The first section is about the tests used to diagnose kidney disease. This section will help you to understand your dog's diagnosis, and help you decide whether additional tests might be advisable. It is important to know the severity of your dog's problem to best understand how to treat it, and it can also be meaningful to find the cause of the problem, especially in younger dogs, who may be suffering from Acute Renal Failure (ARF) rather than Chronic Renal Failure (CRF). See Tests Used to Diagnose Kidney Disease below.
Next, you will find links to and excerpts from a number of different articles and studies that show that feeding a low protein diet will not prolong your dog's life or slow the progression of the disease, and in fact can lead to malnutrition, which causes the body to cannibalize itself, producing more waste products than if an adequate amount of protein were fed. See Is Feeding a Low Protein Diet Necessary or Desirable? below.
Next will be a section on Creating a Diet for Dogs in Kidney Failure. This section will not provide specific diets, but will give you the information you need to create your own diet that is right for your dog. It includes a section on where to buy Green Tripe, and a table that lists nutritional values for a number of different foods you may want to feed. I have also included information on Commercial Renal Diets.
In addition to diet information, I have also provided info on Supplements, Medications, and the use of Sub-Q Fluids.
Near the bottom is a section called Putting It All Together, which includes specific diets and treatment that I have used with my own dog.
At the bottom of the page you will find Links to More Information.
Note about measurements: I refer to the standard US measurement of Creatinine and BUN in mg/dL, but have also supplied the converted numbers in mmol/L (BUN, or Urea) and µmol/L (Creatinine) for those outside the US. To convert BUN (Urea) from mmol/L to mg/dL, divide by 0.357 (or multiply by 2.8). To convert Creatinine from µmol/L to mg/dL, divide by 88.4. See the Clinical Chemistry SI Conversion Factors in the Merck Manual Reference Guides for more info.
Azotemia (elevated BUN and Creatinine) combined with normal urine specific gravity (1.030 and above) may indicate prerenal problems, such as Addison's Disease, or postrenal problems, such as kidney or bladder stones. see Localization of azotemia: Test your skill for more information.
It is also important to do a urine culture and sensitivity when you have indication of kidney disease. A urine culture is the only way to rule out a urinary tract infection, this cannot be done by simple urinalysis and observation of whether there is bacteria in the urine or not. A culture and sensitivity will also help you determine the best antibiotic to use for treatment, if an infection is present. Bacterial infections can cause kidney disease (pyelonephritis), so it is important to rule this out when dealing with kidney problems. Dogs with kidney problems are also at greater risk of devloping urinary tract infections. Although vets prefer to do a urine culture using a sterile urine sample (cystocentesis), I hve had good luck doing cultures on free caught samples.
When protein is found in the urine, you can do a urine protein:creatinine (UPC) ratio to determine how significant it is. Certain types of kidney disease, particularly Glomerlonephritis (GN), are associated with high amounts of protein in the urine, and this may be the first sign of kidney problems in dogs affected with these diseases. See the Links section below for more information on GN. Note that Antech offers a Urine Profile (see SA570 under Diagnostic Profiles) that includes a urinalysis, UPC ratio and numerous other values that can be helpful for only about $30 more than a UPC alone, so this might be something to ask your vet about if you are dealing with a dog that has or is suspected to have kidney problems. This article on Proteinuria is technical, but has a great deal of information about the meaning of protein in the urine, and what these additional tests may mean. There can be many causes of protein loss in the kidneys -- according to the article Protein Losing Nephropathy: An Overview, "Some of the more common infectious agents to keep in mind when diagnosing protein losing kidney diseases include: Brucellosis, Ehrlichiosis [Tick Disease], Leptospirosis, Boreliosis [Lyme Disease], Leishmaniasis [uncommon in the U.S.], chronic bacterial infections, and heartworm disease. Noninfectious causes include inflammatory bowel disease [IBD], systemic lupus erythematosis [SLE] and hyperadrenocorticism [Cushing's Disease], among others." See below for more information on testing for Leptospirosis and Tick Disease.
There is a new test that can find trace amounts of protein in the urine and serve as an early warning of kidney disease. This test is called the Heska ERD (Early Renal Disease Detection). See The E.R.D.-Screen™ Urine Test for information on this test specifically related to the Chinese Shar-Pei. There is additional information about the meaning of this test in the E.R.D. Healthscreen Urine Test Clinic Lab Book.
There is also a urine test called Electrophoresis
that can provide diagnostic clues to the source of protein in the urine.
See the following sites for a little more info:
Urinary
and Serum Protein Alterations in Dogs with Natural Ehrlichia Canis Infection
using Electrophoresis
Total
Protein Electrophoresis
Glomerulonephritis
Dogs
with kidney problems by Dr. Lucy Pinkston, D.V.M.
