17 year old Tibbie with Stage 4 Kidney Failure

[mikiosmom]

My 17 year old Tibetan Spaniel, Miki, was diagnosed with stage 2 kidney failure in Feb 2016. Since then, her numbers have jumped and she's now at stage 4.

BUN was 69 (on 2/28/16), 101 (on 7/16/16), 70 (7 days ago)

Creatinine was 1.9 (on 2/28/16), 4.0 (on 7/16/16), 3.5 (7 days ago)

Phosphorous was 4.4 (on 2/28/16), 6.6 (on 7/16/16), 7.8 (7 days ago)

Albumin was 3.2 (on 2/28/16), 2.6 (on 7/16/16), 2.0 (7 days ago)

We’ve been giving Miki SUBQ 100ml/day at home rather than putting her thru stress of them administering IV. Since 7/16/16 her BUN and Creatinine has lowered slightly and we have her on an Aluminum Hydroxide phosphate binder. Doctor gave us Zeniquin for a possible UTI and says she’s now anemic and an edema may develop. We were advised to keep Miki comfortable and feed her anything she wants until her time comes.

We believe it's not her time and she doesn't seem to be in any pain.  Is there anything we can do?

Her test results from 7/30/16 are below:

BUN: 70 mg/dl  (High*)
CRE: 3.5 mg/dl   (High*)
PHOS: 7.8 mg/dl   (High*)
MO: 6.2%  (High*)
ALB: 2.0 g/dl   (Low*)
RBC: 3.66 10^12/l  (Low*)
HGB: 6.9 g/dl  (Low*)
HCT: 22.22%  (Low*)
LYM: 0.87% 10^9/l  (Low*)
LY: 7.6%  (Low*)
MCH: 19.0 pg  (Low*)

CA: 10.6 mg/dl
GLU: 100 mg/dl  
NA: 146 mmol/l  
K+: 5.8 mmol/l  
CL-: 120 mmol/l  

WBC: 11.35 10^9/l
PLT: 259 10^9/l
MCV: 61 fl
MCHC: 31.2 g/dl
RDWc: 18.8%
MPV: 8.9 fl
MON: 0.70% 10^9/l

[FawnT]

Glad to hear Miki is feeling better!  When Sadie was being very picky about her food and wouldn't eat her Kidney diet food, I looked for low phosphorus foods to try to entice her with something different.  Possibly a scrambled egg white, it is very low in phosphorus and a high quality protein, but not the egg yolk--it is very high in phosphorus.  I also was able to get her to eat some sticky white rice, drizzled with organic honey--which was a suggestion by Tony I read from his articles.  You could try a little lean boiled hamburger with some white sticky rice--I put a little butter on the rice to entice her.  Also, my dog loved mashed sweet potato, which I added a tiny bit of butter (very low in phosphorus) and cinnamon (but she has had issues with her potassium levels, so that is only an option without a potassium issue).  /She also now loves green beans, which I just boil and chop up for her.  Sadie is back to her Kidney canned food, but I have to put something above on it to get her to eat it.  Otherwise, she will take a few bites and walk away when she realizes there isn't anything "good" on it.  

[mikiosmom]

Forgot to ask. Any suggestions on feeding Miki something other than dry food?

[tonyb286]

Hi. Okay, thanks for the weight and fluid info. I think you are underdosing, particularly if you only get 100ml in within 24hrs. The recommendation would actually be 166ml in a 24hr period, which can be split into two 12hr doses if needed. It may be there's a reason why your vet has prescribed slightly less than the ideal dose, so talk to him first.

Refusing to eat kd food is not uncommon. It is fairly unpalatable stuff, despite being the best thing other than home cooking. Have you tried drizzling teaspoon of organic natural honey over the top? This is sometimes enough to entice dogs to eat it. You could also try adding a teaspoon of pure coconut oil or a desertspoon of cooked green cabbage. If it works, then try rotating these three supplements over three days.

