Kidney Failure in Dogs

Kidney failure is defined as the inability of the kidneys to remove waste products from the blood. The buildup of toxins produces the signs and symptoms of uremic poisoning. Kidney failure can appear suddenly (acute kidney failure) or come on gradually over months. Most cases are of the gradual onset type and are caused by nephritis and nephrosis.
Causes of acute kidney failure include:

  • Complete urinary tract obstruction caused by a stone
  • Rupture of the bladder or urethra
  • Shock, with inadequate blood flow to the kidneys
  • Congestive heart failure with low blood pressure and reduced blood flow to the kidneys
  • Poisoning, especially from antifreeze
  • Lyme disease
  • Leptospirosis

Dogs with kidney failure do not show signs of uremia until 75 percent of functioning kidney tissue is destroyed. Thus, a considerable amount of damage occurs before the signs are noticed.

Signs of Kidney Failure

One of the first things you may notice is that your dog drinks and urinates more than usual and indicates her need to go outside to eliminate several times a day. If not allowed to do so, the dog may begin to have house training accidents in the house. These signs are due to the failure of the kidneys to concentrate the urine. This results in a large urine output over which the dog has no control, with subsequent dehydration and thirst.
As kidney function declines, the dog retains ammonia, nitrogen, acids, and other chemical wastes in her blood and tissues. This is called uremia. The degree of uremia is determined by measuring serum blood urea nitrogen (BUN), creatinine, and electrolytes.
Signs of uremia are apathy and depression, loss of appetite and weight, a dry haircoat, a brownish discoloration to the surface of the tongue, and an ammonialike odor to the breath. Dogs at this stage may urinate less than normal. Ulcers may arise in the mouth. With the nephrotic syndrome the dog develops ascites and edema. Vomitingdiarrhea, and gastrointestinal bleeding may occur. At the end stages of kidney failure, the dog falls into a coma.

Treating Kidney Failure

Dogs with kidney failure require periodic monitoring of blood chemistries to detect changes in kidney function that may require medical intervention. A most important step is to restrict salt intake. This helps prevent edema, ascites, and hypertension.
Protein is poorly metabolized by dogs with kidney failure, but what to do about protein levels in the diet is currently an area of controversy. Some veterinarians believe a diet rich in meat, or one that contains poor-quality protein, creates an increased nitrogen load that must be handled by the liver and kidneys. Dogs with weak kidneys can be thrown into uremia by feeding them more protein than they can handle. Other veterinarians believe that as long as the protein is of high biological value, it will help the kidneys retain their function. Diet may need to be customized to the individual dog.
Restricting phosphorus intake is agreed upon by all. Medications to lower phosphorus levels may be required along with dietary adjustments.
It is extremely important to provide fresh water at all times. The dog must be able to take in enough water to compensate for her large urine output. Some dogs will need occasional boosts to their fluid intake. This can be done by giving subcutaneous (known as sub-Q or SQ) fluids. With most dogs, their owners can learn how to do this at home. In the later stages of kidney failure, dogs may need sub-Q fluids daily.
Some types of kidney failure are acute, and are mild enough that if the dog is well supported medically, there will be a complete recovery. More commonly, dogs will have at least some renal function deficit and need a change in care for the rest of their lives. With chronic renal failure, there is no cure; the disease must be controlled as well as possible for the rest of the dog’s life.

Dialysis

Dialysis describes two therapies that try to duplicate the filtering tasks of the kidneys. In peritoneal dialysis, special fluid is put into the abdomen using a catheter. The fluid then washes tissues and absorbs toxins from the body across tissue barriers. After a set period of time, the fluid is removed through the same catheter, taking the toxins out with it. This technique has been used in veterinary referral centers for short-term kidney problems such as antifreeze poisonings.
Hemodialysis is the second technique. This therapy is only available at a few referral centers across the country, because the equipment is expensive and must be specially designed to work with dogs. The dog’s blood is circulated through a machine with filters that tries to duplicate the filtering tasks of a healthy kidney.

Kidney Transplant

Another option for dogs with terminal kidney failure is to consider a kidney transplant. Kidney transplants are only done a few veterinary referral centers, but are becoming more common. As with human transplant patients, drugs must be given post-transplant to prevent organ rejection. These drugs are quite expensive and must be carefully calibrated to minimize side effects.
Original Ariticle: https://pets.webmd.com/dogs/kidney-failure-in-dogs

Heart Disease in Dogs: Chronic Valvular Disease and Dilated Cardiomyopathy

Original Article: https://pets.webmd.com/dogs/heart-disease-dogs-chronic-valvular-disease-dilated-cardiomyopathy
The leading cause of heart failure in dogs is chronic valvular disease. Next is dilated cardiomyopathy, followed by congenital heart disease and heartworms. More infrequent causes include bacterial endocarditis and myocarditis. Coronary artery disease is rare in dogs. It occurs only in dogs with severe hypothyroidism accompanied by extremely high serum cholesterol levels.

