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Everything you've heard about a Kerry is true, and the opposite is also true!

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Chronic Kidney Disease in the Kerry Blue Terrier

 

© 2013

No portion of this article may be reproduced without permission of the copyright holder. Reprinted with permission from .

Chronic Kidney Disease (CKD) is a common disease that generally affects older dogs and cats with a high mortality rate. It is a disease of the kidneys which can affect a variety of parts of the body and manifest with many different symptoms. CKD is a progressive condition, which is generally not reversible and is characterized by permanent damage to the kidneys. The focus of managing a patient with CKD is fi rstly to correctly identify the type of condition and to institute individualized treatment for the patient.

With appropriate assessment, therapy and monitoring, the progression of the disease can be slowed down and the severity of the symptoms reduced, giving patients comfort and a longer and better quality of life. Fortunately for the Kerry Blue Terriers, kidney disease is not a genetic predisposition.

CKD is designated when there is permanent damage to the kidneys and has been present for a duration that exceeds three months. The kidney damage is assessed by measuring the kidney blood enzymes (BUN- blood urea nitrogen, and the CR- creatinine) abnormal elevations, without an ability to concentrate the urine (which is a measure of kidney function). The damage to the kidneys can develop in weeks to years even after the initiating cause has been corrected.

In contrast to CKD, Acute Kidney Disease (AKD) is more characteristic of an abrupt decrease in kidney function and recovery is possible due to less damage. If recovery does not occur, AKD cases will progress to CKD. In both types of disease, 65-75% of the kidney function is compromised by the time the kidney enzymes are elevated on a blood test. As the disease worsens, the enzyme levels increase.

The initial symptom an owner will usually notice is an increase in water consumption and urination. Other symptoms depend on which organs are affected. Seizures, blindness, bleeding problems, and halitosis can also be seen. Some patients will also have a decrease in appetite, energy level, and may exhibit vomiting or diarrhea before being brought to their veterinarian. At this point, the kidneys have already become compromised.

How sick is my dog?

Whether a progression from an acute stage or newly diagnosed case of CKD, the type of disease and initiating cause must be identifi ed if possible to determine the prognosis and subsequent treatment strategy. Blood and urine tests are crucial to evaluate the severity of the state. These include the kidney values BUN and CR, and the other associated changes in the blood that are infl uenced by the kidneys' function (potassium, sodium, calcium, phosphorus, acid, proteins, and red blood cell levels).

Urine tests are important to determine if an infection, tumor, or inflammation exists and how well the kidneys are working to concentrate the urine. A special urine test called a urine protein and creatinine ratio is also important which determines if an excess of protein is being lost through the urine by a diseased kidney. Blood pressure readings are usually also included.

These three measurements: CR level, urine protein-creatinine ratio, and the blood pressure reading are used to "stage" a patient according to the IRIS system (International Renal Interest Society). The stage a patient is in guides the therapy based on the level of severity. The change in magnitude of the abnormalities indicates the severity of the progression.

Additional valuable information is evaluated from specialized tests to determine the cause for the kidney disease, possibly the extent of the damage, treatment options, and the prognosis. These include ultrasound, radiology, biopsy, and testing for specifi c infectious agents.

Some conditions, if identifi ed, are amendable to treatment. Exposure to kidney toxins or other kidney damaging medications should also be included in the evaluation.

Radiographic imaging normally would confi rm a chronic state with small, sometimes irregular shaped kidneys. A large kidney is also possible with cystic disease, tumorous condition or obstruction due to a kidney or ureteral (the passage tube from the kidneys to the bladder) stone. Most stones are detected by radiographs and possibly treatable. An ultrasound study will be valuable in demonstrating how much normal kidney structure remains. Biopsies, which are a microscopic look at the kidney architecture, are usually reserved when other less invasive testing has not yielded enough information. In the chronic state, however, the biopsy information may only indicate general scarring that may not alter the treatment. Specifi c tests would be recommended by your veterinarian based on the symptoms, severity of the condition, historical information, cost factors, or lack of response to treatment.

What is the treatment?

Although CKD is generally not reversible, proper treatment can reduce the symptoms, slow the progression of the disease, and improve your pets' quality of life. Because the disease state is so variable due to the numerous factors that affect this condition, the key to managing CKD is a committed owner in partnership with diligent monitoring and assessment by your veterinarian.

The first step is to resolve any treatable initiating causes. This includes treating for infl ammatory conditions, infectious agents, removing tumorous kidneys, removing stones causing urine fl ow obstruction, and the discontinuation of kidney toxic drugs. Other concurrent diseases must be addressed which impact and contribute to CKD such as diabetes mellitus, cancer, immune system disease, and heart disease. Therapy is then divided into two areas: those aimed at reducing the progression of disease, and others that address the effects of kidney failure.


