Renal Failure And Congestive Heart Failure

[Guest meakah]

I am sad to report my 9.5 year old Koda has officially been diagnosed with Renal Failure.

I had her teeth cleaned in January 2010 in which her bloodwork showed the early stages. I was advised to put her on a lower protein diet but not a prescription one yet. After random bouts of diarrhea, struggles to get her to eat different types of kibble, and weightloss, I decided to switch her (and my other animals) to a raw diet about 2 months ago. Koda did well at first but then the weightloss continued. She has been sporadically hacking/coughing/choking once in a while and it has gotten worse over the past few months. Her mouth is rotted once again and she just smells....bad....not just a bad mouth smell. I got more bloodwork/urinalysis/parasitology done on December 20th and her values were not great.

 

Dec.20 (January 20, 2010)

AMY 1529 (1144) (Normal: 200-1200)

BUN 93 (46) (Normal: 7-25)

CRE 3.2 (2.1) (Normal: 0.8-2.1)

GLU 128 (114) (Normal: 60-110)

 

Urinalysis:

pH: 6.0

Specific gravity: 1.028

Blood: ++

Protein: +++

 

Parasitology: No parasites found

 

Her lymphnodes in her throat were huge at the visit. The first thought is lymphoma but because her teeth are so horrendous, the vet thinks it is due to her mouth. She prescribed 10 days worth of antibiotics, diet change, and more bloodwork in a month or so.

 

I now have her on a prescription kidney diet (SD K/D and/or Medi-cal Low Protein). She is really liking it but I am not a fan of the prescribed foods. I would like to try and find her a good kidney diet I could make for her. Any ideas?

 

The antibiotics killed what little appetite she had and so the vet told me to put her on Zantac 75mg BID. This seemed to help. She is now done her antibiotics but the coughing/choking continues....sporadic episodes. Once in a while she lays there panting really hard and almost wheezing sounding. I am not sure if she is in pain or if she has some sort of lung infection or what is going on. She seems happy otherwise. I still take her to the park and she is a happy go lucky girl and even sprints a bit followed by some coughing/choking. I spoke to the vet yesterday about her wheezing/coughing/choking and she suggested chest x-rays. So she goes in on Jan. 11 for 2 chest x-rays.

 

She seems to have so many different things going on that I don't know what to do really. She looks 10 yrs older now compared to this time last year. It is really heart breaking. Her ribs/spine/hips are sticking out and her mouth is a mess. The vet thinks we should yank the rest of her teeth if/when she goes under again. But right now it seems we may have bigger things to worry about. Her normal weight is 67lbs for years. When I weighed her 2 months ago before commencing raw diet, she weighed 67lbs (which I was surprised because she seems so thin compared to what she normally looks like) and then she weighed in at 65lbs at the vet 2 weeks ago (could be just a scale difference too). So the weightloss is not huge but she has lost a lot of muscle mass and just "looks" old and frail.

 

Anyone have any advice? I am just feeling a little lost. I have not had to deal with this sort of stuff before. The vet wants to start her on Benazepril (ace inhibitor) asap, and possibly Calcitriol (hormone). Any experience with this?

 

ETA: The vet also wants to start her on a phosphate binder....any suggestions?

Edited February 12, 2011 by meakah

[tbhounds]

Did you ever run a lepto panel?? Also, if you would rather homecook there is a Dr out of Angel Memorial that will design a recipe for you.

Oh, I wanted to mention that a 1.028 urine concentration isn't that bad-- was the sample from the first urine of the morning??

Edited January 5, 2011 by tbhounds

[Guest mcsheltie]

Join the big Yahoo kidney group and post the numbers and symptoms there - link There is more knowledge on this subject than anywhere else.

 

Yes to the phosphorus binder!!!

 

I see tbhounds mentioned Lepto. A TBD panel is always a good diagnostic tool for GHs. These diseases show up in weirdest ways and are at the root of a lot of disease processes.

 

Have they done a chest x-ray? FNA of the lymph nodes?

 

ETA: I just saw you had a chest x-ray scheduled. I would get in there and get that done tomorrow.

Edited January 5, 2011 by mcsheltie

[Tallgreydogmom]

I have used Azodyl with my renal failure greyhounds. Our vet was surprised on how the values dropped. I know Marilyn with Grey Heaven in FL has also used it if she would like to chime in.

 

Here is the link for more information on it.

 

http://www.vetoquinolusa.com/CoreProducts/CardioNephrologyRenal/Azodyl.html

[Guest BiancasMom]

Maybe the coughing/gagging episodes could be Laryngeal Paralysis? It is unrelated to kidney disease and it may just be a coincidence.

