18 year old rescue terrier with stage 2 kidney disease

[RunawayHank]

Hello--thank you for providing some of the most comprehensive information on managing chronic kidney failure in dogs that I’ve been able to find.  I am struggling with several issues associated with management of kidney disease in my 18 year old terrier mix rescue dog, who was diagnosed with stage 2 kidney disease 5 weeks ago, on the heels of an episode of acute pancreatitis.  He had been on metacam for osteoarthritis (elbow, spine, hips) for about 2 years, so we have been monitoring his blood work at least every 6 months.  His creatinine had been creeping up slowly, but entered the abnormal zone at 1.8 after (but not during) the pancreatitis.  BUN was about 40 at the time of the kidney disease diagnosis (though I’ll need to check this value).  Urine was tested only for infection (no protein other analyses done), and additional blood work has not been conducted yet to test for potassium, sodium, phosphorus, etc.  Prior to the pancreatitis, he sporadically leaked urine at night, but about a week before his pancreatitis emerged, it progressed significantly to every night, and during the day during long periods of sleep.  This has naturally persisted, along with classical symptoms of increased water intake.  To address his pancreatitis, he was placed on a low fat prescription GI diet (Royal Canin), which I have maintained, but I supplement with canned food (fat < 5%, protein 5-10%) and home cooked food (chicken/sweet potato/pumpkin/green beans/mixed vegetables/rice/flaxseed meal).  Although he seems to have recovered from the pancreatitis--he is active, enjoying his daily short walks, no longer losing weight (he has lost 3lbs in the last two months--from 19.2 to 15.8lbs), OK appetite (this fluctuates—I rotate his food to avoid associations with feeling sick), he has also developed sporadic episodes of trembling, which I assume will worsen as his disease advances.  My vet has discounted the trembling, but I will be making an appointment his week to request blood tests for phosphorus, calcium, sodium, potassium (hate to subject him to another urine test, which my vet does by cystocentesis).  He was prescribed subcutaneous fluids 3 x week at home, but is not tolerating this well—it stresses him out.  Ultrasound testing/x-rays revealed an enlarged liver (present for several years) and reduced kidney size (possible new finding).  Once the new blood tests are done, I will definitely follow the advice in this forum to deal with the issues with diet (and will post again), but I am struggling with the stress caused by the subQ fluids.  I know it is supposed to delay progression, but it is difficult to balance the stress against the suffering caused by kidney malfunction.  I do believe that he suffers with it.  He has also developed extreme restlessness in the evening before settling down to sleep (perhaps driven by hunger, but he often won’t eat additional food after his evening meal—I feed him a small meal in the morning/larger meal in the evening), and sensitivity to sudden exposure to light (such as when we walk into the sun).  His musculoskeletal pain seems controlled with 25mg tramadol twice a day.  By the way, he has too numerous to count skin tumors—mostly sebaceous adenomas—but had a malignant melanoma removed about 3 years ago—it doesn’t appear to have spread, unless his enlarged liver is an indication.  I would like to limit any procedures/trips to the vet to only that necessary to reduce his discomfort.  I am very afraid of him dying without me in the vet’s office—I prefer home euthanasia when the time comes.  Like others in this forum, I struggle with not knowing how long he will last in this state, and with identification of when the bad days outnumber the good.  Do you have a sense of what I might expect from my description?  Thank you for reading through all of this!  

[Misfits4Me]

Welcome....Please join our Kidney Disease group....On this page>>On the right side, you will see a "Groups" tag....Click it & follow to Chronic Kidney Failure in Dogs....There will alot of information for you there....We're glad your here!