Kidney disease is generally associated with a dramatic increase
in urination and drinking - and this is indeed the case with
ongoing or chronic renal disease where the organs are unable
to concentrate urine - effectively water passes straight from
the blood, through the kidney and into the bladder.
When he arrived at our Henley clinic, Henry's bladder was
distended with urine and he was feeling very sorry for himself.
We hospitalised him to confirm our suspicions of either a
urethral obstruction or ARF. Whilst awaiting his blood results
the nurses expressed his bladder manually and he then continued
to urinate on his own, thus ruling out a complete urinary
obstruction. This along with the blood results confirmed our
feared suspicions of ARF.
Amazingly, the kidneys receive up to 20% of the entire cardiac
output, which increases the delivery of any blood borne toxicant
relative to other organ systems. Due to the unique physiological
and anatomical features of the kidneys they are very susceptible
to the effects of toxicants and ischaemia (reduction of blood
flow). There are many causes of ARF, most of which are unavoidable.
The ethylene glycol found in many de-icer products at this
time of year is extremely harmful to the kidneys but a broad
range of other compounds - from pesticides to certain dried
fruits - could have been the origin of Henrys condition.
No matter the cause, the end result is always the same: a
build up of dangerous toxins (including naturally produced
urea) in the blood that should have normally been excreted
into the urine. It is frequently fatal.
The goal of treatment is to flush these toxins from the system
and give the kidneys supportive care with aggressive intravenous
fluid therapy. Also to give prophylactic antibiotic cover
for this compromised patient and treat any resulting gastric
ulceration, a common complication. Finally, it is important
to feed a 'kidney friendly diet' with lower protein and phosphorous
content. This was a trick with Henry as he can be a picky
eater at the best of times, and we finally had to settle on
giving him his favorite food to get him eating ... Beijing
After 48 hours of treatments and supportive care, it was
time to assess his kidneys again. Despite Henry appearing
to feel a bit better in himself the results of his follow
up blood tests were even more grave than when he presented.
This indicated just how early in the disease process his symptoms
had been recognised by his owners - and how quickly he was
brought to us. It did, however, reveal the possibility that
the insult to his kidneys was irreversible.
As he was looking better clinically we gave him the benefit
of the doubt and another 36 hours of treatment. This was a
crucial and nerve racking time for his family and all the
surgery staff looking after Henry. Happily his next blood
test showed that the treatment had been effective and his
kidneys had recovered from the damage caused. He returned
home and has been healthy ever since!
Macgregor Spinks BVM&S MRCVS