Stage 4 Chronic kidney failure in my dog

[indy33]

Hi there,
My beautiful 7 year old blue cattle dog has very recently been diagnosed with Stage 4 Kidney disease.
She had been off her food for a while and a little lethargic so we took her in to the vet's on the 16th of  May and she took a total blood count.
I also requested a Leptospirosis test be done as she has been regularly swimming and wading in a stormwater drain and bush swamp for around 6 months over Summer/Autumn.
Her results were as follows:

Urea - 58.1
Creatinine - 715
Phosphate - 6.80
Lipase -146
Anion Gap -34
Specific Urine Gravity 1.011
All other readings were normal except for a slightly raised White Blood Cell count.

The Lepto test eventually came back and was negative.

The vet just told me she has Kidney failure and referred me onto another Vet clinic for an Ultrasound of her kidneys and other organs.
The ultrasound showed fibrosis and mineralization of both my dog's kidneys, with one being a lot worse than the other. The vet doing the Ultrasound didn't tell us how bad her kidneys are but estimated she only had around a month to live
He said it really wasn't worth doing fluid treatment for her --it would really only prolong the inevitable.

We took her along to a third vet for another opinion and he told us we really should consider putting her down as the blood test results were off the scale' He said giving her fluid treatment was a waste if time and may even make her worse.

None of the them seemed interested in trying to help my dog at all - they have just written her off.

The strange thing is that even though she is not eating properly, has lost a lot of weight and is definitely much quieter and less active than normal, she is still moving around really well and the highlight of her day is going for her customary long walk along the fire trail .
She keeps up with us really well and still chases her ball and sticks almost like normal.
She still has some of her old spirit left and doesn't strike me as a dog who has lost all hope yet.

She has no diaerreah and only occasional vomiting but getting her to eat anything at all is a real struggle and she is losing more weight all the time. She is also having trouble doing bowel motions as she really isn't eating properly.
We have tried her on all sorts of foods including the Hills special renal dog food which she refuses to eat, no matter how we prepare it.
All she seems to like now is a little roast chicken, toast and vegemite, ham and silverside sandwich meat and occasionally a bread roll.

It is heartbreaking to sit by and watch her slowly fade away, especially as she is still so young.

Does anyone here have any suggestions as to how I can help my beautiful Indy?

A list of Meds she is on :
Vet Ace blood pressure tabs
Periactin appetite stimulant tabs
Maxalon anti nausea tabs
Mylanta and Tums tabs for phosphate binding
Zantac anti acid tablets

Please help.
Thank you.

[indy33]

Yes, some lovely ways of remembering and paying tribute to our beautiful four legged friends.
Am finding it hard to find a decent locket on the Australian online pet memorial merchandise sites though.
I'm probably better to have a browse at one of the jewellery stores like Prouds for a quality product.

[lovemybailey]

What a beautiful tribute to your four legged babies.  :)  I intend to have my dogs ashes shattered with mine one day as well.  
I also like the locket idea with the bit of hair.  
Just beautiful.  :)

[indy33]

Yes, it is comforting to have Indy's ashes back with us again.
Having all your beloved pets' ashes scattered with you is a lovely idea.
I have my three dogs' ashes in silver scatter boxes, (along with a framed photo of each), up on a wooden shelf, under cover , on the wall of our back pergola.
This is their favourite place where they used to sit and sleep  and guard their territory, looking out over the lovely back garden and big old gums in the National Park over our back fence.
I am going to buy a silver heart locket so I can wear a lock of Indy's fur close to my heart.

[DogBlog]

I was very comforted once I got Sammie's ashes back home...as well as pets before her!!  I intend to have all their ashes scattered with me someday!!

[indy33]

Thanks so much for your kind wishes.
Much appreciated.
Yes, Indy did let us know when she had had enough - she was more than ready to go as she was starting to suffer and just didn't want to be here anymore.
We are picking up her ashes later today from the vet's....it will be good to have her home with us again.

