Kidney disease is a common, serious problem in older dogs, and it becomes more frequent from about age 5 or 6.1 It comes in two forms. Chronic kidney disease (CKD) develops slowly over months or years and can't be cured, but treatment can slow it down. Acute kidney injury (AKI) is sudden damage, often from a poison such as antifreeze or grapes, or an infection such as leptospirosis, and it can sometimes be reversed if treated quickly.1,2,3 Because healthy kidneys have a large reserve, signs usually don't show until roughly two-thirds or more of kidney function is gone.4,3 This guide explains the causes, the stages vets use, how kidney disease is diagnosed and treated, and what to expect.
Go to a vet or emergency clinic now if your dog:
- May have eaten antifreeze, grapes, raisins or a human pain reliever, even if your dog seems fine. Antifreeze can cause an apparent recovery about 12 hours after it is swallowed, before kidney failure sets in 36 to 72 hours after.5,6,7
- Is producing little or no urine, or straining without passing any2,8
- Is vomiting repeatedly, refuses food, is very weak, collapses or has seizures2
- Suddenly seems blind9
See your vet soon if your dog is drinking and urinating more than usual or losing weight.4,3
What the Research Shows
- Age is a major risk factor. In records from 107,214 dogs at 89 UK practices, dogs over 12 had 5.5 times the odds of CKD compared with dogs aged 7 to 12. Cocker Spaniels and Cavalier King Charles Spaniels were also at higher risk.10
- Vomiting was the most common sign. In that study, vets recorded vomiting in half the dogs with CKD, and increased drinking and urination in 44%.10
- Stage matters for survival. In a small study of 27 dogs, using earlier IRIS stage ranges, median survival was about 15 months at Stage 2, 11 months at Stage 3 and 2 months at Stage 4.11
- A newer blood test can catch it earlier. In a small study of 19 dogs with CKD, a marker called SDMA rose before creatinine in 17, by an average of 9.8 months.12
Chronic Kidney Disease vs Acute Kidney Injury
- Chronic kidney disease (CKD) develops slowly and often goes unnoticed for months or years. The damage can't be reversed, but its progress can be slowed.1 Many dogs with CKD keep a good quality of life for months or years with treatment.3
- Acute kidney injury (AKI) is sudden, major damage to the kidneys. Quick treatment can sometimes reverse the damage, but it is serious: roughly half of dogs with severe AKI survive.2,1 Dogs that recover can be left with chronic kidney disease.1,8
Causes and Risk Factors
Chronic kidney disease
- Age: CKD becomes more common from middle age. Small dogs often show signs at 10 to 14 years, while large dogs can show them from about 7.1,3
- Breed and inherited disease: some breeds have inherited kidney diseases that can start earlier than usual, sometimes in young dogs. Examples include Shih Tzus and Lhasa Apsos (kidney dysplasia), Chinese Shar-Peis (amyloidosis), Samoyeds, English Cocker Spaniels and Bull Terriers (hereditary nephritis), and Soft-coated Wheaten Terriers (protein-losing kidney disease).13
- Other diseases: kidney infections, inflammation of the kidney filters (glomerulonephritis), cancer, amyloidosis, kidney or ureter stones, Lyme disease and leptospirosis.3,1
Acute kidney injury
- Antifreeze (ethylene glycol): it tastes sweet, and a small amount can be fatal.5
- Grapes, raisins and dried currants (a type of small raisin): no amount is known to be safe. Tamarind and cream of tartar, for example in homemade play dough, have also caused kidney failure.6,14
- Medicines: anti-inflammatory pain relievers (NSAIDs), especially ones made for people, and some antibiotics.7,2,15
- Infections: leptospirosis, spread through the urine of infected animals and contaminated water, and kidney infection (pyelonephritis).8,16,2
- Other causes: a blocked urinary tract, heatstroke, shock, snake bites, some rodent poisons and heavy metals.2
Lilies are a well-known kidney poison in cats, but in dogs they usually cause only a mild stomach upset.17,18
Signs of Kidney Disease
The first sign is often drinking and urinating more: the water bowl empties faster, or your dog starts having accidents indoors.4 As the disease progresses, dogs may lose their appetite and weight, vomit, become lethargic, and develop bad breath, mouth ulcers, diarrhea or pale gums.3,1,10 High blood pressure from kidney disease can cause sudden blindness.9 See signs of kidney failure in dogs for a full guide.
