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Advice on food to feed dog with renal failure

Hi there, Jabu is an 11 year old English bull terrier and was diagnosed with stage 3 kidney disease last month. We're still reeling. Ours is the common story, went for a routine check up, my vet wanted to test his thyroid, wasn't happy with the blood, tested for liver and finally kidneys....  He immediately went on a drip for 3 days. And he was on one last week as well for two days. Test results as follows: Creatinine 513 umol/l, BUN 33, SDNA 25 ug/dl, Single U Pr:Cr 0.86. I have him on the Hill's kd (which he hardly eats) The vet prescribed:  metaclopramide 10 mg 1.5 tablets twice daily, Ranitidine 75mg twice daily and Amphogel 15ml 3 times a day. My problem at the moment is that he's hardly keeping any food down. Any advice?
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1916673 tn?1420233270
Hello. Your vet seems to be doing all the right things. The metaclopramide and Ranitidine are  to deal with nausea and vomiting. This is only one option for this symptom, so if it doesn't seem to be working after a few days, let me know and I'll suggest alternatives.

The Amphogel is basically aluminium hydroxide, a phosphate binding medication that aims to reduce dangerously high levels of phosphorous in the blood.

Did your vet get you to do SubQ fluids after they completed the course of IV fluids? I'm assuming not, but this is necessary to maintain the work done by the IVs. Talk to your vet straight away and ask to start SubQ fluids at home - they will need to teach you how to do it and provide you with the fluids (Lactated Ringer Solution). You should continue with SubQ fluids daily for the next month (at least), having bloods taken every 2 weeks to see what impact the fluids are having on creatinine and other values.

Getting your dog to eat may take a while longer. You can try enticing him with a few tricks ... a teaspoon drizzle of natural honey on the top of the kd food sometimes works, as does a desertspoon of chopped cooked green cabbage, or all natural (unflavoured and unsweetened) yogurt. If these fail, get your vet to prescribe Mirtzapine.

Did your vet take his blood pressure. 90% of dogs with kidney disease also have high blood pressure, and it always seriously and adversely impacts on kidney function. If they didn't take his blood pressure, this is an urgent priority.

I am giving you links to two of my articles on Diet and canine kidney disease, which I would urge you to read.

http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease

http://www.infobarrel.com/Changing_Diet_During_Canine_Kidney_Disease

Hope this helps.

Tony
Helpful - 1
2 Comments
Hi Tony, thanks for getting back to me. I really do appreciate it. A lot.

I read both your articles and will now look for a butcher that might supply me with some green tribe.

Went back to the vet with Jabu yesterday, as he continued to vomit. She gave him a Stemetil injection and put him on another drip.

The reason why she has not given him SubQ fluids is because he does not have enough loose skin. Also he is quite a big boy(he was 30kg last week - now 28.5kg), so he would need a lot of it to actually make a difference.

After the injection, he managed to keep down supper. I gave him the  metaclopramide again, but he vomited 3 times today, so that is obviously not working.

My vet prescribed Ondansetron. Our pharmacy only had 4mg and not the 8mg, so they gave me 12 pills to try first. I plan to give him that tonight and tomorrow, to see if there's any difference.

He's had the Mirtzapine (2 tablets) last weekend, but I could not see any difference in his vomiting.

We took the phosphate binder away for the weekend, to see if that might not be the problem. So far, I doubt it very much, as I've seen no change.

I went to a veterinary referral clinic to have his blood pressure measured. It is normal 134mmHg systolic cuff 5 RF. He is only mildly anaemic. (37-55)

Tonight he's refusing to eat. I pretty much think it is as your article says - he now associates the food with feeling bad.

Do you have any other suggestions as to feeding him. I'm going to get him some Royal Canine on Sunday (no one stocks it in our town, so needed to find a lift for it) and maybe that will make a small difference?

Do you think I should try the Mirtzapine again. My vet is a little concerned that it is not fit for long term use?

Thanks again.

