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#1
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Kidney Disease?
I've mentioned the ongoing excessive peeing/leaking issues with Khan. He's
on Proin now, and is doing very well. No leaking, he's not asking to go out more frequently, and no excessive licking. Anyway, as part of his checkup, we ran a urine culture, and while most of his values are fine, the specific gravity was low. That was rechecked, and still came back low (1.019, where 1.025 is the bottom of the scale). Went back to the one that was done 3 months ago when this issue was originally brought up, and the specific gravity was 1.020. Went back 2 years ago, when it was done previously, and it was 1.040. Basic kidney function was checked via blood tests back in September for his geriatric panel, and again before his tooth extraction a few months ago, and BUN, Creatinine, etc. are fine. The vet mentioned that blood work changes generally take place after the kidney function has been substantially compromised, and that the change in specific gravity is suspicious. Here is the complicating factor. Khan's thyroid levels were re-tested at MSU, and just about all the results came back borderline low. Slightly improved from when he was on no supplements, but not as much as the vet would've liked to see (he's on 0.6 mg/day). One result (TSH?) came back normal. The endocrinologist opinion was that the dose should be adjusted, if the dog is still symptomatic. Since thyroid function can apparently affect the dog's ability to concentrate urine, this might be a symptom. Plus, his skin issues are not fully resolved still. After speaking with the vet, here's what we've decided. Change his thyroid meds to something that the vet says seems to have better bioavailability (other dogs that were switched needed their doses revised downward). Check the specific gravity again in 2 weeks, and if the numbers go up (she said around 1.030 is a good benchmark), do nothing but monitor the thyroid levels. If not, it's off to the imaging center for an ultrasound. Sure hope it doesn't come to that. Is there anything else we're overlooking? Does this sound reasonable? Suja |
#2
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Kidney Disease?
Suja wrote:
I've mentioned the ongoing excessive peeing/leaking issues with Khan. He's on Proin now, and is doing very well. No leaking, he's not asking to go out more frequently, and no excessive licking. Anyway, as part of his checkup, we ran a urine culture, and while most of his values are fine, the specific gravity was low. That was rechecked, and still came back low (1.019, where 1.025 is the bottom of the scale). Went back to the one that was done 3 months ago when this issue was originally brought up, and the specific gravity was 1.020. Went back 2 years ago, when it was done previously, and it was 1.040. Basic kidney function was checked via blood tests back in September for his geriatric panel, and again before his tooth extraction a few months ago, and BUN, Creatinine, etc. are fine. The vet mentioned that blood work changes generally take place after the kidney function has been substantially compromised, and that the change in specific gravity is suspicious. Here is the complicating factor. Khan's thyroid levels were re-tested at MSU, and just about all the results came back borderline low. Slightly improved from when he was on no supplements, but not as much as the vet would've liked to see (he's on 0.6 mg/day). One result (TSH?) came back normal. The endocrinologist opinion was that the dose should be adjusted, if the dog is still symptomatic. Since thyroid function can apparently affect the dog's ability to concentrate urine, this might be a symptom. Plus, his skin issues are not fully resolved still. After speaking with the vet, here's what we've decided. Change his thyroid meds to something that the vet says seems to have better bioavailability (other dogs that were switched needed their doses revised downward). Check the specific gravity again in 2 weeks, and if the numbers go up (she said around 1.030 is a good benchmark), do nothing but monitor the thyroid levels. If not, it's off to the imaging center for an ultrasound. Sure hope it doesn't come to that. Is there anything else we're overlooking? Does this sound reasonable? Damn, Suja, you could almost be describing Oppie! (Sorry, I haven't been reading this group much and haven't followed what you'd reported about Khan.) Last fall when we noticed that Oppie was having trouble breathing and the vet scoped him for laryngeal paralysis, he also found that his thyroid levels were a bit low (a common correlation with LP) and put him on thyroxin. Then we noticed leaking and excessive drinking (as high as 13 cups a day), and a urine test and bloodwork showed nothing wrong except low specific gravity. No indication of diabetes, no protein, other levels normal. We