[DogBlog]

sorry I got cut off on my last post.  Having internet problems!!  I was starting to say please don't doubt your decisions.  We do the best we can.  There is never a right or wrong time.  We make our decisions based on our extreme love for our pets......there is nothing wrong with that and no guilt!!!  I know that is easier said than done, but I truly believe it.  Especially at Indy's young age, it made sense to try a little longer.  In the end, she let you know.

My thoughts and prayers are with you!!!

[indy33]

So, so  sad that her life was cut so short - she still had  so much more living to do.
My last cattle dog lived until she was 14  ...they are an incredibly tough and hardy breed so I just took it for granted that Indy would also have a long and healthy life.  
But  yes, it is some small consolation that Indy was able to experience  such an active and wonderful life in her short time here on Earth with us.

So sorry to hear about Sammie - I hope he didn't suffer too much but,  wow, 17 is a really good innings.

[DogBlog]

So very sorry to read about Indy.  I lost my Sammie in September to this horrible disease.  I was lucky that Sammie was almost 17.  You're right....Indywas too young but at least she lived her 7 years filled with love!!!  Please

[indy33]

Hi juniorclara10,

I am so sorry to hear about your beautiful Cavvy dog.
I have a soft spot for this breed as they have such a lovely soft and gentle nature and such expressive, kind, huge brown eyes.

How is your dog faring?
By your description I fear she is currently experiencing a very similar decline to that of my dog over the last little while.
Unfortunately Indy passed away on Monday afternoon (29th June).  
Indy had deteriorated very rapidly over the prior few days to the point where she was no longer eating at all and unable to drink so I was giving her water through an eyedropper. To my horror, on the last day, I noticed that the tip of her tongue had turned black - no wonder the poor darling could not drink or give us kisses anymore.
In those last few days I could see that this cruel disease was finally getting the better of her - she was very "out of it" and miserable and no longer really responding to us. In mind and  spirit she was no longer with us.
I could see in her eyes that she was more than ready to go, and on the last afternoon, when she no longer wanted to go on her beloved walk I knew that it was time to put an end to her suffering.
The next afternoon we took her in to the vet's to get her put to sleep - we sedated her with a couple of KP tablets prescribed by the vet before we left home and sat with her on her blanket out in the sun, stroking her and softly talking to her, as she drifted into semi consciousness.
We were taken out into the grass back yard/exercise area at the vet's and we gently laid her down on a soft blanket and hugged her and said our goodbyes as the vet administered the euthanasia injection into her front leg.
She was gone in seconds and her passing was very gentle and peaceful. It had been a beautiful  clear, warm, sunny mid- winter's day and we sat out there with her for quite a while as the sun set and the last of the sun's ray's bathed her in a soft, orange glow.  

Of course we are heartbroken and I am missing her so very much but it really was the right thing to do.
She may have lingered on for a few more days but in terrible misery and with no quality of life left.
I actually feel now that perhaps we should have put her down a week sooner but I couldn't bring myself to end her life when she still appeared to gain some small enjoyment from her afternoon walks and lying by the fire in the lounge room with us in the evenings as we watched telly.

Yes, you are right in saying that by the time you see the signs of this terribly cruel disease that it is often too late.
This was the case with Indy - she was already in late Stage 4 renal failure when diagnosed 5 weeks ago and the disease was too far advanced to do anything other than make her as comfortable as possible and shower her with love and attention.

I just wish we had caught it earlier ... 7 is way too young .
At least I take comfort in knowing my lovely, fun-loving vibrant Indy sure packed a helluva lot of living into her short life and gave us so much love and joy.

My thoughts are with you and your girl - really hope she is not suffering yet and can be with you for a while longer yet.

Christina

[tonyb286]

Hi. Sorry to hear things have deteriorated with your best friend, but sometimes (with Sub-Q fluids and the right diet) a dog can rally round. It's always worth trying. You don't mention whether the diet is kd specific? If not, it needs to be. Also, the Sub-Q fluids are essential to get the blood levels back down, so keep this up, at least for a week or two. If she's not eating anything, then she may need some intravenous nourishment to give her essential energy and to prevent the electrolyte balance becoming too out of control. Also, the anti-nausea medication may need changing - just because something worked before, it may not work now, so try something different. These are issues you should discuss with your vet today, not tomorrow, as time is of the essence.

