arched back (a sign of painful kidneys)=20
Little or no=20 urine production
Loss of=20 appetite
Poor hair coat=20
Depression=20
Vomiting and=20 (less commonly) diarrhea

These signs may=20 appear suddenly (acute renal failure) or develop slowly over = time=20 (chronic renal failure), and they may be produced by = diseases other=20 than kidney disease.

Usually signs of=20 decreased kidney function are not evident until more than = two thirds=20 to three fourths of the total kidney function has been lost. = The=20 majority of adult dogs have suffered some kidney damage, and = kidney=20 damage is usually progressive. Existing damage to the kidney = cannot=20 be repaired but surviving elements can compensate to take up = the=20 increased workload, and medical and dietary therapy can help = to slow=20 progression of the disease. An early diagnosis is therefore=20 important to be able to start treatment at an early stage, = sometimes=20 even before clinical signs become apparent. Any measure that = helps=20 prevent the disease, delays the age of occurrence, and slows = the=20 progression of this disease will help a dog live = longer.

Diagnosis of=20 Kidney Disorders=20

There are a=20 number of lab tests (commonly, urinalysis and blood tests, = less=20 commonly, ultrasound and kidney biopsies) that indicate = whether the=20 kidneys are functioning properly. When kidneys are working = properly,=20 they produce urine that is typically more concentrated than = the=20 blood plasma. A dog should be able to concentrate urine = above the=20 specific gravity of 1.020. If several urine samples taken = during the=20 day all fail to have a urine concentration greater than = 1.020, that=20 would be a sign that the kidneys are not working properly.=20

Blood=20 Tests

Blood tests=20 should be performed as a part of the dog=92s veterinary = examination.=20 Creatinine (CREAT) is a waste by-product of muscle breakdown = and=20 repair, and its production is nearly constant. Rising level = of=20 (blood) serum creatinine revealed by periodic blood tests is = a=20 strong indicator of progressive kidney disease. Two other = compounds=20 frequently monitored are blood urea nitrogen (BUN) and = phosphorus=20 (PHOS), but these are less reliable since they can be = affected by=20 diet.

Blood tests for=20 minerals such as calcium, sodium, and potassium may also be = abnormal=20 in kidney failure, and severe imbalances of any of these = minerals=20 create weakness and abnormal heart rhythms. However, this = generally=20 occurs only after BUN, CREAT, and PHOS are elevated several = times=20 above the normal ranges. Each diagnostic laboratory will = determine=20 normal ranges for these measurements, and those employed by = your=20 veterinarian may differ from those tabulated below. However, = BUN=20 concentrations above 75 mg/dl are a strong indication that = the=20 kidneys are not doing their job. CREAT values above 2.5 = mg/dl are=20 not likely to occur for any reason other than an inability = of the=20 kidneys to filter the creatinine from the bloodstream. = Rising PHOS=20 levels above 7.0 mg/dl are associated with kidney damage. = Falling=20 total protein levels can occur with kidney failure, and = anemia is=20 not uncommon if the kidneys start to fail completely.=20

Typical Blood Chemistry Reference = Ranges=20

Test	Canine
BUN, mg/dl	10-30
Calcium, mg/dl	8.0-12.0
Creatinine, mg/dl	1.0-2.0
Glucose, mg/dl	65-130
Phosphorus, mg/dl	3.0-7.0
Potassium, mE/L	4.0-5.7
Protein (total), g/dl	5.4-7.6
Sodium, mEq/L	140-158

>From College of Veterinary Medicine, Oregon = State=20 University,
Corvallis, Oregon, April, 1999 (Your = diagnostic=20 laboratory
may use different measurement units and/or = reference=20 ranges)