put him on phenylpropanolamine (proin), and the leaking stopped. (He may have been drinking excessively beforehand, but we hadn't noticed - when you start a new med you're looking for side effects and notice more.) His water consumption has dropped down to an average of 7-8 cups a day (still a bit high) and his specific gravity has ranged from normal to a bit low, but not nearly as low as the reading when he was drinking 13 cups a day and leaking. The normal reading was obtained after 12 hours of water deprivation, indicating that the kidney could concentrate urine under these conditions. We tried stopping the PPA and haven't seen any more leaking. The vets wondered if the highest levels of drinking coincided with the onset of his blindness (perhaps he was in pain and drinking more, though he wasn't giving any outward signs). He's had more tests in prep for surgery, and nothing besides low specific gravity showed up. The vet. ophthalmologist thought that based on retinal bleeds that he saw in the affected eye, high blood pressure might be a candidate, and indeed, it was high (180), even for a vet office visit. He said that that MIGHT account for both the excessive drinking and low specific gravity, as well as the blindness (but why only one eye? the other one looked fine internally, he said). Yesterday before his surgery the surgeon wanted an abdominal ultrasound. She told Hubster that it looked fine, but didn't give any details. I'll ask more about it when we see her. So we still don't know what's causing the excessive drinking and low specific gravity. Based on Oppie's experience, all I can suggest is that you have Khan's blood pressure checked, if that hasn't been done, and monitor his daily water intake, since that seems to correlate with the specific gravity somewhat. Oppie had his surgery late yesterday afternoon. All I know is that the vet told Hubster that it went just fine. We should get an update pretty soon this morning. FurPaw -- My family values don't involve depleted uranium. To reply, unleash the dog. |
#3
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Kidney Disease?
"FurPaw" wrote in message: Yesterday before his surgery the surgeon wanted an abdominal ultrasound. She told Hubster that it looked fine, but didn't give any details. That's great! No kidney disease then, which must be a relief. One of the problems I know I'll run into is convincing Rajesh that an ultrasound is the way to go if things don't improve. He's looking at a perfectly healthy looking/acting dog, and asking why I'm creating problems when none exist. He doesn't even think that Khan needs to be on Proin, since he doesn't leak all the time (that we can tell) when he's asleep. So we still don't know what's causing the excessive drinking and low specific gravity. That's a bummer! That's the problem with these things. It's indicative of way too many things. Based on Oppie's experience, all I can suggest is that you have Khan's blood pressure checked, if that hasn't been done, Nope, not done, I don't think. I'll ask her about it. Do they check for dog BP the same way they do with people? monitor his daily water intake, since that seems to correlate with the specific gravity somewhat. He's not drinking excessively, I don't think. It becomes difficult to monitor water intake with more than one dog in the house. Plus, because we go to the dog park, he drinks water there as well. Oppie had his surgery late yesterday afternoon. All I know is that the vet told Hubster that it went just fine. That's wonderful. Hope he gets to come home real soon. Suja |
#4
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Kidney Disease?
"Suja" wrote in message ... Basic kidney function was checked via blood tests back in September for his geriatric panel, and again before his tooth extraction a few months ago, and BUN, Creatinine, etc. are fine. The vet mentioned that blood work changes generally take place after the kidney function has been substantially compromised, and that the change in specific gravity is suspicious. ......You could have a ERD run if you want to investigate further. Link is on this page: http://www.dogaware.com/kidney.html#tests After speaking with the vet, here's what we've decided. Change his thyroid meds to something that the vet says seems to have better bioavailability ........what's that? (other dogs that were switched needed their doses revised downward). Check the specific gravity again in 2 weeks, and if the numbers go up (she said around 1.030 is a good benchmark), do nothing but monitor the thyroid levels. If not, it's off to the imaging center for an ultrasound. Sure hope it doesn't come to that. Does this sound reasonable? ........sounds reasonable to me. As for testing BP, I know they use the tail in cats. It's not easy with all that fur. buglady take out the dog before replying |
#5
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Kidney Disease?
