What Do The Kidneys Do
Normal kidneys and kidney function
- The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back.
- Each kidney weighs about 5 ounces and contains approximately one million filtering units called nephrons.
- Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus.
- The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.
The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about 2 liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins, dietary and herbal supplements, food additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood.
The kidneys also produce certain hormones that have important functions in the body, including the following:
What Causes Kidney Disease
Kidney diseases happen when your kidneys are damaged and cant filter your blood. The damage can happen quickly when its caused by injury or toxins or, more commonly, over months or years.
High blood pressure and diabetes are the two most common causes of chronic kidney disease. Other causes and conditions that affect kidney function and can cause chronic kidney disease include:
- Glomerulonephritis. This type of kidney disease involves damage to the glomeruli, which are the filtering units inside your kidneys.
- Polycystic kidney disease. This is a genetic disorder that causes many fluid-filled cysts to grow in your kidneys, reducing the ability of your kidneys to function.
- Hypertensive nephrosclerosis. Kidney damage caused by chronic, poorly controlled hypertension.
- Membranous nephropathy. This is a disorder where your bodys immune system attacks the waste-filtering membranes in your kidney.
- Obstructions of the urinary tract from kidney stones, an enlarged prostate or cancer.
- Vesicourethral reflux. This is a condition in which urine flows backward refluxes back up the ureters to the kidneys
- Nephrotic syndrome. This is a collection of symptoms that indicate kidney damage.
Kidneys Have Lots Of Reserve But Getting Ahead Of Small Decreases In Function Prevents Later Damage
You often hear older people say I have weak kidneys. That doesn’t mean they can’t do their job or are destined to fail. But it does indicate you have some form of chronic kidney disease. The kidneysthe body’s blood-filtering urine factoryhave less capacity to filter toxins from the blood and excrete them in the urine.
Half of U.S. adults over 75 may have below-normal kidney function. Most of them will never get sick from it, unless they have other conditions such as diabetes or uncontrolled hypertension, or take medications that can injure the kidney.
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Research Is Revealing More About Sars
While kidney damage in COVID-19 is still not well understood, more data will reveal how this occurs. Sperati, who also conducts research on kidney disease, says the Johns Hopkins Division of Nephrology is exploring exactly how SARS-CoV-2 and the bodys response to it is affecting kidney health.
He says that patients with COVID-19-related kidney damage should follow up with their doctors to ensure kidney function is returning to normal. Lasting kidney damage might require dialysis or other therapies even after recovery from COVID-19.
Mostly, Sperati stresses the importance of adhering to guidelines around physical distancing and hand-washing, the basics of prevention. For everyone, especially people with underlying chronic disease, avoiding infection with COVID-19 for as long as you can is crucial, he says.
Right now, we dont have a treatment or vaccine for this disease. The longer a person can go without getting infected, the better chance they have of benefiting from a future therapy.
Coronavirus
Dialysis And Peritoneal Access Dialysis
In end-stage kidney disease, kidney functions can be replaced only by dialysis or by kidney transplantation. The planning for dialysis and transplantation is usually started in stage 4 of chronic kidney disease. Most patients are candidates for both hemodialysis and peritoneal dialysis . There are few differences in outcomes between the two procedures. The physician or an educator will discuss the appropriate options with the patient and help them make a decision that will match their personal and medical needs. It is best to choose a modality of dialysis after understanding both procedures and matching them to one’s lifestyle, daily activities, schedule, distance from the dialysis unit, support system, and personal preference.
The doctor will consider multiple factors when recommending the appropriate point to start dialysis, including the patient’s laboratory work and actual or estimated glomerular filtration rate, nutritional status, fluid volume status, the presence of symptoms compatible with advanced kidney failure, and risk of future complications. Dialysis is usually started before individuals are very symptomatic or at risk for life-threatening complications.
Dialysis
There are two types of dialysis 1) hemodialysis and 2) peritoneal dialysis. Before dialysis can be initiated, a dialysis access has to be created.
Dialysis access
Peritoneal access
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How High Is Too High For Liver Enzymes
Typically the range for normal AST is reported between 10 to 40 units per liter and ALT between 7 to 56 units per liter. Mild elevations are generally considered to be 2-3 times higher than the normal range. In some conditions, these enzymes can be severely elevated, in the 1000s range.
Can Chronic Kidney Disease Be Prevented
Chronic kidney disease cannot be prevented in most situations. The patient may be able to protect their kidneys from damage, or slow the progression of the disease by controlling their underlying conditions such as diabetes mellitus and high blood pressure.
- Kidney disease is usually advanced by the time symptoms appear. If a patient is at high risk of developing chronic kidney disease, they should see their doctor as recommended for screening tests.
