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4 Y/o Cocker Spaniel in ICU - Acute Kidney Failure

Hi all,

Our poor 4  year old Cocker Spaniel is currently in ICU with what's been diagnosed as Acute Kidney Failure most likely due to an unnoticed heatstroke.
We went for a nice walk (nothing longer/further than usual) on Sunday and once we got home Sammy went to rest for a while. He's always been a dog who pants a lot so we did not notice anything abnormal until he started urinating blood on Monday.

We immediately took him to the vet who ran different blood test but there was nothing at that time to indicate kidney failure. Although we did alert the vet about the walk in the park, the initial thoughts were urine tract infection or some other infection that might have damaged the bladder.

On Tuesday we brought a urine sample (on Monday it was only blood) and the vet noticed a high glucose count, which might have indicated diabetes. He wanted to take Sammy in for another test to make sure it wasn't a false positive.

Turns out that no, it was not diabetes and we were advised to take him home and continue his antibiotics *Zenquin? for now and come in if anything changed.

His urine cleared up, no longer any blood visible so we were pleased and hopeful that he was on the right track back to normal. We waited all day Wednesday but come Thursday morning we were concerned that his behavior did not indicate any positive change. He was still lethargic (more so than Monday) and refused to eat at all.
He'd been drinking some water but nothing excessive.

A different Vet saw him in the same clinic and decided it was time for another sample of urine. This time his Creatine was way higher than it was on Monday with a value of 6.7. She advised us that his Kidneys were no longer functioning and we needed to start flushing him. They kept him overnight on an IV and the next morning his Creatin dropped to 6.1 which still didn't satisfy the vet. She'd hoped it would have gone down a lot more and referred us to the ICU.

We took Sammy in and they're keeping him another night on the IV fluids and we'll hear more tomorrow to see what his bloodwork looks like. He's continuing to urinate as they're pumping fluids in him and we'll be able to visit with him tomorrow afternoon.

We're very worried because we've seen his normal jumpy and excited behavior change into being tired and just wanting to rest. The ICU doctor said kidney damage could be reversible but all depends on how much damage was done. They did a sonogram and she said the kidney's looked OK (not old and shrunken) but that there was some fluid around it, which was to be expected if his acute kidney failure was caused by a heat-stroke.

At this point, we're extremely worried because we can see the medical bill going up ($6000 right now!) and we cannot afford to treat him much longer.

Is there anyone who's had experience with this type of situation or can advise us on what questions to ask, what to look for etc.?

We're very sad that we were unable to diagnose him until yesterday and that basically 4 days went by in which we could have treated him, had we known what was going on.

8 Responses
1916673 tn?1420236870
Heatstroke can indeed cause acute renal failure, although it is unusual. Dehydration is the underlying problem, so intensive fluid therapy is the right course of treatment. Bringing the creatinine down fairly rapidly is the key to retaining the health of the kidney organs and kick-starting them to function properly again. However, IV fluids may not be enough on their own and I would expect there will be a need to continue with SubQ fluids at home afterwards (ideally with lactated ringer solution).

I understand this is all very costly. But it is also the only way to proceed, if you want to have any chance of improving the situation for your dog.

There will be questions you need to ask after the initial run of treatment is complete, but at the moment the important thing is to get the fluid therapy. You might ask about continuing with SubQs, as they will need to teach you how to undertake this at home - possibly for several weeks, with at least 2-weekly blood tests during this period.

Did they undertake a Culture & Sensitivity test on the urine? This test is the only way of ensuring the right antibiotic is identified for the particular strain of UTI ... if indeed there is a UTI (quite common in kd dogs). Giving generic antibiotics (which is what many vets do) is pointless, as the antibiotic may not be the right one for the job and the UTI will consequently just return again and again.

You might also ask to receive copies of all the blood and urine testing that has been (and will be) undertaken. These are extremely useful for comparative purposes, but also to see if anything else is happening that we can help you with.

How old is your dog?

Tony
1 Comments
Hi Tony,

Thank you so much for your detailed answer.

Sammy is only 4 years old, which is why we're trying to do everything in our power to keep him going and with us.

His creatinine levels have dropped from the initial 6.7 to 5.6 and this morning 4.6. Tomorrow morning they'll test again.

At this point, I'm not sure if there ever was a UTI, but I will ask about the antibiotics you mention.

After speaking with the Dr. today, they will continue with the fluid therapy to hopefully drop his creatinine levels some more. He's been urinating very well and his kidneys looked good on the sonogram.

Unfortunately, he has not been eating at all, which made us decide to start intra-nasal feeding for at least today, and tomorrow we'll see if he might be interested in actual food. He has not been vomiting, which I guess means he's tolerating the substances he's being administered.


