Pronefra Oral Suspension (Virbac) – Kidney Support for Cats & Dogs with CKD | 60ml & 180ml

What Is Pronefra?

Pronefra is a palatable oral suspension manufactured by Virbac, formulated to support kidney function in cats and dogs with chronic kidney disease (CKD) or elevated blood phosphorus levels (hyperphosphataemia). It combines five complementary active ingredients in a single chicken liver-flavoured liquid that can be added to food or given directly by the included dosing syringe — making it significantly more practical and palatable than older renal supplements in capsule, powder, or paste form.

Pronefra is a nutritional supplement, not a veterinary medicine. It supports and complements the management of CKD alongside veterinary dietary management, medications, and monitoring — it does not replace them. Always consult your veterinarian before starting Pronefra, particularly in older animals or those on multiple medications.

Why Phosphorus Control Matters in CKD

Chronic kidney disease is one of the leading causes of death in cats over 10 years of age, affecting up to 30% of senior cats and approximately 7% of dogs. As kidney function declines, the kidneys become progressively less able to filter and excrete phosphorus from the blood. Phosphorus accumulates — a condition called hyperphosphataemia — which accelerates further kidney damage through mineralisation of renal tissue, stimulates parathyroid hormone secretion (renal secondary hyperparathyroidism), and contributes to the progression of the disease.

Controlling dietary phosphorus absorption is one of the most evidence-supported interventions in CKD management. Intestinal phosphate binders work in the gut, binding to phosphorus in food before it can be absorbed into the bloodstream, reducing the phosphorus burden on the kidneys.

In addition to phosphorus, declining kidney function leads to the accumulation of uraemic toxins — metabolic waste products (including urea, creatinine, and indoxyl sulphate) that the kidneys cannot adequately clear. These toxins cause the nausea, vomiting, weight loss, and lethargy characteristic of advanced CKD. Binding these toxins in the gut reduces their systemic absorption.

Pronefra’s 5-Ingredient Formula — How Each Works

1. Calcium Carbonate — Intestinal Phosphate Binder

Calcium carbonate binds to dietary phosphorus in the gastrointestinal tract to form insoluble calcium phosphate salts that cannot be absorbed. This reduces the amount of phosphorus entering the bloodstream from food — particularly important at mealtimes, which is why Pronefra must be given with or around food. Calcium carbonate is an established first-line phosphate binder used in veterinary CKD management.

2. Magnesium Carbonate — Complementary Phosphate Binder

Magnesium carbonate provides a second, complementary mechanism of intestinal phosphate binding. Using two different carbonate binders together provides broader and more effective phosphorus reduction than either alone — an approach supported by clinical experience in veterinary nephrology.

3. Chitosan — Uraemic Toxin Binder

Chitosan is a natural polysaccharide derived from crustacean shells. In the intestinal tract, chitosan binds to uraemic toxins — particularly urea and its breakdown products — reducing their absorption from the gut and lowering the circulating levels of these toxic metabolites. This reduces the toxic burden on the body and helps address the systemic toxaemia that causes many of the clinical signs of CKD (nausea, lethargy, reduced appetite).

4. Marine Oligopeptides (Fish Protein Hydrolysate) — Blood Pressure Support

Marine oligopeptides, also known as fish protein hydrolysate, are short peptide chains derived from fish protein. These bioactive peptides have been shown in multiple human and animal studies to help support normal blood pressure by inhibiting angiotensin-converting enzyme (ACE) — the same pathway targeted by ACE inhibitor medications like benazepril (Fortekor). Hypertension is extremely common in cats and dogs with CKD (affecting up to 65% of cats with CKD) and directly accelerates kidney damage. Supporting normal blood pressure is therefore a key component of renal protection.

5. Astragalus Polysaccharides — Renal Structure Support

Polysaccharides extracted from Astragalus membranaceus (a traditional medicinal herb) contribute to maintaining the normal structure of the kidney. Astragalus extracts have been studied for their nephroprotective properties — antioxidant activity, anti-inflammatory effects, and reduction of glomerular damage — in experimental models of renal disease.

Clinical Evidence

A published clinical study evaluated Pronefra over 12 weeks in 10 cats (ages 2–5 years) given the supplement alongside their normal food. The results showed:

• Plasma phosphorus levels decreased significantly (p=0.002) over the 12-week period
• Plasma creatinine levels decreased significantly (p=0.016) — an important marker of kidney function improvement
• Fractional excretion of phosphorus was significantly lower at the end of the study (p=0.02), indicating reduced phosphorus filtration burden on the kidneys

These results support the use of Pronefra as a practical adjunct to dietary and medical management of CKD in cats.

