Aa
Any idea what stage of renal failure my dog is experiencing?
My poor girl Zola has been lethargic and disinterested in her kibble off and on this month. Two nights ago I bought a bag of a different food to see if she would try it. I mixed it with some old food and she ate the whole bowl right away. That was around 6 pm. I work grave shift so I got home Saturday morning and took her out to potty. Her eyes were both covered by the lower eyelid membrane and she seemed disoriented, and confused. I helped her find her way back inside and tried to calm her down as she was trembling. When I checked her gums they were very pale. I've never seen this, so I rushed her off to the vet. She perked up some (she loves car rides) but had an accident there.VET diagnosed her with renal failure...
Creatine was supposed to be 1.8 and hers is 8.1. The BUN number was supposed to be under 29 and she's at a 90. I'm terrified. She has blood in herurine and the protein Is high. Vet gave her an IV catheter and sent her home with me to return in the morning.
At pickup She was prescribed Hills Prescription Diet k/d and some aluminum hydroxide gel to take with it to keep her phosphorous levels down. She hates the syringe of the gel, but ate the canned Hills with vigor so that was promising! She spent last night curled up on the couch with us. She enjoyed her new food again this morning and her stool was a better consistency.
At 9:00 AM today Zola returned to the vet for more IV fluids as planned. They re ran bloodwork and also checked her electrolyte levels to see where her numbers were.
She stayed at the vet all day receiving fluids. She threw up once and had a little diarrhea there. Her numbers haven't improved. She will return tomorrow for another round of fluids and tests. I am so worried and not ready to make any decisions. I know the vet is doing everything they can. Does anyone have advice?
Creatine was supposed to be 1.8 and hers is 8.1. The BUN number was supposed to be under 29 and she's at a 90. I'm terrified. She has blood in herurine and the protein Is high. Vet gave her an IV catheter and sent her home with me to return in the morning.
At pickup She was prescribed Hills Prescription Diet k/d and some aluminum hydroxide gel to take with it to keep her phosphorous levels down. She hates the syringe of the gel, but ate the canned Hills with vigor so that was promising! She spent last night curled up on the couch with us. She enjoyed her new food again this morning and her stool was a better consistency.
At 9:00 AM today Zola returned to the vet for more IV fluids as planned. They re ran bloodwork and also checked her electrolyte levels to see where her numbers were.
She stayed at the vet all day receiving fluids. She threw up once and had a little diarrhea there. Her numbers haven't improved. She will return tomorrow for another round of fluids and tests. I am so worried and not ready to make any decisions. I know the vet is doing everything they can. Does anyone have advice?
Hi. Yes, I am also on it too for very severe acid reflux and (being also Type 1 diabetic) it concerns me too, as the kidneys are likely to be adversely affected by it.It's something I have been meaning to go and get sorted with my doctor since I first read about it.
Anyway, on to Blood Readings ...
You already know that the prime indicators of how the kidneys are performing is related closely to BUN, creatinine and some of the electrolytes in the blood. These readings are still too high, but it is possible that suitable fluid therapy and good diet management may bring these down. Clearly the IV fluids have had a small impact. How long was she on IV fluids for? It remains extremely important that you continue after IV fluids to give SubQ fluids at home. Are you now doing this?
The phosphorus reading is too high and will be impacting on the kidney disease. This can be controlled by diet - but in later stages of kidney failure, diet alone will not solve the high phosphorus readings. It is now therefore important that your vet begins with a phosphorus binder and the one I would choose is Aluminium Hydroxide. This is safer, as it isn't calcium based. Although a specific and carefully controlled kidney diet (incl manufactured canned renal foods) will be low in phosphorus, it cannot be avoided, as it's in all foods. So, a binder invariably becomes essential for later stage kd dogs.
Sodium is too high. This is also lower in specific renal dog food, but it's also important to restrict it in any other foods or treats you may give. It is also in faucet water - so it would be better to give Zola bottled filtered water from now onwards.
Potassium is also too high. You should control this in the diet as much as possible.
