Uremia

Uremic illness is a potentially life-threatening condition that is largely the result of accumulation of organic waste products that are normally cleared by the kidneys. In two outbreaks of pet food-associated renal failure (2004 and 2007), all animals died or were euthanized because of severe uremia.

Urea (CH4N2O), also known as carbamide, is an endogenous product of protein and amino acid catabolism. It is formed in the liver from ammonia to remove nitrogen from the body. Approximately 20–35 grams of urea are excreted in human urine per day. Urea is present not only in urine, but also in blood serum, sweat and even in stomach. The term uremia technically means elevated concentration of urea in the blood, but commonly refers to the collection of clinical signs that are associated with kidney failure. 3

Clinical signs of canine uremia include loss of appetite, vomiting, mucosal ulcers, lower body temperature (99.3°F), and weight loss. Some dogs may develop chronic diarrhea, staggering and disorientation.1 Oral bleeding is sometimes seen and is believed to be caused by toxins (urease) that are released during degradation of urea by bacteria, such as (Staphylococcus, Clostridia, Vibrio vulnificus, Ureaplasma, Proteus, Pseudomonas aeruginosa, Klebsiella, Corynebacterium, Providencia, and Morganella). These toxins are recognized by antibodies and the presence of such antibodies is connected with the progress of several long-lasting diseases, like rheumatoid arthritis, atherosclerosis or urinary tract infections.2,6


A recent study showed the beneficial effect of a commercial dietary supplement with chitosan, enteric phosphate binders, and alkalinizing agents fed to dogs affected by chronic kidney disease. Beneficial effects of renal diet and of the ACE-inhibitors enalapril and benazepril are usually observed after 30 days.4

Hemodialysis is an advanced renal replacement therapy for uremic dogs, with the capability to remove uremic toxins, correct fluid and electrolyte imbalance, restore acid‐base balance, and sustain the life of the patient until the kidney injury resolves. As a consequence, hemodialysis extends life expectancies of dogs with severe uremia. Nonetheless, the mortality of patients with AKI managed with hemodialysis remains as high as 50%. The availability of renal replacement therapies in veterinary medicine is growing, but it remains a costly therapy with limited regional availability.9

References

  1. Linda P. Case. The dog: its behavior, nutrition, and health
  2. Michael Schaer. Clinical Medicine of the Dog and Cat
  3. Brown CA, Jeong KS, Poppenga RH, Puschner B, Miller DM, Ellis AE, Kang KI, Sum S, Cistola AM, Brown SA. Outbreaks of renal failure associated with melamine and cyanuric acid in dogs and cats in 2004 and 2007
  4. Effect of Dietary Supplements in Reducing Probability of Death for Uremic Crises in Dogs Affected by Chronic Kidney Disease (Masked RCCT)
  5. Toxicological Review of Urea (EPA)
  6. Bacterial Urease and its Role in Long-Lasting Human Diseases
  7. Hypothermia in Uremic Dogs and Cats. E. Kabatchnick,corresponding author C. Langston, B. Olson, and K.E. Lamb
  8. The effect of renal diet in association with enalapril or benazepril on proteinuria in dogs with proteinuric chronic kidney disease. Open Vet J. 2016; 6(2): 121–127.
  9. Validation of a Clinical Scoring System for Outcome Prediction in Dogs with Acute Kidney Injury Managed by Hemodialysis. J Vet Intern Med. 2016 May-Jun; 30(3): 803–807.




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