canine kidney failure article

This is a draft of a paper on Chronic Kidney Failure written by a person who is not a DVM. If you
review it or choose to implement any recommendation, it is solely at your own risk.
Kidney Failure – A Message to Owners and Veterinary Practices
Del J. Ventruella
(Owner of a Dead Cairn Terrier)
Abstract – Chronic kidney failure is a disease
that can strike down beloved dogs on short
notice if undetected. Among the warning signs,
increased intake of water and increased
urination (often without regard to the location of
such relief) mark this disease, and owners,
particularly of the breeds most affected, should
be aware of this. The dog tends to “go downhill
quickly” when the disease is advanced at its
detection. Hypertension can accompany this
and raise other issues, such as blindness or risk
of heart attack. If you are the owner of a cairn
terrier or one of more than a dozen breeds of
dogs susceptible to kidney failure, or merely an
older dog, don’t take it lightly. Screen for it (via
ultrasound tests or other means) as soon as your
dog reaches the age of seven (the average age
at which it manifests)14
, and do it every year.
Diet can also play a part if you provide renal
formula dog food to affected breeds in time. If
you can preserve kidney function, it can prolong
your dog’s life, and safeguard a beloved
companion animal.
Introduction
Certain breeds of dog are susceptible to chronic
kidney failure as they age. These include1,5,15
:
 Cocker spaniel
 Lhasa apso
 Shih tzu
 Norwegian elkhound
 Doberman pinscher
 Soft-coated wheaten terrier
 Golden retriever
 Bull terrier
 Cairn terrier
 German shepherd
 Samoyed
 Basenji
 Beagle
 Poodle
 Chow
 Rottweiler
 Shar Pei
 Jack Russell
If your dog is older, is a member of one of these
breeds, or if your mutt has a parent who is,
screening for kidney failure (renal failure) might
just prolong his or her life and grant you months
or years of love and companionship that can
otherwise be abruptly lost when kidneys
suddenly fail after a lifetime of ignorance
regarding this problem, and your dog is taken
from you in a very traumatic manner.
If you are a veterinary clinic, I plead with you to
please notify the owners of your patients of this
problem. Once the kidney function begins to be
lost due to chronic kidney failure, unlike with the
liver, it cannot be recovered through any natural
process. “Destruction has been occurring for
months to years before failure becomes
evident.” 2
1

The human owners of canine patients are
probably utterly ignorant of this. When I
purchased my cairn terrier, the guide books
indicated that cairn terriers were only susceptible
to a few inherited illnesses, including a luxating
patella, but nothing was mentioned regarding
blood tests for chronic kidney disease in the AKC
description of the breed.3
Now there is a long
list of diseases that are documented as being
problematic to the cairn, but tests for chronic
kidney disease, performed annually (or bi-
annually), are not in the list. I can tell you from
personal experience, testing for chronic kidney
disease might prolong your dog’s life.
My cairn terrier, Scribble, was 16 years (and four
months) old when he died of symptoms related
to kidney failure. That in itself was a problem,
not because of his age, he seemed healthy, but
because of the attitudes of veterinarians toward
him. Since his fourteenth birthday Veterinarians
would examine him, and given his collapsed
trachea, offer immediately to euthanize him
based on what was in his chart (while noting
how “nice” puppies were). Scribble was taking
100 mg of Theophylline twice daily, and 2.5
milligrams of Tussigon three times per day.
(Note: Both of these drugs are absorbed
through the liver.) On that schedule, and with
weight management, his collapsed trachea
produced symptoms that were unnoticeable,
then his kidneys began to fail.
I recall mentioning to the veterinary technician
at the front counter that my dog had ceased to
care where he urinated. She replied that this
was the same problem that old people had. I
discounted the symptom of a very serious
disease (chronic kidney failure) as a result. The
veterinarian told me when he left the voice mail
message regarding kidney disease that my dog,
at 16, was “older than most of the dogs” that
they saw. Again, being an older dog was a
disadvantage. They expected him to die, and
seemed more than willing to help him along,
raising issues of “quality of life”, the sort of logic
that causes some of us to shudder.
Scribble exhibited no basis for “qualify of life” to
be a concern until his final day, when he did not
rise or move at all. Had this veterinarian or one
of his team told me of chronic kidney failure and
begun testing Scribble in the years after his 10th
birthday, kidney failure might have been
detected and/or a renal diet implemented...in
time. To hear him speak of “quality of life” only
at the end seemed bizarre, like some false
attempt to seize the high moral ground. Why
hadn't he or his team worried about “quality of
life” when simple testing and a change of diet
might have permitted a good “quality of life” for
years to come?
The veterinarian required a blood test when
Scribble began to have mysterious seizures
before prescribing Phenobarbital. (My dog was
more than sixteen years old at the time, so
blood tests for renal failure should have been
implemented years earlier.) I waited 30 days.
Bills were mounting. This was an unexpected
expense, and I only have a small income. I
needed some breathing room, and I had no
knowledge of kidney failure as a deadly disease.
When I entered the office to have the blood test
performed a month later, too much time may
have passed. More likely, given the state my
dog was in, I fear that his kidneys had already
deteriorated beyond the limit of survival.
2

