Is Chronic Kidney Disease the Same as Chronic Renal Failure?

January 14, 2015

chronic renal failure chronic kidney disease

One of @amcny’s Twitter followers posted the question that is the title of this post. This person also asked, “Should the high end of the normal range of creatinine be 2.4?” These are very good questions, especially for cat families since cats are seven times more likely to have kidney disease than dogs. I am devoting this week’s blog to the answers.

Kidney Tests
A standard panel of blood tests includes measurement of blood urea nitrogen and creatinine. These tests are commonly used to evaluate kidney function, but the results can be abnormal with dehydration, intestinal bleeding and a high protein diet. When combined with a physical examination and an analysis of the pet’s urine, they become a more powerful assessment of how well the kidneys work.

For many years, when veterinarians discovered elevations in blood tests to measure kidney function, we talked with pet families about chronic renal failure or CRF, and before that we talked about chronic interstitial nephritis or CIN. Today we more commonly use the term chronic kidney disease or CKD. As time passed, the name has changed to more correctly reflect our understanding of the disease. Chronic interstitial nephritis comes from microscopic evaluation of a kidney biopsy, something most pets never have. Chronic renal failure was a confusing term to pet owners who were unfamiliar with the medical term for kidney – renal. Failure was a misnomer since the abnormal blood tests indicate decreased function, but not necessarily an absence of function or failure. Thus, renal became kidney and failure was swapped out for disease.

If There is Chronic, There is Also Acute
In medicine, if a disease has the modifier “chronic” you can bet there is also an ”acute” form of the same disease. Acute renal failure has a very abrupt onset in a decline of kidney function and is caused by a variety of disorders including leptospirosis, antifreeze ingestion and lily intoxication. Some pets with acute renal failure completely recover; others improve but continue to have chronic kidney disease and sadly, others don’t make it. The term chronic indicates a long term process that may or may not get worse, but one that, with treatment, can achieve a good quality of life.

Is 2.4 the High End of Normal Range for Creatinine?
Normal range is another term largely gone from the veterinary lexicon because normal depends on the age, sex and even breed of the dogs or cats used for comparison. Now we use the term “reference range or reference interval.” The upper end of the reference range is variable from lab to lab, based on testing methodology, equipment and the exact animals used to develop it. Perhaps more important than the exact reference range from the lab is what is normal for your pet, i.e. what was the creatinine last year and the year before and is the number trending upwards? When that happens, it suggests decreased kidney function and suggests more testing may be indicated.

Thank you to our Twitter follower for asking such important questions. If you are interested in more information about what blood tests tell your veterinarian about your pet’s health, read this recent blog on blood testsLearn more about feline kidney disease.

Holiday Hazards 2012

December 13, 2012

cat_poinsettiaThe holidays can be fun times for everyone in the family—pets included—but they can also pose dangers to dogs and cats. Here are a few of the holiday-related cases we’ve seen at The Animal Medical Center’s Emergency Service this week.

Tarquin, Gracie and Yoggy snacked from the naughty list

Tarquin, a 5-year-old Cavalier King Charles Spaniel, took advantage of chocolate left within her reach. After consuming most of the bag’s contents while her owners were out, her family returned to find her nauseous and vomiting. A trip to The Animal Medical Center ER resulted in an overnight stay because of a rapid heart rate induced by theobromine, a caffeine-like component of chocolate.

Gracie the Maltese barely tips the scale at 3 pounds. Despite her small stature, she managed to wolf down five dark chocolate truffles. This naughty list indulgence landed her in the hospital getting a treatment of activated charcoal to help bind up any chocolate toxins remaining in her intestinal tract. The darker the chocolate, the higher the concentration of theobromine, and baking chocolate contains the highest concentration. In a dainty dog like Gracie, a few bites of stolen baking chocolate could be fatal.

Yoggy, a young Yorkshire terrier, also ate dark chocolate. His owners discovered him racing around their apartment like a mad man in a chocolate-induced hyperactive state. The ER staff found his blood pressure was elevated too. Yoggy got intravenous fluids and a mild sedative. Lucky for Yoggy, he recovered quickly and was discharged from The AMC the following day.

