Fenway's Mystery Pee Problems - Ultrasound Results: Kidney Damage

[Guest 2dogs4cats]

Ultrasound revealed kidney damage. Blood pressure, BUN, creatinin (sp?), etc all are considered normal and within range. So now I research kidney diets. And check urine/blood every 6 months to monitor any changes. Oh, and learn to live with pee accidents.

 

Research Rehmannia 6 and 8. You do not have to live with pee accidents. Incontinence meds won't help, but Chinese supplements are keeping my girl accident free and I am sure she is more advanced stages than your pup. Ella is 14. Also, I may be in the minority, but I do not have her on a kidney diet as I think they lead to decline faster with an under nourished dog. With normal blood work still, you should be fine with a normal diet, but add either canned or foods with a lot of moisture. Hydration is key. So sorry to hear of the diagnosis. This is why I asked if Fenny had eaten anything strange. Something so innocent as raisins can decrease kidney function. Hopefully, her damage will remain as it is now. With the right supplements, I think it is manageable. Healing thought for Fenny and you.

[gracegirl]

A specific gravity of 1.014 and 1.015 is on the low-end of normal, but not dilute enough to indicate Diabetes Insipidus usually. I think for DI it needs to be 1.005 or less. But if the vet begins to suspect DI, I might be able to offer some advice. My dog Cody has DI and is on ADH pills (desmopressin).

 

Does Fenway have incontinence? Could one of the anti-incontinence drugs (DES, Proin) help with the accidents?

 

We go through a lot of pee pads here. Mostly for Sophie, but for Cody as well. PetEdge.com seems to have the best price I've found (I like the XL ones).

 

 

 

~Lindsay~

 

Hi Lindsay. Thanks for the additional info. I really appreciate it! Fenway is not incontinent in the terms of losing control of his bladder while sleeping. Every accident he's had has been in the dining room, the least used room in the house, while he is awake. He always wakes me up in the night if he needs to go out...so it's more that he's drinking more, producing more urine, and therefore needing to go outside more often. He has a dog walker that comes at lunch, but sometimes that's just not enough. Grace is on proin so I'm familiar with the symptoms of a dog that is incontinent while sleeping. (BTW, that's totally under control for Grace now with Proin. Yipee!)

 

We did get a diagnosis today after the ultrasound of kidney damage. And thanks for the info on the pee pads! I'm trying to determine the best course of action to contain the pee accidents.

[gracegirl]

Ultrasound revealed kidney damage. Blood pressure, BUN, creatinin (sp?), etc all are considered normal and within range. So now I research kidney diets. And check urine/blood every 6 months to monitor any changes. Oh, and learn to live with pee accidents.

 

Research Rehmannia 6 and 8. You do not have to live with pee accidents. Incontinence meds won't help, but Chinese supplements are keeping my girl accident free and I am sure she is more advanced stages than your pup. Ella is 14. Also, I may be in the minority, but I do not have her on a kidney diet as I think they lead to decline faster with an under nourished dog. With normal blood work still, you should be fine with a normal diet, but add either canned or foods with a lot of moisture. Hydration is key. So sorry to hear of the diagnosis. This is why I asked if Fenny had eaten anything strange. Something so innocent as raisins can decrease kidney function. Hopefully, her damage will remain as it is now. With the right supplements, I think it is manageable. Healing thought for Fenny and you.

 

Thank you! This is very helpful information. I'm going to be exploring a home cooked diet or modified diet first. I'm not super keen on placing him on an Rx diet right away. Especially since he is so young. We have no idea what caused it. Could have been congenital. Could have been from a previous kidney infection from either when he was a puppy or one that was minor and therefore went untreated. Could have been from 1,000 other things too!

 

The pee accidents are really not a big deal. If I can find something to help them...great! If not, they are so dilute that they are really not that big a deal at all. I hope to someday move to a house where I can have a dog door.

[Guest davidsl88]

Ultrasound revealed kidney damage. Blood pressure, BUN, creatinin (sp?), etc all are considered normal and within range. So now I research kidney diets. And check urine/blood every 6 months to monitor any changes. Oh, and learn to live with pee accidents.

