If your canine companion has been diagnosed with kidney disease, you may notice them shaking or trembling at times. This involuntary quivering is usually a sign of an underlying issue caused by the kidney problems.

If you’re short on time, here’s a quick answer to your question: Dogs with kidney disease often shake due to electrolyte imbalances, anemia, pain, nausea, or side effects of kidney medications.

In this comprehensive guide, we’ll explore the common reasons dogs with kidney issues tend to shake and tremble. We’ll also provide actionable tips on how to ease your pup’s discomfort and discuss when veterinary assistance may be needed.

Electrolyte Imbalances

Potassium

Potassium is one of the most important electrolytes in the body and plays a vital role in muscle contractions, nerve function, and fluid balance. When a dog has kidney disease, they are at risk of developing low potassium levels (hypokalemia) for a few reasons:

First, damaged kidneys have a harder time conserving potassium. Healthy kidneys keep the right amounts of potassium in the blood, but diseased kidneys allow too much potassium to be excreted in the urine.

Second, some medications used to treat kidney disease like diuretics can lead to excessive loss of potassium in the urine. Diuretics help the kidneys remove excess fluid from the body, but they also flush out electrolytes like potassium.

Third, dogs with kidney disease often have poor appetites and may not eat enough potassium-rich foods. Good dietary sources of potassium include meats, fish, dairy products, fruits like bananas, and vegetables like sweet potatoes and spinach.

When a dog has low potassium levels, it can lead to muscle weakness, cramping, twitches, and shakes. Providing potassium supplements, potassium-sparing diuretics, or potassium-rich foods can help restore normal levels. Severely low potassium may require intravenous fluids containing potassium.

Monitoring electrolyte levels through blood tests is important for dogs with kidney disease. Potassium imbalances can develop over time and supplementation may be needed on an ongoing basis.

Calcium

Abnormal calcium levels are another electrolyte imbalance seen in dogs with chronic kidney disease. The kidneys help regulate calcium levels in the body by controlling how much calcium is excreted in the urine.

There are two main types of calcium imbalances:

  • Hypercalcemia – elevated calcium levels
  • Hypocalcemia – decreased calcium levels

Hypercalcemia is more common and occurs because the diseased kidneys cannot adequately remove excess calcium from the blood. Toxic levels of calcium can build up. Some major causes include:

  • Advanced kidney failure
  • Excessive Vitamin D supplementation
  • Underlying cancer like lymphoma or anal gland adenocarcinoma

Dogs with hypercalcemia may have symptoms like constipation, lethargy, excessive thirst and urination, shakes, or muscle twitching. Treatment focuses on addressing the underlying cause, restricting calcium intake, and using diuretics or medications to lower calcium levels.

Hypocalcemia is less common but can happen. The parathyroid glands help control calcium levels by sensing low calcium and releasing hormones to restore it. In kidney failure, the parathyroid glands may not work properly. Causes include:

  • Chronic kidney disease
  • Hypoparathyroidism
  • Vitamin D deficiency
  • Low magnesium levels

Dogs with low calcium may show signs like muscle tremors, twitching, cramps, stiffness, or facial rubbing. Calcium supplements or vitamin D can help increase calcium if levels are too low.

Checking calcium levels is important for identifying imbalances. Dogs with chronic kidney disease should have electrolyte testing every 3-6 months or whenever symptoms develop. Keeping calcium and other electrolytes balanced is key for reducing shakes and other symptoms.

Anemia

Anemia is a common complication of chronic kidney disease (CKD) in dogs. It occurs when the kidneys fail to produce enough erythropoietin, a hormone that stimulates red blood cell production. Anemia can cause several symptoms in dogs with CKD, including weakness, lethargy, shaking, and pale gums.

Causes

There are several reasons why anemia develops in dogs with failing kidneys:

  • Inadequate erythropoietin production – The kidneys normally make this hormone to tell the bone marrow to produce more red blood cells. But diseased kidneys often don’t make enough.
  • Shortened red blood cell lifespan – Toxins that build up in the bloodstream can damage red blood cells, causing them to die sooner than normal.
  • Blood loss – Some dogs with CKD lose small amounts of blood over time, often into their urine.
  • Iron deficiency – The bone marrow needs iron to make hemoglobin that carries oxygen in red blood cells. But some dogs with CKD can’t properly absorb iron from their diets.

Symptoms

The most common signs of anemia in dogs with kidney failure include:

  • Weakness and fatigue – Anemia limits how much oxygen can be delivered to tissues and organs, resulting in tiredness and muscle weakness.
  • Shaking or tremors – As tissues are deprived of oxygen, muscles may involuntarily contract and relax, causing shaking.
  • Pale gums and tongue – The decreased red cell mass causes gums and tongue to lose their normal pink color.
  • Rapid heart rate – The heart beats faster in an attempt to circulate more oxygen-carrying blood through the body.
  • Shortness of breath – Oxygen deprivation forces the dog to breathe faster and harder.
  • Loss of appetite – Anemia can cause nausea, reducing the desire to eat.

The shaking and tremors are not directly life-threatening. But they impact quality of life. Treating the underlying anemia can help resolve muscle tremors in kidney failure dogs.

