What is chronic renal failure?

Chronic renal failure or chronic kidney failure is the result of a slow decline and malfunction of the kidneys. The kidneys act as a filter for the body. They filter out toxins or waste products and discard them in the urine. The kidneys also help balance the electrolytes, pH, and minerals and maintain hydration. To prevent dehydration, the kidneys must draw water out of the urine (concentrate the urine). Chronic renal failure is said to be present when the kidneys fail to concentrate the urine and toxins accumulate in the blood.

What signs might I see if my pet is developing this disease?

The first signs are increased drinking and urination. As the disease progresses, you may notice a poor appetite, poor hair coat, bad breath, weight loss, vomiting, lethargy, and depression. This disease can only be diagnosed properly by blood tests and urinalysis. Early diagnosis means early treatment and possible slowing of the disease process. Routine screening blood tests are the best tool for catching this disease early.

What is the prognosis for my pet if this disease develops?

Chronic renal failure is not reversible, but it is treatable. That is, we can treat your pet and make him or her live longer and more comfortably, but a cure is not possible. The kidneys will continue to get worse with time. Treatment may slow the progression of the disease and make your pet more comfortable. In some cases, treatment will prolong your pet's life span from weeks to years, depending upon the severity of the disease. The goal of treatment is a good quality of life for your pet at home.

What causes chronic renal failure?

Chronic renal failure is the result of many factors including age, toxins, hereditary factors, infection, cancer, immune defects, and environment. Often, the primary cause is not identified. Cats often have chronic renal failure as an age related process. The cause of the renal failure is usually not contagious to people or other animals. Ask your veterinarian about your pet specifically.

How is it treated?

The key to managing chronic renal failure is to prevent accumulation of toxins by flushing the kidneys with water, just as you would flush a filter. Initially, your pet may need to stay in the hospital for several days for intensive intravenous fluid therapy, called diuresis. If and when the results of kidney function tests return to acceptable values, your pet may leave the hospital and be managed at home. Home management consists of providing fresh water at all times and, in some patients, administering fluids SQ (pronounced "sub Q," short for subcutaneously). SQ fluids are water solutions given by slow injection under the skin. Toxin build-up is prevented by feeding a special diet and by giving phosphate binding medications orally. Other medications, oral and injectible, are sometimes needed.

How do patients respond to being frequently medicated?

Amazingly enough, most pets tolerate treatment very well. Our objective is to maintain a good quality of life for your pet. That is, we want your pet to be at home with you doing the things it likes to do. Some of those things might be greeting you, interacting with you, playing, eating, walking around, and showing interest in its surroundings. If your pet's quality of life is seriously impaired by the medication, then a compromise will have to be made, and the medication must be changed or discontinued. With chronic renal failure, your pet's life span is shortened; we want the last weeks, months, or years to be good ones.

How does the pet owner manage caring for a chronic renal failure patient?

The role of a caregiver is not an easy one. You will be working closely with your veterinarian who will help you determine the optimal treatment combination for your pet. You must understand that you may be caring for your pet for many years. You will be bringing your pet to the hospital often and your pet may be hospitalized. This takes patience, dedication, time, money and, most importantly, lots of love. It's a lot of work. Extending a pet's life through constant care and vigilance may not be the right decision for everyone.

If you do meet with problems, start by approaching your veterinarian. The Animal Medical Center has on staff, two full-time counselors who are skilled listeners and can help sort through complex emotional decisions as they come up. Also, many excellent web sites are available on the Internet that provide helpful information. Type in "chronic renal failure'' in the search engine of your choice. A word of caution: always be critical of information on the web—it is usually truthful but not always accurate. Try also researching the topic at your local library.

Is a kidney transplant possible?

Kidney transplantation can be performed in some cats with chronic renal failure. Kidney transplantation is rarely performed in dogs. Ask your veterinarian if your cat might be a candidate.

Is renal dialysis available?

The Animal Medical Center hosts a complete hemodialysis unit and team. If your pet is a potential candidate for dialysis, he or she can be evaluated by the renal medicine team.

Notify your veterinarian if any of the following occur:

• Your pet is vomiting or has diarrhea.
• Your pet is lethargic and depressed or is acting dazed or confused.
• Your pet does not want to eat or loses weight.

The Bobst Hospital of The Animal Medical Center 510 East 62nd Street New York, NY 10021