Helping Your Pet Live With
Chronic Kidney Disease
Chronic Kidney Disease
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The main function of the kidney is to remove metabolic poisons and waste products from the body’s
blood supply. The kidneys act as in-line filters for the blood stream. All of the body’s blood circulates
through the kidneys eventually. There it is cleansed of all chemicals not needed by the body. The
kidneys filter the blood in two steps. In the first step, nearly all of the dissolved chemicals are removed
from the blood. In the second step, some of the desirable items such as blood sugar, most of the water,
and certain other essential substances are returned to the blood stream. All of the chemicals that were
filtered out of the blood in the first step and not returned to the blood in the second step are secreted
as urine.
That’s the way it’s supposed to work. But kidney disease changes things. Kidney disease is an
insidiously progressive disease that destroys the kidney. Causes of kidney disease include birth
defects, bacterial or viral infections, injury, certain medications, poisons, kidney stones, bladder stones,
cancer and many other things. Frequently, the cause cannot be determined. If the kidneys are
damaged severely, they will not be able to perform properly, so waste materials accumulate in the
blood, poisoning the body. The more common forms of kidney disease are often progressive and may
become more serious, especially without proper care. However, most pets are able to recover from
many forms of kidney disease with proper treatment and diet changes.
Signs of kidney disease become apparent once damage reaches the point at which the kidneys cannot
rid the body of the metabolic waste products that accumulate continuously, or when the delicate
fluid/electrolyte balance of the body cannot be maintained. This point varies from pet to pet, but in
general, 2/3 of the functional kidney mass must be lost before symptoms of kidney disease become
apparent. Once a kidney is damaged, regeneration does not occur.
It is important to remember that the body can continue to function fairly normally as long as there
remains at least 10% functional kidney tissue. In our experience, many pets are able to live out fairly
normal lives with kidney disease as long as it is detected early, and proper treatment and diet changes
are started promptly.
Signs of Kidney Disease
Signs of kidney disease can appear suddenly or develop slowly over time. Other diseases can also
produce the same constellation of symptoms. Initial signs of kidney disease include malaise or lethargy,
loss of appetite, poor or unkempt hair coat, increased water consumption (often overlooked in cats), and
increased urination.
Later signs include vomiting, diarrhea, depression, and dehydration. This latter development is often
surprising to pet owners. It results from an inadequate amount of water in the body, from water loss
due to vomiting, from inability to drink and/or from excessive urine output.
Once severe kidney damage has occurred, excessive urine is allowed to pass through the kidneys. This
is actually a defensive mechanism employed by the kidneys. Unfortunately, there is a tendency over
time for this to result in dehydration. The dehydration, in turn, causes the pet to drink more and more,
leading to a continually increasing volume of urine. The cycle gets worse and worse.
Vomiting, diarrhea, and difficult breathing appear as the disease progresses with a buildup of waste
products in the blood stream. Anemia may occur in severe cases because hormones from the kidneys
are involved in the production of red blood cells.
Treatment
Treatment of kidney diseases is focused on the following general concepts:
• Maintenance of proper hydration and water intake.
• Dietary optimization.
• Stress avoidance.
• Elimination or minimization of other treatable concurrent problems that may be interfering with
kidney function.
This includes such things as:
• Infection
• Partial or complete urinary output obstruction
• Heart disease
• Electrolyte imbalances
GENERAL MANAGEMENT STRATEGIES FOR PETS WITH KIDNEY DISEASE
Maintain access to fresh, clean water at all times. Change the water daily.
Protect your pet from environmental and psychological stresses. These would include such things as
extreme exertion, excitement, excessively hot or cold temperatures, new household pets, kenneling,
long trips, excessive exercise, etc.
Diet optimization is one of the cornerstones of kidney disease management!
Feed only Prescription Diet N/F (or the specific diet determined by your veterinarian) as directed. The
diet is specially formulated to reduce the demands on the kidney. The highest quality protein available
must be utilized to decrease the continuing damage occurring within the kidneys.
If your pet is a nibbler (most cats are), leave food available at all times. Otherwise, feed 3-4 small meals
daily, rather than one large meal. Allow your pet to eat all it wants, unless free-choice feeding causes
obesity. Maintain your pet’s body weight at an optimal level. Your pet should be trim and have a
marked waistline.