 

Research Rehmannia 6 and 8. You do not have to live with pee accidents. Incontinence meds won't help, but Chinese supplements are keeping my girl accident free and I am sure she is more advanced stages than your pup. Ella is 14. Also, I may be in the minority, but I do not have her on a kidney diet as I think they lead to decline faster with an under nourished dog. With normal blood work still, you should be fine with a normal diet, but add either canned or foods with a lot of moisture. Hydration is key. So sorry to hear of the diagnosis. This is why I asked if Fenny had eaten anything strange. Something so innocent as raisins can decrease kidney function. Hopefully, her damage will remain as it is now. With the right supplements, I think it is manageable. Healing thought for Fenny and you.

 

Thank you! This is very helpful information. I'm going to be exploring a home cooked diet or modified diet first. I'm not super keen on placing him on an Rx diet right away. Especially since he is so young. We have no idea what caused it. Could have been congenital. Could have been from a previous kidney infection from either when he was a puppy or one that was minor and therefore went untreated. Could have been from 1,000 other things too!

 

The pee accidents are really not a big deal. If I can find something to help them...great! If not, they are so dilute that they are really not that big a deal at all. I hope to someday move to a house where I can have a dog door.

 

As frustrating as this has been, I'm so glad for you and Fenway that the 'mystery' has been solved... Good luck to you both!

[MaryJane]

I got my home-cooked kidney diet for Larry from Dr Remaillard at Angel in Boston. She does phone consults.

 

http://www.mspca.org/vet-services/angell-boston/nutrition/

 

Good Luck

[Guest MorganKonaAlex]

I got my home-cooked kidney diet for Larry from Dr Remaillard at Angel in Boston. She does phone consults.

 

She did the diet for my Kona also.

[Guest mcsheltie]

I do not have her on a kidney diet as I think they lead to decline faster with an under nourished dog.

Kidney diets do not cause undernourishment. A kidney friendly diet uses high quality protein so the renal system has less work to do. The point of a kidney friendly diet is to provide top quality easily digested nutrition. Waiting until your dog has significant kidney damage to start supporting the kidneys with diet is counterproductive. Like shutting the barn door after the horse has escaped.

 

Another excellent nutritionist is Monica Segal.

[BauersMom]

If you need pee pads, I highly recommend Pooch Pads. They are washable and reusable.

[GeorgeofNE]

Well, at least you know what to research and how to attack it. Pee accidents are no fun but you can learn to live with them. Hugs to Fenway for being such a trouper through all of this. You, too!

 

Thanks Carron! There are many worse things that pee on the hardwood floors. I'll explore other options too, if the diet change doesn't help clear those up. He was so good for the radiologist today. He lay down on the floor and didn't move a muscle the whole time she was doing the u/s. I didn't go back with him because he was being so good without me...I just let them proceed without my interruption. And he got a liver brownie as a reward. Mmmmmm, liver!

 

They did it on the floor?

 

George was laying in a U shaped foam form with his legs up in the air!!!!

 

Kramer did very well on Hills' kidney diet. Yeah yeah, I know, people think it's "crap." What can I tell you? It fixed his problem, and when he did eventually die, it was from a nerve sheath tumor and certainly nothing related to Hills food!

[gracegirl]

You know the interesting thing as I'm researching kidney diets today....I've tried him on several grain free/high protien foods in the past with horrible results. Gas, the BIG D, etc. Might not be a connection, but interesting none the less.

 

So many desisions!

[NeylasMom]

You know the interesting thing as I'm researching kidney diets today....I've tried him on several grain free/high protien foods in the past with horrible results. Gas, the BIG D, etc. Might not be a connection, but interesting none the less.

 

So many desisions!

As McSheltie pointed out, the digestibility of the food, particularly the protein is key when feeding a kidney dog. You're not going to get that from a processed kibble, even a high quality grain free one like you would from home cooked food, particularly meat and eggs. The gas and big D could be due to any number of things in the kibble. I certainly would not draw any conclusions between this issue and that.

[Guest 2dogs4cats]

I do not have her on a kidney diet as I think they lead to decline faster with an under nourished dog.

