Dog Reanl Failure, Where to go from here?????

[ADoubrava]

I have a 6yr old male Shar-Pei.  Took him to the Vet today to have him checked due to throwing up for about a week stright.  I got the shock of my life when I was told he was in renal failure.  His BUN was 135 and there were 2 other levels that were very high, but to be honest I stopped hearing after he said renal failure.  My vet told me to push fluids through him tonight, and see if he urniates (which he did) and see if we can re-stimultie his kidneys. He also told me that if we could not get his kidneys re-stimulated and him holding down food and water that he probbly only has about 2 weeks left.  I am crushed!!  Just wondering where we should go from here? Is there Hope?  Whats next?  I have read alot on Azodyl supplement, any opions on that?  I dont want to loose my baby but I dont want to make him suffer either!

[ADoubrava]

I did ask for a copy of the lab work and will post that soon.  I have been pushing fluids through him all night, the vet recommanded pedilyte and/or gaterade and of course water.  I am going to go get some of the fluid that goes under the skin from my vet today. He has went to the bathroom twice since 930 last night, and this morning woke up hungery, so I feed him.  Where can I find some homemade reciepes or recommandations for what to feed him?  Thank you for all the information.  Angel

[Dr. Carol Osborne, DVM]

I am sorry to hear about your dogs kidney failure and glad to help you. There is hope!

If you are able to get copies and post your dogs actual blood and urine results that would help me to offer you specific kidney therapy recommendations.

Fluid therapy is the single most important factor in the treatment of kidney disease.  The kidneys normally function to maintain fluid levels by concentrating the urine.  With kidney disease, excess fluids are lost into the urine so dehydration is a major problem.  

Good nutrition is also critical.  The goal is to decrease the workload on the kidneys by decreasing the amount of waste the kidneys must eliminate.  Excess dietary protein, phosphorus, calcium and salt create a lot of waste. Pet diets should therefore contain small amounts of high-quality proteins, low salt (use salt substitute), and minimal phosphorus.

Home made diets are ideal and can be tailored specifically for each pet.
The most important parameter with respect to dietary protein is quality rather than quantity or an absolute amount of protein. For example human dialysis patients eat eggs. Why? … Each egg contains 7 grams of pure protein on which the kidneys do not work at all to utilize.  

Anemia or a low number of red blood cells is usually present in pets with Kidney Disease.  Supplementing your dog or cats diet with B-vitamins and iron stimulates red blood cell production, which helps to counteract anemia. Vitamin B12 injections are also helpful.

Today kidney therapy may include Calcitriol, which is a natural form of vitamin D and is compounded specifically for each pet.  Capsules are given by mouth once daily.  Calcitriol helps prevent further kidney deterioration, regenerates the kidneys and helps restore normal function. It was given routinely to human dialysis patients.

In pets, Calcitriol is only effective when the value of the blood calcium multiplied by the blood phosphorus level is less than 40. After over 15 years, of successful international clinical trials, Calcitriol is still considered experimental in pets.  So far the results have been excellent for both dogs and cats.  

Kidney transplants are a treatment option in extreme cases, and are available at a few veterinary facilities in the US. The College of Veterinary Medicine, in Davis, California has a top notch Kidney Transplant and pet dialysis facility.

Long-term management involves monitoring kidney functions with blood and urine tests every three to six months.  At home hydration can be monitored by pinching the skin on the back of the dog’s neck.  Hold it for five seconds, then release.  If it takes over five seconds for the skin to return to normal, your pet is dehydrated and fluids are indicated.  

Pet owners may learn to give daily subcutaneous fluids, which are given under the skin at home.  

Aluminum hydroxide, which is available through veterinary compounding pharmacies and veterinarians (rather than Epikacin) is currently the agent of choice to bind and remove excess blood phosphorus in dogs with kidney failure. Ideally canine blood phosphorus levels should be 4.0 and at that time if the sum of the blood Calcium multiplied by the blood Phosphorus is less than 40, Calcitriol may be instituted.

Azodyl offers "friendly bacteria" called probiotics, such as those in the yogurt TV commercial called "Activia", that promote a pets digestive tract to absorb digested dietary nutrients. Azodyl itself contains nothing to specifically promote or enhance kidney health as kidneys are normally sterile and do not contain bacteria.

If a pets kidneys did contain bacteria, then the pet would be quite ill and have a kidney disease called Nephritis.

Many over the counter probiotic supplements are available online and at retail that provide   broad spectrum "friendly bacteria", and are cost effective alternatives.

