Thank you to K9Kidney Forum for permission to post this article.

MY DOG WAS JUST DIAGNOSED WITH RENAL FAILURE - WHAT DO I DO?

First off, don't panic.   Renal failure in dogs isn't necessarily the "deathly knell" it used to be.  With dietary modifications, supplements, medications and fluid therapy (or none of the above!); many dogs can live a few years longer with some quality of life.

Be prepared to post the complete results of your dog's last lab tests, and what lead you to the vet for the diagnosis.  This will give the experienced list members a better perspective on how to help you.  The complete list of items from the lab reports to post is listed below.

Be prepared to post what you're currently feeding (commercial diet, home cooked, other), currently supplementing with (vitamins, anti-oxidants, etc) and currently medicating with (anything!).

Don't be discouraged if at first your veterinarian is less than enthusiastic about the long-term prognosis.   Unfortunately, for the dogs, the end result of chronic renal failure is the same.   It is important that you have confidence in your vet, and be adamant at the levels of treatment you are willing to go to.   There is a great emotional and financial investment that is to be made in the care of a chronically sick dog, and no one will look upon you as being a "bad person" if you choose to let your dog go at an early phase.

There will be *MANY* theories of treatments that are presented on the list.  It is up to you to decide the most appropriate one based on your dogs' condition.  DO NOT EVER FEEL PRESSURED BY THE LIST to make a change to what your veterinarian has prescribed without talking to them first.  DO NOT EVER FEEL PRESSURED TO CHANGE VETS BY THE LIST unless you find you absolutely cannot work with your vet.  Many vets are not used to owners who are willing to "go the extra mile" for their dogs.

If you find you absolutely *have* to change vets, ask for a recommendation on the list for someone in your area.  If there isn't one, check out the "American College Of Veterinary Internal Medicine" for a local, board certified, practioner.  Make some phone calls and ask if they are familiar with treating dogs with renal failure.

THINGS TO DO RIGHT AWAY SO THE LIST MEMBERS CAN HELP YOU OUT:

Get a copy of your dog's blood work from the vet.  BE SURE TO GET THE NORMAL VALUES FOR THE LAB THAT WAS USED.

Critical "renal" numbers are:

* BUN
* Creatinine
* Phosphorus
* Calcium
* Protein
* RBCs
* Hemocrit
* Sodium
* Potassium
* Urinalysis - including specific gravity, protein, bacteria, blood, glucose
* Any other lab work that was done

Chances are your dog's levels are all elevated.  Speak to your vet about subcutaneous fluid administration immediately, based upon your dog's condition.  In the case where dogs have underlying cardiac, respiratory or circulatory problems, this may not be appropriate.  Subcutaneous fluids (called "Sub-Q Fluids") can be done at home after a little instruction and will help your dog immensely.  The fluid used depends on the lab values; your vet should decide which subcutaneous fluid to use.  You will likely require a prescription for:  the fluids, the needles, and the tubing.  Please ask your vet for it right away.  *NOTE:  You can purchase from your vet, but there are online suppliers who are much more economical, and we have that information in our files.  You WILL need to fax or mail your prescription (script) to these pharmacy/suppliers, but using these resources will save you a LOT of $$$$$.

Some dietary changes to make.  Start with supplements.  Go to a health food store (get human vitamins - they have much better quality and variety and are much more economical):

* Multi-B
* Fish Oil (with the highest amount of DHA/EPA you can find) (do NOT get cod liver oil - you do not want anything with extra Vitamins A & D).
* Vitamin E
* Co-Q10
* Pet-Tinic (an iron supplement, available online from pet suppliers, can be used as the dog starts to become anemic)

Phosphorus Binder:  If your dog's phosphorus levels are elevated you will need to get a phosphate binder.  This is given either WITH your dog's food OR immediately afterwards.  The premise of giving a phosphorus binder is that it adheres to the extra phosphorus in the food, binding it so it does not go into your dog's body, exacerbating an already elevated phosphorus level.  It is very important to keep the phosphorus level within normal range, as elevated phosphorus level will cause your dog to get very ill, very fast.  (See "files" section for more information about phosphorus and binder dosages). 

Some commonly used phosphate binders are:

* Alternagel (aluminum hydroxide) (non-script)
* Alum-Caps (aluminum hydroxide) (non-script)
* Phoslo (by script, a calcium acetate binder)
* Renagel (by script, a non-aluminum/non-calcium binder - expensive and relatively new on the market; not much is yet known about side-effects)

Ulcers/Nausea:  Many renal dogs develop ulcers.  Pepcid A/C or Tagamet are given about a 1/2 hour before eating (or some just dose their dogs once or twice a day as needed).  Some are using Prilosec-OTC.  If your dog is not getting any relief using the Pepcid or Tagamet, ask your vet for a script for Carafate (liquid).  Carafate coats the stomach, cuts down the acid and helps heal ulcers.  Reglan or another type of anti-nausea medication may also help.

Dietary Modification. Chances are your vet has given you a bag of Hills KD or some other type of renal diet.  There are various renal foods on the market (Eukanuba, Waltham, Triumph, IVD Modified) - you are not limited to just the one brand. You may also want to do a home cooked or other diet with your renal dog instead.  Renal dogs become very picky in what they will eat (especially if they are nauseous).  This will be on going.  But while it's important to get your renal dog on a lower protein/lower phosphorus diet, it's more important that he EATS.  If your dog is not eating, then anything goes... give him ANYTHING that he will eat at this point (of course try to keep it healthy for him, but sometimes they just want what they want and that is it).

High Blood Pressure:  If your vet did not do it, insist on a blood pressure check.  Many renal dogs have high blood pressure and meds may be needed to get this under control. 

Anemia:  Renal dogs become anemic.  Sometimes adding the B vitamins and an iron supplement will help.  Epogen/Procrit are a   human treatment that sometimes works on dogs, but only for a limited time before the dog's body rejects it. Once the dog's body has generated antibodies to Epogen, however, it can cause anemia to return and become worse, a type of "rebound" effect as the dog's immune system fights the epogen and any intrinsic erythropoeitin of his own. 

Panic:  Don't.  Your dog will definitely pick-up on this.  Try to keep as positive an attitude as possible, and things will go much smoother for you.