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1623561 tn?1299944237

kidney disease uncovered by chf episode in dog

My sweet 14 year old Pomeranian had an episode of Congestive Heart Failure 2 weeks ago.  He was treated successfully and responded well to the Lasix, etc.  However, when he had his follow-up work a few days later, his kidney levels were bad - over 11 phosphorus, high BUN and creatinine.  We took him to the hospital for hydration and the BUN came down to 87, creatinine a little above normal.  On follow up a couple days later his BUN was 140, creatinine 2.8, and phosphorus normal.  His behavior is less exuberant than normal.  He had a bit of vomiting yesterday, no diarrhea.  His appetite today and yesterday was not too good.  The one day he had the Mirtazapine  he was his normal self and ate well.  My vet said to come back in a month for blood work and keep doing what we were doing.  However, I am concerned that I should be doing more- particularly with his diet when he does eat well.  Right now, with a lowered dose of Lasix, his heart issues seem well managed.  

Is there some more aggressive treatment, especially in terms of diet?  
Is his outlook is so bad, doing anything more will be fruitless?
Is a month soon enough to keep a good eye on his kidney blood levels?

Thank you.  We want to keep our buddy as comfortable and happy as we can as long as we have left.  

31 Responses
82861 tn?1333457511
Kidney failure is one of the most heartbreaking conditions to strike a dog and its owner because there really isn't much of anything that can be done to combat it.  By the time symptoms appear and are confirmed by lab results, too much damage has already been done to the kidney cells to arrest its progress.  Unlike the liver, kidneys are not able to produce new cells.  Once they're damaged and die, it's permanent.

The idea behind treating kidney failure is to slow down the damage and treat the symptoms - primarily nausea and vomiting.  If your dog continues to vomit and avoid food, by all means take him back and ask for something for nausea.  You may need to learn how to administer sub-q (under-the skin) fluid injections if your dog cannot stay hydrated on his own.  

While phosphorous is necessary for life, it is deadly to damaged kidneys so you need to feed a low phosphorous diet.  At some point, you'll need to add a phosphorous binder such as calcium (unless his calcium levels are already too high) or aluminum hydroxide.  These things bind to phosphorous and help sweep it out of the body before it can do further damage to the kidneys.  Calcium is easy to find in the form of unflavored Tums tablets.  I found aluminum hydroxide more difficult to find in a pure state without other ingredients.  It's a common active ingredient in over-the counter antacids.  If you can find Alternagel in your area, that would work well.  Check with your vet on dosing requirements.  It may be necessary to order it from a compounding pharmacy.  If you can keep the phosphorous levels down, the nausea won't be as bad.

As far as nausea meds go, you'll want to avoid Reglan (generic form is metaclopromide).  It works by increasing gastric motility and it was only somewhat effective for my dog in the early stages of kidney failure.  When she was in the deep late stages of failure, it caused terrible side effects.  Reglan is metabolized by the kidneys, and since hers weren't working it built up to toxic levels in her bloodstream.  Symptoms are extreme restless and shaking.  That reaction can be treated as an allergic reaction with benadryl.  I found that phenergan was the most effective and cheap nausea medication for my dog.  Many vets aren't aware that dogs can take phenergan, so your vet may have to send you to a pharmacy for it.

There is really no telling how much time your dog has left.  It's a tough act of heavy-duty nursing and attention to symptoms to keep your dog comfortable.  Like people, some dogs fight for every last moment of life and others quickly give in  There's no way to tell until you try.  Here is a link to what I found to be the best resource on managing kidney failure in dogs.  It explains lab results, medications and includes a tremendous amount of dietary information.  Take your time and read through it.  I'm sure you'll find some things there to generate a conversation with your vet.  Meanwhile, enjoy every moment you have with your dog.  You've obviously taken great care of your buddy for many years and I'm sure you'll continue now that he's in his final weeks and months.  Please keep us posted on his progress.  :-)
82861 tn?1333457511
Might help if I pasted the link!

http://www.dogaware.com/health/kidney.html
974371 tn?1424656729
Jaybay gave all good advice.  I'm dealing with that now in our 12 year old Greyhound.  Yes, you need to watch the phosphorus levels.  I am presently feeding Natural Balance Fish and Sweet Potato.  We are also using Pepcid twice a day.  You might want to ask your Vet about that.  
Oh man, stay away from Reglan.  Docs gave me that once for bad nausea after a surgery. I got very restless and had tremors. Doc pulled me off that right away.
Sounds like your Vet is pretty much on top of this.
1623561 tn?1299944237
Thank you so much Jaybay and Margot.  I am sure I will come back here many times for info.  I've been so sad. It's good to be in a place where people know how you feel. Right now, Foxy had a great day, and I am trying to be grateful for every moment I have.  All dogs are so special, especially your own.  