"Because by-products of protein digestion are the main toxins that
need to be excreted by the kidneys, an obvious assumption might be that
all one needs to do is to cut out the protein and the kidneys wouldn't
have any more hard work to do. . . . There is significant evidence, however,
that the daily protein requirements actually increase slightly for dogs
in chronic renal failure. Therefore, severely restricting the protein for
such a dog is likely to result in protein malnutrition, in spite of the
fact that the levels of blood urea nitrogen, or BUN (the primary by-product
of protein metabolism) would be correspondingly lower." This article contains
a great deal more useful information in easy to read format.
Are
High Protein Diets Harmful to a Dog's Kidneys? from the Veterinary
Services Department, Drs. Foster & Smith, Inc.
"The myth that high-protein diets are harmful
to kidneys probably started because, in the past, patients with kidney
disease were commonly placed on low-protein (and thus low-nitrogen) diets.
Now we often put them on a diet that is not necessarily very low in protein
but contains protein that is more digestible so there are fewer nitrogen
by-products."
The Mythology of Protein Restriction for Dogs
with Reduced Renal Function by Kenneth C. Bovee, DVM, MMedSc
"Morris subsequently developed, produced, and
sold a low-protein diet, KD, for dogs with renal failure. He and others
were influenced by the erroneous work hypertrophy concept for urea excretion
advanced by Addis. While experimental or clinical data were never published
to support the value of this or other diets, the concept was broadly accepted
without challenge in the veterinary literature." This article talks about
the history of protein restriction, and about 10 recent experimental studies
that have failed to provide evidence of the benefit of reduced dietary
protein to influence the course of renal failure. This report is no longer
available online, but I have a copy that I can send to anyone who is interested
in reading more, just email me (contact info at bottom of page) and ask
for Bovee.pdf.
Also see Influence
of Dietary Protein on Renal Function in Dogs by the same author, which
concludes, "These results do not support the hypothesis that feeding a
high protein diet had a significant adverse effect on renal function or
morphology."
Nutrition
and Renal Function from the Purina Research Report
"Dietary Protein and Renal Function: Results
of multiple studies indicated that there were no adverse effects of the
high protein diets." This report also includes information on metabolic
acidosis and on the beneficial effects of omega-3 essential fatty acids
in patients with chronic renal failure. The complete reports on each of
the three studies mentioned in this report are no longer available online,
but I have copies of them that I could send to anyone who is interested
in reading more, as follows: "Effects of Dietary Lipids on Renal Function
in Dogs and Cats" (ask for Brown.pdf); "Effects of Dietary Protein Intake
on Renal Functions" (ask for Finco.pdf); and "Acid-Base, Electrolytes,
and Renal Failure" (ask for Polzin.pdf).
Feeding
the Older Dog from the SpeedyVet Clinical Nutrition Library
"The assumption was that low-protein diets retarded
the progression of renal degeneration. This assumption was disproved, using
partially nephrectomised dogs, which showed no uraemic signs and had reduced
but stable renal function for 48 months. These dogs did better on moderate-protein
diets than on low-protein diets. There is no direct evidence that high
protein intake damages canine kidneys or that reducing protein intake in
dogs with renal dysfunction results in preservation of either renal structure
or function."
Dietary
Management of Chronic Polyuric Renal Failure from the SpeedyVet
Clinical Nutrition Library
"Dietary protein restriction improves the clinical
signs and quality of life of uraemic animals with
both naturally occurring and experimentally induced renal failure. . .
. However it is highly questionable whether protein restriction is appropriate
in the azotaemic, but non-uraemic patient. The main risk of protein restriction
is protein deficiency. The protein and amino acid requirements of dogs
and cats with chronic renal failure have not been established, but may
well be increased. . . . The main justification for protein restriction
early in the course of renal failure would be if it was proven to slow
progression of disease. The data that are available do not support this
case in dogs. Dietary protein has been shown to affect renal haemodynamics
in the dog, however, moderate protein restriction does not alleviate glomerular
hypertension, hyperfiltration and hypertrophy. . . . Thus there is no evidence
that moderate protein restriction slows the progression of renal failure
in dogs, and it is not recommended in dogs which are not uraemic."
Demystifying
Myths About Protein from Today's Breeder Magazine
"In contrast, research over the past 10 years
or so has shown that protein does not harm the kidney of dogs. In studies
conducted at the University of Georgia in the early 1990s, both in dogs
with chronic kidney failure and in older dogs with only one kidney, protein
levels as high as 34 percent caused no ill effects. . . . In other studies,
David S. Kronfeld, Ph.D., indicated that compared with high- or low-protein
diets, moderate-protein diets, those with up to 34 percent protein, had
no ill effects in dogs with chronic renal failure and were associated with
general improvement."
