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14 year old husky/Lab strange kidney results - advice?

Hello, my 14-year-old female dog Spirit had to have several teeth removed in July and when they did the pre-op bloodwork, she had some values that were out-of-whack, and a bit confusing to read. Her SDMA was in the normal range, but her creatinine and BUN were both elevated. The vet thought these results were weird, but thought that the massive infection she had in her mouth might have contributed to the results, so he gave me antibiotics and recommended to come back in 2 months to recheck.

I just got the results of her recheck, and though the SMDA is still normal, her Creatinine and BUN are also still elevated (but stable). I've included her test results below, with the current readings on the LEFT and her July readings on the RIGHT:

BUN 69                                  July: 73
Creatinine 3.0                        July: 3.1
IDEXX SDMA 13                   July: 13
BUN:Creatinine Ratio 23.0    July 23.5
Phosphorus 5.3                     July: 5.5
Calcium 10.4                          July: 10.1
Sodium 151                           July: 148
Potassium 5.4                        July: 5.1

Here were a few other stats that were off during both panels:

RBC 5.26                    July: 5.15
ALP 198                      July: 169
Amylase 1,531            July; 1,528
Chloride 121               July: 122

Everything else was in normal range. She had her T4 checked both times and it went from 1.1 in July to 1.0 in October.

Her urinalysis had a gravity of 1.018 both months. A trace amount of protein was found, but no number indicated. Trace amount of blood was found in October (not July), but no number to indicate how much.

In July, she was sucking down water like there was no tomorrow and she had a few accidents in the house. Over the course of her surgery recovery and and administering of antibiotics, she hasn't had anymore accidents and has been drinking normal amounts of water. Beyond that, she has been completely asymptomatic - she doesn't act or seem sick at all.

I got the results via email and when I called to talk to the vet, she had left for the day but will be back tomorrow. In the meantime, I've been trying to figure out what stage she would be in, but none of the tables seem to take into account having a normal SDMA.

I also plan on getting referred to a specialist.

My questions in the meantime are:

What stage would this be considered? It seems she is straddling 2 and 3?

Are there any reasons why her SDMA would be normal but creatinine and BUN not? The vet said the SDMA test is supposed to be more sensitive and reveal kidney issues when as little as 25-40% of the kidney has been damaged, but that the elevated Bun/creatinine usually indicates that 70-80% of the kidney has been compromised? The FAQ from the idexx SDMA test even says that these types of incongruous results are unusual.

Could her kidneys have been injured in an acute attack back in July when she was having issues, and now she has permanent damage as opposed to something that is progressive? (Because her results stayed stable, even though no changes or interventions were made to make her situation better - we thought it would clear up when her infection did)

With what looks like her pancreas and possibly other organs also at least slightly affected, could this be something else - like cancer? Or Addison's?

I see conflicting information about whether low-protein diets are really effective, and at what stage/point they are effective vs. potentially accelerating the disease. With these kinds of numbers, what sorts of tests and/or interventions should I consider asking my vet about?

Anyways, I've been reading a few people's stories and saw some of the great support and advice that people were getting here. I hope someone might be able to chime in on my questions. Thank you. ~ Sam
4 Responses
1916673 tn?1420236870
Hi Sam. I need to review the results and want to consider them for a while, as they are unusual. Normal SDMA suggests something else is going on, but what? Let me have a think and get back to you.

As amylase is abnormal, I'm thinking there may be an element of pancreatitis (inflamed). What were you feeding prior to the blood test results? The more detailed the reply the better.

Also, as I deal with many different countries on this forum and consequently many different blood measurement units, can you let me know whether the phosphorus is mg/dl or mmol/L or any other form of measurement unit?

Low protein diets are a very contentious subject. My opinion is low protein is not helpful in early to mid stages of renal failure, therefore I would tend not to go down that route (yet). However, low-quality protein does affect the kidneys (even healthy ones), so always aim to provide high-quality proteins if possible (this ordinarily means meats and poultry sold that is good enough for humans to eat rather than the offal proteins ordinarily found in dog foods). By exception, specialised KD tinned food usually has high-quality proteins.

