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MishathePooh
21st March 2011, 01:44 AM
I posted on this earlier. Misha is drinking and peeing a lot. Bloodwork and urinalysis and erd test all normal. Urine shows low specific gravity.

On Wednesday he woke up with conjuntivitis (antibiotic eye ointment). He was diagnosed with clostridium on Thursday and is on metronidazole. The drinking/peeing seemed to start with a 2 week prednisone course in early November. Only behavioral change is occasional peeing in the house. He drinks a lot in the evening, but not usually through the rest of the day. His food is homemade and has no salt added.

He also has mild MVD (asymptomatic, no meds) and possible dry eye (optimmune drops).

Soushiruiuma
21st March 2011, 02:33 AM
I believe steroids can increase thirst, and (consequently) urination. Since his tests came back normal, there isn't anything you can do to change it, just try to be more pro-active about taking him out. If it doesn't clear up once he's off the prednisone you'll want to investigate further.

anniemac
21st March 2011, 02:37 AM
Yes. Prednisone makes ella drink tons of water

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GraciesMom
21st March 2011, 02:52 AM
And many other things I hope to forget!!! Hang in there Misha!

Pat
21st March 2011, 10:04 AM
But he stopped the pred four months ago so I would guess that this is not a factor at this point although it may have started the cycle.

Do you have a copy of his blood chem and UA? Even if his creatinine and BUN and phosphorus are in the high normal range, with his symptoms and a low USG combined with his age, I'd be suspicious of early chronic kidney disease. That's one of my areas of interest since I've dealt with it a lot, and I attended a lot of Greg Grauer's sessions last summer at AVMA. He and Dr. Fortney (geriatric expert) opined that chronic kidney disease can be present when kidney values are high normal esp. in geriatric patients. You might want to talk with your vet about this to get his/her opinion.

What exactly is USG and was this on a first morning urine sample (with no drinking or peeing for 8 hours or so before the specimen was taken)? Kidney disease shows up first in USG long before it shows up in abnormal blood chem values. By the time BUN and creatinine are elevated, about 75% of kidney function is already gone. (This is one of the reasons that I've purchased a refractometer so that I can test USG at home early in the AM.) With excessive drinking and peeing, you'd expect USG to be low throughout the day, but that first morning sample gives valuable information.

Since you are home feeding, I'd start to restrict the phosphorus in his diet while keeping protein in the 1.5-2 gram per lb. range. You can calculate phosphorus and protein by running your recipe through nutrition data website. And remember that salt is in foods in various amounts even though you aren't adding it. If you aren't already giving omega 3 fish oil and CoQ10, you may want to add as those are kidney friendly (and heart too) supplements.

Of course he needs access to water at all times and should be not be restricted in his intake. I have a 13 year old shih tzu in early CKD - also low USG but her BUN and creatinine are now slightly elevated. I've changed her diet and I've just started giving her subq fluids. Thus far, she has no symptoms such as anorexia or nausea, etc.

Pat

MishathePooh
21st March 2011, 11:54 AM
USG was 1.01 - measured twice. It was first morning catch but he was drinking at night when I took it. So he was not water fasted.

Will have to get a copy of bloodwork and urinalysis.

So the ERD (http://www.heska.com/Products/Renal-HealthScreen/ERD-HealthScreen.aspx) test would not pick up early renal issues?

ETA: he is on 60mg/day CoQ10 and 1tsp/day fish oil.

Pat
21st March 2011, 12:38 PM
1.010 is really low. Generally the experts say that anything below about 1.033 shows that the kidneys have lost the ability to concentrate urine properly. When dogs drink more and pee more it can be the body's way of attempting to compensate for the poorly functioning kidneys by the additional flushing of toxins that occurs from drinking more and peeing more.

I think that the ERD test isn't very useful - if I see protein loss on a urine dipstick test I immediately run a UP/C - urine protein/creatinine test which is the gold standard for testing for a PLN (protein losing nephropathy). ERD shows trace amounts of albumin lost through the urine; it is free when you run an Antech Superchem with U/A so I do have that test run but I don't think it's particularly helpful.

Most of the time chronic kidney disease does not include protein loss through the urine so the ERD and UP/C do not rule out kidney diseases that don't involve protein loss. Most of my old dogs that had chronic (or acute for that matter) kidney disease did not have a PLN. I had one dog with a PLN that was diagnosed when she was middle aged and she was managed well on an ACE inhibitor.

So, you can have chronic kidney disease and have perfectly normal ERD and UP/C tests.

