What can raise kidney levels in dogs?

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• Testing Protocols & Interpretations

Urinalysis

Urinalysis is an essential test for evaluating kidney function. Whenever blood is collected for a chemistry profile, a urine sample should be obtained whenever possible (especially on the initial sampling). Changes in renal parameters cannot be interpreted without knowledge of the urine results. For example, a high BUN and creatinine (azotemia) in a dehydrated patient with a concentrated urine (urine specific gravity > 1.030 in a dog) is compatible with a pre-renal azotemia, whereas azotemia in a dehydrated dog with a USG of 1.010 indicates a renal azotemia. Urine should be collected into sterile glass red-top containers for all our tests. Plastic tubes should be avoided, because we have found that they often contain microscopic crystalline material that can interfere with the urine sediment exam.

We offer routine urinalysis, protein:creatinine ratios, and certain individual urine chemistry tests. Fractional excretion of electrolytes can be calculated by measuring the concentration of electrolytes and creatinine in serum and urine. Urinary excretion of electrolytes and certain enzymes, e.g. GGT, can indicate renal disease, e.g. Fanconi’s syndrome and aminoglycoside toxicity (urinary GGT).

To view our reports for certain tests below and to obtain more information about the individual components of each test, click on the highlighted test name below.

Ictotest done if dipstick bilirubin positive. Acetest done if dipstick ketones positive.

No additional charge for Acetest and/or Ictotest.

1 ml fresh urine

Urine Osmolality

Urine osmolality is measured by freezing point depression in our laboratory. Osmolality is affected by the number of osmotically active particles in solution and is unaffected by their molecular weight and size. For this reason, osmolality is superior to specific gravity, which is affected by particle weight and size. Isosthenuric urine has an osmolality similar to plasma, approximately 300 to 320 mOsm/kg. Urine osmolality is useful for evaluating urine concentrating ability, for example in water deprivation tests, and is more accurate than measurement of urine specific gravity in this regard.

Urine Protein to Creatinine Ratio

The protein-creatinine ration (UP:UC) is used to provide an estimate of the amount of protein lost in the urine. The urine protein to creatinine ratio on random mid-day urine samples correlates well to 24-hour urine collection, for quantitating urinary protein loss. The degree of proteinuria yields useful information on the source of protein loss; namely losses of large amounts of protein (with high urine protein to creatinine ratios) is due to glomerular, and not tubular, disease. Urine protein to creatinine ratios should only be performed on urine samples with evidence of excess protein (with consideration of the USG) and no evidence of cystitis. For example, there is no point in performing a urine protein to creatinine ratio in a patient with a USG of 1.035 and trace protein on the dipstick. Inflammatory conditions in the urinary tract will increase protein and negate the usefulness of the ratio for determining the source of protein loss.

Interpretation of UP:UC in Dogs & Cats

Dogs

In healthy dogs, the urine protein to creatinine ratio (UP:UC) is usually 1.0 in non-azotemic dogs are abnormal and diagnostic evaluation is warranted. Glomerular proteinuria is usually associated with UP:UC >=2.0. Therapeutic intervention is recommended for azotemic dogs with UP:UC >=0.5. These figures are only valid for urine samples with inactive sediments.

Cats

In healthy cats, the urine protein to creatinine ratio (UP:UC) is usually 1.0 in non-azotemic cats are abnormal and diagnostic evaluation is warranted. Glomerular proteinuria is usually associated with UP:UC >=2.0. Therapeutic intervention is recommended for azotemic cats with UP:UC >=0.4. These figures are only valid for urine samples with inactive sediments.

Urine Uric Acid

This is used to detect excessive urate excretion in breeds, such as Dalmatians, and to monitor response to therapy with allopurinol. Dalmatians excrete up to 400 to 600 mg uric acid per day in their urine, compared to non-Dalmation dogs, which excrete less than 100 mg uric acid per day in urine.

