12 yr old border/lab mix

[ShariMgus]

Was just told this week that our guy gus was in kidney failure.  I am at a loss as to what to do.  We have put him on the k/d diet
the following are is lab results:
cbc
WBC 10.7
RBC  5.2
HGB 13.2
HCT 38.4
MCV 73.8
MCH 25.4
MCHC 34.5
PLT 295
GLUCOSE 93
BUN 107
CREATININE 7.5
SODIUM 146
POTASSIUM 5.3
Na/K 28
Chloride 110
CO2 16
Anion Gap 25
Calcium 11.7
Phosphorous 11.4
Osmolality calc 324
total protein 5.9
albumin2.9
globulin 3.0
a/g ration 1
tot bilirubin .1
alp 165
ggt 4
alt 55
ast 26
ck 124
cholesterol 358
amylase 1031
lipasse 290
T4 (RIA) .9
urinanlysis  only thing out of sync was
blood small
urine sp graqvity was 1.009

My vet has just sent us home with the "watch him" and the prognosis is not favorable..What the heck does that mean?  I have tried to reach him but he is out of the office until tomorrow.  grr.  Any advice would be appreciated.  Our old boy is still getting around, eats his k/d, drinks fluids and urinates but he does sleep alot more than normal.

[tonyb286]

Hi. I am so very sorry for your loss. Everyone here knows how hard these decisions are, but they are our final responsibility to our companions and best friends. I hope you will stay with us here and help support others. You will have gained some unique experience and knowledge which may just help others who are at the start of this dreadful journey. Run free Gus.Tony

[ShariMgus]

Tony,
I wanted to thank you for pointing me in the right direction and for the wealth of information that I gleaned from your web sites.  I was able to make Gus's last days comfortable.  His last blood work after fluids were 160 bun and 10.1 creatine.  We waited a few more days to say our goodbyes and yesterday we let our beloved friend go in peace and with his dignity.  This was probably the hardest decision I have had to make, but I knew the time was right as did Gus.  He told us with his eyes. He was a wonderful friend, companion, and will be missed by all that knew him (and that was a lot as he was our farm dog where many people came to visit and to take his picture.)  Thank you again for helping us to understand this horrible disease.
shari

[tonyb286]

That's great news. Fingers crossed everything goes well. It's a tricky thing, kidney disease, and sometimes the mess it makes of electrolytes, minerals, blood values and systems is so rapid, treatment doesn't manage to deal with it. But you're now absolutely doing the right thing, so Gus has the best chance of overcoming this. Yes, please do keep me posted.

Tony

[ShariMgus]

Already asked for the canned after previously reading your article.  Also am going to store to buy ingredients needed to make his food per your article.  Vet is going to do SDMA test and administer fluids.  Thanks for the input and hopefully we will get gus on track and have him feeling more comfortable.  Will keep you posted.

[tonyb286]

Dry is the worst you can give a dog with kidney failure. Think about it ... your dog needs fluids, is probably urinating more, and has kidney disease. Any and all dry (kibble) foods - even prescription foods - have no water content whatsoever. Worse, they often have little nutritional value either, because heating causes a loss of nuitritional value. So the manufacturers add chemicals and nutrients and preservatives and all kinds of things, to try and make the product viable. Unfortunately, some of these additives cause the kidney disease to deteriorate. You may not be surprised to learn I did another piece on this ...

http://www.infobarrel.com/Why_Dry_Dog_Food_Is_Bad_For_Dogs

So, tinned kd dog food is so much better. Hills do a tinned variety, which is low in phosphorous and protein (but includes high quality proteins) and - importantly - contains about 77% water, so every time you feed him with it, it helps rehydrateand flush out toxins.

One other thing worth mentioning is that feeding 4 to 6 small meals is better than feeding one or two larger meals a day as it means the kidneys aren't put under so much stress.

Tony

[ShariMgus]

Hills dry

[tonyb286]

Out of interest, what brand is the kidney care k/d food you are using?

Tony

[tonyb286]

Another reason for fluid therapy is the Osmolality calc 324, which points towards dehydration (not untypical in kd). Calcium is elevated slightly, so you need to be cautious with the type of fluids ... I would suggest Lactated Ringers are better, as this type of fluid is well balanced for canines.

Tony

[ShariMgus]

Thank you for your advice.  Calling vet now.

[tonyb286]

Ok. So, this could actually be Acute renal failure due to the Rymadil overdose. Dogs tend to love the taste of this medication, so it's no wonder he hunted it out. The overdose has almost certainly caused kidney damage, and possibly liver damage too. Whether this is Acute or Chronic is fairly irrelevant at this stage, because treatment is the same. I/V fluids followed by SubQ fluids at home. This is important and should begin now.

