While kidney disease is frightening, many dogs can live happily with it for years if diagnosed early and treated correctly. 

Most pharmaceuticals used to treat kidney disease in dogs primarily aim to alleviate clinical signs, but providing the proper diet can significantly impact survival. Studies have shown that dogs with kidney disease-specific diets survive substantially longer than those with commercial diets.

Kidney disease in dogs is when the kidneys, vital organs for filtering waste and toxins from the body, are not functioning correctly. When the kidneys are not working well, waste products and excess fluids build up in the body, leading to various health issues.

There are two main types of kidney disease in dogs:

Acute Kidney Injury (AKI): This occurs suddenly, often due to ingesting a toxin or having a severe infection. It can be serious but may improve with proper treatment if caught early.

Chronic Kidney Disease (CKD): This is a long-term condition where the kidneys gradually lose their ability to function correctly. It is more common in older dogs and may worsen over time.

Clinical signs of kidney disease in dogs can include increased thirst and urination, loss of appetite, weight loss, lethargy, weakness, vomiting, diarrhea, and bad breath with a chemical or ammonia-like odor.

Kidney disease is a relatively common condition in dogs, especially in older animals. The prevalence of kidney disease can vary depending on factors such as the dog's age, breed, diet,  and overall health status.

Estimates suggest that approximately 0.5% to 1% of all dogs are affected by chronic kidney disease (CKD). However, this percentage increases significantly in older dogs, where the prevalence of CKD can be as high as 10% to 30%.

Certain dog breeds, such as the Cavalier King Charles Spaniel, Bull Terrier, and Miniature Schnauzer, have a higher genetic predisposition to kidney disease. In these breeds, the prevalence may be even higher.

The prevalence of kidney disease may continue to evolve as veterinary medicine advances, leading to better detection, diagnosis, and management of the condition.

There are several measurements used to assess kidney function in dogs. These measurements help your veterinarian evaluate how well the kidneys work and detect any signs of kidney disease. Some of the standard measures of kidney function include:

The glomerular filtration rate, or GRF, is considered one of the most accurate indicators of kidney function. It measures how efficiently the kidneys filter waste and excess substances from the blood per unit of time. GFR is usually estimated based on blood creatinine levels and takes into account factors such as age, sex, and weight.

The Symmetric Dimethylarginine (SDMA) test is another diagnostic blood test used to assess kidney function in dogs. It is a relatively newer and more sensitive marker for kidney health than traditional kidney function tests, such as blood urea nitrogen (BUN) and creatinine. The SDMA test is particularly valuable for detecting kidney disease in its early stages when other kidney function tests may still appear within normal ranges.

Blood Urea Nitrogen (BUN) is a blood test that measures the nitrogen level in the blood resulting from the breakdown of proteins. Elevated BUN levels can indicate kidney dysfunction or dehydration, but it is not a specific measure of GFR. 

Serum creatinine levels are another standard test for kidney function. Creatinine is a waste product produced by muscle metabolism. Blood creatinine levels are commonly used to estimate GFR because the kidneys filter creatinine out of the blood. Elevated creatinine levels can indicate reduced kidney function.

The test results for BUN and creatinine will also report a BUN: creatinine ratio. The BUN: creatinine ratio is calculated by dividing the BUN value by the creatinine value. This ratio can provide information about hydration status and the possible cause of elevated BUN levels.

Your veterinarian will compare your dog's results to the established reference range for that specific blood test. A reference range, also known as a normal range, is a range of values for a specific blood test or other medical test considered typical and healthy for a specific dog population. This range is determined by analyzing the test results in a large group of healthy individuals and identifying the range within which most of their values fall.

The reference range consists of two values: lower and upper limits. Anything below the lower limit or above the upper limit is reported as abnormal or outside the expected range. 

However, dogs fed raw or cooked (fresh) food diets are likely to have BUN and creatinine levels at the higher end of the reference range or even outside of the reference range because of the high-quality protein in their diet! You must let your veterinarian know that you are feeding your dog fresh, real food to allow for the correct interpretation of blood test results.

Blood tests to determine the sodium, potassium, and bicarbonate levels help evaluate kidney function and detect electrolyte imbalances.

