Gagal Ginjal Kronis (ggk) 581n4z

Gagal Ginjal Pada Anjing

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Fungsi ginjal adalah sebagai sistem filtrasi di dalam tubuh. Ginjal terdiri dari ratusan hingga ribuan sel-sel nefron yang fungsinya menyaring produk sisa dari aliran darah yang disekresikan dalam bentuk urin. Ginjal juga berfungsi mempertahankan keseimbangan air dan elektrolit di dalam tubuh dan juga memproduksi beberapa hormon seperti erythropoietin yang menstimulasi produksi sel darah merah. Gagal ginjal terjadi bila ginjal tersebut tidak berfungsi sebagaimana mestinya. Ada 2 tipe gagal ginjal, Gagal Ginjal Akut (GGA) dan Gagal Ginjal Kronis (GGK). GGA terjadi sangat cepat dan langsung kehilangan fungsinya, biasanya disebabkan oleh keracunan. GGA dapat bersifat reversible, jadi bila ditangani dengan cepat maka fungsi ginjal dapat kembali lagi, tapi juga dapat menjadi ke GGK bila terlambat ditangani. Gejala klinis yang biasanya terjadi pada GGA adalah sedikit minumnya, jarang buang air kecil,lemah,muntah,kadang diare. GGK sangat sering terjadi pada hewan tua, dimana dalam keadaan tua hewan akan mengalami penurunan fungsi organ yang salah satunya adalah ginjal. GGK terjadi karena kerusakan sel 60 – 75% dari sel sel nefron yang ada di ginjal yang menyebabkan fungsi ginjal menurun. Proses terjadinya GGK dapat diperkirakan dalam hitungan bulan atau bahkan beberapa tahun, tergantung dari kondisi hewan yang terkena GGK. Gejala klinis GGK biasanya hewan akan nampak banyak minum (polydipsi), banyak buang air kecil (polyuri), anorexia (kekurusan), muntah, penurunan berat badan, lemah, susah bejalan, nafasnya jelek, ulcer pada mulut (seperti sariawan), anemia (karena hormon erythropoietin tidak berfungsi dengan baik). Beberapa penyebab terjadinya Gagal Ginjal adalah : Keracunan (pestisida, organophosphate, dll.), Obat-obatan (terlalu lama terpapar dengan obat, misal antibiotik, anti inflamasi, anti parasit, dll. Maka dari itu semua pemakaian obat harus dengan persetujuan dan pengawasan dokter), Tumor ginjal (Lymphosarcoma, adenosarcoma), Batu Ginjal, Dehidrasi, Agen Infeksius (Leptospirosa sp. yang menyebabkan Leptospirosis), Geriatric diseases (Penyakit yang timbul pada umur tua diakibatkan karena penurunan fungsi organ dalam hal ini ginjal). Penyakit Gagal Ginjal dapat didiagnosa dari gejala klinis yang nampak dan juga dengan pemeriksaan laboratorium. Pemeriksaan darah QBC dan kimia darah akan sangat membantu mendiagnosa Gagal ginjal terutama dilihat dalam kandungan BUN (Blood Urea Nitrogen) dan Creatinine, bila keduanya hasilnya tinggi menunjukkan bahwa fungsi ginjal sudah jelek. Pengobatan

dan

penanganan Penyakit gagal

ginjal

ditujukan

pada

pencegahan atau memperlambat kerusakan ginjal tersebut. Hewan yang terkena gagal ginjal dianjurkan dilakukan rawat inap di rumah sakit hewan atau klinik hewan dan akan diterapi dengan cairan infus yang fungsinya membantu mencuci atau membuang produk sisa dari aliran darah dan memperbaiki kesimbangan elektrolit di dalam tubuh, dan juga dilakukan pengobatan untuk gejala yang nampak seperti muntah, diare, dan juga kemungkinan terjadi infeksi sekunder oleh bakteri. Pemeriksaan darah rutin pada hewan tiap tahun akan sangat membantu untuk mendeteksi tahap awal sebelum gagal ginjal terjadi, dan bila terlihat tahap awal maka hewan akan mendapat penanganan lebih awal yang dapat mencegah kerusakan ginjal lebih lanjut. Maka dari itu kita sarankan untuk mengecek pemeriksaan darah secara rutin terhadap hewan kesayangan anda.

mengapa kucing sakit L `gagal ginjal adalah penyakit yang mempengaruhi sebagian besar paruh baya kucing dan maju, dan yang datang dengan ketidakmampuan` dari nefron, unit penyaringan ginjal untuk menghilangkan racun yang diproduksi dan terakumulasi dalam organisme . Penyakit ini dapat terjadi dalam dua bentuk: yang pertama, yang disebut "bentuk kompensasi," kucing dengan minum secara tidak terkontrol dan dapat, meskipun dengan susah payah, untuk menghilangkan racun melalui ginjal, di kedua, "bentuk dekompensasi," yang `hewan tidak mampu untuk menghilangkan zat beracun dan akumulasi racun dalam organisme, memicu suatu kondisi yang dapat berakibat fatal ke teman berbulu kita tercinta.Gagal ginjal akut disebabkan oleh kegagalan, parsial atau total, dari ginjal-terkait fungsi. Kegagalan ini dapat dibagi menjadi: pra-gagal ginjal, yang menyebabkan gangguan pencernaan, syok hemoragik, gagal jantung, ginjal (termasuk "nefritis akut" yang disebut) meliputi berbagai jenis dan keparahan infeksi, pasca-ginjal, yang melibatkan obstruksi saluran kemih, suatu kondisi yang disebabkan oleh adanya tumor, peradangan, dan perhitungan.Gagal ginjal kronis, kadang-kadang hanya disebut sebagai penyakit ginjal dan sekarang salah satu penyebab paling umum kematian pada kucing yang lebih tua. Dalam kebanyakan kasus, gagal ginjal adalah penyakit kronis yang berkembang, ia cenderung memburuk jauh dari waktu ke waktu.Kecepatan di mana penyakit berkembang, bagaimanapun, tetapi bervariasi dari kucing ke kucing. Ini mungkin bahwa penyakit tidak menyembuhkan segalanya, tapi tidak pernah ada perawatan yang tepat dan secara konsisten dapat membantu untuk meningkatkan kualitas dan durasi kehidupan kucing sakit, membatasi perkembangan penyakit.