When the blood tests came back, the
phosphorus level in his blood was much too
high. He was immediately placed on a special
diet, and I was given a prescription to bind the
phosphorus and remove it from his blood. Such
diets can slow damage to kidneys, but that
presumes that too much damage has not
already been done. The next blood test, weeks
later, showed that his phosphorus level,
problematic with dogs in renal (kidney) failure,
had dropped to normal, but it was too late for
my beloved Scribble.
I used Science Diet Renal moist dog food and
IAMS Veterinary Renal Plus. My dear little dog
lived another month with this help. In his final
days I was using a syringe to place water in his
mouth, and had moistened the (dry) IAMS
Veterinary Renal Plus until, after sitting overnight
in a bowl filled with water and dog food in the
refrigerator, it fell apart, and I could mash it up
and use a turkey baster to squirt it into my dog’s
mouth, hoping it would help him to remain
strong and to remove some of the waste that
was building up in his system.
On December 18, 2015, just before 2:00 PM, my
dog had a heart attack. He had gone down and
not attempted to rise again 24 hours earlier.
Kidney failure will cause a dog’s blood pressure
to increase,4
and I fear that is what happened
with my dog, leading to the terminal heart
attack.
After his heart stopped, he kept trying to
breathe, perhaps wanting to stay with me, but
he couldn’t. His right front leg and paw were
painfully extended backward twice, and the
process was not momentary. It lasted perhaps a
minute as I pleaded with my little boy to stay
with me and not leave me. I tried to rub his
body and apply gentle pressure rhythmically to
his chest to induce blood flow. In the end, we
lost the fight, and he died.
Note that veterinarian's can treat canine
hypertension with ACE inhibitors and calcium
channel blockers.13
First, they have to care
enough about the animal to measure it's blood
pressure. This was not done with my dog.
Ultrasound
Ultrasound imaging of the kidneys can permit
changes in them to be documented over time,
enabling veterinarians to identify kidney failure
while the organs are still relatively healthy, and
long before blood tests will reveal a problem.
Ultrasound is strongly recommended as a means
of identifying chronic kidney failure.6
Urine tests
will not reveal problems with kidneys until
roughly seventy-five percent of the kidney
function is lost, and blood tests are little better
in terms of preserving kidney function, revealing
it, on average, with 40% of function lost. With
ultrasound, variations in the size, structure of,
and the presence of foreign objects in the
kidneys (stones) can be detected.10
Protein/Creatinine Urine Tests
Protein, meaning blood cells or simply molecules
of protein, are normally filtered out by the
nephrons of the kidney.7
Creatinine, made from
the creatine that powers muscles, is a normal
component of urine and a waste product of the
body.7
3

