Staging and management of canine chronic kidney disease - DVM
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Staging and management of canine chronic kidney disease
CKD remains leading cause of death in dogs


DVM InFocus



Table 2 Hypertension and proteinuric classifications in CKD patients
The classic diagnosis of chronic renal failure based on persistent azotemia superimposed on the inability to concentrate urine pertains to CKD in later Stage II through IV. CKD that is categorized as Stage I or early Stage II CKD (nonazotemic CKD) could be diagnosed in dogs with renal proteinuria (persistent proteinuria with an inactive urine sediment), urine concentrating deficits, increases in serum creatinine over time that remain in the normal range (e.g., serum creatinine that increases from 0.6 to 1.2 mg/dL could indicate a 50 percent reduction in nephron numbers), or abnormal renal palpation or imaging findings. The above stages are further classified by the presence or absence of renal proteinuria and systolic hypertension (See Table 2).

Management of CKD


Table 3 Examples of treatments linked to stage of CKD
Treatment of CKD is ideally linked to the stage of disease (see Table 3). In Stage I and early Stage II CKD, specific treatment directed at the primary cause of the kidney disease is the primary objective (see Figure 1). While it may not be possible to identify the primary cause of the CKD, specific treatments have the potential to reduce the magnitude of subsequent renal damage. As an example, bacterial pyelonephritis can cause or complicate CKD, and this condition can be specifically treated with appropriate antibiotic therapy.


Figure 1 Prioritization of diagnostic and treatment efforts based on the stage of CKD
In many dogs with Stage II CKD, renal lesions progress and renal function deteriorates. Progression of disease, as well as the rate of decline is monitored by physical examination and longitudinal assessment of blood pressure, proteinuria, and serum chemistry values. Dietary management is an example of a so-called renoprotective treatment that has been shown to reduce the progression of CKD in dogs. In a study of client-owned dogs with Stage II or III naturally-occurring CKD, feeding a renal diet resulted in a 70 percent reduction in the relative risk of developing a uremic crisis (acute decompensation). In comparison, dogs fed a renal diet remained free of uremic signs almost two and one-half times longer and had a median survival that was three times longer than dogs fed a maintenance diet.

Reduction of dietary phosphorus is one of the cornerstones of CKD management and can be accomplished by feeding specifically formulated diets for CKD. From a practical nutrition standpoint, dietary phosphorus reduction is combined with dietary protein reduction. If after three to four weeks of dietary phosphorus restriction serum phosphorus concentrations remain high, enteric phosphate-binding agents containing calcium, aluminum, sevelamer, or lanthanum should be administered with meals (initial dosage of 30 mg/kg body weight to achieve normophosphatemia). Physiologic dose replacement of vitamin D3 (calcitriol) is the third line of defense in the treatment of hyperphosphatemia and hyperparathyroidism and has been used successfully in dogs with CKD.


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