PCV stands for packed cell volume, and refers to the number of red blood cells available. In Zola's case, this is a low reading, which means she is anaemic. Anaemia is not uncommon in kd dogs, but it can be a dangerous and harmful condition that needs support by the vet involved. Sometimes, the loss of red blood cells is due to poor production, other times it can be due to blood loss (including internal bleeding from things like stomach ulcers). It may be appropriate to do two things that might address the anaemia. One, start adding a small amount (no more than a desert spoon) of cooked chopped green cabbage to Zola's daily intake of food. And two, talk to your vet about the addition of an iron supplement to help promote red cell production.
The low albumin level is indicative of chronic kidney disease, but also potentially issues with the liver. It's commonly associated with protein loss and/or internal bleeding. In severe cases, which I think may have happened here, it causes edema (build up of tissue fluid). There are several potential treatments available, but one that can truly help is a short course of plasma which can be used to replace albumin and raise osmotic pressure.
I think your biggest concern here is the stage of kidney disease. Is it very severe - or is it only moderate? In very severe cases, there is often not enough kidney organ tissue remaining to prevent rapid deterioration, despite interventions, vet treatments and diet changes. Once kidney tissue is destroyed by the disease, it cannot regrow. But that said, dogs (like humans) can survive on one kidney (so even if both kidneys are 50% damaged, there is a good fighting chance of a decent quality of life for a good amount of time. Xrays and/or ultra-sound scans can determine the physical characteristics and condition of the kidneys. This may be something you want to consider, as it may give you an idea about onward treatment and management options - or suggest a time when hard decisions will have to be considered.
Okay. There's so much info in my last 3 messages that I'm sure you want to take some time to absorb it all - talk to your vet about certain things - and hopefully, revise your joint management plans for Zola. Come back and ask anything, if you have questions, or just come back and let me know how things are going.
Tony
Anyway, on to Blood Readings ...
You already know that the prime indicators of how the kidneys are performing is related closely to BUN, creatinine and some of the electrolytes in the blood. These readings are still too high, but it is possible that suitable fluid therapy and good diet management may bring these down. Clearly the IV fluids have had a small impact. How long was she on IV fluids for? It remains extremely important that you continue after IV fluids to give SubQ fluids at home. Are you now doing this?
The phosphorus reading is too high and will be impacting on the kidney disease. This can be controlled by diet - but in later stages of kidney failure, diet alone will not solve the high phosphorus readings. It is now therefore important that your vet begins with a phosphorus binder and the one I would choose is Aluminium Hydroxide. This is safer, as it isn't calcium based. Although a specific and carefully controlled kidney diet (incl manufactured canned renal foods) will be low in phosphorus, it cannot be avoided, as it's in all foods. So, a binder invariably becomes essential for later stage kd dogs.
Sodium is too high. This is also lower in specific renal dog food, but it's also important to restrict it in any other foods or treats you may give. It is also in faucet water - so it would be better to give Zola bottled filtered water from now onwards.
Potassium is also too high. You should control this in the diet as much as possible.
PCV stands for packed cell volume, and refers to the number of red blood cells available. In Zola's case, this is a low reading, which means she is anaemic. Anaemia is not uncommon in kd dogs, but it can be a dangerous and harmful condition that needs support by the vet involved. Sometimes, the loss of red blood cells is due to poor production, other times it can be due to blood loss (including internal bleeding from things like stomach ulcers). It may be appropriate to do two things that might address the anaemia. One, start adding a small amount (no more than a desert spoon) of cooked chopped green cabbage to Zola's daily intake of food. And two, talk to your vet about the addition of an iron supplement to help promote red cell production.
The low albumin level is indicative of chronic kidney disease, but also potentially issues with the liver. It's commonly associated with protein loss and/or internal bleeding. In severe cases, which I think may have happened here, it causes edema (build up of tissue fluid). There are several potential treatments available, but one that can truly help is a short course of plasma which can be used to replace albumin and raise osmotic pressure.
