Hello, I'm sorry to hear about Sasha being diagnosed with kidney failure.
Ideally she would eat a diet balanced for kidney failure such as Hills k/d, Hills g/d or Purina Veterinary Diets n/f.
Animals with kidney failure need high quality but limited levels of protein. The kidney is responsible for filtering and keeping proteins in the bloodstream. If we overload them on proteins then we over-work already damaged kidneys.
I understand she may not be eating well at this point. Things you can feed to perk her appetite are green beans, peas, squash, mashed potatoes, sweet potatoes, rice, noodles, and carrots. Small amounts of cantaloupe or watermelon are fine too. If she won't eat her dog food small amounts of white chicken, cottage cheese and boiled or scrambled eggs can be added to boiled rice, noodles or mashed white or sweet potatoes. It is very important that she eat but we do want to move her towards eating dog food balanced for her condition if we can. So mixing some things in with her dog food initially if she won't eat it is fine. Just try and limit the amount of protein and make it very high quality. Stay away from fatty meats, lunchmeats and salted meats.
Best of luck with your pup. Please let me know if you have any further questions.
Sorry I missed your earlier reply.
Sasha should stay away from too much protein and foods high in phosphorus. I wouldn't recommend beef liver or yogurt. Beef liver is not a lean protein and yogurt can give some dogs diarrhea because it contains lactose as well as both being foods high in phosphorus. Organ meats in general are high in phosphoru. Phosphorus nis an electrolyte that failing kidneys have difficulty removing. If the blood levels of phosphorus are too high calcium is leached from the bones leading to weak bones and calcification of the kidneys.
Tomatoes are fine however they are highly acidic and many dogs with kidney failure have gastrointestinal irritation/ulceration because of the effects of kidney waste products on the gastrointestinal tract.
As far as beneficial treatments fluid therapy to keep kidney waste products at a low level by flushing them out is often beneficial. Usually we start with intravenous therapy at the veterinary clinic then use subcutaneous fluids long term to manage the levels. You can learn to do this at home.
I also recommend a phosphate binder if her blood levels of phosphorus are too high.
If she isn't eating well sucralfate, a coating medication, can help heal gastrointestinal ulcers which will improve her appetite.
Acid reducers to try and settle her stomach are also useful. Either:
1) Pepcid-ac (famotidine) at one 10mg tablet per 20 to 40 pounds of body weight every 12 hours.OR 2) Prilosec (omeprazole) at one 10mg tablet per 20 to 40 pounds of body weight every 24 hours.These medications are quite safe and can be used for several days if necessary or for as long as necessary.
I also recommend an omega 3 fatty acid. These are natural anti-inflammatories and have been proven helpful in dogs with kidney disease. Reputable brands are 3V Caps and Derm Caps.
Additional testing that should be done is a culture and sensitivity of her urine to check for infection. Infections will worsen kidney failure and in some cases are the cause. Treating the infection can get the waste product levels back inti the normal range in some cases.
If she is clear for an infection then checking a urine protein/creatinine ratio is recommended. If she is spilling more protein then creatinine proportionally then she should be put on a meduction to help decrease protein loss. Protein loss leads to weight loss and worsening disease. Enalapril or Benezapril are commonly used medications for this.
Her blood pressure should be checked as well. Many dogs with kidney failure have secondary hypertension and this damages the kidneys further. If her blood pressure is elevated then Benezapril is the drug of choice for treatment.
Finally if bringing down her waste product levels and controlling stomach upset and hypertension isn't enough to keep her appetite we can use appetite stimulants. Dogs that eat and maintain body weight are proven to do better in the long run. Mirtazapine or cyproheptadine are both worth trying. They have different mechanisms of action so if one doesn't work try the other.
I hope this information gives you a place to start. Good luck with your girl and let me know if you have any further questions.
Thanks for the reply.
An infection in the mouth is a constant source of blood borne bacteria for her kidneys to filter out, as every time she eats and chews bacteria are pushed into her gums and bloodstream. I do recommend cleaning her teeth but I would probably use fluids to try and decrease her kidney waste product levels as much as possible first and use antibiotics to try and control the blood borne bacteria levels. This will get her in her best condition to be anesthetized.
I would probably also give Sasha a little time to adjust to a new diet, and new medications.
After a couple weeks of eating well and taking medications I would plan on cleaning her teeth. Of course she will require intravenous fluids during the procedure to support her kidneys and injectable antibiotics during and oral antibiotics after the cleaning.
As long as an oral infection is present it will compromise her kidneys but anesthesia is a stress on her kidneys and we want her in her best condition before stressing her further.
Let me know if you have any further questions.
