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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 29741
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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My 13 year old Yorkie just died of kidney failure. I am

Customer Question

My 13 year old Yorkie just died of kidney failure. I am wondering if I could have prevented it. In December 2015, I took her in for removal of a bump. At that time she wasn't eating her regular food. I told her vet. No one looked at her teeth. I am thinking that at that point I should have asked for her teeth to be cleaned. I took her back in March 2016 and was told her two back teeth should be removed. I was not aware at that time that her BUN was 71. Her teeth were removed. I took her back a week later for a recheck because she was so weak. Her BUN was >180. This was a nightmare. I could have prevented all this if I had insisted that her teeth be cleaned in December???
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.

My condolences for your loss of your Yorkie. The issue wasn't whether or not her teeth should have been cleaned in December 2015 but, instead, not throughly investigating why a 12 year old stopped eating her regular food. While her teeth may have been painful, her kidneys may have already failed to the point that she had become inappetent and eating selectively. Just a few months later her BUN was elevated and should have been the stimulus for having a full renal blood panel (BUN, creatinine, hematocrit, serum phosphorus, calcium, sodium, potassium, e.g.) and complete urinalysis performed. It's likely that an age-related chronic renal insufficiency would have been identified; this isn't something that can be prevented but dietary alteration, blood pressure management, and various supplements can be helpful in slowing progression of renal failure.

Please respond with further questions or concerns if you wish.

Customer: replied 1 year ago.
Thank you for your answer. For her BUN level to go from 71 to >180, makes me wonder if I should have not let them pull her teeth. I am afraid the shock of the surgery caused her BUN to elevate even higher. OR that her BUN was high to begin with because of bacteria because I did not request that her teeth be cleaned. Would a surgery cause such an elevation in BUN? Also, I did not make an informed decision because I was not told that her BUN was 71 before surgery. Should a dog with a BUN of 71 even have surgery, or should I have tried something else first?
Expert:  Dr. Michael Salkin replied 1 year ago.

I can still anesthetize patients with a BUN of 71 but I'm going to administer IV fluids prior to, during, and after anesthesia and I'm going to make sure that my patient doesn't become hypotensive which is very traumatic to such kidneys. The surgery isn't going to cause such an elevation but hypotension certainly can.

The BUN of 71 was most likely due to age-related degenerative changes in her kidneys. Infection from the mouth (or elsewhere) can worsen those changes. Please continue our conversation if you wish.