I think your biggest concern here is the stage of kidney disease. Is it very severe - or is it only moderate? In very severe cases, there is often not enough kidney organ tissue remaining to prevent rapid deterioration, despite interventions, vet treatments and diet changes. Once kidney tissue is destroyed by the disease, it cannot regrow. But that said, dogs (like humans) can survive on one kidney (so even if both kidneys are 50% damaged, there is a good fighting chance of a decent quality of life for a good amount of time. Xrays and/or ultra-sound scans can determine the physical characteristics and condition of the kidneys. This may be something you want to consider, as it may give you an idea about onward treatment and management options - or suggest a time when hard decisions will have to be considered.
Okay. There's so much info in my last 3 messages that I'm sure you want to take some time to absorb it all - talk to your vet about certain things - and hopefully, revise your joint management plans for Zola. Come back and ask anything, if you have questions, or just come back and let me know how things are going.
Tony
3 Comments
Thank you so much for your responses. Unfortunately Zola decided it was time. She hadn't eaten anything in two days and was even refusing water. We were carrying her in and out to potty. We had to make the heartbreaking decision to let her go. She died peacefully in our arms and for that I am thankful. I miss her so much already. She was my best friend, my everything.
ZolasMommy, I'm so sorry to hear this. Everything you did was in Zola's best interest, and Zola knew that. These first few days will be hard, so feel free to come back here if you need support.
Cheryl
Cheryl
I am so sorry for your loss. Sometimes, there just isn't enough time to intervene and it was possible that Zola's kidney failure had simply progressed too far. These are hard days - but try to remember the many years of happiness and love you provided her with. She isn't suffering anymore and is at peace. Run free Zola.
Tony x
Tony x
Thank you for your informative reply. She is on the mirtazapine, so perhaps I will back off on the omeprazole. That's slightly alarming to me as I myself take omeprazole and have a high liver reading.
Hi. I'm going to deal with the drugs being given first, as there are quite a lot and my reply will be long-winded and potentially overpowering, so it's best you can read it and absorb what's being said before moving on to other matters. I will then post again in a short while about the blood results.
Enalapril is an ACE inhibitor, my personal 2nd choice after Benazapril (I think Benazapril works better with kidney disease). Vets need to be cautious in using Enalapril, as uremia can get significantly worse if creatinine testing isn’t undertaken methodically during treatment. The best monitoring test in those situations is a 24 hours creatinine clearance test or another test that estimates the pet's GFR.
Minocycline is an antibiotic. It is commonly used in animals with decrease kidney function because it is extensively metabolized via the liver, and then primarily excreted as inactive metabolites in the faeces and urine. This is likely prescribed to treat any broad-spectrum bacteria. It may be wise to keep an eye on the liver function, because the liver will already be taking over some of the kidney functions and may be under stress. Adding some Milk Thistle as a supplement may help protect the liver against potential damage. This antibiotic should be given in a lower than normal dose and for a much longer than normal period – up to around a 3 week course – keeping an eye on blood values during and after this time.
Amiodipine is being used to treat the hypertension, but is more commonly given to cats than dogs. However, it is a calcium channel blocker and therefore should prove beneficial in bringing the high blood pressure down faster – but caution is needed, as blood pressure could fall too low quite quickly. Vets need to maintain regular blood pressure monitoring.
Pentoxyfylline has likely been prescribed to treat the gum and skin problems. It helps improve blood flow to these regions. It is contraindicated in patients with cerebral or retinal hemorrhage and should be used only with great caution in patients with severe liver or kidney problems, or bleeding disorders. Vets should monitor blood clotting time (PT), arterial blood pressure, and liver enzymes during treatment.
Omeprazole was considered the miracle drug for acid reflux, until very recently (January 2016). It is now been discovered that it can cause adverse health issues, particularly with the kidneys. proton pump inhibitors may be linked to long-term kidney damage, a new study suggests. Omeprazole, Prilosec, Nexium and Prevacid belong to this class of drugs, which treat heartburn and acid reflux by lowering the amount of acid produced by the stomach. It is still widely used. But I wouldn’t advise it in Zola’s case. A better alternative would be Mirtzapine, which would deal with any nausea, and may help stimulate appetite and better eating. It won’t however deal with acid reflux necessarily (which may indeed be the cause of some of the gum and oesophagus inflammation problems). Frequent vomiting may also have triggered and exacerbated this problem. I would hope your vet may spend a little time looking for a better alternative and at least use the “wait and see” technique to assess whether an ant-acid is needed after other treatments have kicked in.
