Dear Doctor - How could she not have noticed the kidney disease?
Q Since my dog is already 11, her veterinarian wanted to do some routine blood work to clear her for the anesthesia she was going to need for her yearly dental cleaning. The doctor gave her the green light for the anesthesia but said the blood test indicated that she might have chronic kidney failure. This has since been confirmed with an analysis of her urine in addition to imaging of her kidneys. The vet says she could potentially live for several more years but that she must begin treatment right away. How could I have missed this?
Dear Ms. Hatter,
A Don’t berate yourself. You could not possibly have caught it. Most dogs with kidney disease do not feel sick — and do not exhibit any signs, including vomiting, dehydration, and overall malaise — until their kidneys have lost just about all of their function. The good news is that with early detection through blood and urine screening and other tests, as your dog has been through, you can initiate both medical treatment and dietary therapy to delay symptoms by a considerable amount of time.
What’s unusual about caring for a dog with kidney failure (meaning not that the kidneys have failed completely but that they’re going in that direction) is that much of the onus is on you rather than the veterinarian. You will really be thrown into the role of veterinary nurse practitioner, as the mainstays of treatment involve lifestyle and diet.
For instance, you will be advised to keep your dog’s stress level to a minimum, as stress can impact how much she eats and drinks, which is critical to her continued well-being. You will need to take care of physical stress, too, not just psychological. For instance, you cannot leave a dog with kidney failure outside on a very cold or very hot day. Her body won’t be able to respond as well as it should to the physiologic demands of such temperature swings, and that can play out in derangements in appetite and thirst level as well.
Along with reducing stress, you’ll need to go beyond leaving out a bowl of water at all times and actually make a conscious effort to insure she’s drinking enough. (Without enough water, the blood supply to her kidneys will decrease, and that will further impair their function. Water is also needed to rid the body of toxic waste.) This might mean changing her water more frequently or perhaps getting her an automatic water fountain, or putting in ice cubes, or whatever else it might take to entice her to drink. (Eventually, you may have to administer water to your dog through a needle from an IV drip. Your veterinarian will teach you how.)
You’ll also need to feed your dog a therapeutic diet — one lower in protein and phosphorus than you’ve been giving her. Your veterinarian will help you pick the right brand — it may have to be by prescription.
Of course, the doctor will be prescribing medications along the way, both to help keep blood levels of certain substances in the right range and to ease symptoms such as nausea. But kidney disease is truly a condition where you’ll need to step up. That said, many owners are glad for the opportunity to be able to do something rather than just stand by passively.