Bloodwork And Urine Show Kidney Problems

[Guest greykat]

Today I stopped at the vet's office to get a new urine cup (since I want to make sure I use something "perfect" for the collection), and I also wanted my own copy of the urinalysis results. Since I never got a copy of the urinalysis or t4 last year, I asked for those as well. I plan to stop him from urinating and withhold water on Monday night, and I'll collect a mid-stream sample on Tuesday morning and refrigerate it until I can get it to the vet. They said they send samples to the lab twice a day, and the first is around noon. I'm hoping to take it to them before the first batch is sent to the lab.

 

I'm sitting here reviewing the labs from last week and last year, and they are surprisingly similar. Also (not related) the T4 stayed the same, and I'm guessing it's not an issue: 0.7.

 

(Sorry- this doesn't paste well. This is only for last year and this year, so the first result you see for each line is from last year and the second is this year.)

 

PH 6.5 5.5

Specific Gravity 1.049 1.041

Appearance Cloudy Clear

Color Amber Amber

Protein (Verified w/ 3% sulfosalicylic acid) 3+ 3+

Glucose Neg Neg

Ketone Neg Neg

Bilirubin 2+ 1+

Blood Trace Trace

WBC 0-3 0-3

RBC 4-10 4-10

Bacteria None None

Epithelia Rare Few

Epithelia, Renal None None

Epithelia, Transitional None None

Triple Phos. Crystals None None

Amorphus Phosphates None None

Calcium Phos Crystals None None

Calcium Carbonate Crystals None None

Ammonium Biurate Crystals None None

Amorphous Urate None None

Calcium Oxalate Crystals Few Few

Uric Acid Crystals None None

Mucous None None

Hyaline Casts None Seen None Seen

Granular Casts None Seen None Seen

RBC Casts None Seen None Seen

Waxy Casts None Seen None Seen

WBC Casts None Seen None Seen

Budding Yeast None Rare

Oval Fat Body None None

 

Everything is mostly the same. The differences between last year and this year are a slight decrease of PH, specific gravity, last year was cloudy, this year is clear, Bilirubin was 2+ last year, 1+ this year, Epithelia was rare last year, few this year, and there was no budding yeast last year, but this year it's listed as rare.

 

What's flagged in the results as "high" is protein (3+ this year and last), RBC (4-10 this year and last), and budding yeast (rare, this year only).

 

I can't make sense of most of this. I am getting a retest on Tuesday and am hoping my vet will be talking w/ Dr. Couto about the details to figure out the next steps we should take.

 

And Max is still bored silly, crying a lot (although he's always done that), and has been panting (which makes me nervous, but my husband just thinks he's warm). Oh, and I haven't given any NSAIDS in awhile (at least since you guys raised the red flag on it- which was Monday or Tuesday). Hopefully that will help if there is any kidney damage?!

 

Wish us luck! Thanks!

Kat

 

[Guest greykat]

Forgot to mention- last year I didn't know about getting a "good sample." I got it AFTER the morning meal, which may at least explain the bilirubin being higher than it was this year. This year I knew better and did a first catch of the day (but still think I started catching too early- not mid-stream).

 

Anyway, just FYI for anyone reviewing the numbers.

[MaryJane]

I'm surprised that the vet didn't talk to you about the protein in the urine last year.

 

What is the %protein in the food that you are feeding right now?

 

What type of treats and such do you give?

 

 

[Guest greykat]

I'm surprised that the vet didn't talk to you about the protein in the urine last year.

 

What is the %protein in the food that you are feeding right now?

 

What type of treats and such do you give?

 

Yes, there are two vets, and the other one called with the results last year. He said he found "lots of bilirubine" in his urine, blood in the urine, but that it didn't match the bilirubin from the blood tests. He actually sounded a bit scattered (we had two dogs, and at one point I think he was looking at the other's file), and he didn't make it sound like it was cause for concern. He didn't recommend any follow up for further tests or anything. I had read about an increase in bilirubin after eating (and especially in males), so I mentioned that to the vet.

 

I think it can be a big problem when the vet lacks breed-specific knowledge, both when something that seems "abnormal" is actually normal (and fine) for greys, but also when they are reviewing seemingly "normal" test results, when possibly it isn't normal for a grey. That's why I'm glad the vet we normally see said he would call Dr. Couto to discuss everything. That made me feel a lot better.