The best method for measuring urinary urate excretion is from a 24-hour urine collection, as recent studies have shown that a single urine uric acid to creatinine ratio does not correlate well to 24-hour urinary uric acid excretion. In addition, the amount of uric acid excreted in urine is dependent on diet (higher on meat-based diets). However, measurement of 24-hour excretion of uric acid in the urine is cumbersome and impractical and most people use urine uric acid to creatinine ratios for monitoring therapy. Guidelines in the literature for uric acid/creatinine ratios in urine are shown below:

Care must be taken when submitting urine samples for measurement of uric acid. Uric acid precipitates rapidly when urine is cooled, so the sample must be resuspended and a well-mixed aliquot provided to the laboratory, to prevent falsely decreased values due to precipitation (ideally, the urine should be submitted in the original container it was collected into).

Dog Kidney Disease: Symptoms and Stages

Kidney disease does not need to be an immediate death sentence for dogs. Treatment is available to help improve and prolong a pup’s quality of life, which can last for years if the disease is treated in time. The stages of kidney disease are based on the progression of the illness. The International Renal Interest Society has a system to help vets diagnose and treat dogs suffering from the disease. The first symptoms to arise are typically increased drinking and urination. The later stages of kidney disease can also render your dog with pale gums, bad breath, and mouth ulcers. If you want to know more regarding the symptoms and stages of dog kidney disease, please read this article.

What is Kidney- Disease in Dogs?

• Controlling blood pressure
• Maintaining blood acidity levels
• Preventing water loss
• Keeping a healthy metabolic balance

If the kidneys stop functioning correctly, it is referred to as kidney disease. There are stages to the disease. Your Vet would need to investigate to make a correct diagnosis. There are two types of kidney disease which would be acute and chronic.

An acute illness can generally be cleared or cured once there is treatment. When something is chronic, it cannot be cured, and it progresses until treatment will no longer be available to alleviate the symptoms.

What is Acute Kidney Disease?

If kidney disease is acute, the condition has resulted from complications from another illness, such as kidney stones or cancer. It could also be due to exposure to toxins. It is possible to treat and reverse kidney disease when it is acute. The prognosis depends upon the severity of damage to the kidney, and the underlying cause is promptly and successfully treated.

Acute kidney problems occur due to a urinary obstruction in the pup’s body. When blood flow is reduced, it leaves your kidneys more susceptible to infection. Some other causes of acute kidney disease include:

If acute kidney disease is caused by urinary obstruction, it is the exact reverse. Once the block is cleared, the kidneys resume their normal function.

What is Chronic Kidney Disease?

Chronic kidney disease is an irreversible long-term illness that advances gradually over time. Symptoms often do not show until the disease has already progressed. There is no remedy for chronic kidney disease. However, there are treatment options to slow the progression of the disease. Chronic kidney disease is more common in older dogs.

The early symptoms of chronic kidney disease are often overlooked because they are relatively mild or nonspecific. Poor dental health is one of the major causes of chronic kidney disease in older dogs. The bacteria from dental disease enter the dog’s bloodstream and damage the kidneys. Chronic kidney disease can also result due to the aging process.

What Are the Symptoms of Kidney Disease?

It is essential to know the symptoms of kidney disease in dogs. If your dog displays any of the following symptoms, do not dismiss it as simply a change in their behavior. You should take any signs you may notice seriously and have them investigated by your Vet:

More symptoms occur in stages two and three. Due to the build-up of toxins, the dog may start to have breathing problems. They may also be anemic because the kidneys cannot generate the hormone required to develop red blood cells.

What Are the Stages of Kidney Disease?

Your Vet needs to know what stage of kidney disease your dog is in so that they can give them the best treatment possible. Kidney failure advances in stages. Your Vet will use the International Renal Interest Society’s staging system to diagnose your dog. The stages of chronic kidney disease are primarily based on the dog’s serum creatinine concentrations and urine-specific gravity.

