Kidney Failure?

[Guest EmilyLH]

Midas, my 7yo greyhound has recently been diagnosed with renal insufficiency.

 

This started with an incontinence problem. He's currently taking 50mg of Proin 3x a day, and has helped greatly, minus night time. We still have some issues. I had him brought back in to do a urine test to rule out diabetes, and the vet told me his BUN and Creat. levels were off the charts. Knowing greyhounds have higher levels anyways, wanted to know what anyone could tell me about it.

 

BUN 35.1 Creatinine 3

 

Ultrasound last week was able to provide kidney information as well to support kidney failure. Right kidney has no architecture and is not functioning. Left kidney has some architecture and a little function. Vet thinks that the excessive water intake is not allowing the incontinence medicine to fully work -- his urine is not concentrated. He has been drinking a TON of water though -- was told increased thirst was part of kidney failure, creating increased urine production.

 

Any thoughts/comments would be appreciated. I have only had Midas over 2 years now and am pretty bummed What type of diet should be be on? They gave me a prescription for k/d but not only is it very expensive, Midas is not a fan of it. Homemade recipes?

[greyhndz]

Hi and welcome!

 

(We're probably the only 2 people on GT who aren't at Dewey. )

 

The BUN/creatinine values you listed are nowhere near off-the-charts. Check out an article Suzanne Stack DVM has on GreytHealth, which lists normal bloodwork ranges for Greyhounds. The BUN is only minimally elevated, and the creatinine is high, but by no means critical. I'm not sure exactly what the vet means about "loss of architecture" as seen on U/S. There are chronic cortical changes and atrophy of dysfunctional kidneys, but I don't know if that's what your vet was referring to.

 

A few thoughts: I'd get him off the Proin for a couple of reasons: first, it's masking symptoms -- you now know that Midas has PUPD (polyuria, polydypsia) because of renal disease of unknown severity. Proin isn't the answer, and may well be a contributing factor: it can elevate the blood pressure and also constrict the vessels providing blood supply to the kidneys, which is exactly what you DON'T want. People using Proin for incontinence usually use it for spay incontinence, which clearly isn't Midas' problem.

 

One of the most important tests to be done right now is the urine protein creatinine ratio ("UPC"), which helps to quantitate the amount of protein in the urine, and this in turn reflects the degree of damage to the glomerular system of the kidney (integral to the filtering process). In addition, be sure the vet has already sent the urine for a microscopic exam and culture to truly rule out infection. If you haven't obtained a full tick panel, be sure it's done ASAP, as tickborne disease (such as Lyme or Ehrlichiosis) can cause renal disease. Also, go through all the medications, supplements, treats, etc. that Midas is getting, and be sure to discuss with the vet whether any of them could be a factor. NSAIDs like Rimadyl, Meloxicam, etc. have been implicated in causing renal disease. Treats or foods which are tainted can also factor in.

 

As far as diets, the ingredients in KD make me throw up a little in my mouth. One of the best sources of info on caring for "renal" dogs isDog Aware. There are also a number of homemade diets, as well as specific diets and commercial kibble which is low in phosphorus (far more important in managing renal disease than protein moderation). This is something you can discuss with your vet.

 

You may want to think about consulting an Internal Medicine vet, who has better knowledge of diagnosing and managing renal disease. Often, an ACE inhibitor such as enalapril, benazapril, etc. is started to preserve kidney function, especially in dogs with glomerular dysfunction.

 

Adequate hydration is really essential, so don't let water restriction ever come up in conversation. If he's having accidents, give thought to either putting down potty pads for him to use, or install a dog door so he can go in and out as he pleases.

 

I hope this helps a bit -- I really just wanted to reassure you that the BUN/creat. are not terrible or cause for panic. While you continue to have this worked up, just ensure that Midas is getting plenty of fluids.

 

Keep us posted!

Jordan

 

PS - not concentrating urine certainly could be from renal disease, but Diabetes Insipidus also comes to mind. That can be ruled-in or -out with a simple water deprivation test; if he doesn't concentrate after a set interval of water restriction, DI would crawl its way up the list of possible diagnoses.