"buglady" wrote in message: .....You could have a ERD run if you want to investigate further. Link is on this page: http://www.dogaware.com/kidney.html#tests This is awesome. Great information and a great collection of links. I'm going to see if I can get copies of his last two blood test results, so I can go through and see if there is anything worth looking at. .......what's that? I'll tell you tomorrow, after I've picked it up. He's on Thyrotabs now. .......sounds reasonable to me. As for testing BP, I know they use the tail in cats. It's not easy with all that fur. At least that ought to be entertaining, since he is most definitely on the 'extra fluffy' side. It's a good thing he's such a wonderfully patient boy, sounds like they'll be testing it. Suja |
#6
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Kidney Disease?
"buglady" wrote in message: .......what's that? Soloxine. Picked some up today, and will start him on it tomorrow. While I was there, I picked up Khan's pre-anesthetic bloodwork, urinalysis and Thyroid results. When available, the normals are in parenthesis. Abnormal results on the pre-anesthetic work a AMYL - 465.0 U/L (500-1500) HGB - 20.8 g/dL ( 12 - 18) MCHC - 39.4 g/dL (30 - 37.5) Other relevant results (that I can think of) BUN - 13.0 mg/dL (7 - 27) CREA - 1.3 mg/dL (0.5 - 1.8) GLU - 89.0 mg/dL (77 - 125) PHOS - 5.0 mg/dL (2.5 - 6.8) Na - 154.0 mmol/L (144 - 160) K - 5.6 mmol/L (3.5 - 5.8) CA - 10.9 mg/dL (7.9 - 12) The sodiumotassium is 27.5, and I'm wondering if we need to investigate Addison's. That would explain the thyroid and kidney problems, but he is not symptomatic and does not fit the demographic. The urine test results show a low specific gravity (1.02 on the overnight, 1.005 on the non-overnight), pH of 7.5, Urobilirubin - 0.2. Everything else (blood, protein, ketones, glucose) is negative. Thyroid Test Results: Total Thyroxine (TT4) - 30 mmol/L (15 -67) Total Triiodothyronine (TT3) - 1.2 mmol/L (1.0 - 2.5) Free Thyroxine (FT4) - 14 pmol/L (8-26) Free Triiodothyronine - 5.4 pmol/L (4.5 - 12.0) TSH - 9 mU/L (0 - 37) Since he is already on 0.6 mg Thyrotabs, endocrinologist feels that the results, with the exception of TT4, should have been closer to the middle of the normal range, especially since he started off low-normal in the first place. Suja |
#7
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Kidney Disease?
"Suja" wrote in message ... Abnormal results on the pre-anesthetic work a AMYL - 465.0 U/L (500-1500) HGB - 20.8 g/dL ( 12 - 18) MCHC - 39.4 g/dL (30 - 37.5) ........Hmmmm, high hemoglobin can be from dehyration and since MCHC is a ratio that uses HGB that's probably the reason it's high also. So that's the simplest explanation for that......am sure there are others. I don't think the low amylase means anything. http://www.nwlabs.co.uk/testinterp2.htm#AMYLASE. The sodiumotassium is 27.5, and I'm wondering if we need to investigate Addison's. That would explain the thyroid and kidney problems, but he is not symptomatic and does not fit the demographic. ..........27.5.....if I remember right 32:1 is the usual but I don't think your ratio is too low, but something to keep i mind. Aypical Addison's doesn't include low sodium levels. The urine test results show a low specific gravity (1.02 on the overnight, 1.005 on the non-overnight), pH of 7.5, Urobilirubin - 0.2. Everything else (blood, protein, ketones, glucose) is negative. Since he is already on 0.6 mg Thyrotabs, endocrinologist feels that the results, with the exception of TT4, should have been closer to the middle of the normal range, especially since he started off low-normal in the first place. ......I think I'd just go the direction you're going, bump up the thyroid, recheck it and urine. If you're still not happy with urine sp grav, do an E.R.D., which has got to be less expensive than an ultrasound. buglady take out the dog before replying |
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