Gagal Ginjal Kronis (GGK)

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    Gagal Ginjal Pada Anjing (1 Komentar)

    Fungsi ginjal adalah sebagai sistem filtrasi di dalam tubuh. Ginjal terdiri dariratusan 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 jugamemproduksi beberapa hormon seperti erythropoietin yang menstimulasiproduksi 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 biladitangani dengan cepat maka fungsi ginjal dapat kembali lagi, tapi juga

    dapat menjadi ke GGK bila terlambat ditangani. Gejala klinis yang biasanyaterjadi 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 adalahginjal. GGK terjadi karena kerusakan sel 60 75% dari sel sel nefron yangada di ginjal yang menyebabkan fungsi ginjal menurun. Proses terjadinyaGGK 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 airkecil (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 semuapemakaian obat harus dengan persetujuan dan pengawasan dokter), Tumor

    ginjal (Lymphosarcoma, adenosarcoma), Batu Ginjal, Dehidrasi, AgenInfeksius (Leptospirosa sp. yang menyebabkan Leptospirosis), Geriatric

    diseases (Penyakit yang timbul pada umur tua diakibatkan karenapenurunan 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 kimiadarah akan sangat membantu mendiagnosa Gagal ginjal terutama dilihat

    dalam kandungan BUN (Blood Urea Nitrogen) dan Creatinine, bila keduanyahasilnya tinggi menunjukkan bahwa fungsi ginjal sudah jelek.

    Pengobatan dan penangananPenyakitgagal ginjal ditujukan pada

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    pencegahan atau memperlambat kerusakan ginjal tersebut. Hewan yang

    terkena gagal ginjal dianjurkan dilakukan rawat inap di rumah sakit hewanatau klinik hewan dan akan diterapi dengan cairan infus yang fungsinya

    membantu mencuci atau membuang produk sisa dari aliran darah danmemperbaiki kesimbangan elektrolit di dalam tubuh, dan juga dilakukan

    pengobatan untuk gejala yang nampak seperti muntah, diare, dan jugakemungkinan terjadi infeksi sekunder oleh bakteri.

    Pemeriksaan darah rutin pada hewan tiap tahun akan sangat membantuuntuk mendeteksi tahap awal sebelum gagal ginjal terjadi, dan bila terlihat

    tahap awal maka hewan akan mendapat penanganan lebih awal yang dapatmencegah kerusakan ginjal lebih lanjut. Maka dari itu kita sarankan untuk

    mengecek pemeriksaan darah secara rutin terhadap hewan kesayangananda.

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    mengapa kucing sakitL `gagal ginjal adalah penyakit yang mempengaruhi sebagian besar paruh baya kucing dan maju, dan yang datangdengan ketidakmampuan` dari nefron, unit penyaringan ginjal untuk menghilangkan racun yang diproduksi danterakumulasi dalam organisme . Penyakit ini dapat terjadi dalam dua bentuk: yang pertama, yang disebut "bentukkompensasi," kucing dengan minum secara tidak terkontrol dan dapat, meskipun dengan susah payah, untukmenghilangkan 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 fatalke teman berbulu kita tercinta.Gagal ginjal akut disebabkan oleh kegagalan, parsial atau total, dari ginjal -terkaitfungsi. Kegagalan ini dapat dibagi menjadi: pra-gagal ginjal, yang menyebabkan gangguan pencernaan, syokhemoragik, 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 dansekarang salah satu penyebab paling umum kematian pada kucing yang lebih tua. Dalam kebanyakan kasus, gagalginjal adalah penyakit kronis yang berkembang, ia cenderung memburuk jauh dari waktu ke waktu.Kecepatan dimana penyakit berkembang, bagaimanapun, tetapi bervariasi dari kucing ke kucing. Ini mungkin bahwa penyakittidak menyembuhkan segalanya, tapi tidak pernah ada perawatan yang tepat dan secara konsisten dapat membantuuntuk meningkatkan kualitas dan durasi kehidupan kucing sakit, membatasi perkembangan penyakit.