By the way, no vet has suggested Reglan to me - but I am glad to have the info.  Foxy is already on Pepcid.  His appetite has been poor and, unfortunately, he is a dog who is used to holding out for the good food, and he is refusing to eat the more healthy stuff, so I am constantly worrying about his diet.  However, with Mirtazapine (sic?), he is very perky and has had a great appetite.  He has only come back from the hospital 4 days, so we will see.

I would like to start making food for him to make sure he is correctly nourished, however the veterinary staff thus far have been more concerned that I get him to eat than anything else.  I was advised only to try to stay away from processed food.  Perhaps, if he continues to hold his own, there is a little time to learn more about this.  Thanks again.
942557 tn?1272698419
Purina has a prescribtion diet food for kidney function..My peke eats the Purina K.D. food and seems to like it.As far as lab work, My vet ran labs and then another set in 2 weeks.Then we waited a month to check again.Dont give up hope there is still alot of things that you can do to help your baby.I know it is hard when they dont feel well and we dont know what to do to help them.Your baby is very lucky to have someone like you to care for them and to try to help them like what you are doing.You will both be in my prayers.Please keep us posted
82861 tn?1333457511
The KD diet is prescription and merely a low-phosphorous and low-protein food.  For decades the theory was that protein should be avoided because it's hard on failing kidneys.  Dogs absolutely must have protein to maintain good nutrition, so what you're looking for is a more easily digestible form of protein.  You can achieve this goal by making the food yourself.  Check out the link I pasted above for lots of different recipes including phosphorous levels for various foods.  

I understand your vet's advice about getting your dog to eat anything at all.  Nausea is so bad with kidney failure that at some point, they have to eat something even if it's not the best thing for the kidneys.  I gave my dog a daily multivitamin to help with the malnutrition.  It was hard to find and I nearly went blind reading labels, but managed to find a senior dog vitamin with no phosphorus.   Since the urinary tract can be painful with kidney failure, I also kept her on Cranassure capsules to help with that.  It did seem to help and she had no more nighttime explosions of urine.

I know all this must sound completely overwhelming to you.  My experience was that each day was different - some better, some worse but the general direction was downward.  One day she would have a great appetite and the next she was vomiting and lethargic.  All you can do is treat the symptoms the best you can.  If it's caught early enough, kidney failure can be managed for years and the dog may die of something totally unrelated.  It all depends on the underlying cause and how much damage has been done before diagnosis.  Hang in there and keep us posted.  :-)

Give it a couple more days, and if your dog still shows no interest in eating, ask for some phenergan or cerenia.  Cerenia is so expensive I couldn't afford it, so went for the phenergan instead and it works wonders.  One of my dogs has a sensitive tummy and about every 6 weeks his guts make so much noise you can hear him across the room.  He totally stops eating and lays around in misery.  One phenergan pill has him back to normal in 15 to 20 minutes.  It's great stuff and very cheap.

One of the first things you could try is plain boiled dark poultry meat - legs are perfect.  Mix it 50/50 with cooked white rice and see if that will gain some interest.  Hard boiled egg whites are another good source of easily digested protein.  Use only 1 in 4 of the yolks since they're high in phosphorous but have lots of other great nutrients.  Your vet probably checked her calcium with the other labs, so ask him if it was normal.  If so, add a plain, unflavored tums tablet to her meal.

How's your pilling technique?  I got to where I was stuffing pills down my dog's throat several times a day.  Since she wasn't really interested in food I couldn't mix meds in with a meal.  Chica was also a master at working her tongue around the pill to spit it out while keeping the food.  LOL!  She didn't mind being pilled and I knew she got exactly what she needed.  I know it can look awkward, but if you move fast and get it past the hard palate it'll go right down before they know what happened.
974371 tn?1424656729
Actually, and it is on a kidney diet, try green tripe.  I found it canned in PetCo.  It stinks but most dogs seem to love it and it is good for them.
There's some research that shows that Enalapril also helps kidney function in general in dogs, in addition to helping control blood pressure.  My Vet started our Grey on a low dose.

This is also off the boards.  There are some very knowledgeable people on there, so take what you can from it but always discuss your particular situation with your Vet.
At the beginning stage the best thing to feed are proteins that are at the top of the bio-availability chart, such as fish and eggs. These will put the least amount of strain on the kidneys. Mix these with sticky rice to bring the Phos content down further, while keeping the calorie count up. The rice adds some B Vits and other nutrients too. Take a look at nutritiondata.com. You will see that whole brown rice has something like (I am going off memory here...) 165 mg of Phos per cup. While sticky rice (the type you use in sushi) has 12 mg per cup. Balance with a therapeutic dose of Omega 3 and a vita/mineral supplement. When they get a bit farther along start adding a Phosphorus binder. When they get to end stage you need to restrict protein.



