Kidney Disease in Dogs

Kidney disease in dogs may be chronic (developing slowly over time) or acute (happening suddenly). Chronic kidney disease is common in older dogs and often reflects irreversible scarring or loss of functioning kidney tissue. Acute kidney injury can happen after toxin exposure, severe dehydration, heat injury, low blood flow, infection, urinary obstruction, or certain medications. Some dogs also have inherited or congenital kidney disorders.

Risk factors and causes include: • Aging and progressive wear of kidney tissue • Infections such as leptospirosis or kidney infection • Toxins including grapes or raisins, antifreeze, and some medications • Dehydration, shock, or reduced blood flow to the kidneys • Urinary obstruction or kidney stones • High blood pressure or persistent protein loss in the urine • Kidney inflammation, tumors, or other urinary tract disease • Hereditary kidney disorders such as renal dysplasia or polycystic kidney disease in predisposed breeds

Breed-related inherited kidney disorders are not the main cause of kidney disease overall, but they matter in some families and lines. Renal dysplasia has been reported in breeds including Shih Tzus, Lhasa Apsos, Soft Coated Wheaten Terriers, Standard Poodles, Cocker Spaniels, Golden Retrievers, Miniature Schnauzers, Chow Chows, Alaskan Malamutes, Bedlington Terriers, and Shetland Sheepdogs.

Your veterinarian will start with a history and physical exam, then run tests to confirm whether the problem is kidney-related and whether it is acute or chronic. Diagnosis usually includes bloodwork, urinalysis, and often blood pressure measurement.

Common tests include: • Chemistry panel to check kidney values such as creatinine and BUN • SDMA testing, which may help identify reduced kidney function earlier • Urinalysis to evaluate urine concentration and look for protein, blood, or other abnormalities • Urine protein-to-creatinine ratio if protein loss is suspected • Blood pressure measurement, because hypertension can both result from and worsen kidney disease • Urine culture if infection is possible • Imaging such as X-rays or ultrasound to look for stones, abnormal kidney shape, obstruction, infection, or tumors • Additional testing when indicated, such as leptospirosis testing or, less commonly, biopsy

For stable chronic kidney disease, many veterinarians use the IRIS staging system. Staging is based on creatinine and/or SDMA and then sub-staged using protein in the urine and blood pressure. This helps guide treatment and monitoring.

Treatment depends on whether your dog has chronic kidney disease or a sudden acute kidney injury, and on how advanced the disease is. The goals are to correct dehydration and electrolyte problems, reduce nausea, support nutrition, control complications, and slow progression when possible.

Common treatment approaches include: • IV fluids in the hospital for dogs that are dehydrated, very ill, or have acute kidney injury • Prescription kidney diets, which are a cornerstone of chronic kidney disease management • Anti-nausea medications and appetite support when dogs are not eating well • Phosphate binders when blood phosphorus remains high despite diet changes • Blood pressure treatment if hypertension is present • Treatment for protein in the urine when indicated • Antibiotics if there is a documented bacterial kidney or urinary infection • Subcutaneous fluids at home in selected chronic cases, if your vet recommends them • Management of the underlying cause, such as stopping a harmful medication, treating leptospirosis, relieving obstruction, or addressing stones • Advanced referral care in some cases, such as dialysis for severe acute kidney injury or rare transplant discussion

Prognosis varies. Some dogs with chronic kidney disease live months to years with good quality of life when diagnosed early and monitored closely. Dogs with acute kidney injury can recover partially or fully, may progress to chronic kidney disease, or may be critically ill despite treatment. Always call your vet if your dog suddenly worsens, stops eating, vomits repeatedly, or seems painful or weak.