When kidneys are damaged in chronic failure,
protein may seep into the urine through the
damaged kidney, and creatinine levels that are
normally within a restricted range will rise.
These are possible indicators of kidney disease.
Protein/Creatinine urine tests are thus used to
identify dogs with kidney disease, but the test
has its weaknesses. Levels of creatinine in the
blood are directly correlated with muscle mass,
so older dogs, with low muscle mass, or those
suffering from a disease that robs them of
muscle mass, may have artificially low levels of
creatinine in their urine, potentially producing
grounds for false negative determinations of
kidney disease.
Secondly, protein and dangerously high levels of
creatinine are only evident in urine AFTER the
kidney’s function has begun to degrade. If a
dog is only evaluated annually, the potential for
this test to yield results too late, or to never be
undertaken, seem too real. Chronic kidney
failure can develop over a matter of months.
My dog, Scribble, “went downhill quickly”, which
veterinarians have assured me is not uncommon
for dogs, within months of starting to urinate on
the floor. There seems to be significant risk of a
test being performed only after kidneys have so
degraded that it is too late. I would consider it a
non-ideal means of testing for kidney failure and
one with a high risk of loss of significant kidney
function before the kidney disease is discovered.
It is still better than no attempt to discover the
disease at all.
SDMA Testing
This is a new blood test developed based upon
human medical research that has been applied
to animals. Unfortunately, as with the
protein/creatinine urine test, kidney damage
must be induced for the test to have any chance
of detecting kidney failure. (The same may be
true of ultrasound images, but with greater
expertise, the level of damage may be reduced
given the visual feedback of the ultrasound.)
SDMA is a methylated form of the amino acid
arginine, manufactured in every cell, and
excreted into the body’s circulation during
protein degradation. SDMA is produced nearly
exclusively by the kidneys, making it a valid
marker for kidney function.8
SDMA test results
are not positively correlated to a dog’s muscle
mass. (There’s no relationship between how
much muscle a dog has and the results of the
test.)
The amount of damage to kidneys may be as
great, ON AVERAGE, as 40%, or as little as 25%.8
Keep in mind that an average is not the
maximum value of damage, which could be
significantly higher than the 40% average in a
segment of the test population. (Assuming a
bell shaped curve, the 25% minimum suggests a
55% symmetrical maximum for the kidney
function lost curve, with the same level of
confidence.) This means that ON AVERAGE,
dogs must lost 40% of their kidney function
BEFORE an SDMA test will detect kidney failure,
possibly more.11
This is a very high level of loss
of kidney function, but is still better than the
75% loss of function that is typical in urine based
testing. An expert sonogram could detect the
loss of function much sooner.
4

Again, the timing of this test is relevant given
the rapid rate of decline of dogs often
associated with chronic kidney failure. Given the
fast rate at which Scribble diminished in his
external functions (loss of control over muscles,
urination, consumption of large amounts of
water before he consumed no water and faded),
I would think that ANY blood or urine based
test, to be taken seriously, would have to be
administered AT LEAST twice per year, if a
serious attempt to preserve significant kidney
function via dietary changes were to be
undertaken post-diagnosis. At seven “dog
years” per human year (however inaccurate that
may be), waiting a year between tests (or even
roughly three canine years for six month
intervals) seems too long.
A change in diet will not halt degradation of the
kidney function entirely. It will merely slow the
degradation, so catching this problem when
there is still significant function left to permit the
kidneys to “outlive” the dog is a serious concern.
Keep in mind, you are essentially trying to
eliminate kidney failure as an issue, not produce
immortality (regrettably).
Diet and Age
An informal survey of chronic kidney failure
compared to the age of diagnosis12
seems to
suggest that the earliest age at which many
dogs were diagnosed in renal failure in the list of
breeds most susceptible to the illness (ignoring
youthful, statistical outliers) was approximately
12 to 13 years. That is contrary to the seven year
age at which kidney failure is usually diagnosed
on average. Given that the most widely available
tests reliably predict kidney failure for dogs only
AFTER kidneys have been substantially damaged,
there appears to be a motive for putting a dog
on a renal diet (dry or moist prescription renal
dog food produced by major manufacturers) at
the LATEST as approximately 10 to 11 years of
age. (Seven years would be an average value for
short lived breeds.) It is an incentive for dog
food manufacturers to produce a “renal alert”
brand of dog food for older dogs of the most
affected breeds available over the counter.
Renal formula dog food is designed to minimize
the impact of protein and phosphorus on the
kidneys of dogs. If your dog is a member of a
breed subject to kidney failure, then a measure
of safety would seem to be provided by putting
them on the renal failure diet after age ten (and
after age seven if the breed is short lived)
regardless of diagnosis of the disease.
Statistically, roughly one in three dogs are
diagnosed with kidney failure if they are over 12
years of age.9
(Ten percent,13
a much lower
number, according to some sources.) Among
the most affected breeds, the rate of occurrence
would presumably be higher, so it seems a
reasonable measure to make a renal diet
available to dog owners when their high risk
pets (from breeds known to develop chronic
kidney failure) reach the age of ten (or seven for
short lived dogs) to preserve kidney function,
given the amount of damage that must be done
to kidneys before damage can be detected via
blood and urine tests. By increasing
consumption of renal formula dog foods for
older dogs, the cost should decrease as the
volume sold increases.
One must recognize that chronic kidney failure is
occurring in part because of what we feed our
dogs. If the food is more closely adapted to a
5

