Renal failure

• * Indicates drug not licensed for this use in this species.
• Kidneys maintain and regulate fluid, acid-base, electrolyte balance.
• Excrete waste products of protein metabolism, drugs and toxins.
• Role in production of erythropoietin and 1, 25 dihydroxy vitamin D3.
• In renal (or kidney) failure, the kidneys fail to function adequately → consequences in many body systems due to decrease in glomerular filtration rate resulting in potassium, calcium, phosphate, and (in the longer term) anemia.
• Plasma creatinine concentration used to stage cases using International Renal Interest Society (IRIS) system, which also guides treatment and prognosis.
• Treatment of acute renal failure Kidney: acute kidney injury (AKI) should aim to eliminate cause (eg infection - Leptospirosis, nephrotoxic drugs, intoxication); + drugs to improve tubular flow of urine often necessary.
• Treatment of chronic renal failure Kidney: chronic kidney disease (CKD) aims to minimize the biochemical (proteinuria Proteinuria , hyperphosphatemia Hyperphosphatemia , and metabolic acidosis Acid base imbalance ) and clinical consequences (including dehydration, systemic hypertension and hyperparathyroidism Hyperparathyroidism (primary) ).
• Initial IV fluid therapy Fluid therapy: for electrolyte abnormality necessary to control dehydration and ongoing fluid loss due to vomiting.
• Unrestricted access to water.
• Treat vomiting and/or gastritis with H2 receptor antagonist such as cimetidine Cimetidine , famotidine*, ranitidine* Ranitidine. Antiemetics may be necessary, eg metoclopramide* Metoclopramide or maropitant Maropitant citrate.
• Diet needs to be tailored to individual Dietetic diet: for chronic kidney disease (CKD). Reduced phosphorus is essential (hyperphosphatemia → secondary hyperparathyroidism). Protein restriction should be considered. If metabolic acidosis persists, supplement with oral sodium bicarbonate or potassium citrate to effect to maintain blood bicarbonate/ total CO2 in the range of 18-24 mmol/l.
• Reduce elevated systolic blood pressure using angiotensin converting-enzyme (ACE) inhibitor therapy ACE inhibitor: overview at standard dose rates. Increasing the dose may improve the antihypertensive effect. The calcium channel blocker amlodipine* Amlodipine and hydralazine* Hydralazine can be added to treatment if the response is insufficient.
• Adjunctive therapy includes enteric phosphate binders such as aluminium hydroxide or calcium carbonate; oral vitamin D (calcitriol) to combat renal secondary hyperparathyroidism; multivitamins to compensate for loss of water soluble vitamins; and eythropoietin alfa and beta* if anemia (due ro loss of erythropoietin, iron and folate deficiency) affecting quality of life.
• Avoid nephrotoxic drugs, eg aminoglycosides, sulphadiazine Sulfadiazine , amphotericin B Amphotericin B.
• Care with drugs that are excreted exclusively via the kidney, eg aminoglycosides, enalpril Enalapril (dosage adjustment may be required).

Bacterial cystitis

Urinary retention and incontinence - provided urethra not obstructed

Urolithiasis

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Claeys S, Noël S, Hamaide A (2010) Acquired urinary incontinence in the bitch: Update and perspectives from human medicine. Part 3: The urethral component and surgical treatment. Vet J 186 (1), 25-31 PubMed.
• Noël S, Cambier C, Baert K et al (2010) Combined pharmacokinetic and urodynamic study of the effects of oral administration of phenylpropanolamine in female Beagle dogs. Vet J 184 (2), 201-207 PubMed.
• Noël S, Claeys S, Hamaide A (2010) Acquired urinary incontinence in the bitch: Update and perspectives from human medicine. Part 1: The bladder component, pathophysiology and medical treatment. Vet J 186 (1), 10-17 PubMed.
• Coit V A, Dowell F J, Evans N P (2009) Neutering affects mRNA expression levels for the LH- and GnRH-receptors in the canine urinary bladder. Theriogenology 71 (2), 239-247 PubMed.
• Kidder A C, Chew D (2009) Treatment options for hyperphosphatemia in feline CKD: what's out there? J Feline Med Surg 11 (11), 913-924 PubMed.
• Osborne C A, Lulich J P, Forrester D et al (2009) Paradigm changes in the role of nutrition for the management of canine and feline urolithiasis. Vet Clin North Am Small Anim Pract 39 (1), 127-141 PubMed.
• Osborne C A, Lulich J P, Kruger J M et al (2009) Analysis of 451,891 canine uroliths, feline uroliths, and feline urethral plugs from 1981 to 2007: perspectives from the Minnesota Urolith Center. Vet Clin North Am Small Anim Pract 39 (1), 183-197 PubMed.
• Reichler I, Hubler M, Arnold S (2008) Urethral sphincter mechanism incompetence in spayed bitches: new insights into the pathophysiology and options for treatment. EJCAP 18 (2), 187-191 VetMedResource.
• Byron J K, March P A, Chew D J et al (2007) Effect of phenylpropanolamine and pseudoephedrine on the urethral pressure profile and continence scores of incontinent female dogs. J Vet Intern Med 21 (1), 47-53 PubMed.
• Reichler I M, Jöchle W, Piché C A et al (2006) Effect of a long acting GnRH analogue or placebo on plasma LH/FSH, urethral pressure profiles and clinical signs of urinary incontinence due to Sphincter mechanism incompetence in bitches. Theriogenology 66 (5), 1227-1236 PubMed.
• Hoeijmakers M, Janszen B, Coert A et al (2003) Pharmacokinetics of oestriol after repeated oral administration to dogs. Res Vet Sci 75 (1), 55-59 PubMed.
• Scott L, Leddy M, Bernay F et al (2002) Evaluation of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch. JSAP 43 (11), 493-496 PubMed.
• Mandigers R J, Nell T (2001) Treatment of bitches with acquired urinary incontinence with oestriol. Vet Rec 149 (25), 764-767 PubMed.
• Holt P E (1999) Diagnosis and management of canine urethral sphincter mechanism incompetence. Waltham Focus 9 (4), 19-23.

Other sources of information

• European Medicines Evaluation Agency. Incurin Summary of Product Characteristics. Accessed 23 January 2010. http://www.ema.europa.eu/vetdocs/PDFs/EPAR/Incurin/V-047-PI-en.pdf
• International Renal Interest Society. Accessed 23 January 2010. http://www.iris-kidney.com/index.shtml.
• The Merck Veterinary Manual. Bacterial Cystitis. Accessed 23 January 2010. http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/130502.htm
• The Merck Veterinary Manual. Urinary Incontinence. Accessed 23 January 2010. http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191024.htm
• Merck Veterinary Manual. Canine Urolithiasis. Accessed 23 January 2010. http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/130616.htm