If your dog has been diagnosed with this renal disease or you're worried they're showing signs associated with end-stage kidney failure, a lot is probably going through your mind right now. At the forefront might be which stage of kidney disease does your dog fall under, and how can you make them as comfortable as possible? It's advisable to educate yourself about what to expect as your pet's illness progresses. That way, you can give them the best quality of life all the way through their final days.
Dog Kidney Failure Stages
Dogs with kidney failure go through a series of four stages, from diagnosis through the eventual death of the animal. These stages do not necessarily occur within rapid succession. A dog can go through them over the course of a few months or even years. Veterinarians determine the stage your dog is in by testing the urine to look for signs of the deterioration of the kidney's functions and the blood for symmetric dimethylarginine (SDMA) levels.
The Four Stages of Kidney Failure Chart
The canine kidney failure stages are determined by the levels of creatinine and SDMA, as well as the urine-to-protein (UPC) ratio and the animal's systolic blood pressure.
| Dog Kidney Failure Stage | Creatinine (in mg/dL) | SDMA (in µg/dL) |
| Stage 1 | less than 1.4 | less than 18 |
| Stage 2 | 1.4 to 2.0 | 18 to 35 |
| Stage 3 | 2.1 to 5.0 | 36 to 54 |
| Stage 4 | greater than 5.0 | greater than 54 |
Other clinical indications that a dog is in the stages of kidney failure are:
- UPC Ratio:
- Nonproteinuric: less than 0.2
- Borderline proteinuric: 0.2 to 0.5
- Proteinuric: greater than 0.5
- Systolic blood pressure (in mmHg):
- Normotensive: less than 150
- Borderline hypertensive: 150 to 159
- Hypertensive: 160 to 179
- Severely hypertensive: greater than 180
Symptoms of End-Stage Kidney Failure in Dogs
The most common signs a dog is dying from kidney failure include:
- Uremia: The buildup of waste products in the body produces a distinctive ammonia smell that is especially apparent on the breath.
- Pale, dry gums: The gums are duller and dry to the touch.
- Mouth ulcers: Uremia causes raw mouth ulcers that are painful.
- Bloodshot eyes: The whites of the eyes are bloodshot.
- Increased thirst: An affected dog drinks water excessively.
- Increased urination: The dog will urine large volumes of dilute urine.
- Dehydration: Despite more fluid intake, the dog is dehydrated.
- Decreased appetite: The dog loses interest in food.
- Weight loss: The dog steadily loses weight.
- Gradual loss of fat and muscle mass: The weight loss affects both fat and muscle mass and can cause emaciation.
- Dull coat that sheds excessively: The lackluster coat constantly sheds and looks unkempt.
- Lethargy: The dog has little energy or interest in moving around.
- Fatigue: The dog sleeps most of the day and night with only brief periods of wakefulness.
- Vomiting: The dog vomits frequently and cannot keep food down.
- Anemia: The dog may develop anemia.
- High blood pressure: The dog has elevated blood pressure.
- Incontinence: A dog cannot control their urination.
- Difficulty breathing: The dog has problems breathing normally.
- Slowing heart rate: A faster heart rate is generally present with kidney failure, but the heart rate begins to slow down during the end stage of the disease.
- Depression: The dog seems sad and does not respond to any of their favorite things.
- Low temperature: Dogs in their last days of kidney failure can experience hypothermia or a low body temperature.
- Lack of interest in surroundings: The dog is unaware of or disinterested in their surroundings.
- Disorientation: The dog acts confused at times.
- Loss of balance and coordination: The dog appears clumsy and unsteady on their feet.
- Trembling or shaking: The dog has tremors or episodes of shaking.
- Seizures: The dog suffers periodic seizures, one of the major signs of end-stage kidney failure.
Keeping Your Pet Comfortable
Watching your pet go through this can be very difficult. However, there are things you can do to help keep your dog comfortable during the final stages of kidney disease.
- Spend as much time as possible with your dog. Even being in the same room will be soothing to them.
- Make sure your dog's resting area is quiet, warm, and cozy. Provide them with their favorite blanket and toy.
- Protect your pet from other pets or people who may be too rough with them. Supervise interactions with children and teach them to be gentle with the dog.
- Pet your dog and talk to them frequently.
- Change your dog's bedding often and keep them clean and dry. Brush their fur for dry cleaning. Clean their fur with a sponge bath solution of hypoallergenic pet shampoo.
- Feed your pet a low-protein dog food appropriate for a kidney failure diet.
- If your dog refuses to eat or has trouble eating, ask the veterinarian about other feeding options such as an esophagostomy tube to keep them nourished.
- Monitor your dog's temperature and keep them warm with plenty of cozy blankets.
Last Days of a Dog Dying From Kidney Failure
While a dog owner may fear that entering the final stage of kidney failure means their dog's passing away is imminent, it is difficult to predict how long the does has left. In general, you can expect your dog to pass away within three months of moving into stage 4, though some dogs may thrive for up to a year.
It depends on the associated symptoms and other conditions that may arise due to the dog's poor health. Your dog's age is another factor. There's a lot to keep in mind, a lot to hope for, and the reality that you're facing the end of your dog's life.
Controlling your dog's diet can help during their struggle with renal failure. Carefully discuss nutrition with your dog's veterinarian.
When to Consider Euthanization
When a dog enters end-stage renal failure, your veterinarian may recommend an end-of-life home treatment plan or a hospice program to make your pet's last days comfortable and maintain your pet's quality of life. For end-stage kidney failure, a treatment plan may include dialysis, a stomach tube, intravenous therapy, pain medication, and methods to care for an incontinent pet.
Depending on their symptoms, your dog may not necessarily be in severe pain, but they will be uncomfortable at the least from other symptoms, including frequent vomiting and diarrhea, lethargy and depression, and constant dehydration. Your veterinarian may recommend euthanasia if a dog is suffering, unresponsive to pain management, or too weak to handle necessary life-sustaining treatment.
Dealing With the Loss
It's hard to come to terms with the fact that a pet is dying. Find comfort in the fact that your dog appreciates your loving care in their final days. They know you love them and take comfort in your presence and all that you do to make their life easier.