Fortify
The Food Bowl For The Aging Canine by Susan Thorpe-Vargas, Ph.D.
and John C. Cargill, M.A., M.B.A., M.S.
"Because of certain biochemical requirements,
the healthy geriatric dog requires about 50 percent more protein than the
young adult, and depending on the quality of the protein, it should make
up 20 percent to 30 percent of the total calories ingested. . . . Until
recently, protein restriction was recommended in an effort to protect renal
function. Limiting protein fails to prevent urinary filtration problems
. . . Indeed, newer research shows dietary protein is not detrimental to
kidney function. On the contrary, protein restriction can result in impaired
wound healing, diminished immune function and lowered enzyme activities
and cellular turnover. Those dogs with impaired renal function do better
with dietary phosphorus restriction; however, limiting this mineral is
unlikely to delay the onset of renal disease or to benefit healthy geriatric
dogs."
Dietary
Management for Clinical Disorders in Dogs from the Journal of Indian
Veterinary Association, Kerala
"Recent research on dietary protein and the kidney
has shown that
o dietary protein does not cause renal failure
o dietary protein does not appear to be involved
in the progression of chronic renal failure
o inappropriate restriction of dietary protein
may actually have an adverse effect on the normal or compromised kidney"
Kidney
Failure from the Iams nutrition symposium
“'For years, physicians and veterinarians have
treated renal failure by reducing protein levels in diets,' said Gregory
Reinhart PhD, an Iams researcher. 'After working with leading universities,
we have now found that restricting protein in a dog's diet may do more
harm than good by potentially putting the companion animal at risk of protein
malnutrition.'”
Managing
a Renal Crisis by Martha S. Gearhart, DVM
". . . at least one study has taken several groups of dogs in kidney
failure and fed them diets that varied in protein level and phosphorus
level. The groups with severely restricted phosphorus lived longer than
the groups with normal or high levels of phosphorus. The protein intake
made no difference at all in longevity. . . .
"It is important to remember that phosphorus is more important than
protein -- feeding vegetables or salt-free crackers to a dog in kidney
failure will not add protein but it will add phosphorus."
Dietary
Protein and the Kidney by Patricia Schenck, DVM, PhD, Veterinary
Nutritionist
"High protein diets cause an increase in blood flow through the kidney
(glomerular filtration rate). The myth has been that if the dietary protein
is restricted, this will make the kidney work less, and will ‘spare' the
kidney from damage. Thus in the past, many have recommended low protein
diets to ‘protect' a dog from developing kidney disease. This has been
the focus of considerable research over the last 10 years. There has been
no scientific evidence to support this theory. The feeding of low levels
of dietary protein are NOT protective against the development of kidney
disease.
"Reducing dietary protein in the older pet will not protect them from
the development of renal disease. In fact, reducing the protein in the
older dog's diet may have adverse effects. As pets age, their ability to
utilize nutrients decreases. The older pet actually requires a higher level
of protein to maintain its body stores of protein than does the younger
adult dog. . . .
"Dietary protein restriction is appropriate in renal failure when the
disease has become severe. Restriction of protein is based on the appearance
of clinical signs. It has been recommended to start protein restriction
when the dog's BUN (blood urea nitrogen) is greater than 80 mg/dL [28.6
mmol/L], and the serum creatinine is greater than 2.5 mg/dL [221 µmol/L].
Both BUN and serum creatinine are good indicators of kidney function. Protein
is restricted in an attempt to keep the BUN below 60 mg/dL [21.4 mmol/L].
Dietary protein may need to be gradually decreased over time as renal failure
progresses."
Effects
of low phosphorus, medium protein diets in dogs with chronic renal failure
"In this study, 60 dogs with early CRF were fed either Medium Protein
Diet, (CMP group) or a home-made diet (HMD group) which respectively contained
0.36% phosphorus, 27% protein, and 0.38% phosphorus, 21.5% protein on a
dry matter basis, over a 28 week period. . . .
"From the results of this study, it can be concluded that many dogs
with mild to moderate CRF can benefit from early diagnosis of the condition
and dietary management using a diet with a low phosphorus and moderate
protein content."