All of this has been a very scary and sad experience, especially since neither my husband or I are well-versed in (veterinary) medicine.

We're obviously desperate for a prognosis, but I understand that at this point, the only thing that can be done is bringing down the creatinine levels as much as possible. I do have a question in that regard:

If we can bring the Creatinine levels down further, would they then remain at that level? Or will they spike back up as soon as he gets off the fluids?

I will also ask about the SubQ treatment when I speak to the Dr. tomorrow morning.
1916673 tn?1420236870
Hi. Great news that the creatinine levels are falling. That's the priority. When the kidneys are affected and undermined by whatever caused this acute reaction (probably the heatstroke), then providing treatment is undertaken quickly, they can make a full recovery. However, so much depends on how much organ tissue has been damaged in the process. Kidney organ tissue does not replenish itself, so once it is destroyed, it is lost forever.

The question therefore is hard to answer, because nothing will be known until the creatinine levels are brought back to a normal level and the fluid therapy stops. At that stage, the creatinine could begin rising again - and if it does, then it's likely this may have developed into chronic kidney disease. But that's not a likelihood, just a risk.

It's a case of fingers crossed for a positive outcome. There are of course very important lessons to be learned from this experience - the big one being hydration and access to lots of fresh clean water at all times, but more so when out in hot weather. If your dog is particularly active when out, it is also useful to calm him down by keeping him on a leash - which will help prevent overheating and consequential dehydration.

Let me know how everything goes.

Tony
1 Comments
Hi Tony,

Thanks again for your answer.

Here's an update:
Over the past two days his Creatinine levels have continued to drop.

From the earlier mentioned 4.6 we got him down to 4.1, then 3.5 and this morning 3.0.

The Dr. wants to try and get him down as low as possible or at least as close to normal as possible.

Yesterday he ate a little bit after us urging him to but today he wasn't very interested.

He's still peeing like a horse, so I guess that's a good sign :)

Our biggest worry is that once we bring his Creatinine levels down more and stop fluid treatment, he might relapse, but like you said, there's no way of telling just yet.

We certainly did learn a lesson. Even though we've always been careful with him excising and always bring plenty of water to keep both Sammy and us hydrated we did not catch on to any signs of exhaustion this time around. If/once he recovers, we'll certainly treat him much more delicately.

I'll try to keep you posted as you've been so helpful with your responses and kindness!
1916673 tn?1420236870
Hi. That's really very positive news. The fact that creatinine keeps falling is excellent and gives rise to a good outcome. I wouldn't worry too much about eating behaviour just yet (the vet can give nourishment I/V or by tube if absolutely necessary and just to keep him going). He won't want to eat while the toxins are "active", as it produces large amounts of nausea and acid reflux. The vet might want to give some anti-nausea medication, although equally they may not want to complicate the situation with additional meds just yet.

I think the next couple of days will see further falls in creatinine and your dog's appetite should then return.

Fingers crossed for you both that this horrible episode ends with more good news and that the creatinine stays within the normal range over the coming weeks (after fluids have finished).

Tony
1 Comments
Hi Tony,

Thank you again for your time to comment and educate us on this scary matter. Here's an update:

After another few days Sammy's Creatinine levels have dropped to 2.3 (yesterday). Unfortunately, this is also the last day we can keep him in ICU. At this point, it is no longer financially responsible to keep him there any longer and we're devastated by this but honestly we kept him there longer than we could afford at this point.

Yesterday we spoke with his Kidney specialist and he went over some things with us in preparation for Sammy to come home.

They lowered the amount of fluids given to him by the IV so it won't be such a shock when he comes home and we go over to SubQ fluids only.
This morning when they tested his blood his creatinine came up a little bit again to 2.8. This has us worried and we're not sure what the SubQ fluids will be able to do for him.

Yesterday was also the first day he ate something on his own without us urging him to eat. This gave us hope, but naturally after his creatinine levels rose to 2.8 this morning we're not sure what we can do to keep him comfortable and help him make a recovery.

My real question for you:
What is the purpose of the SubQ fluids. Is it just to keep him hydrated or should we hope that those fluids will help him recover and lower his creatinine levels as well?

Sammy is happy and energetic, but naturally mom and dad are worried sick.

Thank you again for your time!!
1916673 tn?1420236870
Hi. The SubQ Fluids will continue to flush out toxins, hydrate and help lower creatinine further. They are standard for renal treatment after IVs have finished and have proved to be effective and beneficial in many cases. The period of SubQs depends on what happens with creatinine levels, but usually a period of between 6 weeks and 3 months is sufficient with blood testing every two to four weeks.

