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Renal Disease
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9.1 Renal Insufficiency
Kidney disease may be seen at any age, but older birds are more likely to develop renal insufficiency. It is found in a high percentage of birds at necropsy, but there are few non-invasive tests available for it antemortem. Uric acid buildup can be responsible for renal disease, but poor diet or contamination can also cause it. Even if the uric acid levels are normal, the bird may still have renal functional impairment. 58
According to D. Styles, older birds whose diets have been poor their whole lives may display polyuria and polydipsia when placed on a balanced diet. They may also exhibit general malaise and have an increase in their plasma uric acid levels. This may be caused by the chronic deficiency in Vitamin A and the Essential Fatty Acids (Omega- 3 and -6) in their previous diet. This condition is most common in cockatiels. These birds may already have compromised renal function caused by malnutrition, and their urinary production and flow have been obstructed or slowed. "Increased protein levels present in an improved (pelleted) diet may overload their renal and hepatic capacities; consequently, the owner should be very cautious when improving the diet of geriatric birds, and he should make the changes gradually." 58 Pelleted diets are not advised for the geriatric bird. Owner and veterinarian should determine together how much of a change should be made and when. Vitamins and Omega-3 and -6 fatty acid supplements should be added to the bird’s diet.58
9.2 Gout
Gout is the accumulation of uric acid crystals (tophi) in the articular joints or viscera (internal organs). Articular gout appears most commonly as subcutaneous pockets of a crystalline uric acid with a paste-like consistence in the joints of the feet and legs." 58 Visceral gout is even more serious and more difficult to diagnose than articular gout. "It appears as whitish accumulations of uric acid in the muscularis layer of vital organs, such as the heart and proventriculus." 58 It may be seen as a light coating on the tissue surfaces. Articular gout produces a cream- to-yellow-colored deposit in affected joints. 11 The causes include excesses in Vitamin D3, calcium, or protein in the diet; these initiate the renal damage that often leads to gout.58
Clinical signs for both visceral and articular gout include weight loss, depression, polyuria, and polydipsia. Blood tests and renal biopsy are used to diagnosis the disease, and persistent hyperuricemia (too much uric acid in the blood) is usually present. Radiographs or CAT scans may show small or enlarged kidneys with or without mineralization. Sometimes urethroliths* are seen. Calcification of vital organs often follows visceral gout. Changing the diet from high protein (pelleted) to a diet of seeds and vegetables may help to alleviate or limit the condition over time.41,58
*A calcification or stone in the urinary passages. Some birds sit very tight on their eggs and fail to void their cloacal contents regularly. Urates can precipitate in the cloaca and lead to the formation of a urolith. Urolithiasis - the presence of calculi, or uroliths, in the urinary passages.
Articular gout is common in older birds, and it is critical to differentiate between arthritis and articular gout due to the vast differences in progression, quality of life, and prognosis. There are many causes of gout, but the following are the most frequently seen in geriatric birds:
- Glomerulonephropathies (malfunctioning kidneys)
- Renal tubular gout
- Chronic bacterial nephritis (inflammation or infection of the kidneys) 37,41
Treatment should involve giving the affected bird supportive care, such as fluid therapy and antibiotics as needed, based on the diagnosis. Once the bird is stable, its diet should be addressed and improved, and the Essential Fatty Acids in Vetomega© (Omega-3 and -6) should be added to help manage the disease. Treatment of articular gout is not always successful; pain relief may be needed, but "NSAIDS for these birds should be given cautiously since they may cause further renal compromise." 37 If the uncontrolled articular gout causes the bird extreme pain, and the pain cannot be managed, the clinician should discuss euthanasia with the client.37
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