Dog diagnosed with kidney disease
February 19, 2016 11:03 AM   Subscribe

My 14-year-old Pekingese was diagnosed with kidney disease. We're at Stage 1 now and besides frequent urination and some chronic itching (which may or may not be related), she's not showing outward symptoms yet. I need some practical advice moving forward.

Our vet gave us Purina NF Diet & Royal Canine Renal Support for food, along with some Omega-3 supplements. No other treatment for now. The plan is to go back in 6 months and see what her bloodwork/urine says.

My questions:

1. We had been feeding higher quality food, so the Purina feels like a step back. She likes it and tolerates it well, but is there a higher quality food you feed your kidney-struck dog? Do you make your own food for her? If so, what?

2. Is there anything else you do for your pup with kidney disease? I want to make sure we have all the information, and are doing everything we can for her. I trust our vet, but we're relatively new to the practice. I don't want to go into this new stage of her life unresearched.

Other relevant info: she's on Tramadol for pain in her leg. Nothing seems to be broken, but there's some fluid build-up in her joints that the vet believes is giving her pain. She's also on occasional Trazodone for anxiety. I work from home, so I'm home with her during the day.

Any other advice you can pass along about care for dogs with kidney disease is helpful. Thanks!
posted by Zosia Blue to Pets & Animals (9 answers total) 2 users marked this as a favorite
I serve as chief of staff to a healthy 16 year old cat, and my vet has informed me that his kidney numbers are still normal but "creeping up." I'm not a vet, and I'm not your vet. This is just what I did for my cat, but kidneys are sort of just kidneys when it comes to what's good for them.

My vet recommended the cat equivalents of what your vet recommended for your dog. My cat won't eat Royal Canine, and I'm not about to feed him Purina anything after a lifetime of higher quality food. Same for Hills/Science diet - I just don't think it's as high quality as what I feed him now.

So I researched what kind of food is best for cat kidneys. For cats, I found that lowering phosphorus in the diet was best - a quick google tells me this is true for dogs with renal issues as well.

I found something high quality that has much less phosphorus than what was feeding him. It's Ziwipeak, the wet food variety - the dry foods have more phosphorus. They make dog food too. (My vet clearly wanted to sell me a whole bunch of kidney food, but said this plan was fine, too, and would not require any additional supplements).

For what it's worth, I wasn't able to find any consensus online or from vets with regard to whether a low protein diet actually slows the progression of kidney disease. Lower protein generally results in lower phosphorus, and a few different sources theorized that it's the lower phosphorus what makes the most difference.

My vet also recommended I start my cat on a powder "binder" to be sprinkled over his food twice a day. I haven't picked it up from him yet, so I'm not sure what it's called, but it's intended to bind to the phosphorus in his diet so it doesn't pass through his kidneys. I'm not sure if they make that for dogs, but it's something you could ask your vet about.
posted by kythuen at 1:23 PM on February 19, 2016

I am not a vet, I am not your vet, this is feline anecdata, and every case is different, but:

We had a cat who lived pretty comfortably and happily for another 2-3 years after being diagnosed with early stage kidney failure. Our vet prescribed a regimen of subcutaneous fluids, which we were pretty good about giving him (at home, ourselves) on a regular basis; once every 1-2 weeks early on, more frequently as his condition worsened... eventually daily. This served to keep him well hydrated, which in turn put less stress on his kidneys. I don't know if subcutaneous fluids are prescribed in similar circumstances for dogs, but it's something you could ask about. It really made a big difference for our guy, especially later on; it got to where he would ask us to do his fluids the same way a critter asks for treats, and he'd perk up visibly afterward.

With regards to kidney diet: We had the same reservations about the quality of the various common brands compared to his regular food... but as his condition worsened (he became prone to UTI infections and renal inflammation) we didn't really have a choice. Unfortunately the lower protein content of the kidney diet made it harder to keep his weight up, but when we tried to compromise by mixing in a little bit of his regular food it almost immediately resulted in noticable inflammation and discomfort.

One other thing we tried was supplementing his food with D-Mannose, which in my layman's understanding is the specific compound found in cranberries that recommends them for urinary health. It wasn't something our vet had any personal experience with, but he read up on it and gave us the thumbs up when we asked him. That wasn't until pretty late though, so we didn't really get a sense of how effective it might have been if we'd started him on it earlier. It's another thing that it couldn't hurt to ask about! As I recall we found it at Whole Foods.

Good luck and feel free to MeMail me any time for moral support - but it sounds like she's in good hands!
posted by usonian at 2:39 PM on February 19, 2016 [1 favorite]

(This is based on five-year-old memories. Also, I'm not anyone's vet.) My dog, Daisy, died of kidney trouble a few years ago. The vet was willing to put her down right away, but I didn't think it was quite time. So they taught me how to give her daily subcutaneous fluids. I did a bunch of kidney research and changed her diet, and she perked up /a lot/. The main thing was cutting down on protein and phosphorus. I could tell when I had to adjust the levels because she got really bad body odor. When she stopped being interested in solid foods, I fed her baby food. (It's hard to find baby food without added protein. The organic stuff was best for this.) I knew it was her time when she started to decline after four or five weeks.

