Kidney Disease in Dogs
Chicken jerky strips (and other treats?) from China may cause kidney failure in dogs
The FDA and the AVMA have been issuing warnings about chicken jerky treats from China being linked to kidney failure in dogs since 2007. The latest warning came in November, 2011. Dogs in Canada are also getting sick. The cause is still unknown.
Note that these products often appear to be made in the U.S., but if you search carefully, you'll find "Made in China" in tiny print somewhere on the bag.
In April, 2012, reports started coming in about dried sweet potato treats, and possibly pig ears, causing the same problems.
In May 2009, researchers in Australia reported a possible link to Veggie Dents dental chews as well.
See Recalls for more information.
My interest in kidney disease stems from being involved with a breed, the Chinese Shar-Pei, that is prone to genetic kidney disease (renal amyloidosis), and belonging to a family that also has genetic kidney problems (my grandfather, father, uncle and sister all have had Polycystic Kidney Disease).
I have compiled information here on diet, supplements, and medical treatments for dogs with some degree of kidney disease. One of my main goals is to provide alternatives to feeding your dog k/d, which I believe is inappropriate for dogs with early-stage kidney disease. It is also a problem if your dog does not want to eat it, as many dogs do not.
The next section is about the Tests Used to Diagnose Kidney Disease. This information will help you to understand your dog's diagnosis, and decide whether additional tests might be advisable. It is important to know the severity of your dog's problem to best understand how to treat it, and it can also be meaningful to find the cause of the problem, especially in younger dogs, who may be suffering from Acute Renal Failure (ARF) rather than Chronic Renal Failure (CRF).
Next is Diet for Dogs with Kidney Disease. This section will not provide specific diets, but will give you the information you need to create your own diet that is right for your dog.
Is Feeding a Low Protein Diet Necessary or Desirable? provides links to and excerpts from a number of different articles and studies that show that feeding a low protein diet will not prolong your dog's life or slow the progression of the disease.
A Table is provided that lists nutritional values for a number of different foods you may want to feed.
Information on Supplements for dogs with kidney disease is also provided.
IDEXX Laboratories introduced a new test, the SDMA, for detecting very early stage kidney disease in 2015. This test can detect reduced kidney function when creatinine, BUN (Urea), and urine specific gravity are all still normal. It will be included with standard blood chemistry tests.
Urine specific gravity decreases when about 2/3 of kidney function has been lost, followed by increases in creatinine and BUN (Urea) when about 75% of kidney function has been lost. Prior to that point, the kidneys are able to function adequately even though they are not operating at full efficiency. The SDMA test identifies kidney disease on average when there is 40% loss of function (25% loss is the minimum level at which this test can detect a problem).
The question becomes, what do you do if you discover that your dog has very early kidney dysfunction?
Let me start by telling you what not to do: do not put your dog on a prescription kidney diet.
A reduced phosphorus diet is not needed until creatinine goes above 2.0 mg/dL (180 umol/L) or blood phosphorus level goes above 4.5 mg/dL (1.5 mmol/L). Note that for most accurate results, it's best if you fast your dog for at least 12 hours prior to the blood being drawn, with no food but free access (always!) to water. Otherwise, a recent meal may bump phosphorus levels up enough to cause concern. I usually try to take my dogs in for a blood test first thing in the morning, then feed breakfast right afterwards (you can also get away with feeding breakfast right before, if there's no time for the food to be digested before the blood is drawn).
When creatinine or phosphorus blood levels go above these limits, then it is best to feed a reduced phosphorus diet, though the degree of phosphorus restriction depends on how advanced the kidney disease is. Keep in mind that foods such as Hill's k/d are designed for dogs with late-stage kidney disease, and are inappropriate for dogs with early-stage disease. See Understanding Phosphorus below for more information.
If your dog has protein in the urine (proteinuria), that calls for additional diagnostics. The first thing to do is to rule out a urinary tract infection, which can cause proteinuria. Since about 20% of UTIs won't show up on a urinalysis alone, it's best to do a urine culture, particularly if your dog is showing any symptoms such as increased drinking and urination, accidents in the house, more frequent urination, painful urination, difficulty urinating, or blood in the urine. If protein in the urine persists after a UTI has been ruled out or successfully treated, a urine protein:creatinine (UPC) ratio should be done to quantify the amount of protein in the urine, which will help to determine what treatment is needed, as well as monitoring progression and response to treatment. Blood pressure should also be tested. See the following for more info:
Here is an overview of things to consider when you discover that your dog has kidney disease, taken from the webinar given by IDEXX about their new test:
- Investigate for underlying cause
- Check for calcium oxalate crystals, WBCs, RBCs, or hyaline casts.
- Urine culture if evidence of UTI or very low USG (urine specifc gravity <1.015).
- UPC (Urine protein:creatinine ratio)
- Treat if > 2.0
- Investigate if > 1.0
- Monitor if > 0.5
- Consider imaging (x-ray, ultrasound)
- Hydronephrosis from kidney stone blockage
- Infectious disease
- Leptospirosis (see Links below)
- Tick disease
- Blood Pressure
- Should be < 150
- > 180 indicates high risk
- Rule out renal toxin exposure
- Treat any underlying cause, including hypertension (high blood pressure) and proteinuria (see UPC above).