Okay. I'll get back with more tomorrow or later tonight.

Tony
1916673 tn?1420236870
Okay. Have had some time to have a bit of a think ... as the SDMA is identical on both occasions, it strikes me unlikely the test itself was faulty, although improper storage can cause abnormal results. I think we have to at least assume nothing went wrong on two different occasions though.

High creatinine and BUN are the first indicators of kidney disease/trauma, but normal SDMA rather suggests something else is going on (as you rightly conclude).

With the elevated amylase, slightly elevated potassium, and several other levels - there is certainly a question about Addisons. I would advise having this tested (even if only to discount it). Talk to your vet about the ACTH Stimulation Test to check for Addisons.

Did they undertake a blood pressure check? I'm guessing they did prior to the dental work - but it would be interesting to know if it was elevated then - and remains so now.

Various medications and antibiotics can interfere with some tests. It may be prudent to re-test SDMA, BUN and creatinine after the antibiotics particularly have finished (2 weeks beyond that point would be even better).

While there are lots of things suggesting this is kidney disease, the SDMA result is a complete abnormality and quite confusing.

Has your dog been tested for Leptospirosis? If not, suggest to your vet that both the RealPCR and the SNAP Lepto tests are performed. These would either confirm or eliminate this possibility.

One further thought ... Husky's have substantial muscle mass. Heavily muscled dogs can have NORMALLY high creatinine and BUN. I'm wondering if your vet has some old blood test results for comparison, just to see if long before the dental work these results were high. If so, this would suggest high creatinine and high BUN are normal for your particular dog. I have a rescued greyhound with similar incongruous creatinine and BUN levels compared with most other breeds.

I'll let you have a think about all of that and perhaps you would get back once you have had a discussion with your vet about them.

Tony
4 Comments
Thanks! I'm actually still waiting for the vet to get back to me, I got her test results in an email and haven't been able to speak with the vet. She is supposed to call me back today.

Spirit's been tested for lepto, negative. She was on antibiotics AFTER the July test results, and she had been off of them for 2 months by the time these October results came around.

I had actually looked up Addison's last night and she might actually have some of those symptoms, but I'd just been passing it off as "old arthritic dog" and "toothless dog" (3 dentals 3 years in a row because her teeth were so bad, she only has front teeth and canines now). She's been quite lazy/lethargic, a little shaky at times and has been picky about eating, but she's been eating - she's gained 5-7 pounds since July. I will definately check that out, as I'm certainly getting a second opinion with a specialist.

I've re-entered her stats below with the units of measurement, as well as some of her older stats (my vet emails her test results to me so I have them going back several years!). I'll have to ask the vet about blood pressure, but vet didn't mention it post op (they monitored her BP extra close with additional fluids while she was under anesthesia).

BUN 69 mg/dl     July: 73  Sept-15: 30
Creatinine 3.0 mg/dl  July: 3.1 Sept-15: 1.5
IDEXX SDMA 13 μg/dL   July: 13 Sept-15: 8
BUN:Creatinine Ratio 23.0    July 23.5 Sept-15: 23.1
Phosphorus 5.3  mg/dl  July: 5.5 Sept-15: 3.9
Calcium 10.4  mg/dl   July: 10.1 Sept-15: 9.8
Sodium 151  mmol/L      July: 148 Sept-15: 147
Potassium 5.4 mmol/L   July: 5.1 Sept-15: 5.0

Here were a few other stats that were off during both panels:

RBC 5.26        July: 5.15 Sept-15: 6.36
ALP 198     U/L    July: 169 Sept-15: 156
Amylase 1,531 U/L  July; 1,528 Sept-15: 1,022
Chloride 121  mmoI/L     July: 122  Sept-15: 116

Looking back through her older results, I also found that these numbers were off in July but were back to normal in October.