Kidney diets do not cause undernourishment. A kidney friendly diet uses high quality protein so the renal system has less work to do. The point of a kidney friendly diet is to provide top quality easily digested nutrition. Waiting until your dog has significant kidney damage to start supporting the kidneys with diet is counterproductive. Like shutting the barn door after the horse has escaped.

 

Another excellent nutritionist is Monica Segal.

 

Well if you read all the recent research, this point is hotly debated by the specialists. The majority of the recent research says that a kidney diet is not necessary if the blood work is normal and that diet does not harm the kidneys or cause the disease to progress at any rate other than what it would. What I was talking about were the commercial kidney diets that are low in protein and in my opinion will cause undernourishment in a 4 year old dog. This is a young dog that needs protein. With kidney disease, the damage is done and kidneys will not be restored, nor are they harmed with diet.

The disease will progress as it wants to, regardless of diet. The point of the kidney diet in the advanced stages is to reduce the amount of toxins that will build up in the blood. Just my opinion. However, there is another camp that will argue your point.

[greyhead]

It's discomfitting to hear that there can be kidney damage that doesn't show up in the blood work. Is that what they mean when they say that the kidneys are 50-75% gone before the damage usually shows up?

 

 

[JJNg]

It's discomfitting to hear that there can be kidney damage that doesn't show up in the blood work. Is that what they mean when they say that the kidneys are 50-75% gone before the damage usually shows up?

Yes, there has to be significant loss of kidney function before any obvious signs can be detected. In general, dogs become unable to concentrate their urine with a loss of at least 66% of the nephrons (the functioning unit in the kidneys). This is when you start to see increased drinking and urination, and the urine specific gravity stays around 1.008-1.012. But it is not until there is 75% loss of function that BUN and creatinine become elevated on bloodwork. Kidney damage can be detected earlier on ultrasound by looking for structural abnormalities.

 

This is why people can donate a kidney and not affect their own health. Losing a kidney is essentially 50% loss as long as the remaining kidney is fully functional.

[Guest davidsl88]

I do not have her on a kidney diet as I think they lead to decline faster with an under nourished dog.

Kidney diets do not cause undernourishment. A kidney friendly diet uses high quality protein so the renal system has less work to do. The point of a kidney friendly diet is to provide top quality easily digested nutrition. Waiting until your dog has significant kidney damage to start supporting the kidneys with diet is counterproductive. Like shutting the barn door after the horse has escaped.

 

Another excellent nutritionist is Monica Segal.

 

Well if you read all the recent research, this point is hotly debated by the specialists. The majority of the recent research says that a kidney diet is not necessary if the blood work is normal and that diet does not harm the kidneys or cause the disease to progress at any rate other than what it would. What I was talking about were the commercial kidney diets that are low in protein and in my opinion will cause undernourishment in a 4 year old dog. This is a young dog that needs protein. With kidney disease, the damage is done and kidneys will not be restored, nor are they harmed with diet.

The disease will progress as it wants to, regardless of diet. The point of the kidney diet in the advanced stages is to reduce the amount of toxins that will build up in the blood. Just my opinion. However, there is another camp that will argue your point.

 

Gracegirl – Help!! I fell down and can’t get up!! LOL!! I’ve lost my place and now I’m confused. Fenway has kidney damage (the cause of which could have been an old untreated infection? making him prone to infection? Maybe he developed a new infection that the AB’s knocked down? – did the AB’s work?), but not (chronic) kidney disease? Are they the same thing? (See what I mean?!!).

 

2dogs4cats – to your point, there are so many different opinions re ‘kidney diet’. And you’re right – the recommendation for a young pup can be very different from the senior and most kidney illness will progress regardless treatment. Talking to the emergency vet and then my own (and trying to find salient info my aching brain can absorb online) - I found this to be the more common view: In ‘support’ of acute disease like stones, a no/low protein diet is recommended, but for no longer than absolutely necessary (4 - 6 months) as malnourishment can be a problem. Combined with high hydration, the stones should dissolve. Kidneys prone to stones will likely develop them again (6 month check up is recommended). Chronic disease can be helped and the dog made comfortable with [protein in the] diet, and even meds if necessary that can help the body process it. Right up there with diet though is water – lots and lots of water, as that is key to helping flush out toxins/processing proteins.

