home Audience 12 Renal failure in dogs treatment. Renal failure in dogs symptoms, diagnosis, treatment of CKD in Shar Pei. How is kidney failure diagnosed in Shar Pei?

Renal failure in dogs treatment. Renal failure in dogs symptoms, diagnosis, treatment of CKD in Shar Pei. How is kidney failure diagnosed in Shar Pei?

Renal insufficiency in dogs refers to problems with the functioning of the kidneys. At the same time, their excretory ability decreases or completely stops, and various harmful and toxic substances begin to accumulate in the body, affecting the general health of the dog. At an early stage, this pathology is practically not detected, because. rarely does a host check the blood and urine of a pet with diagnostic frequency.

The risk group for the development of various pathologies of the kidneys includes dogs older than 5 years. This is without taking into account various damaging factors at an earlier age.

Dog breeds prone to kidney disease

In renal failure, the destruction of renal tissues usually occurs, and an increased burden of the overall excretory function falls on the remaining cells. Kidney cells and tissues are not restored, so the loss of function of this organ is obvious. With regular blood and urine tests, you should already pay increased attention to the upper limits of the norm of indicators - this may be a signal that there is a predisposition to kidney failure. Why is it important to do tests? Because externally, this pathology begins to manifest itself when 50-70% of the kidneys are affected. In such a state, a cure is impossible, only periodic or regular maintenance therapy can be organized.

Pathology occurs in two forms:

acute;
chronic.

Signs, symptoms

It should be repeated that the insufficient work of the kidneys is an insidious pathology, which outwardly begins to manifest itself already when the original state of the kidneys can no longer be returned. Given the natural general good health of dogs, kidney failure can begin to manifest clinically with complete failure of one kidney and a third of the damage to the other. Symptoms can appear, as several at once in a complex, and some separately. You need to be attentive to the condition of the pet.

What are the main symptoms of kidney failure in dogs? First of all, the dog ceases to be active, lies more, looks tired and depressed. The amount of urine excreted can increase dramatically due to the loss of the body's ability to retain and absorb fluid. At the same time, the urge to go to the toilet increases up to 6-8 times. These symptoms definitely lead to dehydration and constant thirst. After that, the amount of urine decreases sharply and disappears completely.

The weight of the dog is reduced due to lack of appetite, periodic vomiting and diarrhea. The mucous membranes become pale, the pulse may increase (normally 70-120 heartbeats) and edema appears, starting from the bottom of the paws. In extreme cases, muscle tremors and inflammation in the mouth are added, up to the appearance of ulcers.

We can assume that the dog is really bad when regular convulsions appear, extensive ulcerative stomatitis, vomiting of undigested food and complete apathy. Most often, after this, the dog dies in a short time through a coma.

Acute form (AR)

This form of the disease is characterized by an extremely rapid rate of development and manifestation of clinical signs. In the dog, acute renal failure is a potentially treatable condition, provided the diagnosis is made in a timely manner. Compensatory therapy can bring the kidneys to a state of maximum efficiency, as much as possible in this particular case. The situation is usually complicated by the fact that the primary acute course is very rare, basically, it is an exacerbation of the chronic course, which causes the main harm to the condition of the kidneys. It is secondary AKI that is considered incurable.

Depending on the main causes that provoke acute renal failure, the pathology is divided into 3 main types:

Prerenal (or prerenal). This type appears due to a sharp drop in blood pressure in the kidneys, which disrupts the renal blood flow (bleeding, dehydration, heat stroke, etc.).
Renal (or renal). The condition develops with direct damage to the tissues and cells of the kidneys with glomerulonephritis, pyelonephritis, drug poisoning, exposure to snake venom, accelerated breakdown of red blood cells and blockage of the tubules by hemoglobin, etc.
Postrenal (or postrenal). The main role in this type of pathology is played by a mechanical effect on the urinary tract - narrowing of the lumen from compression or complete blockage, for example, with urinary stones. It may be against the background of tumor processes, urolithiasis or prostate enlargement in males.

What are the outward signs?

In an acute course, there is always a clinic, which is distinguished by the clarity of manifestation. Symptoms can be many and obvious at once, or maybe one or two and blurred:

What can be seen from the analysis

in the blood, the levels of sugar, phosphorus, creatinine and urea will definitely climb up;
protein and sugar will go off scale in the urine, its specific gravity will decrease, erythrocytes, leukocytes and renal epithelial cells will be detected.

You need to immediately take the dog to the veterinarian for help, because. the animal may die.

Chronic form (CRF)

Most often it develops in older dogs, older than 6 years. Sometimes the kidneys begin to work worse, regardless of the influence of any factors. The underlying cause of CRF usually remains unidentified unless an autopsy is done.

The causes of chronic deficiency in young dogs are considered

previously formed OPN;
genetic predisposition to kidney pathologies;
any primary chronic kidney disease.

With the gradual death of nephrons (kidney cells), their functions are successfully taken over by the remaining unaffected cells. That is why, with CRF, external symptoms begin to appear very slowly and when most of the kidneys are affected and cannot be restored.

What becomes noticeable

What can be seen in the analyzes

increase in blood creatinine and urea;
signs of anemia in the blood;
in the urine, a high content of protein and sugar is found, a decrease in specific gravity is noted. There will be no sediment, as with OPN.

Diagnostics

The diagnosis is strictly complex based on:

survey of owners about the condition and lifestyle of the dog (anamnesis);
clinical examination by a doctor;
laboratory tests of urine and blood (the most important diagnostic components);
Ultrasound or radiography (used to determine postrenal pathologies).

The most important criteria for making a diagnosis

fluctuation in the amount of urine when urinating in any direction and obvious thirst;
external exhaustion and weakness;
an increase in blood creatinine, urea, phosphorus and an increase in its total acidity;
a sharp jump in the level of protein and sugar (glucose) in the urine.

What can be seen on an ultrasound

in the acute form of renal pathology, the kidneys will be of normal size or enlarged;
in chronic renal failure, the kidneys will be significantly reduced.

Prevention of kidney disease in dogs

It is impossible to 100% prevent the development of kidney pathologies in dogs, because, unlike cats, there are many more reasons that provoke this condition. The main emphasis is on the annual medical examination (prophylactic examination at the veterinarian) of young dogs and every six months - old ones. At the same time, it is necessary to take blood and urine tests, as well as to do an ultrasound of the abdominal organs. With this approach, it is possible to identify not only the very beginning of renal failure, which can still be cured, but even determine the predisposition to it.

You should also make sure that the pet does not get to any toxic or poisonous substances, including household chemicals.

