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Progressive, Asymptomatic, Azotemia

by ssilcox - August 16, 2009

Mocha is an 8yr old, MN, Lab that I have begun seeing for renal disease.

Mocha has always been prone to weight gain (at one time being up to 121lbs!) despite trials on many different kibble-type diets. Thyroid levels normal.

About 4yrs ago went on Royal Canin Low Cal and began losing weight. Owner were initially please with the response, until he developed lethargy, polydypsia, vomiting, bloody diarrhea, and weakness, that was then diagnosed as renal failure and transferred to OVC where it was determined that the renal disease was due to Vit D toxicity.

Owners pursued aggressive investigation of Royal Canin diets and found excessive levels of Vit D, as well as mold, in multiple samples tested at 3rd party labs (law suit still pending).

At that time, owner changed to a homecooked diet and found Mocha did very well, particularly when she limited carbs. (Higher carbs lead to weight gain). Condition was stable for years. In Oct â€™08, became azotemic again and changed to K/D, but weight shot up within 1 week. Then changed to G/D with added green beans.

Early this summer, azotemia rose again, and changed to K/D again. Owner can smell uremic breath odour. Is on 100ng Calcitrol SID.

On K/D this time round, has developed diarrhea (no blood/mucous) that is poorly responsive to Tylan/Flagyl. Have tried him on FortiFlora probiotics as well, but with little response.

Put back on homecooked diet as Rx by â€œPetDiets.comâ€, azotemia progressed and they suggested reducing protein further (down to 1oz hamburger per meal BID!).

Despite Mochaâ€™s rising renal values, he remains bright, exuberant, shows no lameness, no change in appetite (in fact, heâ€™s always looking), no polydypsia, and no lameness or weakness.

He has several lipomas, has a BCS of 4/5, weighs approx 93lbs.
His tongue is lavender with a white coating, and his pulses feel (to me) somewhat deep, weak, thin, and a bit wiry?

His most recent values are as follows: BUN 18.3 (3-10), CREA 667 (30-140), PHOS 2.9 (0.8-2.2), HCT 31 (39-60) â€“ with fair regeneration. USG 1.006. Liver enzymes and CHOL are all WNL. Urine Prot:Crea WNL.

Because of the lack of typical renal dz symptoms, and his tendency to weight gain and diarrhea, I have been choosing my acupuncture points based on a Dx of SP def, but with his progression of signs, Iâ€™m starting to wonder if Iâ€™ve missed something and need to change my point prescription. Mochaâ€™s owner would also be very eager to add in some Chinese Herbs, but I have not prescribed any yet, due to my uncertainty in this case.

Any thoughts you can offer would be GREATLY appreciated for this wonderful patient, and exceptional owner.

by naturevet

August 16, 2009

Hi Sarah,

There's basically two ways you can go with renal disease, which you might have gotten a sense of if you searched the forum for discussions of renal azotemia. One is to increase renal blood flow, the second is to decrease it. The latter is more appropriate in inflammatory lesions, as evidenced by increased urine pr/cr ratios. In these cases, or phases (to be more accurate), low protein diets can be helpful.

The other phase is one where we need to increase blood flow. In these cases, I find commercial kibbles in general, and renal diets in particular, have the opposite effect we're looking for. They reduce renal blood flow and exacerbate the disease state, which is more of an ischemic problem than an inflammatory one. Urine pr/cr in these cases is often normal.

Of the two, it sounds like you're dealing with an ischemia. So I suspect the diet is working against you. I also find hypotensives to aggravate these cases as well. To confirm what you have, do some acupuncture: If sedating GB 25, BL 22, LV 13, BL 20, SP 9 or BL 19 aids the dog, it's an inflammatory case. Our top picks are San Ren Tang and Xiao Chai Hu Tang for them.

If, instead, tonification of BL 23 improves the pulse, you have an ischemic case. The formula to start with is one of the Rehmannia family. If the dog is hot with colitis, use Zhi Bai Di Huang Wan. If they are chilly with SI diarrhea, use Ba Wei Di Huang Wan (Rehmannia Eight).

If fluids benefit the dog, it's more likely to be an ischemic case.

Hope that helps!

Steve

by naturevet

August 16, 2009

By the way, if you try BWDHW, and the dog perks up, my recommendation is to move towards a higher protein diet like a grain or starch-free home-cooked diet. Use raw if the dog is hot (e.g. has colitis). At a bare minimum, consider using EVO or Orijen kibble.

As for the food, Royal Canin was involved in the melamine contamination problem that almost every major pet food company got trapped by. You'll recall it caused renal failure.

Here's the link:

http://www.acreaturecomfort.com/royalcaninrecall.htm

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