The veterinarian will also examine your dog’s urine for various substances, including protein, glucose, blood cells, and specific gravity. Abnormal findings in the urine can provide valuable information about kidney health. The urinalysis will include a protein: creatinine ratio that assesses the amount of protein in the urine relative to creatinine. An elevated ratio can be a sign of kidney damage or disease. However, again, this can be naturally elevated in a raw-fed dog.

Another urine test is the Fractional Excretion of Electrolytes (FE), which compares the amount of certain electrolytes filtered by the kidneys with the amount excreted in the urine. It can help distinguish different causes of kidney dysfunction.

Many veterinarians will want to visualize what is happening with your dog’s kidney through radiographic imaging. Imaging tests like ultrasound or CT scans can detect the kidney's and surrounding tissues' physical or structural abnormalities. 

These measurements are combined to provide a comprehensive evaluation of kidney function. Additionally, normal ranges for these tests may vary depending on factors such as age, sex, breed, and diet, so veterinarians must interpret the results in the context of the individual dogs' specific characteristics.

The treatment of CKD in dogs aims to slow the progression of the disease, manage clinical signs, and improve the dog's quality of life. While CKD is a progressive condition that cannot be fully cured, early detection and appropriate management can significantly improve the prognosis and help dogs live comfortably for an extended period. The treatment plan may include:

Dietary Management: Feeding a species-appropriate fresh food diet is crucial in managing CKD in dogs. Studies have shown that a protein decrease can decrease the GFR, causing the CDK to progress faster. Feeding high-quality proteins from organically and pasture-raised animals is essential.

Fluid Therapy: Ensuring adequate hydration is essential for dogs with CKD. Intravenous or subcutaneous fluid therapy may be necessary to reestablish hydration levels and support kidney function. Providing your dog bone broth or kefir in her meals and as supplements to the meals will encourage your dog to stay hydrated. 

Medications: Various medications may be prescribed to manage clinical signs and complications associated with CKD. These may include drugs to control blood pressure, manage anemia, treat gastrointestinal issues, and prevent excess phosphorus levels. 

Supportive Care: Dogs with CKD may experience nausea, vomiting, or loss of appetite. Supportive care, such as anti-nausea, appetite stimulants, herbs, or other natural supplements, can help improve their comfort and food intake. 

Regular Monitoring: Regular follow-up visits to the veterinarian are essential for monitoring the dog's kidney function, adjusting the treatment plan as needed, and addressing any changes in their health status.

Stress Reduction: Depending on the severity of CKD, lifestyle changes are recommended to reduce your dog’s stress levels. Providing a safe space away from the daily commotion of the household and easing the toxin levels in your dog’s environment. Reduction of toxins includes using pet-safe and non-toxic household cleaners, detergents, and air fresheners, natural alternatives for controlling fleas, ticks, and other pests, and pet-safe or organic lawn care products. 

Dog parents must work closely with their veterinarian to create a customized treatment plan for their dog’s needs. Early diagnosis, diligent management, and a caring approach can significantly improve the quality of life and longevity of dogs with chronic kidney disease.

What Changes in Nutrition Should be Made?

Despite the advice from most veterinarians, dogs with CKD should not be fed a reduced protein diet. Based on a faulty study performed on rats, veterinarians have been led to believe that too much protein damages the kidneys and that limiting protein intake delays the progression of renal disease. They often recommend that senior dogs  be automatically switched to a lower protein diet to prevent future kidney disease.

However, additional studies using dogs disproved this theory and showed that dogs fed lower protein levels had a higher mortality rate. An article published over 50 years ago revealed that switching dogs from dry dog food to a meat-based diet benefited the dogs’ kidneys by improving the glomerular filtration rate. 

Another study revealed that dogs fed a reduced-protein diet failed to adjust renal tubular excretion of sodium and phosphate, leading to further kidney damage. 

Several pet food companies now sell low-protein prescription diets for dogs with chronic kidney disease, and dog owners who make their bowls at home are advised to avoid feeding their dogs red meat, poultry, and other high-protein meals. However, if a dog is fed a diet deficient in protein, the body will scavenge protein from the muscle tissue.

