Managing Kidney Disease In Dogs And Cats
The goal of treatment in kidney disease cases is to reduce the workload of the functional kidney tissue. When the disease is diagnosed earlier, there will be a larger percentage of functioning nephrons available to maintain overall health. Initially, pain medications, intravenous fluids, and anti-nausea drugs may be used to stabilize the animals condition. Bacterial infections can be treated with antibiotics, while stones/blockages can be treated with surgery and dietary changes. In severe cases, kidney dialysis or kidney transplant may be indicated.
Once stabilized, kidney damage can be controlled through dietary changes to reduce the amount of protein filtering through the nephrons, allowing them to work better. Depending on the severity of the damage, animals with this condition will have different prognoses. If caught early enough, animals may stabilize and the kidneys may compensate well enough to only require dietary modification and routine monitoring. If the disease has progressed, animals may require periodic fluid therapy along with medications as needed to control symptoms. Diets for kidney disease patients are generally low in protein, sodium, and phosphorus; are enhanced with high-quality protein and carbohydrate sources; and enriched with antioxidants and fatty acids. ;
Hall JA, Yerramilli M, Obare M, Yerramilli M, Melendez LD, Jewel DE. Relationship between lean body mass and serum renal biomarkers in healthy dogs. J Vet Intern Med 2015;29:808-814.
How Do I Prepare For A Creatinine Blood Test
A creatinine blood test doesnt require much preparation. Fasting isnt necessary. You can and should eat and drink the same as you do normally to get an accurate result.
However, its important to tell your doctor about any prescription or over-the-counter medications youre currently taking. Some drugs may increase your creatinine levels without causing kidney damage and interfere with your test results. Let your doctor know if you take:
- chemotherapy drugs
- cephalosporin antibiotics, such as cephalexin and cefuroxime
Your doctor may ask you to stop taking your medication or to adjust your dosage before the test. Theyll also take this into consideration when interpreting your test results.
What Do Your Kidneys Do
Your kidneys are part of your urinary system. The two kidneys sit in the back of your abdomen just below your ribcage. They help your body filter waste materials and expel them as urine. Your kidneys are also vital for producing:
- Hormones that maintain blood pressure.
- Red blood cells, which carry oxygen throughout your body.
- Vitamin D, which maintains bone and muscle health.
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Research Into New Methods Of Diagnosis Of Kidney Disease
Recent research conducted at Oregon State University has led to the discovery of an indicator produced by cats and dogs with kidney disease. This biomarker is called symmetric dimethylarginine .
SDMA is a form of amino acid created through the breakdown of protein and released into the bloodstream to be sent out of the body through the kidneys. An increased level of SDMA in the blood can be seen much earlier than an increase in other indicators of kidney disease . SDMA is important because it is not affected by other conditions that may cause elevated creatinine levels in a sick animal .
It was determined that SDMA levels could be used approximately 17 months earlier to indicate the presence of kidney disease than by measuring creatinine levels . Another study conducted in dogs with chronic kidney disease showed that SDMA could be detected approximately 9.5 months earlier than elevated creatinine levels .;
Counting Blood Cells And Components
Problems such as anaemia and infection can be detected by counting amounts of these blood components in a blood sample:
- haemoglobin normal levels are approximately 110-180 grams/litre in men and 115-165 grams/litre in women
- white blood cells a normal count is approximately; 4-11 thousand million per litre
- platelets a normal count is approximately 150-350 thousand million per litre
- albumin normal levels are 35-45g/litre.
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How Is The Test Done
Usually, your doctor will ask you not to eat excessive amounts of meat or other protein for 24 hours before a kidney blood test. During the test, your doctor will extract blood from your veins into a tube, which will then be sent off for testing at a laboratory. Test results are usually available within a few days, or even on the same day if youre having the test in a hospital.
What Is Kidney Disease
There are two forms of kidney disease in dogs and cats acute and chronic. In the acute version, your pets kidneys immediately stop working correctly. This could be due to infection, injury, ingestion of a toxic substance, or a problem within in the kidney .
Chronic kidney disease has been present for some time , without the animal showing specific symptoms. This disease can progress into kidney failure, which is life-threatening.
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How Is Kidney Disease Diagnosed
A simple kidney function test can help your doctor determine whether you have kidney disease. After measuring your creatinine levels with a simple blood test, your estimated glomerular filtration rate can be calculated using age, weight, body size, ethnicity, and gender. Your eGFR indicates how well your kidneys are functioning. An eGFR of 120 or less can indicate kidney disease. Your doctor may also perform other tests before determining a kidney disease diagnosis.
What Do My Creatinine Blood Test Results Mean
Creatinine is measured in milligrams per deciliter of blood . People who are more muscular tend to have higher creatinine levels. Results may also vary depending on age and gender.
