Impaired Kidney Function

[vsrenard]

Brin has not eaten in 4 days now. She won't accept her regular home cooked meals, her regular kibble, dog treats or even cheese and now hamburgers. She's usually pretty food-motivated. She's drinking a lot more water than normal. I think she might be stiff on her rear right side but can't be certain of that. Her poos have been liquid and mixed with a lot of mucus. Her gums look fine, pink and healthy.

 

I took her to the vet yesterday and they gave her an anti-nausea injection along with fluids, and started her on metronidazole. Her lab results came back today with these values outstanding:

 

AST 72 [16-55 U/L]

CREATNINE KINASE 451 [10-200 U/L]

GLOBULIN 4.2 [2.4-4.0 g/dL]

BUN 35 [9-31 mg/dL]

CREATNINE 2.8 [0.5-1.5 mg/dL]

CHOLESTEROL 370 [131-345 mg/dL]

PHOSPHORUS 6.6 [2.5-6.1 mg/dL]

CHLORIDE 103 [108-119 mmol/L]

POTASSIUM 3.9 [4.0-5.4 mmol/L]

SODIUM 141 [142-152 mmol/L]

SDMA 19 [0-14 ug/dL]

RBC 10.25 [5.3-8.70 M/uL]

HGB 23.9 [13.4-20/7 g/dL]

HCT 63.9 [38.3-56.5%]

 

Bilirubin (1+ and blood (3+) in urinalysis, along with elevated WBC (6-10: range of 0-5 HPF) and RBC (50-75: range of 0-5 HPF).

 

We are waiting on leptosiprosis and urine culture results. The vet gave her more fluids today and gave us a low-protein canned food to feed her; if she doesn't eat soon, he recommends we take her in for an abdominal ultrasound. He was pretty vague on how long I should give her to eat before we take her in. Thoughts?

 

Thank you.

 

[mom2four]

I hope Brin will be OK. I don't want to scare you, but our Galgo pup, Jules, passed away in July and it started with him not eating. In the end the diagnosis was an autoimmune disease causing kidney failure. He became totally dependent on IV fluids. If he had been human he would have needed a kidney transplant.

His creatinine presented initially at 507 umol/L (normal high is 159 umol/L) These are Canadian units, not US ones, but you can see how much his creatinine was elevated. It never came back down to normal.

 

We did have an Ultrasound done as well on his kidneys.

 

I can post Jules' whole story if you want and you think it will help you.

 

Tin

[vsrenard]

I am so sorry for your loss.

 

Can you tell me what tests you did, and what the process to his final diagnosis was?

 

Thank you so much...

 

Vanitha

[mom2four]

Hi Vanitha,

 

I wrote down what happened to Jules (He was a Galgo, a "Spanish Greyhound")the day after he passed away when it was still fresh in my mind. I'm going to copy and paste it here for you, OK? Please ask if you have any questions.

 

In early July Jules started being fussy about eating his food. He would leave half a bowl and not want more. I checked his teeth, in case he had broken one, but his teeth were fine. So I waited him out for a couple of days. But, it’s happened with our other hounds, they would get tired of their food, so I got him a different flavor of food, fish instead of chicken. He seemed interested for one meal, but then he spit out his food again. He still ate treats- he loved veggies, dried liver treats, and cookies….and yogurt, he loved yogurt. But after a week of him not eating full meals, we got him to the vet. It was time for his annual exam and shots anyway. The vet asked if he had diarrhea (no), vomiting (yes, occasionally bile because of an empty tummy). So she put him on some metronidazole to see of that would settle things down a bit and get him eating. Two days later he did have a couple of soft stools. I brought one to the vet, she tested it for worms and giardia, but it was negative for both. She suggested bringing him in for a day of IV fluids to get him over the hump of not feeling well. The day he was at the vet, he was a happy, tail wagging Galgo, hating the cage they had him in (he tried to dig out), so they let him out, which turned him into a happy, tail wagging, loving little Galgo again. They also took some blood for a general test. He came home that Thursday evening, ate a couple of slices of toast and a quarter cup of yogurt, as we were instructed to feed him anything he wanted to stimulate his appetite again.
The next day, Friday July 15, the vet called Michael that Jules’ blood work was in and he should come back to the vet clinic to be put on IV fluids again ASAP. His kidney values were very high. So we brought Jules back to our regular vet. When they closed at 6PM that evening Michael and I transferred Jules to a 24 hr Vet Hospital. He was put straight back on IV fluids, at double the normal rate. Over the weekend they kept him in isolation because they thought he might have Leptospirosis. They tested for Leishmania as well. Both were negative. He was put on prednisone as well, for inflammation. On the Monday the specialist internal medicine vet Dr. C did an emergency ultrasound (probably during her lunch time) to rule out physically abnormal kidneys. Everything looked normal. During this time his creatinine value slowly improved from over 500 to the 300 range (the normal is between 44-159). The BUN and some other blood values were off as well. Dr. C said a biopsy of the kidneys and bone marrow would be the next step, to see what was going on at a cellular level. We gave permission, since the creatinine continued to improve slightly each day. So this was done on Tuesday. Dr. C warned us that there could be a small amount of bleeding from the kidney biopsy, and that did happen. But, despite the use of Amicar, it did not stop.
We visited Jules each day, but he was getting skinnier by the day, despite him eating something for them (chicken breast).
On Friday the bone marrow and kidney biopsy results were back. The bone marrow one was normal, ruling out multiple myeloma. The kidney biopsy results showed abnormalities, though. Basically his kidney cells were dying, and sloughing off- into his bladder. He had a clot (of dead kidney cells, I presume) in his bladder, causing UTI like symptoms. Despite this, there was talk of him coming home on Saturday, and having to go back for blood tests and possibly some IV fluid treatments. They would start weaning him off his IV fluids overnight since he’d been on them so long. They were also going to change the prednisone, which did not seem to be working, to a chemotherapy drug.
When we called Saturday morning, we were told that blood work taken at the 6 hr mark of them weaning him off of the IV fluids, were alarming. His creatinine, at 210 being the lowest on Friday, had risen to the 280’s in that 6 hours. He could not be weaned off of the IV fluids. They would try again on Sunday. When we went to visit him, he was shivering in the air conditioned room he was so skinny by now. We went back later that evening (a 25 minute drive each way) to bring him his PJ’s. Later on Saturday evening the vet on duty called with some results, which were bad. His creatinine was continuing to increase, despite being back on 2x normal IV fluids. He was labelled IV fluid dependent now. But something called a UPC ratio was alarming. It had risen to 13.5 from 6 at our regular vet the week before (normal is less than 0.5). This is when the quality of life discussion started.
On Sunday morning the vet said that if we wanted, Jules could come home for a few hours that afternoon. He was home for 4 hours, the other dogs really wanted not much to do with him. (They knew he was ill, we thought.) Jules peed at least 30 times in that 4 hours, we lost count. He drank lots of water and peed again. He lay down for a bit and fell asleep, he was so tired. This is when our discussion on his quality of life came to a conclusion- Jules could not live like this- he was not going to get better, he was IV fluid dependent, was not eating well and had lost about 1/5th of his body weight in two weeks, he had to pee constantly, and when he was not peeing or drinking, he was sleeping because he was so tired. When we took him back to the clinic after his 4 hours at home, we discussed this with the vet and she agreed with us that Jules had no quality of life left. We did the best thing for him, and at 5:42 PM on Sunday July 24, 2016, Jules crossed over the Rainbow Bridge. My guess is that he’s the life of the party there.

