Dogs and cats have two kidneys. These organs lie within the abdomen along side of the spine. The kidneys are essential filters that remove toxins and wastes from the blood. Kidneys produce a hormone that stimulates the bone marrow to make red blood cells. They also maintain the correct balance of water, various salts and minerals in the body. Each kidney is connected to the urinary bladder by a ureter, a tube for transport of urine.
The kidneys have small filters that remove waste from the blood stream. About 20% of the total blood that is pumped out of the heart goes directly to the kidneys. The kidneys produce a hormone called erythropoietin that directly stimulates the bone marrow to produce red blood cells. Failing kidneys, therefore may cause anemia. The kidneys also regulate the amount of electrolytes (salts) such as sodium, potassium and calcium that is contained in the body. The pH of the body is also controlled by the kidneys via the excretion or retention of acids. They also control the amount of water that is excreted in the urine, thus helping to prevent dehydration of the body. A dog, cat and many other species live a normal life with only one kidney. In fact, they can live fairly normally with slightly more than two-third's of one kidney.
Two types of kidney tumors exist: ones that originate from within the kidney and ones that have spread to the kidney from another tumor within the body. Tumors that originate within the kidney include renal carcinoma, renal adenocarcinomas, transitional cell carcinoma, sarcomas of varying types and a tumor that originates from embryonic cells called a nephroblastoma. At the time of diagnosis of a kidney tumor, about 16% of them have evidence of spread of the tumor to the lungs.
Breeds most common to develop kidney tumors include Cocker Spaniels, Labrador Retrievers, Rottweilers, Golden Retrievers, German Shepherds, Miniature Poodles, Malamute, Springer Spaniel, and Shetland Sheepdogs. Male dogs develop this tumor about 50% more commonly than female dogs and the average age of affected pets is 8.4 years. Patients with nephroblastomas tend to be much younger. Most common clinical signs in affected patients include bloody urine, a palpable abdominal mass, increased thirst, increased urination, lethargy, weight loss, vomiting, pain and behavioral changes.
The diagnosis of a kidney mass is made on abdominal x-rays or abdominal ultrasound. Advanced imaging such as abdominal MRI or CT scan can be used to define the extent of the kidney tumor, but also may be used to determine if metastasis is also present. Chest x-rays are essential to rule out the presence of metastasis to the lungs and lymph nodes within the chest. Blood work and urine testing is done to ensure that the unaffected kidney is functioning normally and other internal organs are healthy.
The day of surgery
Our anesthesia and surgical team will prescribe a pain management program, both during and after surgery that will keep your companion comfortable. This will include a combination of general anesthesia, injectable analgesics, epidural analgesia, oral analgesics and anti-inflammatory medication.
Nephrectomy or surgical removal of a kidney is the best treatment for a kidney tumor, providing that the patient is not in kidney failure. An incision is made along the abdomen to expose the internal organs. The blood vessels and ureters of the affected kidney are tied off and the kidney is then removed.
While in our hospital, your companion will continue to receive intravenous fluids, electrolytes and in some cases plasma or an artificial plasma product called Hetastarch. Uncommonly, a blood transfusion may be necessary. Your companion will be carefully monitored in the intensive care and will be given narcotics to ensure a pain-free recovery. Most patients that have abdominal surgery leave our hospital within 24 to 72 hours.
Aftercare and results
Once your pet is at home, a prescribed pain reliever should be given to minimize discomfort. If the pet is not eating, a home cooked diet containing a 50:50 mix of cooked rice and lean cooked hamburger meat or chicken breast can be offered. Itís also extremely important to limit the activity and exercise level for three weeks after surgery. The incision should be checked daily for signs of infection. Two weeks after surgery, the surgeon or oncologist will evaluate the healing process. Short-term complications following surgery are uncommon and may include internal hemorrhage, infection of the incision, and kidney failure.
In a study, which included 82 dogs, the average survival time following nephrectomy was 16 months, regardless of tumor type. Surgery increased survival of patients that had kidney tumors. In this report, patients that received chemotherapy survived a few months longer than patients receiving only surgery, however this was not found to be statistically significant. At the time of death of affected patients, 77% had evidence of spread of the tumor, in spite of treatments given to the patient.
In cats, the incidence of metastasis at the time of diagnosis was reported to be 64% for renal carcinomas and 100% for transitional cell carcinomas. Seemingly, the prognosis may be poorer for cats that have kidney tumors than dogs.