The other important thing to mention is smaller meals more often, up to six times a day, if it's practical. This will help reduce the nausea and increase the likelihood of better eating, as well as reducing stress on the kidneys.

If Miki continues to refuse her kd food, then try to get your vet to prescribe Mirtazipine. It's a very good medicine for kd dogs and can prove very effective in those dogs it works for ... but it has to be said, it doesn't work on all dogs. Definitely worth trying though.

Try mixing the dry food with a little kd canned food in increasing amounts or a week, using the above enticement ideas. It would be better to wean her off the dry food and get her on the kd canned, if possible. Dogs do like dry foods - but it's a bit like kids liking sweets and chocolate, and just because they like it, it's not necessarily good for them. In canine kidney disease, dry food (rich in sugars and artificial flavourings and no water content whatsoever ... and below-par nourishment values compared with kd canned foods) is particularly ill-advised.

Hope some of that helps.

Tony

[mikiosmom]

Hi, Tony. Thank you for responding. We dropped off a morning collected urine sample and are awaiting the results. As far as the anemia, the vet hasn’t prescribed/recommended anything. We will ask about Epogen when the vet calls us.

Miki was 9lbs in Feb and now weighs 7.2lbs. We are administering 100-150ml of Lactated Ringers Solution every night and Miki seems to be doing better. She seems more alert although she refuses to eat her k/d food. I know you recommend not giving dry food, but that’s all she’ll eat now.

[FawnT]

Hi, I wanted to post, I went thru a similar situation with my Sheltie in June, her creatinine was 1.8 June 1st.  Directly after this Vet visit she started getting picky with her food and always has a stress GI reaction when she goes to the Vet.  Took her back 6/10 and her creatinine had gone up to 2.7, where he ran some tests, including UTI testing and he gave sub-Q fluids.  We went back on 6/24 since she had vomited and seemed to not feel well-- to creatine of 4.0.  I had to leave her for 2 days of round the clock IV fluids, which was very difficult for her (and me )since I know the stress she experiences at the Vet, but after the fact, it made a big difference for her.  We just had her values re-tested a month later and her creatinine is down to 2.2.  She is also now on alum hydroxide & her phosphorus has really come down on it from 7.5 when we went in on 6/24 to 3.8 now.  Hoping Miki will feel better!

[mikiosmom]

Hi, FawnT. Thank you for posting. Miki seems to be doing better. Plan to discuss options with vet. Hopefully the binder will help lower her phosphorus levels.

[tonyb286]

Hi. Thank you for posting the results. I know it's time consuming, but so worth doing.

I'm not convinced there is a UTI as WBC is within normal range. It would be worth dropping off a morning collected urine sample at your t and asking for a Culture & Sensitivity test to be undertaken. This will either confirm or dispute a UTI existing. If a UTI is present, the test will also disclose the best antibiotic to get rid of it completely. The point is that while Zeniquin is useful for any bacterial infection, it will not solve the UTI if it is not bacterial. The other thing is that Zeniquin needs to be used cautiously with both liver and kidney failure and can make the condition worse. All antibiotics ha this effect, which is why they should not  prescribed without a C&S test undertaken first to make sure they are needed - a that they are the right one for the job.

The anaemia is another major problem. How is your vet treating it?

If he isn't, then ask him to prescribe and administer Erythropoietin, a hormone that can kick-start the production of more red blood cells. It may also be useful to start your dog on Aranesp (darbepoetin alfa), which is a supplement related to Epogen that is used to treat anaemia related to kidney disease. The latter can be obtained from internet sources such as ThrivingPets.

Although I appreciate you don't want your dog to go through IV fluids at the vets, that is what's really also needed and works much faster than SubQs. Administering the right amount of SubQs remains important - along with the right type of fluid for SubQs. Can you let me have the weight of your dog so I can assess whether dosage is right? And what type of SubQ fluids are you using?

Hope that all helps.

Tony