Other foods on the naughty list include raisins, grapes, onions, and fatty foods. For a yet unknown reason, raisins and grapes cause kidney failure in dogs consuming even just a few. Onions and their relative, garlic, damage the red blood cells of both dogs and cats, resulting in anemia. Fatty foods can induce severe stomach upset or inflammation of the pancreas, so a purloined pork loin should be off your dog’s holiday menu.

Oliver does a mistleno-no

Oliver, a 2-year-old cat, used up one of his nine lives this holiday season when he decided to have a Japanese snow lily salad. These beautiful flowers grace many holiday floral arrangements, but should be avoided in a home with a cat. Ingestion of poinsettia, mistletoe, holly, and cyclamen’s tuberous roots will cause gastrointestinal upset. Some varieties of lilies and amaryllis will cause kidney failure if eaten by your favorite feline. Best to avoid using these in your holiday decorating or you might be spending the holiday with your favorite veterinarian and not with your family!

Failing Feline Kidneys: No Need to Think the Worst

June 12, 2012

This is the second in a series of blogs about our fabulous felines written for Adopt-A-Cat Month.

Maggie is available for adoption (more info below)

An annual visit to your cat’s veterinarian will result in blood tests being submitted to a veterinary laboratory to test for a variety of diseases such as hyperthyroidism and chronic kidney disease. To the typical cat owner, a diagnosis of kidney disease sounds ominous, but it’s not always as bad as it sounds. Take for example my nephew cat BeeDee. He had a rough start in life, abandoned as a kitten at The Animal Medical Center following a head trauma incident. My sister adopted him and he lived a good life, twenty-one years to be exact, despite having been diagnosed with chronic kidney disease at age eighteen.

Kidney disease: The diagnosis

Estimates suggest one to three percent of cats will develop kidney disease during their lifetime and one in twelve geriatric cats has kidney disease. The diagnosis of chronic kidney disease in a cat like BeeDee is based on elevations in two blood tests: blood urea nitrogen, commonly abbreviated BUN, and creatinine plus evaluation of urine-specific gravity. In chronic kidney disease, the urine-specific gravity is neither concentrated nor dilute; it falls in a middle range known as isothenuric because the impaired kidneys no longer have the ability to concentrate or dilute the urine. Creatinine and BUN can be elevated in disorders other than chronic kidney disease such as a kidney infection or dehydration. Taking a urine sample from your cat to his annual examination will win you a gold star from your veterinarian and allow the urine to be tested to determine if chronic kidney disease is likely. For suggestions on how to collect feline urine, click here.

Severity scoring

The International Renal Interest Society (IRIS) developed guidelines to grade the severity of chronic kidney disease in cats and dogs. The IRIS guidelines rank kidney disease from stage I to stage IV as the creatinine increases. Since as many as twenty percent of cats with chronic kidney disease have hypertension, your cat’s veterinarian will recommend blood pressure monitoring. Blood pressure, urine protein level, and organ damage from hypertension all play a role in IRIS staging. As your cat’s stage increases, so does the need for treatment.

A low score wins!

A study of 211 cats with chronic kidney disease, performed at The AMC, showed IRIS stage based only on creatinine levels in the blood correlated with the cat’s longevity. Cats diagnosed with Stage IIb had a creatinine >2.3 mg/dl, stage III greater than 2.8 mg/dl and stage IV greater than 5 mg/dl. Those cats with IRIS stage II kidney disease survived on average over 1000 days, stage III cats nearly 800 days and stage IV cats only about 100 days.

If your cat’s diagnosis is low IRIS stage chronic kidney disease, try not to worry. Treatment can help keep your cat around for years to come. I can’t guarantee your cat will do as well as my nephew cat and live to the ripe old age of 21 – but you never know!

Maggie is available for adoption in NYC through Petfinder.

Top 5 Health Issues Facing American Pets Today

March 19, 2012

1. Pets are becoming medically underserved

Data shows the pet population in the U.S. is climbing, but visits to veterinarians are declining. On an annual basis in 2007, dogs saw a veterinarian 2.6 times per year and cats only 1.7 times, indicating cats are affected more than dogs. This number has continued to decline in the aftermath of the Great Recession of 2008. Taking your cat or dog to the veterinarian allows early detection and intervention before medical problems like obesity cause serious disease.