peran ginjal Ginjal melakukan banyak kegiatan dalam tubuh kucing, termasuk penghapusan racun dari darah dan menjaga keseimbangan cairan dan mineral dalam tubuh. Darah terus-menerus disaring melalui ginjal, yang mengeluarkan produk sisa metabolisme yang membawa itu, proses ini berlangsung secara simultan dalam memproduksi urin, ginjal juga mengumpulkan urin memfasilitasi kembalinya badan air, mencegah dehidrasi ini.Ginjal memainkan peran utama dalam menjaga keseimbangan elektrolit (kalium, natrium, kalsium, fosfat, dll.) Tubuh Cat, seperti yang terjadi pada manusia, keseimbangan jumlah asam dalam darah dan tekanan darah. Ginjal bertanggung jawab untuk produksi erythropoietin, suatu hormon yang menstimulasi produksi sel darah merah di sumsum tulang. Alam diberkahi ginjal dari "kapasitas cadangan" yang signifikan, pada kucing seperti di mamalia lain, termasuk manusia.Dalam kesempatan yang dihapus ginjal tidak bekerja, umumnya tidak memiliki dampak negatif jika apa yang tersisa adalah yang sehat. Agar ginjal dipengaruhi oleh kegagalan, harus terganggu massa ginjal jaringan yang berlangsung dari dua pertiga sampai tiga perempat dari seluruh organ vital. Mengingat jumlah fungsi dasar yang ginjal bermain di tubuh, jika Anda sakit segera melibatkan pengembangan berbagai komplikasi pada kucing yang terkena.Mereka yang memang ada mengalami beberapa modifikasi elektrolit (Bagaimana nilai-nilai darah tinggi seperti diungkapkan oleh konsentrasi rendah konsentrasi kalium atau tinggi fosfor), koleksi zat asam dari tubuh (asidosis) peningkatan tekanan darah (hipertensi) dan mengurangi jumlah sel darah (anemia).

penyebab dan gejala Gagal ginjal kronis terjadi ketika kerusakan ginjal yang tidak diobati, penyakit yang kondisinya ketidaknyamanan berlangsung untuk waktu yang lama dan menjadi ireversibel. Kondisi ketidaknyamanan menghambat kemampuan untuk secara teratur ihkan tubuh, menghilangkan produk sampah dari darah. Hampir selalu penyebab penyakit ini kurang dipahami tegas, tetapi ketika Anda membuat penarikan untuk ujian nasional biopsi jaringan dari pasien gagal ginjal kronis, biasanya mereka menunjukkan peningkatan jumlah jaringan fibrosa yang menggantikan jaringan ginjal yang normal .Semuanya biasanya dihubungkan dengan kerangka kerja umum peradangan (dikenal sebagai nefritis interstisial kronis). Penyebab beberapa kegagalan ginjal kronis, sampai sekarang terang-terangan, adalah: penyakit ginjal polikistik (yang kucing eksotis dan Persia genetik) di mana jaringan ginjal adalah untuk mengambil alih serangkaian beberapa kista berisi cairan, tumor ginjal - seperti limfoma (kanker sel darah putih), yang dapat menyebabkan ginjal dan dengan demikian menyebabkan gangguan fungsional, infeksi - infeksi bakteri dari kandung kemih, yang dapat menyebabkan kerusakan tersebut untuk menimbulkan gagal ginjal kronis.Di antara penyebab lainnya tetapi ada racun, cacat genetik yang mempengaruhi ginjal atau peradangan ostinata.Nella kebanyakan kasus, gagal ginjal kronis muncul dalam lambat dan berbahaya, meskipun di beberapa kasus tandatanda klinis tampaknya untuk mengembangkan cukup tiba-tiba .Banyak gejala tidak jelas dan tidak spesifik dan hanya muncul ketika racun menumpuk dalam darah dalam jumlah besar, bukannya ditularkan melalui urin. Tandatanda klinis yang paling umum adalah hilangnya nafsu makan, berat badan, dehidrasi, kelesuan dan depresi. Ada sering haus meningkat dengan peningkatan berikutnya dalam output urin (karena ketidakmampuan untuk berkonsentrasi urin Pada kucing ada akan meningkat secara bertahap dalam haus dan buang air kecil:. Ini, dengan mata pengamat, adalah dua indikator utama mengungkapkan ginjal yang tidak lagi dapat saluran urin seimbang.Selain itu, nafsu makan berkurang secara bertahap `sampai mencapai, dalam kasus yang ekstrim, kehilangan nafsu makan sebelum dan penurunan berat badan yang nyata dan anoreksia. Bahkan terjadinya depresi, kelemahan dan muntah adalah gejala mengkhawatirkan lainnya. Gejala terakhir, mungkin, tetapi kurang jelas bagi pemilik kucing, adalah dehidrasi yang progresif, hilangnya elastisitas kulit, napas tidak menyenangkan dan pembengkakan pada mukosa oral dengan radang gusi.Kucing mengalami kesulitan bernapas dan kondisi fisiknya memburuk, bahkan sebelum mata mereka. Rambut kehilangan kecerahan dan mungkin memiliki ruam. Selain itu, kucing muntah sering sakit dan menderita diare. Pada beberapa kucing dikenal sebelum gejala lainnya, kelemahan otot yang kuat gagal ginjal berikutnya, dalam hal ini, kucing bisa sampai ke bahkan tidak bisa meregangkan leher saya dan mengambil posisi berdiri untuk berjalan.

