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Kidney Problems
Chronic kidney failure in Great Dane
Kidney transplant for dogs
Medications that are linked to kidney failure
Serum (or blood) urea nitrogen levels and serum creatinine levels as indictors of kidney function
Kidney disease - when to put on calcitrol
Kidney failure and high calcium levels
Kidney failure in young Cocker
Kidney failure and heart murmur
Kidney disease or Kidney failure?
Kidney disease family history in Brussels Griffon
Cystic kidneys
Canine Kidney failure -causes
Leptospirosis (zoonotic)
Kidney problems in Yorkies
Kidney failure
also see Renal Failure
also see Incontinence
also see Urinary
also see Liver problems
Chronic Kidney Failure in Great DaneQuestion: Dear Dr. Mike,
Thanks for your quick reply and help. Hamish's excessive drinking has stopped after six days of Marbocyl and he appears much more himself although a little lazy. He doesn't appear to have lost anymore weight and is eager for his meals. I took a urine sample in for testing today and the test showed his specific gravity is still 1.005. You say that can happen for a lot of reasons, what are these? If it were a bladder infection as our vet suspected and the
anti-biotics worked would the S.G by now be normal?I read up on Cushings from your site but he doesn't have any of the signs and now the excessive drinking has
stopped I don't know what to think his coat is excellent and he has no pot belly. He is now on his normal food,
should I get more blood tests done or leave him as he seems OK now? The Vet has suggested another urine test in two weeks.Also the update
Our Vet has now given him a diagnoses of early chronic kidney failure. All his urine
samples are all in the region of 1.005-1.008. The vet even remarked that he thought his
dipsticks were faulty but this has been confirmed by lab tests. His creatine is in the normal
range 97 (20-130) our references are different I think. One question I have is; as his S.G is so
low will that mean his creatine levels will start to rise very shortly indicating a worsening of
kidney functions or will he continue just with the low SG and no worsening for months or
years? I haven't been able to find an answer to this question despite checking your site and
other information on line.Hope you can give us some indication of his lifespan as he is only 6 years old and we
previously lost a Great Dane at the age of 22 months from kidney failure who went from
"apparently" healthy to comotose in two weeks.Thanks,
Jacqui
Answer: Jacqui-
There are three ranges for urine specific gravity -- hyposthenuric (below 1.008), isothenuric
(1.008 to 1.012) and concentrated to some degree at all ranges above 1.012. I am not sure
why this range isn't called hyerthenuric but it doesn't seem to be. Hyposthenuric urine actually
indicates that the kidneys are working to some degree because they make the urine more dilute
to get it into this range. Isothenuric urine is not concentrated or dilute and urine that stays
consistently in this range can indicate kidney failure or hormonal diseases. However, your dog
has hyposthenuric urine and there are some specific causes for this.These are the causes of hyposthenuria in a single urine sample:
1) Excessive drinking for behavioral reasons (any cause)
2) central diabetes insipidus (lack of production of anti-diuretic hormone, or ADH, by the
brain)
3) nephrogenic diabetes insipidus, or resistance to the effect of ADH at the kidney level:
a) hyperadrenocorticism can cause this
b) hypercalcemia (too high calcium levels -- hyperparathyroidism, metastatic cancer,
poison)
c) low serum potassium levels
d) kidney failure due to amyloidosis
e) pyelonephritis (infection of the kidney itself)
f) some forms of drug therapy
g) very rarely as a congenital defectOf the things mentioned above, behavioral excessive drinking is probably the most common
cause of dilute urine. However, this should not be a constant finding in a series of urine samples,
in most cases. So the first step is usually just to test several samples, trying to get at least one at
a time when the urine should be concentrated, like the first urine sample in the morning for a dog
that doesn't have access to water during the night. We usually ask for several samples taken
over the course of a single day, if possible.If a series of samples reveals consistently dilute urine then it is necessary to start working through
the list of possible problems until the cause can be determined.Mike Richards, DVM
11/10/2001
Question: Dr. Richards:
I have a 2 year old Rottweiler who was recently diagnosed with chronic
renal failure. The internal specialist we saw found that there was a
loss of the corticomedullary junction and slightly dilated renal pelvis,
as well as persistent azotemia and USPG of 1.025. He was given an ultrasound
of the abdominal area where after viewing the vet described his kidneys
as "severely" damaged with a loss of 75% kidney function. He has moderately
elevated BUN and creatin levels. We have had him for 1 1/2 years after
rescuing him from a neglectful and abusive owner. He was approximately
25 pounds underweight, with severe malnutrition, mange, and a host of
other problems. Per the specialist instructions we have begun changing
him over to a new low protein diet (Eukanuba) specially formulated for
dogs with kidney disease. The vet said his phosphorus and calcium levels
were normal. She stated that although he has lost 75% of kidney function
he is still in the beginning stages of this disease and referred to his
condition as "moderate" at this time. This little guy is a member of
our family and my best friend and I will do anything, regardless of cost,
to help him have as long and healthy a life as possible. I want to treat
this problem aggresively and proactively. Do you have any opinions on
what I can do at this point to combat this disease and hold off his inevitable
decline for as long as possible. I would give him one of my kidneys
if I could. Any help or suggestions you could give would be greatly
appreciated. Thanks, NathanNathan
Answer:Nathan-
It is possible to pursue a kidney transplant for dogs at this time. The University of Minnesota and the University of California at Davis (UCD) are the only places I know of where this surgery is being done in the U.S., but it is an available option. I do think that it might be best to continue with medical treatment for the current problem until the presence of chronic kidney failure is well established, though. The urine specific gravity below 1.030 in the presence of increase blood (serum) urea nitrogen levels and/or increased creatinine levels (azotemia) is a strong indication of kidney failure or kidney insufficiency. The general rule of thumb is that about 75% of kidney function must be gone before azotemia and a decrease in urine concentrating ability occurs. It might be a good idea to check several urine samples, especially ones from early in the morning, to see if the kidneys can concentrate urine at times, though.
There some medications that you might consider using to attempt to slow the progress of the kidney failure or to make your rottie feel better.
Enalapril (Enacard Rx) can help decrease protein loss and possibly slow the progression of kidney failure in dogs. It is important to monitor its effects in the first week of use, though. In a few dogs it can make the kidney failure worse. We have used enalapril now in several patients and our subjective opinion is that it is helpful. This medication makes the most sense when there is demonstratable protein loss in the urine. Even moderate protein elevation in unconcentrated urine samples is indicative of protein loss in the urine.
Calcitriol is recommended by some veterinary kidney specialists and avoided by others. It is an active form of Vitamin D which may help to prevent secondary renal hyperparathyroidism. I am not sure who will turn out to be right in the long term, the people for or against the use of calcitriol. We use this and we think it is helpful but we are not sure. An alternative approach is to use phosphate binders (aluminum hydroxide gel, others) to try to keep phosphorous levels from rising. This is the approach favored by the kidney disease specialists that avoid calcitriol use.
It is very important to maintain hydration in patients who have kidney insufficiency. If you can not encourage adequate drinking, it may be necessary to consider using occasional fluid therapy. This is harder to do in dogs than in cats and is utilized less frequently due to this. It is critically important to use fluid therapy if your dog stops drinking or cuts down on drinking significantly, no matter what the cause.