Urine=20 Tests

A = urinalysis=20 should be done routinely every year on every dog over six = years of=20 age. Urine is the product of the kidneys and will reveal = problems=20 long before blood work reveals any abnormalities. = Additionally, any=20 sick dog should have a urinalysis done. Bacteria, traces of = blood,=20 excessively dilute urine, protein, sugar are abnormalities = that may=20 need further evaluation. Doing a routine urine = protein-to-creatinine=20 ratio in older dogs is extremely important in the successful = diagnosis and management of progressive renal disease in = older dogs.=20 Not only is kidney disease common, but it is easily missed = on=20 physical examination, and even on blood tests in its = earliest=20 stages. The urine, however, holds the key to revealing = low-grade,=20 chronic kidney disease. If discovered early, specific = treatment and=20 appropriate dietary management can prolong the life of an = afflicted=20 pet, or, in the case of a hidden infection, halt the = progress of the=20 disease if diagnosed in time. It is believed that once the = kidney is=20 significantly damaged progress of the disease is inevitable; = the=20 working units of the kidney (nephrons) continue to be lost = due to=20 the excessive work demands placed on those nephrons still=20 functioning.

Normal Findings =96 Fresh Canine = Urine=20

Component	Adult Dog
Color	Yellow
Turbidity	Clear
Specific = Gravity
=20 Minimum	1.001
=20 Maximum	1.065+
=20 Typical Range	1.015-1.045
pH	4.5-8.5
Glucose	Negative
Ketones	Negative
Bilirubin	Trace to 1+*
Occult Blood	Negative
Protein	Trace*
Protein-Creatine Ratio	0-.3**
RBC (per high-power field)	0-5 (?)
WBC (per high-power field)	0-5 (?)
Bacteria (per high-power field)	Negative
Crystals (per high-power field)	Variable

*in=20 highly concentrated urine. **values from .3-1 are=20 questionable,
values above 1 are abnormal.
From = Canine and=20 Feline Nephrology and Urology, Osborne, Carl, et al,=20
Williams and Wilkins, pubs., 1995, p 202.

Treatment of=20 Kidney Disorders=20

Once chronic=20 kidney failure develops it cannot be reversed, but there are = measures that can be taken to slow the progression of the = disease=20 and help the dog live longer. On the other hand, acute = kidney=20 disease can often be stopped, and many dogs recover = completely once=20 the underlying cause is corrected.

Your veterinarian=20 will determine the proper treatment for your dog which may = include=20 hospitalization, fluid therapy, as well as diet and = medication. High=20 blood pressure, a common complication of chronic kidney = failure, may=20 require periodic monitoring to evaluate progress. =

Many of the=20 toxins building up in the blood are chemicals derived from = the diet.=20 Nutrients in the diet that may contribute to progression of = the=20 disease include protein, phosphorus and sodium. By limiting = the=20 intake of these nutrients, while still providing an = excellent=20 quality diet, it is possible to maintain your dog's = nutritional=20 status and reduce production of toxic products. It also is = important=20 to provide enough calories to prevent the body from breaking = down=20 its own tissues as a source of calories, which only adds = more toxic=20 products. By reducing the amount of waste products, animals = often=20 feel better, so they become more inclined to eat and to be = more=20 active.

Water A=20 major thrust of treatment for chronic kidney disease is to = make sure=20 that your dog receives enough water and other fluids. Dogs = that do=20 not receive enough fluids may become dehydrated, which = decreases the=20 amount of blood flowing to the kidney to permit waste = products to be=20 flushed out of the system. Signs of dehydration to watch for = include=20 a dry, "tacky" mouth and loss of skin pliability, which = causes the=20 skin to stick together when pulled away from the body. = Access to=20 fresh water at all times is important. Do Not Restrict = Water for=20 Any Reason, unless your veterinarian specifically requests = you to do=20 so. Some animals drink more water when water bowls are = refilled=20 frequently, and water may be added to the animal's food if = it is=20 eating well.

Special Diets=20 Special diets for patients with chronic kidney disease = are=20 designed to limit the intake of protein, phosphorus and = sodium,=20 while avoiding deficiency of any of these essential = nutrients. Signs=20 of nutrient deficiency in animals fed these special diets = include=20 muscle loss, poor haircoat and listlessness. These signs are = not=20 specific, however, and may be associated with other = problems. If you=20 see any of these develop in your dog, contact your = veterinarian to=20 have them evaluated. You can feed your dog a commercially = available=20 veterinary food, or cook a "kidney friendly" special = homemade=20 diet. =