I am glad to help further, please feel free to contact our office.

Best Wishes,
Dr Carol Osborne, DVM

[ckoeppel1]

Dr. Osborne, I had to put my 10 year old Yorkie down two weeks ago. She had a lot of health issues but was stable with all her medications. She had an enlarged heart, a heart murmur, an enlarged liver, congestive heart failure, IVDD, malignant mass cell tumors, and malignant cells in her blood. She was taking 12.5mg of furosemide every twelve hours, 5 mg enalapril, 5 mg Vetmedin, Palladia twice weekly, 1.8 mg liquid gabepentin, rimadyl as needed, Pepcid AC as needed.

Ruby was taking Palladia three times a week until her kidney values began to increase. The oncologist cut her back to twice weekly. I noticed she was refusing food and wasn't drinking water about a week before she passed. I put a few soup crackers in her food to get her to eat and was putting her meds in a small amount of cheese. I knew not to do this because she had pancreatitis three times before. Her food was canned prescription ID but she wouldn't eat it. I also injected her gabepentin in her food so she would take it. Since she wasn't eating I tried injecting it in her mouth but she would throw it up right after.

I took her to the vet on 8/8/2016. Before going she took Palladia and 0.5mg of Pepcid AC and ate some boiled chicken with a little water. I wanted to have a test done to see if she had pancreatitis. I also asked the vet to check kidney values. Her snap test was mildly positive but her other values were as below:

CBC - HCT 32.1, eosinopenia 60 - mild anemia
Chem - BUN >> 130, Unable to read Creatinine, Phos >>16.1, hyponatremia 132

I was told she was in stage 4 kidney failure and instructed to consider euthanizing. They gave her 0.2ml of bupronex and subcutaneous fluids. We went home and Ruby was very out of it until about 3:00 pm. I had been up with her the night before and was very tired. I laid down on our bed and fell asleep. My husband put her on the bed with me and normally she would have never jumped off but the drugs made her unaware and she did jump. We have a tall bed too. She sat on my lap all evening and didn't want to do much. During the night she had diahrrhea.

The next morning which was Tuesday she was more alert but wouldn't eat and just laid in her bed. I carried her out to pee and she went and walked around the yard. Her behavior stayed the same all evening. I slept on the floor with her that night and she woke me with a loud thud. I believe she got up and collapsed.

The next morning she didn't want to get out of bed and went pee but wanted back in as soon as she was done. She laid in her bed all day and I laid on the floor by her. Early afternoon I carried her outside and noticed she stood like a Halloween cat and wouldn't move. I gave her water through a syringe trying to get fluids in her. I noticed her appearance was a little more rugged and when I took her outside her back end was wobbly and her right front paw rolled under. She wouldn't move. By 3:00 pm she started going down hill. Her nose became very dry, her tongue was sticking out, and her ears were shaking a bit. Keep in mind I was unable to give her gabepentin for her back pain or IVDD for three days. That evening we took her to the vet. Her lip was dropping, her tongue was out, and she looked at me with only a stare. The vet believes she had a stroke.

We euthanized her as a family and it was extremely painful for all of us.

My questions are these:

1) The vet said she was in kidney failure which caused all her symptoms. However she wasn't throwing up, urinated normal, just wasn't eating or drinking which I assumed was from the pancreatitis. The night before she passed she sat on the porch with us looking for bugs. Could her kidneys fail that fast causing the symptoms I described? And looking at her values do you believe she was in kidney failure?

2) I am suffering and grieving with guilt for not giving her gabepentin. Could the jump off the bed made her IVDD worse and threw her into terrible pain since no pain meds were administered? Could the symptoms described be from her IVDD and possible disc damage? Also could the stroke have been a spinal stroke or from high blood pressure from intense pain?

I hope you can help because I know her kidney values were high but I also know dehydration and medications can elevate kidney values. I am struggling with putting her down. Was it really kidney failure or was it her back? Either way she couldn't get fluids because of her heart or surgery on her back if it was hurt for the same reason.

I know I gave Ruby a gift by putting her at peace. I am an analytical person and I need to know what was the straw that broke the camels back. The oncologist said her increased kidney values could have been from the combination of drugs, the five doses of rimadyl, or toxicity from Palladia. Her US showed that her heart was smaller, her tumors hadn't grown and she only had one single malignant cell on her Buffy test.

Can you please help me understand. I believe if I hear an outside perspective I may be able to move on with peace. Until then I don't think so.

Thank you,

Cindy