gejala Dalam kebanyakan kasus gagal ginjal kronis adalah penyakit progresif dengan onset berbahaya dan lambat, meskipun dalam beberapa kasus tanda-tanda klinis muncul untuk mengembangkan tiba-tiba. Banyak gejala yang jelas dan spesifik dan terjadi ketika racun menumpuk dalam darah, bukannya ditularkan melalui urin. Tanda-tanda klinis yang paling umum adalah hilangnya nafsu makan, berat badan, dehidrasi, kelesuan dan depresi. Ada sering haus meningkat dengan peningkatan berikutnya dalam output urin (karena ketidakmampuan untuk berkonsentrasi urin.Kucing memiliki peningkatan berurutan haus dan buang air kecil, indikator dua yang paling mengungkapkan ginjal yang tidak lagi mampu menyampaikan urin. Selain itu, nafsu makan berkurang secara bertahap `sampai mencapai, dalam kasus-kasus ekstrim, anoreksia sejati dengan penurunan berat badan, terjadinya depresi, kelemahan dan muntah. Gejala lain, tetapi kurang jelas bagi pemilik kucing, adalah dehidrasi yang progresif, dengan hilangnya elastisitas kulit, napas tidak menyenangkan dan radang gusi.Kucing mengalami kesulitan bernapas, kondisi fisiknya semakin memburuk, rambut buram dan bentuk ruam, ketika kondisi memburuk, hewan peliharaan `muntah sering dan menderita diare, buang air kecil yang berlebihan dan haus untuk lebih. Beberapa kucing mulai mengembangkan otot kelemahan yang parah gagal ginjal berikutnya, dalam hal ini kucing tidak mampu untuk meregangkan leher dan mengambil posisi berdiri.

diagnosa dan pengobatan Hal ini tidak selalu mudah untuk mendiagnosa gagal ginjal karena melibatkan serangkaian gejala yang dapat menyesatkan untuk diagnosis penyakit. Banyak dari mereka benar-benar mirip dengan penyakit lain. Diagnosis gagal ginjal kronis digambar dengan pasti hanya setelah serangkaian tes darah dan tes urine. Biasanya yang pertama harus dikendalikan dalam darah - urea dan kreatinin - dua zat yang mewakili apa yang ginjal biasanya excretes.Dalam tingkat darah ginjal kronis dari dua elemen meningkat, tetapi karena ada penyakit lain yang dapat mempengaruhi jumlah dan status zat ini dikendalikan pada saat yang sama urin dengan pemeriksaan khusus, di mana dalam kasus gagal ginjal kronis, disertai dengan gejala spesifik dari meningkatnya kadar urea dan kreatinin, zat ini tidak terlalu terkonsentrasi. Jika itu menarik keluar "berat jenis", untuk menganalisis konsentrasi kurang dari 1030 berarti bahwa, pada kucing yang paling, adalah gagal ginjal.Mengistrasikan terapi yang tepat, memungkinkan kemungkinan menghambat pembangunan dan memburuknya penyakit. Dokter hewan dapat meresepkan inhibitor ACE untuk vasodilator (contoh yang baik adalah benazepril pasar). Meskipun orang-orang dengan gagal ginjal biasanya digunakan obat ini, karena mereka memiliki efek menguntungkan pada fungsi ginjal dan batang hilangnya protein melalui ginjal (yang dapat menjadi tinggi dan berbahaya dalam perjalanan gagal ginjal).Obat ini sangat berlaku pada kucing, meskipun tampaknya tidak semua kucing memperoleh manfaat langsung, tampaknya bahwa kucing dengan ditandai hilangnya protein dalam urin memiliki manfaat lebih dari obat ini. Mengambil obat-obatan seperti yang masih memerlukan pemantauan ketat oleh dokter hewan, dan harus menjalani siklus tes darah dan urin, untuk memahami jenis tangan tangan Anda mendapatkan manfaat dari penggunaan mereka dan, dalam kasus ini, perubahan dosis .

diet Verifikasi diet adalah penting untuk kucing yang menderita gagal ginjal kronis. Kucing-kucing yang menderita gagal ginjal kronis sangat rentan terhadap dehidrasi (yang disebabkan penurunan kemampuan ginjal untuk menyimpan air dengan mengkonsentrasikan urin). Menjaga pasokan air yang baik karena itu sangat penting, dan kucing-kucing mengambil sebagian besar air melalui makanan. Langkah pertama untuk memberi makan kucing dengan penyakit ini adalah untuk menawarkan makanan kaleng, lembab bukan makanan kering.Diet terbaik untuk kucing ini harus memiliki kandungan protein sangat rendah: banyak zat beracun yang menumpuk dalam darah dengan gagal ginjal yang dihasilkan dari pemecahan protein, dan rendah protein diet harus meminimalkan limbah ini . Pembatasan protein harus dilakukan dengan hati-hati, bagaimanapun, dan di bawah pemantauan ketat oleh dokter hewan. Jika Anda berlebihan dengan kekurangan protein kucing mungkin menderita penurunan berat badan, Namun, yang akan merugikan kesehatannya.Untuk alasan ini, kami sarankan untuk menggunakan produk komersial diformulasikan khusus untuk kucing dengan masalah kesenjangan, yang meraba-raba berisiko Sebuah pasokan yang cukup dari air untuk tubuh kucing sakit, tentu sangat berharga pada kucing dengan ginjal "diet buatan sendiri.": Lebih dari untuk memberinya semua air yang `dapat minum, meninggalkan segar dan bersih, kita harus memilih daging putih, ikan atau diet khusus yang dokter hewan Anda dapat merekomendasikan dan bahwa, seperti yang diharapkan, sudah tersedia di toko-toko makanan untuk hewan.Kadang-kadang, kekuasaan semacam ini tidak selalu begitu menarik bagi kucing dipaksa untuk makan lebih sedikit dari biasanya. Jadi adalah kesabaran pemiliknya untuk membuat makanan lebih lezat daripada baru mereka, mungkin dengan pemanasan atau dengan mencoba berbagai kemungkinan setiap selera, atau mencoba untuk secara bertahap menggantikan makanan normal bahwa kucing sudah terbiasa dengan.