The type of fluids are equally important. Assuming that sodium levels in the blood are within normal range and not below normal range, then the solution used should be Lactated Ringers. This is the closest to natural canine body fluids and is what's known as a balanced fluid. Saline solution is often prescribed, but that is inappropriate for kd dogs (unless sodium levels are below normal).

Before bringing your dog home, please make sure the vet undertakes a comprehensive blood pressure check. Dogs with kd tend to have high blood pressure, and that adversely effects the kidney disease. Treatment is usually required - the appropriate medication also indirectly helps force more blood volume through the kidneys, thus removing more toxins and helping the remaining organ tissue improve its filtering ability.

Diet is going to be crucial to ongoing care. I would suggest starting with a canned kd prescription food such as Hills kd. This is low in phosphorus (a very influential element in kidney disease) and it also has high-quality proteins compared with the low-quality of most manufactured dog foods.

Having mentioned phosphorus ... what is the current serum phosphorus of the blood tests showing? If they show it is high (or approaching the border between normal and high), then I would start a phosphate binder. The best of these is aluminium hydroxide. Chat to your vet about starting this, if appropriate.

It may help you to start reading-up on some aspects of canine kidney disease, and particularly diet changes. There is a whole raft of my articles available on my website at www.tonyboothwriter.com or you can access them through inforbarrel.com

Fingers crossed for continued good news.

Tony
1 Comments
Hi Tony,

Thank you so much for this information.
Sammy is now back home with us which makes us all feel a little better.

He's slow and not really interested in eating anything at this time but we're hoping that with the SubQ fluids he'll feel a little better every day.

He's got a whole array of pills, from antibiotics to appetite stimulants which we'll go ahead and give him, starting tonight.

Both his blood pressure and phosphorus levels are well within the normal ranges so fortunately at this point, we don't need to worry about that just yet.

For now, our focus will be on getting him to start eating again as well as administering the 300ml of fluids every day.
I have already been reading many of your articles and answers in regards to diets and special foods so hopefully Sammy will show some interest soon.
Our next vet visit will be on Thursday and that's when we'll look at his creatinine levels again.

Thank you again!
1916673 tn?1420236870
Great news. To help aid eating, you can drizzle a teaspoon of organic (pure) honey on the top of the kd food, which improves the taste and makes it more appealing. Or, try adding a tablespoon of chopped cooked green cabbage (I know, sounds crazy), but actually it adds two important things to help kd dogs ... fermentable fibre is one, and cabbage is also a natural preventative for stomach ulcers. KD dogs tend to develop ulcers easily (due to high acid levels in the stomach).

If eating remains a problem, try to find either pure coconut oil (again just a teaspoon drizzled over kd food) or some natural (nothing added) green tripe. The green tripe stinks like hell when you cook it (I use a microwave), but dogs usually love it and it is full of nourishment for them. Again, just crumble a small amount on top of the kd food, as an appetiser.

Okay. Hopefully you won't need any of those things, but just in case.

Let me know how things go.

Tony
1 Comments
Hi Tony,

That's great advice! Thank you for your suggestions!

Here's a quick update:
Sammy was discharged on Saturday with Creatinine levels of 2.8. We have been giving him 300ml of SubQ fluids every morning and yesterday was our follow up with the vet when they performed another blood test.

His Creatinine levels have remained stable, at 2.8. We'd been hoping that it might have dropped but we're relieved it didn't spike back up.
The Dr. advised us to keep up with the fluid therapy and we'll do another check-up next week to see where we stand. Sammy is still recovering.

He's eating pretty well now, but all he's accepting is bland boiled chicken. We tried rice and some other of his favorite foods but anything with a strong smell is a no-no. Including the KD food.

He's been on anti-acids and appetite stimulants but even without those he will eat, but only chicken. The Dr. said that's ok for now, as long as he's getting some calories in and not vomiting, etc. Hopefully once/if his creatinine levels drop a bit, he might be more interested in different foods as well.

In the meantime, Sammy is pretty bright and alert, likes to go out and walk little bits around the neighborhood in the evening. We can tell he's comfortable at home which makes us all happy.

You've been so helpful with all your suggestions and responses, I can't thank you enough!
1916673 tn?1420236870
Great news. I would suggest (if your not already doing it) only using human grade chicken, as this contains high-quality proteins - and only use chicken thighs, as the dark chicken meat has much less phosphorus than white chicken meat. Also, it's best not to buy pre-cooked chicken, because it will probably be sprinkled in salt (too much sodium is not good for dogs with kd).

Fingers crossed things work out over the next week or two on the SubQs. You are doing all you can for now. It would be good to get him on the Hills kd canned soon, but I think the vet is spot-on that the absolutely chicken is fine for now. Eating is half the battle, even if it's not the perfect choice of food long-term.

Tony
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