Edited October 11, 2010 by greyhndz

[Batmom]

Depending on your lab's normals, those figures are high even for a greyhound. Not out of sight, but high as in "we need to do some things differently now."

 

I would check his blood pressure ASAP and consider taking him off the PPA for the time being since that may be complicating the picture. PPA is likely to raise blood pressure, and that is not something you want to do if the kidneys are having a harder time than normal, for whatever reason. A rise in blood pressure can also contribute to overdrinking and urinating.

 

We here have had good results with the prescription food when the dog will eat it. I don't know of any nonprescription foods that have as low phosphorus. But, if you take the phos/protein/sodium numbers from the prescription food, it is usually pretty easy to formulate a homecooked diet that has approximately the same values. The one difficulty is in providing adequate calories; usually you have to add some fat and it can be a bit of a trick to find one that the dog tolerates well. As Jordan above notes, at this point protein restriction probably isn't a huge issue but I do find that most of the popular/laypeople's websites tend to underplay the importance of protein restriction as kidney disease advances. In early kidney disease, you don't need to worry about it a lot; as the disease progresses, you do.

 

Hugs and best luck.

[OwnedBySummer]

Here's are those two values as per Dr. Dodds at Hemopets. So I agree, the values are a bit high.

 

BUN: 22 mg/dL +/- 4

Creatnine: 1.7 mg/dL +/- 0.3

The BUN to Creatnine ratio is 13.

 

Good thoughts are being sent your way and I hope all is well.

[Batmom]

You really can't compare lab values from different sources very well. Every lab has its own norms. They're all in the same ballpark, but what's sneaking over the top end at one lab might be within range at another.

[Guest EmilyLH]

Thanks everyone -- I appreciate it.

 

The vet said the CBC results were normal -- just that the BUN/CR levels were high. His range for normal ended at 29.0mg/dl for the BUN and 1.4mg/dl for the Creatinine. The loss of architecture was when they looked at the US, they did not see the renal cortex, medulla etc in the kidneys. The right one had no architecture left, and was not working at all. The Left they said had some, but not much. There was small amount of function.

 

The incontinence has been an issue for awhile, but I imagine so have the kidneys. Is there a better alternative to the Proin for incontinence?

 

Infection has been ruled out. As has diabetes. He also had a dose of antibiotics to make sure there wasn't anything, just in case.

 

 

The vet also gave Midas a prescription for the enalapril. Tablet and a half per day. The vet gave me a recipe for dog food, including rice, hamburger, cottage cheese or yogurt, bread and vitamins. I'm sure they are all similar, just didn't know if someone maybe had better results with one than another?

 

I was told to restrict water only at night, where he wasn't able to go out as often. Midas (and maybe all greyhounds) is a pee-er! He can pee for 5 minutes straight. Although lately I have been having a hard time getting him to urinate when I know he needs to. He kind of stands in the yard and looks at me. Some days I have to make him come outside with me.

 

I guess what makes me the most nervous is that I may not be doing everything he needs in order to still be productive. Whereas I understand there may not be a fix to the kidney failure, I want to make sure he is comfortable etc until that time. I don't even know if there is a "time" which makes me nervous. Can you put a time label on a dog with kidney failure?

 

Emily

[CaliforniaGreys]

Obviously I am not a vet, but would not consider this kidney failure. Maybe kidney disease but not failure.

 

I don't like the idea of restricting water, I realize it's just at night but I wouldn't

[GeorgeofNE]

George's creatine is considered "abnormal" for a regular dog, but acceptable for Greyhounds at 1.9. It is always high. His urine concentration is totally normal, however, and his BUN to creatine ratio is fine. My vet didn't believe me, so finally I sent an email to Dr. Couto at OSU and he said the blood and urine results, when considered together, were perfectly fine.

 

Creatine of 3.0 IS high. Even for a Greyhound.

 

My dog Kramer ate K/D the last few years of his life, and it was a big improvement for him. There is another food, I think is Purina Veterinary Formula N/F that he liked in the canned variety. He would not eat the canned K/D. It's disgusting! I didn't blame him.

[JohnF]

As already stated Greyhound figures differ from those of other breeds with less muscle mass.

