Kidney Diseases: Symptoms, Causes and Treatments
Dr. Marty Greer, DVM joins host Laura Reeves for a deep dive on diseases that affect the kidneys in dogs. They cover symptoms of kidney problems, causes and treatments for various common kidney issues.
“The symptoms that most people catch first are a change in water consumption, an increase in water consumption and increase in urination,” Greer said. “Now, that’s not the only reason that dogs can need to drink more and urinate more, and what goes in must come out. So those usually go hand in hand.
“The most common things are changes in water consumption, changes in urination. Now other things that frequently cause that are going to be diabetes; which happens in dogs and cats, Cushings disease; which happens in dogs, which is an adrenal gland dysfunction, and other things like pyometra, high calcium that can be related to different forms of cancer. So, there can be other things that we’re looking for. But we’re going to start looking at kidneys, diabetes and Cushing’s disease in the dog most commonly.
“We’re going to get blood work and urinalysis as our basic starting point. But that’s not the only place we’re going to go. We’re going to start with those two things. Because if the dog is still able to concentrate their urine, well, then that tells us something different than if the dog’s urine was really dilute and the BUN and creatinine start to go up.
“Once that happens, that means that only one fourth, only 25%, of the dog’s kidneys are still working correctly, unless it’s a secondary cause from dehydration like vomiting, diarrhea, other causes of dehydration, so it’s super important. You go in and if your vet says we should do lab work, you shake your head up and down and you say yes, yes, yes we should. Please do not argue with them. Do not fight them on it because you can very quickly tell from a urinalysis and a blood panel.
LR: Can a bladder infection go to the kidneys?
“Number one, it can. It’s not common, but it can.”
LR: OK, so what’s going to cause a kidney infection? Where’s our causation?
“It’s usually hematogenous, meaning it starts off in the bloodstream, so can start as a pyometra. It can start as any way that bacteria gets into the bloodstream, but usually the kidneys are protected by the fact that the urine is concentrated so that helps to kill bacteria and remember urine is flowing from the kidneys down the ureters and into the bladder so that constant flushing should keep bacteria from being able to ascend up into the ureter and up into the kidney. So can they still happen? Yes, they can. They’re not at all common, but they happen. And they’re tricky to diagnose because sometimes it doesn’t look obvious. So that’s where that blood and the urine sample is really important because it is life-saving to a dog or a cat to have that diagnosed and be able to resolve that.
Additional causal factors, Greer noted, can include tick born or infectious diseases such as Lyme Disease and Leptospirosis.
For additional details on causes and treatments, listen in to the entire episode, or check the YouTube pod, and click to subscribe, @PureDogTalk.
Dr. Marty Greer on Autoimmune Hemolytic Anemia
Dr. Marty Greer, DVM, this year’s Westminster Kennel Club and Trupanion Vet of the Year, joins host Laura Reeves to discuss Autoimmune Hemolytic Anemia in dogs.
“Autoimmune hemolytic anemia is, as it sounds, an immune mediated disease,” Greer said. “But what it doesn’t exactly describe is that in this particular disease, the target cells for the immune response are the circulating red blood cells. So in a patient that has autoimmune hemolytic anemia… people have it, dogs have it. Not as often in cats…. basically the body attacks its own red blood cells.
“The dog goes from being pretty clinically normal, to being really profoundly sick, weak, out of breath, really, really sick. Sometimes with a fever, sometimes not, within a matter of hours to days. And when this happens, it requires an immediate diagnosis and immediate initiation of treatment. Sometimes requiring blood transfusions, 24 hour stays in the hospital, all kinds of stuff. So, it is a bad disease.
“As soon as you flip the lip and you see that really pale mucus membrane color, like their gums are white or close to white. Sometimes jaundiced, just depends on how rapidly the red blood cells are being broken down and how those are being managed. The dog will look something like a dog with a splenic rupture. Or hemangiosarcoma of the spleen where they’re bleeding into the abdomen. It’s that same really profound anemia. Now, this tends to be most common, like I said, in middle age, to older female dogs, especially spaniels.
