Kidney/glomerular - Blood/urine Results & Diet Changes

[Guest AndyK]

Hi people

 

I touched on this in an post on the diet/food area but this is more about 'health/medical' but also diet as well. Hoping to get some input from you as I'm not great with science!

 

So..situation is

 

• 13 and a bit year old female Greyhound
• Has arthritis - been on Metacam for 2 years and supplement with Yumove
• Always been a skinny girl but I weighed her about a month ago and she'd lost .5 kg in two months. Not good.
• Urine and blood tests done - will put the main points below
• Not long after this I switched her to raw food diet (more on that below too)

OK so vet said in essence - kidney disease and glomerular disease. Here are the 'abnormal' bits from the blood and urine. Just realised I may have got the 2-pages of each print out the wrong way round so apologies if not clear what reading came from what report!

 

• Platelet count 138 'Low'
• Albumin 25.4 'Low'
• Urea 11.2 'High'
• Creatinine 188.9 'High'
• CK (CPK) 37c 'High'
• Protein creatinine ratio 2.4 'high'
• Bile acids (fasting) 17.7 'High'
• Cholesterol 8.90 'high'
• Inorganic phosphorous 1.67 'high'
• Thyroxine (Microgenics) 11.5 'low'

So my main thing here is to radically change and improve her diet to reflect this. My understanding and basic strategy is (bear in mind I'm raw-fooding from now on - but she was on meat/kibble at time of weight loss and tests)

 

• Radically reduce phosphorous intake by making bones minimal
• High quality protein from raw meat, egg white. Try and use fatty meat like beef, duck. Also green tripe.
• Cautious with amounts of liver given due to high Vit A content
• Supplement with salmon oil
• Compensate for calcium reduction (from bones) by adding crushed egg shell
• Increase carbs (to help with weight gain - although since raw fooding she's put 0.60k back on) from mashed sweet potato and unsalted butter
• Keep sodium intake to a minimum
• Feeding her slightly above her body weight needs - am currently working off her appetite - seems to work well, she isn't over stuffing herself
• Get diet settled in then do new bloods/urine in 3-4 weeks
• Possibly re-evaluate her being on Metacam in a month or two - affecting kidneys perhaps?
• She's back to taking very small dose of Tramadol every other day as arthritis a little worse recently

Questions then I guess are

 

1) Any other things I can do diet wise to help her?

2) Anything on above results that I need to think about but haven't?

 

Apologies for the long post..like I said, not great with science but have done a lot of reading last night. Just want to make sure I'm doing everything I can!

 

Thanks in advance

 

Andy (and Misty!)

 

[greyhead]

Our kidney-disease GH is almost 12. I can't compare the numbers between the two dogs as ours are expressed in U.S. units, but Shane also has elevated creatinine and BUN. His other numbers are pretty decent, and he gets a thyroid supplement daily. The vet specialist said no NSAIDS at all, now or in the future, for his arthritis and lumbosacral stenosis. So he does well on tramadol (50 mg twice a day) and gabapentin (100 mg 2-3 times a day). As Metacam is an NDSAID that can worsen kidney function, I'd eliminate that for your dog too and perhaps get a glucosamine/chondroitin supplement. I've been told by others (confirmed by internist) that one can lose a dog with kidney disease very fast, like in a matter of hours. So treating conservatively is a good idea from that point of view. The other thing we do for the kidney disease is give 200 ml of Lactated Ringers solution, subcutaneously, at home every day or two. He perks up amazingly fast after his fluids!

 

We're feeding prescription kidney food, but we supplement some days with such human foods as cooked ground beef and rice, dark-meat chicken (better for kidneys than light meat), 2% milk (he's not lactose intolerant), scrambled eggs, and Ensure (1/2 bottle at a time, total 1 bottle per day) for extra vitamins and calories.

 

We fed 1/3 raw (2/3 commercial) to our other greyhound, who had IBD, and it's great food if you can manage it. We used that particular ratio just because we observed he did better that way than with 100% of either approach.

 

Best of luck to you and Misty!

Edited October 18, 2014 by greyhead

[Guest AndyK]

thanks..yep more I think about the more I don't like having her on Metacam with these kidney issues. Think I'll have a chat with vet about that next week. That said, not too keen on her coming off it as she responded so well to it when the arthritis kicked in.

 

At the moment I feel scared of doing anything wrong, confused with it all tbh.

[TheFullHouse]

Here is the home cooked kidney diet I used for Bullitt. He was not allowed any raw bones and had to take a multi vitamin daily and either ground egg shells in his food or a calcium carbonate powder added to his meal.

