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Need advice: 5-year old dog with kidney failure - BUN level over 180

Hi,

My dog looked sick, not eating at a quarantine place and was rushed to a vet. The vet advised us that he may have chronic kidney failure - we were devastated, and still are....

He is a mongrel and has lost about 3kgs since the diagnosis, he now weighs 12.5kgs.

After 3 days of IV, his test results did not improve significantly. He looked a lot more active though and happily ate the food we brought him.

Initial results:
BUN: > 180 (unreadable by machine)
CA: 9.8
PHOS: 19.8
CRE: 7.3
GLU: 6.2
WBC: 6.52
RBC: 4.75
HGB: 9.8 g/dl
HCT: 32.13%
PLT: 179

Results after 3 days of IV:
BUN: 179
CA: 10.3
PHOS: 10.2
CRE: 6.3
GLU: 5.1
WBC: 10.06
RBC: 4.04
HGB: 8.7 g/dl
HCT: 27.75%
PLT: 111

He was put on another 2 days of IV during hospitalisation stint and due to mounting costs, we decided to take him home. We were given a bunch of supplements/meds (both Western and Chinese) and are told to give 250ml subQ fluid, twice a day.

Western meds/supps (for around a week)
- doxycycline, SAMe, ketosteril, lactogel, food powder (renal N), phosphate binder, ranitdine, virbac

Traditional Chinese meds:
- renal activator and liu wei di huang tang (kidney support)

First night at home, he ate and drank well. Even went out for a walk, he looked so happy! But today.. he looks very quiet, again. He is still eating and drinking (less than usual) and is able to hold food down. We are planning to run another test in a couple of days.

I've read online that many consider euthanasia with BUN level this high. But we can't just part with him yet, he is very young. How long should we expect him to live? What else can we do?

Thanks everyone.
4 Responses
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1916673 tn?1420233270
Sorry, I didn't respond on the fluid therapy question because I would need an accurate CURRENT weight.

Tony
Helpful - 0
1916673 tn?1420233270
Hi Sarah. I have to say I am a little concerned about your response. Dealing with the anemia is very important, otherwise it will continue to decline. Because the kidneys are damaged, it cannot produce EPO, which causes the anemia (by failing to produce new red blood cells in the bone marrow). If treatment is not given, anemia will ultimately prove fatal. Giving white tripe also stresses the kidneys, because the bleach residues have to be dealt with by these organs - and as they are already compromised, the residues will cause increasing toxins to circulate in blood. I am pleased you have changed to chicken thigh meat. You mention fish oils ... ordinarily these are good, but only if they are not cod oil, as that can harm kidney dogs. Fish oil is a good provider of omega-3 fatty acids, which help as an anti-inflammatory. The best source of omega-3 is contained in pure organic salmon oil. If you are giving fish oil, or start giving salmon oil in preference, please also note it is important to also give Vitamin E (canine formulated), because this vitamin is depleted when salmon oil is given as a supplement. Some products combine both a suitable omega-3 fish oil and vitamin E, but you should always check the label to ensure it does. Go easy on the walking trips. Dogs with kidney disease need moderate but not excessive exercise. You could liken this to a human that has been taken to hospital for kidney failure ... they may want to run, but the doctors would not permit it, because their bodies need the energy to fight the illness. If the binder is aluminium hydroxide, that's good, but clearly the dose is wrong because it isn't dealing with the problem. Can you let me know the weight of your dog and how much aluminium hydroxide you are giving.

Tony
Helpful - 0
1916673 tn?1420233270
Hi. Quite a few things to talk about ... but priorities first ... anemia is very common in kidney disease dogs. Your dog's HCT is below 20% which means it is quite severe. It also means it is probably suitable for EPO (erythropoietin treatment). If you go to my website at www.tonyboothwriter.com and look at my articles, you will find one on canine anemia. Please read it. This will explain what is happening to your dog - and more importantly, the treatment that is needed. Once you have read the article, talk to your vet (please don't leave this too long). When you mention tripe in the diet, I assume this is GREEN tripe. White tripe is only suitable for humans (it is bleached to make it white and the bleach is toxic to dogs). Minced beef is okay, but chicken would be better. Beef is quite rich in two things ... fat and phosphorous. Fat can cause pancreatitis to occur in kidney dogs. Phosphorous is always a bad thing for kidney dogs, although it can't be completely avoided. Chicken thighs are the lowest in phosphorous (all dark chicken meat is lower). If you do feed chicken, it MUST be human-grade, because chicken intended for dogs is low-quality and causes even more kidney stress. Phosphorous (blood test result) is still too high - what binder are you using? Creatinine is also still too high and hopefully the fluids will eventually bring that down. You mention giving 250ml daily. What weight is your dog (I can then check that dose for you to ensure it's adequate). Azodyl or ketosteril? I am quite unfamiliar with Ketosteril, so I would take your vet's advice on that one. Tony
Helpful - 0
1 Comments
Hi Tony,

Sorry for the delayed response.