“That being said. I’ve seen it probably in every breed. So, I don’t think you can say, well you know, I have a corgi so it couldn’t be that. I don’t really think that’s the case.
“The other part of this is to try and determine if there’s an underlying cause. It can happen spontaneously in the middle-aged and older female. It can happen after a number of vaccinations are administered at the same time, but we see a lot of it related to tick borne diseases.
“(These) are thought to be triggers for this because something makes your body, say that red blood cell that’s in your circulation, no, that’s not my cell, that’s not my protein. My immune system is going to attack it just like it would have bacteria, a virus or other foreign tissue.”
Listen in to the entire episode for Dr. Greer’s diagnostic and treatment recommendations. And click over to the Veterinary Voice ALBUM for a compilation of every one of Laura’s in depth and practical conversations with Dr. Greer.
Dr. Marty Greer’s Passion Project & Anniversary Episode
Dr. Marty Greer, DVM and host Laura Reeves celebrate their fifth anniversary of sharing important veterinary topics on Pure Dog Talk.
Greer’s passion project is Breast Cancer Awareness in dogs.
“People sometimes forget that dogs get breast cancer too,” Greer said. “It’s not an uncommon kind of cancer to find in dogs, unfortunately. It is definitely linked to spaying at an older age. But, in spite of that, there are still some significant benefits in waiting to spay. So that’s a whole ‘nother topic.
“But essentially we see it in middle age to older, normally female dogs that were left intact after the age of two. So, anybody that’s breeding their dog is typically not going to spay before two because of health clearances, because she needs to mature before you breed her. So this means that almost every dog in a breeding program is gonna fall into a possibility of breast cancer. Mammary tumors, same thing, different term, all the same stuff.
“And I think it’s really important that people know that there isn’t a good treatment other than surgery. So early detection and surgery is going to be almost the only thing that we can offer.
“So, really, early detection, finding a nodule, taking it off when it’s small and then being very attentive for additional ones to develop is very important.
“Dogs have five sets of memory glands. The littlest ones are at the front between the front legs, and then they go down a nice string all the way down, usually in a fairly straight line. Every now and then they’ll be an extra nipple or something else thrown in, and that’s OK. It’s just a normal variation.
“But what you want to do is go along that chain that goes down, so feel from one nipple to the next and in between the nipples and just gently manipulate the skin so that you can see if you find anything that seems abnormal. A breast cancer nodule will feel firm, like a pea or a little cluster of peas. They’ll be firm. They won’t be those soft kind of masses. They won’t be on the belly button. They’ll typically be off to the side. The most common place to find a tumor, and the most serious tumors, are in the glands closest to the back legs.
“I strongly encourage people not to spend the money on a fine needle aspirate. A lot of veterinarians want to stick a needle in it and aspirate it, and because most mammary tumors are mixed of different cell types, that is not going to be an accurate assessment of what you have.”
Listen to the full episode here and then flash back to the first episode, introducing Dr. Greer.
Pre-breeding Protocols, Folic Acid, Cleft Palate and More
Dr. Marty Greer, DVM, JD, joins us for an important conversation about pre-breeding protocols. Greer provides insight on what to do (hint: folic acid!) and what not to do to help ensure a healthy litter.
Bitches who are to be bred should be started on a protocol 6-8 weeks ahead of estrus, Greer noted. Considerations include a proper diet, supplements and when to use flea, tick and heartworm treatments.
“We know from livestock and wildlife that when females are just slightly soft they produce more offspring,” Greer said. “They ovulate more if the caloric intake increases just before mating.”
Appropriate diets should include carbs, Greer said, and avoid phytoestrogens from peas/legumes. Owners should also supplement vitamin b9, folic acid, starting 2 months ahead of breeding to help prevent cleft palates. Greer recommends dosing 5mg/dog/day. For more information on some of the research on this topic, go to
Studies indicate that breeders can insure a 50-70 percent reduction of cleft palates by using folic acid properly.
