Art by Kelly Rega

Kidney Treatments

Management of Renal Disease in Older / Natural Kidney Failure

Not all of these are indicated in ALL kidney cases. read further down for a “synopsis” of how we TYPICALLY manage moderate renal disease. For simplicity, the list further down itemizes treatment recommendations and not the “further diagnostics and monitoring” that might be suggested.

For “How We Do It at Johnson Vet” go to the end of this page.


  • Azodyl
  • Regular / Intermittent Fluids
  • Lactulose
  • FOS Chicory Root Powder
  • Water soluble vitamins
  • Appetite Stimulant
  • Anti-nausea medication
  • Low Protein, high-quality-protein or home-cooked renal-sparing diets.
  • Baking Soda in their water
  • Antibiotics
  • DMSO containing fluids
  • NON DMSO containing fluids
  • Epakitin – Calcium carbonate to complex and reduce phosphate in the bloodstream.

Epakitin is a mixture of chitosan and calcium carbonate.

Websites are giving it credit for doing a LOT of stuff it absolutely cannot do. It’s a lot of “fine print” stuff like saying: “Epakitin and a kidney-sparing diet can reduce phosphate levels and reduce BUN and creatinine values”.  WITHOUT specifying that Epakitin will not effect nitrogen levels at all. It’s the diet that will do that. Still, it can be argued that cats and dogs “feel better” with lower Phosphorus levels. And, it’s mirrored in the improvements you see when you give sodium bicarbonate.


Step one: Get or already-have baseline bloodwork with a BUN value, and a CREATININE value as well as electrolytes.

Step two: Start a Kidney-sparing diet, or a diet based on eggs, whey and sweet potatoes.

Step three: We like to run fluids under the skin once a day (when feasible) for up to 7 days. The intent is to dilute the nitrogen in the blood stream to try and let the kidney “get up”.

Step four: At the conclusion of those daily fluids I like to recheck the kidney values, and electrolytes. It is important to a “prognosis” prediction:  If the values are considerably better, we can improve the prognosis. If the values are actually only the same or worse, then I have a much lower optimism and will then say something like “We’re NOT winning, and the process of proving WHY we’re not winning costs a LOT and requires a specialist referral. What would you prefer to do, more treatments, veer off, or escalate to a specialty practice?”

Step five: If fluids help a lot I like owners to grab the torch and continue fluids twice a week for the long term and recheck the kidney values in a month. If the values are worse, it means the dog needs fluids MORE than twice a week which is ARDUOUS. If the values are better, then we’d stay the same. If the values are NORMAL we might back off to ONCE a week.

All these treatments could be considered. (The extras)

Step six: Sooner or later we will look at the dog or cat and they’ll appear “pale” and anemic. This is practically inevitable. The KIDNEY makes the hormone that CAUSES red blood cell production. That hormone called “Erythropoetin” and if that’s missing, because the kidney isn’t producing this hormone. We can inject that straight out of a bottle. It’s called “EPOGEN TREATMENT” and it’s a little expensive. Some people don’t go down that road.

Obviously some cases go better than others. Some dogs don’t “make it” very long. Some can go for years. Some cases need ADDITIONAL medications for pancreatitis, common bile duct obstructions, infections, and cardiac conditions which show up as we give fluids “all the time” which can disrupt a tenuous situation with the heart.

The following links are to other kidney / renal resources in our web site.

Kidney Diet Home Cooked Diet for Canines in Kidney Failure

So Your Pet Has Kidney Issues?


Auxiliary Treatments For Canines with Renal Failure


Author: Dr. Erik Johnson
Dr. Erik Johnson is the author of several texts on companion animal and fish health. Johnson Veterinary Services has been operating in Marietta, GA since 1996. Dr Johnson graduated from the University of Georgia College of Veterinary Medicine in 1991. Dr Johnson has lived in Marietta Georgia since 1976.