- If a patient has a chronic condition such as diabetes, high blood pressure, or high cholesterol, they should follow the treatment recommendations of their health care practitioner. The patient should see their health care practitioner regularly for monitoring. Aggressive treatment of these diseases is essential.
- The patient should avoid exposure to drugs especially NSAIDs , chemicals, and other toxic substances as much as possible.
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What Is Kidney Disease
Kidney disease can affect your bodyâs ability to clean your blood, filter extra water out of your blood, and help control your blood pressure. It can also affect red blood cell production and vitamin D metabolism needed for bone health.
Youâre born with two kidneys. Theyâre on either side of your spine, just above your waist.
When your kidneys are damaged, waste products and fluid can build up in your body. That can cause swelling in your ankles, nausea, weakness, poor sleep, and shortness of breath. Without treatment, the damage can get worse and your kidneys may eventually stop working. Thatâs serious, and it can be life-threatening.
The Rise In Liver Enzymes
There are two basic types of elevated liver enzymes:
The first is a slight or subtle increase in AST and ALT which and the second is a massive increase in AST and ALT.
We are going to focus on the slight or subtle increase in AST and ALT because this usually indicates a chronic condition that results in low-grade inflammation and damage to the liver over time.
Massively elevated AST and ALT usually indicates an acute life-threatening condition such as liver failure from medication overdose, physical trauma to the liver or massive organ failure.
While massive elevations in liver enzymes are obviously important, the subtle increase is more relevant to most people because they can do something about it.
So what does it mean to have elevated liver enzymes?
Most laboratory reference ranges include a “range” of values to indicate that you are “normal”.
If you go outside this range then you are considered to have elevated liver enzymes.
The standard range largely depends on the laboratory but in general, is somewhere around 0-45 IU/l for ALT and 0-30 IU/l for AST.
If your AST and ALT are higher than the 45 and 35 then they are said to be “elevated”.
And this is a big issue because by definition that means that you are experiencing some sort of liver damage.
More important than just knowing that your liver function tests are elevated is figuring out why they are elevated, to begin with, and the picture behind their elevation.
For instance:
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How To Treat Elevated Liver Enzymes In Dogs
If your dog has been diagnosed with elevated liver enzymes, the best treatment plan will vary based on their specific situation. Each of the factors that we discussed above will require a different treatment approach, and will offer the dog the best chance at treatment.
If the exact cause of a dogs liver distress is unknown, your veterinarian will likely recommend additional diagnostics to get to the source of the issue.
These diagnostics may include an abdominal ultrasound, x-rays, and even a liver biopsy in some cases.
If a dog presents due to feeling ill and is found to have elevated liver enzymes, the veterinarian will often recommend hospitalization. Aggressive hospitalization will allow your vet to rehydrate them, offer medication to relieve their symptoms, as well as monitor their liver values for any improvement or decline.
If a dogs liver values continue to worsen after hospitalization, your vet may discuss their quality of life going forward.
If a dog improves in the hospital or is not critical when they present, your veterinarian may come up with an at home treatment plan going forward. Your veterinarian can prescribe medication that supports a compromised liver, as well as prescribe a special diet that is easier for the liver to process.
Your veterinarian will likely recommend recurring bloodwork for your pup going forward, as it is important to be aware of any future complications.
What Does The Liver Do In Dogs
The liver is an important organ that is responsible for the regulation of many different substances and chemicals within the blood, as well as bile production.
The liver helps to break down components in the blood to make it easier for the rest of the body to use, as well as filter out any foreign substances.
Just a few of the many specific roles that the liver performs include:
- The production of bile, which is responsible for breaking down fats during digestion
- The production of multiple proteins that circulate within the blood
- Converting excess glucose into starch, and storing it for later use when it is needed
- The storage of blood that can be used in serious injuries or circumstances involving blood loss
- The conversion of ammonia to urea, which is a safer product
- Producing some immune factors and helping to fight off infections
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Liver Enzyme Made Easy
What are liver enzymes and what do they mean?
In the most simple sense liver enzymes is used to represent a series of test that can help to determine if your liver is functioning appropriately.
The standard “liver function tests” include:
- Alanine Transaminase : ALT is produced in the liver cells known as hepatocytes and is a very specific marker of liver cell damage.
- Aspartate Transaminase : AST is not quite as specific as ALT for liver damage as it is also found in skeletal muscle, heart muscle, and kidney tissue. AST tends to rise with ALT if liver damage is present.
- Alkaline Phosphatase : ALP is produced by the cells lining the bile ducts or the “plumbing” of the liver. A rise in ALT is commonly seen in conditions that caused blocked “ducts” such as bile stones or direct damage to the bile ducts.