[AEB]

I already posted some of this elsewhere in another thread and apologize for some repeat here. I hope that maybe you can glean something from our experience. First, I am so sorry you are going through this. I am sure it feels like a whirlwind and you're not even completely sure of everything that is going on. It is a terrible feeling not to know. I hope things improve with Koda soon.

 

We lost our Sadie in July after battling kidney disease for two years. We began by monitoring her values frequently. We gave her baby aspirin. But after some research I decided to stop. Medication (Enalipril) was eventually added, and eventually increased. Eventually our vet suggested we needed to adjust her diet. We chose Iams early stage renal. She was 11 when all of this began. We cooked the wet portion of her diet.

She did well until sometime last year, early 2010 when things changed. At first the changes are subtle and we didn't notice because we lived with them everyday. Like you mentioned there was this strange swallowing thing she did, like she was choking. It had become more frequent. I thought it was thyroid related. And she started panting more- a lot more. And yes, her teeth were bad. But she had not had a dental in several years. They were much better than they had been in the past because of home cooking since the 2007 food recalls and the scaling I did at home. But her mouth was like low tide at the town dock. And she started to smell all over. Her anal glands were a problem that we constantly struggled with in the last few years, but this was a weird funk.

 

She had lost some weight but it started going down steadily despite her eating. Our vet said it was a race between her kidneys and weight. We could no longer keep the weight on. She was dropping it like crazy. Eventually she had lost so much muscle mass that she was having trouble standing and would be weak in the rear and stand like a German Shepherd. We kept visiting the vet weekly for weight checks. When she got to 50lbs (from 65lbs 9 months before) we stopped weighing her and just did everything we could. We knew she was still losing. She lost more than that before we said goodbye.

 

I do wonder what was really going on. There were other problems at work. It is heart-breaking. I can simply tell you that in our case her weight ended-up being more of an issue in the end. We got to a point where the vet said forget the kidneys, feed her whatever you can to get the weight on her. She just continued to lose so rapidly despite every effort. So just keep a close eye- on her weight. Weigh her no less than every week. She could lose several pounds in a week and not be able to get them back on. And the low protein diet of a prescription kidney diet . . . I am clearly not a vet but in the end it did Sadie no favors because of the weight problems. There are websites out there that discuss alternative ideas as to diet in a situation such as this. I wish I could find them right now. I will look later when I have more time. I should have bookmarked them. Maybe they could be of help? And do not hesitate to talk to another vet. Ours would consult with others. I just wish you all the best.

[Guest Swifthounds]

Join the big Yahoo kidney group and post the numbers and symptoms there - link There is more knowledge on this subject than anywhere else.

 

Yes to the phosphorus binder!!!

 

I see tbhounds mentioned Lepto. A TBD panel is always a good diagnostic tool for GHs. These diseases show up in weirdest ways and are at the root of a lot of disease processes.

 

Have they done a chest x-ray? FNA of the lymph nodes?

 

ETA: I just saw you had a chest x-ray scheduled. I would get in there and get that done tomorrow.

 

[Guest mcsheltie]

Low protein diets are not what is needed with kidney patients. You need high quality protein. High quality protein is easily digestible and does not produce the by-products that tax the kidneys. Low protein diets actually increases the problem. Protein from grain sources increases the problem, the quantity of nitrogen waste created by these is high. Egg whites and fish are at the top of protein chart. These are usually coupled with a grain that is very low in phosphorous and a fat source from fish oil. Add a phosphorus binder sooner, rather than later.

 

No dry food for a cat or dog with kidney problems. Often adding B Vits helps regain their appetites. B Vits are lost because the kidneys have lost the ability to retain these vitamins.

 

One of my pet peeves is that vets need to start patients with declining kidney function on a kidney diet right away. Not wait until it gets to a certain stage. The sooner you decrease the work the kidneys need to do the better for the dog or cat.

 

Watch the blood pressure and for anemia like a hawk.

 

Anytime a dog with kidney disease does not have a good appetite administer sub-q fluids.

 

ETA: Low sodium is also a diet requirement.

Edited January 5, 2011 by mcsheltie

[AEB]

McSheltie is discussing what I was thinking of re: diet.

[greyhounds1234]

I just joined the K9Kidneys Yahoo group. They aren't your average yahoo chat group.

They do want you to fill out a lengthy questionnaire including all of your dogs blood work, urinalysis, etc. so have all of your printouts handy if you sign up. I tried to do it yesterday and ended up with a raging headache but I did get it finished and submitted today.