In general, however, normal creatinine levels range from 0.9 to 1.3 mg/dL in men and 0.6 to 1.1 mg/dL in women who are 18 to 60 years old. Normal levels are roughly the same for people over 60.
High serum creatinine levels in the blood indicate that the kidneys arent functioning properly.
Your serum creatinine levels may be slightly elevated or higher than normal due to:
- kidney problems, such as kidney damage or infection
- reduced blood flow to the kidneys due to shock, congestive heart failure, or complications of diabetes
If your creatinine is truly elevated and its from an acute or chronic kidney injury, the level wont decrease until the problem is resolved. If it was temporarily or falsely elevated due to dehydration, a very high-protein diet, or supplement usage, then reversal of those conditions will lower the level. Also, a person receiving dialysis will have lower levels after a treatment.
Its uncommon to have low levels of creatinine, but this can occur as a result of certain conditions that cause decreased muscle mass. Theyre usually not any cause for concern.
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Four Key Concepts And Talking Points
1. Talk to patients about their kidneys, CKD, and their risk.
What is CKD? CKD means the kidneys are damaged and may no longer filter blood well. This damage happens over many years. As more damage occurs, the kidneys are unable to keep the body healthy – then dialysis or a kidney transplant may be needed to maintain health.
How can I lower my risk for CKD? The steps you take to manage your diabetes and high blood pressure also help protect your kidneys. Choosing healthy foods, quitting smoking, and being more physically active are all important steps.
2. Communicate the importance of testing and how CKD is diagnosed.
What are the symptoms of CKD? Most people with CKD have no symptoms until their kidneys are about to fail. The only way to know if you have kidney disease is to get tested. The sooner kidney disease is found, the sooner you can take steps to begin treatment and keep your kidneys healthier longer.
How do you check for CKD? A blood test and a urine test are used to find kidney disease. Because you are at risk, you should get these tests regularly:
- GFR – A blood test measures how much blood your kidneys filter each minute, which is known as your glomerular filtration rate .
- Urine Albumin – A urine test checks for albumin in your urine. Albumin is a protein that can pass into the urine when the filters in the kidneys are damaged.
3. Explain the progressive nature of CKD and the basics of treatment.
4. Begin to speak about dialysis and transplantation.
Glomerular Filtration Rate Based On Creatinine Measurement
GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a substance that is later measured in a 24-hour urine collection. Recently, scientists found they could calculate GFR without an injection or urine collection. The new calculation requires only a measurement of the creatinine in a blood sample.
Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When kidneys are not working well, creatinine builds up in the blood.
In the lab, your blood will be tested to see how many milligrams of creatinine are in one deciliter of blood . Creatinine levels in the blood can vary, and each laboratory has its own normal range, usually 0.6 to 1.2 mg/dL. If your creatinine level is only slightly above this range, you probably will not feel sick, but the elevation is a sign that your kidneys are not working at full strength.
One formula for estimating kidney function equates a creatinine level of 1.7 mg/dL for most men and 1.4 mg/dL for most women to 50 percent of normal kidney function. But because creatinine values are so variable and can be affected by diet, a GFR calculation is more accurate for determining whether a person has reduced kidney function.
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Feeling Tired Or Sluggish During The Day
Everyone has a day when they feel tired maybe you didnt get enough sleep, or ate the wrong foods, or some other temporary factors are at play. But sometimes, fatigue is caused by lack of a hormone called erythropoietin, or EPO. The main function of EPO is to stimulate the production of red blood cells, and red blood cells carry energizing oxygen to cells throughout your body.
Stressed kidneys do not produce enough EPO, thereby reducing the number of red blood cells and making you feel weak and tired out.
Additional Tests For Kidney Disease
If blood and urine tests indicate reduced kidney function, your doctor may recommend additional tests to help identify the cause of the problem.
Methods of renal imaging include ultrasound, computed tomography , and magnetic resonance imaging . These tools are most helpful in finding unusual growths or blockages to the flow of urine.
Your doctor may want to see a tiny piece of your kidney tissue under a microscope. To obtain this tissue sample, the doctor will perform a renal biopsya hospital procedure in which the doctor inserts a needle through your skin and into the kidney. The needle retrieves a strand of tissue about 1/2 to 3/4 of an inch long. For the procedure, you will lie on your stomach on a table and receive local anesthetic to numb the skin. The sample tissue will help the doctor identify the cause and severity of your kidney disease.
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Questions For Your Doctor About Test Results
When your test results are ready, you can learn more about their significance by discussing them with your doctor. Some questions that you can ask include:
- Were there any abnormal findings on my renal panel test? If so, what were they?
- For any abnormal findings, can you explain what might be the cause?
- Are there any follow-up tests that are warranted based on my renal panel test?
- Should I take this test again? If so, when?
