What is Anemia Due To Chronic Kidney Disease?
The kidneys are one of the weaker organs in dogs, and chronic disease and failure of the kidneys are common among older dogs. Nephrons in the kidneys contain filtering structures called glomeruli which eliminate waste and toxicity from the blood. The glomeruli tend to become less functional with age, and their effectiveness can also be reduced by conditions that increase levels of protein and inflammatory cells in the blood. The kidneys also produce erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow, so, as large numbers of nephrons become dysfunctional chronic, non-regenerative anemia develops. Symptoms of inflammation and uremia, both of which are common with kidney failure, further contribute to the reduction in red blood cells. Anemia is one of the more advanced symptoms of kidney disease. It can be rebalanced with hormone replacement therapy, but the chance of overall recovery is poor.
As the kidneys lose function in dogs, they fail to produce the hormones that normally stimulate red blood cell production. A type of non-regenerative anemia develops as the bone marrow is no longer able replace lost blood cells. This condition is treatable in the short term, but the chance of full recovery from chronic kidney disease is low.
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Symptoms of Anemia Due To Chronic Kidney Disease in Dogs
Constant drinking and excessive urination are usually the first signs as the body compensates for reduced kidney function. It’s a good idea to discuss these symptoms with a veterinarian if possible. By the time anemia has developed, symptoms will be more severe. Take your dog to see a veterinarian as soon as possible if you notice any of the following signs of anemia or kidney disease:
- Weight loss
- Poor appetite
- Lack of stamina
- Rapid heart rate (tachycardia)
- Rapid breathing (tachypnea)
- Paleness of mucus membranes, especially around the gums
- Blood in the stool
- Excessive drinking and urination
- Lusterless, unkempt coat
- Reduced urine output
- Hunched posture or other signs of pain
Anemia is divided into two types:
- Regenerative anemia – anemia in which the bone marrow is able to compensate for a decrease in red blood cells
- Non-regenerative anemia – anemia in which the body is unable to compensate naturally. Anemia due to chronic kidney disease falls into this category because the hormone imbalance negatively affects bone marrow production. Other types of non-regenerative anemia are usually due directly to bone marrow failure.
Causes of Anemia Due To Chronic Kidney Disease in Dogs
It’s often hard to determine the exact cause of kidney disease in dogs. It is more common in older dogs, but there are sometimes other contributing factors:
- Viral, bacterial or parasite infection (including leptospirosis and Lyme disease)
- High blood pressure
- Chronic inflammation
- Autoimmune diseases
- Overactive adrenaline gland
- Amyloidosis – a genetic abnormality more common among Shar Peis and Akitas
- Other hereditary condition
- Tumor in the thyroid gland
- Bladder or kidney stones
Diagnosis of Anemia Due To Chronic Kidney Disease in Dogs
The veterinarian will be able to diagnose your dog’s anemia with a blood test. A complete blood count (CBC) will show reduced levels of red blood cells. Urine analysis, as well as high levels of toxic compounds in the blood, will suggest kidney disease. Specific tests such as a urine gravity test, protein analysis and levels of nitrogen, calcium, and potassium in the blood will help to determine the severity of the problem. High blood pressure is also common with kidney disease. The veterinarian may order ultrasound or X-rays show to abnormalities in the kidney size. This can help to distinguish between chronic kidney disease and cancerous tumors on the kidneys.
The veterinarian will need to know your dog’s medical history, and any significant conditions like diabetes or chronic inflammatory conditions. A detailed description of your dog’s symptoms and time of onset will also be necessary. Discussing the earliest symptoms of kidney problems with your vet can help get your dog supportive treatment as soon as possible, so it’s important to mention signs like increased drinking or excessive urination. Once clinical symptoms of anemia are present, it suggests a fairly advanced degree of kidney dysfunction.
Treatment of Anemia Due To Chronic Kidney Disease in Dogs
Severe anemia due to chronic kidney disease is usually treated with recombinant human erythropoietin. This medication helps to replace the natural erythropoietin produced by the kidneys and will therefore stimulate red blood cell production in the bone marrow. As the name suggests however, the drug was developed to replace human erythropoietin which is only 81.3% similar to the canine version. It is usually effective to start with, but, at some point, the dog’s immune system may reject it, and it may actually have a negative effect on red blood cell production. The medication is given 3 times per week at varying doses based on weight. Once the blood reaches a target level (usually after about 3-4 weeks) the doses are reduced. Iron supplements should be prescribed at the same time.
Other treatments for kidney failure will depend on the degree of kidney dysfunction in your dog. Early signs are usually treated with diet change. Some pet food is made with lower protein and sodium levels, specifically for dogs with kidney problems. If the veterinarian suggests this type of diet, it is a good idea to have regular check-ups and blood tests to ensure that your dog is still getting good nutrition. The veterinarian may also suggest a home-made diet, or prescribe vitamin and mineral supplements to make up for poor nutrient absorption. This can help to prevent the development of anemia and keep symptoms of mild anemia at bay as long as possible.