Cleanliness is next to godliness
Make sure your bitch is clean before visiting the vet or having her puppies. A bath and sanitary trim will keep the vet and the puppies happier!
What NOT to do
Vitamins A and D in excess during the first two trimesters can *cause* cleft palates, Greer said. She also noted that while most of us know not to give steroids orally during pregnancy, that even topical application in ears or eyes is contraindicated.
More myth busting and important advice
- Can you or should you save cleft palate puppies — Greer shares some of the hard choices to be made
- Goats milk and cataracts — use an appropriate formula for dogs
- Colostrum/plasma — frozen plasma can make all the difference
- Subcu fluids — how and why
Veterinary Ethics and Building a Relationship with Your Vet
Dr. Marty Greer, DVM, JD, president of the Society for Veterinary Medical Ethics visits with Host Laura Reeves about how breeders and veterinarians can work together for a positive outcome.
“Vets are not held in as high esteem as they have been in the past,” Greer said. “And that’s concerning to me. As veterinarians, we touch so many people in a positive way. It’s truly a calling. It’s not just a job that you get in your car and drive there. It has to be a passion, people don’t get rich doing this.”
Too much Dr. Google
“Communication is a really important piece,” Greer said. “Many vets and staff are introverts by nature. Honest open frank communication is the best way to handle any situation.”
Greer recommends that if owners have a particular opinion on diet, vaccines, etc they need to interview vets to find someone they enjoy working with, even if it means driving further.
“Bring ideas but listen to what vet has to say,” Greer said. “Start a conversation that is a give and take.”
Greer noted that up to 30 percent of dogs going to an emergency clinic don’t have good outcomes. She adds that while a client may not have the relationship with the doctor at an emergency or specialty clinic, but these hospitals can do amazing things with new medical procedures.
“Develop a relationship with your vet, even the staff at a local emergency clinic, before you have a crisis,” Greer recommended.
Fear Free Medicine
Greer also suggested that clients check in to some of the methods to condition dogs to quietly accept treatment and handling for a better outcome in any situation, emergent or standard practice.
Telemedicine is a huge, up and coming service, Greer said. While it inherently has some draw backs, she noted that this is the next frontier of veterinary medicine.
“There are multiple services where vets can do real-time, long-distance consultation,” Greer said. “Seismic changes will be happening in the next couple years, with the AVMA releasing new policies recently.”
Other resources referenced in this podcast:
Debra Hamilton’s mediation services: https://puredogtalk.com/finding-common-ground-to-grow-the-purebred-dog-fancy-pure-dog-talk/
Canine Cognitive Dysfunction is More Than Old Age
Dr. Marty Greer, DVM is back with this month’s Veterinary Voice topic, Canine Cognitive Dysfunction.
Canine Cognitive Dysfunction/Cognitive Dysfunction Syndrome: (CDS) is a neurobehavioral disorder affecting geriatric dogs and cats that is characterized by an age-related decline in cognitive abilities sufficient to affect functioning, with behavior changes that are not attributable to other medical conditions.
Signs of Dog Dementia
To look out for canine cognitive dysfunction, remember to check your dog’s “DISH”:
- Wanders aimlessly
- Becomes stuck on the wrong side of the door or behind furniture
- Staring at walls or into space
- Seems lost in the yard or forgets the purpose of going outside
- Forgets where the water and food bowls and doors are
- Fails to recognize familiar people or dogs
- Reduced responsiveness to name or verbal commands
- Abnormal response – increased or decreased – to familiar objects
- Difficulty learning new tasks
- Difficulty performing previously learned task
- Loss of interest in food
- Repetitive behaviors
- Interaction with Family Members
- Seeks less attention (petting, belly rubs, play)
- Less enthusiastic to greet people or other pets in the home
- No longer greets family upon arriving home
- Fails to respond to verbal cues
- Increased irritability and/or aggression with family and pets
- Changes in exploratory behavior
- Intolerant of being left alone
- Sleep and Activity
- Sleeps more hours per day, especially during the daytime
- Sleeps less throughout the night
- Reduced daily activity
- Lack of interest in his surroundings
- Restlessness, pacing, wandering or circling at sunset (sundowning)
- Vocalization at night (barking or howling)
- House Training
- Urinates or defecates indoors
- Urinates or defecates indoors soon after having been outside
- Failure to indicate need to go outside
- Accidents occur in front of his owners
- Elimination at uncommon outdoor locations such as on concrete
The neuroanatomic pathology in dogs and cats shares some characteristics with human Alzheimer’s disease, specifically β-amyloid accumulation, tau phosphorylation and neuronal loss in the frontal cortex, cerebellum, and hippocampus.
