My baby was diagnosed with ckd

[Totomommy]

Hi Tony, I found this website after my dog was diagnosed with ckd less than a week ago.
My baby is 13 and half, Lhasa Apso, female, fixed. She had her annual check up last Saturday and her blood test showed up as she's having CKD. The vet stated she's in stage 3 right now.
Her SMDA was 47 ug/ml
       Creatinin 332 umol/L
       Urea 26.4 mmol/L
        Phosphorus 1.69 mmol/L
        Calcium 2.72 mmol/L
everything else in the normal range. Her culture and sensitivity came out as no growth(?), her x-ray shows no sign of kidney size change.
Her RBC 5.91 and WBC at 7.04. Her protein/creatinine ratio was at 0.3

We have changed her food to K/D right away, but i still find her shivering from time to time. Her energy level seems ok, she still walks 3 times a day and plays with other dogs.

I am so devastated right now and am trying to do anything I can. I am taking her to see a specialist on this coming Monday. She has given no med but the vet instructed us to giver her 100ml IV every other day. She was hospitalized last in July (pancreatitis problem) and Sep (her paw became 3 times bigger than other paws, emergency couldn't find out what really happened. She was given IV anti-biotics and her blood showed no signs of kidney issues back then.

Can you please give us any advice/insight? I am so devastated with the situation..thank you so much in advance

[FawnT]

Hi Toto's Mommy, I just wanted to comment on your post and offer hope, as I know how you are feeling.   My Sheltie, Sadie was diagnosed with CKD almost 2 years ago.  We have managed relatively well, with a few small bumps in the road and one major one when she got dehydrated and had to be hospitalized and put on IV fluids for 2 days due to a spike in her creatinine levels, but that was a year ago.  My Vet is also a advocate of treating the dog, not the #'s, but using them as a reference to keep an eye out.  So if your dog has energy and is eating that is a great sign!   Diet adjustment has played a huge role in managing Sadie's numbers as has adding a phosphate binder last year when we had our hospitalization.  I feed her canned Royal Canin KD, she is picky so I have to supplement it with some human grade foods.  You will find there are a lot of options.  Sadie had high potassium (though in normal reading now), so I have to consider this too.  But if you dog's potassium is normal you can offer sweet potatoes and pumpkin, butternut squash which most dogs love if she won't eat the KD exclusively like Sadie.  With the change in diet you may possibly see Toto's numbers coming down.  We got a decent drop in creatinine and bun after being on the KD a couple months.  Wishing the best for your fur baby.

--Fawn & Sadie

[Totomommy]

Thank you so much Tony, we were thinking to make some food for her at home and wasn't sure if the homemade food would giver her supplement. Our vet thinks her BP is still ok (within normal range) but we will do check up in 2 weeks.

Thank you so much again Tony and will get back to you once new check up ia done.

Sorry for millions of questions and thank you!!

[tonyb286]

No problem. A few of my own recipes for canine kidney disease might get you started ...

http://www.infobarrel.com/10_Home_Made_Recipes_for_Kidney_Failure_Dogs

Tony

[Totomommy]

Hi Tony,
Thank you very and very much for your advice.
I meant to write she was given the omega 3 supplement. We add it to her food everyday.

She will see a doctor tomorrow morning. I wil certainly address all the issues and questions tomorrow including fluid increase.

Thank you also sp much for advice on food. We have a clearer idea on what we should fo mean time.

Thank you so much!!!

[tonyb286]

No problem.

Can you check the omega-3 supplement you have been given and confirm it has Vitamin E included? Or give me the name of the supplement and I'll check it for you.

Omega-3 is very good for kidney disease, but it also tends to deplete vitamin E in the canine body. Supplementing with vitamin E is therefore very important and can help the digestive tract absorb the omega-3.

Also, can you please let me know what dry food you are using.

Tony

[Totomommy]

Hi Tony, sorry for many typos. I should really calm down, right? Sorry.... I am still going though the process of accepting it. I constantly ask myself why/what happened and it certainly doesn't help my dog.

The dry food is also Hill's KD, as per your advice, we have put it in the water first before we give the food to her.
The omega 3 we are giving her is EicosaDerm, the label says it contains 10 IU vitamin E.

Urine gravity was at 1.012 (just checked after reading your comment again)

We have noticed she leaks herself a lot and she's sticking her tung a lot too; we will raise this issue as well tomorrow.

We are also experiencing difficulties in giving her subQ fluid; she cries quite often and we are just so worried about her.

Thank you so much again for your time and such knowledge based advice.

thank you million times.

[tonyb286]

Hi. So, SGrav is slightly low. That's more typical of canine kidney disease.

The Vit E in the omega-3 supplement is good. You don't need to add any more Vitamin E in that case.

I'm wondering what needles you are using for the SubQs? Using the smallest needle possible helps reduce scar tissue and keep dogs comfortable. Terumo 19 and 20 gauge are the ones that seem to combine a small size with ease of fluid movement. The higher grade needles will cause some discomfort, so avoid anything more than 20 gauge - smaller needles than 19 or 20 will cause less pain, but the fluid may not push in so easily.