Dietary Protein by Dr. Jeff Vidt, specialist in Chinese Shar-Pei and Renal Amyloidosis
Protein Restriction and Kidney Disease Extracts from Kirk's Current Veterinary Therapy XII, with links to a number of abstracts"Increased levels of dietary protein do not seem to change rate of progression of kidney failure. Protein levels in the diet do not seem to affect mortality, rate of progression of uremia or the development of kidney lesions. Decreased protein levels in the diet may impair immune responses, decrease hemo-globin levels, cause anemia, decrease total protein levels and result in muscle wasting. . . . Dietary protein levels do not appear to be involved in the progression of renal disease or play a role in the prevention of kidney failure. . . . When the BUN is greater than 75mg/dl [26.8 mmol/L] and/or signs of uremia develop, moderate protein restriction is indicated to decrease the BUN and the clinical signs. Phosphorus restriction is also indicated at this time."
Kidney
Failure in the Dog and Cat
"Contrary to popular myth, diets rich in protein
("high protein levels") do not cause kidney damage. Research done
decades ago indicated that rodent kidneysHigh protein diets do not cause
kidney damage. were adversely affected by diets high in protein... and
misguided researchers extrapolated that data to apply to the canine. There
is no evidence that feeding dogs and cats diets rich in or "high" in protein
actually causes kidney damage or disease. Some day this myth will
be finally be put to rest. In fact, there is ample research and well
documented studies that prove that dogs and cats thrive on diets with levels
of protein consistent with a meat-eater's (carnivore) natural prey selection.
Read more about protein in dog and cat diets here.
"Additionally,documented research on dogs indicates that reducing dietary protein levels in older dogs may be unwise; however, if kidney damage is already present to the extent that the BUN levels are 75mg/dl or above, some restriction of dietary protein may be beneficial for metabolic reasons... not renal reasons. "...restriction of protein intake does not alter the development of renal lesions nor does it preserve renal function." (See KIRKS VETERINARY THERAPY XIII, Small Animal Practice, W. B. Saunders, page 861). Restricting dietary protein may be helpful to those patients whose BUN levels are rather high and that are already in advanced kidney failure."
Note that the above sites are from very traditional sources, including Purina and Iams. I think Hills is the only company still toeing the "low protein" line. The thinking now is that low protein can actually be harmful, and that a moderate amount of high quality protein is desirable for dogs with kidney disease. In addition, feeding reduced protein to dogs with normal kidneys does not help prevent kidney failure.
See http://lpi.orst.edu/infocenter/minerals/phosphorus/ for (human oriented) information on phosphorus and what excess levels in the blood do.
Also see this letter that I wrote to Hill's in response to their complaints about an article I helped write for the Whole Dog Journal on the myth of low protein diets for dogs with kidney disease.
If your dog is not uremic, then the consensus seems to be to feed a moderate amount of very high quality protein. Eggs have the highest quality protein (although egg yolks are high in phosphorus), followed by raw meat, then lightly cooked meat, then well cooked meat. The lowest quality protein comes from processed meat, as is found in commercial dog foods, and from grains.
The site at http://www.vetinfo4dogs.com/dogdiet.html says "High quality proteins are ones that closely match the proper mix of amino acids the body needs. Ideally, there would be exactly the right number of every amino acid and no excess of protein material, making both the liver and the kidneys happy. In general, animal source proteins, such as meat, milk and eggs are higher quality than plant source proteins. This is because the animal that produced these items already made the proper proteins and so they are already in the proper mix. That is why cottage cheese is considered to be a higher quality protein source then soy, for instance." Note that some amino acids, such as taurine, are sensitive to heat, which is one of the reasons why raw meat is considered higher quality than cooked meat.
When developing a diet for your dog with kidney failure, the goal is to feed moderate to high fat, moderate amounts of high quality protein, low phosphorus, and low phosphorus carbohydrates to fill in. Here are some guidelines:
Moderate to High Fat: Fat provides low-phosphorus calories, and so can be used to increase caloric intake without increasing phosphorus. With rare exception, dogs do not suffer from high cholesterol or other human problems associated with high fat intake. However, too much fat can be problematic for some dogs, and renal disease can predispose dogs to pancreatitis. If your dog is overweight or relatively inactive, and doesn't need a lot of calories, then feed moderate amounts of fat. If your dog is quite active and needs a lot of calories, then you can increase the amount of fat to provide more calories without increasing phosphorus. Too much fat may lead to diarrhea or mucousy stools, and dogs that are prone to pancreatitis cannot handle too much fat. It is important to increase the amount of fat you feed gradually, to avoid digestive upset and to try to avoid the possibility of pancreatitis -- if you see signs of problems, such as your dog seeming uncomfortable after meals, or any vomiting or diarrhea, that is a sign to decrease the amount of fat in the diet to a level your dog can tolerate. Dietary sources of fat include:
Moderate Protein: How much protein to feed is still a matter of some debate, although it is not necessary to feed a low protein diet unless your dog is uremic (see above). Protein may need to be moderately reduced for dogs with glomerulonephritis, to reduce protein loss in the urine which contributes to inflammation.
