Dr. Elena Mascherpa, DVM
Master in Cat and Dog Nutrition and Dietetics
Lchronic renal failure (CRI), common in dogs and cats, as we all know, is a condition characterised by a progressive loss of kidney function.
We are familiar with both the symptoms (polyuria, polydipsia, weight loss, vomiting, anaemia and lethargy) and how to make a diagnosis (clinical examination, blood and urine tests, ultrasound or X-rays).
We also know that CRI is a disease that animals will have to live with for the rest of their lives, but we can slow its progression and improve the quality of life of these patients.
Le IRIS guidelines (International Renal Interest Society) are a valuable tool for the management of CRI and include:
- Controlling the dietensuring the correct intake of calories, protein, carbohydrates and fat according to the IRIS staging and the animal's clinical condition. In addition, phosphorus must be reduced.
The introduction of a renal diet, whether commercial or homemade, can significantly prolong the survival time of cats and dogs.
The renal diet should be introduced before the dog or cat manifests anorexia, in situations that are not stressful for the animal and avoiding it in hospitalised animals. It is advisable, especially during the initial phase, not to mix drugs and supplements with the chosen food. In the case of refusal of commercial food or in the presence of other pathologies, it may be necessary to resort to a home feed formulated by a veterinary nutritionist.
- Avoid ddehydrationensuring adequate fluid intake, both through the diet and possibly with specific therapies (hypodermoclysis, phleboclysis). It is important to constantly monitor the animal's hydration and act promptly in the event of signs of dehydration. because it can accelerate the progression of the disease.
- Chelate phosphorus and nitrogen. Hyperazotemia and hyperphosphatemia are often responsible for the most disabling symptoms related to the disease, such as nausea, weakness and a general worsening of the animal's condition. Initially, the increase in phosphorous is not always detectable by haematological examinations as it is compensated by hyperactivation of the parathyroids. Only later can the rise in this value be detected.
There are several options to chelate phosphorus and nitrogen in the intestine, such as the use of chelating substances to be administered with the meal to prevent absorption (chitosan, calcium salts, lanthanum, sevelamer, aluminium hydroxide). In addition, the use of probiotics and prebiotics can help counteract dysbiosis and the resulting production of nitrogenous catabolites. Choosing a diet low in phosphorus and nitrogen catabolites is crucial in the management of chronic renal failure, such as decreasing protein, when necessary, and choosing proteins of high biological value.
- Counteracting metabolic acidosis. Nitrogenous substances accumulated in excess during CRI are initially buffered by alkaline values; subsequently, the body can no longer counteract the lowering of pH, and metabolic acidosis develops. Alkalising substances, such as potassium citrate or sodium bicarbonate, can be used to counteract the drop in pH. The goal is to maintain pH levels between 18-24 mEq/L in dogs and 15-22 mEq/L in cats.
- Counteracting hypertension and proteinuria. Measuring blood pressure is crucial for both staging and choosing treatment for dogs and cats with chronic renal failure. In this disease, the renin-angiotensin-aldosterone system is hyperactivated in a range of 10 to 100 times more than normal. Certain functional ingredients, such as omega-3, support the reduction of systemic and glomerular pressure. Often, however, it is necessary to use antihypertensive drugs, such as angiotensin-converting enzyme inhibitors, calcium channel blockers, and sartans, which, by decreasing glomerular pressure, also help to decrease proteinuria.
- Preventing and fighting infections. The presence of kidney disease increases the risk of infections, especially of the urinary tract. According to several studies, up to 1/3 of cats with chronic renal failure (CKD) have an asymptomatic or paucisymptomatic bacterial infection of the urinary tract. Such infections are often not detectable by looking at the urinary sediment, but require specific bacteriological tests. It is essential to diagnose these infections effectively as they can cause uremic crises and worsen CRI. The use of functional ingredients such as bilberry can be helpful in preventing and reducing urinary tract infections.
- Counteract dysbiosis, systemic inflammation and increased free radicals. The accumulation of nitrogen catabolites in chronic renal failure can cause dysbiosis, with the development of gastrointestinal symptoms, and increase systemic oxidative stress. To improve the patient's quality of life, it is important to counteract these symptoms by using anti-nausea drugs, functional ingredients, probiotics and antioxidants.
- Combat gastric hyperacidity. In the course of CRI, chronic gastritis can often develop due to increased gastrin. Therefore, specific functional ingredients improve the digestibility of the diet and, if necessary, can be used in combination with antacid medication.
- Controlling anaemia. In chronic renal failure, anaemia can be caused by several factors, including a lack of erythropoietin synthesis by the kidneys, iron deficiency, blood loss (gastric ulcers and gastrointestinal symptoms), inflammation and uremic inhibitors. In order to choose the correct treatment approach, it is important to identify the underlying causes and to use an effective therapy, such as erythropoietin or iron supplementation.
- Checking Calcium Levels. In the course of renal pathology, due to increased phosphorous, lack of vitamin D activation and consequent activation of the parathyroids, we may see abnormal calcium levels (hypercalcaemia, more frequent in cats or hypocalcaemia more frequent in dogs) with consequent symptoms. Effective phosphorous control and constant monitoring of calcium values can help to set the most suitable therapy, such as the use of chelators based on calcium salts or calcitriol.
That is why we have formulated DiReNe® which guarantees, in a single product, the supply of several functional ingredients, acting synergistically on different objectives.
CRI in dogs and cats: which therapeutic goals?
Dr. Elena Mascherpa, DVM
Master in Cat and Dog Nutrition and Dietetics
Lchronic renal failure (CRI), common in dogs and cats, as we all know, is a condition characterised by a progressive loss of kidney function.
We are familiar with both the symptoms (polyuria, polydipsia, weight loss, vomiting, anaemia and lethargy) and how to make a diagnosis (clinical examination, blood and urine tests, ultrasound or X-rays).
We also know that CRI is a disease that animals will have to live with for the rest of their lives, but we can slow its progression and improve the quality of life of these patients.
Le IRIS guidelines (International Renal Interest Society) are a valuable tool for the management of CRI and include:
The introduction of a renal diet, whether commercial or homemade, can significantly prolong the survival time of cats and dogs.
The renal diet should be introduced before the dog or cat manifests anorexia, in situations that are not stressful for the animal and avoiding it in hospitalised animals. It is advisable, especially during the initial phase, not to mix drugs and supplements with the chosen food. In the case of refusal of commercial food or in the presence of other pathologies, it may be necessary to resort to a home feed formulated by a veterinary nutritionist.
There are several options to chelate phosphorus and nitrogen in the intestine, such as the use of chelating substances to be administered with the meal to prevent absorption (chitosan, calcium salts, lanthanum, sevelamer, aluminium hydroxide). In addition, the use of probiotics and prebiotics can help counteract dysbiosis and the resulting production of nitrogenous catabolites. Choosing a diet low in phosphorus and nitrogen catabolites is crucial in the management of chronic renal failure, such as decreasing protein, when necessary, and choosing proteins of high biological value.
That is why we have formulated DiReNe® which guarantees, in a single product, the supply of several functional ingredients, acting synergistically on different objectives.
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