It is important to try to maintain a patient's appetite, so if there is a time when it decreases, appetite stimulants are appropriate. A lot of patients with kidney failure have gastrointestinal irritation and using cimetidine (Tagamet tm), famotidine (Pepcid AC tm) or ranitidine (Zantac tm) can be helpful, as well.
Monitoring the progress of the kidney disease through repeated urinalysis and periodic blood tests is a good idea. Sometimes clinical signs do not occur until after there are significant changes in laboratory values and early recognition of a change in the status of the kidneys can be very helpful.
I hope that this information is helpful.
Mike Richards, DVM
9/14/2001
Medications that are linked to kidney failure
Question: Dr Richards,
You said in an earlier post than antibiotics and non-steroidal
anti-inflammatory medications used for arthiritis probably cause
kidney failure. Would you have available those medications that could cause
kidney failure?Tony A.
Answer: Tony-
I don't have a complete list of medications that have been linked to
kidney failure but I can give you at least a partial list.Among antibiotics, tetracycline at high dosages, gentamicin, amikacin
and most sulfonamides and sulfa-trimethoprim combination antibiotics can
cause kidney failure in some patients. Of these,the two aminoglycosides
(amikacin and gentamicin) are the most toxic to the kidneys but are only
available as injections so are rarely dispensed, although they are used in severe
infections in hospitalized animals not too infrequently.The entire class of non-steroidal anti-inflammatory medications can
cause kidney damage due to constriction of blood vessels in the kidney. This
would include aspirin, carprofen (Rimadyl Rx), etodolac (Etogesic Rx),
phenylbutazone (Butazolidin Rx) and others.I don't think that any of these medications are highly likely to cause
a problem in any individual patient, with the possible exception of the
aminoglycosides, which must be used very carefully whenever they are
used. However, when kidney failure signs occur and any of these medications
are being used it is prudent to evaluate the necessity of the use and to
consider adjusting the dosage or changing medications, if possible.There are other medications that are linked to kidney damage to some
degree. These include thiatarsamide (old heartworm treatment
medication), chemotherapy agents such as cisplatin, amphotercin-B (antifungal
agent), enalapril (Enacard, Rx; used for heart failure and sometimes to treat
kidney disease because of beneficial effects it has in most patients),
methoxyflurane (anesthetic) and iodinated contrast dyes used to help
improve the ability to see problems on X-rays. All of these
medications have uses that often make taking a small risk of kidney failure
reasonable -- but again, when problems occur they have to be considered as
possible causes.Mike Richards, DVM
8/13/2001
Serum (or blood) urea nitrogen levels and the serum creatinine levels as indicators of Kidney function
Question: hi,
could you explain to me in 'simple language' what is the difference
between a high kreatonine and a high ureum level in the bloodwork
when there is renal failure ?
Answer: T-
The serum (or blood) urea nitrogen level and the serum creatinine
levels are both indicators of kidney function. Both of these values tend to
rise when the kidneys are not functioning efficiently.The urea nitrogen level is less specific to kidney damage than the
creatinine level. Rises in BUN can occur after a high protein meal, in
response to muscle damage, when corticosteroids are being used and when
dehydration or urinary obstruction is present when there is no kidney
damage. Usually these rises are not severe, though. When kidney
disease is present the BUN tends to rise faster than the creatinine so it is
sometimes considered to be a more sensitive indicator of kidney function, as long
as the non kidney causes for it rise are not present.Creatinine is more specific for kidney disease. It can rise when dogs
are fed diets high in cooked meat but these rises tend to be small. It can
rise when there is dehydration or a urinary obstruction even though the
kidneys are not damaged yet. However, for the most part rises in creatinine do
indicate damage to the kidneys. Over time, the rise in creatinine
levels is a little better indicator for how glomerular damage is progressing
than the BUN. A chronic slow rise in the creatinine is an indication of
ongoing damage.For both creatinine and BUN, it is important to look at other
indicators of how the body is doing to be sure that there isn't a problem like
dehydration or urinary blockage leading to the rises in the BUN and creatinine,
instead of kidney damage. If the urine is concentrated, kidney damage is less
likely. If the patient is normally hydrated but has protein in large
quantities in the urine, then glomerular disease might be present even
if the BUN and creatinine are not very high. So the BUN and creatinine are
important indicators of kidney function but they have to be considered
based on the patient's overall condition and the potential for diseases
other than kidney disease to be present.When monitoring chronic kidney disease, sudden rises in BUN are a good
reason to evaluate overall patient care to be sure that hydration is
good and that there is not an additional problem present, since the BUN
rises more easily due to these types of problems. Rises in the creatinine
occur more slowly but are a stronger indication of long term damage to the
kidney, so rises in the creatinine indicate a need to try to help the
body compensate for the loss of kidney function.I hope this is helpful.
Mike Richards, DVM
8/5/2001
Kidney disease in Sheltie - when to put on calcitrol
Question: Dr. Richards--
My sheltie has just been diagnosed with kidney disease. His BUN is
32; his creanitine level is 1.8. A protein/creanitine urine test showed a
protein >excretion of 2.2. His blood pressure is normal. He is on antibiotics
in case of pyelonephritis, but one of his vets says he thinks he has
amyloidosis. One vet tells me amyloidosis cannot be slowed down at
all, and not to put him on calcitrol yet. The other vet tells me it can be
slowed down, and that my dog should go on calcitrol now. What do you think
about this? My dog's phosphorus level is 3.1.
Both vets recommend that my dog go on the Hill's k/d diet. I do not
like the BHA and BHT preservatives in this food and am looking for
alternatives. Both vets said I could go with the homecooked diet, but will not recommend
a canine vitamin supplement for my dog b/c they don't know what a safe
level of phosphorus would be. Could you suggest anything? I also need to
include calcium carbonate in his homecooked diet, but have yet to find it
except in the form of Tums. I have read that Tums can be detrimental to pets.
Is this true? If so, where do I get calcium carbonate? My health food store
has it but it also contains boron.
Please help! I desperately want to do what's best for my beloved dog,
but no one seems to want to tell me what that is. I would greatly appreciate
any advice.
Thank you. Shanna
Answer: Shanna-
The protein/creatinine ratio can help in determining if there is
excessive excretion of protein by the kidneys. The test works like this: the
amount of protein in a measured amount of urine is compared to the amount of
creatinine in the same urine sample. The amount of protein (mg/dl) is
compared to the amount of creatinine (mg/dl) and a ratio formed by
dividing the protein value by the creatinine value. If this number is less than
1, it is usually considered to be in the normal range. If the ratio is
greater than 1, it supports a diagnosis of protein loss through the kidneys.
With the urine protein/urine creatinine ratio of 2.2, there is excessive
loss of protein through the kidneys. This test can indicate a problem and can
also be used to track the problem over time to get an idea of how much
change is occurring.The BUN and creatinine levels reported in the blood work are not
excessively high. This does seem like a good time to start treatment
since the earlier you start the more long term success you are likely to
have. It is important to know the phosphorous levels when contemplating the use
of calcitriol. If the phosphorous level is less than 6 mg/dl it is usually
OK to start calcitriol. If it is not, then using phosphate binders to get
it down below this level would be necessary. In your dog's case this
should not be a problem since the phosphorous level is not elevated at this
time. I like calcitriol and I think that it helps our patients with
progressive kidney disease. There are veterinary kidney disease specialists who do
not think that calcitriol is beneficial, so at this time the use of
calcitriol still has to be considered to be controversial in veterinary medicine.