Food for dogs with kidney failure

Treatment of any form of renal failure must be accompanied by an appropriate diet. You can feed both your own developed diet and commercially prepared ready-made feeds created specifically for dogs with impaired kidney function.

Self-feeding should be based on the following rules:

Examples of diets for an adult dog weighing 20 kg (for one meal):

200 g of semolina porridge with 2 tbsp. heavy cream and 1 tbsp. l. Melted butter;
- + 200 g of chicken meat (red, because it has less phosphorus);
- + 50 g beef fat and finely chopped chicken skin;
- + 70 g of any vitamin and mineral supplements allowed.
200 g vegetables or grains, steamed;
- + 200 g of any fatty red meat;
- + 1 egg white + 1 whole egg with yolk;
- + 30 g of any by-products (kidneys, liver, scar);
- + 70 g auxiliary additives: ground shells, salmon oil, coenzyme Q10, allowed vitamins.
200 porridge made from peeled sticky rice used for sushi with 1 tbsp. butter;
- + 1 egg white;
- + 100 g of a mixture of fatty lamb and boiled yams (another name for "sweet potatoes");
- + 75 g of any permitted mineral supplements and vitamins.

Important: a dog can be transferred to a normal diet only with acute renal failure and only when blood and urine tests are normalized. With chronic renal failure, a special diet will accompany you for the rest of your life!

If it is not possible to prepare a special healing food for your dog, you can resort to the help of special prepared foods that are balanced in all the necessary nutrients and designed specifically for dogs with kidney failure.

Treatment of kidney failure

Therapy of acute renal failure and chronic renal failure in dogs is carried out with approximately the same drugs, with the only difference being that in acute pathology it is important first of all to eliminate the influence of the provoking factor, and in chronic course it is important to support the exhausted vitality of the animal.

Important: the combinations and sequence of administration of drugs is determined exclusively by a veterinarian! Self-medication is strictly prohibited!

With early diagnosis of an acute process, the dog is subject to treatment. CRF is considered an incurable pathology, the treatment procedures in which help to bring the body into a state of compensation, significantly prolonging the relatively normal life of the dog for a long time. In this case, most often, treatment and supportive therapy for chronic renal failure will remain until the end of the pet's life.

If the cause of kidney failure is congenital underdevelopment or any genetic pathology, then it is impossible to completely restore the function of the kidney / kidneys. Only symptomatic therapy is carried out.

An intensive drip treatment of renal failure is prescribed, aimed at restoring not only the water balance, but also electrolyte and acid-base balance. Also, through droppers, you can remove a maximum of toxic substances that the kidneys cannot handle directly. It is important to administer the solutions warm so as not to aggravate the condition of a dog with a low body temperature.
Drugs are prescribed that relieve vomiting, improve blood counts, normalize biochemical levels in the blood, and eliminate anemia, which is a natural companion of chronic renal failure.
You may need careful antibiotic therapy for purulent lesions (the course and duration is determined by the final urinalysis).
Urination is normalized with the help of diuretics and mechanical diversion of urine when the bladder is full (urine is excreted using a catheter or surgery if there is a mechanical blockage).
In the acute stage, blood and urine tests are regularly done to monitor the dynamics of the development of the disease or recovery. Ideally, the dog should be left in a medical hospital for this period.
Systemic glucocorticoid therapy to restore water balance and suppress immune responses in autoimmune glomerulonephritis.
In cases of urgent need, drugs are introduced that reduce blood pressure (with the development of renal hypertension - high blood pressure due to impaired functioning of the kidneys) and normalize the passage of blood through the kidneys.
There may be a need for drugs that protect the mucous membranes of the gastrointestinal tract and reduce the overall acidity in the stomach.
If the condition worsens, it is possible to carry out hemo- and peritoneal dialysis, plasmapheresis.
Tube feeding or parenteral nutrition is possible if vomiting persists.
Strictly monitor the level of phosphorus in the blood, using drugs that bind and remove its free fractions.

List of medicines for kidney failure

Recovery and rehydration solutions for infusions

Ringer-Locke solution with glucose 40%: up to 20 ml/kg of the dog's weight intravenously (under the control of potassium levels);
rheosorbilact: 200-400 ml with a dropper once a day (under the control of the level of potassium in the blood);
nelit: 50 ml/kg of animal weight for self-feeding or through a tube;
recovery cocktails with saline, glucose and ascorbic acid: up to 100 ml / kg (depending on the severity of the condition) intravenously once a day.

Diuretics

lasix (furosemide): 0.1 ml/kg twice a day in the muscle. If there is no effect, the dose can be increased by 2-4 times (with the correct dosage, the effect appears after 30-60 minutes);
mannitol (mannitol) : 1-1.5 g / kg of body weight into a vein by slow infusion or with a dropper;
lespenephril : 0.5-1 tsp, and in severe cases up to 2-3 tsp. with water inside before meals every other day for a course of 3-4 weeks. Repeat is allowed after a 2-week break.

Protecting the gastrointestinal tract

omez (omeprazole) : inside at 0.5-1.5 mg / kg of body weight daily symptomatically, but not longer than 2 months;
Zantac (ranitidine): subcutaneously or slowly intravenously at a dose of 2 mg / kg or orally at 3.5 mg / kg twice a day at regular intervals (12 hours).

Antiemetics

papaverine : 0.03-0.12 g per animal symptomatic;
Cerucal (Metoclopramide): 0.5-0.7 ml / kg up to three times a day as needed, not longer than a week;
graying (only for dogs): subcutaneously at a dose of 1-2 ml / kg symptomatically.

Antihypertensive drugs

enalapril: the maximum effective dose is 0.5 mg/kg, but this should be approached gradually, starting with 1/3-1/4 dose initially, depending on the general condition of the dog and the level of hypertension;
vasosan (ramipril): the dose is selected individually, starting with 0.125 mg / kg (maximum 0.25 mg / kg) - once a day inside on an empty stomach.

Antianemic and normalizing hematopoietic agents

vitamin B12: 250-1000 mcg/kg (depending on the size of the dog). Enter subcutaneously or intramuscularly. The frequency of administration and the duration of the course depends on the patient's condition;
recormon : 500-1000 IU / 10 kg body weight of the dog every other day intramuscularly;
antianemic iron complex- 0.8 ml / 10 kg of weight intramuscularly in the thigh or neck area twice with an interval between injections of two days;
hemobalance: 0.25-1 ml of the drug, depending on the weight of the dog, into the muscle or intravenously twice a week;
ursoferan: once subcutaneously or intramuscularly at a dose of 0.5-1 ml per head.

