Saturday, September 24, 2011

Kidney Disease – Say What?

by Jennifer Coates, DVM

When I was writing my book the Dictionary of Veterinary Terms, Vet-Speak Deciphered for the Non-Veterinarian, the kidneys (not my kidneys thankfully, but kidneys in general) caused me no end of grief.  Not only are the kidneys themselves complicated, but so is the terminology associated with the diseases that affect them.

So here’s a primer on canine kidneys and all the associated verbiage. 

Kidneys: Where are They and What Do They Do?

The kidneys are two separate but essentially identical organs that are located between the abdominal space and the lower back.  Technically, they do not reside in the abdomen but within the retroperitoneal space (i.e., the space behind the peritoneum or lining of the abdomen).  The left kidney is usually a little farther back than the right.

Each kidney is made up of hundreds of thousands of nephrons, the functional unit of the kidney.  

Think of a nephron as basically being a microscopic filter attached to a long tube.

Image: Encyclopedia Britanica
The blood that enters the kidney progresses through progressively smaller vessels until it meets a single nephron.  There, “bad stuff” (e.g., toxins that are produced by the body’s metabolism) is filtered out and turned into urine, while “good stuff” (e.g., red blood cells and water) is either not filtered out in the first place or is reabsorbed before urine production is complete. 


Normal kidneys have many more nephrons than are needed on a day to day basis.  

Why is this important?  Because we can’t replace a nephron once it is no longer functional, and LOTS of things damage nephrons (more on this later).

But the kidneys do more than just filter out “bad stuff,” they also secrete a hormone that stimulates red blood cell production, play a role in regulating blood pressure, conserve water, help balance electrolyte levels, and more.

What is Kidney Disease/Failure/Insufficiency

A disease can be defined as anything that adversely affects the functioning of the body.  Therefore, kidney disease is anything that adversely affects kidney function… this could be infection, an immune disorder, degenerative disease, neoplasia (cancer), trauma, etc.

Saying that a dog has kidney disease is basically the same as saying that it has sick kidneys. 

What many people mean when they say “kidney disease” is kidney failure.  

Failure can be defined as a loss in the ability to perform normal functions to the point where the body experiences a significant adverse effect.  Some veterinarians don’t like the term “failure” (it sounds so untreatable) so they use “insufficiency” instead. 

A diagnosis of kidney failure usually means that laboratory values associated with kidney function (blood urea nitrogen (BUN), creatinine, urine specific gravity (USG), etc.) are found to be abnormal.

Another word that can apply to this situation is “azotemia.”  An azotemic dog has higher than normal levels of BUN and creatinine in its blood.

Uremia” basically describes the same scenario but also implies that the patient feels poorly because of its azotemia. 

What all this means is that most of the kidneys’ nephrons are no longer functioning. 

In fact, the earliest sign of kidney failure seen in typical lab work is a low urine specific gravity, and this doesn’t occur until about two-thirds of the nephrons have been lost.  Azotemia doesn’t occur until at least three-quarters of the nephrons are gone. 

Acute or Chronic?

Kidney failure can be either acute (describing something that just happened) or chronic (describing something that developed over weeks, months, or even longer). 

Acute kidney failure is caused by things like infections, toxins such as antifreeze or grapes/raisins, and episodes of low blood pressure, but in some cases an underlying cause can’t be identified.  

If the incident kills off enough nephrons, the patient will die without a kidney transplant.  On the other hand, if the patient can be supported through the crisis, nephrons that essentially went “offline” but weren’t fatally damaged may recover allowing the body to return to a satisfactory level of functioning.

Chronic kidney failure comes on slowly and is a progressive disease. 

As I mentioned before, LOTS of things can damage nephrons.  Acute episodes may knock out a bunch all at one time, but the wear and tear of daily life also takes a toll and gradually reduces the kidneys’ reserve supply of nephrons.  Over time, the kidneys may reach the point where only one-third to one-quarter of nephrons are left, and the symptoms and laboratory evidence of kidney failure develop.

The International Renal Interest Society (IRIS) has come up with a staging system that lets veterinarians communicate how severe a dog or cat’s chronic kidney disease is.  IRIS uses the term “disease” because they include animals that are not currently in kidney failure but are at high risk for it in the future.

But this also begs the question, what’s up with the “R” in the “IRIS?” 

Here’s one more term for you.  “Renal” is the adjective form of “kidney.”  I guess “kidneyal” was just too much of a mouthful.

***

Jennifer Coates, DVM graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999.  In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado.  She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-veterinarian

Jennifer also writes short stories that focus on the strength and importance of the human-animal bond and freelance articles relating to a variety of animal care and veterinary topics.  Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and pets.

Related Articles
Whats In The Urine? (Part I: What You Can Notice On Your Own)
What's In The Urine? (Part II: Urinalysis)

Further Reading:
Recognizing the Signs of Kidney Failure in Dogs
Early Diagnosis of Kidney Disease in Dogs
Acute Kidney Failure in Dogs
Diagnosing Chronic Renal Disease and Kidney Failure in Dogs
Kidney and Urinary Disease in Dogs
Kidney Failure in Dogs

Articles by Dr. Coates:
The Perplexities of Pancreatitis
The Other Side Of The Coin: The Cost Of Defensive Medicine
To Neuter Or Not To Neuter… That Is The Question
Don’t Forget the Physical Therapy
Common Misdiagnoses (Part 1)
Common Misdiagnoses (Part 2)
Picking the Right Dog to Breed
When Is It An Emergency?
Dog Allergies: Common, Commonly Misdiagnosed, or Both?

5 comments

  1. Hmmm..... I knew grapes were bad for dogs but I didn't ever know why until now. I've not had a dog with kidney issues before but have with cats.

    ReplyDelete
  2. This is a very interesting article with great explanation to pet parents. Thank you!

    ReplyDelete
  3. Amazon CARES, thank you for reading! :-)

    ReplyDelete
  4. Rumpydog, actually it's interesting because WHY is not exactly known, only the damage it causes. But what is the offending ingredient is only being guessed. Interesting, huh?

    ReplyDelete
  5. I'd like to make a shout out for Omega 3 to help with decreasing inflammation, as well as the probiotic supplement Azodyl to reduce the toxin buildup in the intestines and bloodstream of pets with chronic kidney disease. Thanks for the post!

    ReplyDelete

MINIMAL BLOGGER TEMPLATES BY pipdig