 

For Max's food, we feed him about 2 cups of Eagle Pack Holistic Select Anchovy, Sardine, and Salmon dry food twice a day, and we mix it with a tablespoon of some premium quality wet dog food (several varieties- he gets bored, so we are constantly buying different stuff). For treats, he gets several 3-calorie treats (I forget the name, but it's the only one I've ever seen that actually states the number of calories) when I leave for work in the morning, and we have also given him these organic chicken bites (tiny circles of dried chicken) when we are out and about. And he gets rawhide twists for his chewing pleasure. That's the norm. I don't know the protein levels of most of that, but I could find out. I know the dry food says it's at least 22% crude protein. OH- and we also add milk to his dry food when we run out of canned food. He loves milk! We'll also do cottage cheese if/when we have it.

 

If there is any question after the second urine test, I want to explore and find out what's wrong. Any thoughts on the types of tests/recommendations I might expect (or should request) from the vet (if the second results are the same as the ones we just got)? I know he mentioned the k/d diet, but what else could cause the types of abnormalities we are seeing in his blood/urine? I need Max to stay healthy for as long as possible. We lost his sister two years ago at 11, his brother last year at 12, so he's not allowed to get anything we can't cure- I made him promise. Too much heartbreak so far, so we are rooting for Max to (at least) reach the ripe old age of 15. And he's not quite 10 yet, so he's still a youngin'.

 

Let me know what you think! Thanks!!

Kat

[duncan41]

FWIT: I would drop back 15 yards and start fresh with a good "catch". Erase everything that you think you know about what's been going on because you have been comparing apples and oranges. Now that you have your Vet's attention and he shows such willingness to learn from others (you are sssooo lucky he counts Dr. Couto as a friend!), this is an opportunity to do it right.............the second time. Besides, at this point, it doesn't matter what the test results were last year or the year before that - you wouldn't treat Max for an infection that he may or may not have had in 2006, so why muddy the waters with it now?

Have patience. As you said, Max has been healthy up to this point. Let's hope that his injury and the meds have his system a little out of whack and with time and TLC, he'll be back to his old self. In the meantime, relax, breathe deeply and formulate a plan that makes sense to you. Please keep us updated. Sending prayers and hugs for both of you.

[Guest greykat]

Thanks, Linda! I definitely need to breathe and just wait to see what happens w/ the next test.

 

Another question- Max (separate from everything else) has "greyhound neck" and periodically gets a stiff painful neck. It crops up a handful of times a year, but unfortunately it cropped us last weekend and seems to be bugging him again today. Today he is just holding his head low and cries out a bit when he lifts his head after napping. I would normally try to give him pain killer, but now I'm paranoid about the Metacam since it's an NSAID. Is there something else I can give him? I don't have any other dog prescription pain meds. I have been avoiding the Metacam all week since he may have kidney issues, but I feel bad watching him in pain today. Advice? When this happens, we will put a back ThermaCare heatwrap around his neck, and it often seems to help. Today, though, he seemed more annoyed with it, so we took it off. He is resting peacefully right now, but I feel bad that his neck clearly is painful today when he bends the wrong way.

 

Will one dose of Metacam today today be okay, or should I still avoid it? I don't know how much/for how long using an NSAID takes before it causes noticable adverse effects on the kidneys. If not, should I try something for humans? I feel like I heard at one point that you can give a dog Tylenol, but I've never tried it. Is that possible? Or is that as bad as the Metacam?

 

Sorry- I am clueless when it comes to medication. That's why I often just avoid it altogether (for myself and my dog).

 

Also- if anyone lives in suburban Maryland and knows of a good place for doggy accupuncture, I'd like to try this. I've heard it works wonders for greys w/ neck problems.

 

Thanks!

 

[Guest greykat]

Took another sample in this morning (this time I made sure it was midstream instead of straight away and I refrigerated it), so the results should be in from the lab tomorrow. I'll probably get another call from the tech since the vet doesn't work on Wednesdays, but I'll be sure to keep you posted as soon as I head something. Thanks for everyone's advice and support!!

 

And since I've been doing lots of reading on the subject, anyone have some dog foods to recommend? It seems people think high quality protein and low phosphorus is actually best for dogs w/ kidney problems, so if that is the case for Max, instead of trying a k/d diet, should I ask my vet about other types of foods? I was reading my eagle pack holistic select isn't necessarily the best (contains beets, which may actually stress the kidneys?!). Anyone use EVO? I don't know which ones are best quality with notably lower phosphorus. Any advice on food would be appreciated. I'm trying not to worry, but the more I read, the more it sounds like finding blood and high protein in the urine is definite cause for concern. Since it was almost the same last year and this year, I'm assuming (but hoping not!) that this sample will turn up the same. If so, the vet said we'll go to an ultrasound next...