Renoprotectors

kanefron: small individuals 5-10 drops inside, medium - 10-15, large - up to 25 1-2 times a day for up to 1 month. You can repeat after a break. A drug from a human pharmacy.

Sorbents and antitoxic agents

lactusan: individual dosage with a maximum dose of 50 ml per dog every day. Can be taken for life
enterosgel: 1-2 tablespoons the gel is diluted with water and poured into the mouth of the dog
sirepar: intravenously or by slow injection into the muscle, 2-4 ml 1 time per day until the signs of intoxication disappear.

To keep the heart working

riboxin: up to 10 mg/kg per muscle twice a day at regular intervals for 1.5-2 weeks;
cocarboxylase: 0.5-1 g per day for 5, 14 or 30 days. Inject into a muscle or intravenously with droppers;
sulfcamphocaine: single dose - 2 ml intramuscularly or in a vein. You can enter up to 3 times a day for a month, depending on the severity of the dog's condition.

Antibiotics

ciprofloxacin: 0.2 ml / kg per muscle once a day (the dosage can be divided into two injections) for 5-10 days;
enrofloxacin: 5-10 mg per kg of body weight once a day for 5-7 days.

Glucocorticoid hormones

dexamethasone: 0.5-1 ml intramuscularly or with a slow dropper;
Prednisolone: Usual dosage is 1 ml/kg of dog's weight twice a day for 2 weeks. With a positive dynamics of treatment, the dosage is slowly reduced. It is forbidden to abruptly cancel or reduce the dose in dogs!
metipred (methylprednisolone): 1-2 mg/kg twice a day for up to 2 weeks. If more than two weeks, then the cancellation should be carried out through a gradual dose reduction.

Phosphorus binders

ipakitine: 1 g powder (1 scoop)/5 kg dog body weight mixed with food and given twice a day. The course is long - 3-6 months;
almagel: 1 ml / 5-10 kg of weight up to 4 times a day strictly before meals for 30 minutes for a course of up to 1 month. If the level of phosphorus remains high, the drug should be replaced with another one;
renalcin: 5 ml/10 kg of dog weight per day until the condition returns to normal and longer. The daily dose can be divided into several doses.

Hemostatic agents

vikasol: once a day, 1-2 mg / kg intramuscularly for a maximum of 5 days;
dicynone (etamsylate): intramuscularly 10-12 mg/kg; if inside, then the dosage is 2 times more and taken up to 4 times a day.

Kidney disease in dogs occurs in all breeds. This is a pressing problem in veterinary medicine, as evidenced by the frequency of requests for assistance from small pet owners. But statistical and clinical material on renal pathology in dogs is much less common than scientific work on morbidity in cats.

The most common types of kidney disease in dogs are:

The frequency of referrals of owners of dogs with chronic and acute kidney failure is 10% of all cases. Moreover, diseases are difficult, long-term, disrupting the activity of many systems, and often lead to the death of a pet.

Most often, kidney disease occurs in dogs over the age of 4 years (80%), but pathologies are also noted in puppies up to a year old. This is most likely due to intrauterine development disorders or anomalies in the formation of the kidneys.

There is a seasonality in appeals - the peak falls on the autumn months, which is due to climatic conditions. Damp, cold, windy weather leads to hypothermia and inflammation of the kidneys.

Classification of renal pathologies

All kidney diseases in dogs are classified according to several criteria:

Kidney disease in dogs can occur as an independent (primary) pathology, or as a result of complications of underlying diseases (secondary). Secondary renal failure occurs against the background of dysfunction of the immune system (autoimmune diseases), vascular pathologies that occur as thrombosis, thromboembolism, arterial hypertension.

Common symptoms of kidney failure

Kidney disease in dogs is accompanied by common symptoms, but there are also manifestations that are characteristic only for a certain type of pathology. External manifestations of kidney failure include the following symptoms:

Laboratory studies of urine fix changes in its composition, volume, color:

Clinical blood tests note the following changes:

increased content of urea and creatine, which indicates acidosis;
high content of minerals - potassium, magnesium, phosphorus and a decrease in calcium and sodium;
a moderate decrease in the number of red blood cells (anemia);
increase in the number of neutrophilic leukocytes;
increase in ESR.

The progression of the pathology leads to an increase in intoxication with decay products, a violation of water-salt homeostasis and pH of the body, a decrease in metabolic processes, an increase in protein breakdown and a violation of plastic processes. Lack of treatment leads to an increase in pathological changes and death of the dog.

Methods for diagnosing pathology

To identify the causes of the disease and assess the severity of the process in veterinary clinics, differential diagnostics are carried out. It is carried out using the following methods:

Based on the results of laboratory, physical, instrumental studies and analysis of the collected information, the veterinarian makes a diagnosis and develops an individual treatment regimen. It has been established that the most common cause of kidney pathology in dogs is a violation of the content, errors in the diet of pets. Thus, the main fault lies with the owners of the animals.

Treatment methods for renal pathology

Treatment is carried out using therapies such as:

drug therapy;
physiotherapy;
dietetics;
surgery.

Drug therapy depends on the cause of the pathology and symptomatic manifestations:

The purpose of the impact	Group of drugs	Medicine name
Bacterial and viral infections	Antibiotics	Biseptol, Nitroxoline, Amoxicillin, Cifran, Baytril
Suppression of immunological reactions, improvement of urine excretion, elimination of edema	Glucocorticoids	Prednisolone, Dexamethasone, Metipred
Increased diuresis, elimination of edema	Diuretic	Furosemide, Veroshpiron
Normalization of potassium content in the body	Potassium preparations	Panangin, Asparkam
Elimination of putrefactive processes in the gastrointestinal tract, normalization of defecation, stabilization of urea formation	Probiotics	Lactusan, Lactulose (enemas), Vetom
Restoration of water-salt balance	Droppers with saline solutions	R-r Ringer
Elimination of pain	Antispasmodics	No-shpa, Papaverine
Maintaining heart function, normalizing blood pressure	Antihypertensive drugs, cardioprotectors	Enap, Carboxylase, Preductal, Riboxin, Neoton

If necessary and severe intoxication, dialysis is prescribed:

Diet therapy is of great importance in the treatment of renal pathologies and the prevention of progression and recurrence of diseases. With the help of an adequately designed diet, it is possible to:

weaken the symptoms of pathology in the form of dyspeptic disorders;
reducing the amount of protein in the diet helps to cope with acidosis;
an increase in dietary fiber content provides an alternative way to eliminate toxins and metabolic products - with feces;
ensure the supply of minerals and vitamins to restore metabolism;
restoring body weight with foods containing non-protein calories, vitamins, essential fatty acids.