 

For me, that reasoning makes the most sense. My inclination has always been to treat at the lowest level possible for comfort and cure and work my way up as necessary. I also think the best thing for your dog is whatever you find WORKS for your dog. And it sure ain't easy!! LOL!!

[gracegirl]

Ultrasound revealed kidney damage. Blood pressure, BUN, creatinin (sp?), etc all are considered normal and within range. So now I research kidney diets. And check urine/blood every 6 months to monitor any changes. Oh, and learn to live with pee accidents.

 

I’m going to make this my last post concerning this and I am doing so only with the intent of trying to help and because I feel it is very important. If you read my original post with the information about Nadir’s lab work you will notice that he had a microalbuminuria of 4.6, the preferred is less than 2.5. This here is evidence in itself of kidney damage. I’m not saying you shouldn’t research kidney diets, but at least consider the possibility that a food allergy and the strain it is pointing on his bladder could be causing the damage and if a change is not made will only get worse. Once I found the offending food that was causing Nadir’s problem the incontinence or pee accidents went away. So it is very possible that you do NOT have to live with pee accidents.

I'm curious what Nadir's ultrasound revealed. Did it show any kidney damage?

Edited March 11, 2011 by gracegirl

[gracegirl]

Davidsl88...there is no way of knowing what caused Fenway's kidney damage. Since all of his blood values are within normal range, the best course of action is to research diet changes. As noted, there is conflicting info available and my vet did not express immediate concern in making a switch immediately. He also is open to me consulting a nutritionist and either using a combo of commercial foods or a partially home cooked diet if necessary. Unfortunately I have been sick this week so my research is lagging.

 

The absolute most important thing right now is to make sure he has access to water and is drinking plenty. He's doing great with this on his own right now.

Edited March 11, 2011 by gracegirl

[Guest davidsl88]

Davidsl88...there is no way of knowing what caused Fenway's kidney damage. Since all of his blood values are within normal range, the best course of action is to research diet changes. As noted, there is conflicting info available and my vet did not express immediate concern in making a switch immediately. He also is open to me consulting a nutritionist and either using a combo of commercial foods or a partially home cooked diet if necessary. Unfortunately I have been sick this week so my research is lagging.

 

The absolute most important thing right now is to make sure he has access to water and is drinking plenty. He's doing great with this on his own right now.

 

Sorry you're not well... but thanks for the recap... I have an interest since Colby's illness/surgery. His blood was also within range and here too, there seems to be no urgent need for diet change(s). We go back for his follow-up the 16th. You're so right about the water, both Tufts vets as well as mine have all emphasized letting him drink as much as he wants. He's always been a 'heavy drinker' so it was hard to tell the difference when he was so sick, and he still is, so I got a bigger bowl and fill at least 2X day. Oddly (or not) he was still slightly dehydrated that Tuesday I took him to the vet although he'd been drinking lke mad all morning. I hope you're okay, feel better soon... I know Fenway will be fine, he's getting wonderful care.

[MaryJane]

Larry's urine specific gravity has also been a concern for a few years along with a very slightly elevated creatinne. My vet was also somewhat lax about how quickly I should make changes to the diet and pretty much said to keep Larry on dog food that had protein 22% or lower. I didn't take it lightly though - I made changes to his diet that week with him going full onto a 100% home-made kidney diet (before it was 50% homemade and 50% kibble). On his next blood/urine check the values had improved and they have been stable since.

 

The problem with kibble kidney diets is that they are low in protein but it is not necessarily a "good protein" - you don't know what was used to formulate the kibble. If you do home-made, you control how much protein and more importantly - the type of protein. You can ensure that the protein is high-quality and if it is high-quality, you may need less.

 

One note, occasionally I give Larry a little extra meat as a treat and he'll usually end up peeing more that day or the next. It could be if you cut back on the protein a bit, the peeing accidents might decrease. Strangely, Larry might also pee more if I give him a bit of chicken (or noodles) in his dinner which he happens to be "sensitive" to. So, it could be that in your case there may also be some allergic reaction going on that is making the whole situation worse. In that case, I might suggest that you do a home-made limited ingredient diet that is lower in protein.