1. Bryan JN et al. Primary Renal neoplasia of Dogs. J Vet Intern med 2006; 20:1155-1160.
2. Seaman RL, et al. Treatment of renal nephroblastoma in an adult dog. J Am Anim Hosp Assoc 2003;39:76-79.
3. Henry CJ, et al. Primary renal tumours in cats: 19 cases (1992-1998) J Fel Med and Surg 1999;1, 165-170.
Frequently Asked Questions After Surgery
When should my dog have the first bowel movement after surgery?
- Many dogs will not have a bowel movement for the first 4 to 5 days after surgery
- Reasons that a dog will not have regular bowel movements after surgery include:
- The dog has been fasted prior to surgery
- Dogs do not eat well during the hospital stay
- They frequently do not eat well when they go home
- They are fed highly digestible food that produces little stool
- Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating
- If a pet does not have a bowel movement on the 5th day of being home, a stool softener such as metamucil can be fed
- Dose of metamucil is 1 tsp per 25 Kg mixed in with each meal (canned dog food); feed immediately after mixing, as the metamucil will gel the food and may make it less palatable
My pet had surgery and will not eat. What can be done?
- Most pets will not eat their regular dog food after surgery, especially if it is kibble.
- Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source. The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked). The carbohydrate can be pasta, potato or white rice.
- Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
- Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal
- Try Hill's A/D diet available at most veterinary hospitals
- Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
- Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
- Remember that most pets will not eat the first day or two after they get home from surgery
- Offer smelly foods that contain fish such as tuna or smelly cat foods
- Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
- Hand feeding: with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
- Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
- Some cats will only eat dry food, try kibble if your cat normally has been fed that food
- Petting and stroking your cat frequently will help to stimulate appetite
- Remember that most pets will not eat the first day or two after they get home from surgery
- Appetite stimulants such as cyproheptadine may be helpful
- If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop
My pet is vomiting. What can be done?
- The first thing for you to discern is whether your pet is vomiting or regurgitating. Both will result in fluid or food being brought up. Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus. Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled. Usually the regurgited material will be clear or brown colored fluid.
- Next is to identify the cause of the vomiting or regurgitation.
- Causes and treatment of vomiting after surgery
- When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
- Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery. In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart. Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to. The antibiotic in some cases may be changed to a different one, or may be discontinued.
- Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days.
- An uncommon cause of vomiting after surgery is internal organ failure. Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
- If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present. Do not ignore this sign.
- Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days. In order to decrease the acidity of the stomach, Pepcid AC 0.5 mg/kg can be given by mouth twice daily for 5 days. Metoclopramide and Cerenia are good anti-vomiting medications for dogs and cats. You should always consult a veterinary healthcare professional before administering medication.
- Causes and treatment of regurgitation after surgery
- The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia. Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis. This results in poor motility of the esophagus, therefore water and food will accumulate in this structure. In most cases, esphagitis is self-eliminating and will resolve within two or three days.
- If the esophagitis is severe the esophagus may develop one or more strictures. A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week. This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope). If an esophageal stricture is chronic surgery is needed.
- Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other). Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.
How do I know that my dog is in pain following surgery?
- Signs of pain include
- biting if you get near the surgical site
- grimacing (lips are pulled back and the the dog looks anxious)
- tragic facial expression
- restlessness and unable to sleep; pacing
- if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
- the worst pain will be for the first 2 to 3 days after surgery
What can I do to control my dog's pain?
- Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
- Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
- If an orthopedic surgery has been done cold packing the surgical site may be helpful
- A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack. An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern. Cooling the surgical site helps to numb the area.
How do I know that my cat is in pain following surgery?
- Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
- Signs of pain in a cat include the following:
- biting if you get near the surgical site
- growling or deep cry
- not wanting to eat
- hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)
What can be done for pain at home for my cat?
- Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
- Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
- Anti-inflammatories can be used, but the dose is much less than dogs
Is it okay for my pet to lick the incision?
- If a dog licks the incision, the healing process may be delayed.
- Licking can remove stitches and cause the incision to open
- Licking can become a severe habit that is difficult to break
- Licking can cause infection as the mouth has many bacteria
- Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.
- To stop your pet from licking the following can be tried:
- Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
- Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
- A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
- A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
- Bitter apple can be applied around the incision; many dogs will continue to lick after application of this topical
- Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
- Antipsychotic medication in some cases is needed