Edited December 21, 2016 by mom2four

[EllenEveBaz]

No knowledge here, just sending

[locket]

Oh Brin get better

[NeylasMom]

Urine specific gravity? Was there protein in her urine? Does she have a fever? Did they test for any TBDs?

 

If it were me, I would want her on doxycycline prophylactically until test results come back as lepto results can take a bit of time.

 

Also, her phosphorus is high and that is actually often what makes dogs with renal disease not want to eat. I would ask about a phosphorous binder. Actually if it were me I would probably just start my dog on one, but you shouldn't necessarily do what I'd do.

 

Also, she hasn't eaten for quite some time now. Try anything you can to get her going - scrambled eggs, baby food, any sort of home cooked bland diet. Since you said she ate a bit of the canned k/d, you could try warming it a bit to see if that makes it more appetizing. Or puree with some warm water and consider syringe feeding a bit if she doesn't lap it up.

 

Can't say I know what's going on, but there are clearly elevated kidney values, which can certainly affect appetite. I do wonder if she has a kidney infection. May have started as a urinary tract infection and traveled up. Hope you can get it sorted out soon.

Edited December 21, 2016 by NeylasMom

[tbhounds]

I'm not seeing renal disease. The renal values can be elevated due to dehydration. A 2.8 creatinine value shouldn't make a dog anorexic. A dog of her size receiving sq fluids won't change much-really need to be hospitalized and on iv fluids. I think you need to consider a uti (+/- pyelonephritis) I'm glad you did the urine culture.

Do you happen to have baseline blood work for comparison? I would feed her anything she wants right now just to get some calories on board while you're awaiting the culture results.

[Batmom]

I'm with tbhounds re the kidney values not being enough to make her feel bad -- not anywhere near. I'd ask the vet about getting her on some antibiotics while waiting for the culture results; a tummy protectant (ondansetron or even just pepcid); and let her eat whatever she wants.

[Remolacha]

[vsrenard]

Thank you all. I appreciate the thoughts and the advice! Brin ate a little bit of canned food yesterday and some cheese, but this morning only ate a couple of dog treats. Still, it's something.

 

Her baseline blood work from 6 has always been in the normal range, except for a slightly elevated creatnine six months ago with some dehydration. Her urine sp gravity is 1.019, with no protein. Temperature is normal. No TBD panel was done.

 

This came on rather acutely. She was eating fine (and even trying to scam an extra meal here and there) up until Sat morning. Good news is she's prancing about and even asked for food this morning even if she wouldn't eat anything I offered.

 

Thanks for all the advice. Now I've got some questions to ask the vet.

[Batmom]

Glad she is feeling better! Hope it turns out to be something simple and soon cured.

[Kestrel]

No advice, just sending good thoughts for Brin!

[NeylasMom]

Glad she feels a bit better this morning. Now eat lady.

[vsrenard]

She ate 5 oz of baby food (chicken and beef). She seems to have a better appetite, but is't always interested in the offerings.

 

I'll update when I have some results. Thank you, all.

[tbhounds]

If she's not eating and acting better today I really think she needs to be hospitalized at this point. She is not taking in nearly enough calories and really should have further diagnostics run at this point. Radiographs, ultrasound, iv fluids, anti-emetics.....

[vsrenard]

Yes, we are taking her in this morning to be hospitalized for the ultrasound and other tests as needed. So worried for my baby girl.

[tbhounds]

Keep us posted <3

[vsrenard]

Thank you.

[FiveRoooooers]

All good healing thoughts for Brin.

[sarabz]

Sending healing thoughts.

[Remolacha]

hoping it turns out to be something fixable!

[MauCarden]

Thinking good thoughts for Brin!

[NeylasMom]

[Jenbo]

Please get well, Brin!