Sasha will be going to the vets to get her kidneys flushed on Monday. We have changed her to kd food now and a bit of rice with it. She is also getting 5 mg of faqmotidine tablet 15 min. before she eats and 100 ml of aluminum hydroxide gel with her food.
She doesn"t seem to be as restless and hasn"t had issues keeping her food down. She has had 3 good night sleeps since her food and meds were started, seem to want to eat now and is still drinking lots of water.
She has energy now and wants to go for her walks again.
We shall see how the flushing goes on Monday and go from there with other meds.
If you have any suggestions or questions I should be asking the vet please let me know.
Thank you very much,
Gail Miller (& Sasha)
Thanks for the update on Sasha. It sounds like things are going very well for her.
I am very pleased that she is eating. Dogs that don't eat have a much poorer prognosis. Dogs that do eat tend to do well.
I would make sure that her blood prressure is monitored. High blood pressure is common with kidney disease and does significant further damage to already damaged tissue.
I would also make sure her urine is checked for excess protein loss (by running a urine protein/creatinine ratio) and if it is then medications like Enalapril or Benezapril are commonly used.
I would also ask about adding an omega 3 fatty acid to her reigimen. It is helpful for most dogs as it is a natural anti-inflammatory and has building blocks for tissue healing.
You might also ask about using a product called Azodyl if her BUN isn't coming down with fluid therapy. It changes the gut bacteria population such that urea isn't produced by bacteria in the intestines but is broken down before it is reabsorbed back into the blood. See these links for more information: http://www.vetoquinolusa.com/CoreProducts/RenalUrologySupport/Azodyl.html
Best of luck with your girl, please let me know how things go.
Sasha had her kidneys flushed and seemed to being doing well. She had energy, went for walks and ate very well.
The vet has Sasha on an antacid which she takes once a day 15 minutes before eating.
She is on aluminum hydroxide gel (tablets are no longer available) which she takes 2X a day with food.
After her kidneys were flushed she was put on apo-enalapril 5 mg. once a day. We are also giving her fluids under her skin 1X a day.
Today (Friday) she ate well, but when I came home I saw that she had thrown up everything she ate. She is still drinking water, but isn"t able to keep her food down.
She eats, but about 1 hr. later it comes up.
She is still urinating alot
Her stools are very loose and the last one was very runny.
We took her in today, the vet requested it after she had her kidneys flushed, to get her blood work done.
They said they would like to read them over again tomorrow morning It could be their machine that is not working. They could not get a reading properly.
They did say that Sasha may have a high level of fat in her blood.
We will be taking her in at 9 a.m. Saturday.
Any suggestions you may have would definetely be welcome.
I am very concerned now.
Gail, I'm sorry to hear that Sasha has experienced a setback.
At this point I wouldn't try feeding her anything else, as it will likely lead to more vomiting, just offer small amounts of water to keep her hydrated.
High levels of fat in the blood can interfere with some machine's ability to read kidney enzyme levels so a food fast may help get more accurate levels in the morning as hopefully her serum will be clearer. I will often ask owners to fast their dogs for 24 hours before I retest them.
If she has primary hyperlipidemia (which is a primary problem metabolizing fats) that can lead to high triglyceride (fat) levels in the blood and that can lead to stomach upset, vomiting and pancreatitis. If she still has high levels of fat in the morning I recommend sending bloodwork out to measure lipid levels, especially triglycerides. We can try to control this disease process with high fiber low fat diets and sometimes drugs.
She could also have hyperlipdemia secondary to her kidney disease. This condition is rare and is called Nephrotic Syndrome. Treatment is low sodium fluids, diuretics as needed and low dose aspirin to decrease small clots in the small blood vessels of the kidneys as well as a low fat, low salt diet as well as ace inhibitor drugs (like Enalapril or Benazepril) Here are some links to articles about Nephrotic Syndrome:
There are ways to spin the blood at outside laboratories to remove the fats and get accurate readings so if your veterinarian can't get accurate readings I do recommend sending the bloodwork out to an outside laboratory.
Best of luck with your girl, hopefully we can control this new complication and get her feeling well again.
Hello Dr. Kara,
Sasha was taken off the apo-enalapril, her body did not agree with it. She was vomitting and had blood in her stools.
She was put on noroclav and she did well on it. She got some weight back on and was eating well. She finished taking them on Friday and by Monday morning she was vomitting a bit but her stools were very runny. They put her back on Noroclav today, she ate a bit and is drinking okay but she did lose the wieght she had put on.
She is now on benazepril,just started it tonight.
She quivers for a bit and then relaxes.
We are to take her in on Friday again for more blood work. They think she might have had a bout of pancreaitis.