Managing Canine Cognitive Dysfunction
- Purina Neurocare/Bright Minds
- Hills B/D
- Royal canin
- Addition of antioxidants (Vitamin C and E) for cellular-level health and medium-chain triglycerides for cognitive improvement. L-Carnitine for muscle mass.
- Phosphatidylserine, Apoaequorin and S-Adenosyl-l-Methionine (SAME)
- Anipryl/selegeline – Is a selective monoamine oxidase -B inhibitor, which could enhance catecholamine neuron activity and increases dopamine levels in dogs.
- Avoid unnecessary vaccines
- Skip pharmaceuticals when possible
- Reduce stress including changes in their routine and environment
- Potty pads, confinement, outside more often
- Pet-proof the house
- Social interaction and mental engagement/ environmental enrichment
- Keep the day/night cycles regular with sunlight
- Walking/exercise/stroller if needed
- Situational anti-anxiety drugs – trazodone and gabapentin
Prostate Problems, Prevention and Solutions
Dr. Marty Greer gives us the low down on male dog prostate and reproductive issues. Additional discussion on emergency semen collection, dogs whose semen doesn’t extend well and more.
“This is an area that is often misunderstood by the general practitioner vet,” Greer said.
Symptoms of a prostatic complication include blood in the urine or ejaculate, straining to pass stool, blood dripping from the penis, Greer added.
Prostate cancer, benign prostatic hypertrophy, prostatitis are the most common complications. Dogs over five years old are the most commonly affected.
Greer advises that neutering is not absolutely necessary for dogs with non-cancerous prostate disease.
Dogs with a prostate infection are very sick, typically run a fever and clearly don’t feel well, Greer said.
Prostatic cancer manifests in two different forms. Which type the dog has needs to be confirmed with a biopsy.
“Both kinds of prostate cancer are quite serious,” Greer said. “Counterintuitively, it is almost always a neutered dog that has these cancers.”
Benign prostatic hypertrophy (enlarged prostate) is a hormonal disease, Greer noted. Dogs don’t need antibiotics, neutering isn’t required. The condition can be successfully treated with hormone therapy.
“Neutering will cure BPH and prostatitis. However, it is very difficult to breed neutered male dogs, unless they have had semen frozen. The best time to freeze semen is when a dog is between 2 and 5 years of age. The dog should be healthy and producing great quality semen. It will cost you a lot less money to freeze a canine’s semen when he is young. If he later turns out to have a disorder that you don’t want in your breeding program, you can either wait until a DNA test is conducted to determine how you can use him in your breeding program or discard the semen.” — Dr. Marty Greer
K9 Flu Is Serious Risk Because Dogs Have No Natural Immunity
Dr. Marty Greer takes us through the outbreaks of Canine Influenza (K9 Flu) in the United States. She also offers recommended vaccination protocols for adults and puppies.
Outbreaks of two different strains of Canine Influenza have left U.S. dog owners struggling with if and when to vaccinate against this virus. Greer advocates strongly for “yes” and “annually.”
K9 Flu causes pneumonia
“No dogs have natural immunity to the disease,” Greer said. “Unless vaccinated, dogs are at serious risk. I have my personal dogs on a three-year protocol, but even Dr. Ronald Schultz is advocating that owners vaccinate for influenza in ALL dogs.”
