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My dog was diagnosed with acute renal failure. Lab results

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2 months ago were normal...
My dog was diagnosed with acute renal failure. Lab results 2 months ago were normal, including normal values for Creatinine and BUN. Is it realistic to hope that she will recover? Our friend's dog died from renal failure; however, he was not diagnosed early. How helpful is early intervention for recovery? Can improper diet during the early stages of treatment (such as cat food, hotdogs, etc.) negatively the long term prognosis? Please refer me to authoritative sources in support of your answer. Thank you. Janice
Submitted: 9 years ago.Category: Dog
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Answered in 5 minutes by:
10/3/2008
Dog Specialist: Dr. Z, Veterinarian replied 9 years ago
Dr. Z
Dr. Z, Veterinarian
Category: Dog
Satisfied Customers: 135
Experience: 20 yrs as small animal vet; 30+ yrs in animal care; interests incl: breeding, skin probs, training
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Janice,

I really need more information to be able to give you good answers.
For starters:
1. How old is your dog?
2. What was the cause of the acute renal failure?
3. What treatment has been done to address the cause?
4. What have the kidney values been since being diagnosed?
5. How is her urine output and concentration?

Thanks

Dr. Z
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Customer reply replied 9 years ago
Hello Dr. Z,

Our dog is 13 years old. The cause of renal failure is unknown. All we know is that her lab values were normal when tested 2 months ago prior to dentistry. I suspected a problem a couple of days ago when she wouldn't eat and didn't want to go for a walk. I took her to the doctor and a repeat blood test showed her Creatinine to be 7.9 and her BUN 143. I am unsure of her I am pretty certain that her urine was negative, but I need to find the lab sheet.
Dog Specialist: Dr. Z, Veterinarian replied 9 years ago
Janice, thanks for your quick response. I do have couple more questions.
Was a urinalysis done 2 months ago, or just blood work? What about when you took her in to be checked this time? As for the BUN of 143 and Creatinine of 7.9 - when were these values done, and have they only done the 1 set, or have they repeated it since the diagnosis?
As for the urine - how have her urinary habits changed? Does she drink and/or pee a lot? Has this changed (more or less) over the last few months? When she does urinate, does her urine look very yellow, or clear, more like water? And have you noticed whether it has a strong odor or not?

Dr. Z
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Customer reply replied 9 years ago
Urinalysis was not done 2 months ago; just blood work prior to having her teeth cleaned. She had an endocrine reaction to her dentistry the time prior. I did not notice any change in her urinalysis pattern or drinking habits. I did not detect any unusual odor, and would likely not be aware of change in color.

The BUN of 143 followed a BUN in the 70's the day prior. Her creatinine rose from over 5.0 to 7.9 in the 24 hour period also.

Does diet matter at this point? Shall I give her any kind of food she will accept, such as hotdogs? We have a cat and she seems to want to eat the cat's food, but takes no interest in the kidney diet we have her on.
Customer reply replied 9 years ago
I am sorry. Did I miss your response to my inquiry to diet? Shall I give my dog the cat food she wants, or the hotdog she begs for? She will not accept the kidney diet. Any suggestions?
Dog Specialist: Dr. Z, Veterinarian replied 9 years ago
Janice,
The reason I asked about a urinalysis done previously, is that it is a more accurate indicator of kidney function than bloodwork. It takes at least a 75% reduction in kidney function before it will affect blood values - that's why you can donate 1 kidney, because even with only 1 kidney, you still have as much as twice the kidney function you need.
So, without a urinalysis from before, all we can say is that she had at least 25% of her kidney function at that time.
The numbers you gave initially (143 and 7.9) are definitely elevated, and pretty serious. However, what I find more concerning is that the numbers are increasing rather than decreasing. This indicates to me that the damage is continuing.
Generally, acute renal failure, if they survive the initial insult, has a better long term prognosis than chronic renal failure. Depending on what that initial insult was - for instance, anti-freeze poisoning causes acute renal failure, but has a very poor prognosis. On the other hand, infections and other toxicities can cause acute damage, but if promptly and appropriately treated, can recover and survive, although they may have long term kidney damage.
Without knowing the cause, it is impossible to say whether her chances for recovery are good or not. A lot depends on what treatment she is receiving. If she is on IV fluids and is still not improving, then her chances are much worse. If she stops producing urine at all, or in very small but dilute amounts, that's a very bad sign. On the other hand, as long as she is urinating, whether it be large amounts that are dilute, or small amounts that are concentrated, that is good.
If she is not on any sort of fluid therapy (intravenous would be much preferred, but even subcutaneous fluids are better than nothing), then it is much harder to evaluate. The fact that her condition, based on her kidney values, seems to be getting worse is bad, but we have no way then of knowing whether she would or would not respond to treatment.
I usually tell my clients who bring in a pet with elevated kidney levels to give the pet 24-48 hours of aggressive treatment - i.e. intravenous fluid therapy. If we don't see improvement in that time, or if the condition continues to worsen despite treatment, then I would usually advise to at least consider letting them go. I say usually, because there are always exceptions - such as if we are dealing with a serious kidney infection and waiting on response to antibiotic treatment, or something like that. But without those mitigating factors, lack of response or worsening despite aggressive fluid therapy is a pretty strong indication that the pet is not going to recover.
As for what to feed. Well, diet does matter, to a point. Because metabolizing proteins is hard on the kidneys, ideally a low protein diet should be fed. The more protein the dog is given, the more work the kidneys have to do. HOWEVER, if she is not eating at all, her body will start to break down stores from her own tissues, and the by-products of that catabolism are even harder on the kidneys. So, while it is important that she eats an appropriate kidney diet, it is more important that she eats at all.
I would try to stay away from the cat food, just because cat diets are generally very high in protein. Hotdogs are also probably not the best source of protein. Ideally, we want to not only minimize her total protein intake, but make sure that the protein she DOES get is high quality. If you're going to tempt her with people food, steak or chicken breast would be a better option than hotdogs. On the other hand, if hot dogs, or even cat food, are ALL she will eat, then better she eat something than nothing. I would just try offering her the better options first, only going to poorer options as a last resort.
Also, I would recommend asking your vet about nausea medicine and antacids. Often, dogs in renal failure won't eat because they are nauseous due to the high levels of toxins (BUN and creatinine, for instance) in their blood that the kidneys are no longer able to filter out sufficiently. By giving medication to reduce that nausea, she may be more willing to eat. And they can also develop gastric and oral ulcers secondary to the kidney disease (one reason pets with kidney disease often have bad breath), so medications such as Pepcid or Tagamet can help.