Rather than decrease the protein intake, you need to reduce the phosphorus levels by lowering the organ content and feeding lean meats. You should also limit sodium intake, as excessive sodium can contribute to fluid retention and worsen hypertension (high blood pressure) in dogs with CKD.

Understanding the fat content associated with different types of meat will allow you to select the best meat for your dog’s bowl. Muscle meats  with the lowest fat content are quail, wild rabbit, turkey, emu, goat, camel, and kangaroo.

Meats containing moderate fat include domesticated turkey, rabbit, venison, bison, ostrich, and veal. And meats to avoid due to the high-fat content include duck, goose, lamb, pork, and beef.

Adding small fatty fish such as herring, sardines, anchovies, or capelin is beneficial due to their high levels of Omega-3 fatty acids, which have anti-inflammatory and antioxidant properties. Inflammation and oxidation can contribute to kidney damage and worsen the disease. 

You must ensure your dog’s diet contains adequate moisture to help with hydration. Dogs with CKD are prone to dehydration, and incorporating moisture-rich foods and adding bone broth or kefir to their meals will help to support their kidney function. 

Your dog’s drinking water should be filtered or bottled unless you have good well water. Municipal tap water is full of impurities such as chloride, fluoride, and residual prescription medications, all of which must be filtered through the already weakened kidneys. 

Fruits and vegetables can also be added to your dog’s diet for variety and to provide vitamins, minerals, and other nutrients that nourish the body. Vegetables that are hydrating and low in potassium are best, including green beans, cabbage, zucchini, cucumber, and celery. Fruits should be low in phosphorus, like apples, blueberries, and cranberries. 

Synthetic vitamins and minerals should be avoided as they are not nearly as bioavailable as their natural counterparts and must be excreted by the kidneys.

Several herbs are beneficial to dogs suffering from chronic kidney disease. 

Milk Thistle (Silybum marianum), although commonly used to support liver health, also benefits the kidneys. It contains a compound called silymarin, which has antioxidant properties and may help protect kidney cells.

Dandelion (Taraxacum officinale) and Nettle (Urtica dioica) have diuretic properties and help support kidney function by promoting urine production and flushing out toxins. They are often used in herbal blends for kidney support.

Clinical signs of kidney disease in dogs can include increased thirst and urination, loss of appetite, weight loss, <a href="https://feedreal.com/glossary/lethargy">lethargy</a>, weakness, vomiting, diarrhea, and bad breath with a chemical or ammonia-like odor.

The glomerular filtration rate, or GRF, is considered one of the most accurate indicators of kidney function. It measures how efficiently the kidneys filter waste and excess substances from the blood per unit of time. GFR is usually estimated based on blood <a href="https://feedreal.com/glossary/creatinine">creatinine</a> levels and takes into account factors such as age, sex, and weight.

Serum creatinine levels are another standard test for kidney function. Creatinine is a waste product produced by muscle <a href="https://feedreal.com/glossary/metabolism">metabolism</a>. Blood creatinine levels are commonly used to estimate GFR because the kidneys filter creatinine out of the blood. Elevated creatinine levels can indicate reduced kidney function.

The veterinarian will also examine your dog’s urine for various substances, including protein, <a href="https://feedreal.com/glossary/glucose">glucose</a>, blood cells, and specific gravity. Abnormal findings in the urine can provide valuable information about kidney health. The urinalysis will include a protein: creatinine ratio that assesses the amount of protein in the urine relative to creatinine. An elevated ratio can be a sign of kidney damage or disease. However, again, this can be naturally elevated in a raw-fed dog.

Despite the advice from most veterinarians, dogs with CKD should not be fed a reduced protein diet. Based on a faulty study performed on rats, veterinarians have been led to believe that too much protein damages the kidneys and that limiting protein intake delays the progression of renal disease. They often recommend that <a href="https://feedreal.com/articles/your-senior-dogs-raw-diet">senior dogs</a>  be automatically switched to a lower protein diet to prevent future kidney disease.

Understanding the fat content associated with different types of meat will allow you to select the best meat for your dog’s bowl. <a href="https://feedreal.com/articles/proper-protein-in-your-dogs-bowl">Muscle meats</a>  with the lowest fat content are quail, wild rabbit, turkey, emu, goat, camel, and kangaroo.

