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Advanced kidney failure

Hello,

I'm new to this forum. And, like most, I've been researching the internet compulsively to help my dog.

I have a 13+ year old rescue beagle, Gracie.  Up until about 4 months ago, she was happy and active.  She started drinking a bit more than usual a little over a year ago.  I took her in to get her teeth cleaned a year ago and had the usual blood work done. Her vet called and stated all levels were normal, except her BUN was elevated to about 70.  He didn't think that was a concern, since her CREA was normal.  

Fast forward about 9 months, she's drinking and peeing nonstop.  I take her in and the clinic vet runs blood work and urinalysis.  She comes back telling me that she has a bladder infection. We treat that with antibiotics, but the excessive drinking and peeing did not stop. More bloodwork, ultra sound.....

The vet diagnosis is Cushings.  I asked about kidney disease, but she stated that the urinalysis came back fine.  Vetoryl was prescribed, but she still kept drinking and peeing excessively.  She had occassional back leg weekness that they thought were back problems reoccurring, so Metacam was prescribed. The leg weekness increased to the point where she could not hold herself up. I continued giving her the Vetoryl, since hind leg weekness is a sign of Cushings.....until she went into a full blown Addisonian crisis last week.

3 days in the hospital...BUN 111, CREA 3.4, phosphorus 13.  We took her home after 3 days, and she was so active and so happy. We thought we had our spunky girl back. She was diagnosed with Addison's and prescribed Prednisone. Her numbers were BUN 65, CREA 1.6 when we left....phosphorus was not checked.

It wasn't even 2 days that she vomited and had trouble holding herself up again.  She's at the vet currently on her 3rd day of IV with a diagnosis of advanced kidney failure.  Her numbers shot back up to where they were during the crash.  Their belief now is that she had mild kidney failure which now is advanced due to the Addison's crisis.  I'm glued to my computer trying anything that will help her.  She was doing really good last night when we took her home, except for some muscle tremors and losing control of her back legs.  I have her on k/d food, aluminum phospate, a couple of antiuclers, Azodyl, and the Prednisone for her Addison's. Will start the sub q fluids, too.

I just feel so guilty....she was feeling fine just a few months ago, and now I feel like I've poisoned her.
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1916673 tn?1420233270
Hi. Addisons is not my area of knowledge, so I may not be much help, although clearly there is a close link with kidney disease. I was reading some info from The Merck Veterinary Manual about Addisons just the other day and managed to find the following, which may be helpful (at least worth checking with your vet):

"For longterm maintenance therapy, the mineralocorticoid desoxycorticosterone pivalate (DOCP) is administered at 2.2 mg/kg, IM or SC, every 25–28 days. Electrolytes should be measured at 3 and 4 wk after the first few injections to determine the duration of action. Alternatively, fludrocortisone acetate is administered PO at 10–30 mcg/kg/day. Serum electrolytes should be monitored weekly until the proper dose is determined. Some dogs (especially dogs on DOCP) also require daily oral glucocorticoid therapy to adequately control clinical signs. Replacement doses of prednisone (0.2–0.4 mg/kg/day) are required in ~50% of dogs. Additional glucocorticoid supplementation may be required (2–5 times maintenance) during times of illness or stress. Dogs with atypical Addison disease require only replacement doses of prednisone, although it is recommended that electrolytes be monitored every 3 mo for the first year after diagnosis."

There is evidence that many cases of Addisons are due to a lesion (probably cancerous) on the pituitary gland. Has your vet looked into this possibility?

I find it extraordinary that phosphorous wasn't checked on the last set of blood results. This is not acceptable and I would have a word with your vet to ask why it wasn't done. High phosphorus is one of several primary contributors to rapid deterioration in kidney disease in dogs, so ensuring it is brought under control quickly is a major and urgent objective.

Muscle tremors and losing control of her back legs is likely to be related to electrolyte imbalances, and these can be caused both by Addisons and compounded by kidney failure. Correcting any serum electrolyte imbalance is crucial. Your vet should be maintaining close observation of all blood electrolyte levels and adding supplement treatments as required.

Hope some of this is helpful.

Tony
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4 Comments
Thanks, Tony!

Thanks for the information!
I'm not even concerned about her Addison's.  That's a chronic, treatable disease. She's only Addison's now do to the Cushings med.....iatrogenic Addisons is what it's now.

Yes....I thought from the beginning it was kidney disease. Her BUN has been between 60-75 for over a year. But, they ran numerous tests.  Over $1000 worth of tests and ultrasounds and urinalysis to confirm Cushings. Said her kidneys were fine.  But even when she was medicated for Cushings, she was still drinking often and losing control of her back legs.  I can't obsess about the past right now.

As of last night, we did 3 more days of IV fluids and all her numbers came back to normal except her BUN....49.  We are managing at home with sub q fluids. I'm just concerned that her numbers doubled in just one week time. Will the sub q fluids be enough? We're doing everything needed to lower numbers... hills k/d diet, aluminum hydroxide, Denamarin, Azodyl, fish oil.  I have co q 10 and green tripe ordered.  I guess I will find out at the follow up in 2 weeks.
Hi. As previously stated ... you need more test results ... serum phosphorus, sodium, potassium, calcium at the very least. Without knowing these, you cannot hope to correct any imbalance, and therefore things like muscle tremor and weakness will get worse. I would also check RBC, amylase and WBC.

You have some good supplements for kidney disease there ... but does the fish oil have Vit E included (check ingredients). If not, it needs to be given, as some fish oils deplete this essential vitamin in the canine body.

Whether SubQs will have a positive effect is not an answer I can give. Basically, IV fluids are fast acting and more aggressive, which is why it usually has a good and quick effect. But you cannot keep giving IV fluids, because it then starts interfering with other organs and systems. SubQs are milder in their actions (and therefore take longer to work), but very useful as a continuing therapy. If sodium levels are either normal or high in blood test results, the fluid type should be Lactated Ringer (worth checking).

Tony
Thanks for the information, Tony! It turns out her intervertebral disc disorder is acting up again....thus losing control of the hind legs and muscle spasms.  This would be round 3 with that problem.

She's going back for bloodwork next week. I'm hoping the sub q fluids are maintaining her, since she only went 3 days post IV fluids before she started becoming lethargic again.

Her liver enzymes actually increased between the first round of IV fluids and second round of IV fluids. The vets wanted to perform an ultrasound to look for a liver tumor, but I wouldn't put her through surgery at this point....so no point in extra tests.
Hi. A tumour does sound like a real possibility and I do understand your reasons for not putting her through surgery. Please post the blood results when you get them. They may suggest something in the diet or medication regime that can be tweaked to make her feel more comfortable.

Tony
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