In extreme cases, surgery may be required, for example, to remove stones from the kidneys. The problem is that not all veterinary clinics can provide surgical treatment for renal pathology. To avoid serious pathologies of the kidneys, long-term and expensive treatment, it is necessary to use prevention methods.

Prevention of kidney pathology

There is a breed predisposition to kidney pathologies in dogs. For example, dalmatians, dachshunds, bulldogs, terriers are more likely than other breeds to have urolithiasis. Therefore, the owner must know the characteristics of the breed of his pet and carry out the prevention of renal pathologies:

Regularly visit the veterinary clinic to monitor the condition and function of the kidneys.
Observe the drinking regimen, especially when eating dry food and high physical activity of the dog, as well as during a hot period of time.
With age, a visit to the veterinary clinic should be regular - at least 1 time in 6 months.

As the experience of veterinarians and statistical data show, the health and well-being of his pet depends on the responsible behavior of the owner. This is also true for renal pathologies in dogs.

The kidneys maintain a stable volume of intercellular fluid, its ionic composition and osmotic pressure, providing optimal conditions for the vital activity of the human and animal organism.

They take part in the regulation of acid-base balance, excretion of products of nitrogen metabolism, metabolism of carbohydrates, proteins, secretion of biologically active substances, hematopoiesis. The kidneys have a fairly wide range of functional adaptation, since they are able to significantly change the qualitative composition of urine, its volume and pH.

Kidney function is based on two main principles:

1) separation of a large amount of intercellular fluid from the rest of it by ultrafiltration in the renal glomeruli;
2) transport of water and substances diluted in it through the epithelial cells of the renal tubules.

This should be considered in the diagnosis and treatment kidney failure in dogs.

kidney failure- clinical and biological syndrome, caused by the inability of the kidneys to perform physiological functions (excretory and endocrine). In clinical practice, there are three main syndromes that are determined by the methods of assessing renal failure.

Acute renal failure (ARF)- characterized by severe impairment of kidney function. The transitional state of the disease, a priori, has the opposite character, provided that the disease is in a critical stage of its development.

Chronic renal failure (CRF)- the end, as a rule, of most pathologies of the kidneys of a bilateral nature, when destruction of 3/4 of all nephrons is observed.

Nephrotic syndrome (NS)- a symptom of renal failure, accompanied by massive prolonged proteinuria, which is associated with hypoproteinemia and hypercholesterolemia. Clinically, it is manifested by edema.

In veterinary practice, the determining factors of kidney damage are destructive changes and the action of nephrotoxic substances, including chemotherapeutic drugs, aging processes, dehydration, hyperthermia, liver disease, hypokalemia and hypercalcemia.

Early symptoms of renal failure are polydipsia, polyuria and proteinuria, which is easy to detect in the analysis of urine - an increased specific gravity of urine (1.025-1.030) and the presence of a light sediment. All this should be taken into account in order to determine the stage of the disease and the possible application of adequate treatment, which, in turn, is expensive, requires a long time and effort.

In biochemical blood tests, the values of the level of α- and β-lipoproteins, the activity of the enzymes aspartate and alanine aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, cholinesterase and a-amylase should be carefully analyzed. An increase in the activity of the aforementioned enzymes against the background of a high value of the de Ritis index, rhealy and protein coefficient indicates the progression of renal failure with an increase in nephrotic syndrome. An important point in the diagnosis of kidney diseases is the determination in the blood of the parameters of acid-base balance, the concentration of inorganic phosphorus, potassium and calcium, as well as the parameters of nitrogen metabolism (creatinine, urea, residual nitrogen, urea nitrogen).

In our studies, high concentrations of α- and β-lipoproteins (>400 mg%), residual nitrogen (47.5 mg%), creatinine (>144.3 µmol/l) and urea (10 .7 mmol / l) against the background of oliguria and proteinuria.

When carrying out therapeutic measures for renal failure, the main pathogenetic factors in the development of pathology should be taken into account - a decrease in the active area of the renal glomeruli and their obstruction, low renal blood flow, diffusion of the glomerular filtrate through the damaged wall of the renal tubule, cellular and interstitial edema.

Based on this, the main tactical principles in the treatment of dogs with renal insufficiency were:

Carrying out intensive infusion therapy with Ringer-Locke solutions, sorbilact, rheosobilact, saline;
- the use of diuretics: mannitol, dopamine, lespenephril, lasix;
- enterosorption therapy using Belosorb-P tablets;
- use of the drug Heptral as a detoxifying and hepatoprotective agent and, as a possible renoprotector, the drug Kanefron;
- homeopathic therapy with Solidagocompositum and 5 and Coenzyme compositum Ampullen;
- low-protein diet.

The period of intensive therapy continued until the stabilization of nitrogen metabolism and excretory function of the kidneys. An important point in the treatment of dogs with renal pathology is the use peritoneal dialysis.

The issue of post-therapeutic monitoring of biochemical parameters of blood serum and the activity of enzyme systems in order to prevent the development of irreversible changes in the tissues of the kidneys remains relevant.

Kidney failure is a process of organ failure combined with a deterioration in the overall health of the dog. As a result of changes in kidney function, there are problems with the removal of toxins and harmful substances from the body. As a rule, the disease is diagnosed in the later stages, when irreversible changes are already occurring that are life-threatening for the pet.

Renal failure develops as a complication against the background of another disease or pathology. At risk are pets who have previously had problems with the urinary organs.

Types of disorders against which kidney failure develops:

Destruction of kidney tissue due to infectious, inflammatory and genetic diseases: pyelonephritis, leptospirosis, glomerulonephritis;
Poisoning with poisons or chemicals;
Violations in the work of the urinary canals;
Severe blood loss, due to which the required amount of blood does not reach the kidneys.

The possibility of developing complications of kidney disease is also influenced by factors such as the age of the dog, the conditions of its maintenance, diet, the presence of stress, as well as heredity and predisposition of breeds.

Dog breeds with a predisposition to kidney disease:

Most often, this disease occurs in animals older than 5 years of age. If a dog develops kidney failure, then the symptoms and treatment are determined by the veterinarian. As you know, the destroyed tissues of the kidneys do not recover over time. And this means that it is almost impossible to get rid of insufficiency in the later stages. In this case, treatment is prescribed to maintain life and improve the quality of life of the pet.

External signs of kidney failure begin to appear only when 60% of the kidney tissue has already been destroyed, so it is very difficult to detect the disease in the early stages. Deterioration of the functioning of these organs can be determined by blood and urine tests.