Hopefully there will be conclusive studies one way or the other over
time. Calcitriol does not affect the progression of amyloidosis at all, to
the best of my knowledge. What it is supposed to do is help prevent renal
secondary hyperparathyroidism, which is a common problem as any form
of chronic kidney disease progresses. This is an important benefit for
patients with kidney failure but it doesn't have a direct effect on the
kidney disease.I am hoping that your veterinarian's impression that the kidney disease
is due to amyloidosis is wrong. Amyloidosis is the deposition of amyloid
in the kidneys. This is a form of protein and when it accumulates it
eventually causes kidney failure. It can occur in the kidneys and in
other organs, as well. The progression of kidney failure is usually faster in
dogs with amyloidosis than with glomerulonephritis and the treatment
options are much more limited. As far as I know the only way to tell
amyloidosis from glomerulonephritis is by kidney biopsy. From a
practical standpoint, though, kidney biopsy is not commonly pursued because time
will help differentiate between these conditions and knowing which one is
present doesn't alter treatment much. Amyloidosis can occur for
unknown reasons or it can occur secondary to cancer, so it is a good idea to
look carefully for cancer when this condition is suspected.Glomerulonephritis is a lot more common than amyloidosis.
Glomerulonephritis is inflammation of the glomeruli (the filtering
structures of the kidney). It can occur secondary to many other
illnesses, including many disease organisms (leptospirosis, Lyme disease,
heartworms, brucellosis, hepatitis), cancer, pancreatitis, immune-mediated
hemolytic anemia, hyperadrenocorticism and systemic lupus erythematosus and other
immune mediated diseases. It can also occur as a primary, or
idiopathic, illness. Sometimes finding and controlling the underlying problem can
arrest the degenerative process and stop the progression of kidney
failure. More often, once this problem starts it is slowly progressive over
time.There are treatments that can help with glomerulonephritis. As
mentioned above, an effort should be made to find and treat any contributing
condition. To help prevent protein loss and control high blood pressure
associated with kidney failure, enalapril or other acetylcholinesterase
(ACE) inhibitors may be helpful. The usual dosage of enalapril for this
condition is 0.25 go 0.5mg/kg once or twice a day. Aspirin may help to
prevent blood clotting that sometimes occurs due to glomerulonephritis.
The dosage for aspirin therapy for this purpose is usually lower than for
other conditions. A dosage for aspirin of 0.5 to 5mg/kg is enough to inhibit
blood clotting. A low sodium, low total protein but very high quality
protein diet, such as Purina NF (tm) or Hills k/d is helpful.
Encouraging fluid intake is helpful. If the serum albumin level drops low enough to
cause fluid accumulation in the abdomen it may be necessary to give
diuretics. Calcitriol is more likely to provide a benefit in a patient
with glomerulonephritis since this tends to be a more slowly progressing
disease.It is possible to make a home made diet for dogs with kidney failure. A
good approach to this would be to contact a veterinary nutritionist for
specific advice. However, to the best of my knowledge, there is no
problem with using unflavored Tums (tm) in dogs for calcium carbonate
requirements. One Tums tablet contains 0.5gm of calcium carbonate. It is also
possible to find calcium carbonate as the calcium ingredient in some human calcium
supplements. I don't know the names but you could probably pick them
out by reading the ingredients. Lately most veterinary nutritionists seem to
be recommending Theragram M (tm) as a good multivitamin tablet to use in
homemade diets. I have also seem recommendations to use Centrum Silver
(tm), so it is likely that other multi-vitamins are OK, too.I hope that this information is helpful.
Mike Richards, DVM
8/2/2001
Kidney failure and High calcium levels
Question: Dr Richards,
Poor Princess seems to be plagued with bad luck. Whenever a refill is
ordered timely, the med always arrives the next day. But when a med has to
arrive the next day, it fails to arrive. Today was the 3rd. time that this
has happened. No one can explain why. This is so weird.
What causes BUN, phosphorus, creatinne, calcium levels to rise in
kidney patients and at what rate? The reason it was so important for the
Calcitriol to have arrived today was because we needed to get her started
on it before the phosphorus level rose to unacceptable levels. It was at
5.1 on the 2-16 blood test. In treating Princess we have had to experience
a lot of delays. Much of it beyond our control and we wonder why that is.Tony
Answer: Tony-
Blood urea nitrogen (BUN) and creatinine are removed from the circulation
by the kidneys. When the kidneys are not working well, the levels of these
hormones rise. This is a direct effect of the damage to the kidneys. Urea
nitrogen and creatinine are not particularly harmful compounds but they are
good markers for other toxins the kidneys should be removing from the
system that do cause serious problems.High calcium levels in patients with kidney failure are a more complex
problem to explain. This probably results from several contributing
factors. As the phosphorous levels rise in patients with kidney failure
there is an increased production of parathyroid hormone (PTH), which
regulates calcium and phosphorous levels, in an effort to compensate for
this. Over time, the rise in PTH becomes significant and a condition
referred to as renal secondary hyperparathyroidism develops. Low calcitriol
levels contribute to this condition, which is why supplementation of
calcitriol can be beneficial for patients with kidney failure. The odd
thing, though, is that increased PTH should actually cause the calcium
level to be lower in the blood stream. The active form of calcium is the
ionized form. In most patients with increased total calcium levels caused
by kidney failure, the total calcium is high but the ionized calcium, which
is what parathyroid hormone actually controls, is low. The total calcium
is thought to increase due to accumulation of inactive forms of calcium in
which the calcium molecule is bound to other compounds that keep it from
working.To make this a little more confusing, high calcium levels can be harmful
to the kidneys -- but only high ionized calcium levels. When total calcium
is high in a patient with kidney failure it may be due to a problem like
malignant cancer, which causes rises in both the total and ionized calcium
levels. In this case, it is important to lower the calcium levels and to
deal with the primary problem which is the cancer. When total calcium is
high but ionized calcium is normal or low in a patient with kidney failure,
the odds are higher that the kidneys themselves have created the situation
and treatment should be directed at dealing with the kidney failure. In
this situation, the use of calcitriol even when total calcium is elevated,
can be beneficial, as long as total phosphorous is below 6 to 6.5 mg/dL and
calcium supplements are not being administered.Mike Richards, DVM
3/10/2001
Kidney failure in young Cocker
Question: DR Mike,
I just found out that my 2 1/2 year old female cocker spaniel is probably in kidney failure
and would like some advice.On her blood test the BUN value is 149 mg/dL and the creatinine is 7
mg/dL. She is very lethargic, but does not seem to be in any pain. I have been able
to get her to drink small portions of water (at a time, a good amount of water,
overall) and eat cooked chicken in small portions after giving her about 4 mL of
pepto bismol and amforal. My vet is leaning toward euthanising her, but I'd
rather let her go naturally, as long as she doesn't seem to be in much pain.In a response to a letter from Sharon, Dr. Richards indicates that "some
patients respond to aggressive fluid therapy, diet, phosphorous binders, B-vitamin
supplementation, gastrointestinal protectants such as cimetidine, omega
fatty acid supplementation and good nursing care from their owners." I was
wondering if I could get a more detailed description of what these different things
are and which things I can carry out on my own (and how to) and which require the