Chronic Valvular Disease

This common heart disease of unknown cause affects 20 to 40 percent of dogs. It occurs most often in toy and small breed dogs, particularly Cavalier King Charles Spaniels, Miniature and Toy Poodles, Chihuahuas, Lhasa Apsos, Yorkshire Terriers, Schnauzers, and Cocker Spaniels.
Chronic valvular disease is characterized by degenerative changes in the heart valves. The mitral valve is affected in nearly all cases; the tricuspid valve in about one-third of cases. The valve leaflets become thickened and distorted so that the free edges of the valves no longer make contact. The cords that attach the valve leaflets to the lining of the heart may rupture, allowing the valve to flap in the bloodstream.
These changes result in loss of valve function and a fall in cardiac output. When the ventricles contract, some blood is ejected backward into the corresponding atrium. This is called regurgitation. Regurgitation increases the blood pressure in the atrium and causes it to enlarge. Because the mitral valve is invariably involved, chronic valvular disease is also sometimes called mitral valve disease or mitral regurgitation.
The hallmark of chronic valvular disease is a loud heart murmur heard over the left side of the chest. A chest X-ray, ECG, and echocardiogram may show an enlarged left atrium, thickened valves, or a ruptured cord (muscle band). If the tricuspid valve is involved, there will be a loud heart murmur heard over the right side of the heart. It is important to exclude heartworms as a cause of a right-sided heart murmur.
Signs of congestive heart failure can be attributed to low cardiac output and lung congestion. They include a cough that occurs after exercise and/or is worse at night; lethargy and tiring easily; and fainting spells often related to cardiac arrhythmias.
Treatment: Many dogs with uncomplicated heart murmurs associated with chronic valvular disease remain asymptomatic for years. The disease, however, is chronic and progressive. Treatment should be started at the first signs of impending heart failure (coughing, easy tiring). The outlook depends on how far the disease has progressed and the general health and age of the dog.

Dilated Cardiomyopathy

Dilated cardiomyopathy is a disease in which the heart chambers enlarge and the walls of the ventricles become thin. The heart muscle weakens and begins to fail.
Dilated cardiomyopathy is the most common cause of congestive heart failure in large and giant breed dogs.It is rare in toy breeds and small dogs. A high incidence is found in Boxers, Doberman Pinschers, Springer Spaniels, and American and English Cocker Spaniels. Other breeds affected include German Shepherd Dogs, Great Danes, Old English Sheepdogs, St. Bernards, and Schnauzers. Most dogs are 2 to 5 years of age at the onset of symptoms. The majority are males.
In most cases the cause of dilated cardiomyopathy is unknown. Myocarditis, an inflammation of the heart muscle, may precede dilated cardiomyopathy in some dogs. Hypothyroidismhas been associated with dilated cardiomyopathy. A genetic or familial basis has been proposed for giant and large breed dogs. Cardiomyopathy related to taurine and/or carnitine deficiency is seen in American Cocker Spaniels, Boxers, and possibly Golden Retrievers, Newfoundlands, and other breeds.
The signs of dilated cardiomyopathy are the same as those of congestive heart failure and cardiac arrhythmias. Weight loss can occur in a matter of weeks. Affected dogs are lethargic, tire easily, breathe rapidly, and cough frequently, sometimes bringing up bloody sputum. Coughing is especially common at night. A swollen abdomen (called ascites)may be noted. Cardiac arrhythmias can cause weakness and collapse.
The diagnosis of dilated cardiomyopathy is based on ECG changes showing cardiac arrhythmias, a chest X-ray showing enlarged heart chambers, and an echocardiogram showing the characteristic pattern of a failing heart muscle.
Treatment: Treatment is directed at improving the force of the heart muscle, controlling arrhythmias, and preventing the buildup of fluid in the lungs and abdomen (see Congestive Heart Failure). Many dogs benefit from the addition of taurine and/or carnitine to their diet. The prognosis for long-term survival is guarded. With excellent medical control, some dogs may live for a year or more. Death usually occurs as the result of a sudden cardiac arrhythmia. Some dogs will drop dead without any noticeable signs beforehand.
 