Forms of the disease

With violations in the work of the kidneys, a veterinarian can diagnose chronic (CRF) or acute (ARF) forms of insufficiency.

CRF occurs against the background of any other diseases of the urinary system and requires timely treatment. Otherwise, an intensive process of kidney cell death begins. If the loss of nephrons exceeds 65% of the total mass of organ tissues, then the urinary function of the animal is completely lost.

In order to prevent irreversible processes, it is necessary to systematically check blood and urine tests in breeds with a predisposition to kidney failure, as well as in any dogs that suffer from kidney disease.

Acute renal failure also develops against the background of diseases of the urinary system. Initially, the animal shows only signs of the underlying disease, and after a while its condition deteriorates sharply.

Symptoms

In chronic renal failure, symptoms may be blurred or absent completely. The disease proceeds in several stages, the longer there is no treatment, the more irreversible the processes occur in the body of the animal.

Stages of development of chronic renal failure, and their symptoms:

The initial stage - from time to time the animal becomes lethargic, sleeps a lot, refuses to eat. In this case, only urine and blood tests can indicate a problem.
The stage of compensated insufficiency - the dog drinks a lot, as a result of which the volume of fluid released during urination increases. By increasing the amount of urine, the kidneys manage to cope with the purification of the blood from toxins. In this phase, the physical activity of the animal remains normal.
Decompensation phase - the animal's health deteriorates, its motor activity decreases and its weight decreases. Frequent urination, false urges appear. The pet refuses food, vomiting and diarrhea occur. In addition, at this phase, the dog's vision may deteriorate, and an unpleasant smell from the mouth appears. When conducting urine tests, an excess of red blood cells is found in it.
The terminal stage is a significant deterioration in the state of the body and all its systems. At this stage, there are violations of the heart rhythm, anemia, softening of bone tissue, problems of the gastrointestinal tract, neurological disorders, shock, coma. The combination of these symptoms leads to death.

Signs of acute renal failure develop rapidly. As a rule, this disease manifests itself after the cure of the ailment that caused it.

Symptoms of acute renal failure in dogs:

In the blood test, there is a slight deviation from the norm;
Increased urination;
Reducing the amount of fluid released;
The dog is weakened, does not show interest in communication and games;
Lack of appetite in the animal, nausea and vomiting;
Diarrhea;
The presence of the smell of acetone from the dog's mouth;
There is a slight decrease in the body temperature of the pet.

If your pet shows symptoms of acute renal failure, you should contact your veterinarian to prescribe the correct therapeutic measures. The duration of treatment, started in a timely manner, is 6-12 months.

Diagnostics

To diagnose the disease, the veterinarian conducts a conversation with the owner, studies the symptoms of the disease from the words of the owner of the dog. After that, a careful visual examination of the state of the body, mucous membranes, palpation of the internal organs of the animal is carried out.

Other methods for diagnosing acute renal failure and chronic renal failure:

Blood analysis;
Analysis of urine;
radiography;
Ultrasound of internal organs.
Diagnosis of determining the form of renal failure: chronic or acute.

Based on the results of the examination, the veterinarian prescribes treatment. The use of drugs without the appointment of a specialist in this case is not recommended.

Treatment

Treatment of kidney failure in dogs depends on whether the disease is acute or chronic.

With chronic renal failure, especially in the later stages of the disease, the prognosis for the animal is unfavorable. There is a chance of a cure in the compensated stage of failure, so it is very important to identify a kidney problem as early as possible. In this case, drug treatment and a special diet are prescribed, which includes a sufficient amount of useful substances: fats, salts and trace elements.

Treatment of acute renal failure is carried out in several stages:

Determination and treatment of the root cause of the disease, against which AKI developed;
Restoration of the urinary system: infusion agents, anticoagulants, antiaggregants;
Elimination of metabolic problems, on the basis of which there was a violation of kidney function: intravenous administration of glucose, vitamin-containing solutions, amino acids;
Carrying out detoxification of the body with the help of diuretics.

During treatment, it is necessary to provide the animal with satisfactory living conditions, rest, and most importantly, a balanced diet.

Nutrition principles

In renal failure in animals, it is important to monitor their nutrition. What foods a pet will consume greatly affects the process of healing and recovery. It is better to discuss the features of food selection and the number of feedings in each individual case with a veterinarian.

Principles of nutrition for dogs during kidney failure:

It is necessary to feed the dog foods rich in fats: meat, egg yolk, sour cream, yogurt, coconut or butter;
The use of protein with a minimum content of phosphorus: eggs, meat, special feed;
Exclusion from the animal's diet of phosphorus-containing foods, such as offal, cheeses, fish and bones;
Half of the diet of a sick animal should be cereals with a minimum amount of phosphorus in the composition: rice, semolina, potatoes;
Fish oil, soy, sunflower and corn oils are best excluded from the pet's diet.

On sale there are special feeds for dogs with chronic renal failure. They must be selected on the recommendation of a veterinarian.

chances of recovery

With the diagnosis of acute renal failure, the animal can be completely cured without any consequences in the future. The only condition is that you need to contact the veterinarian immediately after the onset of alarming symptoms.

With chronic renal failure, it will be possible to extend the stage of compensation if the disease is detected in a timely manner. Otherwise, the animal will not live long, since at the moment there is no method for treating the later stages of this disease.

MAIN PROVISIONS

Chronic renal failure (CRF) is the most commonly diagnosed kidney disease in dogs.
Clinical signs of the disease appear only after at least 67% of the renal parenchyma ceases to function.
Diagnosis of early stages of impaired renal function allows timely use of protection techniques, incl. transfer the animal to a special diet and prescribe appropriate drug therapy in order to slow down the development of further lesions of these organs, speed up recovery and improve the quality of life of the animal.
The plasma clearance test for exogenous creatinine can be used in routine veterinary practice.

Chronic renal failure (CRF) is the most commonly diagnosed kidney disease in dogs. It develops as a result of the progressive and irreversible loss of functioning nephrons. Clinical signs of renal failure begin to appear when 67-75% of the renal parenchyma ceases to function. Polyuria and polydipsia are usually the first signs of kidney disease, but they are often overlooked for a long time. It is generally accepted that a decrease in the specific gravity of urine and azotemia (i.e., the excess of the concentration of creatinine and / or urea of the permissible norm) occurs only after the failure of at least 67% and 75% of the renal parenchyma, respectively (Fig. 1). Therefore, CKD is usually diagnosed at a relatively late stage of kidney disease. Over the past 20 years, significant progress has been made in diet therapy and drug treatment of chronic renal failure, but the problem of its early diagnosis is still relevant. Establishing a violation of kidney function at the very beginning of the disease makes it possible to use means to protect these organs from further damage, incl. prescribe a special diet or drug therapy. This will slow down the development of kidney disease, shorten the recovery period and improve the quality of life of sick animals. This publication describes a number of strategic approaches to the detection of renal impairment in dogs with subclinical CKD.