Hemoglobin: 13.5  g/dl July 12.9 Sept-15: 15.3
MCV  76 fl      July 79      Sept-15: 72
MCHC 33.8 g/dl July 31.7 Sept-15: 33.3

Food that she has been on: As I said before, she lost what was left of her teeth in July and ever since then, I've fed her a few things to try to figure out what/how she wants to eat. She's a lab, so she still practically swallows her kibble whole, but I've been adding water, basically making "kibble soup". The specific foods that I fed/tried to feed her include: Iams Proactive Health Senior Plus for dogs 11+, Purina One Vibrant Maturity for dogs 7+, Wild Harvest Lamb and Rice Recipe with Carrots (organic), a little bit of canned Purina Alpo (her junk food) and more recently Freshpet Select Tender Chicken Recipe (human grade, requires refrigeration).

Hoping the vet calls soon, but feeling ever-so-slighty better that I'm not the only one confused by this. Vet said in the email that kidney disease is present, so I still have a lot of worry on my mind, but I'm definately going to get a second opinion.

Thanks so much for responding and let me know if you have any other ideas based off of the additional info. I'll also come back here with an update after the vet calls me back.
So she has an x-ray and addison's disease test set for Thursday. Any idea how likely side effects are for the addison's test? Some of the potential side effects look a bit scary.
I have another question. Could I have caused this? :( I have been doing a lot of poking around on the internet and found some things that make me feel like I might have caused her kidney damage. At the beginning of July, about 3 weeks before she had her teeth taken out, she had been out on a camping trip and was sore when we got home. For 2-3 days, she had 300 mg aspirin + 262 mg bismuth subsalicylate to counteract the tummy irritation the aspirin might cause, 1-2 times per day (she weighed 60 pounds at the time). She didn't seem to have any reactions, but some side effects listed online seem to say that kidney damage is possible with aspirin, and that some bismuth subsalcylates also contain aspirin, so she might have overdosed? The sites I've found describe acute cases where dogs needed to go to the doctor for fluids and observation, but nothing like that happened to Spirit. But they also say if acute cases aren't solved within a certain time frame (4-6 hours) that the damage can be permanent. Could she have overdosed enough to get kidney damage without there being any outward, obvious signs she was in trouble?
The more I look around at Addison's, the more I think it's possible.

I'm trying really hard to keep an even keel and try not to get my hopes up, because odds are (and with my luck) she has kidney disease. BUT..... after reading the symptoms, to me it seems like there is a very real possibility she could have Addison's instead.

Spirit has had Addison-like "symptoms" that I witnessed but passed off completely as old age/arthritis: Hind-end pain, joint pain, muscle pain and weakness, tremors, shivering, excessive shedding (which I thought might be seasonal but it's been going on for 3-4 months), and having the drinking/appetite issues wax and wane. Within the last few weeks, she has started dropping food out of her mouth, which I thought was just because of her not having teeth, but she was eating fine before that - less ability to swallow is also a less frequent symptom of Addison's. I did some cross-reference search, and none of these seem to be symptoms typically associated with kidney disease, but more with Addison's.

Finally, she had an episode about 1-1.5 years back in which she got sick so fast that I thought she got into something and we brought her to the emergency vet. They ran a full panel and toxicity screening and couldn't figure out what she got into (we also searched the house for any sign of anything she could have eaten and found nothing). Gave her IV fluids and the next day she was back on her feet, happy and energetic. That kind of "crash" of unknown cause that seems miraculously fixed with simple rest and IV fluids often happens in dogs that are later diagnosed with Addison's.

Of course, I'm keeping in mind that I'm not the most objective person because she is my baby, and I could be grasping at straws.... But I had previously been thinking of all these things as seperate issues, and suddenly this health issue that could possibly explain all of them.