I hope this helps and answers your questions sufficiently. If you have additional questions or need more info, please let me know. Also, this was all off the cuff from my daily practice, so I don't have authoritative sources to refer you to off hand. However, if you would still like those references, let me know and I will see what I can find for you.

Dr. Z

PS Nope, didn't miss your response. Just long-winded when I get going. Something my techs are constantly complaining about - especially when I run them late at night cuz I talk too much. ;-)
Dr. Z
Dr. Z, Veterinarian
Category: Dog
Satisfied Customers: 135
Experience: 20 yrs as small animal vet; 30+ yrs in animal care; interests incl: breeding, skin probs, training
Verified
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Customer reply replied 9 years ago
You are very helpful, and I am most appreciative.

I would appreciate references so I can do some research on my own as well.


Thank you.
Janice
Dog Specialist: Dr. Z, Veterinarian replied 9 years ago
Here is one site that is pretty good. A little basic, but it also includes recipes for home made diets - that might be a little more tempting for your girl.
http://www.petshealth.com/dr_library/caninekidney.html

This one is not as in depth as the first, but does give some treatment suggestions - including dialysis.
http://www.howtodothings.com/pets-and-animals/a3688-how-to-treat-canine-kidney-disease.html

And this is probably going to be the best site if you want to continue doing research on your own - not only providing a number of articles on canine kidney disease, but also a link to an e-list regarding canine kidney disease.
http://www.vetprof.com/clientinfo/KidneyDiseaseInDogs/

Here's another good sight, with lots of information and links to other sources.
http://www.danemist.com/renaldisease.html

If, in doing your research, you find you have additional questions, please feel free to contact me back for more help. I lost my own dog to kidney failure, after 5 days of hospitalization and intensive treatment, so I truly understand what you are going through. Just let me know how I can help. Good luck.

Dr. Z
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Customer reply replied 9 years ago
Are there references you can refer me to regarding the best protocols to follow in acute renal failure to bolster the best prognosis to keep it from becoming a chronic condition?

Thank you,
Janice
Dog Specialist: Dr. Z, Veterinarian replied 9 years ago
Janice,
Most of my references are my medical text books. But I will see if I can find anything good and appropriate online, and get back to you.

Dr. Z
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Dog Specialist: Dr. Z, Veterinarian replied 9 years ago
Janice,
I'm not finding very much in the way of specific protocols. In general, the recommendation is aggressive fluid therapy (as long as the dog is still producing urine) and, where possible, treatment of the cause of the acute renal failure.
If you go to the links on the vetprof and danemist sites that I provided you before, you will find a lot of very good information.
There are some additional treatment options, if the fluid therapy does not do the trick (and there are some medication recommendations, but they are all in addition to the fluids).
If she stops producing urine at all (or very small amounts), dialysis may be an option. The problem is that there are only a few places in the country that offer veterinary dialysis, but if you are close enough to get to one, that may be something to look into.
On the other hand, if she does progress to chronic kidney failure, there are a very few of the vet schools doing canine kidney transplants. UC Davis in California is one. I THINK there are a couple others, but don't recall where off the top of my head.

I hope this is helpful.

Dr. Z
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Customer reply replied 9 years ago
Relist: I still need help.
My dog is 10 lbs. She requires 30 ml drip rate of IV fluid 24 hours per day. Would she need an equivalent amount of fluid subcutaneously? Is it possible for her to receive this amount sub-q?

Also, are all practicing veterinarians board certified or licensed?
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Dr. Z
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