According to Dr Celeste Clements DVM DACVIM in an article on Pet Health Network, there’s a one in ten chance your dog will be affected by kidney disease in her lifetime. And kidney disease is life-threatening.

It’s easy to miss early warning signs that your dog may have problems with her kidneys. And by the time signs of illness appear, 75 percent or more of the kidneys’ function may already be lost. Early diagnosis is key. It allows you to stop the disease from progressing through diet and supplementation.

At the Natural Canine Health Symposium (NCHS) in 2014, Dr Jodie Gruenstern DVM CVA gave a talk on diet for kidney disease. The information in this post is from that talk, and was approved by Dr Gruenstern.

First, here’s a look at the kidneys and some warning signs you should look out for.

What The Kidneys Do

The kidneys are your dog’s water and toxin filtration system. They remove waste products from your dog’s bloodstream and regulate fluids. When the kidneys malfunction, large amounts of fluid are flushed out of the body with the urine. The kidneys manage moisture. Without this, secondary constipation can occur.

The kidneys remove toxins.  If toxins are not removed, your dog can experience nausea, loss of appetite and vomiting. The kidneys also make a hormone called erythropoietin which stimulate bone marrow production of new, baby red blood cells. Without this, your dog can become anemic.

Early Signs Of Kidney Disease

One of the first signs your dog may have a kidney problem is that she’s thirstier than usual and asks to go out more often. She may not be able to hold her urine overnight, and may ask to go out at night or have accidents in the house.

Other symptoms can include:

  • Decreased appetite
  • Weight loss
  • Bad breath
  • Vomiting and diarrhea
  • Sore mouth
  • Weakness
  • Lack of energy and sleeping more
  • Poor coat appearance
  • Depression

If you’re noticing some of these symptoms, check with your vet. Remember, the sooner kidney disease is diagnosed, the better the chance you have of saving your dog’s kidney function.

Your vet can run blood and urinalysis tests to confirm kidney disease. Researchers are looking at ways to improve diagnostics too. A study at University of Guelph into biomarkers for canine kidney disease explained (1) …

“The main parameters used to diagnose acute and chronic kidney disease include circulating creatinine and urea concentrations, and urine-specific gravity. However, these parameters can be insensitive.”

AR Cobin et al, Ontario Veterinary College Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada

As an example, later studies, like one by. L Gys et al at Belgium’s University of Ghent, have identified the potential of a marker called Cystatin C to measure glomerular filtration rates. (2)

But if you catch kidney disease early, there’s a lot that can be done to manage your dog’s kidney disease with diet.

Managing Kidney Disease With Diet

Conventional veterinarians usually recommend a low protein prescription diet for your dog. But holistic vets like Dr Jodie Gruenstern say there are some problems with certain parts of these diets.

Here’s what Dr Gruenstern says about the theory behind these foods.

Prescription Kidney Diets Are …

Protein Restricted
There is no reason to restrict protein in your dog’s diet.  Your dog needs high quality protein to maintain muscle mass.

Phosphorus Restricted
This is a good thing (more information Dr Gruenstern shared about phosphorus later).

Sodium Restricted
This is completely unnecessary and potentially harmful. Reducing sodium can lead to tissue dehydration. Your dog needs good trace minerals and salt to help her body retain moisture properly.

Vitamin B Supplemented
Vitamin B supplementation is okay.  Adequate vitamin B can help your dog’s appetite.

High Energy Diets
These are intended to put weight on your dog. However, they use “junk” like poor quality fats and high carbohydrates to put weight on. Dogs need high quality protein to maintain muscle mass.

Supplemented With Omega-3 Fatty Acids
In processed form, these fats can easily become rancid, making these supplements ineffective and even harmful. It’s better to add omega-3 supplements to your dog’s fresh food diet just before feeding.

Prescription diets also alkalinize urine and blood, which is useful, but is done in an artificial way in prescription foods.

What Works Better

Here are Dr Gruenstern’s general dietary rules from for dogs with kidney disease.

Quality Ingredients

Feed high quality protein to maintain muscle mass. Your dog also needs high quality fat for energy.

Nitrogen Trap to Remove Excess Protein

Because meat-based diets are high in protein, your dog needs a “nitrogen trap” to help remove excess protein from the body.  The “nitrogen trap” helps divert the waste products of protein metabolism from the bloodstream into the colon, which reduces the burden on the kidneys.

If your dog has a high BUN (Blood Urea Nitrogen) value when lab tests are done, the nitrogen trap can help lower the nitrogen (contained in protein) and lower her BUN levels. There are many ways to do this. The easiest one is to feed lots of dark leafy greens, and add probiotics to your dog’s diet.


Your dog may need potassium supplementation as well as other products that help rebuild the kidney and aid detoxification (more about those in a minute).

Keep Your Dog Hydrated!

Dr. Gruenstern strongly emphasizes the importance of fluid therapy.

“No matter what diet you’re feeding and what supplements you’re giving, you must monitor your dog closely for signs of dehydration.  If your dog’s stool is hard and dry or if your dog is lethargic, you need to get more fluids into him.”

Dr Jodie Gruenstern DVM CVA

In Dr. Gruenstern’s practice, she teaches all owners of dogs with chronic kidney disease how to recognize the symptoms of dehydration and how to do subcutaneous therapy at home. You should ask your vet to do the same for you so that you don’t need to take your dog to the clinic if she needs hydrating.