care of a vet.Thank you, Kim
Answer: Kim-
The initial thing to do in a dog this young is to try to figure out why
kidney failure would occur.Kidney failure occurs due to poisonings (antifreeze, ethylene glycol),
changes in blood flow to the kidney (renal ischemia), obstructions to urine
flow, infections, congenital defects and for no apparent reason. Two and
half years of age is young enough to be affected by a congenital defect. I
don't think this is a really common problem in cockers but there are some
congenital kidney diseases recognized in cockers, including kidney fibrosis
and improperly formed kidneys (renal cortical hypoplasia). So making sure
there is not something obstructing urine flow from the kidney to the
bladder, considering the possibility of an infection such as leptospirosis
and trying to eliminate that possibility, ruling out toxins and trying to
rule out conditions that might lead to reduced kidney blood flow, such as
dehydration, heat stroke, blood loss, heart failure, hypoadrenocorticism
(Addison's disease) and medications (non-steroidal anti-inflammatory
medications rarely have this effect and it is also an uncommon side effect
of ACE (angiotensin-converting enzyme) inhibitors used for heart conditions).In acute renal failure situations, it is really important to institute
aggressive fluid therapy as soon as possible. Your veterinarian would have
to do the initial placement of an intravenous catheter and monitor care
closely, but you could administer the fluids at home if your vet is
comfortable with that arrangement. In chronic renal failure there is less
benefit from high dosage fluid therapy but administration of fluids is
still helpful. In chronic renal failure, it is important to focus on the
things that can be controlled that might enhance the kidney damage, so
control of phosphorous in the diet, controlling blood pressure, keeping
patients eating, protecting their gastrointestinal tract and similar
concerns are more important.Low phosphorous diets are available from your veterinarian or you can
administer phosphate binding agents and feed a moderate protein diet. There
are a lot of phosphate binders, including aluminum hydroxide, aluminum
carbonate, calcium carbonate, and calcium acetate products. Amphogel (tm)
has been a popular one but is hard to find now and PhosLo (tm) is another
available product. Your vet can help you find one of these products that is
available in your area.Famotidine (Pepcid AC Rx) is a good protectant for the GI tract for
patients with kidney failure. Some vets prefer other products and there are
several, such as cimetidine (Tagamet Rx).3V Capsules (tm) are a good source of the omega fatty acid supplements that
can be helpful in some forms of chronic kidney disease.Kidney failure in dogs is harder to deal with than kidney failure in cats
and it can be discouraging to try to treat this condition in dogs but there
are some successes and it is reasonable to try, especially if an underlying
cause like leptospirosis or Addison's disease can be identified and treated.Mike Richards, DVM
11/4/2000
Kidney failure and heart murmur in Poodle
Question: Dr. Mike,
I have a beautiful 12 yr/ 18# miniature poodle. She was diagnosed 4
months ago with kidney failure and a heart murmer. We started daily sub
q's at home immediately. At first twice a day- then once- then twice and
now three times a day. Her bun jumped from 115 to 56 to 101 and now
112. Her creatine started at 1.7, 2.6, 1.8 and now 4.6. Her phosp
started at 8.7, 4.6, 5.9 and now 9.7. Her heart murmer has been more
pronounced with each appt and now it is continuous.
She has developed fluid in her stomach and lungs and we have been doing
a balancing act between lasix and sub q's. She currently is taking 90
mg lasix per day in three divided doses. Three sub q's 100/75/100.
Enacard 6.25 mg am and 12.5 mg in the pm. She developed an ulcer and is
taking cimetidine 100 mg three times a day. She is also taking a
potassium supplement, B-12 shots for anemia and lixatonic. She was also
placed on Clavamox which we have since discontinued because we found
that it was a trigger for her vomiting. She collapsed once after a
very bad episode of diarrhea and vomiting but soon recovered her
strength. The vomiting is only occasional but now the diarrhea is 2x a
day but controlled with pepto bismol. Her appetite is good and she has
never refused to eat. She still takes pride in her appearance and
performs her daily grooming. Her urine appears to be concentrating to a
small degree. Her most urgent problem is fluid in the lungs. Our vet
advised tapering down the sub q's which triggered more diarrhea and a
general unwell feeling. We have now increased the fluids and she is
comfortable except for the breathing dfficulty. She has not had any
tests for her heart and wonder if there is still something that can be
done for her. Have we overlooked any other possibilities to improve her
quality of life and help her with the fluid problem? Her energy level
is very good considering her condition and her mental state is
excellent. Your help would be greatly appreciated. It means the world
to our family to know that we are doing everything we can for our girl.
Thank you.
Betty-
Answer: In your note, you did not mention whether your poodle is being fed a
restricted protein/restricted phosphorous diet, such as Hill's k/d (tm),
Purina's NF (tm) or Waltham's restricted protein diet. This can make pets
with kidney disease feel better and may slow the damage to the kidneys that
occurs over time. These diets are also low salt, which can be helpful, too.Phosphorous binding agents may be helpful. Over-the-counter antacid
preparations (like Amphogel tm) can help lower the phosphorous levels.
Sucralfate, a gastrointestinal protectant that may help with ulcers, also
may help to bind phosphorous, so it may be worth considering, too.Recently, omega-3 fatty acids (from fish oils) have been reported to help
protect kidneys from some of the ongoing damage in renal failure. Omega-6
fatty acids are reported to be harmful to the kidneys, so it is important
to be sure of the composition of any fatty acid products used.Some veterinary referral practices do either hemodialysis (as is done in
humans) or peritoneal dialysis (more common in pets). This can be very
helpful but it takes some luck to be close to a facility that offers this
care.It can be hard to balance the fluid administration necessary for the
kidneys with the need to avoid overloading the cardiovascular system. If
there is a veterinary cardiologist near you, it may be helpful to get help
from the cardiologist in managing this situation.It is not possible to stop the progression of kidney failure in most cases.
However, it is possible to slow the rate of damage down and to provide a
reasonable quality of life for some time, in many cases.I hope that this information helps some. If you need clarification or
additional information do not hesitate to write back.Mike Richards, DVM
8/13/2000
Kidney disease or kidney failure?
Question: Dr. Mike
I have a question that I have not seen answered in all your files.
Question: How do you determine if a dog has kidney disease or kidney
failure. My dog was diagnosted with kidney disease 8 months ago. Now my vet
seems to think that Missy's prognosis is poor and he is suggesting
euthanatia. She was not eating a week ago and the Emergency Vet Clinic gave
her fluids. The next day, I gave her pedialite and pepsid AC and she came
back with playing, eating, and no diarreah. However, it has been almost a
week later, and she is showing signs of not eating once again (she ate a few
bits of cookies, but refuses all other food). I also noticed she is drinking
much more water today and goes out much more frequently to urinate. A couple
of times she appeared weak (and could not jump a step easily), but then she
would turn around and jump a step later. I am beginning to think she is
going back down. Since she is 12 1/2 years old, and cannot get her teeth
cleaned any longer (too risky according to the vet since she also has heart
failure), I wonder if I should just let her go (euthanize) if she continues
not to eat in the next few days. I don't want to drag her through a lot,
since renal failure is almost always leads to death sooner or later.So again, my question: how do you tell kidney disease from kidney failure?