Figure 1. The consequences of kidney disease and the development of uremic syndrome with it.

Informing and educating pet owners, identifying risk factors

CRF is frequently reported in dogs. Therefore, every dog owner should be informed about chronic renal failure, its prevention, manifestations of diagnostic significance, as well as factors contributing to the development of this pathology. Particular attention should be paid to dog breeds that show a predisposition to kidney disease. It is important to reassure breeders that kidney problems can occur even in clinically healthy dogs. Owners should be advised to monitor their pets on a regular basis so that they can judge whether the disease is progressing or not and seek timely help from specialists for further examinations. Well-informed breeders can provide very important information about the water and food intake of their pets, as well as changes in animal body weight.

Risk factors associated with the development of CKD in dogs are poorly understood, but apparently this pathology is most often manifested in adult animals of this species: 45% of dogs with CKD are over 10 years old. This does not mean that any adult dog can get sick, but suggests the need to determine the concentration of creatinine in the blood plasma and specific gravity of urine (URG) in animals as the most important indicators of the health of aging animals. Hereditary nephropathies have been reported in some dog breeds (Table 1), although their incidence remains unknown. These hereditary diseases can develop in puppies, young, adult and aging dogs. If it is suspected that dogs of these breeds have impaired renal function, it is necessary to collect anamnestic data on whether such a disease has occurred in animals of this line (in parents, littermates, other relatives). CRF can be caused by various causes, and the establishment of any of these etiological factors (for example, according to anamnestic data that the animal had had piroplasmosis, hypertension, etc. in the past) (Fig. 2) should serve as a reason for kidney studies.

Figure 2. Causes of Acquired Chronic Renal Failure

Table 1. List of dog breeds in whichregister hereditary nephropathy
Disease	Breed
Amyloidosis	Shar Pei English Fox Terrier
Autosomal dominant nephropathy	bull terrier
Diseases associated with damage to the basement membrane of the kidneys	Cocker Spaniel (autosomal recessive) Doberman Pinscher Samoyed (sexual predisposition)
Fanconi syndrome (renal tubular dysfunction)	Basenji
Glomerular disease	Rottweiler
Glomerulonephritis	Bernese Mountain Dog English Spaniel
Multiple cystadenocarcinoma	German Shepherd
Periglomerular fibrosis	norwegian elkhound
Polycystic kidney disease	Bull Terrier Cairn Terrier West Highland White Terrier
Progressive nephropathy	Lhasa Apso and Shih Tzu
Entero- and nephropathy, accompanied by protein loss
kidney dysplasia	Alaskan Malamug golden retriever Miniature Schnauzer Smooth Coated Wheaten Terrier Poodle standard
Telangiectasia	welsh corgi
Renal glucosuria (impaired renal tubular function)	norwegian elkhound
Unilateral absence of a kidney

Regular assessment of animal water intake, diuresis, appetite and body weight

Polyuria and polydipsia resulting from loss of the ability to concentrate urine are not specific to CKD but are considered early clinical manifestations. It can be difficult for owners to determine how much urine their dogs produce. To accurately determine this indicator, the animal is hospitalized and placed in a metabolic chamber for a day (usually this is used for experimental purposes, and not for routine diagnostic examinations). Before being placed in the chamber and before being released from it, the animal is made to perform the act of urination. An adult dog excretes urine in the amount of approximately 20-40 ml/kg of body weight during the day (in puppies this figure is higher).

Assessing a dog's water intake is much easier, especially when the animal's access to water is controlled. Owners of dogs at high risk for CRF are advised to conduct an annual control determination of their pets' water intake. This indicator is considered normal if it does not exceed 100 ml / kg of body weight. The volume of water drunk daily by animals is variable, as it depends on a number of factors, incl. physical activity, air temperature, type of diet, etc. Therefore, the measurement of the amount of water consumed by the dog is carried out for 3-4 days in a row. To avoid subjectivity in determining this indicator, the dog owner needs to weigh a bowl of water 2 times a day (with an interval of 24 hours).

Some decrease in appetite and body weight, although not specific to CRF, often accompanies this pathology. Daily feed intake is estimated by weighing it at each giving to the animal. When changing diets, an animal's appetite may change depending on how attractive the new food is to them. Weighing animals is less subjective, but should be done regularly and on the same scales.

Indirect assessment of kidney function based on the results of repeated studies of blood plasma and urine

This article discusses the possibility of diagnosing CRF only in those animals in which this pathology is asymptomatic or manifests itself with mild clinical signs. The best markers of kidney function in this situation are creatinine and urine specific gravity.

Plasma creatinine concentration

Creatinine is constantly produced in the muscles as a result of creatine metabolism. It is excreted from the body only in the urine, being completely filtered in the kidneys through the glomeruli and only slightly secreted in the renal tubules. Plasma creatinine concentration is considered the best indirect indicator of kidney function, although many factors influence the accuracy of its determination.

In this regard, it is impossible to discount the influence of various factors acting before taking the analysis and during its implementation. Blood samples for its implementation should be taken from animals on an empty stomach (a 12-hour overnight fast is enough). Most foods contain some creatinine, so after taking them, dogs can experience an increase in its blood concentration above the acceptable level, which causes non-specific test readings. Physical activity does not lead to a significant change in the concentration of creatinine in the blood plasma in dogs. Plasma creatinine concentration is better determined by the enzymatic method, and not by the Jaffe method, since the indications of the latter are influenced by an increased (> 50 μmol / l) concentration of bilirubin in the blood.

Figure 3. Dependence of plasma creatinine concentration and glomerular filtration rate (GFR) is graphically expressed by a curved line. This indicates an early stage of renal dysfunction, manifested by a decrease in GFR and a corresponding slight change in plasma creatinine concentration. In contrast, dogs with severe renal insufficiency show significant fluctuations in plasma creatinine levels, with relatively limited fluctuations in GFR.

It is believed that an increase in the concentration of creatinine in the blood plasma indicates a decrease in the functional state of the kidneys. The dependence of this indicator and GFR is graphically depicted by a curve (Fig. 3). Meanwhile, the concentration of creatinine in blood plasma depends on a combination of factors such as the formation, distribution and excretion of creatinine from the body. This means that this indicator can be increased in dogs with developed muscles or suffering from dehydration. In animals with renal insufficiency, endogenous creatinine production is reduced (2). As a consequence, elevated plasma creatinine does not necessarily correlate with GFR, as creatinine production can also be reduced as a result of decreased muscle mass. Dehydration can lead to a decrease in the volume of distribution of creatinine, which depends on the total body water supply. However, dehydration usually occurs only in the later stages of CKD.