 

They recommend reading this site for kidney disease info and I have learned a lot from just the first reading.

http://dogaware.com/health/kidneymedical.html#subq

[Guest meakah]

Did you ever run a lepto panel?? Also, if you would rather homecook there is a Dr out of Angel Memorial that will design a recipe for you.

Oh, I wanted to mention that a 1.028 urine concentration isn't that bad-- was the sample from the first urine of the morning??

I didn't run a lepto panel....perhaps I will have them do that when we run blood work again in a few weeks. Thanks for that and the heads up on the recipe.

 

The urine I collected was the first urine after work....about 2pm and she had been in the house since 7am...and had breakfast at 7am.

 

Join the big Yahoo kidney group and post the numbers and symptoms there - link There is more knowledge on this subject than anywhere else.

 

Yes to the phosphorus binder!!!

 

I see tbhounds mentioned Lepto. A TBD panel is always a good diagnostic tool for GHs. These diseases show up in weirdest ways and are at the root of a lot of disease processes.

 

Have they done a chest x-ray? FNA of the lymph nodes?

 

ETA: I just saw you had a chest x-ray scheduled. I would get in there and get that done tomorrow.

I did join the yahoo Kidney group and the yahoo Kidney diet group over the last day or two. I saw those links on another thread for kidney disease. Thanks!! Valuable resources indeed!! I have yet to get all the way through the process so I have not posted Koda's values yet but I will be doing that in the next week or so.

 

I will start her on a phosphorus binder asap.

And no FNA of the lymph nodes. We were going to see if they went down after some antibiotics assuming her teeth were the culprit.

I would get her chest x-ray done sooner but they can't do it until Tuesday due to a lack of staff this week.

[greyhead]

Low protein diets are not what is needed with kidney patients. You need high quality protein. High quality protein is easily digestible and does not produce the by-products that tax the kidneys. Low protein diets actually increases the problem. Protein from grain sources increases the problem, the quantity of nitrogen waste created by these is high. Egg whites and fish are at the top of protein chart. These are usually coupled with a grain that is very low in phosphorous and a fat source from fish oil. Add a phosphorus binder sooner, rather than later.

 

No dry food for a cat or dog with kidney problems. Often adding B Vits helps regain their appetites. B Vits are lost because the kidneys have lost the ability to retain these vitamins.

 

One of my pet peeves is that vets need to start patients with declining kidney function on a kidney diet right away. Not wait until it gets to a certain stage. The sooner you decrease the work the kidneys need to do the better for the dog or cat.

 

Watch the blood pressure and for anemia like a hawk.

 

Anytime a dog with kidney disease does not have a good appetite administer sub-q fluids.

 

ETA: Low sodium is also a diet requirement.

 

This is a very valuable post! Please reread it when you feel overwhelmed by all the information out there. The basic things of central importance are here.

 

I don't know if I'd wait several weeks for a Lepto test. Kidney stuff can go downhill very fast. If Lepto is at the base of it, you'll want to tackle it. Just my thinking.

 

Wishing you and your family all the best,

Mary

[Guest meakah]

I have used Azodyl with my renal failure greyhounds.

Thanks for the info, I will check into that.

[Guest meakah]

To reply to the others....

 

I have considered the coughing/choking being completely unrelated to the kidney disease. This is why I am even more concerned. :S

 

 

AEB, thanks so much for all of that info. I am very sorry you had to go through that. I appreciate you sharing your story in order to help others.

 

mcsheltie, interesting post. You are not the first to tell me this and so I have been thinking and researching. I am actually more on your train of thought than the low protein one. I just felt I needed to do something quick but perhaps it was not a good choice. I will have to find out how I could find a good recipe with higher but BETTER proteins. Thanks for that information.

Watch the blood pressure and for anemia like a hawk.

What sort of things would I be watching for? Pale gums and distress I would imagine...anything else?

I did ask the vet about getting set up at home for sub-q fluids as required but she didn't think it was a good idea and said dogs don't take to sub-q fluids as well as cats. Any thoughts on that? I thought ok...maybe that is true...but isn't some better than none? And I have had a home set up in the past for one of my cats so it is something I can do easily at home if needed.

Also, she is on canned food cuz I don't think her teeth would tolerate her eating kibble. So at least I am doing something right there... I will look into adding vitamin B to her diet...any good sources? And I do add Salmon Oil to every meal she gets. I also add Solid Gold SeaMeal...figure it can't hurt her.

[Guest mcsheltie]

To reply to the others....

 

I have considered the coughing/choking being completely unrelated to the kidney disease. This is why I am even more concerned. :S

 

 

AEB, thanks so much for all of that info. I am very sorry you had to go through that. I appreciate you sharing your story in order to help others.