Stage 1 Kidney Disease

When the kidneys work properly, they can remove toxins from the pup’s body. When the kidneys are compromised, waste builds up in the blood, which causes what is referred to as uremic poisoning. When dogs are in stage one of kidney disease, there is no build-up of waste in the blood.

In stage one, there is a small amount to no protein in the urine, and the pup typically maintains normal blood pressure. However, diagnostic tests may indicate abnormalities in the urine concentration or irregular kidney palpation. Most dogs do not present with symptoms during this stage.

Stage 2 Kidney Disease

Waste is typically eliminated through the kidneys. During stage two, kidney disease waste starts to accumulate in the blood. The dog’s renal function declines. They may begin to leak protein into their urine, and their blood pressure will rise. Pups in stage two may have mild kidney failure but still not display clinical symptoms.

Stage 3 Kidney Disease

The dog may demonstrate moderate amounts of waste products in their blood during this stage. Dogs with stage three will often have protein in their urine and increased blood pressure. Their excessive drinking and urination may escalate as well. Kidneys are only working between about 15 and 25 percent during this stage.

Stage 4 Kidney Disease

In stage four kidney failure in dogs, creatinine levels are high. The pup is at risk for emerging systemic signs affecting the entire system. The kidneys will not be able to filter out waste. Protein in the urine increases further, and blood pressure may become higher or still be elevated. Dogs suffering from stage four kidney failure have kidneys that only work about under 15 percent.

Acute Kidney Disease

There are five stages of acute kidney disease. In acute kidney failure, the severity of the illness can vary in different dogs. Many dogs recover once they receive treatment. Other dogs develop chronic illness, and some dogs sadly do not heal. Creatinine levels will climb higher in some more than others, and there are varying degrees of decreased functioning of the kidneys.

What is Treatment for Kidneys Disease?

Treatment for kidney disease typically occurs in two phases. First, the kidneys are flushed to remove toxins from the dog’s system. Three possibilities can happen in the first phase of treatment:

• Kidneys resume normal functioning for months or years
• Kidneys resume normal functioning during treatment but stop when treatment ends
• Kidney function does not come back

If the first phase of treatment is effective, your Vet will help you improve your pup’s quality of life. This improvement is achieved through one or more of these steps:

Special Diet

The best food for a dog with kidney disease is low in protein and phosphorus and not acidic. This way of eating will help decrease the protein wastes or toxins that may make your dog feel sick. It is meant to take the stress off the kidneys. Talk to your Vet about the proper diet for your pup.

Phosphate Binder

High blood phosphate levels can lower your dog’s energy and leave them no appetite. There are binding phosphate drugs that keep phosphate from getting into the bloodstream. Your pup will need these drugs for the duration.

Home Fluid Therapy

Fluid will help prevent dehydration, flush out the toxins, and maintains electrolytes. Once the dog becomes stable, fluid therapy may be decreased.

Therapy for Protein in the Urine

Dogs with increased protein in the urine are at risk for the swift progression of chronic kidney disease. Blood pressure medications will help decrease pressure in the kidneys.

Drug to Adjust Parathyroid Gland and Calcium Levels

The increased blood calcium stimulates the parathyroid gland to remove calcium from the bones. It makes the bones brittle and weak. Calcitriol may help increase calcium absorption from the digestive tract.

Drug to Promote Production of Red Blood Cells

Your Vet may recommend this treatment if your dog has consistent anemia.

Kidney Dialysis

If the above treatments do not work, your Vet may suggest kidney dialysis to extend and improve the quality of your pup’s life. It involves a machine taking and cleansing the dog’s blood before going back into their system.

Conclusion

There are four stages of chronic kidney disease. Symptoms vary with the stages, but there are common symptoms to watch out for, including increased drinking and urination. Treatment is not expensive or complicated. It is worth it to pet parents to improve the quality of life for their faithful companion.