Of course she is an old dog, and some of those symptoms just happen to old dogs, but she developed all of these symptoms (hind-end pain, excessive shedding, tremors and shaking, etc.) all within the last few months.

It's hard not to have a glimmer of hope.

And it's also hard not to expect that glimmer to be dashed tomorrow after receiving her xray/ACTH results.

Thanks for listening. If anyone else has experience with these sorts of things, I'd love to hear about it.
1916673 tn?1420236870
Hi. I think the most crucial thing here is to get an accurate diagnosis, and either confirm or discount Addisons first. So, you are doing all the right things. It's very hard to say a) whether there is (also) an element of kidney failure, and b) what caused it. It is indeed possible for an acute phase to linger into chronic kidney disease, but there would almost certainly have been symptoms at the acute stage. It's all very well for us to analyse these events in hindsight, but not necessarily helpful. We do the best we can at the time - and that's all we can do.

The blood pressure is quite important, as it can have a disastrous effect on kidney failure (if kd is present). So, double-check it with your 2nd opinion vet.

Once Addisons and/or kidney disease are confirmed, we can take things from there. Get back once you know for sure.

Tony
2 Comments
Thanks :( I'll never know if kidney issues were already present, or if I caused them, and I am going to try not to dwell on that.

I asked the vet about her BP during the tooth extraction and they hadn't made any notes about it (even though I know they monitored it), so it must not have been high or I think they would have put that in her file.

Her X-rays came back and showed she does have spine issues, including arthritis in her spine. She also has "severe arthritis" in her hips. It sounds like she could have been in pain for a long time and I never knew it, which could bring about an adrenaline response which could cause all kinds of havoc on her internal organs.

However, the test for Addison's came back and the vet said she was negative.

So I have been moving forward with the idea that she probably has kidney disease and have been looking to change her lifestyle to accommodate this. And I thought the vet was on the same page with me.... But....

To make Spirit feel more comfortable with her back/hips, vet gave me a pain reliever for her that was supposed to be safe for dogs with kidney issues. She's been on it for 5 days and after having increasing difficulty getting her to take the pill, I looked up online to see if it could be safely dissolved in water.

First page I open, what do I see? Numerous warnings not to give Tramadol to  dogs with kidney disease. WTF! How is this any better for her than the Rimadyl she was on? (also not recommended for dogs with kidney issues).

I've asked for a referral to Blue Pearl, but have to wait for my vet to send them my info and have BP call me to set an appointment. At this moment, until I can get her to the 2nd opinion appointment that hasn't even been made yet, I feel like I have to decide between treating her kidneys or treating her pain.

She has been so much happier and more active since the new pain pills, on the one hand I don't want to stop, but on the other, if this is really bad for her kidneys, I risk hurting her worse if I continue.

I'm so angry with the vet and I feel so helpless about being able to do anything for Spirit right now. I appreciate any information or moral support.
She has an appointment at the specialist on Thursday! YAY! And not a moment too soon. I just want to know for sure if it's primary kidney disease or if it's secondary to another issue, so I can get her the support and maintenance that she needs.

Talked to my original vet, too, and she said the lower dosage of tramadol that spirit is on should be less stressful for kidneys than a full dose.

I think her tummy is bothering her today. She only ate part of her breakfast, but otherwise seems fine. Bright-eyed and alert, begging for belly rubs and she wanted to go for a walk, and just wanted to keep on walking and walking, but I didn't want her to get too sore so redirected her back home.

48 hours from now she has her appointment.
1916673 tn?1420236870
Well, it's good to know that one concern - Addisons - can now be taken out of the picture. It's one less confusion.

Lower doses of Tramadol are okay short-term. Sadly, there are really no effective pain relievers that do not cause some kind of stress on the kidneys. But, I am of the opinion that it's better to use them to relieve pain, than perhaps add a few weeks onto life.

Let me know what the 2nd opinion vet says. Fingers crossed.

Tony
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