2. Obesity in pets, like in humans, is skyrocketing

Veterinarians know pets are getting fatter, but research has shown pet owners are not likely to recognize obesity in their pets, perhaps because they themselves are overweight. In dogs, obesity is linked to an increased body mass index (BMI) in their owners. If you love your pet and want it to live a long, healthy life, keep its weight down. Obese pets have a shorter lifespan and increased risk of cancer, heart disease, respiratory problems, bladder disease, and, like humans, diabetes.

3. Diabetes is increasing in both cats and dogs

Banfield State of Pet Health reports a 32% increase in diabetes in dogs and 16% increase in cats, comparing 2006 to 2010. This is likely tied to the obesity epidemic in pets. Diabetes can be treated in dogs and cats, but it involves someone in the family injecting insulin once or twice daily under the skin and monitoring response to treatment. Preventing diabetes by maintaining an ideal body weight is simply easier for everyone.

4. Cancer: a major illness in both cats and dogs

According to the Morris Animal Foundation, 1 in 4 dogs dies from cancer and cancer is the leading cause of death in dogs over 2 years of age.

In dogs, breed is strongly associated with specific types of cancer. Golden retrievers commonly develop lymphoma, German shepherds a splenic tumor called hemangiosarcoma, and Pugs a skin tumor known as a mast cell tumor. Cats get cancer too, most commonly lymphoma. Annual examinations and blood tests by your family veterinarian will help to detect tumors while they are still easily treatable.

5. Dental disease is on the rise

Reluctant is the descriptor for many pet owners when it comes to dental procedures in their pets. I understand their concern for the required general anesthesia, but I am concerned their reluctance is compromising their pet’s health. Periodontal disease is very prevalent in cats and in one study, all cats had evidence of periodontal disease. Over 10% were severely affected and nearly all had bone loss in the jaw as determined by dental x-rays.

Having periodontal disease may cause collateral damage in other parts of your pet’s body. In dogs, periodontal disease was associated with increases in markers of systemic inflammation and indicators of failing kidney function, and was also associated with endocarditis and heart muscle problems.

For more information on healthcare issues facing American pets today, watch my video interview with Yahoo! Animal Nation.

Photo: iStockphoto

This may also be found in the Tales from the Pet Clinic blog on

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit To make an appointment, please call 212.838.7053.


Rat Poison and Pets: Diagnosis and Treatment

February 13, 2012

In my last post I wrote about rodenticides and the dangers they pose if ingested by our animal companions. This post will describe the clinical signs and treatment of dogs with rodenticide intoxication, including both anticoagulant and vitamin D poisons.

The photograph shows a hemorrhage in the retina from rodenticide poisoning.

Anticoagulant rodenticides

Ingestion of this type of rat poison by dogs typically causes internal hemorrhage, anemia, and, in the worst cases, death. If your dog has ingested this type of poison, you might notice a bloody nose, blood in the stool or urine, and a general lack of energy from anemia due to blood loss. Many dog owners do not realize rat poison has been placed by their landlord or an exterminator until an emergency room veterinarian suspects rodenticide intoxication. A blood test showing abnormal blood clotting can confirm the diagnosis.

Anticoagulant rodenticide intoxication can be successfully treated. The antidote is vitamin K, but not the type of vitamin K available in a health food store; a prescription is required. Severely ill dogs will require hospitalization, blood transfusions, and close monitoring in an intensive care unit. The good news is, most will recover.

Vitamin D analogues

Minor elevations in blood calcium caused by ingestion of vitamin D analogue rat poisons will cause your pet to increase its drinking and urination. If the exposure to vitamin D analogue rat poison is prolonged or the amount ingested large, kidney damage, seizures, and death can occur.

For veterinarians, making a diagnosis of vitamin D rodenticide intoxication can be challenging. An increase in drinking and urination is not specific for vitamin D rodenticide intoxication and is a common finding in several disorders, including diabetes, kidney failure and pyometra.

Routine bloodwork can readily identify elevated calcium levels, but like an increase in drinking and urination, elevation of calcium levels is nonspecific and occurs in several disorders, including kidney failure, lymphoma, and an overactive parathyroid gland. A dog with elevated calcium levels often needs an extensive medical evaluation to determine if rodenticide intoxication is causing the elevation in calcium levels.