- Gamma-glutamyl transferase : GGT is found in liver, kidney, pancreatic and intestinal tissues. If GGT is elevated along with ALP this is highly indicative of an obstruction in the plumbing of the liver or may indicate gallbladder disease.
If you are dealing with “elevated liver enzymes” you most likely have an issue with AST and ALT.
While ALP and GGT are still important to assess what is happening in the liver most physicians refer to AST and ALT as the “liver enzymes”.
So what do liver enzymes tell us?
Liver enzymes help us determine if there is damage to the cells of the liver or direct damage to the liver tissue itself.
And this is obviously less than ideal.
The Four Liver Enzymes
When your veterinarian performs a full panel of bloodwork on your dog, there will be four liver enzymes that they will review.
To help you better understand each enzyme that will be discussed, lets cover each enzyme and its purpose.
- AST : AST is an enzyme that can be found in the liver, heart, muscles, red blood cells, and pancreas. Because it is found in so many other components and structures, it is not the only enzyme examined in search of liver disease or damage.
- ALT : ALT is an enzyme that is present in the liver, kidneys, and intestines. High ALT in dogs can be an indicator of liver cell damage, so it should always be a sign to look deeper for serious liver damage.
- ALP : ALP is an enzyme that is found in highest concentration in the liver and the bone. While ALP can be elevated in growing puppies, an elevated ALP count can point to liver complications once a dog reaches adulthood.
- GGT : GGT is an enzyme that is often considered one of the most sensitive indicators of liver or bile disease. This enzyme can often help veterinarians rule out other potential causes of elevated liver enzymes, because if the GGT is not elevated along with the other enzymes, liver disease may not be the issue.
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Can Claritin Cause Elevated Liver Enzymes In Dogs
Loratadine and desloratadine use are associated with a low rate of liver enzyme elevations which are usually asymptomatic, mild and self-limited even without modification of the dose. In addition, rare instances of clinically apparent liver injury attributed to loratadine and desloratadine use have been reported as isolated case reports.
Preventing Renal Failure In Dogs
There are currently no known methods for preventing kidney disease. Dietary protein is sometimes restricted, since it can further compound the problem.
Feeding diets with an appropriate amount of protein may help reduce unnecessary wear on the kidneys. Some commercial diets have much more protein than your dog needs, and this excess can damage the kidneys. Talk to your vet about your pets dietary needs.
Have your dog vaccinated against leptospirosis, a bacteria that may cause kidney damage even without noticeable symptoms .
Annual blood monitoring can reveal early stages of kidney damage, which can allow you and your veterinarian to start a kidney protection plan.
And of course, be sure your dog always has access to plenty of fresh, clean water.
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Causes Of Kidney Failure In Dogs
Causes of kidney failure in dogs can include kidney disease, cancer, diabetes mellitus and genetic factors. Some breeds, including Bull Terriers and English Cocker Spaniels, have a higher risk of kidney disease. Acute kidney failure can be caused by urinary blockage , certain prescription pet medications, toxins and infections.
What Other Testing Might Be Required
Depending upon your pet’s clinical signs, and the results of the initial screening tests, further testing for kidney disease may include any of the following:
A urinary protein/creatinine ratio is recommended if the urine dipstick evaluation suggests that an excessive amount of protein is being lost in the urine. A urine sample is sent to a veterinary referral laboratory, and the ratio of protein to creatinine in that sample is calculated. An increased protein/creatinine ratio can indicate kidney damage.
Urine culture may be performed if the urinalysis findings are suggestive of a bacterial infection as the cause of the kidney disease.
Leptospirosis titers may be recommended if this organism is suspected of causing the kidney disease. See handout Antibody Titers for more information.
Occasionally ultrasound examination and/or kidney biopsy may be recommended to evaluate the kidneys.
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What You Should Do
Elevated liver enzymes in cats are not the end of the world, but are an indication that something is wrong. The results of the blood tests require expertise and experience to decipher, as the overall pattern and ratio between the various enzymes need to be taken into account. You have to work with your veterinarian on getting a proper diagnosis. It may take further testing and some time, but it is the key to getting your cat better.
As always, if you dont feel comfortable with the medical care given to your cat, its perfectly ok to seek a second opinion, preferably from a feline specialist.
Youre not alone. Many cats have suffered and recovered from liver disease. Share your experience in our cat health forum to get the support of other cat lovers.
Dr. Miller is a founding fellow of the International Association of Cat Doctors and has served as president in 2012 and 2013. She is also a member of the American Veterinary Medical Association, the Connecticut Veterinary Medical Association, the International Society of Feline Medicine, and the Veterinary Information Network.