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I have a dog with early stage kidney disease. Even with his…

Customer Question
I have a dog...

I have a dog with early stage kidney disease. Even with his kidney issues, he has been an excellent eater. However, about two weeks ago he stopped eating. We tried everything conceivable to get him to eat but he would barely eat anything. When he did eat, he would chew the food a few times but swallow almost nothing, letting most of it fall on the floor. Then one night three days ago he developed severe diarrhea and started throwing up persistently. First thing in the morning we took him to our vet, but our vet was unsure what the issue is. Unfortunately, the blood test showed a spike in BUN (99), PHOS (6.7) AND CRE (4.9), with CA and GLU at the top end of normal. His blood tests from three and six weeks prior were within normal (with BUN and CRE at the high end of normal. Or vet gave anti-nausea medication and prescribed an anti-diarrhea and appetite stimulant, as well as providing the supplies to do fluid injections once per day. Our dog is no longer throwing up, the diarrhea is gone, and he is fully hydrated. However, he still will not eat. We have set aside the low protein/low phosphorus diet that he was on in an attempt to get him to eat, but he will not eat anything (even though he comes into the kitchen constantly and checks his bowl for food often. Do you have any ideas??? Thank you.

Veterinarian's Assistant: I'm sorry to hear that. The Expert will know if the dog will be able to digest that. What is the dog's name?

Athos

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Athos?

He is about to turn 15, he is a schnauzer, and has been incredibly healthy for his entire life.

Submitted: 4 months ago.Category: Cat Veterinary
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Answered in 8 minutes by:
11/26/2017
Cat Veterinarian: petdrz, Veterinarian replied 4 months ago
petdrz
petdrz, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 7,621
Experience: Over 30 years of experience in caring for dogs and cats.
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Hello. Welcome to JustAnswer. I am Dr Z. I'm reviewing your question now, and will post back with a reply ASAP.

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Customer reply replied 4 months ago
Hello. I am not sure why this inquiry was filed under "Cat Veterinarian" because I am inquiring about my dog.
Cat Veterinarian: petdrz, Veterinarian replied 4 months ago

Thanks for trusting me to help you and Athos today. I am a licensed veterinarian with over 30 years of experience and would be happy work with you but need a bit more information to better assist you if you don’t mind.

Did your vet recommend any imaging studies such as xray or ultrasound of the abdomen?

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Customer reply replied 4 months ago
No, no recommendation of any imaging.
Cat Veterinarian: petdrz, Veterinarian replied 4 months ago

The significantly elevated kidney values over the previous ones were likely what we refer to a pre-renal. That means that due to the dehydration that developed secondary to the diarrhea and vomiting and anorexia, his renal values probably looked worse than they really are once his hydration was corrected. Was a urine sample checked at any time after the high normal renal values or the most recent very high values?

Have the renal values been rechecked since the fluids were given?

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Customer reply replied 4 months ago
I understand that they levels were likely elevated due to the dehydration, but I provided them as a reference. Since the diagnosis 10 weeks ago, I have his blood tested every three weeks with no significant increase (in fact, since putting him on a restricted diet, his number have come down). The big issue now is the sudden change in eating behavior. He is refusing to eat anything, regardless of what it is, and regardless of the form. We have tried every conceivable food that you can image (from the healthy to the unhealthy), we have tried blending the food just in case it is a size or consistency issue, we have tried chopping it very small, but nothing is enticing him. The only thing that we can get him to even eat a tiny amount of is fresh ground, unsalted peanuts. However, he cannot sustain for much longer on just a couple of teaspoons of peanut butter a day. And no, he has not had a urine test done.
Customer reply replied 4 months ago
Oh, and his blood has not been rechecked since the fluids were given since that was only two days ago. I was planning on bringing him back in tomorrow morning for another blood test.
Customer reply replied 4 months ago
Dr. Z, are you still there?
Cat Veterinarian: petdrz, Veterinarian replied 4 months ago

I suspect that his refusal to eat is a secondary problem, unrelated to his renal disease. Dogs with early stage renal disease usually continue to have a good appetite. I suppose it is possible that something triggered an acute insult to his kidneys and the worsening values are real. In the absence of toxin exposure or diseases like leptospirosis (not likely), about the only thing that would do that is if he developed a urinary tract infection that ascended to his kidneys. If his renal values are not better after the fluid therapy, a urinalysis and a urine culture need to be run to rule that out.

If the anorexia is not due to worsening renal disease, there are a few things I would think about. One is the possibility of dental disease or pain in the oral cavity causing him to not want to chew or swallow. I would make sure that is evaluated. There is also the possibility that he has developed a problem with his ability to swallow or move the food through the esophagus, but these are not common and difficult to confirm.

I am typing a few other thoughts.

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Customer reply replied 4 months ago
These are all things that I have considered, but he tends to confuse me with some of his actions. Yesterday he ate an entire apple (but he did chew and spit some of it out...although he went back and finished the pieces that he dropped after spitting them out). However, today he wouldn't even consider an apple. Today he ate two pieces of bacon (I know bacon is bad, but we are desperate). He also drinks water (even with the fluid injections). Also, he had his teeth cleaned 12 weeks ago, which is how we discovered the elevated blood readings, so I would assume that teeth wouldn't be the issue (but I can certainly check that out). It is all so confusing because there is almost no consistency.
Cat Veterinarian: petdrz, Veterinarian replied 4 months ago

The fact that he developed the vomiting and anorexia at the time that his glucose values were high makes me wonder about the possibility of pancreas involvement. Inflammation of the pancreas, as seen in pancreatitis, can lead to all of the GI signs mentioned and if the pancreas is "sick" it often will not secrete insulin as efficiently leading to an elevated glucose. Pancreatitis can be a challenge to confirm. There is a specific blood test called a PLI or cPL that can lend support to the possibility. Imaging is also helpful, specifically changes seen on ultrasound. Schnauzers are prone to this disease. Here is a link with more information about pancreatitis and it's diagnosis. LINK HERE

Based on bloodwork results tomorrow, I would probably advise that an ultrasound of the abdomen be performed. I would also consider having a feeding tube placed to provide nutritional support while you are pursuing the cause of his anorexia. We place these all of the time and they are well tolerated by the pets. LINK HERE

Yes, it does seem like this is a challenge to be sure. I would be happy to provide additional thoughts after his blood test tomorrow.

I hope this is helpful. Please let me know if you have ANY other questions. My goal is to give you 100% satisfaction and if you are not yet satisfied, please reply so I can clarify for you.

My posted replies are for general education only and not meant as a diagnosis. Only after a thorough veterinary examination can a diagnosis for your pet be made and specific treatments be advised or medications be prescribed.

Dr Z

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Customer reply replied 4 months ago
Thank you for the information.
Cat Veterinarian: petdrz, Veterinarian replied 4 months ago

You are welcome and good luck with him.

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