Congestive heart failure (CHF) is a common cardiovascular disorder in geriatric dogs, causing significant morbidity and mortality (Bozkurt et al., 2021). In dogs, CHF primarily results from degenerative mitral valve disease or dilated cardiomyopathy, which impairs cardiac function and circulation (Keene et al., 2019).

Chronic kidney disease (CKD) may develop as a complication of CHF due to renal hypoperfusion and neurohormonal pathway activation, reflecting the interaction between the cardiovascular and renal systems (Savira et al., 2020). In advanced CKD, uremic toxins can disrupt gastrointestinal integrity, causing vomiting, diarrhea, uremic enteritis, and gastrointestinal bleeding (Summers & Quimby, 2024).

Despite the recognized cardiorenal interaction in dogs, reports of concurrent CHF and CKD with uremic enteritis remain scarce in the veterinary literature. This case report describes the diagnostic evaluation and management of a geriatric Golden Retriever with multi-organ dysfunction, emphasizing the importance of an integrated approach in the management of complex diseases.

Anamnesis and Clinical Signs: A 12-year-old male Golden Retriever weighing 32 kg was presented to the Veterinary Teaching Hospital of Padang State University with progressive dyspnea, nocturnal cough, vomiting, diarrhea, and generalized weakness. The dog had a one-month history of dermatological disease treated with topical and oral medications. Previous cardiovascular and renal histories were unknown, as this was the first hospital visit.

Clinical Examination: Severe dyspnea with mild cyanosis, pale-cyanotic mucous membranes, and capillary refill time (CRT) >2 s, respiratory rate was 48-60/min and pulse rate were 140-160/min with weak quality.

Laboratory Findings: Mild anemia, leukocytosis, and thrombocytosis. Serum biochemistry showed severe azotemia with markedly elevated urea (238.9 mg/dL) and creatinine (14.85 mg/dL) levels.

Diagnostic Imaging: Cardiomegaly with diffuse interstitial-alveolar opacities consistent with pulmonary edema secondary to left-sided heart failure (Figure 1). Intestinal gas distension, suggestive of uremic enteritis.

Diagnosis: Left-sided congestive heart failure complicated by advanced chronic kidney disease and uremic enteritis.

Prognosis: Infausta.

Management: The patient received four days of supportive therapy (Table 1), including low-rate intravenous Ringer’s Lactate (±1.5 mL/kg/h), injectable amoxicillin followed by oral cotrimoxazole, gastroprotectants (omeprazole and molagite), vitamin B-complex supplementation, and oxygen therapy.

CHF in geriatric dogs is commonly associated with degenerative mitral valve disease or dilated cardiomyopathy (McCauley et al., 2020). Decreased cardiac output can lead to renal hypoperfusion, causing cardiorenal syndrome and elevated urea and creatinine levels. Uremic toxins can irritate the gastrointestinal mucosa, causing impaired motility and increased permeability, leading to uremic enteritis (Wang et al., 2019). Histopathological changes include lamina propria edema and gastric gland atrophy (Puccinelli et al., 2025), while vomiting, diarrhea, and gastrointestinal bleeding are common in dogs with CKD (Pradnyani et al., 2021).

The differential diagnosis included gastroenteric ulceration, infiltrative enteritis, and gastrointestinal neoplasia (Bedel et al., 2025); however, abdominal ultrasonography and endoscopy were not performed because of the patient's instability. Supportive therapy included intravenous fluids, antibiotics, gastroprotective agents, vitamin B-complex, and oxygen therapy. Diuretics were not administered owing to severe azotemia and the risk of worsening renal perfusion (Pouchelon et al., 2015).

This case demonstrates complex interactions between the heart, kidneys, and gastrointestinal tract in elderly dogs. Aging reduces cardiovascular function, renal filtration, and gastrointestinal mucosal integrity (Rahbar et al. 2025). CHF and CKD limit therapeutic options, as interventions for one organ can worsen the other (Lombardo et al., 2025), contributing to poor prognosis in geriatric patients (Martinelli et al., 2016).

This case highlights that congestive heart failure in geriatric dogs may be accompanied by chronic kidney disease and uremic enteritis, resulting in multi-organ dysfunction. The coexistence of these conditions complicates diagnosis and clinical management and is associated with a poor prognosis. Careful monitoring and an integrated clinical approach are essential for managing such complex cases.