What Does The Kidney Do
Your kidneys main function is to filter waste products out of your bloodstream. As blood is circulated through the kidneys, waste substances are extracted and then excreted into the urine, which then passes out of the body. Besides being a filter, your kidneys also:
- Regulate your bodys water balance by excreting excess water via urine
- Maintaining the acid/alkaline balance of the body
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How Often Do I Need To Have A Test For Albuminuria
People who are at increased risk for kidney disease should have this test as part of routine checkups by a healthcare provider.; Those at increased risk include:
People with diabetes
People with high blood pressure
People with a family history of kidney failure
People who are 65 years or older
Certain ethnic groups including African Americans, Hispanics, Asians, American Indians
Will These Screening Tests Determine Exactly What The Underlying Cause Of The Kidney Disease Is
Occasionally, specific changes in these screening tests will point to an infectious, inflammatory, or toxic cause for the kidney disease.
However, because there are many underlying causes of kidney disease, and because the kidneys are able to compensate for damage so well, testing may not tell your veterinarian the exact reasons why the kidneys are malfunctioning. A reduction in kidney function characterized by either a decreased urinary concentrating ability, or an increase in serum BUN and creatinine, is not measurable until two thirds to three quarters of the kidney function is already lost. By this time, many kidney diseases have progressed to a chronic phase and the original cause can no longer be determined. This is one reason why the SDMA test described earlier is important, as it is able to detect subtle kidney disease much sooner.
Nevertheless, it is still important to evaluate your pet using these tests. Not only will they allow your veterinarian to confirm that the cause of your pet’s clinical symptoms is kidney disease, but they will also allow your veterinarian to choose the most appropriate course of treatment and may indicate if further testing is required.
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How Much Does The Test Cost
There is no universal fixed price for a renal panel test.
Different charges that can figure into the total price include office visits, fees related to the blood draw procedure, and costs of laboratory analysis. How much is billed for these charges can depend on several factors including:
- Where the blood draw is performed
- The laboratory that performs the testing
- The specific measurements included in the renal panel
- Whether you have health insurance
Many health insurance plans will cover some or all of the costs of a renal panel if the test is prescribed by your doctor, but some costs, such as for a deductible or copays, may still have to be paid out of pocket.
For more detailed information about what will be covered and your expected costs, talk directly with your doctors office and your health insurance company.
What Might These Tests Indicate If My Pet Has Kidney Disease
A);A complete blood count involves the evaluation of the red blood cells, the white blood cells and the platelet components of a single blood sample. A hematology analyzer will provide your veterinarian with the total numbers of these cells, and evaluation of a blood smear will allow a look at the physical characteristics of these cells.
The kidneys produce a substance called erythropoietin that is necessary for proper red blood cell production within the bone marrow. With kidney disease, the amount of erythropoietin produced may be decreased, causing a decrease in red blood cell production. This shows up in the CBC as anemia.
The white blood cell numbers may be increased if the underlying cause of the kidney disease is due to an infection or inflammation.
Rarely, platelet numbers may be reduced if a clotting problem has occurred as a result of the underlying kidney disease.
B) The serum biochemistry profile requires a separate blood sample from which the serum is separated from the cellular portion of blood. Serum contains many substances including enzymes, proteins, lipids , glucose and metabolic waste products.
Of most importance in the diagnosis of kidney disease are the determination of the levels of two substances, namely blood urea nitrogen and creatinine.
Increases in BUN and creatinine may be seen with kidney disease, as well as with dehydration and other causes of reduced blood flow to the kidneys.
“Severe increases in potassium may cause cardiac arrhythmias.”
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Best For Price Convenience: Pixel By Labcorp
;Pixel by LabCorp
Samples can be drawn both at home or in the lab
Online support and results on HIPAA-compliant portal
Easy access to physicians to review orders and test results
Complaints in online reviews about customer services
Limited testing options
LabCorps Kidney Health Test Package allows you to get kidney function test results at home. The kidney test includes all the measurements that will give a snapshot of your kidneys overall healthcreatinine, estimated glomerular filtration rates, albumin, and the albumin-creatinine ratiofor the price of one or two tests from competitors. Other tests can give you much more detailed information about your kidneys, but this $89 test kit will provide you with enough information to show any red flags or concerns. You may also find cheaper tests, but they may not include as many measurements within your lab results.
LabCorp doesnt bill insurance, Medicare, or Medicaid, but you can use Health Savings Accounts and Flexible Savings Accounts to purchase these kits.
LabCorp also offers the more basic albumin-creatinine ratio test alone for $59. This test uses just a urine sample to detect proteins in your urine.
We did find complaints in online reviews about LabCorps lack of responsiveness for customer service issues. The company offers details about its different services online, as well as a help section and a blog, but online support is not available.