    peran ginjalGinjal 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 mengeluarkanproduk 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 utamadalam menjaga keseimbangan elektrolit (kalium, natrium, kalsium, fosfat, dll.) Tubuh Cat, seperti yang terjadi padamanusia, keseimbangan jumlah asam dalam darah dan tekanan darah. Ginjal bertanggung jawab untuk produksierythropoietin, suatu hormon yang menstimulasi produksi sel darah merah di sumsum tulang. Alam diberkahi ginjaldari "kapasitas cadangan" yang signifikan, pada kucing seperti di mamalia lain, termasuk manusia.Dalamkesempatan yang dihapus ginjal tidak bekerja, umumnya tidak memiliki dampak negatif jika apa yang tersisa adalahyang sehat. Agar ginjal dipengaruhi oleh kegagalan, harus terganggu massa ginjal jaringan yang berlangsung daridua pertiga sampai tiga perempat dari seluruh organ vital. Mengingat jumlah fungsi dasar yang ginjal bermain ditubuh, jika Anda sakit segera melibatkan pengembangan berbagai komplikasi pada kucing yang terkena.Merekayang memang ada mengalami beberapa modifikasi elektrolit (Bagaimana nilai-nilai darah tinggi seperti diungkapkanoleh konsentrasi rendah konsentrasi kalium atau tinggi fosfor), koleksi zat asam dari tubuh (asidosis) peningkatantekanan darah (hipertensi) dan mengurangi jumlah sel darah (anemia).

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    penyebab dan gejalaGagal ginjal kronis terjadi ketika kerusakan ginjal yang tidak diobati, penyakit yang kondisinya ketidaknyamananberlangsung untuk waktu yang lama dan menjadi ireversibel. Kondisi ketidaknyamanan menghambat kemampuanuntuk secara teratur membersihkan tubuh, menghilangkan produk sampah dari darah. Hampir selalu penyebabpenyakit ini kurang dipahami tegas, tetapi ketika Anda membuat penarikan untuk ujian nasional biopsi jaringan daripasien 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 untukmengambil alih serangkaian beberapa kista berisi cairan, tumor ginjal - seperti limfoma (kanker sel darah putih), yangdapat menyebabkan ginjal dan dengan demikian menyebabkan gangguan fungsional, infeksi - infeksi bakteri darikandung kemih, yang dapat menyebabkan kerusakan tersebut untuk menimbulkan gagal ginjal kronis.Di antarapenyebab lainnya tetapi ada racun, cacat genetik yang mempengaruhi ginjal atau peradangan ostinata.Nellakebanyakan kasus, gagal ginjal kronis muncul dalam lambat dan berbahaya, meskipun di beberapa kasus tanda-tanda klinis tampaknya untuk mengembangkan cukup tiba-tiba .Banyak gejala tidak jelas dan tidak spesifik danhanya muncul ketika racun menumpuk dalam darah dalam jumlah besar, bukannya ditularkan melalui urin. Tanda-tanda klinis yang paling umum adalah hilangnya nafsu makan, berat badan, dehidrasi, kelesuan dan depresi. Adasering haus meningkat dengan peningkatan berikutnya dalam output urin (karena ketidakmampuan untukberkonsentrasi urin Pada kucing ada akan meningkat secara bertahap dalam haus dan buang air kecil:. Ini, denganmata pengamat, adalah dua indikator utama mengungkapkan ginjal yang tidak lagi dapat saluran urinseimbang.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 bagipemilik kucing, adalah dehidrasi yang progresif, hilangnya elastisitas kulit, napas tidak menyenangkan danpembengkakan pada mukosa oral dengan radang gusi.Kucing mengalami kesulitan bernapas dan kondisi fisiknyamemburuk, 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, kelemahanotot yang kuat gagal ginjal berikutnya, dalam hal ini, kucing bisa sampai ke bahkan tidak bisa meregangkan lehersaya dan mengambil posisi berdiri untuk berjalan.

    gejalaDalam 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-tandaklinis yang paling umum adalah hilangnya nafsu makan, berat badan, dehidrasi, kelesuan dan depresi. Ada seringhaus 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 mengungkapkanginjal yang tidak lagi mampu menyampaikan urin. Selain itu, nafsu makan berkurang secara bertahap `sampaimencapai, 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, denganhilangnya 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 mulaimengembangkan otot kelemahan yang parah gagal ginjal berikutnya, dalam hal ini kucing tidak mampu untukmeregangkan leher dan mengambil posisi berdiri.