Warning: Many pets initially refuse a new food. BE PERSISTENT. Dietary optimization is crucial for long-
term maintenance. Getting your pet on the right food could literally add years to his/her life.
If your pet absolutely refuses to eat the recommended diet, then try one of the homemade diets shown
below. Be aware, however, that these homemade diets may not be as beneficial as the specially
formulated prescription kidney diets, such as N/F.
The prescription diet or the homemade diet should be supplemented with additional amounts of the
water-soluble vitamins B and C, and zinc. Additional medications may be required depending on the
severity and type of kidney disease present. Repeat kidney tests and urinalysis every 30-60 days, until
your pet’s condition has been stabilized, and then every 4 months from then on.
Canine Restricted Protein Diet
¼ lb. ground beef (do not use lean ground chuck)
2 cups cooked white rice, without salt
1 hard cooked egg, finely chopped
3 slices of white bread, crumbled
1 teaspoon (5 g) calcium carbonate (from ground egg shell, or health food store)
Vitamin and mineral supplement
Cook the beef in a skillet, stirring until lightly browned. Stir in the remaining ingredients and mix well.
The resulting mixture is somewhat dry and its palatability can be improved by adding a little water (not
milk). Keep covered in refrigerator. Yield about 1 ¼ pound. Initially, feed at a rate of ¼ pound of food
per 5 pounds of body weight. Adjust up or down as necessary to maintain normal body weight.
Feline Restricted Protein Diet
¼ lb. liver (from beef or chicken only)
2 large hard cooked eggs, finely chopped
1 tablespoon vegetable oil
1 teaspoon (5 g) calcium carbonate (from ground egg shell, or health food store)
1/8 teaspoon KCI (salt substitute)
Vitamin and mineral supplement
Taurine supplement (cats need about 250 mg/day)
Dice and braise the meat, retaining all the fat. Combine all ingredients and mix well. The resulting
mixture is somewhat dry and its palatability can be improved by adding a little water (not milk). Keep
covered in refrigerator. Yield about 1 ¼ pound. Initially, feed at a rate of ¼ pound of food per 5 pounds
of body weight. Adjust up or down as necessary to maintain normal body weight.
blood supply. The kidneys act as in-line filters for the blood stream. All of the body’s blood circulates
through the kidneys eventually. There it is cleansed of all chemicals not needed by the body. The
kidneys filter the blood in two steps. In the first step, nearly all of the dissolved chemicals are removed
from the blood. In the second step, some of the desirable items such as blood sugar, most of the water,
and certain other essential substances are returned to the blood stream. All of the chemicals that were
filtered out of the blood in the first step and not returned to the blood in the second step are secreted
as urine.
That’s the way it’s supposed to work. But kidney disease changes things. Kidney disease is an
insidiously progressive disease that destroys the kidney. Causes of kidney disease include birth
defects, bacterial or viral infections, injury, certain medications, poisons, kidney stones, bladder stones,
cancer and many other things. Frequently, the cause cannot be determined. If the kidneys are
damaged severely, they will not be able to perform properly, so waste materials accumulate in the
blood, poisoning the body. The more common forms of kidney disease are often progressive and may
become more serious, especially without proper care. However, most pets are able to recover from
many forms of kidney disease with proper treatment and diet changes.
Signs of kidney disease become apparent once damage reaches the point at which the kidneys cannot
rid the body of the metabolic waste products that accumulate continuously, or when the delicate
fluid/electrolyte balance of the body cannot be maintained. This point varies from pet to pet, but in
general, 2/3 of the functional kidney mass must be lost before symptoms of kidney disease become
apparent. Once a kidney is damaged, regeneration does not occur.
It is important to remember that the body can continue to function fairly normally as long as there
remains at least 10% functional kidney tissue. In our experience, many pets are able to live out fairly
normal lives with kidney disease as long as it is detected early, and proper treatment and diet changes
are started promptly.
Signs of Kidney Disease
Signs of kidney disease can appear suddenly or develop slowly over time. Other diseases can also
produce the same constellation of symptoms. Initial signs of kidney disease include malaise or lethargy,
loss of appetite, poor or unkempt hair coat, increased water consumption (often overlooked in cats), and
increased urination.