 

¼ lb. ground beef (do not use lean round chuck)

2 cups cooked white rice without salt

1 hard-cooked egg, finely chopped

3 slices white bread, crumbled

1 t (5g) calcium carbonate¹

*Also add a balanced supplement which fulfills the canine MDR for all vitamins and trace minerals.

Cook beef in skillet, stirring until lightly browned. Stir in remaining ingredients and mix well. This mixture is somewhat dry and its palatability can be improved by adding a little water (not milk). Keep covered in refrigerator. Yield 1 ¼ lbs.

Feeding Guide

Feed sufficient amount to maintain normal body weight.

​Approximate

Body Weight​Daily Feeding

 

5 lb...1/4 lb.

10 lb.....1/2 lb.

20 lb........1 lb.

40 lb....1 ½ lb.

60 lb....2 lb.

80 lb....2 ½ lb.

100 lb..........3 lb.

 

You can substitute chicken for beef for variety and can add a little home made salt free chicken broth. Bullitt ate this for a while and then I found a prescription kidney food that he would eat and would alternate between that and home made. A lot of kdney dogs have issues with their appetite so feeding at times can be difficult.

Edited October 18, 2014 by TheFullHouse

[Guest AndyK]

great thanks for recipe!

 

forgot to add to above, she's just had #1 of 4 Catrophen injections.

 

Really want to get her off Metacam I'm just so worried it's going to mean she goes back to barely being able to stand

[TheFullHouse]

You can try Tramadol for the arthritis pain. You won't have the added benefit of the anti inflammatory but it's easier on the kidneys.

[macoduck]

At "138" Misty's platelet count is not low.

 

Normal ranges for greyhounds are different than other dogs.

80,000-200,000 per Dr Stack

110,000-205,000 per Dr Couto

 

I'm not sure of the other values since they are in UK measurements

[RedHead]

Some of the numbers you have posted are on the "normal" range on my bloodwork that I just got back. I am guessing they are using the same measurement system. My charts say the following:

 

Urea normal range: 3.0-11.5 (yours was 11.2)

CK normal ranges: 35-529 (yours was 37 but my measurements are in U/L..not sure if the same)

Cholesterol normal range: 2.50-9.90 (yours was 8.9)

Albumim normal range: 26-44 (yours was slightly low at 25.4)

Phosphorus (**not sure if it is the same as inorganic phosphorus as you posted) normal range: 0.7-2.5 (yours was 1.67)

 

Creatinine normal range: 24-140 (although my grey is 179 (around 2.0) with no problems as some greys run higher. Yours is 188.9 which is around 2.14.

 

This is not to say that your grey doesn't have kidney issues as some of your numbers are off, but you may want to check if the lab used greyhound values (or ask a local grey group there for bloodwork info) before you fully make a diet plan.

 

 

[4My2Greys]

If he's not already I would talk to your vet about the need to start him on blood pressure medicine. Renal disease unfortunately goes hand in hand with the development of cardiovascular disease. If he has high blood pressure this will put further stress and damage to the kidneys, which in turn does further damage to the heart and the rest of the cardiovascular system.

[NeylasMom]

Does he have symptoms of kidney disease? Can you post the "normal" ranges from your lab for all of those values? Most of us are in the US. Normal ranges can vary even here, but a lot of yoyrs are in entirely different units.

[Guest AndyK]

thanks everyone..here are links to the full report, should make more sense..one of the pages wouldn't rotate so you may have to download and rotate, apologies.

 

http://tinyurl.com/k6gj45k (urine part 1)

http://tinyurl.com/koxd2yu (urine part 2 - upside down!)

http://tinyurl.com/l943god (blood / T4 page 1)

http://tinyurl.com/lc2c3go

 

 

You can try Tramadol for the arthritis pain. You won't have the added benefit of the anti inflammatory but it's easier on the kidneys.

 

She's on very small dosage at the moment every other day but yep that's my worry, not having the AI side of it.

 

Does he have symptoms of kidney disease? Can you post the "normal" ranges from your lab for all of those values? Most of us are in the US. Normal ranges can vary even here, but a lot of yoyrs are in entirely different units.

 

Hi, well I originally got tests done just due to the (at time) unexplained weight loss. She hadn't been drinking loads of water and indeed since the weather has cooled off has reduced a fair bit (as has my healthy 6 year old male).

Certainly in the last year or so she's been urinating more frequently (she gets me up twice a night usually) and often has two wees on her walk whereas, maybe 2-3 years ago would just be one. I had (maybe naively) put it down to old age. Don't think anything aside from that.