 

mcsheltie, interesting post. You are not the first to tell me this and so I have been thinking and researching. I am actually more on your train of thought than the low protein one. I just felt I needed to do something quick but perhaps it was not a good choice. I will have to find out how I could find a good recipe with higher but BETTER proteins. Thanks for that information.

Watch the blood pressure and for anemia like a hawk.

What sort of things would I be watching for? Pale gums and distress I would imagine...anything else?

I did ask the vet about getting set up at home for sub-q fluids as required but she didn't think it was a good idea and said dogs don't take to sub-q fluids as well as cats. Any thoughts on that? I thought ok...maybe that is true...but isn't some better than none? And I have had a home set up in the past for one of my cats so it is something I can do easily at home if needed.

Also, she is on canned food cuz I don't think her teeth would tolerate her eating kibble. So at least I am doing something right there... I will look into adding vitamin B to her diet...any good sources? And I do add Salmon Oil to every meal she gets. I also add Solid Gold SeaMeal...figure it can't hurt her.

Blood pressure & anemia need to be monitored by your vet. Checking for anemia is done in a standard CBC. Dogs with renal problems should be getting blood work done every six months (or sooner if they are going downhill)

 

Dogs are no harder to give sub-q fluids than a cat. Easier in fact! Making a dog stand still is MUCH easier than a cat!

 

Give 1/2 of a 50 mg HUMAN B Vit pill once a day. B Vits taste bad, so pop it down her throat. Don't give it in a treat or hidden in her food.

 

Up the amount of salmon oil if she will tolerate it.

 

Ask on the kidney list for diet recommendations. If you want to run any by me, feel free.

Edited January 5, 2011 by mcsheltie

[AEB]

Thank you. I am glad to share in the hope that it may help another grey. I tried to do my best for Sadie, but with 20/20 hindsight . . .

When we got Kevin a few weeks ago I was pointed to GT as a resource. I saw a post on kidney issues by another GTer and it spured me to join.

 

 

I can't emphasize enough my belief that low protein was not right for Sadie. It doesn't mean it is not right for your girl. But the weight she lost as a result of that diet could not have been easy on her kidneys.

 

As for blood pressure, very difficult to get in the vet's office. She would be too nervous. We wanted a confirmation of a significant elevation before adding Enalapril (again, greys have a different "normal" as to BP as well). We ended up having the techs come to the car. She loved the car and felt safe there. The sound during the reading scared her but not like being in the office. Something to think about for BP readings and your girl.

 

Also, the swallowing thing, Sadie had thyroid problems (at least we thought she did- I'm not sure about anything anymore). Could it be an enlarged thyroid that your girl has??

[Batmom]

Just a note about diet: The reason you need to reduce protein is twofold. 1. With protein comes phosphorus. All the proteins that we feed are high in phosphorus. 2. It is the protein fraction of any feed that produces nitrogenous waste, which is hard for damaged kidneys to handle. The recommendations and articles you see on many websites re not reducing protein for dogs with kidney disease -- those recommendations apply to early-stage renal insufficiency. That would not describe your dog at this point.

 

And a note about other things: Get a urine culture.

 

Hugs and best luck.

[Guest meakah]

Just a quick update....she is going downhill VERY quickly. :( Last night she had laboured breathing for quite a few hours with intermittent coughing/choking/gagging. And she would hold her head straight out....head sort of held high with throat fully stretched out...perhaps trying to open her trachea as much as possible. She really labours her breathing while laying on her side and seems to find some relief when propped straight up (in a sphinx position...in which she NEVER does) and her head/neck resting on a blanket or pillow. Her breathing improved throughout the night but she kept getting up coughing/gagging and then would lie back down again. This morning she seemed a bit more comfortable but still not really herself. I was in another city and so I couldn't take her to my vet but I did call. I was able to bump up the chest/neck x-rays to tomorrow so that is a relief. And the vet suggested I try giving her a cough suppressant if she has another rough night. She has lost a tremendous amount of weight in the last couple of weeks and looks like a walking skeleton. Her spine is even sticking out between her should blades. This is heart breaking because I don't know what to do for her. Hopefully I get some answers tomorrow. I am leaving her there for the day so they are going to really check her over and take some pictures of her chest/neck/head to see what is going on. Please keep Koda in your thoughts....I am starting to get really concerned for my girl...

[AEB]

I am so sorry. I will keep her in my thoughts. I hope you will have answers. I hope she is comfortable tonight. Good luck tonight getting some sleep. Let us know how it goes tomorrow when you can. I hope for the best.

