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MishathePooh
5th April 2011, 03:10 AM
Still trying to figure out if Misha has kidney issues. Pat - do you have any more good reading material? I PM'd you a while back. Anyone else dealing/dealt with this? Right now we have drinking and peeing with ever so slightly off blood values. I am also thinking of asking for a vitamin b12 test since low RBCs, diarrhea and nerological issues are related. My boy is nearly 15, but no matter how many years you have, it's never enough. Thanks for any suggestions.

Zumie05
5th April 2011, 07:24 PM
Is he on the Renal diet? I know there is a special veterinary food for kidney issues - may not be a bad idea to start. Sorry to hear about what has been going on :(

GraciesMom
5th April 2011, 10:39 PM
Gracie was just diagnosed with this deficiency which has likely been factor in her on-going poop issues. She has not had the neurological symptoms but all of the others. You also may want to have Misha's pancreatic enzymes checked as well....that can lead to the B12 shortage. I wish you the best. I know how frustrating the diagnostic drill is. Seems like we have to do the research ourselves to point vets in the right direction!

Pat
6th April 2011, 01:16 AM
Crud - just typed a long post and lost it - will try to reconstruct but just have a few minutes. I am so far behind on various lists on which I post about health issues. I drafted this last night but fell asleep before I could finish:
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I am so far behind, and have been working 70 hour weeks.

Yes, I am dealing with this with my 13 year old shih tzu girl. She is in Stage II kidney disease (per IRIS staging below) with values a little worse than Misha's. I have already adjusted her diet, and I'm giving her subq fluids every other day. But this is easier in my case because she does not have heart disease which can complicate the treatment; you have to be more careful giving fluids to a dog with heart disease.

Here is some reading:

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

http://www.iris-kidney.com/guidelines/en/staging_ckd.shtml

http://www.thepetcenter.com/article.aspx?id=3496

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The B-12 test isn't going to be helpful I suspect. Misha's profile is of a geriatric dog with polyuria/polydipsia and borderline high normal BUN and creatinine and low RBC's. This is classic early chronic kidney disease. In this case, the RBC's are low because the failing kidneys are not producing erythropoietin not because there is a problem with B-12 (read about this in the above links). We do supplement with B vitamins but this is not going to correct the anemia problem but just help it a little. When anemia reaches a certain point in kidney disease, an option is to give EPO injections (very expensive and there are some problems with rejection since EPO is a human blood product). You don't need to study up on this yet - you have a long way to go before this happens.

As I mentioned before, the first thing to consider is a dietary change to reduce phosphorus in the diet which helps the kidneys with their workload and helps delay the azotemia. In the yahoo group where I am a moderator (K9KidneyDiet) we teach members how to formulate homemade kidney diets themselves. We don't encourage paying a nutritionist to devise a diet because kidney dogs are notoriously picky eaters as the disease progresses so you must constantly switch diets around. You can figure out how to do this yourself without paying anyone. Commercial kidney kibble is an alternative (I actually use this for Polly much of the time at this point but hope to change over) but the diet quality is less than a homemade cooked diet. Also, commercial kidney kibble is high in fat so if you have a dog that is prone to pancreatitis, this is a problem.

For Misha, the first thing I'd do is change his diet to low phosphorus. You can consult with your nutritionist on that. I would not be anxious to start subq fluids because Misha has concurrent heart disease. I've started subq fluids with my Polly, but she has no heart disease and also her BUN is already in the 60's and higher that Misha's. I'll dig up more links later - I actually still have a lot of employment related work to do tonight even though it is past 7 pm here.

You can also discuss these topics with Misha's vet for feedback. I think the vet just said to monitor at this point.

Pat

MishathePooh
6th April 2011, 07:00 PM
Thanks all. Pat - I know about EPO and kidneys, but couldn't help hoping the low RBCs due to B12 issues which is certainly fixable. I am just having a really hard time dealing with this - both because there's not much I can do other than tweak his diet and because we're just waiting for those numbers to turn bad. Not to mention, CKD has no cure.

The liver friendly diet he was on had 704mg Phosphorous daily which he ate for approximately 3 months though has eaten 3 times in the past 6 weeks.

The other diets he has been on in the past 6 weeks have 476, 467 and 410mg/day. Calcium levels are 759, 854 and 816mg/day - mostly in the form of calcium citrate. Sodium levels are 532, 802 and 327mg/day. Potassium 788, 837 and 812mg/day.

He is also on B complex, fish oil, Vit E, CoQ10. I was hoping to add SAMe and phosphatidyl serine in case it helped his neurologic issues. He is also on Tylan and Fortiflora.

I joined the yahoogroup, just waiting on approval.

Thanks for your help and sorry for taking up so much time!