 

If he's not already I would talk to your vet about the need to start him on blood pressure medicine. Renal disease unfortunately goes hand in hand with the development of cardiovascular disease. If he has high blood pressure this will put further stress and damage to the kidneys, which in turn does further damage to the heart and the rest of the cardiovascular system.

 

Thanks that's helpful, something I will discuss for sure.

 

Thanks again everyone I really appreciate it.

 

Andy

[Guest AndyK]

confused even further..read on http://vet.osu.edu/sites/default/files/greyhound_pdfs/faq/KidneyFailure.pdf

 

that "Urine specific gravities greater than 1.020 are considered adequate and indicative of functioning kidneys."

 

..and as you can see, Misty's are 1.028

[tbhounds]

I only see a few concerning numbers. The first one I noticed is the UPC--while not sky high it is elevated enough where I believe it warrants medication -enalapril and low dose aspirin. A UPC of 2.4 in a rather diluted urine concentration makes it a bit more concerning-granted the urine wasn't horribly low but, low enough to see that high a UPC. For example-a 2.4 UPC with a 1.040+ specific gravity would be less concerning. Make sense? The renal values are slightly elevated too--a renal friendly diet might make good sense to start. Is your hound drinking and urinating excessively? Ghs tend have a lower blood protein --I see the albumin is a tad low-could be gh normal or it could be from the proteinuria or because the liver isn't producing properly (the high bile acid test).

Platelets, thyroid normal. The CK can elevate just from shaking--it's not a too much of a concerning number and it most likely returned to normal an hour after your return home from the clinic.was your hound worked up at the clinic?

I imagine your vet will recommend an abdominal ultrasound to better elevate the liver and recommend monitoring those kidney values. They will also most likely start your hound on enalapril or benazapril and low dose aspirin (to prevent a stroke) because of the increased UPC value.

Overall it's most important to treat the pet and not the numbers--how is your hound feeling??

[tbhounds]

One more thought--thinking twice about the thyroid level. Wouldn't hurt to run a cTSH. The higher cholestrol may be a red flag for hypothyroidism here.

[Guest AndyK]

Thanks for replying tbh, really appreciate it. I'll try and answer everything below..

 

I only see a few concerning numbers. The first one I noticed is the UPC--while not sky high it is elevated enough where I believe it warrants medication -enalapril and low dose aspirin. A UPC of 2.4 in a rather diluted urine concentration makes it a bit more concerning-granted the urine wasn't horribly low but, low enough to see that high a UPC. For example-a 2.4 UPC with a 1.040+ specific gravity would be less concerning. Make sense? The renal values are slightly elevated too--a renal friendly diet might make good sense to start. Is your hound drinking and urinating excessively?

 

Not really no - I would say she's been urinating more frequently over, say, the last year. In the night she normally gets me up for a wee twice. And on walks sometimes its two wees whereas maybe 6-8m ago was one. But drinking wise no I wouldn't say so.

 

The CK can elevate just from shaking--it's not a too much of a concerning number and it most likely returned to normal an hour after your return home from the clinic.was your hound worked up at the clinic?

 

She wasn't best pleased with being there but I don't recall her shaking as such.

 

I imagine your vet will recommend an abdominal ultrasound to better elevate the liver and recommend monitoring those kidney values. They will also most likely start your hound on enalapril or benazapril and low dose aspirin (to prevent a stroke) because of the increased UPC value.
Overall it's most important to treat the pet and not the numbers--how is your hound feeling??

 

None of this has been discussed with me by the vet, was just put as glomreular/kidney disease.

 

Misty appears to be feeling OK - she's being inconsistent about wanting to walk or not but my gut feeling is putting it down to change in weather and her arthiritis. E.g. yesterday she quite happily had a slow-ish 45 m walk but then later I took her out and she wanted to go home again.

Other than that appears to be good - still running up and down the stairs - appetite is great - much better since I switched to raw food (she put the 0.50k she had lost back on when I changed diet - this was after the tests above btw), no vomiting or lethargy etc.

 

I'm not sure how to play this now - I need to have a re-discussion with the vet I guess but not sure how to approach it. I don't want to be like "you're wrong" but on the other hand I'm worried they haven't touched on your points. Any ideas how to approach it?

 

In meantime I'm cutting right back on phosphorous in her diet but keeping her on raw. Also not sure whether to consider cutting out Metacam if it's stressing her kidneys - but would be worried then she'd be back to square 1 with arthiritis again.

