Kidney disease is a very common problem in small-animal medicine. There are many different types of kidney disease, and I will describe a few of the more common ones in this article. Pyelonephritis is a bacterial infection of the kidney, including the renal pelvis and ureter. Most cases are caused by a bladder infection that travels up the ureter. There may be a predisposing blockage or congenital malformation of the urinary tract. Occasionally the infection arrives at the kidney by way of the blood stream. Acute pyelonephritis begins with fever, loss of appetite, vomiting and pain in the lower back. A stiff-legged gait and a hunched-up posture are characteristic. Some patients exhibit signs of painful urination. On a urinalysis, one sees white blood cell casts, which are plugs of cells expelled from the infected kidney tubules. An IVP, or intravenous pyelogram or renal ultrasound, may show an enlarged kidney, a dilated kidney or a dilated renal pelvis. Chronic pyelonephritis is an insidious condition that may or may not follow an acute pyelonephritis. Signs are loss of appetite, weight loss and excessive thirst and urination. This disease may smolder for months or years, eventually destroying the kidney. Aggressive and successful treatment of acute pyelonephritis may prevent this. The therapy for pyelonephritis includes antibiotics for extended periods of time. Initially the urine should be cultured and recultured until it is certain the infection is resolved. Nephrosis and nephritis are kidney ailments that result in scarring and eventual renal failure. Nephritis is an inflammatory condition caused by a variety of infectious diseases, such as canine hepatitis, canine ehrlichiosis, Rocky Mountain Spotted Fever and Lyme disease. Dogs with systemic lupus erythematosis and chronic pancreatitis can also develop nephritis as a secondary condition. An inherited condition called glomerulonephritis has been documented in samoyeds, bull terriers, and Doberman pinschers. Nephrosis is the name given to the degeneration of the kidney's nephrons, the microscopic functional unit of the kidney. Toxins and poisons that target the kidney tissue cause it. Common nephrotoxins include aspirin and ibuprofen. Some antibiotics can cause nephrosis, especially if given for prolonged periods of time. These include Polymyxin B, gentamycin, amphotericin B and Kanamycin. Diagnosis is made by way of a kidney biopsy. A serious condition called Nephrotic Syndrome can develop in pets with nephritis or nephrosis. If this happens, large amounts of protein are lost into the urine due to the kidneys' being so damaged that they cannot reabsorb them. This causes a low serum protein, which results in loss of fluid into the legs (edema), the chest cavity (pleural effusion) and the abdominal cavity (ascites). These symptoms may be confused with right-sided congestive heart failure. Your veterinarian can perform tests to easily differentiate these two conditions. Kidney failure is characterized by the inability of the kidneys to adequately filter waste products from the blood. Uremic poisoning develops because of the buildup of toxins. Kidney failure can develop suddenly as in acute kidney failure, or it can develop slowly over many months, as in chronic kidney failure. The majority of chronic kidney failures are caused by nephrosis or nephritis. Some causes of acute kidney failure are poisoning, especially drinking antifreeze; rupture of the bladder or urethra; shock, with inadequate blood supply to the kidneys; congestive heart failure with low blood pressure and reduced blood flow to the kidneys; or complete urinary tract obstruction, such as a stone. Pets with kidney failure do not show symptoms until 75 percent of the kidney is no longer functioning. So a considerable amount of damage occurs before the symptoms are evident. One of the first things you may see is that your pet drinks and urinates much more than usual. Your dog may indicate that he needs to go outside far more often than normal. If not allowed to do so, he may start having accidents in the house. This happens because the kidneys are unable to concentrate the urine. This results in a large amount of urine output over which the pet no longer has control; then the pet can become dehydrated. You may then notice a greatly increased thirst. As kidney function deteriorates, the pet retains ammonia, nitrogen, acids and other chemical wastes in the blood and tissues. This is called uremic poisoning. Your veterinarian can perform tests to determine the degree of failure by measuring serum blood urea nitrogen (BUN), creatinine and phosphorous. Symptoms of uremic poisoning include apathy; depression; loss of appetite; weight loss; poor, dry hair coat; and an ammonialike odor to the breath. In advanced stages, there may be ulcers in the mouth. If the pet develops the nephrotic syndrome, you may see ascites and edema. Vomiting, diarrhea and gastrointestinal bleeding may occur. Sometimes a condition called rubber jaw may be seen with chronic kidney failure, due to the loss of calcium. The jawbone becomes soft and the teeth become loose. Oral ulceration is also noted. Pets with kidney failure require careful monitoring of blood chemistries in order to detect changes in kidney function. The vet must tailor specific treatment to each individual case. An important step is to restrict salt intake to minimize edema, ascites and hypertension. Another important step is to restrict dietary protein. The body breaks down protein, and its waste products become BUN. A diet high in meat or containing poor quality protein can increase the nitrogen load that must be handled by the kidneys. Pets with weak kidneys can be thrown into kidney failure by being fed more protein than their kidneys can handle. Phosphorus restriction is also important. Your veterinarian can help you select a proper prescription diet to address their needs. Fresh water needs to be available always; the pet must be able to take in enough water to compensate for the excess lost by the large urine output. B vitamins are also lost in the urine, so a supplement must be given to make up for these losses. Sodium bicarbonate tablets may be prescribed to correct an acid-base imbalance. A phosphorous binder may be needed to lower serum phosphorous. A pet that becomes dehydrated due to an illness or failure to drink enough may decompensate rapidly and fall into a uremic crisis. Hospitalization with intravenous fluids may be needed to rehydrate these patients. Once stabilized, many advanced cases can be maintained with subcutaneous fluids given at home by properly trained owners. Then patients can live long quality lives at home if adequately cared for. Last but not least, a few universities are now starting to do kidney transplants. This is not suitable for all patients with kidney failures, but for a few select cases it holds some promise. In the years to come, this procedure may become more readily available. -Dr. Michael Shaff owns and practices at The Animal Clinic of Woodmont located at 8295 N. Pine Island Rd in Tamarac, Fla. A University of Pennsylvania graduate, he is also a member of the South Florida Academy of Veterinary Medicine. He can be reached at (954) 726-3647 or by e-mail at acwoodmont@aol.com.

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