What You Should Feed 

According to Dr. Gruenstern, the ideal diet for a dog with kidney disease includes:

A Species-Appropriate Raw, Balanced Meat Based Diet

“The food needs to be wet, and it needs to be warm. In nature, prey is not refrigerated, so a truly natural diet shouldn’t be fed straight out of the refrigerator.  Take your dog’s food out of the refrigerator ahead of feeding to let it come to room temperature.”

Dr Jodie Gruenstern DVM CVA

Don’t microwave or cook the food to warm it. It reduces the nutritional value of the food.

Nitrogen Trap

Add a nitrogen trap of probiotic supplements and the prebiotics that feed them, plus blended leafy greens, which provide enzymes and whole food vitamins.

Probiotics help balance the bacteria in your dog’s gut to maintain a healthy digestive system.  Natural sources of probiotics include fermented foods like kefir or fermented vegetables, or you can give a high quality probiotic supplement.

Prebiotics are non-digestible plant fibers that provide food for the probiotics.  Sources of prebiotics include fructooligosaccharides (FOS) and beet pulp (but some dogs may suffer gassiness with beet pulp). Raw garlic, mushrooms and dandelion greens are other good sources of prebiotics.

Dr Gruenstern emphasizes the importance of avoiding laboratory derived (synthetic) vitamins and minerals. They create extra stress on the kidneys and are not well absorbed by the body.

RELATED: Find out which probiotics are best for dogs …

Feed Kidneys

Feed organ meat as 10-15 percent of your dog’s diet. It’s especially important to feed your dog kidneys. The nutrients in kidneys can help support the kidney itself!

RELATED: Dr Patricia Jordan explains how feeding organ meats supports your dog’s own organs …

Limit Phosphorus For Kidney Disease

Since phosphorus can create extra work for the kidneys, it’s best to choose protein sources with lower phosphorus content.The chart below shows the phosphorus content of some foods you might give your dog.

You can see that sardines are high in phosphorus, so it’s okay to feed a sardine as a treat, but you wouldn’t want to give a whole meal of sardines.Near the other end of the scale you’ll see wild duck is low in phosphorus, so that is a great meat source if you can get it.

Quinoa is a complete protein that’s a great option, especially for end-stage kidney patients.

Phosphorous content in meat

Phosphorus Binders

Another way to address the high levels of phosphorus in meat diets is to add phosphorus binding agents to the diet.  Phosphorus binders help to pass excess phosphorus out of the body in the stool, so there is less phosphorus entering the blood stream.

Phosphorus binders are usually calcium sources … not just bone, but also products like Epakitin or Chitosan (both available at health food stores) or calcium carbonate (the active ingredient in Tums).

The dosage amount of these supplements will depend on your dog’s diet as well as your dog’s ongoing phosphorus levels, which your veterinarian should be monitoring.  Talk to your holistic veterinarian about the amount of phosphorus binders your dog needs.


Feeding foods high in potassium can help maintain your dog’s potassium levels. Bananas and green beans are two of Dr Gruenstern’s favorites!

Supplements For Kidney Health

Protomorphogens (PMGs)

PMGs (made by Standard Process) are growth factors that may be able to reprogram the cells at a DNA level to help regenerate kidneys. The conventional belief is that the kidneys can’t regenerate, but Dr Gruenstern says that if you can support a pet long enough, it is possible to restore the kidneys to better health. 

Glandular Supplements

Standard Process’s Canine Kidney Support supplement include a variety of ingredients including …

  • Bovine kidney
  • Kidney bean extract
  • Bovine kidney PMG extract

You’ll note the second ingredient is kidney bean extract.  In holistic medicine, the doctrine of signatures recognizes the benefits of plants (or parts of plants) that look like the organ, gland or tissue that you’re trying to help. So in this instance, kidney beans help support the kidney organ!

Standard Process’s supplements are only available through medical practitioners. You will need to ask your vet for help in getting their products.

You can also find other sources of glandular supplements, like freeze-dried organ meat blends.

Western Herbs

Dandelion, parsley and urva-ursi: these herbs all support the kidneys. Add some fresh chopped herbs to your dog’s food – a pinch per 10 lbs up to 1 Tbsp for a dog 100 lbs or larger.

If you buy dried herbs, capsules or tincture, assume the dose on the label is for a 150 lb human and adjust the dose for your dog’s weight.

Cordyceps mushroom: this mushroom has great affinity for the urinary tract and there are many good supplements that contain it.

Animal Apawthecary’s Tinkle Tonic: this supplement can be used preventively and as part of ongoing kidney support.

Chinese Herbs

Rehmannia is a Chinese herb that nourishes the kidneys and is used in Standard Process’s Rehmannia Complex.

The Chinese formulas below also include Rehmannia.  You’ll need a Traditional Chinese Veterinary Medicine (TCVM) practitioner (find one at to tell you which combination is best for your dog, as it depends on his Chinese medicine diagnosis.  This is usually done by observing the tongue and pulse.

  • Ba Wei Di Huang Wan
  • Liu Wei Di Huang Wan
  • Zhi Bai Di Huang Wan

These guidelines from Dr Jodie Gruenstern are important to support your dog’s kidneys. Don’t forget to consult your holistic vet about other nutritional support that might help your dog’s individual needs.

A big thank-you to Dr Gruenstern for this valuable information she shared during her talk at the 2014 NCHS.

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