Graham has Kidney Failure AND Cushings

[BettyGraham]

Hi Tony, thank you for running this group. I hope it is alright if I jump right in with a question, but after receiving my dog's latest blood results I am very worried. I have posted some of his results, they are in the English system, I'm sorry I didn't convert them to what is used in the US.

My 16 year old dog Graham was diagnosed with kidney failure three years ago, and with Cushings in June this year.
He is having Fortekor 2.5mg for the kidneys and started 10mg Vetoryl for the Cushings, under close observation because it is not recommended for dogs with kidney failure.  He became unwell after 6 weeks on it and I stopped it immediately.  He is currently not being treated for the Cushings disease.

He had a blood test this week - Urea  (33.2mmol/L) Creatinine (201.0 umol/L) Cholesterol (13.06  mmol/L) Potassium (6.27 mmol/L) Inorganic Phosphorus (2.38 mmol/L) All of these are increased since his last test two months ago.

He also had an ACTH - pre 95.2 nmol/L and post 596 mol/L  

He seems well in himself and has a reasonable appetite, His Cushings symptoms seem to have almost disappeared although some days he drinks a little more water than normal, but not the massive amounts he used to.

I am worried that by not treating the Cushings, it is making his kidney problem worse.  Could this be true? Or would it be even worse if the Cushings was treated?

I would be very grateful for any advice.

[tonyb286]

That's good Betty, although giving an antibiotic injection wouldn't have been something I would have allowed. Why? Because unless there's a certainty of infection, all it does is cause more stress on the kidneys (which have to try and remove the by-products and toxins created by this medication). Also, antibiotics are going to be needed at some stage to treat probably infections (particularly UTIs), and if they are used too much without good reason, they may not work when you really do need them.

This disease is a learning curve, isn't it.

Keep me informed how things go.

Tony

[BettyGraham]

Hi Tony,
After Graham ate the Encore on Sunday he didn't eat anything on Monday and was sick a few times.  I took him to the vet yesterday morning and while he couldn't find anything, he said that his stomach was very tense. He gave him an antibiotic injection and also one for the vomiting.  Graham seemed a bit better after we got home and after a good sleep he ate some boiled chicken leg and a little sweet potato. He has been his usual self today and had two very small meals of the chicken again. It was lovely to see him clear his plate. I have to take him back to the vet again this evening so he can check on how he is. I mentioned about the mirtazapine and he said he had used it before with good results and would consider it for Graham. He was reluctant to start him on it until his stomach was back to normal.

[tonyb286]

Hi Betty. You are very welcome. Coconut oil ... less than a teaspoon is all you need. Also, I know it's very tempting to let Graham eat everything and anything when he seems hungry and willing to eat, but large meals (as in a full tin of Encore chicken) could cause problems. If possible, feed very small amounts more often, say 4 to 6 times a day. This places less stress on the kidneys.

Also, talk to your vet about adding Mirtzapine. This is both an appetite stimulant and deals with nausea caused by the toxins.

Tony

[BettyGraham]

Thank you for that information about Fortekor. I suppose the next step would be for Graham to have his blood pressure taken, and urinalysis done?

Thank you for the information about food.  I have briefly looked at your website because it was getting late last night, but I will definitely try some of your recipes.  

His appetite was quite poor over the weekend.  He seems to be hungry but just sniffs his food and walks away.  He ate nothing all day yesterday but then I gave him a tin of Encore chicken and he ate all of it.  I do have some pure coconut oil at home and will try a little of that on top of his next meal.

Thank you so much for all the help and advice.

Betty

[BettyGraham]

Graham's latest urine test was on 16/9/15.

Creatinine 194 umol/L
Urine protein 150 g/l
Urine creatinine 2986 umol/L
Urine protein:Creatinine ratio 0.44

UP:C 0.2 - 0.5 are considered borderline proteinuric

[tonyb286]

I wanted to add this as a separate message, because it has a great deal of relevance. Fortekor is a good and useful medication in kidney failure - and also for blood pressure and cardiac problems - as it dilates the blood vessels, allowing more oxygenated blood to flow around the body and, importantly, through the kidneys.

However, it does have certain effects which may be relevant. It can LOWER blood pressure significantly, which is good if a dog is hypertensive (common in kd dogs), but when blood pressure is actually normal, it can lower it to become dangerously hypotensive. It's crucuial your vet keeps a regular and close eye on blood pressure for this reason alone.

Also, interestingly, it can raise potassium levels. As Graham has high potassium in his blood readings, this may well be part of the cause.

It can also have side effects that cause gastro-intestinal upset such as vomiting, diarrhea, lack of appetite and possibly weakness. These are also common in kd dogs, so it's a bit of a double whammy. While I am not suggesting the Fortekor is stopped, it does demand a little more cautious and careful monitoring by your vet.

While his appetite remains good, there's no need for adding an appetite stiumulant or anti-nausea medication. But if you think these symptoms are starting to creap in, let me know and I'll advise the best remedies for kd dogs.

Tony