Is it in the blood test results; i.e., BUN, Creatin, Phosporous. If so what
numbers are these usually when kidney failure are involved?I would appreciate a quick response, since I feel I will have to make a
decision I really dread, sometime in the near future. I am going on a trip
(4 nights) in another week and am worried about Missy getting even worse
while I am away. My daughter thinks Missy will grieve so much for me she
will get even sicker. I am prepaired to euthanize her in a couple of days,
though, if she does not eat.Thanks, Sharon
Answer: Sharon-
I think that most veterinarians, including me, use the term kidney failure
to describe any condition in which the kidneys are not able to adequately
do their job. This is probably a poor policy. What is happening in most
cases is that the kidneys are working, they just aren't working as well as
they need to be. This should probably be referred to as kidney
insufficiency. The term kidney failure should probably be used to describe
the terminal stages of kidney insufficiency, or the point where the kidneys
are actually no longer functioning at all. I think the term is so
entrenched in veterinarian's vocabulary in its current use that it is
unlikely to change, though.Kidney disease is also used pretty generically. There are a number of
possible kidney problems that can lead to the kidneys having enough
accumulated damage that they can not adequately do their job. The most
common is probably chronic interstitial nephritis, which is disease most
closely associated with kidney damage as pets age. Glomerulonephritis,
amyloidosis, polycystic renal disease (more common in cats),
pyelonephritis, cancer, viral and bacterial infections, hypertension,
hypotension and a number of other conditions can cause kidney damage
sufficient to induce kidney insufficiency or failure.There are a number of lab tests that indicate that the kidneys are not
functioning properly. When kidneys are working, they produce urine that is
more concentrated than the plasma. Typically, a dog should be able to
concentrate urine above the specific gravity of 1.020. If several urine
samples taken during the day all fail to have a urine concentration greater
than 1.020, that would be a sign that the kidneys are not working properly.
Blood urea nitrogen (BUN) concentrations above 75 mg/dl are a strong
indication that the kidneys are not able to do their job. Creatinine values
above 2.5 mg/dl are also pretty unlikely to occur for any reason other than
an inability of the kidneys to filter the creatinine from the bloodstream.
Rising phosphorous levels (> 7.0 mg/dl) are associated with kidney damage.
Falling total protein levels sometimes occur with kidney failure. Anemia is
not uncommon when the kidneys really do start to get close to failing
entirely.The big problem with this situation is that we can often treat kidney
problems and gain some time, even when they are very serious. I have copied
a letter I wrote tonight to another subscriber below, as it has some
treatment options in it, so that you have that information. However, what I
think that you are asking is this: How do you tell when the kidneys will
no longer respond to treatment?I do not have a sure answer to that question. It helps a lot if it has been
possible to get an exact diagnosis of the cause of the kidney disease. This
may not be possible at this point and it may not even matter. For now, I
think it is reasonable to assume that it is chronic interstitial nephritis
in Missy's case.We have seen patients with BUN values > 180mg/dl and creatinine values >
13.5mg/dl respond to aggressive fluid therapy, diet, phosphorous binders,
B-vitamin supplementation, gastrointestinal protectants such as cimetidine,
omega fatty acid supplementation and good nursing care from their owners.
Due to this, we tend to try to treat patients even when they have very high
blood values for chemistries relating to kidney disease. However, if they
do not respond to treatment pretty rapidly, with a decline in BUN that is
substantial within 48 to 72 hours, we consider that to be a very bad
prognostic sign. So response to treatment is the way that we try to
differentiate between patients whose kidneys are not working well but who
have enough remaining kidney function to allow management of their
condition for some time and patients whose kidneys have so much damage that
they are unable to respond to therapy.There is always some point where therapy will no longer help. The bad thing
is that we often can not discover where that point is without trying to
treat for two to three days, as a minimum, past the time when pets start to
feel very bad. That is the sad part about treating kidney failure. When
you reach the point where is it obvious that Missy is not going to respond
to treatment one more time or when she gives you strong indications that
she no longer wants to fight with this condition, it is good that you have
the option of euthanasia. This is a problem that can cause significant
suffering and I am grateful that we can put an end to that suffering when
it is necessary.I hope that this clarified things a little. If you are still confused or
need more specific information please let me know.Mike Richards, DVM
8/13/2000
Kidney disease family history in Brussels Griffon
Question: Dr. Richards,
My dog, a 3 year old Brussels Griffon, has a family history of kidney
disease on both sides of his parents. His grandfather on his father's side
died of the disease at 4 years of age and his great grandfather on his
mother's side had chronic kidney failure most of his life, but did live to
be 10 years of age. I recently found out this information and informed my
own vet. He ran all the kidney function tests which came out normal, but he
recommends that I switch my dog to KD due to his family history. Since the
protein level is reduced, I'm wondering if this will harm him. What are
your thoughts?Sharon
Answer: Sharon-
There is still controversy among veterinary renal specialists and
veterinary nutritionists over the value of restricting protein levels in
patients with chronic renal failure. The most recent edition of Small
Animal Clinical Nutrition (Volume 4) suggests that it is helpful, though.
However, there is no evidence that I am aware of that there is any benefit
in using a reduced protein diet in a patient with no identifiable signs of
renal failure. So I guess I would lean towards feeding a "normal" diet
until there was evidence that your puppy would have problems similar to
those that family members have experienced. Checking urine samples or blood
samples on a regular schedule would be a good idea, probably.There is ample evidence to suggest that the protein levels in the renal
care diets such as Hill's k/d (tm), Purina's NF (tm) and similar diets are
sufficient for adult dogs. I would not be concerned about using these diets
as long as there wasn't something like pregnancy, extreme athletic pursuits
or other reasons to suspect that a higher protein level in the diet might
be necessary than these diets are designed to provide. The safety margin in
protein requirement with these diets is pretty big -- adult dogs can
survive on about 6% protein if it is very high quality and these diets
usually have about 14 to 15% protein. So if your vet is more comfortable
with this approach it isn't likely to cause problems.I think you can comfortably proceed in either direction -- feeding this
diet is unlikely to cause problems but it probably isn't necessary at this
particular time.Mike Richards, DVM
7/9/2000
Question: Dear Dr Michael,
First of all I'd like to say how wonderful your website is. It's so
helpful and well organised and has been a valuable reference source for
me and I'm very happy to have finally subscribed! Thank you for
providing us with all this information!My question:
I have a 1 and 2 month old mongrel female, she has just been spayed
about 2 months ago. She was not operated on by my regular vet and
experienced several problems. First of all it took her over 2 hours to
recover from the anaesthetic - they usually take less than 30 minutes
(all my other dogs recovered quickly with the other vet) .. Her eyelid
reflexes were almost non-existent for over an hour or more and I was
worried to the point of panic that her recovery took so long...Then she was fine the next day ( a bit groggy and not her usual self but
then she had just had an operation). The second day and for the 14 days
following she vomited continuously, was lethargic, refused to eat
completely, drank excessive amounts of water and kept belching it all
out. Her vomit was yellow and frothy.The vet who performed the surgery told me it was probably acidity
resulting from the anaesthetic and prescribed some medicine for her
which didn't work. My other vet saw her and said her liver was affected
by the anaesthetic and prescribed "motillium", "legalan" -something
which improves liver function, and several other medicines which she
would only throw up so I stopped using them.. I was giving her cortigen
shots twice a day.One night, around 3 am, she was very uncomfortable and vomitted non stop
and passed some strange diarhea - yellowy orangey coloured. I panicked
and called the vet who had done the spaying and he put her on an IV drip
and gave her a cortigen shot. She was then put on drips for a week and
seemed recovered.Since then she's been whining sometimes, and we didn't know if she was
just playing around or in pain - she didn't seem stressed at all, in
fact she would frequently be wagging her tail when she did this. And we
thought she was only calling her sister (to whom she is extremely
attached). About a month ago she vomited several times within an hour
and then seemed perfectly normal and was eating so I didn't think twice
about it... About a week ago her whining increased and this time she
seemed to be very uncomfortable and started vomiting again, excessively,
almost like someone with food poisoning! She also stopped passing urine
- she would sqaut then get up immediately but wasn't straining or even
trying to go..She also lost her appetite and was drinking alot of water.