If your dog is sticking its tongue out, it's worth asking the vet to check teeth and gums. Ulceration and loose teeth are not uncommon symptoms in kidney disease (due to Rubber Jaw symptom, which is caused via calcium issues).

Leaking of urine is another issue, more commonly associated with higher volumes of fluid being given and also with urinary tract infections (common). But the latter doesn't seem to be the issue, so maybe more urination is likely.

Yes, this disease causes a rollercoaster ride of ups and downs. Try not to fret too much. Let me know how the appointment goes.

Regards

Tony

[Totomommy]

Hi Tony, I will certainly let you know how it goes tomorrow. We can't thank you enough for your time.

Thank you!!!!!!!

[tonyb286]

No problem. Hope it goes well.

Tony

[Totomommy]

Hi Tony, no miracle that we were so hoping for. No meds yet until we get our regular blood check up done in 2 weeks. One hopeful part was that the specialist felt our dog was doing quite well (energy level and her appetite).

Thank you for your enormous support. We do know this won't be an easy journey but we are going to do our best.

We really can't thank you enough for your dedication for making this forum and such kind advice.

Thank you!

[tonyb286]

No problem. What did they say about the teeth and gums (assuming they checked them)? What needles are you using for SubQs ... it really can make a massive difference using the right ones. What did they say about the high blood pressure?

Tony

[Totomommy]

Hi Tony,
Sorry I forgot to mention them.
Her teeth and gum are doing well so far, no ulcers yet. The needle we are using for subQ is 20; we will ask our regular vet to reduce the needle size to 19?
The specialist saw the blood pressure and didn't say anything (this is our fault, we really should have asked again). Our regular vet is coming back today (she was away for the Easter holidays) so I will give her call and ask her this morning.

Tony, before I forget, I would also ask your advice on supplements. We have a supplement called MEZOTRACE and wasn't sure if this would be ok to her. ( we started giving her milk thistle yesterday).

Thank you so much Tony, we really and really appreciate it!! Thank you millions.

[tonyb286]

I wouldn't actually use MEZOTRACE. The problem with this type of supplement is it packs a whole range of active ingredients into it, some of which may not be helpful. For example, let's say blood results show serum potassium is high. By giving MEZOTRACE you would be further increasing the amount of potassium going into your dog, making things worse. The same would be true for high calcium, sodium, choline and others. The best route to supplements is to look at current blood values and then choose only those elements that are needed. Some supplements are helpful regardless, as with omega-3 and vitamin E (taken together).

I would certainly urge you to discuss the blood pressure asap. If (as I believe) it is high, then treatment with something like Enalapril would be helpful.

Tony

[tonyb286]

Hi. Lots of questions is a good thing ... and never a problem. And thank you for your kind words.

Sodium is just on the upper range of normal, but close enough to the abnormal range to be causing "issues", so reducing it in diet and water is a good idea. Potassium and chloride are within normal limits.

Not many people know that dogs actually do not have a "normal" blood pressure reading, because there are so many varieties of breeds and crossbreeds (each with their own peculiarities), sizes and shapes. The nearest "normal" B/P I can gauge in terms of size at least would be that for a West Highland Terrier, which would be 126/83 (+ or - 7). So, 144 strikes me as being high. Your vet may know more about your own dog though (for example, they may have past reference ranges on record or more information than I have about Lhasa Apsos.

It's certainly worth having a discussion with them about this, as high blood pressure can be a significant cause of kd dogs deteriorating.

The urine specific gravity (Sp Gr) is high. Normal range is 1.015 to 1.050. The high specific gravity is not untypical of canine kidney disease. However, it is more normal for the Sp Gr to low, as this would indicate there is a problem in a dog creating concentrated urine. When the Sp Gr is high, this is more likely linked to dehydration (insufficient fluids). This rather adds to my opinion that more SubQ fluids are required.

I should add at this point that I am not a vet - and you should take your vet's advice over and above mine. While I can supply you with information that may prove useful, I cannot advise you take any action without your vet's supervision and approval.

The urine pH is right in the middle of the reference range, so completely normal. This is very good news, as variances in the pH can contribute to kidney and bladder stones forming.

I have never been a fan of dry foods. If you think about it, they were designed for our (human) convenience, mostly at the expense of nourishment and quality. I don't think there is an issue at the moment with the amount of dry food you are feeding, but do make absolutely certain you are pre-soaking it in bottled water for at least half an hour beforehand. There will come a time when you will need to withdraw the dry food, so you might want to start this process now, bit by bit. What is the name of the dry food you are using?

"since she was diagnosed with omega 3 as well" ... I'm sorry, I don't quite understand this phrase. Omega-3 is not a diagnosis.

Milk Thistle is a supplement that helps protect the liver (not the kidneys). It can, however, be a useful supplement, because as the kidney disease progresses, the liver needs to take over some of the functions normally provided by them. This can put the liver under some stress and the Milk Thistle will help support it.

