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Kidney Disease?



 
 
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  #1  
Old March 22nd 07, 01:47 PM posted to rec.pets.dogs.health
Suja
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Posts: 2,483
Default 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  
Old March 22nd 07, 02:24 PM posted to rec.pets.dogs.health
FurPaw
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Posts: 1,469
Default 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  
Old March 22nd 07, 04:23 PM posted to rec.pets.dogs.health
Suja
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Posts: 2,483
Default 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  
Old March 23rd 07, 12:09 AM posted to rec.pets.dogs.health
buglady
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Posts: 863
Default 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  
Old March 23rd 07, 03:38 AM posted to rec.pets.dogs.health
Suja
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Posts: 2,483
Default 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  
Old March 24th 07, 05:32 AM posted to rec.pets.dogs.health
Suja
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Posts: 2,483
Default 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  
Old March 24th 07, 12:24 PM posted to rec.pets.dogs.health
buglady
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Posts: 863
Default 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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