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Protein Losing Nephropathy In A Dog

by dmtdvm - August 31, 2016 View Case Report

Ozzy is an 8 yr old 4# CM Yorkie who presented to me for a second opinion on diet for his proteinuria. He is currently on enalapril 2.5mg tablets 1/4 tablet BID and Pepcid SID and Fortiflora. His entire life he has GI problems mostly vomiting, occationally with blood. He does not tolerate any of the renal diets and is currently eating cooked chicken, white potatoes and broccoli with Standard Process Whole body support.

On PE- he is emaciated, has and has pale mm. His HR 120, T 101.7.
His abdomen is very taut and bloated. I believe he has ascites. His pulses are weak and feeble.

Bloodwork from previous vet on 6/26/16 showed :
HCT 39% UA- catheterized SpG 1.024
BUN 143 1+ Blood
Cr 1.8 4+ Protein
TP 5.3 10-15 WBC
Alb 1.8 10-15 RBC
his liver values were normal No bacteria seen
UPC- 11.5

I saw him on July 21, at that time his HCT had decreased to 25 % and TP was 4.2. I did not do full bloodwork at that time. Because the owner thought his ascites was making him uncomfortable I started a low dose of spironolactone SID.

I started him on SRT 1/4 tsp BID and Benefit Hips and Knees 1/4 tablet BID

Currently he is still eating several small meals a day and the owner says he still is playing with his toys.

I repeated blood and urine on 8/25/16:
BUN 94 Free Catch UA SpG 1.020
Cr 1.1 pH 6.5
TP 3.3 3+ protein
Alb 0.9 !!! No WBC, RBC, bacteria
UPC- 14.4
I have increased the SRT to 1/2 tsp BID and Benefit Hips to 1/2 tablet BID. The owner says he is still eating small meals and playing, though I am amazed that is still possible.

Any other thoughts??

Diane

by naturevet

September 3, 2016

Hi Diane,

Did his CBC improve at all in August? It certainly seems that renal function did, despite the increase in UPC. Did the spironolactone take down the ascites at all?

Despite the high UPC, it may be time to introduce something more tonifying, to begin to actively resolve any renal inflammation. The glomeruli may be so damaged that our normal rules of thumb surrounding UPC and what herbs to use don't hold, and that to get control of renal inflammation you have to introduce tonics more quickly. They might have the double benefit of stimulating albumin synthesis in the liver, and improving hematocrit.

In terms of what to use, you could jump in there with good old Rehmannia Eight. If you're in a position to make your own formula, though, you could try Rehmannia Six and add 12 g Wu Wei Zi and 18 g Huang Qi. A recent Cochrane review noted that Astragalus (Huang Qi) significantly reduced proteinuria and increased albumin in humans with chronic kidney disease. It's a Qi tonic to boot, and meanwhile Rehmannia Six can support RBC synthesis. I had one case of PLE, albeit much milder than yours, that completely resolved on this formula. It might be worth a try in this case, giving at least as much as the combined total of the other two formulas you're using.

Hope that helps,

Steve

Liu Wei Di Huang Wan

by dmtdvm

September 14, 2016

Thank you Steve,

The PCV remained unchanged. I added the spironolactone because the owner thought Ozzy was uncomfortable and having difficulty having a BM. I am just using a low dose SID. The ascites is still present, although the abdomen is less taut and the dog seems more comfortable to the owner. I just ordered the LWDHW and hope to start that with the added Wu Wei Zi and Huang Qi soon. As far as dosing, does a 1/2 tsp TID sound high enough?

Diane

by dmtdvm

September 15, 2016

Hello Steve,

After several days of Rehmannia 8, Ozzy has started vomiting. The owner thinks he is more bloated and is not acting as playful. Since he felt much better on the other 2 formulas I've restarted them. When I had rechecked his pulse while on the SRT and Benefit the hips, his pulse was actually strong and +/- wiry. Comments?

Thank you,
Diane

by naturevet

September 21, 2016

Hi Diane,

I think you're right and that you should go back to the anti-inflammatory approach for a while. Strong wiry pulses suggest you are not dealing with a Kidney deficiency.

If the response to SRT and BH&K continues to be not quite what you need, there is plenty of room to double or triple the doses you're giving, or look at using granular extract versions. The latter are sometimes more potent or consistently acting in critical cases.

Meanwhile, regular acupuncture can help a lot, too, as it changes renal circulation immediately (assuming you feel the pulse change in response to treatment).

Continued good luck!

Steve

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