Diagnosis

Veterinarians use several blood tests to diagnose anemia, check its severity, and look for underlying causes:

  • Complete blood count (CBC) – Checks red blood cell, white blood cell, and platelet numbers. It also measures the hematocrit level, which indicates what percentage of the blood volume is made up of red blood cells. Dogs with anemia will have a low hematocrit.
  • Reticulocyte count – Counts young red blood cells recently released from the bone marrow. Low numbers indicate poor bone marrow response.
  • Biochemical tests – Assess kidney function and look for waste products like urea and creatinine.
  • Urinalysis – Checks for blood in urine as a potential cause of anemia.

Based on exam and bloodwork findings, vets determine the anemia’s severity, whether it is regenerative (bone marrow is responding) or not, and rule out non-kidney related causes like parasites, infections, or cancers.

Treatment

Treatment focuses on managing the underlying kidney disease and directly correcting the anemia. Common treatments include:

  • Fluids – Fluid therapy helps flush toxins from blood, better control kidney function, and improve anemia.
  • Iron supplements – Oral or injectable iron helps ensure bone marrow has enough iron to produce hemoglobin.
  • Erythropoietin injections – Synthetic forms of this hormone stimulate red blood cell production by the bone marrow, raising hematocrit levels.
  • Blood transfusions – Quickly increase red blood cell numbers in severely anemic dogs as a short-term fix before other treatments raise numbers.

As anemia improves and red cell numbers stabilize, symptoms like lethargy, weakness, and shaking often lessen. With treatment, most dogs with kidney disease-related anemia can achieve a good quality of life.

Pain and Discomfort

Dogs with kidney disease often experience pain and discomfort due to the buildup of toxins and waste products in their blood. This can make them feel generally unwell. Some common signs of pain and discomfort in dogs with kidney problems include:

Shaking and Trembling

One of the most noticeable signs of discomfort is when a dog starts shaking or trembling. This shaking is not from cold, but rather from nausea, pain, or anxiety associated with their illness. The toxins circulating in their blood can make dogs feel quite sick.

The shaking may come and go or be more constant.

Restlessness and Pacing

Sick dogs may seem restless or pace around. They may have trouble getting comfortable and have difficulty finding a position to rest in. The discomfort makes it challenging for them to fully relax. Their bodies hurt and their minds are anxious.

Whining or Crying

Dogs in pain may vocalize more with whines, cries, or other sounds indicating their distress. This is their way of communicating to their human caregivers that something is wrong and they need help or comfort.

Loss of Appetite

As dogs feel increasingly unwell from their kidney issues, they often lose their appetite. The toxins make them feel too nauseous to want to eat. Lack of appetite is a clear sign a dog is not feeling like their normal self.

Agitation and Irritability

Dogs in discomfort may seem more agitated or irritable. Gentle touch that would normally comfort them may cause them to flinch or snap if they are hurting. Their lowered tolerance for stimuli makes them jumpy and upset.

Nausea

Nausea and vomiting are unfortunately common symptoms in dogs with kidney disease. As toxins build up in the blood due to the kidneys’ inability to filter properly, it can make dogs feel quite unwell. In fact, over half of dogs in kidney failure experience nausea and vomiting.

This nausea often leads to a loss of appetite and shake/tremors as the body grows weak from an inability to keep food down. As veterinarian Dr. Cathy Langston explains, “Toxins generate acute nausea. It’s common for kidney disease dogs to vomit bile, foam and lose their appetite.”

She recommends discussing anti-nausea medications with your vet to help settle your dog’s stomach and control the shakes.

Medication Side Effects

When treating kidney disease in dogs, medications are often necessary to help manage symptoms and slow the progression of the disease. However, some medications can cause side effects like tremors and shaking.

Here is an overview of some common medication side effects that may cause shaking in dogs with kidney disease:

Blood Pressure Medications

Medications like ACE inhibitors (such as Enalapril and Benazepril) are often prescribed to help control high blood pressure in dogs with kidney disease. These drugs work by dilating blood vessels to improve blood flow.

However, they can sometimes lower blood pressure too much, resulting in tremors, shaking, and weakness.

Diuretics

Diuretics like Furosemide are used to help flush excess fluid and waste from the body in dogs with kidney disease. However, they can lead to dehydration and electrolyte imbalances. Low potassium levels in particular can cause muscle twitches and tremors.

Anti-nausea Medications

Medications like Cerenia and Metoclopramide help control nausea and vomiting caused by uremia (waste buildup in the blood due to kidney failure). But they can have neurological side effects like tremors, shaking, and restlessness in some dogs.

Pain Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) like Rimadyl may be used to relieve pain and discomfort in dogs with kidney disease. However, NSAIDs can cause gastrointestinal ulcers and kidney damage. Tremors and seizures are possible side effects if toxic levels build up in the blood when the kidneys are not functioning properly.

Steroids

Steroids like Prednisone have anti-inflammatory effects and may help dogs with kidney inflammation. But steroids can also cause muscle weakness and tremors, especially with long-term use.

Antibiotics

Antibiotics treat secondary infections that can develop as a complication of kidney disease. However, certain antibiotics like aminoglycosides can be toxic to the kidneys. Tremors and neuromuscular blockade are possible side effects if toxic levels accumulate.

Conclusion

In summary, kidney disease can lead to an array of symptoms in canines, including shakes and tremors. Keeping a close eye on your dog’s behavior patterns is crucial for getting them the right treatment.

If nonsurgical remedies don’t alleviate their distress, your vet may recommend dialysis or kidney transplants in more severe cases.

By understanding the common culprits behind your kidney dog’s shivering and trembling, you can be better prepared to soothe their discomfort and improve their quality of life.

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