[Burpdog]

Did they culture the urine?

 

Almost all of my seniors have 3+ protein in their urine. Their BUN/creatine ratio is normal so we ignore it.

 

PS imo k/d is not very good. I'd be more afraid of pancreatitis in a senior on that food.

 

A good senior food will do. Solid Gold Holistique Blendz is another decent food for those that really have kidney problems.

Edited June 23, 2009 by Burpdog

[MaryJane]

If the protein still shows up in the urine, you may want to get a package of the "urine protein stix" so you can test yourself every few days/weekly. I did this when my former dog had a similar issue. You can get them online or order them from a local pharmacy. It helps you to monitor how the diet is doing.

 

You may also want to consider a home-made diet - it's easier to control how much and the type of protein that they get. I got my diet from Dr. Remaillard at Angel Memorial Animal Hospital in Boston. She used to do phone consults, not sure if she still does them ...

 

Good Luck

[Chicocat]

I will be interested in seeing your results tomorrow and what your vet recommends.

 

Darlin had her dental today and the vet was concerned with her creatine levels, which were almost the same as Max.

 

BUN = 12

Creatine = 1.7

 

When I saw the numbers, I really didn't think they were out of line very much. We didn't have the benefit of a urine sample today. So, we will be retesting in 2 weeks and she will be on the K/D diet. (I'm not thrilled with that product either).

Edited June 24, 2009 by Chicocat

[Guest greykat]

I haven't yet talked to the vet since the guy we normally talk to isn't in until tomorrow, but I did press the receptionist for numbers. Not good. The latest sample is as bad and probably a bit worse, from what I can make of it. Unfortunately I am not sure if they did the BUN/Creatinine ratio. I have a hunch we are on the path to an ultrasound, but I'll hear from the vet tomorrow.

 

I didn't ask for all the numbers, just what I knew was of concern. And she pointed out a new one I hadn't seen as a red flag before...

 

PH 6 (up 5.5 from last time)

Specific Gravity 1.05 (up from 1.041 last time)

Protein 3+ again

Bilirubin 1+ again

RBC 4-10 again

And she pointed out that calcium oxalate crystals were listed as "many" (up from "few" last time)

The only other thing was that "budding yeast" went down to none again (said "rare" last time), but I have no idea what that even means or if it matters at all.

 

What now? I hate waiting until tomorrow to talk about the results, although I have a feeling he's just going to say it's time for an ultrasound (which is essentially what he told me when I dropped off the sample yesterday- if the results stay the same, ultrasound).

 

I did more reading yesterday, and I have to admit everything seemed rather bleak and scary. Do I have something irreversible on my hands? Is Max actually feeling pain or anything from this? What should I be prepared to hear?

 

I'm so sad because I feel helpless, and I am also mad that the red flag wasn't raised last year when the results were bad. I'm so confused as to why the other vet didn't push me to do any further testing last year. I swear I remember only that he said these things were abnormal, but that the blood results somewhat contradicted them (or something?). I don't remember anything like "so you need to make another appointment to do this..." or I would have made a follow up appointment. My guess is it was more like, "if he isn't acting strangely and appears healthy in all other ways, let's just wait and see" (although I can't be certain...I just remember not feeling like it was being presented as something of major concern).

 

Help. My husband is almost too nonchalant, and it's driving me mad. I don't want to worry unnecessarily, but I just feel like worrying is in order. Yesterday my stomach was just churning and I was shaking after I read a bunch more on kidney disease and diet controversies.

 

Looking for hope and words of wisdom...

[Chicocat]

I wish I had words of wisdom, but there will be no shortage of hopes and prayers for your Max.

[Burpdog]

Ann: those readings are fine although the BUN looks low Do you have Bill's kidney papers? I can email them to you if you email me at Burpdog@msn.com

 

Is Max feeling ok? Did they culture the urine?

[Batmom]

Has he been treated for a plain old UTI?

[Guest greykat]

Max isn't feeling okay. He's actually been whining a lot and hasn't really eaten. He didn't eat yesterday morning, he did eat last night, he ate a bit this morning, and now he's turning his nose up at dinner. He keeps walking over to it, sniffing it, walking away, crying, occasionally getting a drink, and then gives up and lies down and gives me a sad look. Mind you, the food thing just started happening this week. He was always good about eating meals. His poop is still normal. Hasn't had diarrhea and vomitting in a long long time... Seemed healthy until I started getting these test results back.