A once determined concentration of creatinine in the patient's blood plasma is usually compared with the maximum allowable value of this indicator. If the concentration of creatinine in the blood of the animal is higher than the latter, then the presence of kidney pathology is assumed, and if it is below the permissible level, then the animal is considered healthy. But in some situations this approach is wrong. Literature data on the permissible value of such an indicator are very variable (Fig. 4), which is partly due to the characteristics of the populations of dogs in which blood testing was performed, its dependence on age, breed, and a number of other factors. In dogs of different breeds and animals of different ages, the normal concentration of creatinine in the blood is not the same. For example, it is higher in adult dogs compared to puppies, as well as in breeds of dogs with more developed muscles. Therefore, one should be very careful in interpreting a slight excess of this indicator of the norm. Impaired renal function can also occur in cases where the concentration of creatinine in the blood plasma remains within the normal range.

Figure 4. Various allowable values for canine plasma creatinine levels (according to veterinary guidelines or from Reflotron, Kodak and Vettest analyzers). There are significant discrepancies between data obtained from different sources, which may be due to differences in control samples or methods of analysis

Nevertheless, even the results of a single determination of the concentration of creatinine in blood plasma provides valuable diagnostic information, on the basis of which the International Renal Interest Society has recently proposed a classification of stages of CRF in dogs and cats, based on the value this indicator (table 2).

Table 2. ClassificationdiseaseskidneyAndkidney failuredogs (ByIRIS*)
stagesdiseaseskidney Andrenalinsufficiencydogs
Plasma creatinine concentration (µmol/l)			181 - 440 2.1 to 5.0
IRIS: International Renal Interest Society

Significantly more accurate readings are obtained by serially determining the concentration of creatinine in the blood plasma in a dog for some time (for example, one year). At the same time, it is important to standardize the conditions for testing in order to to avoid the influence of factors that complicate the interpretation of the results. So, for example, blood should be taken from the dog on an empty stomach each time, the same testing method should be used, and the body condition of the animal should not change throughout the entire study period. Blood plasma samples are stored until the study is frozen (at a stable temperature not exceeding -20°C). When it is time to study the next blood plasma sample, the one taken the previous time is thawed and examined simultaneously with the last one. This establishes a "critical change" in the measurable index, which is the minimum difference between two consecutive levels of plasma creatinine concentration and reflects biologically significant changes in kidney function in healthy dogs. dl).

When a dog suddenly develops significant changes in the concentration of creatinine in the blood plasma, their relationship with the state of health of the animal is checked by a repeated study, which makes it possible to exclude diagnostic errors (Fig. 5).

Figure 5. Variation in plasma creatinine due to analytical errors. From the blood plasma samples of the dogs, they were blinded twice in the same laboratory. Very large discrepancies in the results of testing one sample were obtained - 0.7 (62 µmol/l) and 2.1 mg/dl (186 µmol/l). These observations indicate the need to re-examine serum samples in cases of unexpectedly high or low readings compared to previous plasma results from the same animal.

Specific Gravity of Urine (SPM)

TPM is the ratio of the mass of a certain volume of urine to the mass of the same volume of pure water at the same temperature. UPM is determined using a refractometer. Changes can occur already at the initial stage of renal failure. However, TMR - highly variable even in healthy dogs - can change with the animal's water intake and diet. The TFR also varies from day to day, from one sample to another. When the body is normally hydrated, the BMR usually ranges from 1.015 to 1.045, but can decrease to 1.001 or increase to 1.075. If the TMR rises above 1.030, the dog begins active resorption of water from the renal tubules and collecting ducts of the kidneys. With a decrease in the UPM below 1.008, the animal begins the resorption of salts from the filtrate located in the renal tubules. In both cases, the kidneys compensate for these changes. When determining the RPM, the degree of hydration of the animal's body is taken into account: too low RPM (<1,030) на фоне обезвоживания организма указывает на первичную дисфункцию почек или другие причины, повлекшие за собой снижение концентрирования мочи. Однако возможна и такая ситуация, когда при обезвоживании организма у собаки с субклиническим нарушением функции почек УПМ оказывается выше 1.030. Из-за вариабельности УПМ однократно выявленные изменения этого показателя не обязательно указывают на полиурию, но критериями последней служит персистентное значение УПМ в пределах от 1,008 до 1,029. Сопутствующая азотемия дает больше оснований подозревать наличие заболевания почек, но не позволяет поставить окончательный диагноз.

Other indicators

Plasma urea (or "blood urea nitrogen") concentration is also important in the diagnosis of clinical CKD. A number of researchers believe that this indicator correlates better with the clinical signs of the latter than the concentration of creatinine in blood plasma. However, plasma creatinine seems to be a better reflection of GFR decline than blood urea, due to the presence of many extrarenal factors that can affect the value of the latter indicator. These factors include feeding and starvation, metabolic activity of the liver, dehydration, etc. Therefore, the concentration of creatinine in the blood plasma is more important for diagnosing the early stage of impaired renal function and the latter in subclinical cases.

Electrolyte disturbances (hyperphosphatemia, hypokalemia, hypocalcemia) are noted during a period of significant impairment of kidney function, but they are absent in the early subclinical stages.

Proteinuria can develop at any stage of CRF. and its intensity is largely determined by the etiology of the disease. When proteinuria is detected, additional studies are necessary to establish the cause of the disease. However, in many animals with CRF, proteinuria is mild.

Testing the ability of the kidneys to concentrate urine

With chronic renal failure, the ability of the kidneys to concentrate urine decreases, but other factors also influence the value of the ULR, incl. treatment with diuretics and glucocorticoids, glucosuria, diabetes insipidus, imbalance of basic electrolytes. The test, based on the restriction of the dog in water, allows you to evaluate the concentrating activity of the kidneys in polyuria or polydipsia without determining their causes. It should not be used to examine dogs suffering from dehydration and/or azotemia, as its administration in such cases is associated with the risk of harm to the health of animals and since dehydration in patients with low TLR is itself evidence of the loss of the ability of the kidneys to concentrate urine. This test can be carried out in two versions (table 4). However, its sensitivity in the diagnosis of early stage CKD has not been documented.