- Avoid potentially renal toxic drugs if possible
- NSAIDs such as Rimadyl, Deramaxx, Metacam, and Aspirin
- Gentamicin and other aminoglycosides
- Fresh water from a variety of sources should always be available
- Kidney diet may be of benefit if creatinine > 2.0, phosphorus > 4.5, proteinuria
- Consider renal protective diet. Includes diets that are phosphorus and sodium restricted, high in polyunsaturated fatty acids (fish oil), and supplemented with antioxidants. It is not known at this time if protein restriction is necessary or beneficial in animals with early CKD.
- Consider medications/supplements to support renal health
- Fish oil: give an amount that provides up to 30 mg EPA+DHA combined per pound of body weight daily.
(note I know nothing about this supplement other than what they said in the webinar)
- Calcium carbonate and magnesium carbonate decrease dietary availability of phosphorus by intestinal binding.
- The polysaccharides of Astragalus membranaceus are known to contribute to maintenance of normal kidney architecture.
- The fish protein hydrolysate may support normal blood pressure.
- Highly palatable liquid supplement, for an easier administration vs. capsules and tablets.
- The formulation also contains: butylated hydroxytoluene, chitosan, colloidal silica, fatty acid triglycerides, poultry liver powder, sorbitan monooleate.
- Maintain BP under anesthesia: Make sure your dog is kept on IV fluids before, during, and after any procedures involving anesthesia.
- Timing dependent on progression.
- Recheck first time after about 2 weeks to see if stable.
- Check again in 2-3 months. If continues stable, recheck every 6 months or so after that.
- Timing may be sooner if it appears progressive or to monitor response to therapy
- Body weight, appetite, overall attitude.
- CBC, chem panel with electrolytes, urinalysis.
- SDMA (included in chem panel).
- UPC (urine protein:creatinine ratio, see above).
- Blood Pressure.
- Timing dependent on progression.
For more general information on kidney disease, see the IRIS guidelines.
Dietary protein does not cause kidney disease, nor does it speed progression of chronic kidney disease. Dogs with kidney disease who are fed high-protein diets live longer and have a better quality of life than dogs fed low-protein diets. There are only two situations where protein needs to be reduced:
- Feeding too much protein to a dog with advanced kidney disease can lead to uremia, a syndrome caused by very high creatinine and BUN (urea) levels that causes nausea, vomiting, loss of appetite, and lethargy. Reducing dietary protein can reduce uremia and help with these symptoms, even though it doesn't help the kidneys themselves.
- Protein-losing kidney diseases such as glomerulonephritis are often linked to inflammation or infection anywhere in the body. It is thought that feeding too much protein may lead to higher protein loss in the urine (proteinuria), which increases inflammation, which in turn can lead to more protein loss. In this case, a moderate reduction in protein may reduce proteinuria and decrease inflammation. A low-protein diet, including a prescription kidney diet, is not indicated, as this can lead to low blood albumin that can cause edema (excess fluid in the body). Proteinuria can be monitored using a urine protein:creatinine (UPC) ratio to determine what level of protein works best for your dog. See the section on proteinuria above for more information.
See the following for more information:
- Is a Low Protein Diet Necessary or Desirable?
- High-Protein Diets
- Diets for Senior Dogs#protein
- Glomerulonephritis (links below)
Dietary phosphorus does not cause kidney disease, and there is no benefit in reducing dietary phosphorus when the kidneys are still able to process phosphorus adequately. Once blood creatinine levels to above 2.0 mg/dL (180 umol/L), this indicates that the kidneys are starting to have trouble processing all the wastes they need to. Limiting dietary phosphorus at this point has been shown to slow progression of kidney disease and prolong life by preventing mineralization of organs due to unprocessed phosphorus.
The best measure to use is to monitor blood phosphorus levels. The goal is to keep blood phosphorus at no more than 4.5 mg/dL (1.5 mmol/L) after fasting for at least 12 hours (no food but always free access to water). Fasting before the blood test can be important in order to get an accurate reading of blood phosphorus levels, since these can rise from a recent meal. I recommend scheduling blood tests for first thing in the morning, then feeding breakfast right afterwards (you can also get away with feeding breakfast shortly before the blood is drawn, if there is not enough time for the food to be digested).
When creatinine rises above 2.0 mg/dL or fasting blood phosphorus rises above 4.5 mg/dL, then it is time to start reducing dietary phosphorus, with the amount of reduction linked to how high the creatinine and blood phosphorus readings are. For very early-stage kidney disease, a valid goal is about 60 mg phosphorus per kilogram of body weight (about 27 mg/lb) daily. This amount would go down to about 40 mg/kg (18 mg/lb with moderate stage disease, to a low of about 22.5 mg/kg (10 mg/lb) for dogs with late-stage kidney disease.
The goal is to maintain blood phosphorus levels below 4.5 mg/dL for dogs with early-stage kidney disease (creatinine up to 2.0), 5.0 for dogs with moderate-stage kidney disease (creatinine 2.1 - 5.0), and 6.0 for dogs with late-stage kidney disease (creatinine > 5.0). When blood phosphorus goes above the recommended level for the stage of kidney disease, phosphorus binders should also be added to the diet.
