Treatment In-depthTreatment of chronic kidney failure must be individualized based on the severity of the condition, the cause, secondary diseases or conditions and other factors that must be analyzed by your veterinarian. A search for reversible causes of kidney failure should be completed. The ultimate goal of the management of CRF is to provide supportive care while trying to treat/eliminate secondary factors aggravating kidney failure such as, infections, dehydration, malnutrition, anemia, etc.
Fluid therapy is important to correct dehydration and abnormalities in serum electrolytes. Care must be taken to avoid over-hydrating the patient, because the kidneys may not be able to produce urine to get rid of the excess fluid.
Dietary therapy may include a diet that is low in protein and phosphorus. Special diets are formulated for pets with chronic renal failure such as Prescription diet k/d, CNM NF-FORMULA, Eukanuba Nutritional Kidney Formulas, IVD Modified.
Management of abnormal blood potassium may be done. The level may be low or high (with late stage of kidney failure). Correction of metabolic acidosis may be performed by treating the problem with sodium bicarbonate if needed.
Elevated phosphorus may be treated with intestinal phosphorus binders such as aluminum hydroxide and aluminum carbonate.
Control of vomiting may be treated with drugs that may beneficial, including: cimetidine (Tagamet®), ranitidine (Zantac®) or famotidine (Pepcid®).
Anabolic steroids are available, but there are no long-term studies demonstrating their efficacy.
Anemia may be treated with recombinant human erythropoietin. Cats treated with Epogen have demonstrated resolution of anemia, weight gain, improved appetite, improved haircoat and improved sociability with their owners. There are some risks associated with its use.
Vitamin D (calcitriol or 1,25-dihydroxycholecalciferol) may be supplemented (as Calcitriol synthesis is impaired with CRF). The benefits of supplementation are controversial. Calcitriol must only be used after hyperphosphatemia has been adequately controlled.
Patient monitoring is an important part of continuing optimal treatment. Monitoring may include the following: serial body weight (to determinations facilitate proper fluid therapy); measurement of urine output; packed cell volume (PCV) and total plasma proteins (will help monitor fluid load); and serial determinations of serum biochemistry are necessary to determine if the animal is responding to treatment. These determinants will help determine the proper fluid and drug therapy.
Treatment may be required from three to five days, depending on the response and secondary causes. If treatment fails, dialysis or kidney transplant may be a treatment possibility. Referral may be required for dialysis treatment. CRF may be progressive despite treatment. The prognosis for recovery of renal function depends on the severity of the kidney lesions and the cause of CRF. Euthanasia may be considered for pets that do not respond to treatment.