Hope you can give me some more advise on how to proceed. We have not given her much to eat tonite because of the vomitting and the runny stools.
I'm sorry to her that she's had so much trouble.
High kidney waste levels change bacteria in the the gut and can cause diarrhea and stomach upset. Ask your veterinarian about using Azodyl to help with that. This is a probiotic type supplement that breaks down those waste products so that they don't irritate the gut and they don't get reabsorbed into the blood.
If you aren't using Prilosec (omeprazole) I highly recommend it. Give 1/2 of a 10mg tablet per 10 to 20 pounds of body weight every 12 hours.
I would fast her for 12 hours then feed a bland diet of 2/3 boiled white rice and 1/3 boiled white, skinless chicken or lean hamburger. Add 1 to 2 teaspoons of pumpkin to each meal as pumpkin soothes the gut and should help with diarrhea. Once her gut settles down a little you might slowly reintroduce her regular food but discuss using pumpkin with her food to keep her gut settled.
Let me know how her bloodwork comes out.
Sasha is spending the night in the hospital. She was not eating and seemed to be in pain. She was not herself. They are putting her on fluids, antibiotics, a pain patch and something to help with the vomitting. Her blood pressure was up slightly, nothing that the vet was concerned about. He did say that she may have pancreatitis.
We will know more in the morning. It will be one sleepless night for Neil and I.
I'm so sorry to hear that Sasha isn't doing well. Try and get some sleep tonight, your girl will need you tomorrow.
She is in the best possible place tonight. Getting fluids, pain medication and injectable medication for nausea are exactly what she needs.
It has been awhile!
Sasha came home from the hospital the next day and seemed to do much better.
She ended up in the hospital again in extreme pain in October. The hooked her up to fluids and gave her a pain patch. We did not want to put her in over night. She does better at home. She had a good sleep and we took her back the next day for a check up. They could not believe how she was so much better. They had done some more blood work and we had taken her on a trip for 5 days. She was doing great. She had the pain patch on while we were gone.
We are wondering why her mouth is out of wack though. We noticed this in September when she was in over night at the hospital. The vet said it is rubber jaw. It has come back a bit.
We just got results from her blood work last week, everything is looking good. All levels are showing normal. Her red blood cells are down a bit.
They may put her on another medication to help with that and to help with the loss of calcium in jaw. She has lost a fair amount of weight. She still eats, but we can see that with her mouth being the way it is, she can't always pick up her food properly.
We are suppose to hear from the vet this week. I shall keep you posted.
Thank you for all your help,
Gail, Neil and Sasha Miller
Thanks so much for the update on Sasha.
Considering all that she's been through she seems to be battling this and doing as well as she can. You and your veterinarian are an amazing team.
It is true that kidney failure can lead to bone loss in the jaw, "rubber jaw" and that is hard to reverse. I suspect that she will be put on a phosphate binder to help decrease phosphorus levels which bind calcium and lead to calcium loss as well as a drug called calcitriol to replace her decreased serum amounts which healthy kidneys would normally produce. This hormone helps increase intestinal absorption of calcium and decrease calcium loss through the kidneys.
Anemia is another common sequelae of kidney failure as the kidneys produce erythropoietin which stimulates red cell production. When the kidneys fail they decrease production and anemia follows.
Let me know how things go or if you have any further questions. Thanks again for the update, Dr Kara.
Sasha is on a phosphate binder. And she will probalby will be going on calcitriol next week. I do hope that her jaw will improve some more. It is about 50% better than it was in September.
Sasha was doing so well up until 2 days ago. She started having seizures . She had her first one at home at 2:30 a.m. and another at 7:30 a.m. We took her into the hospital and they checked her out. She was in a lot of pain and they put her on the patch. She came home with us and was pretty good but then had another attack at 7:30 a.m. We had her in the hospital for fluids and she had a bad one at 5:00 p.m. She was not doing well and we had to make the difficult decision. We knew it was not a good thing to keep he going. She finished her journey on earth in my arms.
It is hard to understand how she was doing great up until 3 days ago,
I thank you very much for all of your help and encouraging words. May you go on for many more years helping other pet owners with their questions and concerns.
Gail and Neil Miller
I am so sorry to hear that you lost Sasha. My deepest condolences, I can only imagine how very difficult those words were to type.
Know that you absolutely did your best for her letting her go and ending her suffering and that you went the extra mile all along to make sure that she had the best chance of doing well.
I'm glad that the end was peaceful for you and she and that you could be there for her.
I know it's hard to imagine how things could go so wrong so quickly but she was walking a very fine line with the degree of disease that she had and it was only through your watchful care that she was able to do so well for as long as she did.
Thank you for your kind words and letting me know. You are both in my thoughts,