During later stages of kidney disease, your doctor may recommend you to specialist capable of devising the best diet for your condition. These specialists are known as "renal dieticians."  Your renal dietician will work with you to reduce the stress on your kidneys while maintaining a balance between the fluids and minerals in your body. Most specialized diets will include elements similar to those described in this article. For instance, you might be instructed to reduce your intake of sodium, potassium, phosphorus, and protein. Most CKD and low GFR rates are caused or influenced by other underlying conditions. In such cases, you'll need to get these other ailments under control before you can raise your GFR.  High blood pressure and diabetes are the two most common causes. When the cause of kidney disease isn't easily identifiable, your doctor may administer additional tests to diagnose the issue. These may include urine tests, ultrasounds, and CT scans. In some cases, your doctor may recommend a biopsy to remove and evaluate a small sample of kidney tissue. When another condition causes kidney disease, or when kidney disease causes related problems, your doctor may prescribe certain medications to help treat your overall condition.  High blood pressure is often linked to low GFR, so you may need some type of blood pressure medication. Options include angiotensin-converting enzyme inhibitors (captopril, enalapril, and others) or angiotensin receptor blockers (losartan, valsartan, and others). These drugs can maintain blood pressure while also reducing protein levels in your urine, allowing your kidneys to work less hard as a result. During late stages of kidney disease, your kidneys may not be able to produce an important hormone called "erythropoietin," so your doctor may need to prescribe drugs that can help remedy the problem. You may also need vitamin D supplements or other drugs to help control phosphorus levels since your kidneys will have difficulty filtering phosphorus in the body. All drugs are filtered through the kidneys, so you should discuss any medication you plan to use with your doctor while your GFR levels are low. This includes both prescription and non-prescription drugs.  You may need to completely avoid NSAID and COX-II inhibitor drugs. Common NSAID drugs include ibuprofen and naproxen. One common COX-II inhibitor is celecoxib. Both drug classes have been linked to increased incidents of kidney disease. Talk with your doctor before trying any herbal remedy or alternative treatment, as well. "Natural" treatments are not necessarily better for you, and if you aren't careful, you could take something that may make your GFR levels dip lower. Even if you successfully increase your GFR, you should continue to check your GFR throughout your lifetime. This is especially true if you've ever had lower than average rates or if you face an elevated risk of kidney disease. GFR and kidney function naturally decline with age, so your doctor will likely recommend continued exams to help monitor the rate of decline. He or she may need to adjust your medications or dietary recommendations based on any changes to your GFR. If your GFR is extremely low and you've entered into renal failure, you'll need to go on dialysis to filter waste products and excess fluid from your system.  Hemodialysis involves the use of an artificial kidney machine with a mechanical filter. Peritoneal dialysis uses the lining of the abdomen to help filter and clean waste products from your blood. Kidney transplants are another option for people with advanced kidney disease and exceptionally low GFR. You'll need to be matched with the right donor before a transplant can take place. Oftentimes the donor is a relative, but in many cases, it may also be a stranger.  Not everyone with advanced kidney disease qualifies as a candidate for transplant, however. Age and medical history may rule out this treatment option. After receiving a transplant, you'll still need to carefully monitor your diet and overall kidney health to prevent your GFR rate from dropping too low again.

Summary: Speak with a renal dietitian. Identify any underlying cause. Take prescription kidney medication. Discuss other medications with your doctor. Periodically check your GFR. Go on dialysis. Wait for a kidney transplant.


The first step to take when teaching your dog how to crawl is to have him lie down.  This will get him in position and ready to focus on the new trick he is learning.  If your dog doesn't already know the lie down trick, consider teaching him this first before teaching him how to crawl. Have a treat ready to help your dog focus and to reward him with. Once your dog is lying down, take a few steps in front of him.  Squat down and show your dog the treat.  Keep the treat low to the ground and say “crawl.”  Your dog should start to crawl along the ground, trying to get the treat from you.  Reward your dog immediately if he crawled correctly.   Your dog may stand up and walk over to you.  If this is the case, start over from the lying down position. You should only be a few steps away from your dog at first.  Walking too far away may confuse your dog. Make sure your dog crawled correctly before rewarding him.  Your dog will repeat whatever behavior you reward. Once your dog starts to understand what the “crawl” command means, you can start to increase the distance your dog crawls.  Work gradually, taking a few steps more each time you train your dog.  This will increase how far your dog can crawl as well as reinforce the trick overall.  Always work slowly to increase the distance your dog is crawling. Practice around twice a day.

Summary: Have your dog lie down. Use the "crawl" command. Increase the distance.


These reactions reward the dog with attention and are to be avoided. Shouting is also ineffective. Instead, completely ignore any barking.  Telling the dog to be “Quiet” could be counter-effective. In some cases, spritzing your dog's with a spray bottle full of water can be an effective and harmless way to startle her out of barking. However, some dogs see this as a game rather than a distraction, so you'll have to determine whether it works for your dog. Rewarding your dog for behaviors you want to eliminate must be avoided, as this will only reinforce those behaviors. For example, if your dog barks at you to get attention and you respond by giving him attention, you've just rewarded him for the action you want to remove!  Ignore your dog when he's barking for attention. This can be tough, akin to ignoring a crying baby, but in order to avoid confusing your dog it's important that you not pay him any attention when he's demanding it. Don't reward your dog's demand for attention with glances, pets, or talking. If you're able to, turn your back to him. This will signal that you don't like this behavior. Eventually, the dog will quiet down. When your dog stops barking, praise him and give him treats. As he begins to understand the system, require him to stay quiet for longer periods of time before you reward him. If your dog is not a nipper, it can be helpful to close your dog's mouth when she barks inappropriately. This is a physical reinforcement that you do not approve of the dog's behavior. There are leashes and halters that allow you to gently pull the mouth closed while you're out on a walk. When feasible, remove your dog from anything that triggers barking.  Close blinds or curtains if your dog barks at people passing by. Put your dog alone in a room if she barks at guests.  Territorial barking can often be addressed by changing what your dog is able to see. Installing a wooden fence instead of a chain link fence or covering your windows with opaque film (that still allows light through) can help a territorial dog quiet down.  If your dog startles at unfamiliar noises, play a white noise machine or leave a fan running while you're not home. This can help distract your dog from the other noises she hears. If your dog barks whenever she sees other dogs or people, she may not get enough socialization. Model good behavior at the dog park, on walks, and when you interact with people. This can help teach territorial dogs that they don't have to bark to protect their territory everywhere they go. You can also take your dog to “doggie day care,” where she can play with other dogs and learn good dog behavior.
Summary: Avoid speaking to the dog or giving a hand gesture. Remove rewards for barking. Close your dog's mouth. Control the environment. Socialize your dog.