Meats containing moderate fat include <a href="https://feedreal.com/glossary/domesticated">domesticated</a> turkey, rabbit, venison, bison, ostrich, and veal. And meats to avoid due to the high-fat content include duck, goose, lamb, pork, and beef.

Adding small fatty fish such as herring, <a href="https://feedreal.com/glossary/sardines">sardines</a>, anchovies, or <a href="https://feedreal.com/glossary/capelin">capelin</a> is beneficial due to their high levels of <a href="https://feedreal.com/glossary/omega3">Omega-3</a> <a href="https://feedreal.com/glossary/fatty-acids">fatty acids</a>, which have anti-inflammatory and antioxidant properties. <a href="https://feedreal.com/glossary/inflammation">Inflammation</a> and <a href="https://feedreal.com/glossary/oxidation">oxidation</a> can contribute to kidney damage and worsen the disease. 

Your dog’s drinking <a href="https://feedreal.com/glossary/adenosine-triphosphate">water</a> should be filtered or bottled unless you have good well water. Municipal tap water is full of impurities such as chloride, fluoride, and residual prescription medications, all of which must be filtered through the already weakened kidneys. 

Synthetic vitamins and minerals should be avoided as they are not nearly as <a href="https://feedreal.com/glossary/bioavailable">bioavailable</a> as their natural counterparts and must be excreted by the kidneys.

Dandelion (Taraxacum officinale) and Nettle (Urtica dioica) have <a href="https://feedreal.com/glossary/diuretic">diuretic</a> properties and help support kidney function by promoting urine production and flushing out toxins. They are often used in herbal blends for kidney support.

Marshmallow Root (Althaea officinalis) has soothing and anti-inflammatory properties and may help reduce irritation and inflammation in the urinary tract.

Astragalus (Astragalus membranaceus)is an adaptogenic herb that supports the immune system and overall kidney health.

Medicinal mushrooms for anti-inflammatory and immune support

Monitoring the progression of CKD is imperative to ensure that you provide the proper diet and environment to maintain your dog comfortably for as long as possible. Repeating bloodwork regularly will allow you to determine if other dietary changes are necessary. Finding a holistic or integrative veterinarian will make using real foods and natural supplements easier, as they will be willing to support you and your dog through this journey.

<a href="https://pubmed.ncbi.nlm.nih.gov/11990962/">Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs</a> 

<a href="https://pubmed.ncbi.nlm.nih.gov/6711979/">Influence of reduced protein diets on morbidity, mortality, and renal function in dogs with induced chronic renal failure</a> 

<a href="https://pubmed.ncbi.nlm.nih.gov/6625324/">Influence of modified protein diets on the nutritional status of dogs with induced chronic renal failure</a> 

<a href="https://pubmed.ncbi.nlm.nih.gov/27540513/">The effect of renal diet in association with enalapril or benazepril on proteinuria in dogs with proteinuric chronic kidney disease</a> 

<a href="https://pubmed.ncbi.nlm.nih.gov/9605110/">Beneficial effects of chronic administration of dietary omega-3 polyunsaturated fatty acids in dogs with renal insufficiency</a> 

<a href="https://www.merckvetmanual.com/urinary-system/noninfectious-diseases-of-the-urinary-system-in-small-animals/renal-dysfunction-in-small-animals">Renal Dysfunction in Small Animals - Urinary System - Merck Veterinary Manual</a> 

<a href="https://www.sciencedirect.com/science/article/abs/pii/S0022316622179897">Influence of Dietary Protein on Renal Function in Dogs </a> 

<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356378/#:~:text=Symmetric%20dimethylarginine%20(SDMA)%20is%20a,decreases%20%5B9%2C10%5D">Evaluation of Symmetric Dimethylarginine (SDMA) in Dogs with Acute </a>Pancreatitis<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356378/#:~:text=Symmetric%20dimethylarginine%20(SDMA)%20is%20a,decreases%20%5B9%2C10%5D"> - PMC. </a> 

What to Feed a Dog with Kidney Disease

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