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Severe Azotemia In A Dog

by drjjudkins - November 21, 2014 View Case Report

I saw a 2 yr-old shih tsu 3 weeks ago that had severe azotemia discovered on pre-anesth blood wk for a torn dewclaw. BUN was 137, creat 6.0, HCT of 35%. Client noted the dog had been PU/PD since a young puppy, but otherwise seemed completely healthy. Good appetite and normal stools.

The dog looked great, but had a pale pink tongue, and a toned, taught, even choppy, full pulse. I started the dog on You gui wan and recommended a raw meat diet with w/ 1/3 added cooked yams and pureed veggies to lower the protein a bit.

I saw Bandit again yesterday, and he still was doing fine. Guardian noted that he had stopped needing to go out at night to urinate...which I thought was great. When I got his blood wk back today, his BUN and Creat were no better, and even slightly worse. His phos was elevated at 10.7 (never checked before) and HCT down to 32 from 35.

I suspect this dog has congenital kidney disease, and has somehow adjusted to living with his poor renal function. I was not confident that I could improve his values, but I was surprised they got a bit worse. Maybe the higher protein diet was responsible.

I wonder if it is possible to help this guy. Im going to start him on a phase binder, but otherwise not sure where to go with him.

Thanks in advance, Jeff

by naturevet

November 21, 2014

Hi Jeff,

I agree it may be a congenital condition best suited to Kidney tonics. But before you go in that direction on a permanent basis, we need to explore the opposite possibility - a pathological excess. These animals are often young to middle-aged as well, and often quite vibrant, and have strong toned pulses

Generally we use Minor Bupleurum and San Ren Tang together - veterinary versions only. I would institute them, give them a couple of weeks, and then re-assess. Hopefully you'll see a reduction in the azotemia. If GB points improve the pulse, you'll know for sure that the herbs will work.

Even if that were to happen, these dogs often need Kidney tonics later, but they don't tend to work until the 'excess' has been removed. Look at the therapies as 'opening the door' that the tonics will later enter. Once the pulse becomes weaker and the point of maximum improvement has been reached, it will probably be time for something like Rehmannia 8 or You Gui Wan.

Hope that helps. Remember to update this case once you get results

Steve

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