Get help navigating end of life care and euthanasia decisions in dogs with kidney disease. Learn what symptoms to watch for that may indicate your dog is in pain and when to let them
Kidney disease in dogs is a complex and challenging condition to navigate. You may be here to find exact answers but what you will find is there are no easy answers. Every dog is different as such, every case of kidney disease is different. We will review basic kidney function, the definition of kidney disease, how to help your dog at home and explore when it is time for euthanasia. Armed with knowledge and a good relationship with your veterinarian, you can help your dog during this very difficult time.
The kidneys are amazing little organs that remove toxins from the body. Blood is filtered through the kidneys and the toxins are pulled out and excreted in urine. The kidneys also keep vital electrolytes in balance, manage blood pressure, produce urine, maintain water balance in the body, signal the bone marrow to make new red blood cells and regulate calcium and phosphorus levels. As you can see, it is a big job, and the kidneys play a large part in keeping the body in balance. Luckily, the kidneys are tough and have a large reserve, therefore they can withstand minor insults over the course of a dog’s life and still maintain homeostasis (biological stability).
When the kidneys are damaged significantly, they begin to lose function and the body's homeostasis is thrown off. Toxins start to build up and the systems that are so delicately managed go off the rails. Insults to the kidney can come on suddenly (acutely) or they can happen over a long period of time (chronic). Acute disease happens when there is a direct incident that causes major damage to the kidneys. Your dog may become very sick, very fast. This requires immediate and swift action as treatment is necessary and can improve prognosis. Chronic kidney disease sneaks up on you slowly and you may not notice until changes in blood tests are identified by your veterinarian.
One of the challenges with kidney disease is that symptoms are not unique to this disease process alone. Initial symptoms can resemble other metabolic conditions, such as Cushing’s Disease or Diabetes Mellitus in dogs. Therefore, it is important to perform diagnostic testing to be sure the correct condition is identified. Symptoms of kidney disease may be subtle weight loss, an increase in thirst (polydipsia) and an increase in urination (polyuria).
As the disease progresses, new symptoms may arise and should be addressed with your veterinarian. Those symptoms are weight loss, decreased appetite, weakness, drooling, lethargy, vomiting, diarrhea, bad breath, sores in his/her mouth and pale gums.
Treatment will be dictated by the stage of disease and whether there are any other comorbidities present. Often for acute disease, there is a need to administer intravenous fluids to help flush out the toxins that are affecting the kidneys. Other treatments may include anti-nausea medications, blood pressure medication and appetite stimulants if your dog is not eating well.
If your dog has chronic kidney disease you may not even know it. This can sometimes make the diagnosis shocking as you may not have noticed any symptoms. Treatment depends on severity and can be guided based on the stage of disease. Your veterinarian will use the IRIS staging guidelines to identify the appropriate stage and treatment will be instituted.
Intravenous fluids may be necessary if your dog is having an acute episode of the chronic disease. This is called Acute-on-chronic renal disease. Other treatment options may include diet change, periodic subcutaneous fluids, blood pressure medications, potassium supplements, phosphate binders, anti-nausea medications, and medications to help soothe the mouth. As the disease progresses these treatments are gradually added on as new symptoms arise.
As you can see this disease can be complicated and challenging to treat. It can be overwhelming and unsettling to have to see your dog deteriorate. Progression of disease is variable, and some dogs stay stable in early kidney disease for years. They may progress later on in life or if a major insult to the kidneys occur. Some dogs are diagnosed and despite all the treatments available they progress to end stage failure rapidly. Response to treatment can sometimes give us a better idea of prognosis and can help guide decisions that need to be made.
This can be the hardest part to handle as a dog owner. It’s important to take care of yourself throughout this process and be sure to have an idea of what you are prepared to handle emotionally and financially. The reality is that the financial side of a disease like this can be challenging. Monitoring these patients requires consecutive appointments for blood work to check progress and alter treatment plans.
It is normal to wonder if your dog is suffering when diagnosed with kidney disease. Unfortunately, there is not a clear-cut answer, and this determination needs to be made based on each case. For many dogs, they can live with managed kidney disease for a long time with very few problems. They may need to go to the bathroom more often, but this is not causing them pain. In contrast, another dog may get to the point in the disease where the kidneys are not working any longer and the toxins build up in the body. This can lead to painful sores in the mouth, and can be uncomfortable. There are treatments that help (ex: magic mouthwash), but these only treat the symptoms; the inciting cause is still present. Due to the variability of disease, it is important to discuss new symptoms and changes in behavior with your veterinarian. A new symptom may mean that your beloved dog is entering into the next phase of the disease. It may also mean that medications or frequency of fluid administration may need to be altered.
In addition to following your veterinarian’s treatment plan you can also try to keep your dog as comfortable as possible while at home. Managing the conditions at home that may cause your dog stress will help his overall wellbeing.
Knowing when to euthanize can vary for each dog and person. Remember that there isn’t always an exact time, but a window where it is appropriate to make the decision to let them go. Sometimes, you can look at your beloved dog and know that the light is gone. The fight is over, and they are ready. Sometimes you cannot see the light go out, but you can see their bodies fail them. It is important to be able to look at your dog objectively and know when things change. Helpful tools are out there such as this Pet Quality Life Assessment quiz.
It can be helpful to keep a list of 6-8 characteristics that make your dog unique and truly “your dog”. When more than half of those things can no longer happen, it is often within that window of time. It is also important to remember that not all dogs will stop eating. It is instinctual for dogs to eat until the very end even when the rest of their body is failing, so it is not always a fair assessment of your dog’s quality of life. For this reason, you should not use one individual quality to make the decision to let them go.
Your veterinarian can help you determine if your dog’s quality of life has diminished. They can stand back and assess the situation more objectively . Together, you can make an informed decision so that you can feel comfortable that you are doing the right thing.
Humane euthanasia of your beloved dog is always an emotional and challenging decision. It is wise to think about how you want to have this done so that you are prepared, and you do not have to make decisions when you are panicked or in an emergency. A wonderful option is In-home euthanasia. When the veterinarian comes to you, the process can be one of the most beautiful, rewarding experiences. The stress level is lower because you are in the comfort of your own home with no distractions. Your veterinarian will give an injection of sedatives, and this will allow your dog a peaceful slumber while veins are accessed for the final injection. Other benefits of letting your pet pass at home are that family, both human and four legged, can be nearby to say goodbye.
The end stages of kidney disease occur when the kidneys no longer work, and the body is not responding to treatment. Your dog may become very lethargic, or sleepy, and have a hard time rising. They likely have lost a great deal of weight and their appetite is usually diminished. They may be too nauseous to keep food down. Confusion is often a sign of late-stage disease and is caused by the toxins present in the blood stream.
Communication with your veterinarian is imperative during this time. Medications may be altered, and frequency of subcutaneous fluid administration can be increased. If you are already doing daily fluids and your dog is exhibiting the symptoms described above, it may be time to let him or her go. In that case, be kind to yourself and know that you have allowed your dog the best care possible. When you are ready to give them the final gift you can schedule an appointment with a CodaPet veterinarian.
Need more information to know when the time is right? Take our Pet Quality of Life Assessment
Here are our frequently asked questions to help you feel fully informed and at ease.