Finally, please join our Group. As a member, you will get regular updates about new research material, news and members comments - all useful things to help support you and your dog.

Cheers,

Tony

[juniorclara10]

So sorry to hear about your beloved dog Indy.  I am in the throes of the same thing.  My 10 year old Cavalier King Charles Spaniel was in acute kudney failure back in February.  She did very well with treatment - subQ fluids, Pepcid, and Alternagel.  Treatment stopped in May and she has been wonderful - until this past Monday when she vomited once and only ate part of her breakfast.  By dinner she had lost interest in her meals but would eat her treats.  I took her to the vet hospital on Tuesday and they determined that she was in chronic kidney failure.  I took her home in the same treatment as  before and has gotten worse.  She is not eating at all. And is very lethargic. It is breaking my heart, but I know the end is near.  Between the tears I am giving her as much live as I can in her final days.  We took herbtontgebicean yesterday and today stevia on a blanket in the sun with my 6 year old daughter. We are going to miss her so much and inhopebto see the signs that the time is right before she is in pain.  Best of luck to you - kidney failure is awful in that by the time you see the signs it's too late!

[tonyb286]

Hi Christina. I think the peach stone wouldn't have caused the kidney disease. The stones do contain toxic substances, but in relatively small quantities. The swimming in stagnant water is a possibility, but quite honestly, I think this kidney disease began maybe 2 or 3 years ago, so again it may have adversely affected an already existing condition, but not necessarily caused it.

In a fairly young dog, this was most likely either due to poor quality foods (low quality manufactured dog food has bad things in them) or exposure to poisons early in life or a genetic factor. I am inclined to think the latter. In many ways, it now makes no difference, because it is ingrained and established now.

I am a bit surprised your vet put your dog on blood pressure pills without taking the blood pressure ... this smacks of very unprofessional behaviour. I wopuld definitely change your vet. He is right that most dogs with kidney failure do have high blood pressure, but not all dogs, and blood pressure medication for a dog without high blood pressure is very dangerous and potentially fatal..

I would not advise having your dog go into the vets for IV Fluids - as this would cause additional stress (and cost), which frankly could make the kidney disease worse. However, you could undertake Sub-Q Fluids at home yourself, with the vet's supervision regarding the type of fluids and any additional electrolytes to the fluid bags. Your vet can teach you how to do this - and there are lots of training videos online that show you how to do it. Fluids are the first line of treatment for all kidney failure dogs - so it is a consideration. Would it work? Would it lower the blood levels? How long would it lower the levels for? These are all unknown, because every dog responds differently, but it would be wrong of me not to let you know, there's a chance it could prolong life.

Hope this helps.

Tony

[indy33]

Hi Tony,
Thanks so much for your kind advice and the info on diet and Calcitriol therapy.
Your articles are really informative and  would definitely be very useful for owners with dogs suffering with less advanced kidney disease- unfortunately I fear that Indy is just too far down the line to benefit from any of this treatment now.
I just wish we had caught this disease earlier so we could have done some of these things and possibly prolonged her quality of life.

I tried the KD with a little honey and also a little salmon oil but she just wasn't interested. I will also try the green tripe but she appears to be fast losing interest in all foods.
I  have previously asked one of the vets about the Azodyl and they said it is not used for dogs here in Australia, only for humans, and that it is extremely expensive.
Regarding her blood pressure, the vet didn't measure it but went ahead and prescribed 2 1/2 months worth of Vet Ace pills because she said it was likely Indy would have high blood pressure as a result of the kidney disease and the medication would slightly aid kidney function.
I was a bit concerned that these pills would place unnecessary strain on her already overloaded kidneys but the vet claimed the blood pressure pills would be beneficial.

Just a couple of questions:

Any idea why a dog so relatively young would develop chronic kidney failure? Could it possibly be due to inbreeding?
As she has really only begun to display the symptoms over the last few months and there was no anaemia present in her blood count I wonder if she initially had Acute kidney failure brought on by a leptospirosis infection which has permanently damaged her kidneys? The lepto blood test was negative but I have read that the antibody test is not always 100 per cent accurate, and they did not test her urine for lepto.
She has been swimming/drinking/wading in a sometimes stagnant stormwater drain for around 6 months which is located in bush with lots of wildlife and feral dogs, native rats and mice and foxes around.
She seemed absolutely fine before this.