Dosage

Give Pronefra twice daily, with food or at mealtimes. Ensure fresh water is available at all times during treatment.

Do not exceed the recommended dose. In the case of regurgitation, temporarily reduce the amount slightly for a few days and consult your veterinarian if this persists.

Weight-Based Dosing Table

How Long Does Each Bottle Last?

For cats and small dogs, the 60ml bottle is suitable for a one-month supply. For dogs over 10–15kg on long-term supplementation, the 180ml bottle is significantly more economical.

How to Administer

1. Shake the bottle vigorously before each use — light sedimentation is normal
2. Unscrew the white cap to open the bottle
3. Screw the blue cap onto the bottle
4. Keeping the bottle upright, open the blue cap and firmly insert the tip of the dosing syringe
5. Turn the bottle upside down and gently pull the plunger to draw liquid into the syringe to the desired marking
6. Turn the bottle upright and gently twist the syringe to remove
7. Close the blue cap and replace the white cap
8. Administer by mixing into food or directly into the mouth using the syringe
9. Give at or around mealtimes (phosphate binders are most effective when given with food, as they need to bind phosphorus from the meal)

Which Pets Should Use Pronefra?

Pronefra is suitable for adult cats and dogs that:

• Have been diagnosed with chronic kidney disease (CKD) at any stage
• Have elevated blood phosphorus levels (hyperphosphataemia)
• Are being managed with a renal diet and require additional phosphate binding support
• Have elevated creatinine or urea levels indicating reduced kidney function
• Have early-stage renal insufficiency and require kidney support supplementation
• Have mild to moderate hypertension associated with kidney disease

Pronefra may not be suitable for some older animals or animals under specific medical treatment for digestive conditions. Always consult your veterinarian before starting — particularly in animals already receiving phosphate binders as part of prescription medication, or those with severe gastrointestinal conditions.

IRIS Staging and Pronefra

The International Renal Interest Society (IRIS) classifies CKD in cats and dogs into four stages (Stage 1–4) based on creatinine/SDMA levels, with sub-staging for proteinuria and blood pressure. Phosphorus management is recommended from Stage 2 onwards if dietary restriction alone is not achieving phosphorus targets. Pronefra is particularly well-suited to early intervention — Stage 1–2 — where palatability and owner compliance are critical for long-term success.

Pronefra vs Other Renal Supplements

Storage

• Store at room temperature (do not refrigerate unless stated on individual country label)
• Keep in original packaging
• Shake vigorously before each use
• Keep out of reach of children and animals other than those being treated

Frequently Asked Questions

When should I start my cat on Pronefra?

As soon as your veterinarian identifies elevated phosphorus or early-stage kidney disease (IRIS Stage 1–2). Earlier intervention is more effective than starting at advanced stages — Pronefra helps slow the progression of CKD by reducing the phosphorus-driven damage to remaining kidney tissue. Your vet will typically use blood phosphorus levels and IRIS stage to guide when to start phosphate binders.

Can Pronefra be given to cats alongside a renal diet (e.g. Hill’s k/d, Royal Canin Renal)?

Yes — and this is the most common approach. Renal diets reduce dietary phosphorus intake, while Pronefra reduces the absorption of what phosphorus remains in the diet. The two strategies are complementary. Many cats in IRIS Stage 2–3 require both a renal diet AND an intestinal phosphate binder to achieve the IRIS target blood phosphorus levels.

How do I know if Pronefra is working?

Your veterinarian will monitor blood phosphorus and creatinine levels at regular recheck appointments (typically every 3–6 months in stable CKD). A reduction in blood phosphorus and stable or decreasing creatinine levels suggest the supplement is having its intended effect. Improvement in clinical signs — better appetite, less lethargy, reduced vomiting — may also be seen as uraemic toxin levels are reduced.

My pet is already on benazepril (Fortekor). Can they also take Pronefra?

Yes — Pronefra’s marine oligopeptides provide blood pressure support through a similar pathway to ACE inhibitors but are not a replacement for prescription ACE inhibitors in cats with proteinuria or hypertension. Pronefra can be used alongside benazepril under veterinary supervision. The two approaches are complementary rather than duplicative.

Which size bottle should I buy — 60ml or 180ml?

For cats (typically 4–6kg), the 60ml bottle provides approximately 3–4 weeks’ supply and is suitable for initial trials. For long-term supplementation, the 180ml provides approximately 3 months for most cats. For dogs over 10kg on long-term supplementation, the 180ml is the much more economical choice. See the bottle duration table above for your pet’s specific weight.

Related products: Fortekor Plus (Benazepril + Pimobendan) – ACE Inhibitor for Cardiac & Renal Patients | Cerenia Injectable – Anti-nausea for CKD-related vomiting