 

I haven't talked to the vet, and I have a feeling they didn't do a culture (unless I just don't understand what that means). I googled it and saw that it looks for bacteria, and the urinalysis results say no bacteria was found. Is that what you mean? I'll have to ask the vet tomorrow about the culture and bun/creatinine ratio, since those are things I don't see specifically listed on the urinalysis report, I guess it means they don't typically do them?

 

And would that relate to the UTI question? Wouldn't the urinalysis report show bacteria if there was a UTI? I don't know what to look for.

 

Ugh! He won't stop crying. I am totally helpless tonight. I took him out, he peed and pooped, and he has food and water. Those are all the normal reasons for crying, so I can only assume he's hungry and frustrated with the food. Or he's in pain? He's always been a "talker" (aka whiner), but I feel he's been worse lately. He still sleeps through the night, though, w/out getting up or crying. He may rise to do a turn or two, but that's all.

 

My husband is gone for another couple of hours, and I am going a bit insane with worry and frustration (no fun listening to a dog cry and look at you upset as if to say, "why aren't you listening?" But I don't know what the heck he's trying to tell me.

 

Is this the beginning of the "food issues" I've been reading about with the kidney problems?

 

Gosh, I really wish he weren't injured. I feel like that's messed up a lot of warning signs. He's been limping and depressed for months now, and it was natural to assume it was only because of his injury and the lack of mobility. The poor guy isn't even allowed to play or go for walks. He is usually so active, so he truly must be bored senseless. But to have all of these problems crop up at one time?

 

Sorry- I haven't talked to anyone, I'm alone with my crying dog, and I am really starting to go a bit mad. Thanks for listening.

[Guest Greensleeves]

Get yourself some Pepcid--20 mg pills, and give him one in the morning, and one in the evening. Kidney disease (as you know from your reading) causes nausea--which is what you're seeing with the refusal to eat after showing initial interest in food.

 

Max isn't feeling okay. He's actually been whining a lot and hasn't really eaten. He didn't eat yesterday morning, he did eat last night, he ate a bit this morning, and now he's turning his nose up at dinner. He keeps walking over to it, sniffing it, walking away, crying, occasionally getting a drink, and then gives up and lies down and gives me a sad look. Mind you, the food thing just started happening this week. He was always good about eating meals. His poop is still normal. Hasn't had diarrhea and vomitting in a long long time... Seemed healthy until I started getting these test results back

 

Unfortunately, you just described exactly what we saw with Nelly. I'd be scheduling that ultrasound and asking about sub-q fluids.

 

Nelly went from K/D to a home-cooked diet to syringe feeding (of K/D) within about five or six weeks. There is an entire book of home-cooked diets for dogs and cats with various medical issues, written by a veterinarian (it has a long title and a white cover; check Amazon). The key is getting enough calories without getting too much protein, and it's a really delicate balance. We used a home-cooked recipe from Hills, which our vet got for us. Honestly, though, I wish we'd gone to syringe feeding sooner, because not being able to eat just stressed Nelly out so much.

 

ETA: link to book on Amazon:

http://www.amazon.com/Home-Prepared-Dog-Ca...8522&sr=8-1

 

Also ask about Epakatin and Azodyl, which are nutritional supplements to support kidney patients.

 

Hugs. I'll keep praying it's something else.

Edited June 25, 2009 by Greensleeves

[Guest greykat]

Okay- good news. He just ate. I had given him his dry food mixed w/ cottage cheese at 6:30, and we wouldn't eat it. I finally got the cottage cheese container (about 10 minutes ago), let him eat straight out of it (there were maybe 2 tablespoons left), and then I walked over to his food, used the empty container to scoop and mix the food, and then called him over to take a look. He started eating it! I don't know why, but it worked. Whew. At least he won't go to bed hungry. That's something, I suppose.

 

Now I should go fix myself something to eat. I'm starving...

[Batmom]

Presume they're just doing dipstick testing?

 

Before you panic, treat him as if he had a UTI. If your vet won't do it, find another one.

[Guest greykat]

Presume they're just doing dipstick testing?

 

Before you panic, treat him as if he had a UTI. If your vet won't do it, find another one.

 

Not sure. They called it a "thorough" test and it did include specific gravity. Is that still dipstick?

 

Also, would a UTI show blood and protein and crystals w/no bacteria? I'd love it if that were the case, but I am trying to be realistic with this.