Prognosis =

Prognosis for=20 acute renal failure largely depends on the severity of = injury to the=20 kidneys. Short-term survival depends on whether the dog can = live=20 through the worst part of the acute episode. Expert, mainly=20 supportive, medical care will allow some animals that would=20 otherwise die to survive the worst of their illness. = Long-term=20 prognosis for these dogs is fair to good for those that = survive the=20 critical stage and begin to show signs of recovery.=20

No test can=20 determine how long your dog will live with chronic renal = failure.=20 Some animals tolerate kidney failure amazingly well, while = others=20 with the same degree of kidney failure are very sick. = Information=20 from the physical examination, response to treatments, = general=20 history of well being, and laboratory data should provide = the needed=20 information to provide the best care for your = dog.

Prevention=20

Of critical=20 importance for a dog of any age is the avoidance of injury = to the=20 kidneys either by physical causes or the ingestion of = substances=20 that are toxic. Urinary tract infections that could possibly = lead to=20 pyelonephritis should be treated by a veterinarian. Diseases = such as=20 leptospirosis can have a severe impact on the kidneys and=20 vaccinations are available to assist in prevention. Certain=20 medications such as NSAIDS that are used to alleviate pain = and a=20 number of antibiotics are known to cause kidney damage when = used for=20 prolonged periods; this is especially true in the geriatric = dog.=20 Some common household chemicals can cause acute renal = failure; the=20 most notorious of these is the automobile anti-freeze, = ethylene=20 glycol, the ingestion of only a tablespoon of which can be = fatal to=20 a medium size dog.

Problems with=20 maintaining healthy kidneys and aging are the most difficult = to=20 confront. Should every dog over seven years of age be on a = senior=20 diet? Every dog ages differently, and most dogs do very well = on=20 senior diets because the protein levels are above adult = maintenance=20 minimal requirements. However, many dogs are still leading = active,=20 working lives at 11, 12, or older. Service dogs, hunting = dogs, and=20 jogging companions may need 22 % protein to maintain = condition.=20 Similarly sick dogs, even ones with kidney disorders, may = need extra=20 protein for coat condition, muscle tone, and the = preservation of a=20 healthy immune system. What older dogs don't need is mineral = levels=20 as high as those that are recommended for growth and = reproduction.=20

It is generally=20 agreed that protein alone does not cause kidney failure in = the=20 normal dog. But it is likely that many dogs older than five = are not=20 truly normal. Perhaps only 15% of senior dogs retain normal = kidney=20 function. Studies like these are the impetus behind urging = people to=20 feed a "senior" (protein restricted) diet to their = dogs.=20

Classes of Dog=20 Food

All = stages of=20 life =96 Satisfies AAFCO* standards for puppies,=20 reproduction and adults; commercial brands in this = category=20 typically contain 26-30% protein (AAFCO minimum 22%) = and=20 12-20% fat (AAFCO minimum 8%).

Adult = maintenance=20 only =96 Satisfies AAFCO* standards for = non-reproducing=20 adults; commercial brands in this category typically = contain=20 20-25% protein (AAFCO minimum 18%) and 12-16% fat = (AAFCO=20 minimum 5%).

Senior =96=20 Typically lower in calories, protein and fat, higher = in fiber;=20 commercial brands in this category typically contain = 16-20%=20 protein and 8-12% fat.

Lite = =96 Typically=20 lower in fat and calories; commercial brands in this = category=20 typically contain 16-21% protein and 5-10%=20 fat.

*AAFCO (The = Association=20 of American Feed Control Officials) sets guidelines = and=20 definitions for animal feed, including pet foods. = Percentages=20 in DM (dry measure) basis. =

In the opinion of some = veterinarians, the=20 restriction of phosphorus is of greater value than protein=20 restriction. Some, but not all, protein sources are also = high in=20 phosphorus. Switching from an "all stages of life" diet to = an "adult=20 maintenance only" may be sufficient for many dogs; an actual = "senior" diet may not be necessary. However, vegetables and = starches=20 are very high in phosphorus; this is why some "lite" = formulas are=20 often higher in phosphorus than are adult maintenance diets. = "Lite"=20 formulas should not be considered the equivalent of senior = diets,=20 but, regardless of the diet you choose, be sure it is a = reputable,=20 name-brand product. Generic products have no reputation to = maintain=20 and, consequently, do not always use quality, fully = digestible=20 products.