trik lain yang berguna Jika kucing tidak memiliki niat minum, kita dapat mencoba untuk membeli salah satu air mancur minum listrik untuk kucing, yang merangsang keingintahuan mereka dan membantu dia untuk minum lebih banyak. Metode lain yang baik adalah dengan menggunakan air rasa dengan ayam atau tuna, misalnya, dapat digunakan untuk tujuan ini air yang digunakan untuk memasak makanan ini, jika lemak bebas, hanya biarkan dingin dan ditawarkan kepada kucing dalam mangkuk normal. Pada beberapa kucing dengan gagal ginjal pada stadium lanjut, mungkin berguna untuk tunduk mereka untuk istrasi cairan secara berkala, baik oleh intravena dan subkutan.Perawatan ini, bagaimanapun, menjadi halus, harus selalu dilakukan di fasilitas hewan. Gagal ginjal kronis tidak dapat disembuhkan, sayangnya, tidak pernah benar-benar, dan dalam kebanyakan kasus akan meningkat dari waktu ke waktu, meskipun terapi, pengobatan yang optimal memerlukan siklus inspeksi secara berkala (termasuk pengukuran tekanan darah dan tes urin semua kemungkinan waktu), untuk mendeteksi kemungkinan komplikasi yang mungkin timbul sesegera mungkin.Ini bukan kali pada kenyataannya, kematian akibat anemia, atau disfungsi akibat dari kadar kalium yang rendah atau tekanan darah tinggi.

Kucing Written by Diandra Azahra

Penyakit Ginjal pada kucing / Gagal Ginjal

Gagal ginjal juga bisa terjadi pada kucing, gagal ginjal biasanya disebabkan oleh penyakit ginjal dan menjadi salah satu penyebab utama kematian pada kucing yang lebih tua. Penyebab penyakit ginjal pada kucing meliputi usia, genetika dan faktor lingkungan seperti akses menelan zat beracun. Gagal ginjal pada kucing bisa mengambil dua bentuk, yaitu akut atau kronis. Gagal ginjal akut dikaitkan dengan berhenti tiba-tiba fungsi ginjal, sedangkan hasil gagal ginjal kronis dari kerusakan progresif pada fungsi ginjal.

Gagal Ginjal Pada Kucing Sejumlah gejala dapat muncul sebagai akibat dari penyakit ginjal pada kucing, gejala gagal ginjal seperti buang air kecil yang berlebihan, rasa haus meningkat, mual, bunyi berderak di rahang, muntah, dehidrasi, konstipasi, kehilangan nafsu makan, penurunan berat badan, halitosis (bau amonia) dan kelesuan. Bila kucing kita mengalami gejala-gejala tersebut, dokter hewan kita bisa melakukan uji atau test diagnosa untuk penyakit ginjal dan gagal ginjal. Urinalisis dapat menguji untuk melihat apakah urin kucing diencerkan, yang menunjukkan bahwa ginjal yang tidak lewat sampah. Tes darah bisa mengetahui kreatinin dan BUN (urea nitrogen darah) tingkat. Tingkat kreatinin tinggi dapat menjadi tanda hilangnya fungsi ginjal. Meskipun tidak ada obat untuk penyakit ginjal kucing, kita bisa mengobatinya melalui penyesuaian makanan kucing kita, obat-obatan, dan diuresis (terapi hidrasi). MenurutMerck Veterinary Manual, hewan yang menerima pengobatan mampu bertahan dalam jangka waktu yang lama dengan hanya menggunakan 5 hingga 8 persen dari jaringan ginjal mereka. Sementara beberapa penyakit pada kucingadalah akibat dari penuaan, banyak yang dapat dicegah dengan memastikan kucingkita selalu terawat, selalu dirumah dan segera diobati bila terluka.

Chronic Kidney Disease and Failure (CKD, CRF, CRD) Chronic kidney disease is defined as kidney disease that has been present for months to years. Chronic renal disease (CRD), chronic renal failure (CRF), and chronic renal insufficiency refer to the same condition.

CKD is not a single disease. There are many different causes of CKD but by the time the animal shows signs of kidney disease the cause may no longer be apparent. Some potential causes of CRF include:

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congenital malformation of the kidneys (birth defects)

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chronic bacterial infection of the kidneys with or without kidney stones (pyelonephritis)

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high blood pressure (hypertension)

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diseases associated with the immune system (e.g. glomerulonephritis, systemic lupus))

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acute kidney disease, for example poisoning with antifreeze, that damages the kidneys can lead to CKD Often the cause of CKD is unknown.

Structure of the kidneys The microscopic unit of the kidney is called the nephron. Each kidney contains thousands of nephrons. When the pet is young and healthy not all nephrons are working all of the time; some nephrons are held in reserve. As the animal ages or if the kidneys are damaged, some nephrons die and other resting nephrons take over the work of those that die. Eventually all the remaining nephrons are working. When there are no extra nephrons remaining and kidney damage continues the pet will start showing signs of CKD. Because of this stepwise loss of nephrons the kidneys are able to "hide" the fact that they are damaged until the damage is severe. When 2/3 of the nephrons have been lost the pet is no longer able to conserve water and the pet es larger amounts of dilute urine. By the time a pet has an elevation in the waste product creatinine in its blood, 75% of the nephrons in both kidneys have been lost.