Yes we heard about EPO injections - it is quite expensive where we live and we heard some potential side effects :( not sure if we want to take the risk since our dog looks better these days. He is eating 3 times daily, walking trips 3-4 times daily (incl 1-hour long walk at night), no diarrhea and good amount of urine passing.

We gave our dog white tripe as green variety was not available. Noted and we have changed his diet to chicken thighs (human grade) instead.

New items on his diet: kelp, hawthorn berries and fish oils. We will be doing another blood test in the next few days - fingers crossed!

Think the phosphate binder  we were given is aluminium...

Our dog used to be 12.5kg (after hospital discharge 1 month ago) and is slowly gaining weight. Since he's drinking so well, we have dropped subq from 500 to 250ml daily. Is this fine?

Thanks Tony.

Cheers,
Sarah
1916673 tn?1420233270
Hello. It is impossible to say how long your dog will live with this disease. It is extremely unpredictable. I have known dogs live just a few days - and others that have survived for years. You and your vet seem to be offering good management. Daily SubQs are worthwhile and help maintain the improvements already gained from IV fluids. In terms of diet, it is absolutely essential to keep to a low phosphorous and low sodium diet. As the kidneys cannot easily process protein, it is also important to offer ONLY high-quality (human grade) meat and poultry - and to give approximately 20% protein in every meal. More will cause stress on the kidneys, and less will cause malnutrition. Specialised kidney specific dog food ordinarily contains high-quality proteins, but always check with the manufacturer to be certain of it. It is also beneficial to feed less but more often, so small meals every 3 or 4 hours, as that helps relieve stress on the kidneys too. Hopefully the next round of bloodwork will be good news. Did your vet check blood pressure? I ask because 90% of dogs with kidney disease also have high blood pressure, and that can adversely impact on the disease. Hoping your dog rallies on this management plan. Tony
Helpful - 0
1 Comments
Hi Tony,

Thanks for your insights. We went to a different vet (closer to home, let's call her Vet B) for another round of blood test, 8 days after he was first diagnosed with CKD). Unfortunately the blood work got worse and the machine isn't as sensitive as the one in the first vet's place.
Result is as follows..

Initial results -> 21/03/18 (Vet A)
Results after 3 days of IV -> 24/03/18 (Vet A)

Results after additional 2 days of IV + daily SubQ -> 29/03/2018 (Vet B, no additional meds prescribed)
BUN: >130 (unreadable by machine)
PHOS: 9.9
CRE: 7.1
WBC: 6.92
RBC: 2.91
HGB: 6.8 g/dl
HCT: 18.7%
PLT: 165

Blood pressure -> 29/03/2018:
1st reading: 160/89  (114)
2nd reading: 201/106  (137)
3rd reading: 163/89  (109)
4th reading:146/75   (101)
5th reading: 155/79 (106)

The vet ruled out his high blood pressure due to stress and kidney disease nature. What can we do to lower his blood pressure?

Since then, we switched to home cooked food: we have been feeding him about 25% protein based on online recipe/. We'll lower it down to 20% starting tomorrow. His meals/snacks consists combo of:
- White rice (he wouldn't touch glutinous rice)
- Minced Beef
- Broth (from boiled beef)
- Tripe
- Egg whites
- Cabbage
- Carrots
- Blueberries
- Some banana
- No salt added

His appetite is crazy high these days, he can't seem to have enough food and he's gained some weight slowly. We'll keep an eye on his food intake and give him smaller meals as per your recommendation! His diarrhea has improved, he's had some solid stools the past few days :) Energy level is definitely getting better, he doesn't listen to us much anymore during walks and tends to pull.....

SubQ -> we tried to give 500ml at one go (busy with work) and he vomited a lil of food 4 hour later. We are giving him only 250ml daily now, seeing as how he is eating and drinking well. No vomiting so far.  Are we doing it right?

Azodyl or ketosteril -> should we continue this? our dog was prescribed ketosteril only for a week by Vet A..

Chinese meds, virbac nutriplus gel and phosphate binder -> the only medicines our dog is taking now.

The other thing that we're concerned about is his anemia.. the RBC seems to be dropping by the week. His breathing rate is normal during rest, but quite fast after walking trip. How many mins of exercise daily do you recommend, since he's anemic?

We will be going to Vet A (with more sensitive lab machine) in less than 2 weeks time for a follow up check. Hope for a positive outcome :)

Cheers,
Sarah
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