 

thanks again for responding!

 

Andy

[tbhounds]

Ahhhh-didn't mention that she was eating raw (at least not that I read)--raw fed dogs tend to have higher renal values. That said the remaining concern would be the proteinuria. Also forgot to ask--was the urine a mid day catch? If not I would submit a first morning sample after an 8ish hour water fast-the urine should be much more concentrated.

Regarding giving an NSAID--I'm not sure if you have this available there but, previcox might be a better option for you-it's a kinder NSAID on the kidneys.

[Guest AndyK]

thanks

 

To clarify - the raw food change came after the tests - it had co-incided with my decision to go raw..i.e results above were on kibble/wet diet mix.

 

Urine was I think around 4pm, which went to vets that evening.

 

Previcox I will discuss with vets - going there on Wed for her next injection of Catrophen so going to talk everything over..still not sure how to play things in terms of above.

 

So you think the proteinuria is still indicative of kidney problems?

 

thanks again!

[tbhounds]

The proteinuria and chronic renal disease should be addressed separately. I would definitely medicate for the glomerulonephritis but, honestly I would just monitor the renal values looking for a trend in values. Perhaps the diet change will level off the numbers. Do watch that phosphorus number.

[4My2Greys]

The trouble with chronic kidney disease is that it usually doesn't show up re lab values until about 75% of kidney function is lost. No one seemed to think that my greyhound Nadir's values were indicative of kidney issues even though he had

been being seen for inability to hold his urine for more than 2 hours at the most.

This was the comment from his last visit with internal medicine prior to losing him 5 months later.

 

We recommend rechecking a chemistry to evaluate kidney function and electrolytes. The creatinine (measure of kidney function) was high in the hospital today. Before we consider him to have kidney insufficiency, we would like to rule out lab error or a transience finding. The fact that his urine is just below concentrated makes kidney disease a lower likelihood.

 

The following is from his necropsy report after his death just 5 months later.

 

Histopathdx

Marked glomerularosclerosis with focal capsular mineralization; multifocal lymphoplasmacytic interstitial nephritis with fibrosis

Marked pulmonary congestion

Mild myocardial adipose deposition

Marked splenic congestion; focal siderotic plaque Marked hepatic congestion

Mild lymphoplasmacytic gastritis

Decreased exocrine pancreatic zymogen granules Sections of brain, small intestine, and colon demonstrate no significant abnormalities

 

Comments:

The histopathological lesions in the kidney are consistent with chronic end-stage renal disease. There is histopathological evidence of some fatty deposition within the myocardium, which can been associated with cardiomyopathy. The widespread vascular congestion is consistent with cardiovascular insufficiency.

The decreased granules in the exocrine pancreas are suggestive of recent anorexia.

[Guest AndyK]

thanks.

 

We've got new blood/urine being done next Wed..also switching from Metacam to Previcox (just waiting for it to be delivered).

Will be interesting to see if diet changes impact next test results.

[MaryJane]

With 3+ protein in the urine, I would cut down the protein/phosphorous in the diet and make sure that the protein you do give is high quality. You can get the protein urine dipstix at a pharnmacy and that way, you can do checks yourself on how much protein is being excreted - check the 1st morning specimen.

 

My Larry has had issues for years with creat and specific gravity (along with food allergies) and has been on a kidney friendly diet for 7+ years. He gets total about 10 tablespoons (1/2 cup) of hamburg a day over 2 meals. He also gets white rice, potatoes, oatmeal/grits & veggies.

[Guest AndyK]

that's an awesome tip about the dipstix, going to order some on Amazon..how often do you tend to check your hounds?

 

thanks!

[Burpdog]

I have had many of my seniors test 3+ to the point I questioned the test!

 

We did a protein/creatine ratio on one and it was fine so we (vet & I) ignored the protein. They all lived to 14 + years old without any changes in diet.

[MaryJane]

that's an awesome tip about the dipstix, going to order some on Amazon..how often do you tend to check your hounds?

 

thanks!

 

 

Depends on the reason for the protein leaking into the urine. One of my dogs had an acute kidney condition and I was checking his every few days and if I was getting more than a trace protein reading, I would decrease his protein intake until the next reading. My current dog is stable and does not require checking more than every few months.

 

The kidneys have a delicate filtering mechanism and while small amounts of protein leaking rarely should be OK, long term leakage of protein can damage the filtering mechanisms.

 

This link seemed to be pretty good --

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354822/

[Guest AndyK]

much appreciated, thanks.