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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 27905
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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I'm seeking a second opinion on my dog's renal failure

Customer Question

Hello,
I'm seeking a second opinion on my dog's renal failure prognosis. Tests show creatinine levels rising over 3.0 and BUN 45+. He was put on drip therapy for 72hrs, and did not reduce creatinine. He behaved normally before therapy (diuresis?), but now on brink of death.
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 1 year ago.

I'm sorry to hear of this with Elmo. Can you upload a copy of all of his test results to our conversation? I understand that you might not have a copy of the results at home but his vet should be able to give you one which you could scan into your computer and give me the link or you can photograph the page(s) and upload the images by using the paperclip icon in the toolbar above your message box (if you can see such an icon) or by using an external app such as dropbox.com. To answer you directly, no, a creatinine of 3.0 and BUN of 45 isn't life-threatening and his normal behavior prior to diuresis should have precluded diuresis. There's reason to believe that his renal values were due to a pre- or post-renal disorder rather than primary renal insufficiency.

Customer: replied 1 year ago.
I'll send you a copy of the labs soon. I don't have them on hand. The only abnormal results were the Creatinine and BUN. I remember the creatinine went from 2.9 to 3.6 in just a week, even after the meds and infusion. BUN did decrease somewhat. Vet said it was chronic kidney failure.
Expert:  Dr. Michael Salkin replied 1 year ago.

I understand. I need to know from what value the BUN decreased to 45. I need to see Elmo's serum phosphorus, his hematocrit (HCT or PCV), and - very important - a complete urinalysis prior to diuresis. The creatinine rising from 2.9 to 3.6 in a week is a negative prognostic finding but that finding alone doesn't identify chronic renal kidney failure.

Customer: replied 1 year ago.
Hello Dr. Salkin, I have attached the lab results for Elmo.
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you! If we just look at the BUN and creatinine as well as the high normal serum phosphorus, we would think that Elmo has approximately 20% normal functioning kidney tissue left. Without a urinalysis, however, I can't tell if Elmo can still concentrate (or dilute) his urine and I can't know if he's proteinuric. In general, dilute urine is a negative prognostic finding as is excessive protein loss through the urine (proteinuria). I also don't see a a hematocrit which tells me if he has developed a nonregenerative anemia indicative of chronic renal insufficiency. I'm picky, I know, but you deserve to know more about Elmo's prognosis.

Expert:  Dr. Michael Salkin replied 1 year ago.
Hi,
I'm just following up on our conversation about Elmo. How is everything going?
Dr. Michael Salkin
Customer: replied 1 year ago.
Hello Doctor. Elmo passed on thanksgiving. Seems the meds and diuresis precipitated it. Thank you for following up.
Expert:  Dr. Michael Salkin replied 1 year ago.

Oh my. My condolences for your loss of Elmo. I appreciate your taking the time to let me know. You may receive an inappropriate follow up sent by the site ostensibly sent by me. It wasn't and I apologize in advance should you receive it.