Kidney Concerns

My puli, Miss Emma, is having some issues, and while I trust her vet, I have some questions.  When we originally went to the vet with problems on July 2nd, they tested her blood at the office.  Her BUN was 127, ALT was 527, and her creatinine was 7.6.  We were sent to the emergency animal clinic to have her started on an aggressive diuresis treatment for the holiday weekend.  She had a urinalysis run at the emergency clinic as well, and I was told that she had a horrible UTI (for which she didn't give symptoms of until the day before). On July 5th, the last blood test at the emergency animal clinic showed her BUN to be 33.7, creatinine at 3.6, and ALT at 282.  The morning of July 6th, Emma was transferred back to our regular vet clinic and continued on her diuresis for the day with another blood test at the end of the day.  Her BUN dropped to 28, but her creatinine reading went up to 5.2 and her ALT was in the 290's.  I've been giving Emma about 200 mg of fluid under her skin each day, and has been put on a kidney prescription diet.  She's still not eating much, but behavior is normal as is her drinking.  Today (July 9th) she had her blood tested again, and the creatinine is at 5.5, but BUN is 28 and ALT is 194.  

My question is how/why did her creatinine jump from 3.6 to 5.5 even with the diuresis treatment continuing on Monday?  Is it at all possible there's something going on with the testing?  I'm really concerned, and the vet seems to be concerned about her creatinine number.  They want to run another urinalysis and are talking ultrasounds.  Why is her creatinine still up but her other levels down?  

[Brian C Hurley, D.V.M.]

Hi Jennie,

Miss Emma is very lucky to have an owner that is very in tune with what is happening and great job listening very carefully to your veterinarian.

Bun and Creatinine are both indicators of kidney function as you are aware.  Each of these values will increase when the glomelular filtration rate (GFR) is affected.  The urinalysis is important because the Specific Gravity is consistent with kidney compromise.

The diuresis is important to flush the toxins that are developing in the system.  We normally see both the BUN and Creatinine decrease with this treatment.   Due to the process that is going on in Miss Emma’s kidneys, you may see fluctuations in the values at a given point in time.  I am never surprise to see the values change at different rates.

However, one explanation for the decrease at the emergency clinic and the increase at your veterinarian’s office may be variation in the lab machines between the emergency two places.   I would definitely continue to track the BUN and Creatinine at your veterinarian’s office, recheck the urinalysis due to the observed changes on the first sample, and an ultrasound would be a logical diagnostic test to run if the problems persist.  You could also discuss radiographs of Miss Emma’s abdomen prior to the ultrasound.

Due to Miss Emma’s age, hopefully you are dealing with an acute renal insult that with aggressive treatment your veterinarian and you may be able to reverse.  We can see acute insults that cause issues with the kidneys from systemic infections, toxins, medications, foreign bodies, and cancerous processes.

Continue your open line of communication with your veterinarian and based on further diagnostic testing, your veterinarian and you will be able to treat Miss Emma appropriately.  Again, while the increase in creatinine is concerning, you may be seeing this anomaly due to the differences in the lab machines used between the two hospitals.  I hope this helps and keep us posted.

[Dr. Carol Osborne, DVM]

There are many reasons for the variations in blood values, some are real and others may be artifact depending on the lab used at the time and the way the blood was handled. The values for calcium and phosphorus are also important values to have because once the value of the calcium multiplied by the  phosphorus level is less then 40, calcitriol may be used. Calcitriol is a natural, active form of Vitamin D that human dialysis patients used to take to regenerate the kidneys and my patients results with this have been excellent. The fluid diuresis is necessary to flush the ammonia from the body. Many dogs do not like K/D and therefore do not eat it. A home-made diet is a valid consideration: 1/3 lean protein like chicken, lamb, salmon, or eggs (1 egg contains 7 grams of pure protein on which the kidneys do little to no work to metabolize), 1/3 long acting carbohydrates such as sweet potatoes, oatmeal, rice and pasta and 1/3 vegetables including broccoli, green beans, peas, etc. Cook them any way you desire, mix it all together and add a teaspoon of extra virgin olive oil, The oil enhances the smell and taste and is a great source of omega-3 fatty acids. Then season it up to make it tasty. Most dogs like barbecue sauce, pasta sauce or tamari sauce, which is the brown sauce used in many types of Chinese food. You can buy low sodium tamari sauce at the grocery store. There are a few excellent natural supplements that have proved to be very beneficial for kidney support in my patients and may be used once the diuresis is complete.
Thank you
Dr. Carol Osborne, DVM