Recommendations for dogs with mild to moderate CRF (creatinine 1.6-4.5 mg/dL, or 141-398 µmol/L) are 2.0 - 2.2 g/kg body weight of high biologic value protein, or around 1 gram of protein per pound of body weight (see the section on How Much Protein? from the Journal of Nutrition). This is higher than the recommendations for normal, healthy dogs.
As long as the amount of phosphorus is kept within desirable limits, and your dog is not uremic and does not have excessive proteinuria, you really don't have to worry much about feeding too much protein (you may need to be careful not to feed too little). It is important to feed high quality protein. Eggs have the highest quality protein, but egg yolks are very high in phosphorus, so you may want to feed 2 - 3 egg whites for every egg yolk that you feed. Note that cooking egg whites will increase their bioavailability. Raw or lightly cooked meat is another high quality source of protein. Green Tripe may be an excellent food for dogs with kidney failure, see below for more info.
Low Phosphorus: Feeding a low phosphorus diet has definitely been shown to be beneficial for dogs with kidney disease. NRC guidelines are to feed no more than 22.25 mg/kg phosphorus daily (about 10 mg per pound of body weight)for a dog with advanced kidney failure. For dogs in early stages, recommended phosphorus amounts can be as high as 60 mg/kg (or 30 mg/lb). Anywhere from 15-40 mg/kg (7 - 18 mg/lb) is considered a low phosphorus diet. In general, foods highest in phosphorus include bones, dairy products, fish (with bones), organ meats, and egg yolks. That does not mean not to feed these foods at all, as they are an important component of a healthy diet, but they should be fed in moderation. Be wary also of the amount of phosphorus in grains and vegetables that you feed. The table below lists some approximate values for a variety of different foods. Examples of the amount of phosphorus you should be feeding daily, based on the range of 15-40 mg/kg, and 60 mg/kg for very early stages (the further advanced the kidney disease is, the less phosphorus you should be feeding):
Other Restrictions: Most other dietary restrictions depend on your individual dog. If your dog has high potassium, you will need to limit the amount of potassium you feed, for example (bananas, pumpkin, potatoes, sweet potatoes, pears, sardines, kiwi, beets, yogurt, winter squash, banana, carrots, celery, broccoli. are high in potassium) -- keep in mind that high potassium is unusual in dogs with kidney disease and may indicate Addison's Disease instead. Conversely, if your dog's potassium levels are too low, you will need to give potassium salts (both can occur with kidney disease, but it is my understanding that low potassium is more common, and high potassium is only likely to occur when kidney disease is very advanced).
Green Tripe may be an excellent food for dogs with kidney failure, as it is fairlylow in phosphorus and is highly palatable to dogs. You need to find green tripe, as the bleached tripe that is sold for human consumption does not have the same nutritional value. Most dogs love green tripe, so it might tempt a dog to eat that was anorexic. I've never heard of a dog having digestive upset from green tripe (though sometimes the owners do, it has a fairly strong smell, and some prefer to feed it outside). Unbleached green tripe is hard to find, see the following (note many will ship, although the cost can be high to ship frozen products):
Raw Meaty Bones: For those who feed a diet based on raw meaty bones, you may be able to continue to feed that diet, but you will need to reduce the amount of bone fed as the disease progresses (BUN and Creatinine increase), or if your dog has problems with elevated mineral values, such as magnesium, in their blood work. Bones are high in phosphorus and other minerals that can be hard on kidney patients. The table below lists some approximate values for a variety of raw meaty bones. If you substantially reduce or eliminate the amount of bone in the diet, you should add 1/2 to 3/4 teaspoon ground eggshell per pound of meat fed to balance out the calcium/phosphorus ratio. If your dog's calcium values are too high, you may need to use aluminum based phosphorus binders instead (see below).
Treats: I don't worry much about treats, since they're such a small part of the diet. There are no foods that you have to avoid for dogs with kidney failure -- the goal is to reduce phosphorus levels, but again, if treats are a small part of the diet, the amount of phosphorus in them would not be significant. You might want to avoid things like dried liver for that reason, though very small amounts would be fine. I would also avoid chicken jerkey treats imported from China, due to fears of potential contamination -- see my Pet Food Recall web page for more information on this topic. Biscuits by Lambchop offers low-phosphorus, gluten-free treats, but again, they're not really necessary.
Water: Dogs with kidney disease should always have access to water, even if it causes accidents in the house. Distilled water may be best to use, or maybe purified water, such as with a faucet filter. Well water may be very high in minerals and is best avoided, use bottled water instead, or find a filter that will remove excess minerals. If you use a water softener at your house, your water will be high in sodium, which is not a good idea if your dog has high blood pressure. Again, switch to bottled water (filters do not remove sodium from water). It is important that your dog stay hydrated, as dehydration is very harmful to the kidneys. Adding water to the food, particularly if you feed dry food, may help with this. If your dog is drinking a LOT of water, I would definitely consider giving sub-q fluids to help him stay hydrated.