Table 4. Tests, foundedonlimitationgiving to an animalwater
An approach	Description
Sudden cessation of summer residencewater	Conditionsholding	The test on an empty stomach is preferable. Before it is performed, the degree of hydration of the body must be sufficient.
	Procedure	1. Determination of the degree of hydration, giving the dog the opportunity bladder emptying, determination of UPM and body weight. 2. Depriving the animal of access to water. 3. Determination of the dog's body weight, degree of hydration and TMR (4 hours after depriving the animal of access to water).
	Interpretation	Testing is completed when: UPM becomes higher than 1.040 (this excludes CRF and diabetes insipidus, but allows for the possibility of psychogenic polydipsia); Or if the body weight of the animal decreases by more than 5% (with a TMR below 1.030, the presence of CRF, diabetes insipidus and damage to the renal medulla are allowed; with RPM within 1.030-1.040 do not draw definite conclusions and conduct a test based on the gradual deprivation of the dog of water).
Gradual deprivationdogswater	Terms and Conditions	Carried out when the previous test does not allow diagnosing the disease
	Procedure	The animal is given water for 3 days in a limited amount. For example, at first its volume is reduced to 75%, then sequentially by 50% and 25% compared to the initial level until its giving is stopped. Then the animal is examined in the same way as in the previous test.
	Interpretation	The same as in the evaluation of the results of the previous test

Direct method for determining GFR

GFR is currently considered the best direct indicator of kidney function. Over the past 30 years, many new methods for determining this indicator have been proposed and tested, based on determining the clearance of certain markers in urine and blood plasma from the corresponding marker.

Urine and plasma clearance, application restrictions

Determination of inulin clearance in urine is considered a reference method for assessing GFR. The calculation is simple, and for its implementation it is necessary to know only three indicators: the volume of urine excreted by the animals for a certain period, as well as the concentration of the marker in the urine and blood plasma. Despite providing valuable diagnostic information, urine clearance tests are rarely used in veterinary practice, because they are time consuming and labor intensive. In addition, it is necessary to collect urine at a certain time, and in the process of frequent catheterization, the risk of injury and infection of the urinary tract of animals increases. While the dog is in the metabolic chamber, urine collection can be limited to 24 hours, but there is a need for repeated washings of the chamber to maximize the collection of the marker, the remains of which in subsequent tests can cause an incorrect determination of clearance.

For these reasons, tests designed to determine plasma clearance (especially those involving a single intravenous administration of a marker) are considered an alternative to appropriate urinalysis in cases where urinary excretion of the marker is negligible. The main advantage of the test, which determines GFR by its clearance from blood plasma after a single intravenous injection of a marker, is that only one blood sample is required to obtain a result. Radiopaque agents (eg, iohexol and iothalamate), inulin, various radioactively labeled substrates, and creatinine are used as markers. These tests have a number of limitations. For example, radioactively labeled nucleotides cannot be used in routine diagnostic practice due to safety and legal restrictions. The detection of most of the available markers is difficult, expensive, or simply not available to the conventional veterinary clinic. The iohexol test requires a rather large volume of blood plasma (3-4 ml, i.e. approximately 8 ml of blood), which is too much for small breed dogs. This marker is detected by a specific fluorescent glow in x-rays. Finally, the determination of plasma clearance, which is the ratio of the dose of a marker administered to an animal and the area under the curve of its plasma concentration (AUC) over time, requires complex calculations (data modeling using exponential equations), which discourages veterinary practitioners. from its application.

Plasma clearance test for exogenous creatinine (ECPEC)

TCPEC was developed recently and tested on dogs in comparison with known methods for assessing GFR (tests to determine the clearance of inulin and endogenous creatinine in the urine, blood plasma from iothalamate). Plasma and urine clearance from creatinine is consistent with GFR in dogs. With its help, it is possible to diagnose subclinical kidney dysfunction in this animal species. The main advantage of TCPEC is the ability to determine the baseline plasma creatinine concentration, which provides a direct estimate of GFR, regardless of the volume of distribution and endogenous production of creatinine.

The main stages of the TCPEC

> Determination of fasting baseline (initial) plasma creatinine concentration before the test.
> Intravenous administration of a certain amount of creatinine.
> Determination of plasma creatinine concentration.

Calculation of blood plasma clearance.

The main advantages of TKPEC:

> The test can be performed in normal veterinary practice because it is simple, easy to perform (intravenous marker injection and blood sampling) and time-consuming.
> Only 1 ml of blood is needed to obtain a result, which makes it possible, if necessary, to re-sample blood from small breed dogs or puppies, and, in addition, limits the number of manipulations performed on the animal.
> Creatinine is safe: an increase in the plasma concentration of creatinine in CRF dogs after intravenous administration to 8000 µmol/l (90 mg/dl) does not lead to undesirable side effects.
> There is no need to resort to the services of specialized laboratories, because Plasma creatinine concentration can be quickly determined using a conventional veterinary chemistry analyzer.
> The results of the test are received immediately after it is set.
> Determination of creatinine clearance does not require complicated calculations
> TCPEC does not require large financial outlays.

There are no commercial preparations of creatinine - they have to be prepared independently, although preparations are underway for the production of this reagent.
- The last blood sample must be taken from dogs for examination no later than 6 hours after administration of creatinine. Therefore, the dog has to be hospitalized for the whole day during the test.
- Limits of normal GFR values for dogs have not been definitively defined. Currently, the maximum allowable value of this indicator is 1.5 ml / kg / min, but the results of further studies may make their own adjustments.

Conclusion

The fight against CRF is one of the main problems in ensuring the health of small domestic animals. Currently, its early diagnosis is difficult, because in the initial stages of chronic renal failure is asymptomatic. However, a number of useful actions can be taken in this direction: informing pet owners about this pathology, regular examination of their pets, including determination of changes in TLR and plasma creatinine concentration in their blood over time, and assessment of GFR (if available in this need). The main hope is that early diagnosis of CRF will help to start treating a sick animal in a timely manner and transfer it to a special diet, which will both prolong the patient's life and improve its quality.

Herve P. Lefebvre
Herve P. Lefebvre, DVM, PhD, Dipl ECVPT, Professor of Physiology
Jean-Pierre Bron
Jean-Pierre Braun, DVM, PhD, Dipl ECVCP, Professor of Biochemistry, Physiology and Therapy, Department of Pathophysiology and Experimental Toxicology, National Veterinary School in Toulouse, France
A. David J. Watson
A. David J. Watson, BVSc, PhD, FRCVS, FAAVPT, MACVSc, Dipl ECVPT,
Associate Professor of Veterinary Medicine, Department of Veterinary Sciences, University of Sydney, Australia