I think dogs can carry on OK with just 15% kidney function remaining.

I've lost 3 dogs to CRF over the years and I really hate that disease.

You may get a lot of support and useful information if you consider joining this online group:

http://pets.groups.yahoo.com/group/K9KIDNEYS

[Guest EmilyLH]

Again, thank you so much for all the input.

 

Does anyone know if the incontinence problem is most likely linked to the kidney stuff? The vet did find a small polyp in his bladder, but said it appeared to not be in the way of anything or causing problems. He saw it with the U/S. He also said that he thought Midas suffered from incontinence, but the kidney failure was causing an increase in the urine production, because of the excessive thirst created by the kidneys.

 

I guess my main question is how quickly can/do the kidneys shut down? Is there a type of time frame? He has already started to lose some weight -- I think attributed to the lack of appetite he has had the last few weeks. Including pre K/D. He seems happy and acts alright -- a little sleepier in the mornings but otherwise a happy camper. The vet told me the main things that would happen were lose of appetite, fatigue and weight loss.

 

Thanks again, Emily

[Guest EmilyLH]

Additionally, I have read that incontinence medicine can have a direct effect against the kidney stuff? Is there a better way I can try and treat both, safely? Our vet also gave the option of testosterone injections. One every 4-7 depending.

[JohnF]

You asked how long dogs can take to decline? Well, the problem is every dog is different and will handle it in different ways. Some go quickly like one of mine did in just over a month from going off food. The second one made it about 8 weeks and the last one we managed for 18mths to 2 years.

Towards the end you'll often see persistent vomiting and worsening seizures as well as the other symptoms. If you talk to a human kidney sufferer they'll say it feels like a really bad and nauseaous hangover all the time.

You can treat with subcutaneous fluids at home to help keep the stress off the remaining kidney function by flushing toxins out. You can give Antepsin (Sucralfate) or slippery elm bark to keep the acid-sore stomach linings under control, regular anti-nausea meds, and Calcitrol to help stabilsise the ion balance too. Plenty of stuff to try.

You have to be careful with the strong NSAIDs like Metacam (already someone mentioned this) as they too can restrict blood flow to the kidneys - the last thing you need.

I found that Yahoo support group to be incredibly helpful and there is a huge resource of kidney-specific message threads and what to do info there. They require you to upload the most recent vet lab report.

http://pets.groups.yahoo.com/group/K9KIDNEYS/

[duncan41]

FWIW: A friend's 4 year old male has a "normal" Creatinine of 3.0. Everything else is in the normal range for any dog - greyhound or not. He has no symptoms of kidney failure.

 

When my Suze has ARF, her kidneys looked horrible on the ultrasound - not much left of either one. That was February, 2009 and she's lying at my feet right now only because my chair isn't big enough for the two of us, with a "normal" Creatinine of 2.6. Sounds like you may need to start from the beginning and consult with a board certified internist, preferably one that is familiar with greyhounds or one that is willing to learn. Consultation with Ohio State's Greyhound Health and Wellness Program is a viable option, too. https://greyhound.osu.edu/ If you can get hard copies of his medical records (including all tests) and email them, you will receive a response relatively quickly. Note: you must "join" for $99.00, but that's a heck of a lot cheaper than a visit to a specialty clinic. You can consult with a very good Veterinary Nutritionist, Dr. Rebecca Remillard at rremillard@mspca.org who "sees/hears" the worst of the worse every day. She will want all medical records and test results as well in order to formulate a diet. These are things that I have done as a result of my close encounter with ARF and it's consequences. Every dog is different, so please go with your instincts and do what you know to be in the best interest of Midas. There is no timetable with this disease. You need a diagnosis first followed by a treatment plan.

Please update when you can. Will be sending prayers.

[Guest EmilyLH]

Thank you, again! I am a little overwhelmed with everything! It's nice to know that there are other dogs who have had similarities to Midas -- makes me feel as if this isn't as bad as the vet made it seem to be. Thanks!