Greer notes that the 2015 virus outbreak came with Korean meat dog “rescue” imports and spread rapidly. Dogs traveling for competition at the highest risk of contact.
Influenza in the dog causes pneumonia, Greer said. The symptoms look like kennel cough to start, but progress rapidly to pneumonia, including a hemorrhagic variant.
“Eight percent of infected dogs die,” Greer said. “This really is a big deal.”
An ounce of prevention is worth a pound of cure
Treatment with two weeks of antibiotics, iv fluids, possibly even oxygen, is common Greer said. Follow up xrays to confirm the pneumonia is controlled are required. Even dogs less severely affected are infectious for up to 3 weeks.
Two vaccine companies offer products which cover both strains of the disease and are readily available, Greer said. The vaccinations require two injections, two-four weeks apart, with an annual booster. Since the vaccines have only been available since 2016, there isn’t sufficient data to determine if they are effective longer than that.
Impacts on puppy vaccination protocols
Adding the K9 Flu vaccine into a puppy vaccination protocol can be a challenge, but Greer said the vaccine can be given as young as seven weeks of age. She recommends inoculating on a staggered schedule. She also strongly recommends the nomograph system of establishing vaccination timing for puppies. Her recommendation is to pull blood on the dam at the same appointment in which ultrasound confirms pregnancy. This blood is shipped off to a laboratory that measures the bitch’s immunity levels to disease and pinpoints exactly what date the puppies should be vaccinated.
Canine Nomograph – What is it?
A nomograph is an estimate of the amount of antibody passed to a litter of pups from the mother via her colostrum. During the puppy’s first hours of life, its intestinal tract is able to allow colostral antibody to be absorbed into the bloodstream. This passive antibody helps to protect the newborn from all the diseases that the mother is protected from. As the puppy grows up, maternal antibody breaks down in approximately 2 week “half lives” until it is no longer present in the pup. While this antibody is at higher levels, it is able to neutralize viruses such as canine parvovirus and canine distemper virus. Because of this neutralization, puppy vaccine can be blocked. Maternal antibody interference is one of the most common causes of vaccine failure to immunize! The reason that puppies are given multiple doses of vaccine is because most of the time we don’t know what their maternal antibody titers are, and so don’t know when the vaccine will be effective. Nomograph testing helps us understand the best timing of vaccination to assure a litter will be effectively immunized. Because the nomograph is limited by the ability of the dam to make colostrum and for the pups to receive it, nomograph results should not be used as a definitive indication of protection from disease. If you are a breeder who is experiencing a disease outbreak, please contact us prior to submitting a nomograph.
(Reference: Baker, Robson, Gillespie, Burgher, and Doughty. A nomograph that predicts the age to vaccinate puppies against distemper. Cornell Veterinarian, Aug 1958, page 158-167.)
Listen to Dr. Gayle Watkins in an early PureDogTalk interview on the topic of nomographs.
Pyometra is a life threatening disease
Pyometra is a severe bacterial infection with accumulation of pus within the uterus. Though it often occurs with middle-aged or older unspayed females, younger dogs are sometimes affected. Pyometra most commonly develops a few weeks after a heat cycle. The condition results from hormonal changes that decrease the normal resistance to infection. As a result, bacteria enter the fluid in the uterus and large volumes of pus can accumulate.
Signs of Pyometra include loss of appetite, excessive thirst and urination, lethargy, and/or vomiting. Sometimes, there is a vaginal discharge. The disease may develop very slowly over several weeks.
This condition often requires emergency surgery, provided the animal is stable. Surgery consists of removing both ovaries and uterus, which not only corrects the condition, but also eliminates bothersome heat cycles. Because the patient is ill and the uterus is infected, the surgery is more complicated and carries a higher risk than a routine spay. Ultrasound and blood tests are useful in both diagnosing and evaluating surgical risk. Post-operative treatment includes antibiotics and intravenous fluids.