The Stages of Kidney Disease (IRIS)
Vets stage chronic kidney disease using the International Renal Interest Society (IRIS) system. The stage is based on blood creatinine and/or SDMA (ideally both), measured at least twice while the dog is stable and well hydrated.19
| Stage | Creatinine, mg/dL (µmol/L) | SDMA, µg/dL | What it usually means |
|---|---|---|---|
| 1 | Under 1.4 (under 125) | Under 18 | Blood values in range, but other kidney changes found (for example dilute urine or protein in urine) |
| 2 | 1.4 to 2.8 (125 to 250) | 18 to 35 | Mild; may drink and urinate more |
| 3 | 2.9 to 5.0 (251 to 440) | 36 to 54 | Moderate; signs of illness more likely |
| 4 | Over 5.0 (over 440) | Over 54 | Severe; dogs are usually unwell |
Stage descriptions are a general guide; signs vary between dogs.1,19 If creatinine and SDMA point to different stages, vets use the higher one. Very small or very large dogs, and Greyhounds, can have different normal values.20,19 Each stage is also sub-staged by the amount of protein in the urine and by blood pressure, because both affect treatment and outlook.19
The stage cut-offs were updated in 2026. Many websites and older studies still use the earlier ranges.21,20
How Kidney Disease Is Diagnosed
Your vet will usually check:3,1,20
- Blood tests: creatinine, SDMA, urea (BUN), phosphorus, electrolytes and red blood cells
- A urine test: how concentrated the urine is, which is often the earliest change, plus protein and signs of infection
- Blood pressure, which IRIS recommends checking in every dog with CKD
- Ultrasound or X-rays to look at the size and shape of the kidneys and check for stones
Dogs diagnosed with CKD need regular rechecks, often every 3 to 6 months in the early stages and every 1 to 2 months in Stages 3 and 4.1,22
Treatment
Treatment depends on the stage and the cause. For chronic kidney disease, it aims to slow the damage and keep your dog comfortable:23,1
- Fresh water at all times. Never limit water for a dog with kidney disease.4
- A kidney (renal) diet, usually from Stage 2, or earlier if there is persistent protein in the urine. In a controlled trial in dogs, a kidney diet reduced kidney-related crises and deaths compared with a regular diet.24 See dog food for kidney disease.
- Medicines your vet may prescribe to control nausea, appetite, blood pressure, protein loss in the urine and high phosphorus.23,15
- Extra fluids, sometimes given under the skin at home, in later stages.23
- Treatment of anemia and any urinary infection.21,1
- A feeding tube may be considered in Stage 4 to keep a dog eating and drinking enough.23
Acute kidney injury needs hospital care, usually with intravenous fluids and treatment of the cause. With poisons, fast treatment matters most.2,5 Dialysis and kidney transplants are rarely available for dogs.1
Life Expectancy
How long a dog lives with kidney disease varies widely and can't be predicted with certainty. With good care, some dogs live several years.4 Survival is generally longer when the disease is found early.10 In a study of 27 dogs, median survival was about 15 months at Stage 2, 11 months at Stage 3 and 2 months at Stage 4.11 A larger study of 150 dogs found average survival of 377, 165 and 49 days for the same stages.25 Both studies used the older IRIS stage ranges.
Dogs with high phosphorus, a lot of protein in the urine, muscle loss or a poor appetite tend to do worse.11,26,27 Dogs that kept eating a kidney diet most of the time lived longer.27
Can Kidney Disease Be Prevented?
Age-related CKD can't always be prevented, but you can lower the risk of sudden kidney damage:
- Keep antifreeze, grapes, raisins and human medicines out of reach, and clean up antifreeze spills.5,6,7
- Ask your vet about the leptospirosis vaccine. US specialist guidelines now recommend it for all dogs, given every year.28,29,16,30
- If your dog takes an anti-inflammatory pain reliever long term, follow your vet's advice on regular blood tests.7
- Take older dogs for regular checkups with blood and urine tests (ask your vet how often), which can find kidney disease before signs appear.12,20
Frequently Asked Questions
Can a dog recover from kidney disease?
Chronic kidney disease can't be cured, but it can often be slowed. Some dogs recover from acute kidney injury if it is treated quickly.
How long can a dog live with kidney disease?
It varies with the stage. Dogs diagnosed early can live a year or more, and sometimes several years; Stage 4 survival is usually short.
What are the first signs of kidney disease in dogs?
Drinking more water and urinating more, often followed by a poorer appetite, weight loss and vomiting.
Is kidney disease in dogs painful?
It can make dogs feel very unwell: nausea, mouth ulcers and weakness are uncomfortable, and some causes of sudden kidney injury, such as antifreeze or leptospirosis, can make the kidneys sore. Your vet can treat many of these problems.
What causes kidney failure in dogs?
Aging, inherited disease, infections such as leptospirosis, kidney stones, and poisons such as antifreeze, grapes and some medicines.
What is SDMA?
A blood test that can show reduced kidney function earlier than creatinine. Vets use both to stage kidney disease.
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Sources and further reading
This article was written and fact-checked on October 18, 2026 against current veterinary references and specialist guidelines:
- Brown SA. Noninfectious Diseases of the Urinary System in Dogs. Merck Veterinary Manual (pet owner version), reviewed June 2018, updated May 2026.