See Commercial Kidney Diets below for information on ways to combine fresh foods with commercial foods to create a diet appropriate for dogs with kidney disease.
See Recipes for Home-Made Meals for Dogs with Renal Disease and CRF Homemade Diets (created for cats, but the recipes can be used for dogs as well) for a selection of recipes that have been suggested for dogs with kidney disease. As you learn more, you should be able to make substitutions to reduce the phosphorus in these recipes, and increase the protein, making them even more beneficial for your dog. Keep in mind, too, that most food is more nutritious and easier to digest when fed raw. Exceptions include egg whites (more bioavailable when cooked), starchy vegetables, such as potatoes, sweet potatoes and winter squashes, and grains, although grains can also be soaked overnight and fed raw.
Notes on using this table:
|
|
|
|
|
|
|
|
|
| Ground Beef (20% fat) |
17.2
|
20.0
|
0.0
|
254
|
18
|
158
|
62
|
| Ground Beef (10% fat) |
20.0
|
10.0
|
0.0
|
176
|
12
|
184
|
105
|
| Ground Turkey |
17.5
|
8.3
|
0.0
|
149
|
13
|
156
|
105
|
| Chicken, Dark Meat and Skin |
16.7
|
18.3
|
0.0
|
237
|
11
|
136
|
57
|
| Chicken Breast (skinless) |
23.1
|
1.2
|
0.0
|
110
|
11
|
196
|
178
|
| Ground Pork |
16.9
|
21.2
|
0.0
|
263
|
14
|
175
|
67
|
| Ground Lamb |
16.6
|
23.4
|
0.0
|
282
|
16
|
157
|
56
|
| Beef Heart |
17.7
|
3.9
|
0.1
|
107
|
7
|
212
|
198
|
| . | |||||||
| Chicken Liver |
16.9
|
4.8
|
0.7
|
119
|
8
|
297
|
250
|
| Beef Liver |
20.4
|
3.6
|
3.9
|
135
|
5
|
387
|
287
|
| Beef Kidney |
17.4
|
3.1
|
0.3
|
99
|
13
|
257
|
260
|
| Braunschweiger (liver sausage) |
14.5
|
28.5
|
3.1
|
327
|
9
|
168
|
51
|
| Liverwurst |
14.1
|
28.5
|
2.2
|
326
|
26
|
230
|
71
|
| Abady Beef Kidney (canned, cooked) |
9.6
|
8.0
|
2.2
|
116
|
95
|
158
|
135
|
| . | |||||||
| Jack Mackerel (canned, drained) |
23.2
|
6.3
|
0.0
|
156
|
241
|
301
|
193
|
| Pink Salmon (canned, not drained) |
19.8
|
6.1
|
0.0
|
139
|
213
|
329
|
237
|
| Sardines (canned in tomato sauce) |
20.9
|
10.5
|
0.7
|
186
|
240
|
366
|
196
|
| . | |||||||
| Green Tripe (per greentripe.com*) |
15.8
|
11.7
|
0.0
|
167
|
120
|
140
|
84
|
| Abady Green Tripe (canned, cooked) |
8.5
|
10
|
2.3
|
134
|
226
|
164
|
122
|
| Canine Caviar Venison Tripe |
15.0
|
11.5
|
1.1
|
167
|
220
|
190
|
114
|
| . | |||||||
| Whole Milk Yogurt |
3.5
|
3.3
|
4.7
|
61
|
121
|
95
|
156
|
| Whole Milk Kefir |
3.3
|
3.5
|
2.2
|
61
|
120
|
100
|
164
|
| Cottage Cheese (creamed) |
12.5
|
4.5
|
2.7
|
103
|
60
|
132
|
128
|
| Ricotta Cheese (whole milk) |
11.3
|
13.0
|
3.0
|
174
|
207
|
158
|
91
|
| Cream Cheese |
7.6
|
34.9
|
2.7
|
349
|
80
|
104
|
30
|
| Mozzarella Cheese (whole milk) |
22.2
|
22.4
|
2.2
|
300
|
505
|
354
|
118
|
| Cheddar Cheese |
24.9
|
33.1
|
1.3
|
403
|
721
|
512
|
127
|
| Butter |
0.9
|
81.1
|
0.1
|
717
|
24
|
23
|
03
|
| Heavy Whipping Cream |
2.1
|
37.0
|
2.8
|
345
|
65
|
62
|
18
|
| . | |||||||