There is no problem in giving human grade chicken as a treat and instead of the canned Hills kd for a day or two a week. Chicken is high in good protein - but it also has some phosphorous, so less is more, if you know what I mean. The best part of the chicken (for kd dogs) is the darker meat from thighs and legs. You can keep the skin on the chicken meat, as this helps provide useful fat and energy. However, I noted earlier in your post that your dog has suffered from pancreatitis - and excessive fat in the diet can induce bouts of pancreatitis, so it's something to keep an eye on.

Eggs "can" also be a good addition to the diet of kd dogs ... BUT ... while egg white is rich in omega-3, the yolk is very high in phosphorous and omega-6. The best balancing rule to follow therefore is one egg yolk for every 3 egg whites. Eggs are also extremely high in good protein ... so I would only give them (like the chicken) as a treat maybe once or twice a week.

Kind regards

Tony

[tonyb286]

Ok. Thank you. The amount being given is about half of what is really needed. My calculations put it at around 200ml per day that's advised. There may be a reason why your vet is suggesting 100ml, such as heart conditions. If there are no other conditions that are relevant, I would certainly ask why such a small volume of fluids is being suggested. Maybe, they're just being cautious.

Phosphorous is under reasonable control, but is edging up towards the abnormal range. Diet restriction is crucial at this stage. If it has climbed again by the next set of blood tests (suggested in about 2 weeks time), then a phosphate binder will be needed (we can discuss that at that time if necessary).

The urea is very high. This is primarily due to the kidneys failing to clear toxic substances from the body. I'm hopeful the fluids will help bring the urea down closer to the normal range. Again, this is a good reason for checking bloods and urine again in two weeks time. During this period it's also very important to help hydrate your dog as much as possible - and I would advise low-sodium water for drinking, such as purified or filtered water. Faucet water has too many additional chemicals (such as sodium and chlorine) and is therefore not advised.

Although it's good that the X-Rays showed no kidney size change, it may be useful to have an ultrasound scan to see if there are any crystals/stones blocking the circulation to the kidneys and bladder.

RBC and WBC suggest no anemia and no infection, which is excellent. The culture and sensitivity (C&S) test was negative too, helping confirm no urinary tract infections are present.

I am a little surprised your vet hasn't arranged for blood tests for a wider range of electrolytes and minerals (potassium, chlorine, magnesium, for example) as these are relevant when a kidney disease dog has tremors/shivers. The point being that if these are related to abnormal electrolytes and minerals, then the tremors could be neurological nerve misfiring. Bring any abnormal levels under control, and the tremors should fade.

I'm also concerned your vet didn't do a specific gravity test of the urine - this should be done, as it helps determine the severity of kidney disease progression.

What food has your vet suggested/given you to use? The type of food is very important right now as it needs to be restricted phosphorous, restricted sodium, high-quality proteins (moderately restricted). It should also be a canned kd variety (Hills kd, for example) - not a dry kibble. I would also suggest adding in a few good supplements ... pure organic salmon oil is one of the most useful ones, as it supplies essential omega-3 fatty acid. Note, when giving salmon oil, you must also give a canine formulated vitamin E capsule at the same time. You could also add a dessertspoon of chopped cooked green cabbage to your dog's meal every 3rd day. This will help prevent ulcers forming in the stomach. Azodyl is also a useful (prebiotic) addition - although it is very expensive.

I'm guessing that's enough to take in for now. I know all this information can be overwhelming sometimes.

I'm giving you a link to one of my articl;es below. When you have a moment, please have a read - then ask questions about it if you have any.

Regards

Tony

http://www.infobarrel.com/My_10-Point_Plan_for_Dogs_with_Kidney_Failure

[Totomommy]

Hi Tony, thank you SO much for your advice. I can't thank you enough in words. I think I again missed many information due to my urgency in writing at the beginning.
Her calcium is at 2.72 mmol
       sodium at 154 mmol
       potassium 4 mmol
        chloride 111mmol on
No sign of blood/hemoglobin in her urine so far. Her blood pressure was at 144. Specific gravity1.102, ph 6
urine protein, glucose and keytones negative. blood/hemoglobin negative, bilirubin negative, urobilinogen normal



She's been eating Hills K/D foods (canned plus dry foods, should we stop giving her dry foods??) since she was diagnosed with omega 3 as well.
Also we have given her bottled water as well. I will certainly ask to increase fluids as well

Yes, we will do her blood test again in 2 weeks.

I read your article plus many advice you have given in this forum. I came across with Milk Thistle quite often and I was just wondering if it's good to add that at this stage. Also, my husband wants to add egg and human grade chicken (boiled), and wasn't sure if this would be good for her.

Could you please kindly advise us?

Thank you so much and sorry so many questions.... sorry

[tonyb286]

You mention you are giving 100ml IV ??? I assume you are referring to fluid therapy. If so, please let me have the weight of your dog - and the type of fluids you are giving. I assume you mean this is being given SubQ rather than IV?

Tony

[Totomommy]

Hi Tony, I was writing so fast that I don't think I was clear in conveying the message. The fluid bag says lactate ringer? And we were given needles to use. She's about 6.4 kg.
Thank you so much and my apology for such a messy message. I feel everything is just falling apart