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    diagnosa dan pengobatanHal ini tidak selalu mudah untuk mendiagnosa gagal ginjal karena melibatkan serangkaian gejala yang dapatmenyesatkan untuk diagnosis penyakit. Banyak dari mereka benar-benar mirip dengan penyakit lain. Diagnosis gagalginjal kronis digambar dengan pasti hanya setelah serangkaian tes darah dan tes urine. Biasanya yang pertamaharus dikendalikan dalam darah - urea dan kreatinin - dua zat yang mewakili apa yang ginjal biasanyaexcretes.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, dimana 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 dari1030 berarti bahwa, pada kucing yang paling, adalah gagal ginjal.Mengadministrasikan terapi yang tepat,memungkinkan kemungkinan menghambat pembangunan dan memburuknya penyakit. Dokter hewan dapatmeresepkan inhibitor ACE untuk vasodilator (contoh yang baik adalah benazepril pasar). Meskipun orang-orangdengan gagal ginjal biasanya digunakan obat ini, karena mereka memiliki efek menguntungkan pada fungsi ginjaldan batang hilangnya protein melalui ginjal (yang dapat menjadi tinggi dan berbahaya dalam perjalanan gagalginjal).Obat ini sangat berlaku pada kucing, meskipun tampaknya tidak semua kucing memperoleh manfaatlangsung, tampaknya bahwa kucing dengan ditandai hilangnya protein dalam urin memiliki manfaat lebih dari obatini. Mengambil obat-obatan seperti yang masih memerlukan pemantauan ketat oleh dokter hewan, dan harusmenjalani siklus tes darah dan urin, untuk memahami jenis tangan tangan Anda mendapatkan manfaat daripenggunaan mereka dan, dalam kasus ini, perubahan dosis .

    dietVerifikasi diet adalah penting untuk kucing yang menderita gagal ginjal kronis. Kucing-kucing yang menderita gagalginjal kronis sangat rentan terhadap dehidrasi (yang disebabkan penurunan kemampuan ginjal untuk menyimpan airdengan mengkonsentrasikan urin). Menjaga pasokan air yang baik karena itu sangat penting, dan kucing-kucingmengambil sebagian besar air melalui makanan. Langkah pertama untuk memberi makan kucing dengan penyakit iniadalah untuk menawarkan makanan kaleng, lembab bukan makanan kering.Diet terbaik untuk kucing ini harusmemiliki kandungan protein sangat rendah: banyak zat beracun yang menumpuk dalam darah dengan gagal ginjalyang dihasilkan dari pemecahan protein, dan rendah protein diet harus meminimalkan limbah ini . Pembatasanprotein harus dilakukan dengan hati-hati, bagaimanapun, dan di bawah pemantauan ketat oleh dokter hewan. JikaAnda berlebihan dengan kekurangan protein kucing mungkin menderita penurunan berat badan, Namun, yang akanmerugikan kesehatannya.Untuk alasan ini, kami sarankan untuk menggunakan produk komersial diformulasikankhusus untuk kucing dengan masalah kesenjangan, yang meraba-raba berisiko Sebuah pasokan yang cukup dari airuntuk tubuh kucing sakit, tentu sangat berharga pada kucing dengan ginjal "diet buatan sendiri.": Lebih da ri untukmemberinya 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, sudahtersedia di toko-toko makanan untuk hewan.Kadang-kadang, kekuasaan semacam ini tidak selalu begitu menarikbagi kucing dipaksa untuk makan lebih sedikit dari biasanya. Jadi adalah kesabaran pemiliknya untuk membuatmakanan lebih lezat daripada baru mereka, mungkin dengan pemanasan atau dengan mencoba berbagaikemungkinan setiap selera, atau mencoba untuk secara bertahap menggantikan makanan normal bahwa kucingsudah terbiasa dengan.

    trik lain yang bergunaJika kucing tidak memiliki niat minum, kita dapat mencoba untuk membeli salah satu ai r 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 administrasi 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.

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    Kucing

    ritten by Diandra Azahra

    Penyakit Ginjal pada kucing / Gagal Ginjal

    Gagal ginjal juga bisa terjadi padakucing,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 daripenyakit 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 mengalamigejala-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

    makanankucing kita, obat-obatan, dan diuresis (terapi hidrasi). MenurutMerck Veterinary Manual, hewanyang

    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 memastikankucingkita selalu terawat, selalu dirumah dan segera diobati bila terluka.