dog's needs as it ages, the disease may be
substantially controllable by changing diet. A
lack of suitable diet available over the counter
may cost your dog seventy-five percent of his
kidney's capacity to function, or his or her life.
At present, the cost of a fifteen pound bag of
renal formula dry dog food is roughly four times
that of a quality, name brand dog food from the
grocery store, and roughly one and a half times
a premium brand of dog food for the same
amount of food. (Premium brand manufacturers
tend to produce renal formula dog foods, which
accounts for some of the pricing level.) Dog
food is hardly the most expensive purchase that
we must make, so it seems reasonable to offer
this recommendation.
Conclusion
The onset of kidney disease in dogs generally
occurs between seven and twelve years of age.
Among dogs over twelve years of age, kidney
disease is prevalent in roughly 30% of the
population.9
(Some claim occurrence rates as
low as 10% for dogs over twelve.)13
If you own a dog who is a member of a breed
particularly subject to chronic kidney failure (or a
pet of advanced age), and if you are like me and
deem him or her to be one of the most
important creatures in the world to you, take
advantage of modern science and the diets that
are available, as well as a test to identify kidney
disease EARLY on. Prescriptions (or Tums) can
remove the phosphorus from their blood by
binding it with aluminum or calcium.
Prescription “renal failure” diets address their
dietary needs while trying to prevent damage to
the kidneys. Ideally, an over the counter dog
food will eventually come to be that considers
renal failure in its formulation.
Veterinarians recommend that when your pet
reaches the age of seven (with some preferring
to begin testing as soon as age five) you screen
for kidney disease every year to show changes in
the kidneys as they develop. This may result in
some damage to kidneys to produce conditions
that can yield detection, depending on the level
of expertise of the operator if ultra-sound is
selected, but it is clearly preferable to no
detection at all. (Blood and urine tests,
described above, seem, according to reason, to
require a bi-annual evaluation to avoid loss of
significant kidney function and to offer any hope
of discovering the disease in time, before the
kidneys have become too damaged and the dog
is left to rapidly “go downhill”.)
Veterinarians may be of the perspective that if
an animal is older, kidney disease is simply a
natural cause of death. 5
Kidney disease could
eventually kill your dog, but “eventually” may
mean months or additional years of
companionship.
You can attempt to slow down the effects of
kidney disease through diet and prescription
medications or Tums (to reduce the phosphorus
level in their blood). Dogs today can live to be
nineteen, with a reasonable quality of life, on the
diets that are now available with the aid of a
veterinarian. (Note that Tums, as calcium
carbonate, should have no effect on calcium
channel blockers that work at the level of cellular
respiration where hypertension is present.)
My dog seemed entirely healthy at sixteen, save
for the symptoms of kidney failure and his
6

