Veterinary Guide to Azotemia & Uremia in Dogs 2025 ⚕️🐶

By Dr. Duncan Houston BVSc

🧬 What Are Azotemia & Uremia?

Azotemia is elevated nitrogenous waste (urea, creatinine) in the blood, due to impaired filtration. Uremia is the clinical syndrome—vomiting, fatigue, neurologic signs—resulting from severe azotemia.

🔍 Types of Azotemia

• Pre-renal: due to reduced kidney perfusion—dehydration, shock, heart failure.
• Renal: direct kidney damage—AKI (toxins, infection) or CKD.
• Post-renal: urinary obstruction (stones, tumors) causing backflow.

👀 Clinical Signs

Azotemia may be lab-only early. Uremia manifests as:

• Vomiting, diarrhea, anorexia, and weight loss.
• Uremic halitosis, mouth ulcers, and poor coat.
• Neurologic signs—weakness, ataxia, seizures.
• Dehydration, changes in urination, and hypertension.
• Oral bleeding, petechiae, pale mucous membranes.

🔬 Diagnostic Approach

1. History & exam: assess hydration, urine production.
2. Bloodwork: BUN, creatinine, SDMA, electrolytes to confirm azotemia.
3. Urinalysis + USG: distinguish prerenal vs renal causes.
4. Imaging: abdominal ultrasound, X-rays to check kidneys/obstructions.
5. Additional tests: evaluate endocrine, infectious, and toxic etiologies.

🛠️ Treatment Approaches

1. Fluid Therapy

Intravenous or subcutaneous fluids restore perfusion, dilute wastes, and support diuresis—the cornerstone of acute and chronic management.

2. Correct Underlying Cause

• Pre-renal: rehydrate, treat shock/heart disease.
• Renal AKI: treat toxins, infections, and antibiotics.
• CKD: dietary therapy, blood pressure control, phosphate binders.
• Post-renal: relieve obstructions surgically or catheterize.

3. Supportive Symptom Management

• Anti‑emetics and gastric protectants.
• Electrolyte supplementation: potassium, bicarbonate.
• Treat hypertension and anemia in chronic cases.

4. Advanced Interventions

Dialysis (hemo- or peritoneal) in severe AKI with oliguria/anuria.

📊 Monitoring & Prognosis

• Recheck labs & USG every 24–48 hrs in AKI until stabilised.
• Chronic stage labs, BP, SDMA per IRIS staging every 3–6 months.
• Prognosis varies: AKI reversibility depends on the cause; CKD is progressive, and lifespan extension with early care.

🏡 Owner Home-Care Tips

• Encourage hydration with fresh water and sub-Q fluids if instructed.
• Feed renal diets: low protein, low phosphorus, balanced energy.
• Track appetite, urine output, and weight daily.
• Administer meds: ACE inhibitors, phosphate binders, antihypertensives.
• Create non-slip surfaces, calm environments for weak dogs.

📱 Ask A Vet Support Integration

• Telehealth check-ins: assess appetite, hydration, and meds.
• Guidance on home fluid administration and early warning signs.

🎓 Case Example: “Riley” the Senior Poodle

“Riley” presented with BUN 80 mg/dL, CREA 3.5 mg/dL, and USG 1.008. After IV fluids, anti‑emetics, renal diet, and antihypertensive meds, values normalized by day 5. At the 6‑month check, Riley’s SDMA is stable, appetite is good, and quality of life is maintained, thanks to home monitoring and Ask A Vet follow-ups. 💖

Dr Duncan Houston BVSc, Ask A Vet founder. Don’t forget to download the Ask A Vet app for expert kidney-care support anytime, ensuring your pup’s renal wellness every day! 🐶