This is a large amount of interactive drugs and they will all produce both good and bad effects. A good vet will therefore use some caution and maintain close supervision and regular assessment of the doses used and whether their continued use is useful. The point being that all drugs produce waste-products as part of the process, and the canine body needs to extract these waste products or they simply become toxic. In kidney disease, there is already a build-up of toxins in a dog’s body, and the means of extracting them (the kidneys) are already compromised. So, more drugs means more stress on the kidneys and more toxins, potentially. There is always a balance and a compromise to be made when considering these various treatments, and a good vet will continue to assess how many are needed and whether they are working and when to withdraw them as treatments.
Tony
Enalapril is an ACE inhibitor, my personal 2nd choice after Benazapril (I think Benazapril works better with kidney disease). Vets need to be cautious in using Enalapril, as uremia can get significantly worse if creatinine testing isn’t undertaken methodically during treatment. The best monitoring test in those situations is a 24 hours creatinine clearance test or another test that estimates the pet's GFR.
Minocycline is an antibiotic. It is commonly used in animals with decrease kidney function because it is extensively metabolized via the liver, and then primarily excreted as inactive metabolites in the faeces and urine. This is likely prescribed to treat any broad-spectrum bacteria. It may be wise to keep an eye on the liver function, because the liver will already be taking over some of the kidney functions and may be under stress. Adding some Milk Thistle as a supplement may help protect the liver against potential damage. This antibiotic should be given in a lower than normal dose and for a much longer than normal period – up to around a 3 week course – keeping an eye on blood values during and after this time.
Amiodipine is being used to treat the hypertension, but is more commonly given to cats than dogs. However, it is a calcium channel blocker and therefore should prove beneficial in bringing the high blood pressure down faster – but caution is needed, as blood pressure could fall too low quite quickly. Vets need to maintain regular blood pressure monitoring.
Pentoxyfylline has likely been prescribed to treat the gum and skin problems. It helps improve blood flow to these regions. It is contraindicated in patients with cerebral or retinal hemorrhage and should be used only with great caution in patients with severe liver or kidney problems, or bleeding disorders. Vets should monitor blood clotting time (PT), arterial blood pressure, and liver enzymes during treatment.
Omeprazole was considered the miracle drug for acid reflux, until very recently (January 2016). It is now been discovered that it can cause adverse health issues, particularly with the kidneys. proton pump inhibitors may be linked to long-term kidney damage, a new study suggests. Omeprazole, Prilosec, Nexium and Prevacid belong to this class of drugs, which treat heartburn and acid reflux by lowering the amount of acid produced by the stomach. It is still widely used. But I wouldn’t advise it in Zola’s case. A better alternative would be Mirtzapine, which would deal with any nausea, and may help stimulate appetite and better eating. It won’t however deal with acid reflux necessarily (which may indeed be the cause of some of the gum and oesophagus inflammation problems). Frequent vomiting may also have triggered and exacerbated this problem. I would hope your vet may spend a little time looking for a better alternative and at least use the “wait and see” technique to assess whether an ant-acid is needed after other treatments have kicked in.
This is a large amount of interactive drugs and they will all produce both good and bad effects. A good vet will therefore use some caution and maintain close supervision and regular assessment of the doses used and whether their continued use is useful. The point being that all drugs produce waste-products as part of the process, and the canine body needs to extract these waste products or they simply become toxic. In kidney disease, there is already a build-up of toxins in a dog’s body, and the means of extracting them (the kidneys) are already compromised. So, more drugs means more stress on the kidneys and more toxins, potentially. There is always a balance and a compromise to be made when considering these various treatments, and a good vet will continue to assess how many are needed and whether they are working and when to withdraw them as treatments.