increased urination, even with his problems with
a collapsed trachea that were completely
managed (to the point of being symptom-less)
with two prescriptions. When your dog reaches
the age of seven, and particularly if the animal is
a member of a breed (or a descendant of one)
known to be susceptible, have ultrasound tests
performed (or seek to use some other form of
testing procedure) to detect kidney disease at
least once every year (and more often if
possible).
If you must rely on blood or urine tests, consider
having the testing done bi-annually. I can not
recommend biopsies, because they are a form of
damage to kidneys.
Once the kidneys are damaged, they cannot
repair themselves, and veterinary science is
powerless to do anything to affect a cure. Now
you know.
Veterinarians may be too clinical and fail to
communicate the nature of the problem to an
average person, or they may never breach the
subject with you. Don't expect to find a
recommendation for a blood test to detect
kidney failure among annual veterinary
recommendations even if your dog is among a
more susceptible breed after age seven. I
received no such recommendation until it was
too late.
If the veterinarian does make any related
recommendation, at most, they may suggest
that you do “blood work”. That is too general a
reference, and incorporates a recommendation
that may indicate a problem only when it has
become a death sentence. That doesn’t begin to
explain what you risk by not doing an ultrasound
test to detect kidney failure early or undertaking
a change in diet before the diagnosis at an
appropriate age.
A veterinarian may speak in terms of “renal
failure”. Renal failure is kidney failure. Don’t be
confused.
It would seem that the safest path for breeds
susceptible to kidney failure is to place them on
renal failure diets no later than age ten (perhaps
as early as age seven), regardless of whether
they have been diagnosed with kidney failure.
On such a diet, the health of their kidneys
should be optimized. Annual or bi-annual
testing might then be sufficient (every seven or
three “dog years”), because management of the
disease would already be in place, and
discovering a dog diagnosed in kidney failure
would simply be reduced to medical diagnosis.
Nothing new could then be done relative to diet.
I’ve lost my little boy, the best little dog in the
world. I told him these things again and again
as I petted and kissed him in his final hours. I
told him that my life would never be the same
again without him, and that I did not know what
I would do.
Now I must live with “the silence”. I no longer
hear the clicking of his claws as he approaches
me on the linoleum in the kitchen. I no longer
feel his head lean against my leg as I stand at
the sink doing dishes. He no longer goes to the
door to encourage me to take him outside for a
walk. His harness and leash sit by his bedside,
unused. His sweater lays folded on his bed,
awaiting a little dog, whom it will never warm
again. I’ll never feel his tongue as it licks my
face, or his soft fur beneath my hand as I tell him
7

that he’s a good boy. There is nothing but “the
silence” all around me, and it is maddening in his
absence.
In the short term, I am trying to save others the
pain and suffering that I am now going through
to whatever extent possible by recommending
screening for kidney failure, and, to slow down
the rate at which damage is done, suggesting
renal failure diets no later than age ten (and
perhaps as early as age seven) for the most
affected breeds. These steps should be taken
EARLY, before substantial damage is done to
the dog’s kidneys, even before a dog is
diagnosed as being a victim of chronic renal
failure.
Conservative dialysis or “bagging” is a technique
used by veterinarians if your dog is not too far
gone, and represents an attempt, by injecting
water intravenously under your dog’s skin, to
flush out the toxic wastes while hydrating the
animal. Vitamin B and anti-nausea medication
can be injected with the water used as a buffer
to prevent the sting that is often associated with
these medications. My dog was “bagged”
twice.5
He proved too far gone for it to help.
I will miss you, Scribble. You were my dearest
friend. You were my family. Nothing will ever
be the same without you.
References
1. http://www.petplace.com/article/dogs/di
seases-conditions-of-dogs/kidneys-
bladder-urinary-system/chronic-renal-
kidney-failure-in-dogs , Copyright 2015,
www.petplace.com, accessed on
12/19/2015.
2. http://www.vcahospitals.com/main/pet-
health-information/article/animal-
health/kidney-failure-chronic-in-
dogs/828 , Copyright 2015,
www.vcahospitals.com, accessed on
12/19/2015.
3. http://www.akc.org/dog-breeds/cairn-
terrier/care/#health , Copyright 2015,
www.akc.org , accessed on 12/19/2015.
4. Chronic Kidney Disease and Failure,
http://www.vetmed.wsu.edu/ClientED/ck
d.aspx , Copyright 2015,
www.vetmed.wsu.edu , accessed on
12/19/2015.
5. http://www.vetmedclinic.com/?p=269 ,
Copyright 2015, www.vetmedclinic.com,
accessed on 12/19/2015.
6. http://cairnterrier.org/index.php/Static/s
uggested-minimal-health-testing-
guidelines#other , Copyright 2015,
www.cairnterrier.org , accessed on
12/22/2015.
7. Creatinine and Protein Test,
http://www.livestrong.com/article/41791
2-normal-levels-of-urine-creatinine-
protein/ , Copyright 2015,
www.livestrong.com, accessed on
12/22/2015.
8. SDMA testing,
https://www.idexx.com/small-animal-
health/solutions/articles/earlier-
diagnosis-kidney-disease.html ,
Copyright 2015, www.idexx.com,
9. Canine Kidney Disease,
http://fampetvet.com/canine-kidney-
disease/ , Copyright 2015,
http://fampetvet.com , accessed on
12/22/2015.
8