[NeylasMom]

I think if you don't get clear answers from the x-rays tomorrow, you need to see an internist. Additional tests as mentioned above - urine culture, TBD testing, and lepto test, plus you might consider an abdominal u/s if those are all negative.

 

I also second everything mcsheltie said about diet - switching to a homecooked diet would be your best bet and may encourage your dog to eat more. Add a phosphorus binder and calcium to balance the phosphorus, plus also recommend trying the Azodyl (no harm, it's just a probiotic w/psyllium husk to get them to the gut). Details on all of this if you join the k9kidney yahoo group.

 

I'm sorry you'r edealing with this, I hope you get some clear answers soon.

[Guest Swifthounds]

[kudzu]

Also, she is on canned food cuz I don't think her teeth would tolerate her eating kibble. So at least I am doing something right there... I will look into adding vitamin B to her diet...any good sources? And I do add Salmon Oil to every meal she gets. I also add Solid Gold SeaMeal...figure it can't hurt her.

A note of caution on oral b-vitamins is that it can upset some dogs' stomachs. I believe the suggestion for adding b-vitamins is an excellent one. It was one of the most beneficial things I did for my dog. However, I found the injectable form to be the best for us. It was given sub-q & the needle used was quite small. Easy, peasy even for queasy me-sy. Also, in my experience dogs are no less tolerant of sub-q's than cats. In fact, they are easier. Your vets opinion seems to be a not too uncommon one. It baffles me. Yes, it takes more fluids for dogs but I found actual administration easier & the benefits just as real for my dog as my cat. However, the cough is a big concern. Unless she is dehydrated you would not start administering fluids until you knew more about the cause of that cough. I hope the xrays & exam tomorrow can give you some answers.

[MaryJane]

Switch to a home-cooked diet where you can control the amount of protein/phosphorous better. I have used Dr Remaillard at Angel memorial in Boston for cancer, kidney, and regular diets and she does phone consults.

 

Good Luck

[Guest 2dogs4cats]

I am dealing with this as well with my 14 year old greyhound. My girl started losing weight and urinating more frequently. It sounds like your pup is maybe a more advanced stage than mine. My dog coughs/hacks like your's does which makes me think it is related to the kidney problem. Kidneys control the moisture in the body, which includes the lungs. The dryness in the lungs creates this cough. (I think)

 

I have successfully gotten my girl's weight back up with a combo of Canidae Platinum canned (really smelly so she loves it and pretty low in phosphorus), eggs, raw ground beef (fatty), Total cereal, cream cheese and cottage cheese. She has now bypassed her normal weight and I think a little extra will be good for her. I had the vet calculate the calories needed for the goal weight (this was very helpful). My vet said most dogs don't like the prescription diet much and she didn't really recommend it. I am no expert, this is just what I formulated to help her gain weight. It seems the weight issue is a big problem with this disease. The more weight she gains, the more her syptoms weaken. Every dog is different though. I think some progess slow and some fast.

 

I also have her on Liu Wei Di Huang Wan. This is a Chinese medicine formulation which includes Rehmannia. I have just begun, so I don't know if it really helps, but will let you know. I am also a member of K9Kidney, but couldn't find much info on people using this.

 

I know what you are going through. It is so difficult. I lost my Grey boy in 2009 at the age of 13. It is heartbreaking. Good luck to you.

[greyhead]

Also, she is on canned food cuz I don't think her teeth would tolerate her eating kibble. So at least I am doing something right there... I will look into adding vitamin B to her diet...any good sources? And I do add Salmon Oil to every meal she gets. I also add Solid Gold SeaMeal...figure it can't hurt her.

A note of caution on oral b-vitamins is that it can upset some dogs' stomachs. I believe the suggestion for adding b-vitamins is an excellent one. It was one of the most beneficial things I did for my dog. However, I found the injectable form to be the best for us. It was given sub-q & the needle used was quite small. Easy, peasy even for queasy me-sy. Also, in my experience dogs are no less tolerant of sub-q's than cats. In fact, they are easier. Your vets opinion seems to be a not too uncommon one. It baffles me. Yes, it takes more fluids for dogs but I found actual administration easier & the benefits just as real for my dog as my cat. However, the cough is a big concern. Unless she is dehydrated you would not start administering fluids until you knew more about the cause of that cough. I hope the xrays & exam tomorrow can give you some answers.

IIRC, I read/heard some time ago that dogs don't absorb sub-q fluids as well as cats do, not that they resist it behaviorally. I don't know what that means, unless it just takes a longer time for absorption to occur. But at this stage I wonder if getting some IV fluids at the vet's would be a better idea.

 

Here's hoping that you get some good answers and good help tomorrow...which I guess is today where you are!