Tony
1 Comments
Before I get on to talk about the blood results ... a word or two about Zola's tendency to spit out her tablets. I’m assuming you have tried putting her pills in some of her favourite food. Or hiding them in a pill-pocket. The link is really just to show you the different types of pill pockets widely available for dogs:
https://www.greenies.com/dogs/pill-pockets.aspx
If that doesn’t work, then you really have no option but to force them. This is an easy process once you get the hand of it, and it does require a firm and authoritative procedure. Remember, you are doing this to help Zola, so no hesitation.
This video link might be helpful to you:
https://youtu.be/Y3yHgItqGmo
Tony
https://www.greenies.com/dogs/pill-pockets.aspx
If that doesn’t work, then you really have no option but to force them. This is an easy process once you get the hand of it, and it does require a firm and authoritative procedure. Remember, you are doing this to help Zola, so no hesitation.
This video link might be helpful to you:
https://youtu.be/Y3yHgItqGmo
Tony
The first vet got these numbers also
ALKP:20U/L
ALT:22U/L
Ca:10mg/dL
CHOL:213mg/dL
TBIL:0.2mg/dL
TP:5.3g/dL
GLOB:3.4g/dL
ALKP:20U/L
ALT:22U/L
Ca:10mg/dL
CHOL:213mg/dL
TBIL:0.2mg/dL
TP:5.3g/dL
GLOB:3.4g/dL
She presented to the emergency vet 3/14 with neck and facial edema, petechia on her gums and abdomen. Her numbers improved there, but only marginally. She is not Addisonian. She came home last night, her edema is down significantly but she is disinterested in her k/d and knows how to spit up the pills so it's been difficult.
She is on enalapril 10mg/12hrs, minocycline 250mg/12hrs, amlodipine 5mg/24hrs, pentoxyfylline 200mg/12hrs, omeprazole 40mg/24hrs.
Yesterday's numbers:
BUN: 70mg/dL
Creatinine: 7.5mg/dL
BUN/creatinine:9
PHOS:12.8mg/dL
ALB:1.9 g/dL
Sodium: 160mmol/L
Potassium:7.0 mmol/L
Na/K:23
Chloride:122 mmol/L
PCV/TS:20%
ACTH STIMULATION: Cortisol sample 1: 3.2ug/dL
Cortisol sample 2: 8.9 ug/dL hyperadrenocorticism
She is on enalapril 10mg/12hrs, minocycline 250mg/12hrs, amlodipine 5mg/24hrs, pentoxyfylline 200mg/12hrs, omeprazole 40mg/24hrs.
Yesterday's numbers:
BUN: 70mg/dL
Creatinine: 7.5mg/dL
BUN/creatinine:9
PHOS:12.8mg/dL
ALB:1.9 g/dL
Sodium: 160mmol/L
Potassium:7.0 mmol/L
Na/K:23
Chloride:122 mmol/L
PCV/TS:20%
ACTH STIMULATION: Cortisol sample 1: 3.2ug/dL
Cortisol sample 2: 8.9 ug/dL hyperadrenocorticism
Hi. I'm assuming she is not on any blood pressure medication? That's a very important priority for your vet to deal with, because high blood pressure seriously and adversely prevents the kidneys (even when they are compromised) from doing their job. The best blood pressure medication for kidney failure dogs is Benazepril. Please encourage your vet to prescribe it and then check blood pressure each week to see if it has any effect. If it does not seem to be bring blood pressure down (or not enough), then a Calcium Channel Blocker should be added to the Benazepril.
Blood numbers needed include: Creatinine, BUN, phosphorus, calcium, potassium, sodium, and sodium potassium ratio if given. It is also useful to have RBC results (red blood cells), WBC (white blood cells), lipase and amylase. If your vet has access to it, he should run an SDMA test (Idexx Laboratories). There should also be urine testing results for specific gravity and protein leakage.
Tony
Blood numbers needed include: Creatinine, BUN, phosphorus, calcium, potassium, sodium, and sodium potassium ratio if given. It is also useful to have RBC results (red blood cells), WBC (white blood cells), lipase and amylase. If your vet has access to it, he should run an SDMA test (Idexx Laboratories). There should also be urine testing results for specific gravity and protein leakage.