10. Ultrasound Tests, Kidney Disease,
http://www.petwave.com/Dogs/Health/K
idney-Disease/Diagnosis.aspx ,
Copyright 2015, www.petwave.com,
11. Case Study of Kidney Disease,
https://www.idexx.com/small-animal-
health/solutions/articles/case-study-
discovering-disease-with-sdma.html ,
Copyright 2015, www.idexx.com,
12. Survey of Age of Dogs in Kidney Failure
(informal),
http://www.medhelp.org/posts/Dogs/Ca
nine-Kidney-Disease-Lifespan-
Survey/show/1611104 , Copyright 2015,
www.medhelp.org, accessed on
12/23/2015.
13. Canine Kidney Failure with
Hypertension,
http://www.veterinarypracticenews.com/
May-2012/Understanding-Treating-
Chronic-Kidney-Disease/ , Copyright
2015, www.veterinarypracticenews.com,
14. Chronic Renal Failure, Canine,
http://www.vetmedclinic.com/?p=269 ,
Copyright 2015, www.vetmedclinic.com,
15. Kidney Failure, Jack Russell Terriers,
https://books.google.com/books?
id=z20BPs7agHgC&pg=PA42&lpg=PA42&dq=jack+
russell+terrier+and+kidney+failure&source=bl&ots=
k2RvxMA6TC&sig=FbOCPIny5k1_K3bRzJLlSbdRY
Bo&hl=en&sa=X&ved=0ahUKEwih0-
nlvZrKAhUKKiYKHdEGC-
4Q6AEIQDAF#v=onepage&q=jack%20russell
%20terrier%20and%20kidney%20failure&f=false ,
Google Books, accessed on 1/7/2015.
Biography
Del John Ventruella acquired Scribble (Sam
Scribble Von Skye) in November of 1999 as a
puppy. Scribble died in December 2015, almost
exactly sixteen years later. I purchased him late
in the year as my Birthday and Christmas
present. When he died the dearest friend I have
ever known was taken from me, exactly one
week before Christmas. He learned what he has
discovered about cairn terriers and kidney
disease the hard way, on a short, steep curve
that ended in the death of his beloved dog.
9

Nature of E-mailed Message from Veterinarian’s Office. Note that recommended actions for 2015
DO NOT include ANY test screening for kidney disease, although my dog was more than twice the
age at which most veterinarians recommend it and a member of a breed known to suffer from
kidney failure.
(Reminder E-mail with Name of Veterinary Practice Redacted.)
7/15/15
To: ventruella@(email address.com)
(Veterinarian)
Fort Wayne, IN
Dear Ventruella Family:
According to our records Scribble is due for the below mentioned items. Please call 260-###-#### to set
up an appointment. Please remember to bring a stool sample. We look forward to seeing Scribble soon!
Don't forget to "Like" us on facebook and follow us on twitter!
If you no longer have this pet or no longer want to receive your reminders by email please contact our
office. Thank you in advance. Check out our new and improved website!
08-15-15 Canine Bordatella Injectable
03-15-15 Heartworm Test 2 Year Reminder
Del Ventruella
10

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