Just after she was diagnosed, she vomited up a peach stone that must have been stuck in her throat or stomach for an extended period, as we have not bought peaches since December/January.She must have swallowed it scavenging in the garden after someone has thrown the peach pit down in the back yard over summer.
I recently read that peach stones are poisonous as they contain cyanide so perhaps this was gradually releasing the toxin into her system over a long period and may have led to her kidney damage.
One of the vets didn't seem to think that a peach stone would be that harmful apart from perhaps causing a small partial blockage.
What do you think?

Also, if my dog underwent an intensive course of dieresis to help flush her kidneys out, how long would the effects last?
If her BUN and Creatinine levels were significantly reduced, approximately how long would their levels take to build back up to the previous high levels?
(Obviously if it were only for a few days, it really wouldn't be worth putting her through all the distress of being away from home in a strange place.)

Sorry this is so long !

Indy is very subdued and depressed today but still has the spirit to lie tummy up to catch the sun and weakly bark at the trail bike riders riding past our side fence.

Regards
Christina

[tonyb286]

Hello Christina. I am so sorry your dog has received this diagnosis. The great difficulty with dogs is they don't often show symptoms of kidney disease until things have gone a very long way down the line, and the numbers (particularly the creatinine) are very bad indeed. Correcting this is, as two vets have said, probably impossible. I suspect there simply isn't enough kidney material left to deal with toxin by-products from food and medications, which means the kidneys will continue to deteriorate until they stop completely. Fluid therapy may remove some of the toxins, but it won't prevent them building up again. It's incredibly frustrating and upsetting when we feel so helpless, and I totally empathise with how you must be feeling.

Some dogs seem to carry on almost normally, except for refusing food and being a bit sleepy and lethargic ... right up to the last couple of days, when their outward appearance of health takes a nose-dive. I suspect you will see this happen with your dog. You may wake up one morning to find her unable to stand, unable to walk, sleeping throughout the day, refusing all food, depressed and obviously very seriously ill. This heart-wrenching "end of life" is extraordinarily painful for owners to observe.

I notice she is on blood pressure tablets, which I assume means she has raised blood pressure. This in itself is very typical of dogs with kidney disease and it does make things far worse. Treating it is good, but in turn, the blood pressure treatment causes more toxins to be produced (because the kidneys cannot process the by-products of the medication, just like the protein and by-products of food).

You have her on things that will make her feel more comfortable, but some are obviously not working. I think (sad for me to say) the disease has simply progressed too far. You can go down two alternative routes and it's truly impossible for me to say which would be better for you and your best friend.

You could try to encourage the kd food (important in trying to reduce the toxin build-up). Try putting a little natural honey on the food, pure salmon oil or a probiotics (no sweetener or flavourings). This will not only help get some useful nourishment in her, but the supplements also taste good, so might encourage her to eat. When you give her chicken, keep the skin on - the fat will give useful energy and is easier to process than protein contained in the meat. You could also try things like Azodyl, which is a supplement specially designed for kidney disease. You could also try forcing your hand with the vets, instructing them (or an alternative one) to undertake intensive fluid therapy. You might also suggest Calcitriol Therapy to your vets ... a link for more details about this (one of my own articles) is below. These measures combined may work to reduce the levels slightly, maybe even successfully for a short time ... but the chance of them doing very much for very long is quite low.

http://www.infobarrel.com/Calcitriol_Therapy_For_Dogs_With_Kidney_Disease

The second alternative is to give Indy whatever she wants, any food she will eat and just try to keep her pain free. When things progress to the point that you see "that look" in her eyes, then that's the time to say goodbye. I'm sure that is heartbreaking to read, and I'm so sorry for saying it, but I need to be honest with you.

In terms of food, my article on diet might have some suggestions you haven't tried. Here's a link to that one too:

http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease

I hope some of this helps. Please let me know how things progress.

Regards,

Tony