- Weir M. Acute Kidney Injury in Dogs. VCA Animal Hospitals, updated April 2026.
- Barnes C, Llera R, Weir M, Ward E. Chronic Kidney Disease in Dogs. VCA Animal Hospitals, updated May 2026.
- International Renal Interest Society. What pet owners should know. IRIS, accessed October 2026.
- Regehr T. Ethylene Glycol Toxicosis in Animals. Merck Veterinary Manual (professional version), reviewed January 2022, updated September 2024.
- Hayes C. Grape, Raisin, and Tamarind Toxicosis in Dogs. Merck Veterinary Manual (professional version), reviewed September 2024.
- US Food and Drug Administration, Center for Veterinary Medicine. Get the Facts about Pain Relievers for Pets. FDA, September 2022.
- Roman N. Leptospirosis in Dogs. Merck Veterinary Manual (pet owner version), reviewed June 2026.
- BluePearl Specialists. Kidneys: Chronic Kidney Disease and Long-Term Renal Failure. BluePearl, June 2016.
- O'Neill DG, Elliott J, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Chronic kidney disease in dogs in UK veterinary practices: prevalence, risk factors, and survival. J Vet Intern Med. 2013;27(4):814-821.
- Rudinsky AJ, Harjes LM, Byron J, Chew DJ, Toribio RE, Langston C, Parker VJ. Factors associated with survival in dogs with chronic kidney disease. J Vet Intern Med. 2018;32(6):1977-1982.
- Hall JA, Yerramilli M, Obare E, Almes K, Jewell DE. Serum concentrations of symmetric dimethylarginine and creatinine in dogs with naturally occurring chronic kidney disease. J Vet Intern Med. 2016;30(3):794-802.
- Kearns S. Familial and Congenital Renal Disease of Dogs. Angell Animal Medical Center (MSPCA-Angell), May 2023.
- Handley H. Journal review: Wegenast CA, et al. Acute kidney injury in dogs following ingestion of cream of tartar and tamarinds. Pet Poison Helpline, December 2022.
- Van Vertloo L. Renal Dysfunction in Dogs and Cats. Merck Veterinary Manual (professional version), reviewed March 2025, updated March 2026.
- Sykes JE. An Update on the Diagnosis and Management of Leptospirosis. Today's Veterinary Practice, February 2025.
- El Bahri L. Lilies: lethally toxic to cats, but not toxic to dogs. Vet Times. 2026;56(19):12-15.
- Pet Poison Helpline. Lilies. Pet Poison Helpline, updated May 2026.
- International Renal Interest Society. IRIS Staging of CKD (modified 2026). IRIS, 2026.
- International Renal Interest Society. IRIS Staging System. IRIS, accessed October 2026.
- International Renal Interest Society. IRIS Guidelines (2026 revisions). IRIS, accessed October 2026.
- Michigan State University Veterinary Diagnostic Laboratory. Chronic Kidney Disease: Living with Your Pet and the Diagnosis. MSU College of Veterinary Medicine, undated.
- International Renal Interest Society. IRIS Pocket Guide to CKD. IRIS, June 2026.
- Jacob F, Polzin DJ, Osborne CA, Allen TA, Kirk CA, Neaton JD, Lekcharoensuk C, Swanson LL. Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs. J Am Vet Med Assoc. 2002;220(8):1163-1170.
- Lucero MC, Duque FJ, Gil M, Ruiz P, Macias-Garcia B, Cristobal JI, Zaragoza C, Barrera R. A plasma calcium-phosphorus product can be used to predict the lifespan of dogs with chronic kidney disease. Can Vet J. 2019;60(12):1319-1325.
- Jacob F, Polzin DJ, Osborne CA, Neaton JD, Kirk CA, Allen TA, Swanson LL. Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure. J Am Vet Med Assoc. 2005;226(3):393-400.
- Pedrinelli V, Lima DM, Duarte CN, et al. Nutritional and laboratory parameters affect the survival of dogs with chronic kidney disease. PLoS One. 2020;15(6):e0234712.
- Sykes JE, Francey T, Schuller S, Stoddard RA, Cowgill LD, Moore GE. Updated ACVIM consensus statement on leptospirosis in dogs. J Vet Intern Med. 2023;37(6):1966-1982.
- American Animal Hospital Association. 2022 AAHA Canine Vaccination Guidelines (updated 2024). J Am Anim Hosp Assoc. 2022;58:1-19.
- dvm360. Lepto consensus statement. dvm360, December 2025.
About this article
Last updated : new page, written using IRIS staging guidelines, Merck Veterinary Manual, VCA and ACVIM guidance and published studies of kidney disease in dogs.
This page is for general information and is not a substitute for an exam by your veterinarian.