What do the kidneys do? When blood flows through the kidneys, the kidneys act as a complex filter that removes from blood wastes that are generated from break down of food, old cells, toxins or poisons and many drugs that are given for treatment of other diseases. The wastes are removed with water as urine. Waste products than can be measured in the blood include creatinine and urea nitrogen but there are many other waste products that are not measured by blood tests. The kidneys also acts as a filter to keep "good" substances in the blood.

The kidneys regulate the amount of water in the blood by excreting extra water and retaining water to prevent dehydration by varying the amount of urine that is produced. The kidneys help regulate blood pressure by saving or eliminating sodium based on how much sodium the pet is eating. The kidneys help regulate calcium and vitamin D which keep bones strong. The kidneys produce a substance that helps with the creation of new red blood cells. Because the kidneys have so many functions, when the kidneys are not working normally, there are many signs that the pet may show.

CKD is progressive By the time the pet shows signs of CKD, the damage is severe. There is no cure for CKD. The remaining nephrons are working so hard that with time they will fail as well. CKD is usually fatal in months to years but various treatments can keep the pet comfortable and with a good quality of life for months to years.

Signs of CKD Because the kidneys perform so many functions, the signs pets with CKD show can vary quite a bit. The signs may be severe or may be subtle and slowly progressive. Despite the chronic nature of the disease, sometimes signs appear suddenly. Some of the more common signs of CKD include:

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drinking too much (polydipsia) and urinating large volumes of urine (polyuria)

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the increased volume of urine in the bladder may lead to, or worsen incontinence (leaking urine), especially at night

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vomiting and/or diarrhea

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lack of appetite and weight loss

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general depression related to the elevation of waste products in the blood

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anemia resulting in pale gums and weakness due to a low blood count

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overall weakness from low blood potassium

Less common signs include

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weakened bones can result in bone fractures

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high blood pressure can lead to sudden blindness

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itchy skin from calcium and phosphorous depositing in the skin

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bleeding into the stomach or gut or bruising of skin

Signs you may see if you examine your pet include: dehydration, weight loss, pale gums and ulcers in the mouth. The signs seen in pets with CKD and the findings on examination are not specific for CKD and may be seen with many other diseases so blood and urine tests are needed to make a diagnosis of CKD.

Diagnostic Tests Abnormalities that are often seen on diagnostic blood and urine tests include:

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anemia without signs of a response by the body to the low blood count (non regenerative anemia)

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increased wastes that are normally removed by the kidneys (blood urea nitrogen [BUN] and creatinine)

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increased phosphorus

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calcium is often normal but can be elevated in some pets with CKD and rarely is decreased

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dilute urine

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+/- protein or bacteria in the urine Sometimes bruising occurs where the blood sample was drawn as pets with CKD may have platelets that are less sticky than normal (normal platelets prevent bruising). A diagnosis of CKD can usually be made based on the signs, physical examination and blood and urine tests but other tests may be performed to look for an underlying cause for the CKD and/or to "stage" the CKD. Details about staging (click to expand)

Other tests that may be performed include 1.

Determination of kidney size using abdominal radiographs (x-rays) or ultrasound

What might this test show? The kidneys in pets with CRD are usually small reflecting the death of a large number of nephrons. If the kidneys are large then certain causes for the CKD should be considered such as lymphoma (cancer) of the kidneys, or an uncommon disease called amyloidosis. Some pets with signs of kidney disease who have large or normal sized kidneys may have acute kidney failure rather than CKD. The treatment and prognosis for pets with acute kidney disease differs from the treatment and prognosis of pets with CKD. 2.

Kidney biopsy

What might this test show? A biopsy is not required to make a diagnosis of CKD but the results of a biopsy may show a cause for the CKD. A biopsy is more likely to show specific information when

the kidneys are big rather than small. A biopsy can be valuable in pets who develop CKD at a young age or who are of a breed known to develop congenital kidney disease. There may be specific microscopic changes in a kidney biopsy from an animal with congenital kidney disease that may suggest that related animals are also at risk for developing CKD. Knowledge that the cause of CKD is caused by congenital kidney disease does not change the treatment of the affected animal but does provide information for related animals, for example if you should remove them from a breeding program. When a biopsy is planned, usually the biopsy is collected using ultrasound or laparoscopy to see the kidney during the biopsy so that no other organs are damaged during the biopsy. 3.

Bacterial culture

What might this test show? Bacterial infection is not a common cause of CRD but pets with CKD may develop a bacterial infection as several aspects of the pet's immune system may be less functional when the kidneys are failing. If white blood cells are observed on microscopic examination of the pet's urine, a bacterial culture of the urine should be obtained. 4.

Tests of clotting ability

What might this test show? If a pet is going to under go kidney biopsy, tests may be performed in advance to evaluate the ability to stop the bleeding from the biopsy site.

Treatment of CRF The severity of the pet's signs will determine what treatments are needed. Not all treatments presented below may be needed or appropriate for each pet with a diagnosis of CKD. Treatments may also be started incrementally (a few treatments are started and then based on patient response, additional treatments may be added later).