Best of luck to you and your Pekingese.
posted by bentley at 2:57 PM on February 19, 2016 [2 favorites]

We got an extra couple-three years out of two cats with kidney failure serving sub-q fluids at first weekly and then gradually eventually daily. Their quality of life over all made it well worth it, and there weren't really other complications until near the end. We also used the powder binder on their food and they ate it cheerfully. Idk if it helped. Best of luck to you.
posted by toodleydoodley at 4:24 PM on February 19, 2016 [1 favorite]

Please understand that while you may see the Purina as a downgrade (and believe me, I get that) you need to feed what the vet says to feed. Every kidney case is different, of course, so there's no real telling what the future holds, but your vet has seen lots and lots of kidney failure cases. They're doing what they know is best. The problem with kidneys is that you don't detect failure until they're 3/4 gone already, and they don't heal. Once parts start failing, they are failed. You're simply concentrating on keeping things from getting any worse. You are at least fortunate enough to have discovered this early and hopefully you have lots of time yet with your pup. Do as your vet says, and emphasize quality of life over anything else.
posted by azpenguin at 4:33 PM on February 19, 2016

With any dog (or cat) in kidney failure, I need to recommend investigating calcitriol and whether your pet is a candidate with your vet, or with a vet that's familiar with it if yours isn't. It can greatly extend quality and length of life.

Also, there are Yahoo groups that are quite good discussion areas for owners of dogs with CRF.
posted by vers at 7:24 PM on February 19, 2016

OFAs (dosed appropriately) and a prescription diet are a good start. Definitely calcitriol. Also if your vet is not regularly monitoring your dog's blood pressure you need to find a vet who follows a more up to date renal protocol, since hypertension and renal failure go hand in hand and untreated hypertension hastens renal decline. Famotidine is also often used. There are MANY things that can be done relatively inexpensively to keep your dog feeling good and slow the decline of the kidneys. Blood pressure monitoring and intervention when needed is paramount.

And with all the hype about pet food out there, you should be aware that prescription diets all have feeding trials and are proven to do what they say they do, and Purina's are extremely good diets. There is SCIENCE! behind them, unlike most of the foods that random people on the internets prefer.
posted by biscotti at 2:27 AM on February 20, 2016

I'm so sorry to hear that you have to go through this. My pup had a similar diagnosis at age 15-16. He was also in the early stages and mostly asymptomatic, and we only discovered the kidney failure via blood work.

I had similar feelings to you about the Purina and RF being "downgrades." I'd fed my guy top-grade, organic, healthy, etc. food for his whole life. Our vet, who we loved, told us that many dogs found renal diets to be unpalatable and weren't tolerated well. (Renal diets are low in protein, as too much can stress the kidneys; dogs being carnivores, they're not huge fans of the low-protein stuff). She told us that the decision was ours whether to try and feed the rx food or just stick with what our pup would eat. We decided to go with his regular food and supplement it with goodies that he liked. There is a Yahoo group about kidney dogs that has homecooking recipes--many involving bones, tripe, etc. The tricky thing with homecooked food is that you have to account for the right mix of nutrients, vitamins, and minerals that dogs need. You may want to ask your vet for any recommendations regarding if you decide to go that route.

We were told that asymptomatic kidney dogs often do really well until, suddenly, they don't. As I mentioned, our pup was largely asymptomatic until his appetite waned greatly and he seemed exhausted. Sure enough, we checked his labs and they were right at a crucial turning point. Our vet told us that it could be, literally, any day that he suddenly got very ill (vomiting, incontinence, lethargy, etc.) and there would be very little we could do to help him at that point or to prolong his life, let alone to improve its quality.

Because our guy was 16, we opted to maximize his quality of life, knowing that, well, kidney failure or not, our time together would be ultimately limited. As others above have noted, kidney failure is a terminal diagnosis, especially in older dogs. For us, and for him, doing sub-Q fluids, famotidine, etc. weren't a good choice. He was an active and happy guy right up until the very end. I think we had about 6 months with him after his initial diagnosis via blood work, and I'm happy to report that we were able to make each of those days pretty darn good ones for him, and I don't think he suffered at all. I am really grateful for that, even if I still miss him every day.

Feel free to memail me if you want to chat more, or have other questions. Wishing you good thoughts and sending your pup lots of love.
posted by stillmoving at 4:14 AM on February 21, 2016

This is all wonderful, compassionate, helpful advice - thank you so much. I plan to join one of the Yahoo groups, but will keep her on the prescription food for now. I'll check back and let you know how she's doing.
posted by Zosia Blue at 8:11 PM on February 21, 2016

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