I took her to the vet immediately and he palpated her and said he
suspected cystitis and said she should do an ultrasound ( this is the
1st time I've found out that there is an ultrasound for pets here -
diagnostic instruments are so hard to find in Egypt for pets!), I was
relieved to find they had finally an ultrasound for pets here. She did
the ultrasound (I've attached the scans), and the vet who did them said
she had internal pus (!!!), cysts in both kidneys (!!!) and this is his
short report:"Urinary bladder: cystitis with sedementation inside
Kidney: Rt & Lt kidneys showed multiple cysts and the Rt. hydronephrosisLiver: normal
Gall bladder: normalConclusion:
Internal pus and hydronephrosis in Rt. kidney
Palycystic kidney"What does all this mean?! The ultrasound vet assured me all this wasn't
serious and was all treatable but the other vet said there was reason to
worry and this meant her right kidney had failed and might not work
again! I am soooo scared and worried and don't know who to believe.
The vet put her on daily ringer drips and will give her glucose today,
she's taking lasix shots, an antibiotic and other shots I don't know
what they are (my vet isn't very talkative!). I've included her blood
picture results that seem to be very bad. What do you think is happening
to my dog - Samba? Is it a bad prognosis or do you think everything will
be ok ? She's so young and we resuced her from the streets of Cairo when
her mother was poisoned and killed (we have many strays here). One of
the vets said it was hereditary? Is it? we have her brother and sister -
should we be concerned about them now? She's now drinking less and her
appetite is poor and her prescribed low protein diet isn't helping with
her appetite much. Of course she urinates quite alot now due to the
lasix. I am so worried Dr Michael, I love my dogs so much and they are
the light of my life and would be devasted if anything happened to them,
they are the only thing keeping me going in life...Money, time and effort are no concern for me when it comes to my pets -
do you think there are more tests or anything else that can be done?Sorry about the long email but I wanted to explain everything as best as
I could, I don't have access to all the tests and info I've seen other
subscribers write about, veterinary medicine here is very different than
in the US - we're quite backward and as I mentioned before diagnostic
instruments are virtually non-existent - only the ultrasound ( very new
here) and x ray machine - only one or two I know of here in Egypt and I
was told they weren't used well (?).Thank you kindly for your time and any advice/info you can give me on
Samba's condition.Sincerely,
Hind.
Cairo, Egypt.ps: the vet who did the ultrasound said the cysts could be sucked out(?)
after they treat the pus if they don't lessen in size - is this a
complicated proceedure? it is risky? if they are removed, do they return
again? Any info would be greatly appreciated in this!Answer: Dear Hind-
I am sorry for the delay in responding to your question. The IV fluids,
diuretic (Lasix Rx) and antibiotics are the necessary first steps in
treating the kidney disease affecting your dog. I tend to agree with the
second vet who thought this condition was serious. Kidney insufficiency
(chronic kidney failure) in dogs can be very difficult to stabilize for
long periods of time. Cystic kidneys are not as common in dogs as they are
in some cat breeds and I do not have much information on this disease in
dogs. However, there do seem to be dogs that have this particular defect as
a benign problem for much of their lives.It might be worth asking your vets about the possibility of an ectopic
(misplaced) ureter. This is one of the major causes of hydronephrosis and
can sometimes be surgically corrected.There are several anesthetic agents used in dogs and they vary widely in
the amount of time the dog sleeps and the after effects. Some of the
anesthetics are more likely to cause liver problems than others. It seems
more likely that the kidney problems were already present and the recovery
from anesthesia difficult to the kidney problem, though.I wish I could help more but I hope it is reassuring that your vets do seem
to be doing the right things and that you were able to obtain really high
quality care for your dog, giving her the best possible shot at recovering.
There is a chance even with the good work done so far that she could be in
trouble, but I hope not.Good luck with this.
Mike Richards, DVM
6/5/2000
Canine kidney failure - causes
Q: Wolf, our 6.5 year old bichon frise is demonstrating symptoms of kidney failure.
What are the possible causes?( Lab work forwarded). Are we missing anything?