Dr Goo is shown with Kiara teaching Judi and Don Young, Kiara's human parents, how hydration is done in the home. The needle from the suspended saline bottle is inserted just under the skin on Kiara's back and the fluid is slowing drained under her skin where it is then disbursed throughout her body, thus rehydrating Kiara. Kiara has needed such hydration at home in the past as treatment for her CKD.

Dietary therapy is an important strategy to slow progression. A protein restricted diet, with lower phosphorus levels, may increase your pet's survival time. An appropriate diet consists of a high quality protein at a lower protein level and is generally prescription formulas available through your veterinarian. Nonprescription diets do not have the recommended protein levels or may not be of a high enough quality. Therefore it is important to check the labels for protein content and ingredients on all diets or treats you are giving to your Kerry. Home-cooked diets are also a good option if balanced by a nutritionist or approved by your veterinarian.

Most importantly, adequate nutrition or calorie intake is important to maintain your pet's body weight. If proper caloric needs are not met, a feeding tube should be placed. There are several feeding tube options. Your veterinarian would discuss which is best for your Kerry. It is also an excellent way to administer medications and fl uids, in addition to nutrients. Omega 3 fatty acids mainly derived from fi sh oils, have anti-oxidative and protective benefi cial effects on the kidneys and should be considered. Patients with high urine protein loss may also benefi t from the use of angiotensin converting enzyme (ACE) inhibitors drugs, which will help to slow the progression of disease.

Controlling the symptoms of CKD involves correcting and limiting the resulting negative effects of failing kidneys. As the kidneys fail to function, toxins in the blood rise, and disturbances and imbalances occur in the body. These treatments are aimed at improving the comfort and quality of life of your Kerry.

Treatments will depend on what symptoms are present for the individual patient. Dehydration is a common condition. Fluid therapy is important to correct the dehydration and help to remove the build up of toxic wastes by the inadequate kidney function. Severe situations require hospitalization with intravenous fl uid therapy for a variable amount of time. More chronic cases can be effectively maintained at home by owners administering fl uids via a subcutaneous (under the skin) route on a weekly to daily basis. Owners can easily be taught this technique.

Anorexia is a common symptom in which appetite stimulants are helpful. Nausea and vomiting can be controlled with antacids, anti- nausea, and anti-vomit medications, gastrointestinal moving medications, and stomach coating agents.

As the signs and severity of failure increase, additional medications are needed to balance the calcium and phosphorus levels, potassium and acid level, control of high blood pressure, and increase the red blood cell count. As adjunctive therapy, a plethora of supplements are available which may help the kidneys as well. Choose these products based on scientific information or your veterinarian's recommendations.

Alternative medical options include homeopathy and the documented benefits of using acupuncture.

Look for an integrative veterinarian if you are interested in alternative adjunctive treatment.

Kidney organ transplants and kidney dialysis are other available treatment modalities for CKD, when conventional options are failing. Both options require a dedicated owner and a costly fi nancial commitment. Kidney transplantation is available for dogs at specialized veterinary hospitals.

Patient selection is critical for a successful outcome because of the numerous criteria and the post-transplant care that is required. Kidney dialysis is also available at specialty hospitals. Dialysis removes the toxins from the blood, thereby reducing the symptoms of CKD. Three treatments a week are usually required which take up to several hours to complete.

How often should my pet be monitored?

Your veterinarian will determine how often recheck examination visits should be made and what tests need to be run depending on the situation. In general, the more severe state your Kerry is in, the more often he or she must be examined and tested. This includes evaluating the kidney blood values, urine tests, blood pressure, body weight, and hydration status, as often as weekly to as long as twice a year if a patient has been stable. Any change in therapy or your pet's condition will necessitate an evaluation.

How long does my pet have?
What can I expect?
Is my pet in pain?

Unfortunately, there is no way of predicting how long a patient has to live with CKD, with a variability of weeks to years. However, with today's therapies and diagnostic abilities, a good response to therapy and conscientious care, your Kerry may live a long comfortable, high quality of life after a diagnosis of CKD.

Thankfully, CKD is not a painful condition and can be dramatically affected by monitoring and stage based therapies to slow the progression of this irreversible disease.

Because kidney disease increases in prevalence with age, early detection is possible before your pet shows any clinical signs and treatment can then be initiated sooner.

