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Dr. B.
Dr. B., Board Certified Veterinarian
Category: Veterinary
Satisfied Customers: 15313
Experience:  General practice veterinary surgeon with extensive experience in a wide range of species.
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Customer Question

I have a 15y/o female shihtzu recently diagnosed with kidney problems . My vet put her on a very low protein diet (k/D) she will not eat for 5 or 6 days on this walks around sniffing for food her blodd level was 40. I also have 14 y/0 male her brother with same problem his blood level was 80. What do I do?
Submitted: 3 years ago.
Category: Veterinary
Expert:  Dr. B. replied 3 years ago.

Hello & welcome to Just Answer/Pearl. I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today.

I am sorry to hear that Sugarbaby and her brother have kidney disease. We are seeing it more and more often in our pets as they are living longer then ever before.

Now as I am sure you can appreciate, if they do not like the K/D then no matter how good it is for them, its not going to help. Especially because we don't want them picking at the food and barely getting nutrition in. Rather we want them to eat well and feel good while they can. And this K/D aversion Sugarbaby is showing is telling is that we need to address this.

As I am sure you can appreciate, when we are faced with managing a chronic progressive condition like kidney disease, we do have to make compromises. By this I mean, we need to find a means to best support the kidneys while keeping our dogs as happy and comfortable as possible. If Sugarbaby doesn't like the Hill's K/D, then do consider trialling her on an alternative kidney diet. For example, Royal Canin Renal (LINK) or Purina NF (LINK)

If she decides that she doesn't like those either, then you can consider any diet she will eat but you want to aim to use diets that are as close to those lower protein, lower phosphorus, and lower sodium levels that are in the kidney diet. (So it is worth a peek at the back of all the dog food labels). As well, if she isn't amenable to those renal diets and you do find one with low levels of the above, then aim to feed the wet food version if possible (since its 35% water and will get more hydration into her to support the kidneys).

Further to dietary management for your wee ones, there are other angles that can be addressed to support a dog with kidney disease. This includes medication to aid kidney filtration and get them to work as best they can (ACE inhibitors like Fortekor) and phosphate binders (ie Epakitin ) to help remove phosphate build up commonly seen with this disease. If she is anemic as well, there are drugs the vet can administer (ie Laruabolin, Epogen, etc) to stimulate marrow to produce red blood cells (which normally would have been hormonally stimulated to work by the kidneys). Furthermore, if they have chronic issues with their kidneys you may want to speak to your vet about fluid therapy options for them (since we can often give sterile fluids under the skin to keep them hydrated and to aid the kidneys in flushing out the body's toxins). Depending on their demeanors, you may even be able to do this yourself for them at home You can find further information on subcutaneous fluids therapy HERE.

Finally, we do need to consider that if they both have such elevated kidneys levels that they may also have secondary nausea (since high urea often makes animals nauseous and this can make them less inclined to want to eat). And this could be playing at least a bit of a role in their aversion to the K/D. Therefore, in some cases, we find it helpful to also treat with an antacid. There are a number of antacids that can be used to help dogs in this situation (ie Cimedtidine, Pepcid (LINK) or Zantac (LINK)). And if nausea is playing a role here for them, then addressing this may also get them eating better for you.

Overall, our number one focus is keeping these dogs eating and as happy as long as we can. Ideally, in a perfect world, this would be on a diet that is less work for their kidneys (so Royal Canin or Purina' kidney diets are worth a try) but if your dogs are totally opposed to them then we need to just make sure we are trying to feed them something they like that is as 'stress free' on their systems as possible. At the end of the day, this isn't a disease we can cure, but it is something we want to manage for them as best as we can so that they can enjoy the time they have left with us.

I hope this information is helpful.
Please do let me know if you have any further questions.
If you have no further questions, feedback is greatly appreciated.

All the best,

Dr. B.


Please remember to only rate my answer when you are satisfied. IF you have any lingering questions or concerns, please stop and reply to me via the REPLY or CONTINUE CONVERSATION button with the issue you have. I will be happy to continue further and do everything I can to provide you with the service you seek. If you are satisfied, please click the 4-5 stars or associated happy face so that I may receive credit for my assistance.

Customer: replied 3 years ago.

Can I make home cooked food for them that will be good for them? If so can you please give me a guide of what should be included in it? I know we need to keep Protein and sodium and phosphorus levels down very low but what do I substitute for protein? Rice, barley, soy products or what. I know fresh vegetables like carrots and broccoli are good for them and have always these as part of their treats but past that I am lost.

Thank You,


Expert:  Dr. B. replied 3 years ago.
Good evening Mary,

Home cooked meals would certainly be an option for them as long as they are done properly (since it is quite easy to accidentally leave out vital vitamins/minerals when doing so). If you'd like to undertake developing a home diet for them, I would strongly advise you have a wee peek at the BalanceIT website (HERE). This is a very good website that is very helpful in developing home cooked diets to meet our pets' needs. If you look at the 'free recipe generator,' this will give you a good starting place on what making a diet for them will require.

Alternatively, if you wanted a clinical veterinary nutritionist to create a balanced diet just for your wee ones' needs, PetDiets (LINK) is another good source to check out.

Overall, a home diet may be a good alternative for diet discerning dogs. And these two sites will aid you in developing a properly balanced diet that they will tolerate better then their current diet. And if you are able to do so and can get them eating better, then this will aid in supporting both their kidneys and their overall health.

All the best to you and the wee ones,
Dr. B.
Customer: replied 3 years ago.

Doesn't answer question and considering The reply is here almost as soon as I leave question I do no believe this is a real vetrinarian, I t hink this whole thing is aequesting my money back and withdrawing my membership asap! SHAM! I am r

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