Ace inhibitors can sometimes be prescribed to decrease the rate of nephron destruction, but they usually become less effective as the condition progresses. The veterinarian may also recommend dialysis appointments to reduce toxicity levels in the blood. Very severe cases of anemia could require blood transfusions.
Organ transplants are rare in animals, but this would be the most effective long-term treatment for chronic kidney disease. An acceptable donor would need to be found. This treatment would include potentially risky surgery as well as the possibility that your dog’s body might reject the new organ. The possibility of this type of treatment would have to be evaluated by a veterinarian.
Recovery of Anemia Due To Chronic Kidney Disease in Dogs
It’s unlikely that your dog will make a full recovery from chronic kidney disease, unless the veterinarian is able to perform a successful transplant (which is rare.) Diet, medication and other treatments can help to reduce symptoms and delay progression, however, and it’s possible your dog may survive for a number of years after the first signs become noticeable. You should always ensure your dog is getting plenty of water to help make up for reduced kidney function. Eventually, you may need to administer extra fluids through an eye dropper. As time progresses, medication and other treatments will become more and more extensive.
Anemia Due To Chronic Kidney Disease Questions and Advice from Veterinary Professionals
I live in India, so we do not have as good facilities for animals as in the west. My labrador retriever is 12 years old. She had been on a renal diet for nearly 2 years. Last year in June, she was very sick and her creatinine was 2.0. The vet gave her cephalosporins as she felt that my dog may have leptospirosis infection. She recovered very quickly and started eating normally, urinating regularly (but had a greater urgency to go and would sometimes urinate in the driveway itself. We thought it may just be incontinence that comes with age. She would defecate twice a day. However since our bedrooms are one flight upstairs she stopped coming up. She also developed mange for which we had been treating her with ivermectin which she did not tolerate well, so we stopped it.
Ten days ago she stopped eating her normal food. She urinated thrice in the house over a ten day period, something she has never done in her 12 years. We took her to the vet 4 days ago and her blood tests revealed her creatinine to be 9.7 and Hb to be 4. The vet told u she is in 4th grade chronic renal failure.
Can iron supplements and hormone therapy help at this stage? We are also preparing to put her to sleep and are emotionally preparing ourselves too. She is like our second daughter, so it is taking time to decide the best course and we want the best possible professional advice. Can you please help share your professional thoughts?
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So I took him into emergency Wednesday night because he was doing a weird mouth gesture that looked like seizures to me and he had 18 of them in one day They diagnosed him with chronic renal disease and anemia he received IV fluid therapy injectable antiacids injectable calcium and anti-nausea medication additionally he received oral iron supplements . We slept at the clinic from Wednesday night until Monday morning when we checked out they sent us home with LRS subcutaneous fluid it's says give 150 ML under the skin once daily for three days then every other day but we did it for four days in a row they also sent us home with purina NF prescription diet. That he is not eating they gave us two wet kinds and one dry pebbles .
And azodyl A probiotic supplement for Reno help it says give two capsules or early in the morning and one in the evening Also lixotinic iron supplement give to 2mL orally every 24 hours
And famotidine 20 mg 1/4 tablet 2 times a day . He looks happy and very animated since we took him home Monday He doesn't look like he's in any pain but the doctor said he had one week left he is also not eating because we cook for him and he's very spoiled he is hungry but doesn't like his food we try and trick him but it doesn't work he's been barley eating Tuesday he had 41 pebbles but barley Wednesday he had 34 pebbles and yesterday I took the liberty of giving him half instead of the 1/4 the vet recommended if mirtazapine 15 mg to get him to eat 37 pebbles . When we went into the clinic Wednesday night His CREA was at 12.7 his Phos 14.8 his CA 5.6 BUN at 123 and when we left Monday morning his CREA was 9.7 BUN 68 CA 6.9 PHOS 6.7 Do you think I can give him baking soda and his water I read that it helps cleanse Also can I cook for him specific things it would really be helpful if I could make him food he weighs 13.4 pounds Any food suggestions that I could make him would be really helpful of foods that he can eat anything you might think it's helpful the vet says I might have to put him down But right now he looks very happy and animated he's peeing Fine but barley defecating tiny bits of diarrhea his urine is clear. Please help any advice would be so helpful and beside myself with grief
Firstly mirtazapine shouldn’t be increased in dogs with kidney disease as the renal clearance of this drug is decreased so usually prescriptions are written 30% below regular dosage. There is still a lot of controversy surrounding protein levels in dogs with kidney disease; I tend to stay away from homemade diets as they can be difficult to perfect and you may end up leaving out an important nutrients. There are many different commercial diets which would be suitable for most dogs suffering from kidney disease; if you are to make your own food: high quality highly digestible protein like dairy products (be careful if lactose intolerant) and egg whites as well as sweet potatoes, spinach or kale along with an omega 3 supplement. Nutrition isn’t my area, so it may be worth speaking with a Veterinary Nutritionist who may be able to recommend a diet with measurements etc… Regards Dr Callum Turner DVM
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