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Hello I am Dr Ola B and I am a small animal veterinarian. It is highly unlikely that the kidney failure was directly caused by the ingestion of the tissue box and tissue however, it is possible that pancreatitis occurred from that ingestion and pancreatitis can lead to multiple organ failure including kidney failure. At this point, the biggest issue isn't WHAT caused the kidney failure but trying to reduce her kidney values (blood urea nitrogen and creatinine) to get out out of the kidney failure and then maintain that with other means (such as low fat diet). Unfortunately, once dogs are in kidney failure you can only provide treatment with a IV catheter and aggressive fluid therapy until, hopefully, the values decrease.
Hello:) I am just checking in to see how Annabelle is doing?? If you have other questions please let me know. Also, please tahek the time to rate my response for helping you with you question about Annabelle?