Clinical Experience in the Diagnosis and Treatment of Chronic Renal Failure in Dogs

Chronic renal failure (CRF) is a serious and often fatal syndrome representing the end stage of various chronic kidney diseases in canines. It manifests as a gradual decline in renal function, ultimately leading to failure. Due to impaired excretory and regulatory functions of the kidneys, CRF presents with various metabolic disturbances and imbalances in water, electrolytes, and acid-base homeostasis. This article details the diagnosis and treatment of a typical case of canine CRF, offering insights into effective management strategies.

I. Case Presentation

A 2-year-old, 3.1 kg Teddy bear dog presented with lethargy, severe vomiting (yellow, viscous material), halitosis, subnormal body temperature (38.5°C), oliguria, and pale yellow urine.

II. Diagnosis

Routine blood tests revealed significant abnormalities (Table 1):

Table 1: Day 1 Blood Chemistry Results

| Parameter | Test Value | Unit | Reference Range |

|—————–|————–|————–|—————–|

| Blood Urea Nitrogen (BUN) | 24.5 mmol/L | mmol/L | 2.14-11.79 |

| Creatinine (CRE) | 664 μmol/L | μmol/L | 53.06-141.5 |

| Inorganic Phosphorus (IP) | 4.65 mmol/L | mmol/L | 0.58-1.68 |

The markedly elevated BUN, creatinine, and phosphorus levels strongly suggested CRF. Further examination revealed respiratory acidosis and hypocalcemia, leading to a diagnosis of stage 3 (non-compensated, oliguric phase) CRF.

III. Treatment Course

The treatment strategy focused on addressing the underlying disease, preventing dehydration and shock, correcting hyperkalemia and acidosis, and alleviating azotemia. The initial treatment plan (Day 1) is detailed below:

Day 1 Treatment Plan:

| Group | Drug Name | Dosage | Route of Administration |

|——-|—————————|—————————–|————————–|

| 1 | Ampicillin/Sulbactam | 1/5 vial (20kg/vial) | IV |

| | 0.9% Sodium Chloride | 60ml of 500ml solution | IV |

| 2 | Inosine | 0.8ml (2ml:100mg) | IV |

| | ATP | 0.8ml (2ml) | IV |

| | Vitamin B6 | 0.6ml (2ml:0.1g) | IV |

| | Vitamin C | 0.8ml (2ml) | IV |

| | Glucose/Sodium Chloride | 60ml of 500ml solution | IV |

| 3 | 10% Calcium Gluconate | 6ml (10ml) | IV |

| | 5% Glucose | 60ml (100ml) | IV |

| 4 | Sodium Bicarbonate | 3ml (10ml) | IV |

| | Lactated Ringer’s Solution | 80ml of 500ml solution | IV |

| 5 | Metabolic Enhancer | 0.6ml | IV |

| | 5% Glucose | 40ml of 250ml solution | IV |

| 6 | Hepatoprotective Agent | 0.6ml (0.1-0.2ml/kg) | IM |

The dog was kept NPO (nothing by mouth) and kept warm.

By Day 3, urine production had improved, but the dog experienced severe abdominal pain. Blood work (Table 2) revealed persistently elevated BUN and creatinine, normalized phosphorus, and drastically elevated amylase, indicating the development of pancreatitis.

Table 2: Day 3 Blood Chemistry Results

| Parameter | Test Value | Unit | Reference Range |

|—————–|————–|————–|—————–|

| BUN | 20.1 mmol/L | mmol/L | 2.14-11.79 |

| CRE | 224 μmol/L | μmol/L | 53.06-141.5 |

| IP | 2.26 mmol/L | mmol/L | 0.58-1.68 |

| Amylase (AMY) | 1609 IU/L | IU/L | 141-938 |

Treatment continued to address CRF, incorporating pancreatitis management (Day 3 treatment plan included medications like activated charcoal and analgesic).

By Day 6, significant improvement was observed (Table 3). By Day 9, all parameters returned to normal ranges. The dog was discharged on a renal prescription diet (Royal Canin).

Table 3: Day 6 Blood Chemistry Results

| Parameter | Test Value | Unit | Reference Range |

|—————–|————–|————–|—————–|

| BUN | 15.6 mmol/L | mmol/L | 2.14-11.79 |

| CRE | 204 μmol/L | μmol/L | 53.06-141.5 |

| IP | 2.01 mmol/L | mmol/L | 0.58-1.68 |

| Amylase (AMY) | 889 IU/L | IU/L | 141-938 |

IV. Clinical Reflections

1. Etiology: CRF has multiple causes, often stemming from acute renal failure or various chronic kidney diseases (pyelonephritis, glomerulonephritis, diabetic nephropathy, urolithiasis). High-protein diets and aging are also contributing factors.

2. Clinical Stages: CRF progresses through oliguric, polyuric, and recovery phases. Oliguria necessitates prompt diuresis, addressing acidosis (if bicarbonate <12-15 mmol/L), hyperkalemia (using saline or lactated Ringer's), and azotemia (mannitol post-rehydration). Polyuria requires close monitoring and electrolyte replacement, especially potassium, to prevent hypokalemia.

3. Treatment Considerations: Managing vomiting (via adsorbents if tolerated), maintaining adequate hydration, and daily monitoring of acid-base balance and electrolytes are crucial.

4. Recovery: A high-protein, high-carbohydrate, and vitamin-rich diet (renal prescription diet) is essential during recovery.

This case highlights the importance of comprehensive diagnostic testing, tailored treatment plans addressing both primary and secondary conditions, and close monitoring for successful management of canine CRF. Prognosis is significantly improved through early intervention and diligent management. Further research into the pathophysiology of CRF and development of novel therapeutic strategies remain crucial for improving the lives of affected animals.