[OwnedBySummer]

My vet, the one I had happily used for 11 years with my previous non-greys... told me that Summer had kidney problems, too. Scared the life out of me. Armed with a copy of the results, I contacted Ohio State University as well as Dr. Dodds at Hemopets and both places told me that her bloodwork was JUST FINE. I have since switched to a greyhound savvy vet as (a) I wasn't willing to go through that again and ( I certainly no longer trusted that clinic. If you would like a full copy of standard greyhound results for a full bloodwork, just let me know. I know you probably can't PM yet so you can email me at "rainbrighton@hotmail.com". I don't know if your dog does or doesn't actually have kidney issues but hang tight! Make sure your vet is using greyhound values, that's the first step.

[MaryJane]

I also suggest doing a consult with Dr Remaillard for a kidney diet. I have used her countless times for home-made kidney diets, cancer diets and regular diets and I cannot praise her enough. She will do consults over the phone.

 

I also would reconsider taking any medication to "stop the urine". Usually I would think that you want to make sure that the kidneys keep on functioning and they need "liquids" to do that. But, I'm not a doctor so, at the least get a second opinion on courses of treatment.

 

As a note, a previous greyhound of mine had an "acute" kidney issue (source unknown?) and protein was leaking into the urine and his creatinne was high. A few months on the kidney diet and the issues were resolved and he went to a regular diet. One of my current greyhounds runs a high creatinne and a low specific gravity and his condition is controlled with a kidney diet. In his case, I increased his protein intake (phosphorous) to a normal level a few times and it ended up causing problems and so .. he has stayed on a kidney diet. He gets updated bloodwork every 8 to 12 months to ensure that there are no changes.

[Guest EmilyLH]

I wrote to Dr. Dodds at Hemopets. She had some good news for me. Although still bad news, she did say that his BUN was a high normal, although his creatinine was high. She also recommended testing for thyroid, and dosing for that IF there were a problem. She said if there were, the meds would help to regulate tissue and helping kidney function.

 

She also thought that the Proin was ok to keep Midas on. That it didn't affect his kidneys, as the PPA was meant to tighten the sphincter so he does not drip and urine does not leak out from the bladder.

 

She also recommended some food to try, holistic type foods that were not K/D. THat were dairy, wheat and corn free. As well as some additives to put into the kibble to help with the kidneys.

 

Thank you for all of your help and sharing your experiences. I am so glad that I am able to feel as if Midas still has a long life ahead of him, and that he isn't as bad off as the vet here made it seem like. She said because the ultra sound revealed one kidney not functioning and another one only partially functioning, that it's most likely early stages of chronic progressive renal failure.

[Guest zoolaine]

Luna (non-grey) started having kidney issues earlier this year. She would not eat the K/D or the other kidney kibble that we tried - it was around the time that Sunny got very ill and subsequently died of cancer, so I think she was depressed with that since they are litter mates and had been together everyday of their lives. She is on the home cooked diet with hamburger, rice, bread, boiled eggs and crushed Tums. Problem is that she doesn't like the rice or bread but will eat pasta so we do that instead. Not sure how it is going - we go back for blood work in another month.

 

Luna has been on thyroid meds for several months now, the last blood work her thyroid numbers were actually high but the vet didn't want to decrease her meds because it has a protective effect on the kidneys.

 

hugs to you and Midas -

[Batmom]

I honestly would consult another vet.

 

The values depend on your lab's normals, but I have never seen a set of normals where BUN of 35 and creatinine of 3 are not high. At every lab I've used, those would be nothing like high normals. They're high.

 

Thyroid supplementation does not protect kidney function. Rather the opposite. You need to be rigorous in periodically checking kidney-related blood chemistry if the dog is taking thyroid supplements.

[Guest EmilyLH]

I honestly would consult another vet.

 

The values depend on your lab's normals, but I have never seen a set of normals where BUN of 35 and creatinine of 3 are not high. At every lab I've used, those would be nothing like high normals. They're high.

 

Thyroid supplementation does not protect kidney function. Rather the opposite. You need to be rigorous in periodically checking kidney-related blood chemistry if the dog is taking thyroid supplements.

 

 

 

I found a vet in Idaho where we'll be moving, that is greyt savvy. Recommended by the rescue group in Boise. I will definitely take Midas there to go over everything!

[OwnedBySummer]

Glad to hear you will be having a different vet!