For dogs who are in a breeding program, Dr. Marty Greer, DVM provides information in the podcast about medical management that may avoid the spay surgery.
From Dr. Greer…. “Your pet has presented with a condition called pyometra, or a uterine infection. These can be life-threatening, and most cases will not resolve without surgery. Pyometra usually occurs 1-5 weeks after the last heat cycle. In this illness, the uterus has filled up with pus (white blood cells and bacteria) and is at risk for rupturing if not treated immediately.
Prior to surgery, we will stabilize your pet with intravenous fluids, antibiotics, and pain medications. Most patients with pyometra are very sick – with either a very high or very low white blood cell count, fever, dehydration, a low blood sugar, and vomiting and diarrhea. As soon as your pet is able to tolerate anesthesia, we will start surgery to remove the uterus.
Your pet will be in the hospital for at least 2-5 days, depending on how she does during surgery and afterwards. It is important to know the possible complications of pyometra surgery. These include:
- Peritonitis is the most common. This means infection within the abdomen. It is treated with antibiotics, IV fluids, and may require additional surgery and drainage.
- Rupture of uterus in surgery. The uterus is often very thin and easily damaged. It is possible that it can rupture during surgery, spilling pus into the abdomen. This can prolong the hospitalization for several days.
- Aspiration pneumonia. Fluid and food sometimes bubble up into the throat and mouth during surgery. This can be inhaled into the lungs, leading to pneumonia. Every precaution is taken to avoid this, but it still happens in some cases.
- Sepsis, systemic inflammatory response syndrome, acute respiratory distress syndrome (ARDS), and disseminated intravascular coagulation can also occur before, during, or after surgery. These are uncommon complications in which the white blood cell count drops, the patient develops or continues to have a fever, sometimes develops difficulty breathing and difficulty with normal blood clotting. These are not common but can occur. If they do, very aggressive treatment must be undertaken to save your pet and can significantly prolong hospitalization and lead to death.
- Acute kidney failure can occur before, during, or after surgery. This is not a common complication but can happen. Often patients will also have a urinary tract infection. Once your pet is stable, eating, comfortable and able to take oral medications, discharge home can be discussed with the doctor. ”
Blastomycosis is deadly hazard for dogs
Dr. Marty Greer, DVM, discusses the causes, symptoms and treatment of deadly Blastomycosis and other fungal infections. Greer notes that fully 25 percent of dogs affected by this disease will die.
Greer is notably not an alarmist, but she is adamant that Blastomycosis is a deadly and dangerous disease. Specific areas of the country, including the upper Midwest and South/East River valleys, are most commonly affected.
This particular fungal infection is contracted by spores inhaled from disrupted soil, particularly near water. Greer also addresses other fungal infections that can affect dogs.
The most common symptom of Blastomycosis is a dog that is coughing, sounding like pneumonia. The dogs will often also present with a draining sore on the foot that is of indeterminate cause.
Diagnostics for the disease are conducted on urine samples sent to a specific laboratory in Indiana. Dogs can decline rapidly, with acute onset of the disease in less than 24 hours. Treatment of the disease is expensive, time consuming and even successful treatment may leave the dog with permanent damage.
Dogs are treated with oral medication, with a 75 to 90 percent success rate, using the urine test to monitor efficacy of treatment.
Blastomycosis is a zoonotic disease, meaning it affects people and animals. People will not be exposed by their sick dogs, but they can acquire the disease from the same source of disrupted soil. The spores live in the soil. She goes so far as to recommend dogs that pass from the disease be cremated, not buried, so as to not release more spores into the soil.
“There have been outbreaks where 120 people were sickened in one event,” Greer said. “It is bad, bad stuff. Nobody messes around with this. It is serious.”
Blasto can be a challenge to diagnose, as the early symptoms are similar to many other diseases, Greer said. She adds that owners should keep track of dogs after traveling to areas where the disease is prevalent.