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Renal Failure In JRT

by mikemesley - July 15, 2009

6 year old jack russell terrier - off colour 3 months maybe.

Bloods = urea, crea, phos all very high, USG 1.012, prot only 1+
Currently sent urine to lab to run urine prot:crea ratio.
Amylase also high but ruled out pancreatitis. No Liv enzyme elevations.
Anaemia - significant PCv 18.9. Some retics present but not heavily regenerative.

So all looks a lot like a Rehmannia case to me up to this point - however tongue is lavenderish colour (nurse described it as brown!) and pulse is extremely superficial and extremely wiry. Also jugular pulse visible - has all the appearances of extreme renal hypertension - including mild heart murmur bilatrally (perhaps from anaemia or hypertension or both? - not heard on examination 12 months ago for vaccine).
Acupuncture - tried BL23 - tonifying seemed to make it worse. Sedating BL23 seemed to improve pulse!!
Tried GB34 - slight improvement. GB25 - no real improvement noted. Best pulse was found with GB34 and BL23 in place - both having been sedated.
Am I thinking too hard? Should I just jump in with XCHT and added Qin Jiao? Had thought a DEEP wiry pulse more likely if TB obstruction was on.
Any pearls of wisdom to drop this way - the dog is REMARKABLY well despite the dreadful blood results. Appetite OK at times. Also touchy cranial abdomen might be useful finding for you to know about!

Thanks everyone,
Mike

by naturevet

July 16, 2009

Hi Mike,

Yes, that pulse is a little confusing. You didn't mention how severe the azotemia was, but I'm guessing it was pretty significant to create the severe hypertension. If so, then a formula to take away excess (i.e. an anti-inflammatory) is indicated. Probably a urine culture is in order, too. In addition, if the urine pr/cr comes back as >4, that should clinch it as inflammed (excess). An excess situation would certainly explain the sedation of BL 23 creating a pulse improvement, as well as the benefits of GB 34.

So I would start with Xiao Chai Hu Tang until the case is otherwise confirmed as deficient (e.g. low or normal pr/cr in urine; worsening of azotemia on above protocol; only mild azotemia showing). Add the Qin Jiao for extra efficacy if you like. Think about a low protein diet, at least. I would also institute benazepril if the dog is that hypertensive. If we're lucky, this excess phase should only last about 6 to 8 weeks, before you need to start looking at deficiency formulas like Rehmannia Eight. Don't forget to culture the urine to ensure there is no pyelonephritis.

Hope that helps you out. Good luck!

Steve

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