The information below is not meant to be a substitute

for veterinary care. Pets with severe signs may be hospitalized for fluid and intravenous drug treatment to reduce the amount of waste products in their body. Many pets with CKD will feel better in response to treatment with IV fluids but if the kidney disease is extremely severe the pet may not respond to treatment. Those pets who are still eating and not showing severe signs are treated with a variety of treatments, often introducing treatments incrementally as new signs develop. The treatment approach is often called "conservative" compared to more aggressive treatments such as hospitalization for fluid therapy, dialysis or kidney transplantation. that CKD is not a disease that can be cured. Treatments are designed to reduce the work the kidneys need to perform, to replace substances that may be too low

(such as potassium) and to reduce wastes that accumulate such as urea (generated by the body from proteins) and phosphorus. The initial response to conservative therapy may be relatively slow, taking weeks to months to see a response. Diet Feeding of a kidney diet is usually recommended. Kidney diets contain less protein compared to other diets and the protein is high in quality. It is protein in the diet that is converted to waste products that the kidneys must remove in the urine. The higher the quality of the protein in the diet, the less wastes created for the kidneys to eliminate. Low quality protein requires the kidneys remove more wastes. which makes them work harder. Egg and meat contain higher quality protein; cereal grain protein is of lower quality which leads to more wastes for the kidneys to eliminate. Protein is used by the body to repair cells and tissues that are continually regenerating, so a pet needs some protein in their diet. By feeding a low quantity, but high quality protein diet that contains an appropriate amount of fats and carbohydrates, the pet's body can use the protein for replacing the cells and tissues and use the fat and carbohydrates for energy. Kidney diets also contain a lower amount of phosphorus. Phosphorus accumulates in the blood when the kidneys are diseased. Kidney diets control the amount of other substances that may be too high or too low in patients with CKD such as salt, potassium, magnesium and B vitamins. There are differences in the kidney diets for dogs and cats. When making diet changes it is often beneficial to gradually introduce the new diet by adding increasing amounts of the new diet while reducing the amount of the current diet over 1 to 2 weeks. The pet is more likely to accept a new diet when it is introduced gradually and it is less stressful to the kidneys to gradually adapt to changes in the diet. Protein restricted diets are less palatable than higher protein diets. Pets with CKD that are still eating are more likely to accept a change in diet to a protein restricted diet than are pets who are very ill and refusing most foods. Protein restricted diets are more expensive than higher protein diets. There are many pet food companies that sell kidney diets. Dr. Tony Buffington at the Ohio State University is a good source of information on available diets. http://vet.osu.edu/1442.htm select a species, a diet form and select Reduced Phosphorous/Protein for a list of diets for pets with kidney disease. Homemade diets can be fed but it is best to work with your veterinarian to formulate a diet that is balanced. Diet effect (click to expand for published information about diet in pets with CKD)

Water Because pets with kidney disease cannot conserve water by making concentrated urine, their water intake is very important to prevent dehydration. Make sure they always have plenty of fresh water available. If

the pet is not eating well, or is vomiting, then s(he) may not be drinking enough and may get dehydrated. Pets can be encouraged to drink by giving them flavored broths in addition to plain water. The broth should be low in sodium and its best to discuss with your veterinarian other ingredients in the broth to make sure it doesn't contain substances that will make the kidneys work harder. Water soluble vitamins like B and C are lost in greater amounts when the pet is urinating greater amounts. Kidney diets contain increased amounts of water soluble vitamins so additional vitamins do not need to be given unless a homemade diet is being fed. Potassium Lack of appetite and increased loss of potassium in urine may result in low body potassium (hypokalemia). Cats with CKD are more likely to have low body potassium than are dogs. Cats with low potassium may develop painful muscles. Both cats and dogs may be weak when potassium is low. Cat kidney diets contain higher levels of potassium so additional supplementation is probably not needed unless the cat shows signs of muscle pain. Potassium gluconate or citrate can be given by mouth if potassium supplementation is needed. Potassium chloride is acidifying and is not recommended. Phosphorus, calcium and PTH Pets with CKD usually have increased blood phosphorus. In health, phosphorus and calcium are controlled by a hormone called parathyroid hormone (PTH). PTH works with vitamin D on the intestine, kidney and bone to keep calcium and phosphorus normal. As the kidneys fail the amount of PTH in the body is elevated and the amount of vitamin D is reduced. Elevated PTH itself may be responsible for some of the signs shown by pets with CKD. PTH draws calcium and phosphorus from the bones which can weaken bones which can lead to bone fracture.

Kidney diets typically contain reduced phosphorus and an appropriate amount of calcium but if phosphorus remains elevated when the pet is eating a kidney diet then phosphorus can be tied up in the intestinal tract so it can be eliminated in the stool. Intestinal phosphate binding agents include aluminum carbonate, aluminum hydroxide, aluminum oxide, calcium citrate, calcium acetate and calcium carbonate and sevelamer hydrochloride. Phosphate binding agents which contain calcium should not be used until blood phosphorus is normal to prevent calcium and phosphorus from combining and precipitating in tissues including the kidneys. It is not usually necessary to give additional calcium but if a pet has low blood calcium, the phosphorus should be normalized before giving calcium. Even when blood phosphorus is normalized, PTH levels are still higher than normal. The istration of low doses of vitamin D (1, 25 dihydroxycholecalciferol [calcitriol]) will suppress PTH and possibly slow the rate of progression of kidney deterioration.