 

Inflammatory Bowel Disease in Cats

https://pets.webmd.com/cats/inflammatory-bowel-disease-cats

There are three bowel problems in cats characterized by chronic and protracted diarrhea, sporadic vomiting, malabsorption and, in long-standing cases, weight loss,anemia, and malnutrition. Together, these are classified as inflammatory bowel disease (IBD). Some affected cats show clinical signs in a cyclical pattern, while others are constantly in discomfort.
All of these diseases are immune-mediated reactions of the gastrointestinal system to food, bacteria, or parasite antigens. These reactions get out of control, with large numbers of inflammatory cells collecting along the gastrointestinal tract and interfering with digestion and absorption. These syndromes can be managed but are seldom cured, and over the long term may lead to ulcers or cancer, such as lymphosarcoma.
Other health problems, such as parasites,hyperthyroidism, and kidney disease, must be ruled out first. Blood work and ultrasound or X-ray studies of the gastrointestinal tract may be needed.
The role of bacteria in these syndromes has not been clearly established in cats but has been suggested, since cats tend to have higher concentrations of bacteria in their small intestines than many other mammals. This may be related to their being obligate carnivores and having a relatively short  intestinal tract. Some scientists believe that cats fed a high-protein, low-carbohydrate diet that is more like a wild cat’s natural diet are less likely to develop these problems.
In each disease in the IBD complex, a different type of inflammatory cell (plasma cell, eosinophil, lymphocyte, macrophage) accumulates in the mucous lining of the small or large intestines. Pancreatitis and intestinal cancer may cause similar signs. A definitive diagnosis is made by endoscopy or exploratory surgery, during which biopsies are taken of the intestinal wall.
Treatment: This is an illness for which the realistic goal is control, not cure. Treatment tends to be lifelong for most cats. Although the exact medications may vary for the three versions of IBD, all three types often respond, at least partially, to dietary changes as described for lymphocytic-plasmacytic enterocolitis. Along with immunosuppressive drugs such as prednisolone and azathioprine, omega-3 fatty acids, antioxidants, and probiotics such as acidophilus may be helpful. Metronidazole, which is used to lower bacterial counts, can reduce symptoms. Budesonide is a new drug being looked at for treating IBD. This is a version of a corticosteroid, but it may have milder side effects. More research must be done before this drug can be recommended.

Lymphocytic-Plasmacytic Enterocolitis

This is the most common inflammatory bowel disease in cats. Lymphocytes and plasma cells are the predominant inflammatory cells seen on biopsy of the small and large intestines. The disease has been associated with giardiasis, food allergy or intolerance, and an overgrowth of intestinal bacteria. Vomiting is a common sign but is not present in all cases.
Treatment: An antibiotic (metronidazole) is given to treat bacterial overgrowth and giardiasis. Immunosuppressant drugs such as azathioprine (Imuran) and/or prednisone are used if other treatments are not successful. As a general measure, the cat should be placed on a hypoallergenic diet, either homemade (baby foods or boiled chicken) or commercially obtained from your veterinarian. The diet should be highly digestible and low in fat. If colitis is present, fiber may need to be added. A homemade diet may be developed by consulting a veterinary nutritionist. Raw diets are not recommended because the cat already has a stressed immune system.

Eosinophilic Enterocolitis

On biopsy, eosinophils may be found in the stomach, small intestine, or colon, and the eosinophil count in the blood may be elevated. Some cases are thought to be associated with food allergy or the tissue migration of roundworms and hookworms.
Treatment: Treatment involves the use of high-dose corticosteroids, such as prednisolone, that are tapered as symptoms are controlled. The cat should be tested for food allergies and intestinal parasites and treated accordingly. Dietary changes, as described for lymphocytic-plasmacytic enterocolitis, may be beneficial. This form of IBD is the most difficult to treat successfully and has the poorest outlook.

Granulomatous (Regional) Enteritis

This is a rare disease, similar to Crohn’s disease in humans. There is thickening and narrowing of the terminal small bowel due to inflammation of surrounding fat and lymph nodes. Macrophages, which are cells, found in tissues, that fight infections, are found when the colon is biopsied. The diarrhea contains mucus and blood. Biopsies are processed with special stains to exclude histoplasmosis and intestinal tuberculosis.
Treatment: Corticosteroids and immunosuppressive drugs are used to reduce inflammation and scarring. A course of metronidazole may be of benefit. Surgery may be required for a strictured bowel.
 
 
 
 
 

cushings-disease-in-dogs

From Washington State University College of Veterinary Medicine. Original link: https://www.vetmed.wsu.edu/cliented/cushings.aspx