 

His test results are very similar to last year (which would seem he had the same problem last year at this time?), and he was on an antibiotic (Clavamox) from April 14 (day of the fracture) through May 5 (3 weeks). Would that have cured any UTI at the same time?

 

Sorry- I feel very ignorant when it comes to the medical stuff. I don't understand the tests and various types of tests.

 

[Batmom]

Presume they're just doing dipstick testing?

 

Before you panic, treat him as if he had a UTI. If your vet won't do it, find another one.

 

Not sure. They called it a "thorough" test and it did include specific gravity. Is that still dipstick?

Probably, but they're the only ones who know.

 

Also, would a UTI show blood and protein and crystals w/no bacteria?

Technically, it shouldn't. You should see some WBC or bacteria hanging around there. But we've had more than one UTI here that was atypical and resolved with antibiotics. Last one was Joseph -- urinalysis showed blood and a few crystals only.

 

I asked about the dipstick partly because things like RBC floating around in the urine can cause false readings on other things, like protein.

 

 

he was on an antibiotic (Clavamox) from April 14 (day of the fracture) through May 5 (3 weeks). Would that have cured any UTI at the same time?

Maybe yes, maybe no. If the antibiotic wasn't the right one for the UTI, it wouldn't help. 'Course, if you culture and don't get anything out of the culture, you don't know what antibiotic to use, which is another conundrum we have been through. In those cases my vet might go with 10-14 days of Baytril or Zeniquin, which are pretty pricey but which are a whole lot easier to contemplate than kidney disease. Which is why I suggest treating for a presumed UTI. Costs a little but otherwise doesn't hurt and might help.

 

Hugs and best luck.

 

 

 

ETA: The other thing that makes me suspicious is your pup's injury. Have known more than one male dog get a UTI after surgery or activity-limiting injury. They're not moving around and eliminating as often, giving bacteria more chance to creep in.

Edited June 25, 2009 by Batmom

[MaryJane]

Presume they're just doing dipstick testing?

 

Before you panic, treat him as if he had a UTI. If your vet won't do it, find another one.

 

Not sure. They called it a "thorough" test and it did include specific gravity. Is that still dipstick?

 

Also, would a UTI show blood and protein and crystals w/no bacteria? I'd love it if that were the case, but I am trying to be realistic with this.

 

His test results are very similar to last year (which would seem he had the same problem last year at this time?), and he was on an antibiotic (Clavamox) from April 14 (day of the fracture) through May 5 (3 weeks). Would that have cured any UTI at the same time?

 

Sorry- I feel very ignorant when it comes to the medical stuff. I don't understand the tests and various types of tests.

 

A part of the urine results would have been from a dipstick but, they likely also did a microscopic which would have picked up the crystals and red blood cells. If there was an infection, bacteria would likely have been seen in the microscopic of the urine but, it wouldn't hurt to get a urine culture to see if bacteria grows.

 

If there is bacteria, it might not be susceptible to just any antibiotic, it they do a culture for bacteria and it grows something they usually also do a sensitivity that tells what antibiotic the bacteria does not like.

 

 

[Guest greykat]

Thanks! I'll certainly ask and will see what we can do.

 

If we do wind up needing an ultrasound, any ideas on cost and how many vets offer such a service? Again, I'll ask my vet, but I'm full of questions now and can't talk to him until tomorrow.

 

We got an MRI once for our Reiger, and it was $2K (ouch!). Results were good...nothing to report. Definitely preferred to hear that than something negative, but it also made the expense a bit frustrating. Did we even need it? I guess that's the general problem w/ diagnostic tests- you need them to find out if there's something wrong, but imaging costs so much.

 

Am I looking at the same type of expense for an ultrasound? That sounds simpler to me (I'm assuming you don't need to anesthesize, do you?).

[Batmom]

Ultrasound cost depends on where you are and what type of equipment your vet has. Usually the dog does not need to be anesthetized. Here a basic ultrasound -- just looking at a suspect area or two -- usually costs $60-$85.

[Guest greykat]

Ultrasound cost depends on where you are and what type of equipment your vet has. Usually the dog does not need to be anesthetized. Here a basic ultrasound -- just looking at a suspect area or two -- usually costs $60-$85.

Whew! Much better than the MRI! Our x-rays for his foot have been costing about $75 I think, and that is from our vet (who has some of the best prices I've seen in this DC area).

[Batmom]

Well, here an x-ray starts at @ $35, so your ultrasound will probably be more, but hopefully not much more if it is needed.