What do we do next.?Scott and Kay
A: Scott and Kay-
Wolf's lab work does support renal failure from some cause. Weight loss,
vomiting and increased drinking and urinating are symptoms often found
with renal disease. In addition, the lab work is supportive of this
diagnosis, particularly the increases in BUN and creatinine and the
decreases in albumin levels. I'll try to answer your specific questions
first and then give a more general overview of the potential kidney
problems and ways of differentiating between them.1) Are we missing anything? The first thought that came to mind for me was
that continued monitoring of Wolf's ability to concentrate urine would be a
good idea. This is easily accomplished by testing for specific gravity in
urine samples. The ability to concentrate urine to a specific gravity of
1.030 in a dog is a pretty good indication that the kidneys are
functioning better. The other thought is that there are lot of possible
causes of this condition and that it may take a lot of work to figure out
exactly which one is present -- and that you may or may not want to go
through the process. A more costly test is a urine protein/creatinine ratio
which can help in determining whether kidney disease is continuing to
progress or is stable at the moment. A protein/creatinine ratio greater
than 1.0 is bad, less than 0.6 is good.2) Leptospirosis is definitely possible with the symptoms seen. It has to
be included in a list of differential diagnoses and it is a good idea to
initiate treatment while waiting on the lab results. Cancer is also
possible but primary kidney cancers are not all that common in dogs so it
is perhaps less likely.3) I think it is a good idea to monitor urine concentrating ability for a
long time after an initial unexplained bout of renal disease. It is an
inexpensive test and I like to check urine specific gravity weekly for a
few weeks, then monthly for a few months and then occasionally after that
in dogs that have had a serious episode of renal disease.4) Subcutaneous fluids are cold compared to body temperature and it is not
unusual at all for dogs to shake or tremble (shiver, actually -- but it can
look more like trembling in a dog) after administration of the fluids. Low
potassium levels sometimes accompany renal disease and potassium levels
below 3.5 mEq/L can cause muscular weakness. Pain can cause trembling and
it is hard to figure out if there is pain in our canine patients, sometimes.5) If Wolf was dehydrated prior to the tests it would influence the tests
that are related to kidney function. Dehydration has the most effect on BUN
but can affect creatinine as well. High protein levels are also commonly
associated with dehydration. Therefore the correction of a dehydrated state
could lead to decreases in BUN and creatinine, as well as other blood
values. I don't think that this would completely explain the lab work in
Wolf's case, though. The creatinine, in particular, is still high after
treatment.What to do next is the big question. It may help to review the most likely
causes of Wolf's problem and the ways of differentiating between them.Renal (kidney) failure can occur for a lot of reasons. It would be hard to
compile a list that anyone would agree was a complete list of causes, due
to the number of potential causes that exist. So this is a partial list:Pyelonephritis, which is infection of the kidney itself
Congenital disorders, which are recognized to occur in the following
breeds, according to Nelson and Couto, in their book "Essentials of Small
Animal Internal Medicine" - Lhasa apso, shih tzus, Norwegian elkhounds,
shar peis, Doberman pinschers, samoyeds, standard poodles,, soft-coated
Wheaton terriers, cocker spaniels, beagles, keeshonds, Bedlington terriers,
cairn terriers, basenjis and Abyssinian cats.Renal hypoplasia or dysplasia - congenital but not always hereditary
anything that blocks urine from getting from the kidney out of the body -
congenital urinary tract defects, large bladder or kidney stones, renal
parasites, trauma, etc.Immunologic disorders --- systemic lupus erythematosus,
glomerulonephritis, vascular disorders, feline infectious peritonitisAmyloidosis - a disorder that normally occurs in dogs over 5 years of age
but can occur earlier is shar peis. It can occur for no apparent reason or
it can be linked to underlying causes such as chronic infections (not
necessarily of the kidney), chronic inflammation that isn't from infection,
cancer, cyclic hematopoiesis in gray collies. It occurs for no apparent
reason more commonly than it occurs due to discoverable underlying causesGlomerulonephritis - inflammation of the glomerulus (the individual
functioning units of the kidney). Can be due to a number of causes,
including: bacterial infections {Lyme disease, brucellosis, other systemic
infections}, viruses {infectious canine hepatitis, feline leukemia, feline
infectious peritonitis, feline immunodeficiency virus, chronic feline upper
respiratory virus infections}, rickettsial infections {ehrlichiosis, Rocky
Mountain Spotted Fever}, heartworm disease, protozoan infections
{trypanosomiasis, leishmaniasis}, cancer, chronic inflammatory conditions
{pancreatitis, systemic lupus erythematosus, prostatitis, chronic skin
disease, possibly periodontal disease}, hyperadrenocorticism, diabetes
mellitus and finally hereditary disorders in Doberman pinchers, samoyeds,
rottweilers, greyhounds, bernese mountain dogs, soft-coated wheaton
terriers and cats.Acute insults to the kidney - trauma, ischemia (lack of blood flow) due to
{clots, low blood volume, shock, heart failure} and drug reactions or
toxins {covered separately}Leptospirosis
Hypertension (high blood pressure) -- from hyperthyroidism, chronic heart
failureHypotension (low blood pressure) -- usually associated with shock
Hypoadrenocorticism (Addison's disease)
Cancer -- usually primary kidney cancer, lymphoma or spread of cancer
(metastasis) from other sitesunidentifiable causes
Toxins that are known to affect the kidneys: lead, mercury, arsenic
(usually arsenicals used to treat heartworms), cadmium, chromium, thallium,
ethylene glycol (antifreeze), carbon tetrachloride, chloroform, pesticides,
herbicides, solvents, snake or bee venom, possibly mushrooms, vitamin D
toxicosis from rodenticidesmedications known to affect the kidneys sometimes: aminoglycoside
antibiotics (gentamicin, amikacin), cephalosporins, polymixins,
sulfonamides, tetracyclines, amphotericin B, thiacetarsamide (Caparsolate
Rx), methoxyflurane anesthesia, non-steroidal anti-inflammatory medications
(aspirin, acetaminophen, ibuprofen, phenylbutazone), many chemotherapeutic
agents, gold salts, radiographic contrast agentsSo there are a lot of possible causes of kidney disease. Reviewing the list
can sometimes help in ruling out possibilities. If you suddenly remember
changing the antifreeze or have been struggling with skin disease for
awhile it may be important to be sure those things have been considered,
for instance.I will try to send some information on distinguishing between these
possibilities in the next few day or so.Mike Richards, DVM
Leptospirosis (zoonotic)- Wolf continued
Q: Dr. Mike,
Thanks for all the info about canine kidney problems. It has been very
helpful. Here's a quick update on Wolf, our 6.5 year old bichon frise who
was demonstrating symptoms of kidney failure.Last night our vet called and told us that Wolf tested positive for
leptospirosis. His levels were elevated for 2 of the 5 antibodies they
tested for. The vet said specifically Wolf was exposed to grippotyphosa and pomona
strains of lepto. Both can cause kidney problems, sometimes permanent,
depending on the infection. It seems our vet was wise to get Wolfie on the
amoxi immediately as a precaution. He was confident that, with the symptoms
and test results, lepto was the cause.We believe Wolf was eating squirrel poop while we were on walks (at first we
thought he was chewing on acorns but then I saw what he was really eathing!)
and Kay recently recalled that Wolf got to a dead squirrel that was hidden
under some leaves. He may have munched on it once or twice before she yanked
him away. I suspect either of these could be how he contracted lepto.We are going to get some more specifics from the vet today but the vet
said it would be a good idea to talk to our doctor/pediatrician about the possibility
of Wolf passing the lepto to us or Jake (our 9 month old 2-legged furless
son). He also recommended testing Glennis, Wolf's sister/littermate. Wolf
will finish out his amoxi series (10 days total) and then go on a month of
doxicyclin. After the amoxi we'll do some standard bloodwork looking for
reduced urea nitrogen and creatinine, globulin level, protein levels, etc.
Eventually we will need to retest Wolfie to confirm he beat the lepto, but
the vet wasn't sure if that would be in a month, 6 months or what. He is
going to
get back to us today on that.FYI, there is some good info on the net on leptospirosis. I can't remember
the site address but using "leptospirosis" as the search word on Yahoo it hit
only 3 sites that are all linked. Lots of good info.Since we are now financial supporters (albeit very minor ones!) of your great
website, I might as well ask a couple of quickie questions if you have time:1) We live in Fairfax, VA, and I see you are just down the road. Do you see
or hear much about lepto from other vets in VA? It seems to be relatively
rare.2) Our friend, a microbiologist in a pediatric lab, suggested we confirm
with the vet that the elevated antibody levels were NOT caused by his vaccination
against lepto which occurred in Mar 98. I would think, however, that the lab
would be looking for a significant increase in the antibody level, more than
that caused by a vaccination. We'll get the actual numbers today
(hopefully), but any thoughts on that since you deal routinely with vet labs and are
familiar with their procedures? Could this be a false result due to the
vaccination in March?3) Will we be able to tell from the lepto tests (antibody levels, type,
etc.) how long Wolfie has had the infection? What else can we tell about it?