Canine Cushing’s Disease

This information is not meant to be a substitute for veterinary care. Always follow the instructions provided by your veterinarian.
Cushing’s disease (hyperadrenocorticism) is the overproduction of the hormone cortisol by the adrenal glands that are located in the belly near the kidneys. Cushing’s disease occurs commonly in dogs, but is rare in cats. Most dogs with Cushing’s disease are about 6 years old or older but sometimes Cushing’s disease occurs in younger dogs. Cortisol affects the function of many organs in the body, so the signs of Cushing’s disease may be varied. Some of the more common signs of Cushing’s disease include hair loss, pot-bellied appearance, increased appetite, and increased drinking and urination called polydipsia and polyuria (PU/PD). Hair loss caused by Cushing’s disease occurs primarily on the body, sparing the head and legs. The skin is not usually itchy as it is with other skin diseases. If you pick up a fold of skin on a dog with Cushing’s disease, you may notice that the skin is thinner than normal. The pet may have fragile blood vessels and may bruise easily.
Less common signs of Cushing’s disease are weakness, panting, and an abnormal way of walking (stiff or standing or walking with the paws knuckled over). Some dogs with Cushing’s disease develop a blood clot to the lungs and show a rapid onset of difficulty breathing.
Dogs that are given prednisone or similar drugs can develop signs that look like Cushing’s disease (called iatrogenic Cushing’s).
There are two types of Cushing’s disease that are treated differently. The most common form of Cushing’s disease is caused by the overproduction of a hormone by the pituitary gland in the brain that in turn controls the amount of cortisol produced by the adrenal glands. This is called pituitary-dependent Cushing’s. A small percentage of dogs with Cushing’s disease have a tumor of one of the adrenal glands which is called adrenal-dependent Cushing’s.
There is no single test to diagnose Cushing’s disease. The history, physical exam, and results of initial blood and urine tests often provide a strong suspicion for the presence of Cushing’s disease. Laboratory tests that are most commonly altered by Cushing’s disease are an increase in white blood cell count, increase in the liver enzyme ALP (also called SAP or serum alkaline phosphatase), increased blood sugar (although not as high as the blood sugar levels of diabetic patients), increased cholesterol and dilute urine. See What Do Those Lab Tests Mean? for additional information about laboratory tests.
The large amount of cortisol in the body suppresses the immune system and allows the pet with Cushing’s disease to get bacterial infections. The most common location for infection is the bladder. Pets with Cushing’s disease may have a silent bladder infection meaning they don’t show signs of having the infection such as straining to urinate.  A culture of the urine may be necessary to diagnose the infection.
X-rays of the belly often show a large liver. Occasionally the x-ray will show calcium in the area of one of the adrenal glands that is suggestive of an adrenal tumor. Ultrasound of the belly may show enlargement of both adrenal glands in pets with pituitary-dependent Cushing’s or enlargement of just one of the adrenal glands in pets with an adrenal tumor. The adrenal glands are NOT always seen during an ultrasound exam in pets with Cushing’s. In some pets with an adrenal tumor, the tumor can be seen growing into large blood vessels close to the adrenal gland or spread from the tumor may be seen in the liver.
Specific tests for Cushing’s disease are performed to confirm the diagnosis and to determine the type of Cushing’s disease that is present, pituitary-dependent, or adrenal-dependent. Specific tests for Cushing’s disease have varied results. In some cases the results are clear cut and the diagnosis is made, but in other cases the test results are not clear cut and a series of tests must be performed. Some of the specific tests for Cushing’s disease include urine cortisol/creatinine ratio, low dose dexamethasone suppression test, high dose dexamethasone suppression test, and an ACTH stimulation test.
The treatment of the most common type of Cushing’s disease (pituitary-dependent) is lifelong oral medication. The most common drugs used to treat Cushing’s disease are  o, p’-DDD (also called Lysodren or mitotane) and Trilostane.  Occasionally ketoconazole or L-Deprenyl  are used to treat Cushing’s disease but are less effective than Trilostane or Mitotane.  o, p’-DDD is initially given daily or twice daily for about a week (sometimes more, sometimes less). The initial treatment is called induction. o, p’-DDD can have serious side effects, so pets being treated for Cushing’s disease must be closely watched. After induction o, p’-DDD is given less often, usually once or twice weekly for the life of the pet. Some pets will have a recurrence of signs of Cushing’s disease later in life, even though they are receiving o, p’-DDD. Trilostane tends to have fewer side effects than o, p’-DDD but is more expensive. Discuss with your veterinarian which treatment is best for your pet.
Treatment of adrenal dependent Cushing’s disease is by surgical removal of the cancerous adrenal gland. Adrenal gland tumors can spread to other parts of the body in which case all the cancer cannot be removed by surgery. Medical treatment may be given before surgery to reduce hormone levels before surgery. o, p’-DDD is not as effective in reducing signs in pets with adrenal-dependent Cushing’s disease as it is in pets with pituitary-dependent Cushing’s disease. Trilostane may be effective in controlling the signs of Cushing’s in some dogs with adrenal tumors.
The prognosis for pituitary-dependent Cushing’s disease with treatment is usually good. Some signs will disappear quickly and others gradually. Appetite and water consumption usually return to normal in a few weeks where as full return of the fur may take several months.