Is there anything that can help my 14 yo lab with end stage kidney disease?

[nalh]

I have a 14 yo female lab who was diagnosed with kidney disease last year after we noticed she was drinking more than usual.  The vet gave her Hills k/d food.  Other health issues include arthritis/ possible degenerative neuropathy (hind end weakness).  She's taking gabapentin and galliprant for that.  She had been doing well up until last week.  She basically stopped eating.  We tried different kidney foods, and we really couldn't get her to eat much of anything.  She was also trembling when inhaling at times.  

We took her to the vet yesterday.  He thought she was nauseous, gave her fluids and shots of cerenia and fomatadine and took bloods and urine (ugly results below).  This did not improve her appetite, and she only ate pizza crust last night and this morning.  We took her in again today, and she had more SubQ fluids and more shots. She ate 3/4 can of food when she got home, but she just refused her dinner.  We have SubQ fluids to give her at home, as well as cerenia and amphigel.  Does anyone have any suggestions?  I know it looks like she has pancreatitis, too, but right now am just trying to get her eating and hydrated again in hopes we can get her on the right track.  
ALT- 129 (12-118)
Alk Phosphatase- 220 (5-131)
Urea Nitrogen- 85 (6-31)
Creatinine- 7 (.5-1.6)
Phosphorus- 10.8 (2.5-6)
Magnesium- 3.1 (1.5-2.5)
Potassium- 5.7 (3.6-5.5)
Na/K Ratio- 26 (27-38)
Amylase- 1680 (290-1125)
Precision PSL- 256 (24-140)
CPK- 53 (59-895)
RBC- 4.4 (4.8-9.3)
Hemoglobin- 11.5 (12.1-20.3)
Hematocrit- 35 (36-60)
Monocytes- 1400 (0-840)
Total T4- 0.6 (.8-3.5)
Urine:
Protein- 1plus (negative)
WBC- 4-10 (0-3)

Thank you.

[tonyb286]

Hi and welcome to our group here. Firstly, it's important to point out that both galliprant and gabapentin will both be having an adverse effect on kidney function. Sadly, these are difficult choices we have to make as owners, and by veterinarians too. Trying to deal with one health concern often means we give medications that will cause problems for another one, and that's the case here with these two medications. Vets can often find similar medications that will not affect the kidneys so badly, so it's certainly worth having a discussion with yours about this issue.

It strikes me there are some liver issues (according to the blood values), so I would start giving milk thistle daily as a supplement. This will help protect the liver here onwards.

The pancreatitis is a problem. You should try (at least as well as you can) to reduce fat in the diet, as this will just inflame it more. Hills kd is actually quite high in fat, so it may be worth doing half and half, that is, half normal amount of Hills kd mixed with something like sticky white rice to add some nutritional fiber and carbohydrates.

Creatinine is very high and that's a worry. SubQs are okay, but really only designed for maintenance whereas what your dog needs now is slightly more aggressive fluid therapy from IV fluids. Talk to your vet about this. There is also some anemia creeping in, which is probably non-regenerative. Once fluid therapy is finished, you should recheck the RBC count to see if the anemia is still evident. You might also ensure you give some iron supplementation, which may help (again please talk to your vet about this).

Hydration is the first priority, so you are right about that. Then making sure you are giving enough food to prevent malnutrition. It can help to divide the normal daily food into 4 smaller portions given at equal times throughout the day. These smaller portions help relieve stress on the kidneys and reduce nausea.

If inappetence continues to be a problem ... talk to your vet about Omeprazole - or Mirtazapine.

Let me know the weight of your dog, the amount of fluids currently being given daily, the type of fluids too.

Next, phosphorous is very high. I gather you aren't giving a phosphate binder with food? What you really need is aluminium hydroxide (you can get this at ThrivingPets.com or through your vet). A binder will help deal with the rising phosphorous levels, which currently ill be having a detrimental effect on kidney function.

Hope some of this is helpful to you.

Tony

[nalh]

Hi Tony, Thank you so much for your reply.  Chappy weighs 73 lbs.  We had been giving a 1/2 bag of Ringer's Lactate twice a day  for the past two days (so a full bag each day).  Now we are giving her 1/2 a bag per day.  The amphigel is a phosphorus binder.  She's still not eating well.  I've tried multiple kidney canned foods, and she just isn't interested.  I've been giving her chicken and rice to try and get something into her.  She has seemed perkier with the fluids, and she went for a walk today.  She is following me around like she wants to eat, and I've tried egg whites, beef and rice, etc. but she just sniffs and walks away.  She has eaten pizza crust.  I spoke to the vet today.  He thinks pancreatitis is a possibility-- this came on right after Christmas and table scraps-- but said the treatment would largely be the same. We have discontinued the galliprant and gabapentin-- she doesn't even want pill pockets.  I am hoping to get something she will eat reliably that is okay for now-- as it is, I'm cooking multiple things a day and then throwing it away.  Willing to do that, but wish I could find a magic recipe that was a sure thing for her.  Any other thoughts?  Thanks again.

[nalh]

We had to put her to sleep today. While we could get her to eat hot dogs and roast beef, she wasn’t able to stand anymore. She had the vacant look.  Best dog ever.

[tonyb286]

I'm really sorry. Just caught up with your post after a few days away. This is a horrible disease. Tony