[Guest mcsheltie]

You don't need to lower the protein. If they are not end stage, what you are looking for is lower phosphorus. Vets will tell you to lower the protein because meat is high in phosphorus. To formulate a kidney friendly diet you need to do your research and use protein sources that contain the least amount of phosphorus. The USDA website and nutritiondata.com are good sources.

 

You can find good recipes on the internet so you don't have to do all the number crunching. Here are some guidelines to help you sift thru the bull.

 

-Egg whites and certain types of fish that are low Phos are the easiest proteins to digest, hence less waste products, hence less work for the kidneys.

-Usually sticky (sushi type) rice is added because it is low in Phos. Rice adds calories that are hard to get onto the diet without raising the Phos and is easy to digest. (whole grain rice is higher in Phos and harder to digest)

-The diet is balanced using low Phos low Na food sources (once again check USDA & ND.com to verify their choices are good)

-A slightly higher than normal Calcium supplement (not bone meal, it is high in Phos)

-And a vit/mineral supplement.

-Make sure the potassium and B complex is adequate.

[Guest candt]

i am kind of going thru this with True right now...

 

one day she suddenly had to pee every few hours...then every hour...then every 15 minutes...and there was some bright blood and tissue in it. brought in some pee in a cup and the vet found red and white blood cells and some trace of bacteria.

 

vet gave ehr clavamox...she got better right away but still ahd occasional accidents during those two weeks.

 

went off of clavamox and within 3 days had lots of accidents again.

 

is now on 2 weeks of amoxie. still having some accidents, but only every few days. the vet took a sterile sample from her, but she had peed recently so there wasnt much pee in her bladder. they found NO bacteria

 

vet wants to do an ultrasound but i feel like we should wait til she goes off the antibiotics, see if it comes back, and see if they can culture some of the bacteria (if there is any).

 

they keep saying that they didnt see bacteria so they think its not an infection, however, she gets SO much better on antibiotics, so i feel like an ultrasound would be a waste of time and money (much like it was for many on this thread).

 

anyway, im very frustrated. i asked for her to be put on baytril or something other than clavamox/amoxie but the vet wants an ultrasound instead...is it time to switch vets?

[Batmom]

Does she still have blood and white cells in her urine? How often is she having to go out? How is her bloodwork -- any sign of elevated WBCs, BUN, creatinine?

 

Depending on her condition and symptoms, I'd probably continue the amox, and do a vet's-office urine sample on the last day of amox or the next day (do the test strip, and look at it under the microscope). Then wait 5-7 days, and do a culture at that point if she is still having symptoms. If the culture is clear, then time for an ultrasound.

 

If the dog has had antibiotics within the last several days, sometimes you've knocked the beasties back far enough that you won't see anything even on a culture.

[gracegirl]

Does she still have blood and white cells in her urine? How often is she having to go out? How is her bloodwork -- any sign of elevated WBCs, BUN, creatinine?

 

Depending on her condition and symptoms, I'd probably continue the amox, and do a vet's-office urine sample on the last day of amox or the next day (do the test strip, and look at it under the microscope). Then wait 5-7 days, and do a culture at that point if she is still having symptoms. If the culture is clear, then time for an ultrasound.

 

If the dog has had antibiotics within the last several days, sometimes you've knocked the beasties back far enough that you won't see anything even on a culture.

 

Batmom nailed it, as usual. I was going to say the same thing.

 

Continue with the ABs. Then do a urinalysis. Then culture. At some point it would be good to do bloodwork as well if you haven't already. This will give you a pretty good idea if any of the kidney indicators are "off".

 

Fenway's bloodwork was normal, but the urinalysis indicated that he has low USG (urine specific gravity) which is an indicator of kidney function. When I could find no other answers, I opted for the ultrasound. Personally I'm glad I did, but in your case since the ABs help I would pursue that a bit longer before doing an ultrasound. Please keep us posted. I hope True feel better very soon!