Treatment of vitamin D rodenticide intoxication can be equally as challenging and require administration of several different treatments to bring the calcium down. Hospitalization is frequently required for administration of intravenous fluids and diuretics. The hormone calcitonin has also been used to lower dangerously high calcium levels and steroids may also be used to increase calcium excretion in the urine.

An ounce of prevention is worth a pound of cure, and in the case of rodenticides, cautious use could save your pet’s life. The Environmental Protection Agency has a very useful consumer website on rodenticides and their safe use in homes with pets. It may be worth your pet’s life to check it out.


This may also be found in the Tales from the Pet Clinic blog on

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit To make an appointment, please call 212.838.7053.

Summer Pet Hazards

June 1, 2010

As the weather warms up, everyone, including the family pet, wants to spend more time outdoors. Fresh air, sunshine and more opportunity to exercise are just a few of the benefits of the summer season. But summer also brings with it an opportunity for injury. To keep your pet safe this summer season, here are a quintet of pet hazards that could spoil your fun in the sun.

Heatstroke is a completely preventable emergency. Pets should never be left in a closed car on a hot day. At home on scorching hot days, close the blinds, provide plenty of water and a fan or air conditioner. Some dogs have a greater risk of developing heatstroke. If you have a porky pooch, a dark-coated doggy or a flat faced fur friend like this French Bulldog, exercise them outdoors in the early or later part of the day when it is coolest. An overnight change from spring to summer weather may not allow your pet to acclimatize, increasing the risk for heatstroke. If your pet becomes overheated, is panting excessively or collapses, go immediately to an animal ER.

Our mothers told us cats always land on their feet and have nine lives. Every year, New York City cats prove our mothers wrong. Whether chasing pigeons or losing their balance on a slippery fire escape, every summer cats fall out of apartment windows. They clearly don’t always land on their feet because they commonly suffer a triad of injuries: fractured roof of the mouth, fractured wrists and punctured lungs. This type of injury may use up all nine lives at once, so please keep your windows closed or use window screens to protect your cat.

Is your dog better at predicting a thunderstorm than the weatherman? Some believe dogs hear thunder as it approaches and before humans do. Others believe the static electricity from the storm accumulates in their fur, making them act crazy before a storm. Whatever the cause, a special jacket may help. The Storm Defender coat diffuses the static electricity accumulating in your dog’s fur during a thunderstorm. The Anxiety Wrap’s tight fit soothes anxious or frightened dogs. However they work, these jackets are worth a try if your dog has thunderstorm phobia. They may protect your house from destruction by your frightened dog during a thunderstorm.

Watching your cat stalk bugs in a summer garden can provide hours of entertainment, but the garden can be a dangerous environment for pets. Azaleas, lilies, tulips, cyclamen and narcissus can cause stomach upset or even kidney failure. It is best to check the plant’s toxicity profile before adding it to your garden. Mulch holds moisture around plants and creates an attractive look in your garden. Cocoa mulch has become popular for its dark color and aroma. Some dogs will eat the cocoa mulch, resulting in chocolate toxicity. For a pet-friendly garden, skip the cocoa mulch altogether.

Beaches and Pools
The beach is a great place to make a summer getaway for swimming, boating or reading a good book. Just be sure your dog is properly outfitted. A dog life jacket will prevent a dog overboard emergency if you have a landlubber dog. Take fresh drinking water for your dog if you are spending the day at the ocean – sipping too much salt water can result in stomach upset and/or diarrhea. If you can’t make it to the beach and are poolside, keep it safe for your dog by installing floating pool stairs. Most dogs can’t negotiate a pool ladder to escape if they fall into to the pool. Before there is an emergency, practice using the pool stairs so your dog knows where they are and how to use them. Swimming rules are for dogs too – never let them swim alone!

For more summer pet safety and health information please join us at The AMC’s PAW Day 2010, a day of pet and wellness fun for families and their furry companions, on Saturday, June 5 from 9am-12pm in Carl Schurz Park in Manhattan.

The Animal Medical Center
For 100 years, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit To make an appointment, please call 212.838.7053.

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