Tony
Zola will be eight next month. She is a pit lab mix. Her blood pressure is currently 240 very high. I do have access to her blood records what numbers do you need?
Hello and welcome to our User Group, though sorry you feel the need to be here. Your vet has done all the right things so far. IV fluids are the key at the outset to getting those blood numbers down. It will take at the very least 4 days and possibly up to 7 days of IV fluids to make a significant difference. Sometimes, the numbers get worse during this time, before they get better. You just need to be consistent and patient.
Once the IV fluids are finished, you must then continue with SubQ fluids at home (you can do this yourself, after receiving some training from your vet). The fluids should be Lactated Ringer fluids, unless sodium blood values are below normal. You should then continue with SubQs for at least 2 or 3 weeks, with the dose advised by your vet and with regular blood level checking during this time.
I am a little saddened that you have been feeding kibble - which is the worst kind of dog food, despite what some vets, most manufacturers and all the advertising says. Think about it ... this is dehydrated food (similar to us eating cheese crackers). It has no water content at all. Over time, it causes dogs to become chronically dehydrated, and that can result in kidney failure along with many other problems. Dry dog food is full of chemicals and is less nutritional than most canned food. If you want to learn more ... read my article here: http://www.infobarrel.com/Why_Dry_Dog_Food_Is_Bad_For_Dogs
But now you have started on Hill kd canned, that's good, as it contains about 80% water and is low in protein and phosphorus. These are important when trying to get kidney disease under some control. Diet changes are the most important secondary management protocol after IV and SubQ fluids. Don't forget ... treats are also part of the daily food intake, and most will contain excessive amounts of bad things for caninine kidney disease. Another of my articles explains about diet for kd dogs here:
http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease
It is hard to say the stage your dog is at without access to the full blood and urinalysis reports. Ask your vet for copies (they can usually email them to you). There may be things in the reports that I can advise about, so make this a priority "to do" task.
What breed is your dog and how old is Zola?
Did your vet complete a blood pressure check on Zola?
That's probably enough for you to concentrate on right now. Come back with answers and ask any questions you may have.
Tony
Once the IV fluids are finished, you must then continue with SubQ fluids at home (you can do this yourself, after receiving some training from your vet). The fluids should be Lactated Ringer fluids, unless sodium blood values are below normal. You should then continue with SubQs for at least 2 or 3 weeks, with the dose advised by your vet and with regular blood level checking during this time.
I am a little saddened that you have been feeding kibble - which is the worst kind of dog food, despite what some vets, most manufacturers and all the advertising says. Think about it ... this is dehydrated food (similar to us eating cheese crackers). It has no water content at all. Over time, it causes dogs to become chronically dehydrated, and that can result in kidney failure along with many other problems. Dry dog food is full of chemicals and is less nutritional than most canned food. If you want to learn more ... read my article here: http://www.infobarrel.com/Why_Dry_Dog_Food_Is_Bad_For_Dogs
But now you have started on Hill kd canned, that's good, as it contains about 80% water and is low in protein and phosphorus. These are important when trying to get kidney disease under some control. Diet changes are the most important secondary management protocol after IV and SubQ fluids. Don't forget ... treats are also part of the daily food intake, and most will contain excessive amounts of bad things for caninine kidney disease. Another of my articles explains about diet for kd dogs here:
http://www.infobarrel.com/How_Diet_Affects_Dogs_with_Chronic_Kidney_Disease
It is hard to say the stage your dog is at without access to the full blood and urinalysis reports. Ask your vet for copies (they can usually email them to you). There may be things in the reports that I can advise about, so make this a priority "to do" task.
What breed is your dog and how old is Zola?
Did your vet complete a blood pressure check on Zola?
That's probably enough for you to concentrate on right now. Come back with answers and ask any questions you may have.
Tony
You must join this user group in order to participate in this discussion.
You are reading content posted in the Chronic Kidney Failure in Dogs Group
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