Finally, the most important = thing you can=20 do nutritionally for your dog is to be sure that your pet is = free of=20 parasites and disease. The finest diet in the world will not = benefit=20 a dog full of heartworms, hookworms, tapeworms, whipworms,=20 roundworms, or coccidia -- the parasites get all that great=20 nutrition. Similarly, a sick dog will lose condition even on = a=20 premium diet. Not only should your pet be examined annually = and kept=20 on a heartworm prevention program in those geographic areas = where=20 the parasite is common, but a yearly stool and urine = examination is=20 necessary as well, especially for the "senior" = dog.

References=20

Canine and=20 Feline Nephrology and Urology, Osborne, Carl, and = Finco,=20 Delmar R., Williams and Wilkins, pubs.,=20 1995.
Association of=20 American Feed Control Officials Incorporated. Official = Publication=20 1997. Atlanta: AAFCO, 1997
"New Insights=20 and Treatments of Kidney Disease, Part I.", Gearhart, = Martha A.,=20 D.V.M., Dog World, March = 1997.
"Managing a=20 Renal Crisis," Gearhart, Martha A., D.V.M., Dog = World, vol=20 82, April 1997, pp 40-44.

=20

=20

K9Kidneys List=20

K9KIDNEYS is a=20 list for owners of dogs who are currently suffering from one = or more=20 forms of kidney disorders. Emphasis of the discussions will = revolve=20 around the current available veterinary therapies, and = practical=20 management techniques. You can join this discussion group by = subscribing on-line at: =

http://groups.yahoo.com/group/K9KIDNEYS/ =

Kidney=20 Informational Links=20

1.=20 Kidney Disease in Dogs: an excellent resource = maintained=20 by Susan L. Fleisher with numerous links to other web pages = relating=20 to kidney disorders.
http://www.geocities.com/jj= fleisher/=20

2. Canine Kidney = Disease: an=20 informative article from the Columbia Animal Hospital = library with=20 descriptions of acute and chronic kidney disease, diagnosis = and=20 treatment.
http://www.cah.com/= library/caninekidney.html=20

3. Chronic renal = disease and=20 failure: a teaching resource on chronic renal failure by Dr. = Cheryl=20 R. Dhein, the Washington State University College of = Veterinary=20 Medicine.
h= ttp://www.vetmed.wsu.edu/boeing/small_animal_medicine/crf.htm=20

4. Acute renal = failure: a teaching=20 resource on acute renal failure by Dr. Cheryl R. Dhein, the=20 Washington State University College of Veterinary = Medicine.
h= ttp://www.vetmed.wsu.edu/boeing/small_animal_medicine/arf.htm=20

5. The Kidney in = Health and=20 Disease: article by Martha S. Gearhart, DVM with description = of=20 normal and diseased kidneys, functions and treatment
http://ww= w.geocities.com/willowind_dals/gearhart1.html=20

6. Managing the Renal = Failure=20 Patient and Feeding the Older Dog: another article by Martha = S.=20 Gearhart, DVM, with case studies of dogs with kidney = disorders.=20
http://ww= w.geocities.com/willowind_dals/gearhart2.html=20

7. The Ohio State = University=20 Veterinary Hospital Nutrition Support Service: nutritional=20 information about canine diets for kidney disorders.
http://www.nssvet.org/food/=20

8. Antifreeze = Poisoning:=20 Washington State University College of Veterinary Medicine=20 discussion on the dangers of antifreeze poisoning.
http://www.vet= med.wsu.edu/cliented/antifreeze.htm=20

9. A Pet Owner's Guide = to Common=20 Small Animal Poisons
http://www.avma.org/pubh= lth/poisgde.asp=20

Please submit your questions, = comments, requests=20 and suggestions to
The = Dalmatian Club=20 of America

Copyright =A9 2002 - 2003
The Dalmatian Club = of=20 America, Inc.
All Rights Reserved

Page last modified on = December=20 29, 2003