Regards

Nici
Hi. Sorry he still isn't eating well. This is very much an up-and-down journey, and sometimes things don't work for all dogs with this disease.

Yes, I would get him back on Mirtazipine ... one dose is not going to do anything at all. It needs to be a daily dose. There can be long term effects, your vet is right about that, so once he starts eating again it can be withdrawn slowly by tapering off.

In all the years of dealing with cases of canine kidney disease, I have never heard of a dog "not having enough loose skin" for SubQ fluids. ????

Personally, I would be doing SubQ fluids, regardless. It may be the only way of getting the numbers down - and get the numbers down and your dog will start eating better. It's the toxins in the blood and digestive tract that are causing the nausea.

Ondasteron (Zofran) is a fairly good anti-emetic for dogs. It should stop any vomiting within 10hrs. However, be aware of the side effects and refer back to your vet if any seem to be starting. There is also a danger of some adverse liver effects with this drug, so I would use Milk Thistle as a supplement to help protect the liver while he is on it.

Don't stop using the phosphate binder. High phosphorous will adversely damage the kidneys even more, so getting this under control is crucial.

Once you start him back on Mirtazipine, I would add Cerenia as well. These two drugs work together to solve nausea in dogs.

Hope some of this helps.

Tony
1916673 tn?1420233270
How does she know there's only 15% kidney function remaining? Has your dog had a scan? This would be the only true way of determining this.

I honestly feel your vet is talking nonsense about SubQ fluids. IV fluids are expensive (maybe the reason she's happy to do it for you). And IVs are more extreme, so they are meant to kick-start a fall in creatinine levels, but SubQs are then needed to maintain the treatment. I can only repeat that there is absolutely no reason you cannot undertake SubQ fluids at home, with veterinary support, as this would be far less stressful for your pup. This is very common practice in the UK, USA, and many other countries - so not sure why your vet is being so obstructive.

You don't need a prescription for Milk Thistle. It's a herbal supplement you can get easily at health stores - or just Google it and see if you can get it supplied by mail.

It's worth asking your local pharmacies about cerenia and whether they can compound it and/or supply it for your dog. If not, then as long as there's not a long wait, you may just have to hold on till your vet gets it.

Mirtazipine should be given in a low dose every day - not just every now and then. SubQ fluids are the same - every day - and to the right dose for the weight of your dog. You should not be giving IV fluids yourself, as it is more intense and things can go wrong very easily when you are injecting straight into the bloodstream.

I would tend to consider trying for a 2nd opinion from another vet. You don't have to leave the one you are with, just get a 2nd opinion. Another vet may be more amenable and more proactive.

Tony
Helpful - 0
Avatar universal
Hi. So I went back to the vet this morning to discuss Jabu and what we can and should do.

She's gave me a subscription for Mirtazipine and another for Ondasteron. Cerenia is not available at the moment from their supplier. I don't know if its just in the Eastern Cape or the whole of South Africa. Do you think I should phone a few pharmacies or maybe the manufacturer. The vet did ask for a some as soon as it becomes available. Is there anything else I could ask for?

My vet is also still not budging on the SubQ fluids. She is more than happy to place him on an IV as many times as he needs it, though. I also think I would be able to convince her to let me administer the IV at home if I have to. She says to just bring him in whenever he looks like he might need it. Does he still need SubQ if he is getting a drip? She says no, I just want to double check.

I forgot to ask about the milk thistle. I'll phone and find out if they can give me a prescription or if I can just pick it up somewhere.

She suggested I increase the doses of Ondasteron and will be ordering the injection for me, if he continues to vomit even with the higher dose. She said to give him the Mirtazipine when he looks "off". Or over a weekend when I can't take him for a drip etc.

My vet said she suspects Jabu only has about 15% of his kidney function. She is a great vet, but I'm a little concerned that she might have already given up on him. I'm hoping he'll be around for a while longer.

Thanks so much for all the advice. I really, really appreciate it.

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