Is he potentially still infected and a carrier? Our vet said to avoid his urine
(clean leaks with gloves, etc) and since he licks himself after urinating,
his kisses will be off limits until we get to the bottom of this.4) Ever hear of lepto making the canine-human jump? The vet said it is
possible but we should talk to our pediatrician. Our microbiologist friend
said that if a human's immune system is down that a zoonosis like lepto might
make the jump but she thought it unlikely (but recommended talking to the
pediatrician ASAP anyway.)Well, that's it for now. Thanks for sending us such good info and any more
that you have will be appreciated. We'll keep you posted.Scott and Kay
A: Scott and Kay-
To answer your questions:
1) I don't see many cases in which leptospirosis seems likely and have only
diagnosed this condition twice in my career. It is possible that I have
missed some cases, though. We usually do not consider leptospirosis titers
unless there is renal disease in conjunction with other signs, including
anemia, low platelet counts, increased white blood cell count and increased
liver enzymes or other signs of liver disease or some other reason to
suspect it. Since we wouldn't diagnose the condition without at least
considering it and testing for it, we may see more cases than we think we
do -- or we may not.2) Veterinary vaccines contain L. interrogans servovars canicola and
icterohaemorrhagiae, so titers to L. interrogans pomona and L. interrogans
grippotyphosa are not likely to come from the vaccination. Just having a
titer to these organisms is not sufficient proof to base a diagnosis on,
though. Very high titers (over 1:1000) are considered to be likely to be
due to active infection, though. Paired serum titers -- one set taken
immediately upon suspicion on the illness and a second set two to four
weeks later -- in which there is a rise in the titer, are more likely to be
actually due to infection.3) All you can really tell from the titer is that there has been exposure
to the lepto strains, or something that cross reacts with the strains. In
the case of high titers it is easier to assume that infection has occurred.
It is not possible to tell much else because titers may stay elevated for a
long time even after the infection has been eliminated. It is best to
assume that Wolf might be a carrier, though. It is just better to be cautious.4) Infection of humans by pets seems to be unusual but it is possible.
Again, it is best to error on the side of caution. An article (Canadian
Veterinary Journal, 1991, Prescott et al) says that of 820 cases of
leptospirosis in humans from 1962 to 1978 that dogs were implicated as
potential sources of infection in 58% of the cases.Mike Richards, DVM
Q: Is it normal for a breeder to write on a dogs papers "not to be breed"? We got him when he was 4.5, and told he is the large type and shouldn't be breed. Our Yorkie is only 8 and has kidney disease. He is showing symptoms and the vet said he has a few weeks to go. Is this a genetic trait in Yorkshire Terriors? We may get another one but want to know if this is common in this breed of dog. Regards Stephen
A: Stephen- We have seen more purebred dogs with contracts that specify that the dog may not be bred recently than we did in the past. I think this is becoming a fairly common thing.
I am not aware of familial or genetic tendency towards renal disease in Yorkies but that doesn't rule out the possibility. They do get bladder stones pretty readily, based on the ones I see in my practice.
Michael Richards, DVM
Q: I need help for my friend Lila. My 13 year old lab has had progressive weight loss and loss of appetite. I noted 4+ proteinuria last year and took her in for a check-up. All labs at that time other than serum protein (1.5) were normal. The vet wanted to do a renal biopsy. I refused. Follow-up exam nearly a year later included a heart worm test which was positive (recheck confirmed this unlikely diagnosis in New Mexico). She was treated with 2 shots and cleared of the worms. I suspect she had a "worm byproduct embolus" (my diagnosis) as she seemed rather different after the treatment... ataxia, sloooooow response time, and confusion. She was otherwise all right except for her pronounced osteoarthritis. Labs still the same. Only meds were Bactrim for UTIs and ASA- enteric. She began losing more and more weight. I took her back this month. Labs now show BUN >50, Cr >3, Serum Protein still 1.5, WBC 3.5. UA still with 4+ protein, some blood. CXR neg. No diagnosis given. I assume nothing more unusual than a protein losing nephropathy. So my questions: 1. She refuses to eat. Is it alright to "force feed"? I use a turkey baster and give her a slurry of rice, egg, a little milk, canola oil, and a flavor of pedigree. She is not pleased with me. Should I go low protein or high protein. Which is the better gamble? Am I interfering with her natural way of handling terminal illness? 2. She is in a lot of pain from the arthritis. What is the best drug given her condition? I was given Rimadyl, but I know nothing about its side effects, esp on the kidneys. 3. Is there any value to an ultrasound as was suggested? Why? Thanks for any help you can give. I really appreciate it.
A: I am confused by part of the labwork. A total serum protein level of 1.5 gm/dl is low enough to be considered critical. Serum protein is composed of two major fractions, albumin and gammaglobulins. Albumin serves many functions but the major one of concern with protein levels this low is maintaining the osmotic pressure of the blood. Just having an albumin level of 1.5gm/dl is considered to be sufficient reason to consider plasma administration. This is not always helpful with chronic renal failure from glomurolonephropathy, though. Gammaglobulins are the proteins of the immune system. One problem with low levels of these is the potential for immune incompetence. I think it would be a good idea to confirm that the protein level is this low and to discuss possible corrective actions with your veterinarian. As odd as this sounds, it is still recommended that a low total protein, but very high quality protein, diet be given to dogs with glomerulonephropathy and chronic renal failure for other reasons. The reasoning is that administration of high protein levels doesn't help because they aren't conserved and that there may even be increased damage from the increased protein passing through the kidneys. It is also good to provide a low sodium diet to decrease hypertension which may be damaging the kidneys and low phosphorous since it appears that phosphorous may actually be a major cause of damage in deteriorating kidneys. Rimadyl (Rx) is new and is supposed to be effective in the treatment of arthritis on a chronic basis without the gastrointestinal and renal effects of other non-steroidal anti-inflammatory medications such as aspirin. All things considered, I think it would be my first choice right now. Like all new things, it is possible some unforseen effect may occur but that is less likely with Rimadyl since it has been in use in other countries for some time. Ultrasound imaging provides a method of obtaining a renal biopsy without surgically entering the body other than the use of long biopsy needles. The image from the ultrasound allows the needle to be placed appropriately and lessens the risk associated with attempting a blind needle biopsy. Other than that, it is probably more of a prognostic indicator than diagnostic necessity. This is based on the limited exposure I have had to ultrasound. Your vet may well be more knowledgeable than I am about this subject. Force feeding is probably a good idea. In addition, making sure that gastrointestinal irritation is controlled using cimetidine (Tagamet Rx) or similar medications is a good idea. There is a liquid diet made for dogs with renal failure (Clini-Care) if that might be easier to administer. Good luck with all of this. It is tough to decide how far to go when treating chronic degenerative illnesses. Trust your instincts.
Mike Richards, DVM
Last edited 03/18/07