Later signs include vomiting, diarrhea, depression, and dehydration. This latter development is often
surprising to pet owners. It results from an inadequate amount of water in the body, from water loss
due to vomiting, from inability to drink and/or from excessive urine output.
Once severe kidney damage has occurred, excessive urine is allowed to pass through the kidneys. This
is actually a defensive mechanism employed by the kidneys. Unfortunately, there is a tendency over
time for this to result in dehydration. The dehydration, in turn, causes the pet to drink more and more,
leading to a continually increasing volume of urine. The cycle gets worse and worse.
Vomiting, diarrhea, and difficult breathing appear as the disease progresses with a buildup of waste
products in the blood stream. Anemia may occur in severe cases because hormones from the kidneys
are involved in the production of red blood cells.
Treatment
Treatment of kidney diseases is focused on the following general concepts:
• Maintenance of proper hydration and water intake.
• Dietary optimization.
• Stress avoidance.
• Elimination or minimization of other treatable concurrent problems that may be interfering with
kidney function.
This includes such things as:
• Infection
• Partial or complete urinary output obstruction
• Heart disease
• Electrolyte imbalances
GENERAL MANAGEMENT STRATEGIES FOR PETS WITH KIDNEY DISEASE
Maintain access to fresh, clean water at all times. Change the water daily.
Protect your pet from environmental and psychological stresses. These would include such things as
extreme exertion, excitement, excessively hot or cold temperatures, new household pets, kenneling,
long trips, excessive exercise, etc.
Diet optimization is one of the cornerstones of kidney disease management!
Feed only Prescription Diet N/F (or the specific diet determined by your veterinarian) as directed. The
diet is specially formulated to reduce the demands on the kidney. The highest quality protein available
must be utilized to decrease the continuing damage occurring within the kidneys.
If your pet is a nibbler (most cats are), leave food available at all times. Otherwise, feed 3-4 small meals
daily, rather than one large meal. Allow your pet to eat all it wants, unless free-choice feeding causes
obesity. Maintain your pet’s body weight at an optimal level. Your pet should be trim and have a
marked waistline.
Warning: Many pets initially refuse a new food. BE PERSISTENT. Dietary optimization is crucial for long-
term maintenance. Getting your pet on the right food could literally add years to his/her life.
If your pet absolutely refuses to eat the recommended diet, then try one of the homemade diets shown
below. Be aware, however, that these homemade diets may not be as beneficial as the specially
formulated prescription kidney diets, such as N/F.
The prescription diet or the homemade diet should be supplemented with additional amounts of the
water-soluble vitamins B and C, and zinc. Additional medications may be required depending on the
severity and type of kidney disease present. Repeat kidney tests and urinalysis every 30-60 days, until
your pet’s condition has been stabilized, and then every 4 months from then on.
Canine Restricted Protein Diet
¼ lb. ground beef (do not use lean ground chuck)
2 cups cooked white rice, without salt
1 hard cooked egg, finely chopped
3 slices of white bread, crumbled
1 teaspoon (5 g) calcium carbonate (from ground egg shell, or health food store)
Vitamin and mineral supplement
Cook the beef in a skillet, stirring until lightly browned. Stir in the remaining ingredients and mix well.
The resulting mixture is somewhat dry and its palatability can be improved by adding a little water (not
milk). Keep covered in refrigerator. Yield about 1 ¼ pound. Initially, feed at a rate of ¼ pound of food
per 5 pounds of body weight. Adjust up or down as necessary to maintain normal body weight.
Feline Restricted Protein Diet
¼ lb. liver (from beef or chicken only)
2 large hard cooked eggs, finely chopped
1 tablespoon vegetable oil
1 teaspoon (5 g) calcium carbonate (from ground egg shell, or health food store)
1/8 teaspoon KCI (salt substitute)
Vitamin and mineral supplement
Taurine supplement (cats need about 250 mg/day)
Dice and braise the meat, retaining all the fat. Combine all ingredients and mix well. The resulting
mixture is somewhat dry and its palatability can be improved by adding a little water (not milk). Keep
covered in refrigerator. Yield about 1 ¼ pound. Initially, feed at a rate of ¼ pound of food per 5 pounds
of body weight. Adjust up or down as necessary to maintain normal body weight.