Pat

Pat
21st March 2011, 01:10 PM
Forgot to say - as comparison, my girl's USG runs from 1.020 to 1.024, and her creatinine is 1.6 to 1.9 - high normal to slightly out of normal range and her BUN runs in the 60's (normal range ends at 27). She absolutely has chronic kidney disease. She has no protein loss in her urine so ERD is normal. Her phosphorus is normal and she has no symptoms yet of kidney disease; she was diagnosed strictly due to routine blood chem and UA. The first thing we did was adjust her diet. We're hoping to stay ahead of it for awhile since it was diagnosed very early - before symptoms. I have started subq fluids because of that elevated BUN which indicates dehydration, and also she doesn't drink much at all like Misha is doing. Also, she has no heart disease so I don't have to be as careful about subq fluids. But when I tested at home and saw a USG of 1.020 I knew right away that she had CKD even before we ran blood chem. I'm a big believer in "no surprises" - i.e., trying to diagnose diseases such as heart failure and kidney failure before there is a crash. Harder to recover after a crash (an acute episode often requiring hospitalization).

Also, FWIW, the experts that I know (far smarter than I am) tell me to only give fish oil in capsules and not in liquid form. Supposedly when the liquid is exposed to air it loses its potency so a bottle of liquid goes bad very fast. You can cut off the end of the capsule and squirt on the food if you don't want to give the entire capsule.

Pat

MishathePooh
21st March 2011, 08:34 PM
USG - 1.019 on both 3/15/11 and 2/17/11
2/17/11 Bloodwork:
EOS - 0.17K/ul
HCT - 32.6%
RBC - 4.75M/uL
MCH - 29.7 pg
ALT - 105 U/L

BUN - 35mg/dl
CREA - 1.2mg/dl

Everything else in the mid of the normal range.

Should I assume he is in chronic renal failure due to slightly elevated BUN and low USG? Any ideas on why low RBCs?

How do I proceed if I assume renal failure? How much time does he have?

MishathePooh
21st March 2011, 09:31 PM
Oh dear, I just read about the kidneys enhancing RBC production. Looks like Misha has a kidney problem :-(

What are the steps I take from here?

mommytoClaire
21st March 2011, 11:51 PM
I am so sorry to hear about Misha.

I don't have any advise, only that I have a friend whose dog has kidney issues and is on a special diet for Kidney Disease. It seems to be helping quite a bit.

Keeping you both in my thoughts and prayers


Cindy and Claire

Pat
22nd March 2011, 02:10 AM
USG - 1.019 on both 3/15/11 and 2/17/11
2/17/11 Bloodwork:
EOS - 0.17K/ul
HCT - 32.6%
RBC - 4.75M/uL
MCH - 29.7 pg
ALT - 105 U/L

BUN - 35mg/dl
CREA - 1.2mg/dl

Should I assume he is in chronic renal failure due to slightly elevated BUN and low USG? Any ideas on why low RBCs?

How do I proceed if I assume renal failure? How much time does he have?

Well, first I would not panic. Dogs and cats can live a long time with a decent quality of life with CKD with the right supportive care. And if indeed that is what is going on, it's pretty early in the process so you can be proactive about making diet changes early before he becomes a picky eater.

1.019 is better than 1.010 - when you quoted 1.01 I just assumed you dropped a zero at the end. What are your normal ranges for the above values - I can't tell if you used Antech labs or if the blood chem was done inhouse. And I'd really want to look at the entire report, even the normal values as well as any past reports you have. Do you keep copies of reports at home? That's a good thing to do for many reasons. One reason is that you want to look for trends......blood chemistry is just a snapshot in time and it's trends that you want to observe. It's nice with a geriatric dog to be able to look back and see what values were in middle age, etc.

Lowered RBC production and resulting anemia are part of the process of kidney disease. Another part of the process can be hypertension. When was the last time his blood pressure was checked? Hypertension is something that can be controlled with meds so that is fairly easily addressed. And uncontrolled hypertension destroys kidney function.

Here is a good primer to start, and I can provide other helpful reading materials:

http://www.marvistavet.com/html/body_chronic_renal_failure.html

PM me with your email address if you'd like for me to take a look at his diet and run it through nutrition data. Many people with dogs with kidney disease home cook because they don't want to feed commercial renal kibble so you're already ahead of the game since you already understand about home prepared food. I'm part of a group of moderators for a yahoo canine kidney diet group so I have access to some very experienced and smart people who can give helpful advice. I also want to dig up my notes from Dr. Fortney's presentation on geriatric dogs and cats because he talked a lot about geriatric animals often having early kidney disease that goes undiagnosed until there is a crisis and about the importance of being proactive.

I think I'd recommend that you start by doing some reading and then go back to your vet and discuss what you've learned and ask for feedback. What does your vet think is going on and what advice has he/she given? Polyuria/polydipsia with lowered USG in a teenaged dog is pretty classic for chronic kidney disease.

Pat

MishathePooh
23rd March 2011, 12:57 AM
Pat, I PMed you with my email addy FYI. I would be happy for any educational materials. I'm currently working towards a masters in nutrition and have been working in that field in research for nearly 5 years - so I can probably handle even technical readings. I have access to most scientific articles as well.

Thanks all for your kind comments.