| Eggs (2 large=100 grams) |
12.6
|
9.9
|
0.8
|
147
|
53
|
191
|
130
|
| Egg Yolks (2 large=34 grams) |
5.4
|
9.0
|
1.2
|
110
|
44
|
133
|
122
|
| Egg Whites (2 large=66 grams) |
7.2
|
0.1
|
0.5
|
34
|
5
|
10
|
29
|
| . | |||||||
| Chicken Necks (with skin): 25% meat, 36% bone, 39% skin and separable fat |
12.7
|
16.7
|
267
|
700-840
|
420-870
|
242
|
|
| Chicken Necks (w/o skin): 41% meat, 59% bone |
15.6
|
11.1
|
152
|
890-1580
|
500-1415
|
630
|
|
| Chicken Backs (with skin): 29% meat, 44% bone, 10% skin, 17% sep fat |
15.4
|
15.8
|
208
|
740-1300
|
480-970
|
349
|
|
| Chicken Backs (w/o skin): 40% meat, 60% bone |
16.1
|
7.2
|
(137)
|
1500
|
840
|
(613)
|
|
| Chicken Wings (with skin): 32% meat, 46% bone, 22% skin and sep fat |
17.5
|
15.3
|
244
|
620-1150
|
430-660
|
223
|
|
| Chicken Legs (with skin): 57% meat, 27% bone, 11% skin, 5% separable fat |
17.2
|
11.4
|
(187)
|
770-1190
|
540-690
|
(329)
|
|
| Whole Chicken: 48-51% meat, 28-32% bone, 12-14% skin, 7-8% separable fat |
13.8
|
12.3
|
192
|
723
|
456
|
237
|
|
| Turkey Necks: 58% meat, 42% bone |
17.0
|
7.9
|
116
|
1190-2590
|
670-1390
|
888
|
|
| Rabbit (whole, skinless) |
17.8
|
5.8
|
0 |
125
|
500-800
|
370-690
|
424
|
| o | |||||||
| Sweet Potatoes (boiled) |
1.4
|
0.1
|
17.7
|
76
|
27
|
32
|
42
|
| Yams (boiled or baked) |
1.5
|
0.1
|
27.6
|
116
|
14
|
49
|
42
|
| Potatoes (boiled) |
1.7
|
0.1
|
20.0
|
86
|
8
|
40
|
47
|
| Winter Squash (Acorn, Butternut, etc) |
0.9
|
0.4
|
8.9
|
37
|
22
|
19
|
51
|
| . | |||||||
| Farina (Cream of Wheat)** |
1.4
|
0.1
|
10.5
|
48
|
4
|
12
|
25
|
| Cream of Rice Cereal |
0.9
|
0.1
|
11.4
|
52
|
3
|
17
|
33
|
| Malt-O-Meal Cereal*** |
1.4
|
0.2
|
8.7
|
42
|
61
|
25
|
60
|
| Glutinous (Sticky) Rice** |
2.0
|
0.2
|
21.1
|
97
|
2
|
8
|
8
|
| White Rice** (short grain) |
2.4
|
0.2
|
28.7
|
130
|
1
|
33
|
25
|
| White Rice** (medium grain) |
2.4
|
0.2
|
28.6
|
130
|
3
|
37
|
28
|
| White Rice** (long grain) |
2.7
|
0.3
|
28.2
|
130
|
10
|
43
|
33
|
| Brown Rice** (medium grain) |
2.3
|
0.8
|
23.5
|
112
|
10
|
77
|
69
|
| Oatmeal** |
2.6
|
1.0
|
10.8
|
63
|
8
|
76
|
123
|
| Barley** (pearled) |
2.3
|
0.4
|
28.2
|
123
|
11
|
54
|
44
|
| Millet** |
3.5
|
1.0
|
23.7
|
119
|
3
|
100
|
84
|
| White Bread (4 slices = 100 grams) |
7.6
|
3.3
|
50.6
|
266
|
151
|
99
|
37
|
| Whole Wheat Bread |
9.7
|
4.2
|
46.1
|
246
|
72
|
229
|
93
|
| Egg Noodles |
4.5
|
2.1
|
25.2
|
138
|
12
|
76
|
55
|
| Macaroni |
5.8
|
0.9
|
30.1
|
158
|
7
|
58
|
37
|
| Couscous |
3.8
|
0.2
|
23.2
|
112
|
8
|
22
|
20
|
* Figures listed above for greentripe.com used to appear on their website and refer to their raw green tripe product. The site has been updated and while the figures for protein, fat, fiber and moisture are still for the raw product, the rest of the figures refer to the cooked product, which is much lower in moisture, making the percentages appear higher (closer to "dry matter" percentages). I have confirmed this with the site owner.
