Renal issues in dogs - what should I know, consider ask?
Another round of issues for my Chessie - she went to the vet because I thought she seemed to be having stomach issues, nausea. Physically she checked out okay, vet wants me to continue with Famotidine and stay on same food for another month to see if that gets better. If not, may scope her when she gets her dental to see if there's any evidence of GERD, basically.
However, we did bloodwork because she was sick earlier this year and albumin was way off and he wanted to see if that was back. Albumin was good, but BUN was 32 and Creat was 1.8 or 1.9. So, at levels that get termed signs of kidney insufficiency, apparently. Did a urinalysis and there was blood in the urine, but no elevated white blood cell count or sign of infection. This concerns my vet, so she's going in for a kidney and bladder ultrasound Tuesday.
The girl has one kidney and was previously diagnosed with diabetes insipidus, which she's not treated for currently. She had an ACTH stim test earlier this year but negative for Cushings and Addison's.
Vet said the words "kidney tumor" so I'm really nervous.
Is there anything else I should ask about or consider as far as renal issues? I don't feel like I even know enough about what kidney disease can be like to make sure I ask the right questions.
She eats Acana Pacifica, gets Fortiflora every day.
Anything can trigger higher renal values. I will admit those numbers mean nothing to me as I am used to the numbers us canadians use. Treatable issues like pyelonephritis, obstructions etc. or general degeneration of the kidney, tumors (less common) etc. Its probably worth the money to have an ultrasound done by a specialist (not a general practitioner) who can evaluate the entire kidney, ureter etc. Here's hoping its something easily treatable!
The vet did talk a little about neurogenic versus nephrogenic DI, and not really knowing which she had. I guess he's thinking that maybe it's been the latter and that whatever caused the DI progressed to the point of damage or the beginning stages of kidney failure. I'm probably not translating that quite correctly...
I attempted to treat her for the DI, using the nasal spray as eye drops. It seemed to help for a couple of weeks and then lost its effectiveness. At the time, we were seeing an internist who said that it was very common for the dosage to be hard to get quite right. His thought was that since she was an indoor dog, and wasn't having accidents, we didn't necessarily need to treat it. So, she hasn't been treated in years and it hasn't been an issue.
During all the time of testing and eventual DI diagnosis, I don't think her specific gravity ever got higher than 10.06, even with a water deprivation test that was monitored at the vet's office overnight. Oddly, at the vet's this week, it was 10.20, which is the highest she's ever had.
I'm out of my league on this one. Do keep us updated. It's an interesting case. You never want to be an interesting case but it sounds like you've got a good team working on this and have the resources at hand to get a good diagnostic workup.
Sure wish you the best!
A good horseman doesn't have to tell anyone...the horse already knows.
there are two kinds of diabetes insipidus- neurogenic, which is caused by a deficiency of a hormone produced in the brain, and nephrogenic, which is the result of the kidney itself not responding to hormonal signals to conserve water. It's important to find out which type the dog has, because the treatment depends on which type the dog has- the nasal spray you mention only works for the neurogenic type. Treatment for the condition isn't really important, though, as long as the dog gets enough water.
The problem, obviously, is what caused the condition in the first place, and is this cause progressing?
The neurogenic kind is often caused by brain tumors; the nephrogenic kind can be caused by an assortment of kidney diseases. The condition can also be "idiopathic", namely, inherited.
At this point your vet is probably going to run a lot of tests to try to figure out what is wrong with the kidneys. I don't know what you should be asking about, specifically, at this point. Your vet probably doesn't know the answers until after the tests.
Well, the ultrasound was today. She has a mass on her kidney and fluid leaking into the capsule around the kidney. We will go back in tomorrow to aspirate and see what kind of fluid and whether it gives us a clue as to what the mass is. But, given that she only has one functioning kidney, there may not be a lot of options. If there are signs of cancer, we will go to see an oncologist but vet's gut says she's not a great chemo candidate. And obviously we can't remove the kidney.
For those who like specs - kidney measures 5.65 cm, mass is 2.6 cm or so.
He did actually find the vestigial right kidney. So there's that.