Further blood work before IV fluids?

[MaLiPutzMom]

Hi, my 6-year-old Shar Pei was just diagnosed with advanced kidney failure with a creatinine of 11.2 and BUN registering off the chart on their limited chem panel.  Phosphorus was not run, nor was blood pressure assessed.  I suspect this is a chronic condition, as subtle signs have been present for some time now.  She has a current ear infection and has been under a bit more stress the past month or so due to a recent addition to our dog pack of now 3, but all of them get along well.  Should I pursue more extensive blood work prior to IV fluid infusion?  She would find this very stressful, and I'd hate to put her through it if likely to be futile.  The vet feels she only has a few weeks left.  I want to make her final time as comfortable as possible, but she's so young for all this!  I am unable to spend a fortune to keep her well, but willing to try if her comfort and lifespan could be significantly improved.  Would K/D diet be beneficial?  She is refusing dog food at this point but will take cooked chicken.  Thank you in advance for any advice.  

[tonyb286]

Unless you have the additional testing done, the BP check, the fluid therapy, and the Lepto test ... it is impossible to say what might be feasible in terms of both longevity of life and quality of life. Kidney disease is different for every dog - and so much depends on what stage your dog is at and how much damage may have been caused to the kidney tissues.

In many cases, dogs can be having an acute episode (rather than something that is chronic) and early treatment can restore good health. However, when it has developed into a chronic condition, it is more certain that the disease will become progressive and deteriorate over time. How much time? That's the hard thing to answer. Sometimes no more than weeks, sometimes months, more often a year or so if caught early and with good diet control and management, and occasionally even several years.

If WBC is abnormally high in urine test, then that indicates infection. However, your vet needs to determine what type of infection BEFORE giving any antibiotics. This is why I suggested the Lepto test (which is frankly the most urgent). Once antibiotics start, it will seriously affect the results of the test. If the Lepto test proves negative (hopefully), then the urine needs to be Culture & Sensitivity (C&S) tested, as this will identify the type of bacterial infection and (importantly) tell the vet the best antibiotic to use to treat it. Many vets give a generic antibiotic - and that is the worst thing they can do, because the infection may not be cured with it. It is equally important to give a longer course of antibiotics with kidney failure (minimum of 21 days), and then re-test with a C&S.

Hope this helps.

Tony

[MaLiPutzMom]

Hi Tony,
Thank you for your response.  My biggest question is whether putting her through the stress of treatment is feasible and likely to yield results with levels this high. She's pretty sensitive, so spending time away from home would be traumatic.  Administering SQ fluids would be very difficult for me, as I'm needle squeamish.  She is lethargic and has lost a considerable amount of weight.  Today she refused chicken but ate about a half can of K/D.  Her breath is strongly uremic, so the vet immediately knew what was happening.  I actually noticed this months ago but didn't understand what it meant.  Her urine came back fairly normal except for some WBCs.  I will discuss additional blood work, BP and IV ringers with the vet Monday.  He is very knowledgable and well respected but didn't seem to feel there is much that can be done.  Acute external causes are unlikely where we live in Wisconsin, USA.  She has had  a few unexplained fever episodes throughout her life without joint swelling and was not diagnosed with Shar-pei fever.  I'll keep you updated. Thanks so much for your help!
Jana

[tonyb286]

Hi. This is very young to have chronic kidney failure, though not unheard of. More bloodwork and a full urinalysis are absolutely essential. Phosphorous is one of the key blood test/diagnostic references, so this really needs doing. At the same time, you could have other tests run alongside, including WBC, RBC, amylase, potassium, calcium, sodium ... if these are not included on the prior test. Please post any results you have so I can assess them.

Has the vet given any indication of a) what type of kidney disease it is; and b) how it may have developed?

It is also vital that blood pressure is checked. 90% of dogs with kidney failure have high blood pressure, and it can be fatal as it progresses the kidney disease dramatically. Treating high blood pressure is therefore crucial.

Has the vet checked for Lepto and other tick borne diseases? These commonly inflict kidney disease in younger dogs.

Yes, IV fluids (with lactated ringer solution) is definitely something I would do. This will be primary to getting the creatinine down. After 2 to 3 days of IV fluids, you can continue with SubQ fluids at home - get the vet to teach you how to do this (or ask and I will help support you with it).

I would start with a kd specific diet. This can always be amended later, once more results are obtained. I would use something like Hills kd canned food. In addition, you could start supplementing with pure organic salmon oil + a canine formulated vitamin E capsule daily. It would also help to give a desertspoon of chopped green cabbage every 3rd day, mixed into the food.

While talking about food ... if possible, feed less more often - up to 6 times a day, so the total amount equals the normal amount for the breed of dog. These small meals remove some of the stress on the kidneys, which have to deal with all the by-products and toxins produced through digestion.

I am giving you a link to one of my articles. Please have a read.

http://www.infobarrel.com/My_10-Point_Plan_for_Dogs_with_Kidney_Failure

Tony