Here is some other links that may help off my Greyhound boards.  Excellent site.
http://www.dogaware.com/health/kidney.html
1623561 tn?1299944237
Thank you all so much for the great advice.  I have been on dogaware site and now will make sure to read it more thoroughly.  I am very sad today because I have to go to work and leave my little buddy behind.  He comes with me when I am in the office and loves it, but today and many days this week he won't be able to come.  My husband will care for him - but I don't like to miss a day with him.

He is already taking Enalapril for heart function, so I'm glad to find out that it is good for kidneys.  He has taken pills very well with food until lately.  However, when I have to pill him, he fights like crazy, shakes his head, gags, etc.  I hate to put him through it.  He sometimes spit them out - his throat opening is so small, it's hard to get the pill down far enough.

Re: diet - I made some dark poultry meat and broth and am trying to find acceptable carbs to mix with it that he will like. I put potatoes in it with the broth of the soup and he accepted them after he has had his appetite stimulant.   I haven't tried sticky rice, but will look for it now.  He actually spits out individual grains of white rice I've tried with him.  He is very fussy, but so cute.  

Well - off to giving him meds and to work. Hopefully he will eat.  Thank you all again.
974371 tn?1424656729
try sweet potato instead of the regular potatoes.
You may find sticky rick in an Asian market.  Some I know order it on line.
I give our Grey his pills in the small pill pockets twice a day and he eats them right down.
942557 tn?1272698419
What other meds is your baby on besides Enalapril.My Peke is on Enalapril, Vetmedin and lasiks.She also takes 1/2 a pepcid a day and Sulfracate.It helps her from getting ulcers from her meds.You could try getting some of the Nutri-cal and putting Foxy's meds in it.Also pumpkin is another way you could try.When my baby first went on her meds she did great and then she started spitting her meds out.I tried all kinds of things and since they have little mouths it is hard to pill her,But after a couple of weeks she got better about it.IWell i hope that Foxy is feeling better.Take care and God Bless
1623561 tn?1299944237
Hello Chasha33,

Foxy is taking 1/4 Enalapril,1/4 Pepcid, and 1/4 Mirtazapine related to the kidney issue.  He also takes a bit of lasix (furosemide), and Vetmedin for his heart disease.  Enalapril also works on the heart issue.  His heart medicines are working fine.  Nutri-cal sounds so familiar - where would I find it?

How old is your Peke?  Has he been diagnosed long?  Do you do subcutaneous fluids?
The vet didn't suggest that to me yet.  I hope he continues to do well.

I will be trying all the food suggested here.  However, it seems as if I don't have enough time to do it all because of work.  It worries me.   I had to leave him to work yesterday and I hated to, but I think he was able to get a good day's rest with my husband there and he was very perky and happy when I got home. However, this morning he is nauseous again and doesn't want to eat.

I've had a hard time, of course, but a friend of mine with a young dog with kidney failure said she was the same way at first.-crying all the time, etc.  Now it is better.  

I so appreciate your interest.  God bless you and your Peke as well!
942557 tn?1272698419
You can find Nuri-cal at most petstores like Petco ot Petsmart and alot of vets carry it.I know how hard this has to be for you.My peke Snowball is 12 years this all started  over a  year ago.I took her to the vet cause she had gained 8lbs in a few weeks.I didnt know what was wrong with my baby.Well  it took several weeks and lots of test and 3 different Drs and then they found out it was CHF and her kidneys.But her lab work would change every few weeks durindg all of this.Sometimes she was fine then her Bun and creatinine levels go up.Her lab work for her kidneys would look like a normal for her age then they would get high.When we found out what was wrong my vet did labwork and then waited 2 weeks after she started her meds to check again and then  waited a  month.My vet put her on the Purina KD and  I do feed her  KD to help cut back on her sodium intake.Cause restricting there salt helps prevent edema,ascites,and hypertension.Also KD has low protein and protein is hard for them to metabolize when they have kidney problems.Also the phosphorus in the kd is lower.With the kidneys and the CHF problems, Foxy needs a food that will help all of that.I also feed Nutro holistic.
I havnt had to do subq's on her But i did have to do them with my other Peke.Foxy seems to be a really lucky little guy to have you.I will keep ya'll in my prayers Take Care and God Bless
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