See the following for more information:
- Overview of Dietary Goals for Dogs with Kidney Disease
- Phosphate Binders
- Prescription Renal Diets
- Non-Prescription Commercial Diets
- NAT Nutritional Analysis Tools and System Calculate the nutrient content of various foods in a meal
- USDA Nutrient Database or Nutrition Facts Database Look up the nutrient content of individual foods
- Raw Meaty Bones Analysis Lists the nutrient content of several different raw meaty bones
- Nutrition Counter Lists the amount of sodium (Na), Potassium (K) and Phosphorus in various foods
- Phosphorus and Calcium Guidelines Lists the amount of calcium and phosphorus in various foods
- Potassium and Sodium Guidelines Lists the amount of potassium and sodium in various foods
- A Guide to Good Nutrition Links to information on various foods and nutrients (human oriented)
- Dietary management of chronic renal failure General information on the role of protein, phosphorus, fat, sodium, potassium and calcium in the diet of dogs with chronic renal failure.
Web Sites with Current Information on Kidney Disease
- International Renal Interest Society (IRIS) See IRIS Guidelines for clearly written information on staging of CKD and treatment recommendations.
- Dogs with kidney problems Excellent article on kidney disease in dogs, written by a vet
- Kidney Failure in the Dog and Cat Good overview of the different types of kidney failure and their causes
- Chronic Renal Failure: What You Should Know Another good overview with information on test results and treatment options
- Managing a Renal Crisis
- Chronic Renal Failure and Diabetes
- Plan of Action for Amyloidosis Although this article is geared toward Shar-Pei with amyloidosis, it has a lot of information about various medications and dosages used to treat dogs with chronic kidney disease.
- Chronic Renal Disease and Failure (CRD, CRF) Very technical but lots of good information.
- Class Notes from WSU College of Veterinary Medicine Highly technical but very good information.
- The Canine Kidney from the Waltham Course on Clinical Nutrition.
- Chronic Renal Failure Class notes, highly technical but informative.
- Chronic Renal Failure Very complete overview of different tests and treatments for various problems relating to kidney disease.
- Prolonging Life and Kidney Function Very thorough overview of treatment for various aspects of kidney disease from 2009 conference proceedings.
- Phosphatemia: Management in the Treatment of Chronic Kidney Disease, A Roundtable Discussion (2006) Detailed information regarding phosphorus restriction and the use of binders.
- 11 guidelines for conservatively treating chronic kidney disease Written for vets but fairly easy to understand.
- Tanya's UK Feline Chronic Renal Failure Information Centre Feline oriented, but lots of good information
- Feline CRF Information Center Feline oriented, very informative.
- Chronic Renal Failure from Holisticat
- Kidney Disease in Dogs Lots of links to information of all kinds. Also includes some homemade diets near the bottom of the page.
- Canine and Feline Nephrology and Urology Page Links to more info
- Glomerular Disease in Dogs Good basic overview written for the pet owner
- IRIS 2009 Treatment Guidelines See sections on Proteinuria
- Glomerulonephritis in Dogs
- Glomerulonephritis in Dogs (pages 1-4; click Close Windows on the popup)
- Glomerulonephritis and Allergies Article from Good Dog Magazine
- New Thoughts On Proteinuria And Management Of Glomerulonephritis
- Lyme Disease
- What Every Dog Owner Should Know About Lyme Disease
These sites are technical, but provide very good information:
- Glomerulonephritis remains an important cause of renal disease in dogs (be sure to see both pages)
- Glomerulonephritis in Dogs and Cats
- Consensus Recommendations for the Diagnostic Investigation of Dogs with Suspected Glomerular Disease (2013)
- Consensus Recommendations for Standard Therapy of Glomerular Disease in Dogs (2013)
- Diagnosis and Management of Canine Glomerular Disease
- Proteinuria and Renal Disease: A Roundtable Discussion
- Strategies for Protein Losing Nephropathy
- Assessment and Management of Proteinuria in Dogs and Cats
- Glomerulopathy (glomerulonephritis) (GN)
- Protein Losing Nephropathy: An Overview
- Protein Losing Nephropathy
- Case of the Month: Canine with glomerulopathies
Leptospirosis (Acute Renal Failure)
- Leptospirosis in Dogs
- Update on Leptospirosis
- 2010 ACVIM Small Animal Consensus Statement on Leptospirosis: Diagnosis, Epidemiology, Treatment, and Prevention
- The features of naturally occurring leptospirosis in dogs
- An Overview of Canine Leptospirosis
- Leptospirosis - An Update
- Leptospirosis posing new threat for canine hepatic, renal disease
- Lethargic Chesapeake Case study of a dog with lepto
- Serovars that may cause disease in dogs Table of the serovars commonly transmitted by a variety of different animals
You can contact me if you have any comments, but I regret to say that I can no longer respond to questions about individual dogs. See my Contact page for more information. My name is Mary Straus and you can email me at either or