It is not 100% agreed that giving your pet calcitriol will slow the deterioration of the kidneys. Here are some web sites on using calcitriol http://.bellatlantic.net/~vze2r6qt/calcitriol/ Acidosis Some pets with CKD will have an acid blood pH. Kidney diets are designed to counteract the acidosis but very sick animals that are hospitalized may need addition treatment to correct the acidosis. Sodium Diseased kidneys are less efficient at regulating sodium and sodium in turn helps control blood volume and pressure. Excess sodium can lead to water retention and not enough sodium can lead to dehydration. When changing diets that contain different amounts of sodium (kidney diets usually have less sodium than regular diets) make the change gradually over several weeks. Use caution when giving your pet table scraps or treats that may be high in sodium. High blood pressure (hypertension) Many pets with CKD have high blood pressure. High blood pressure can contribute to further decline of kidney function and can occasionally lead to sudden blindness from retinal detachment. Ideally blood pressure should be measured by your veterinarian and hypertension confirmed before giving drugs to treat high blood pressure but measuring true blood pressure in dogs and cats can be difficult. If the pet has an elevation in blood pressure it may be due to the excitement of being examined or due to CKD. The calmer you are able to keep your pet during examination, the more reliable the readings for blood pressure. There are several drugs that may be used to manage high blood pressure including enalapril, benazepril, or amlodipine (and others). Enalapril and benazepril are in a class of drugs called ACE inhibitors and are sometimes used in pets with CKD that have abnormal amounts of protein in their urine even when blood pressure is normal. Anemia The kidneys play a role in producing a hormone called erythropoietin which stimulates the production of new red blood cells. Red blood cells live about a hundred days so new cells are continually being made. Less erythropoietin is made in pets with CKD leading to anemia. The packed cell volume (PVC) (also called hematocrit) is the percentage of blood cells compared to fluid in whole blood. When the PCV is ~20 in cats and ~ 25% in dogs, anemia may contribute to lack of activity and weakness. Anemia can be treated by blood transfusion or by the istration of human erythropoietin. Erythropoietin is very effective in increasing PCV but because human erythropoietin is not exactly the same as dog and cat erythropoietin, over time, the pet may form antibodies that cause the medication to become ineffective. Canine and feline erythropoietin are currently being studied.

Fats/lipids Certain types of fats (polyunsaturated omega 6 fatty acids) may slow the decline in kidney function are are often present in kidney diets. Subcutaneous Fluids Some cats and dogs with kidney disease may not drink enough to prevent becoming dehydrated and may benefit from the istration of intermittent SC fluids. If your veterinarian feels your pet may benefit from giving subcutaneous fluids, we provide some instructions on how to give SC fluids. See http://www.vetmed.wsu.edu/ClientED/cat_fluids.aspx orhttp://www.vetmed.wsu.edu/ClientED /dog_fluids.aspx Lack of Appetite The accumulation of wastes in the body often decreases appetite. A goal of several of the above treatments is to reduce the amount of wastes in the blood. If the pet remains off food despite above treatments you might try different brands of renal failure diets, warming the food or adding odiferous toppings to entice the pet to eat. Vomiting Increased levels of waste products cause the pet to vomit. Your veterinarian may recommend medications that reduce nausea or act directly on brain centers to reduce the urge to vomit. Drugs used to treat other diseases Because the kidneys are responsible for elimination of many drugs, make sure that your veterinarian is aware of any other medications you are giving your pet as these may accumulate in the body to toxic levels if the kidneys cannot eliminate them. Antibiotics If the urine shows signs of infection or if a urine culture grows bacteria then antibiotics may be istered. If a urinary tract infection is involving the kidneys, the period of treatment is much longer than a infection of the bladder.

Avoiding Stress You are in the best position to judge what is stressful to your pet. When a pet is stressed they may drink and eat less than normal. Reduced water intake is detrimental to diseased kidneys. When possible, keep your pet calm. That might mean for example: having an in-home pet sitter if your pet is stressed by boarding, removing the pet from the household during a party or limiting with other animals if these situations appear to be a source of stress for your pet. Extremes in heat or cold are stresses. Certain drugs such as prednisone/cortisone make the kidneys work harder.

Kidney Transplantation There has been progress made in transplantation of kidneys, more for cats than for dogs.

Staging and management of canine chronic kidney disease CKD remains leading cause of death in dogs Mar 1, 2009 By: Gregory F. Grauer, DVM, MS, DACVIM DVM InFocus

Chronic kidney disease (CKD) occurs over a period of months to years and is a leading cause of morbidity and mortality in dogs. Nephron damage associated with CKD is usually irreversible and can be progressive. Whether the underlying disease primarily affects glomeruli, tubules, interstitial tissue, or renal vasculature, irreversible damage to any portion of the nephron renders the entire nephron nonfunctional. The histologic appearance of CKD caused by different primary diseases is often similar since the healing of irreversibly damaged nephrons occurs by replacement fibrosis. It is usually not possible to improve renal function in CKD; therefore, treatment is aimed at stabilizing renal function. Increasing evidence indicates that dietary and antihypertensive/antiproteinuric treatments can decrease the progressive nature of canine CKD. The pathophysiology of CKD can be considered at both the organ and systemic level. At the level of the kidney, the primary pathology of CKD is loss of nephrons and decreased glomerular filtration. Reduced glomerular filtration results in increased plasma concentrations of substances that are normally eliminated from the body by renal excretion. In addition to excretion of metabolic wastes and maintenance of fluid and electrolyte balance, the kidneys also function as endocrine organs and catabolize several peptide hormones. Therefore, hormonal disturbances also play a role in the pathogenesis of CKD. For example, decreased production of erythropoietin contributes to the nonregenerative anemia of CKD and decreased metabolism and excretion of parathyroid hormone and gastrin contribute to osteodystrophy and gastritis, respectively. Finally, part of the pathophysiology of CKD is brought about by compensatory mechanisms like the hyperparathyroidism that develops in an attempt to maintain normal plasma calcium and phosphorus concentrations. Similarly, the individual glomerular filtration rate of intact nephrons increases in CKD in an attempt to maintain adequate renal function; however, proteinuria and glomerulosclerosis may be consequences or trade-offs of this hyperfiltration. Due to the interdependence of the vascular and tubular components of the nephron, the end point of irreversible glomerular or tubular damage is the same. Morphologic heterogeneity between nephrons exists in the chronicallydiseased kidney with changes ranging from severe atrophy and fibrosis to marked hypertrophy. Progressive diseases that destroy nephrons at a slow rate allow intact nephrons to undergo compensatory hypertrophy, which can delay the onset of renal failure (persistent azotemia superimposed on the inability to concentrate urine). Therefore, when renal failure finally occurs, nephron hypertrophy can no longer maintain adequate renal function and usually < 20 percent of the original nephrons are functional. Renal diseases that have been associated with the development of CKD in dogs include glomerulonephritis, amyloidosis, tubulointerstitial disease, pyelonephritis, nephrolithiasis, leptospirosis and neoplasia.