Blood pressure being done is crucial.

Low phosphorous diet and low-protein diet (high-quality human grade meats and poultry) is essential too. Try to make sure your dog gets no more and ideally no less than 18% daily protein in diet. Replace protein with carbohydrates.

Let me know how things go.

Tony

[ShariMgus]

I don't believe that they took his blood pressure

[ShariMgus]

too fill you in more... gus tore his ccl in  may was put on rimadyl and tramadol.  In July gus found the bottle of rimadyl and ate 40 tabs, was taken to pet er and spent 2 days flushing his system.  Blood work at that time was normal.  No rimadyl just as needed tramadol since then.  on 10/6 I took him in for vaccinations and asked about the tore ccl as he is still limping and the recommended putting him back on the rimadyl, I asked about blood work before doing that as the previous er vet said that would need to be done before administrating it again.  He told me that by  now it should be flushed out of his system and that he should be ok.  I gave gus 3 pills over 2 days...he got sick, unsteady on his feet so back to the vet we went when blood work was done and those were the results I posted.  The vet also said given his age and injury there wasn't much he could do but to keep him comfortable.  I have been in contact with him about retrieving the previous blood work from july to see how it has progressed.  I also have scoured your pages and have gleaned useful information.  I will ask about the test today as I am calling him.  He is on the kidney care k/d food.  Hope I have answered your questions.
Gus has been an active dog and lives on a farm.  Now he is sleepy, and today he didn't eat his breakfast, so not like him as he will eat anything.  I really don't want him to suffer and don't know what to do to help him.  Thank you for answering my questions.
Shari

[tonyb286]

Hi. Ok. I have had an opportunity to look over the blood results. Thank you for posting them. Another question ... did your vet offer any medications or treatment advice, other than the "watch him" suggestion?

If that's all he said, it's not good enough - you can either change your vet or insist on certain forms of treatment.

The first thing to be aware of is this is probably late-stage kidney failure. The creatinine is the biggest indicator of this and is extremely high. An SDMA test would confirm this as a diagnosis, but not all vets are able to do this test, particularly those that have not brought their practices up to date.

The blood results also show that phosphorous levels are too high. A kd diet will help rectify this, but a phosphorous binder is needed too. Your vet needs to prescribe one - aluminium hydroxide would be the better option of the various binders that are available. This will help reduce phosphorous over time. Restricting phosphorous in the diet will also help, but it won't be enough to control it - hence my suggestion to get a binder prescribed.

Next ... the tot bilirubin and alp levels suggest some liver problems. Get Milk Thistle from a good health shop or from your vet or online (dog not human products). Milk Thistle will help protect the liver against further damage and may even help it recover. I am assuming your dog has not been on any NSAID medication recently, as that can also cause these levels to rise and can affect the liver.

Some good news ... the bloods don't suggest there is any evidence of anemia or urine infection, which are common in kd dogs.

Cholesterol is moderately high. As sodium levels are within normal levels, this may be entirely down to his diet and is not something I would be too worried about. Dogs don't ordinarily suffer from cholesterol issues like humans do. It is also possible this is the result of a meal having been eaten prior to having bloods taken or also potentially due to the liver concern, which is where fats are stored.

My recommendation would be to have IV fluid therapy started now. This must be done by a competent vet with good nursing supervision. Fluids should be balanced Lactated Ringers, not saline, as that would increase the currently stable sodium levels. After a day or two of IV fluids, it would be beneficial to repeat the blood test to see if it has had the desired effect of bringing the BUN and creatinine down. If this is the case, you can then carry on giving subcutaneous (SubQ) fluids at home for a further few days and up to a week. This will help gain the maximum benefit of fluid therapy - which, if successful, will help flush toxins from the system.

I have a couple of my articles which you will find helpful, I'm sure, so please take some time out to read them:

http://www.infobarrel.com/My_10-Point_Plan_for_Dogs_with_Kidney_Failure

and

http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease

Please get back to me with answers to questions I have asked when you can.

Tony

[tonyb286]

Hi and welcome to our family of friends here. I will respond properly later today, but wanted just to ask a quick couple of questions before doing so ... what kd food have you started feeding?

Did the vet take your dog's blood pressure?

I note the SDMA test is not included in the blood results ... could you ask your vet why this hasn't been done? It's quite new, but extremely useful in staging kidney disease in dogs.

Thanks.

Tony