**All cereal and grain values are for cooked grains. See the following
for info on a variety of grains by dry weight:
http://waltonfeed.com/self/ntr1.html
http://waltonfeed.com/self/ntr2.html
http://waltonfeed.com/self/ntr3.html
http://waltonfeed.com/self/grains.html
Glutinous (sticky) rice can be hard to find. It can be ordered online
at quickspice.com.
*** Values for Malt-o-Meal recently changed,
with phosphorus amounts more than doubling. Use
Farina or Cream of Wheat instead. Check the box for any sign of added phosphorus
-- Regular, Instant and Mix'n Eat all have low phosphorus according to
the Nutrition Database, but Quick has much more. If "% of Daily Value"
is shown, you can calculate the amount of phosphorus, which is based on
adult recommendations of 1,000 mg. For example, if the box shows 2% of
DV, that would be approximately 20 mg phosphorus. Divide that number by
the number of calories per serving and multiply by 100 to determine mg
of phosphorus per 100 kcals. For example, if a serving has 20 mg phosphorus
and 80 kcals, that would be 25 mg phosphorus per 100 kcals (20/80 * 100).
In the table below, use the "dry matter" percentages for comparing brands, and canned vs. dry. Use the "as fed" values for computing how much you are feeding. In particular, do not use the amount per can or per cup for comparison purposes, as the size of the can/cup varies quite a bit between brands. Remember that low protein is unnecessary and even harmful unless your dog is uremic, but low phosphorus is advisable. Moderate protein reduction may be required if your dog has proteinuria (significant protein in the urine). In general, I think canned may be preferable to dry, because canned foods do not contain chemical preservatives, and usually contains far less grain than dry foods. In addition, the extra moisture can help your dog stay hydrated, though you can add water to dry food to accomplish the same purpose.
For comparison purposes, most regular commercial diets have around 1-2% phosphorus on a dry matter basis. A dog with early stage kidney disease should be limited to around 0.6% phosphorus on a dry matter basis.
Some senior and light diets contain less phosphorus than regular dog food, and may be usable as part or all of the diet for dogs with early stage renal problems, though if your dog has high blood pressure, the sodium levels in these foods may be too high. A few have been included below, but there is a chart of many more included in the article Phosphorus Content in Dog Food -- this chart is listed in the order of amount of phosphorus per calorie, which is ideal. For example, although Innova Senior Plus dry has 0.83% phosphorus, which is on the high side for a renal diet, it is also high calorie, so this comes out to 204 mg phosphorus per 100 calories. This is less than Royal Canin (formerly IVD) Mature, which is actually recommended as an early stage renal diet. Note that the numbers provided below are extracted from a number of sources and are not guaranteed to be current, it is always best to check the label of any food you buy, and contact the manufacturer if more information is needed.
In addition to those foods listed below, the following commercial foods have less than 0.6% phosphorus on a dry matter basis: Hill's Science Diet Canine Light and Canine Senior (all), as well as their canned Canine Maintenance Beef, Beef & Rice, and Beef & Vegetable formulas; Nature's Recipe Select Balance Canine Reduced Activity (dry). The following foods have phosphorus amounts between 0.6% and 0.7% on a dry matter basis: Hill's Science Diet Canine Maintenance Beef & Chicken, Chicken, and Tukey formulas (canned) and their Canine Maintenance Dry formula; Nature's Recipe Select Balance Canine Reduced Activity (canned); Nutro Natural Choice Lite; Royal Canin LA23, Maxi, Medium and Mini Adult 2 (dry); and Superior Brands Dr. Ballard Oven Bake Senior (dry). These are foods I happen to know about because they were included in a chart that showed phosphorus percentages, they're not high-quality foods but may be better choices than lower-protein diets for dogs with early-stage disease.
It has occurred to me that another possible choice for feeding a commercial diet to dogs with kidney problems is to use a diet developed for cats with kidney problems. Because cats require higher protein, these diets will have more protein than the diets developed for dogs with kidney problems, while still reducing phosphorus. Unfortunately, for the most part these are still not high quality foods, though Royal Canin is probably better than Hill's and Iams (formerly Eukanuba). See Dry Cat Food and Canned Cat Food for tables listing the amount of protein, phosphorus and other values in various prescription cat diets.
A number of prescription diets, including Iams (formerly Eukanuba), Royal Canin, Hill's, Purina and Waltham are available online at RxPetFood.com (prescription from your vet is required, but prices may be lower).
Add water If you feed dry food, it's best to add water to help your dog stay hydrated. Remember that dry food will spoil once water is added, so you shouldn't leave it out all day.