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    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:

    congenital malformation of the kidneys (birth defects)

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

    high blood pressure (hypertension)

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

    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 passes 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.

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    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:

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

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

    especially at night

    vomiting and/or diarrhea

    lack of appetite and weight loss

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

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

    overall weakness from low blood potassium

    Less common signs include weakened bones can result in bone fractures

    high blood pressure can lead to sudden blindness

    itchy skin from calcium and phosphorous depositing in the skin

    bleeding into the stomach or gut or bruising of skin

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    Signs you maysee if you examine your pet include: dehydration, weight loss, pale gums and ulcers in themouth.

    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:

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

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

    increased phosphorus

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

    dilute urine

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

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    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 CKDmay develop a bacterial infection as several aspects of the pet's immune system may be lessfunctional 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 abilityWhat might this test show? If a pet is going to under go kidney biopsy, tests may be performed inadvance 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 substitutefor 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. Remember that CKD is not a disease that can be cured. Treatments aredesigned to reduce the work the kidneys need to perform, to replace substances that may be too low

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    (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.

    DietFeeding 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/Proteinfor 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)

    WaterBecause 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

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    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 vitaminslike 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.

    PotassiumLack 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 PTHPets 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 administration of low doses of vitamin D (1, 25

    dihydroxycholecalciferol [calcitriol]) will suppress PTH and possibly slow the rate of progression of kidney

    deterioration.

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    It is not100% agreed that giving your pet calcitriol will slow the deterioration of the kidneys.Here are some web sites on using calcitriolhttp://members.bellatlantic.net/~vze2r6qt/calcitriol/

    AcidosisSome 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.

    SodiumDiseased 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.

    AnemiaThe 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 administration 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.

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    Fats/lipidsCertain types of fats (polyunsaturated omega 6 fatty acids) may slow the decline in kidney function are are

    often present in kidney diets.

    Subcutaneous FluidsSome cats and dogs with kidney disease may not drink enough to prevent becoming dehydrated and may

    benefit from the administration 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. Seehttp://www.vetmed.wsu.edu/ClientED/cat_fluids.aspxorhttp://www.vetmed.wsu.edu/ClientED

    /dog_fluids.aspx

    Lack of AppetiteThe 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.

    VomitingIncreased 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 diseasesBecause 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.

    AntibioticsIf the urine shows signs of infection or if a urine culture grows bacteria then antibiotics may be

    administered. 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 contact 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.

    http://www.vetmed.wsu.edu/cliented/cat_fluids.aspxhttp://www.vetmed.wsu.edu/cliented/cat_fluids.aspxhttp://www.vetmed.wsu.edu/cliented/cat_fluids.aspxhttp://www.vetmed.wsu.edu/ClientED/dog_fluids.aspxhttp://www.vetmed.wsu.edu/ClientED/dog_fluids.aspxhttp://www.vetmed.wsu.edu/ClientED/dog_fluids.aspxhttp://www.vetmed.wsu.edu/ClientED/dog_fluids.aspxhttp://www.vetmed.wsu.edu/ClientED/dog_fluids.aspxhttp://www.vetmed.wsu.edu/ClientED/dog_fluids.aspxhttp://www.vetmed.wsu.edu/cliented/cat_fluids.aspx
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    Kidney Transplantation

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

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    Staging and management of canine chronic kidneydiseaseCKD 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 byreplacement 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 ofCKD 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 chronically-

    diseased 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 CKDMany different terms have been used to describe renal disease and decreased renal

    function. Unfortunately, these terms can be confusing due to lack of standard

    definition and application. For example, there are no uniform definitions for terms

    like "early renal disease," "renal insufficiency," or "end-stage renal disease."Table 1 Stages of Chronic KidneyDisease (CKD)

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    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 concentratingdeficits, 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

    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 itmay 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

    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. Ina study of client-owned dogs with Stage II or III naturally-occurring 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

    Table 2 Hypertension and proteinuricclassifications in CKD patients

    Table 3 Examples of treatmentslinked to stage of CKD

    Figure 1 Prioritization of diagnosticand treatment efforts based on thestage of CKD

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    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 administered 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 renalfunction 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

    alkalinizationall 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.