Staging CKD

Table 1 Stages of Chronic Kidney Disease (CKD)

Many different have been used to describe renal disease and decreased renal function. Unfortunately, these can be confusing due to lack of standard definition and application. For example, there are no uniform definitions for like "early renal disease," "renal insufficiency," or "end-stage renal disease."

Recently, a staging system for CKD was proposed by the International Renal Interest Society (IRIS). This group consists of approximately 20 independent veterinary nephrologists from ten countries with the mission of helping practitioners better diagnose, understand, and treat canine and feline renal disease. The following system was developed by the IRIS Board in order to improve communications surrounding CKD and link appropriate diagnostic and therapeutic efforts to patients with varying stages of CKD. This staging system has been adopted (after input and modification) by both the American and European Societies of Veterinary Nephrology and Urology (see Table 1). This system uses serum creatinine concentrations as the major determinate for the four stages. Serum creatinine concentrations should always be interpreted in light of the patient's urine specific gravity, body condition score, and examination findings in order to rule out pre- and post-renal causes of azotemia. In addition, the staging system should only be applied to dogs with stable CKD since in other forms of renal disease (e.g., acute renal failure or acute decompensation of CKD) the plasma creatinine concentration can change significantly over a short period of time. The classic diagnosis of chronic renal failure based on persistent azotemia superimposed on the inability to concentrate urine pertains to CKD in later Stage II through IV. CKD that is categorized as Stage I or early Stage II CKD (nonazotemic CKD) could be diagnosed in dogs with renal proteinuria (persistent proteinuria with an inactive urine sediment), urine concentrating deficits, increases in serum creatinine over time that remain in the normal range (e.g., serum creatinine that increases from 0.6 to 1.2 mg/dL could indicate a 50 percent reduction in nephron numbers), or abnormal renal palpation or imaging findings. The above stages are further classified by the Table 2 Hypertension and proteinuric classifications in CKD patients presence or absence of renal proteinuria and systolic hypertension (See Table 2).

Management of CKD Treatment of CKD is ideally linked to the stage of disease (see Table 3). In Stage I and early Stage II CKD, specific treatment directed at the primary cause of the kidney disease is the primary objective (see Figure 1). While it may not be possible to identify the primary cause of the CKD, specific treatments have the potential to reduce the magnitude of subsequent renal damage. As an example, bacterial pyelonephritis can cause or complicate CKD, and this condition can be specifically treated with appropriate antibiotic therapy. In many dogs with Stage II CKD, renal lesions progress and renal function Table 3 Examples of treatments linked to stage of CKD deteriorates. Progression of disease, as well as the rate of decline is monitored by physical examination and longitudinal assessment of blood pressure, proteinuria, and serum chemistry values. Dietary management is an example of a so-called renoprotective treatment that has been shown to reduce the progression of CKD in dogs. In Figure 1 Prioritization of diagnostic and treatment efforts based on the a study of client-owned dogs with Stage II or III naturally-occurring CKD, stage of CKD feeding a renal diet resulted in a 70 percent reduction in the relative risk of developing a uremic crisis (acute decompensation). In comparison, dogs fed a renal diet remained free of uremic signs almost two and one-half times longer and had a median survival that was three times longer than dogs fed a maintenance diet. Reduction of dietary phosphorus is one of the cornerstones of CKD management and can be accomplished by feeding specifically formulated diets for CKD. From a practical nutrition standpoint, dietary phosphorus reduction is

combined with dietary protein reduction. If after three to four weeks of dietary phosphorus restriction serum phosphorus concentrations remain high, enteric phosphate-binding agents containing calcium, aluminum, sevelamer, or lanthanum should be istered with meals (initial dosage of 30 mg/kg body weight to achieve normophosphatemia). Physiologic dose replacement of vitamin D3 (calcitriol) is the third line of defense in the treatment of hyperphosphatemia and hyperparathyroidism and has been used successfully in dogs with CKD. Treatment of patient symptoms becomes a higher priority in the later stages of CKD when the decreased renal function has a more pronounced effect on the patient's quality of life. In addition to phosphorus restriction and protein reduction, dietary management includes omega-3 fatty acid supplementation, salt reduction, and alkalinization—all of which are designed to reduce patient symptoms and slow disease progression. Acceptance of a renal diet is enhanced with early initiation (while the patient still has a good appetite) and gradual implementation. Vomiting and anorexia are common patient symptoms in dogs with later stage CKD and can often result in decreased caloric intake. Causes of vomiting and anorexia include: 1) stimulation of chemoreceptor trigger zone by uremic toxins, 2) decreased excretion of gastrin and increased gastric acid secretion, and 3) gastrointestinal irritation secondary to uremia. Vomiting may be treated with metoclopramide, which blocks the chemoreceptor trigger zone. Metoclopramide also increases gastric motility and emptying without causing gastric acid secretion, and is one of the drugs of choice for vomiting associated with renal failure. H2-receptor blockers (e.g., famotidine or ranitidine) have been shown to effectively decrease gastric acid secretion, which may attenuate vomiting in dogs with CKD. Oral ulcers, stomatitis, and glossitis may occur as a result of gastritis and vomiting or the effect of uremic toxins on mucosal membranes and will often also result in anorexia. If vomiting has been controlled but anorexia persists, placement of a feeding tube (esophagostomy or gastrostomy tube) will often facilitate the maintenance of caloric intake and hydration status. In many stage III and IV dogs without feeding tubes, fluid therapy with polyionic solutions, given intravenously or subcutaneously in the hospital or subcutaneously by owners at home (10-50 ml/kg every one to three days), will help improve the patient's quality of life.