First, if they didn't recheck her bloods after IV fluids, then we don't really know how well she responded to those fluids. That said, if she is still feeling terrible, I would be worried that her situation is quite advanced and her prognosis may be guarded.
That aside, there are some treatments and support we can try for her. Now you noted that she has always had acid reflux but I do have to note that kidney disease can cause GI upset and vomiting due to a secondary condition called uremic gastritis. So, this could be making her worse. As well, her high blood urea can also cause ulcers of the mouth and throat; and that could also be causing her gagging. And while scoping could let us see these issues, we may want to instead try to tackle them for her. Therefore, with these concerns in mind and her nausea, I would advise considering treating her with an antacid at this stage. There are a number of antacids that are available over the counter and pet friendly. I would advise only treating with one, but the two I tend to recommend are Pepcid (More Info/Dose Here
), Tagamet (More Info/Dose Here
), or Zantac (More Info/Dose Here)
. As well or alternatively, you can request that your vet dispense further stomach
settling/anti-vomiting medication like Metoclopramide, Zofran, or Cerenia. These can further reduce her nausea and settle her stomach signs.
Otherwise, I would note that when we have dogs with kidney disease, we often will put them on a kidney diet (be it Hill's K/D (here
), Royal Canin Renal (here
), or Purina NF (here
)) to reduce strain on the kidneys' daily work by keeping dietary intake of protein, sodium, and phosphorus as low as possible. I have listed a few diets for you there, just in case you wanted to research these further.
As well, there are some medications that can be used to support patients with kidney disease. One that may be of use here is an ACE inhibitors like Benazepril. This medication just helps the kidneys function as best they can and can reduce protein loss via the urine (often the reason they lose weight).
Finally, if her kidney parameters even after IV fluids are still high, then we may also find routine use of subcutaneous (SQ) fluids helpful in supporting her kidneys. Now the use of this treatment would depend on your keenness to do this at home (not all owners are able) and her being amenable to treatment. If you are interested in this, it is worth a discussion with her vet, as SQ fluids can be quite helpful to just support the kidney on a daily/weekly basis to keep the metabolite levels from reaching a level where she feels poorly with them. Just in case you are interested, I do want to leave a good guide (HERE) and a very good video on giving SQ fluids HERE.
Overall, I am quite concerned with how poorly she is despite IV fluids. So, instead of scoping, you may want to instead use the above to try and soothe her GI signs and help her manage with her struggling kidneys.
I hope this information is helpful.
If you need any additional information, do not hesitate to ask!
All the best,