It is recommended that mature pets (older than seven years of age) be screened with blood and urine tests yearly to check for kidney disease and other conditions that increase with age.

The key to the best possible care and keeping your pet as healthy as possible is prompt diagnosis through early detection and working closely with your Kerry's veterinarian. 

Dietary therapy is an important strategy to slow progression. A protein restricted diet, with lower phosphorus levels, may increase your pet's survival time. An appropriate diet consists of a high quality protein at a lower protein level and is generally prescription formulas available through your veterinarian. Nonprescription diets do not have the recommended protein levels or may not be of a high enough quality. Therefore it is important to check the labels for protein content and ingredients on all diets or treats you are giving to your Kerry. Home-cooked diets are also a good option if balanced by a nutritionist or approved by your veterinarian.

Most importantly, adequate nutrition or calorie intake is important to maintain your pet's body weight. If proper caloric needs are not met, a feeding tube should be placed. There are several feeding tube options. Your veterinarian would discuss which is best for your Kerry. It is also an excellent way to administer medications and fl uids, in addition to nutrients. Omega 3 fatty acids mainly derived from fi sh oils, have anti-oxidative and protective benefi cial effects on the kidneys and should be considered. Patients with high urine protein loss may also benefi t from the use of angiotensin converting enzyme (ACE) inhibitors drugs, which will help to slow the progression of disease.

Controlling the symptoms of CKD involves correcting and limiting the resulting negative effects of failing kidneys. As the kidneys fail to function, toxins in the blood rise, and disturbances and imbalances occur in the body. These treatments are aimed at improving the comfort and quality of life of your Kerry.

Treatments will depend on what symptoms are present for the individual patient. Dehydration is a common condition. Fluid therapy is important to correct the dehydration and help to remove the build up of toxic wastes by the inadequate kidney function. Severe situations require hospitalization with intravenous fl uid therapy for a variable amount of time. More chronic cases can be effectively maintained at home by owners administering fl uids via a subcutaneous (under the skin) route on a weekly to daily basis. Owners can easily be taught this technique.

Anorexia is a common symptom in which appetite stimulants are helpful. Nausea and vomiting can be controlled with antacids, anti- nausea, and anti-vomit medications, gastrointestinal moving medications, and stomach coating agents.

As the signs and severity of failure increase, additional medications are needed to balance the calcium and phosphorus levels, potassium and acid level, control of high blood pressure, and increase the red blood cell count. As adjunctive therapy, a plethora of supplements are available which may help the kidneys as well. Choose these products based on scientific information or your veterinarian's recommendations.

Alternative medical options include homeopathy and the documented benefits of using acupuncture.

Look for an integrative veterinarian if you are interested in alternative adjunctive treatment.

Kidney organ transplants and kidney dialysis are other available treatment modalities for CKD, when conventional options are failing. Both options require a dedicated owner and a costly fi nancial commitment. Kidney transplantation is available for dogs at specialized veterinary hospitals.

Patient selection is critical for a successful outcome because of the numerous criteria and the post-transplant care that is required. Kidney dialysis is also available at specialty hospitals. Dialysis removes the toxins from the blood, thereby reducing the symptoms of CKD. Three treatments a week are usually required which take up to several hours to complete.

How often should my pet be monitored?

Your veterinarian will determine how often recheck examination visits should be made and what tests need to be run depending on the situation. In general, the more severe state your Kerry is in, the more often he or she must be examined and tested. This includes evaluating the kidney blood values, urine tests, blood pressure, body weight, and hydration status, as often as weekly to as long as twice a year if a patient has been stable. Any change in therapy or your pet's condition will necessitate an evaluation.

How long does my pet have?
What can I expect?
Is my pet in pain?

Unfortunately, there is no way of predicting how long a patient has to live with CKD, with a variability of weeks to years. However, with today's therapies and diagnostic abilities, a good response to therapy and conscientious care, your Kerry may live a long comfortable, high quality of life after a diagnosis of CKD.

Thankfully, CKD is not a painful condition and can be dramatically affected by monitoring and stage based therapies to slow the progression of this irreversible disease.

Because kidney disease increases in prevalence with age, early detection is possible before your pet shows any clinical signs and treatment can then be initiated sooner.

It is recommended that mature pets (older than seven years of age) be screened with blood and urine tests yearly to check for kidney disease and other conditions that increase with age.

The key to the best possible care and keeping your pet as healthy as possible is prompt diagnosis through early detection and working closely with your Kerry's veterinarian.


Dr. Goo is shown here with her dog Trixie, her faithful companion at their Honolulu veterinary practice, King Street Pet Hospital.

 


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