Question Details
2nd Opinion Kidney Disease In A Dog
by LJH - February 22, 2021    View Case Report
Hi Steve, I’ve started seeing a 8 yr M Pomeranian wt about 3 lbs. Diagnosed kidney failure more than a year ago. Sept/20 BUN > 41.6 Creat 188 Phos 2.6 nonregenerative anemia RBC3.08 HCT 19.6% HGB 6.7. Was low energy,poor appetite and losing weight. In Oct rDVM did IV fluid flush and he picked up some. Getting Aventi Kidney Complete and homemade low protein diet per kidney failure discussion group owner is part of. I saw him for the first time mid Jan. Appetite picky, heat seeking, Tongue pale pink with lavender tinge Pulse moderate strength, sl deep, thin, a bit wiry. Haircoat a bit thin and dry with a little small flake dandruff. As a young dog had alopecia X that responded to Dermagic ointment and diet change. Very tiny dog, no teeth left with dental issues in past. A bit of mucoid ocular discharge. With tongue and heat seeking and UPC of 0.4 elected to start BWDHW rather than LWDHW. Wondered with excessive increase BUN/Crea and more middle aged when started if should look at SRT +/- XCHT with Qin Jiao but rehmannia formula thought might help anemia more. Dog put on a bit of weight, appetite and energy improved. Substituted Amino B plex part of the time for Aventi kidney complete. Feb 9 recheck on bloodwork showed some improvement on RBC to 3.28 HCT to 21.0% HGB to 9.7 but BUN and Creat has continued to worsen BUN > 46.4 Crea 235 but Phos a bit down to 2.33 The UPC is up to 1.4 Wondering if adding SRT to BWDHW will be helpful enough from an anti inflammatory approach since UPC under 3 and the rehmannia improving the anemia and still heat seeking or with the really high BUN/Creat I should go to XCHT with QJT +/-SRT for now. Will laser acupuncture points this week again.Your thoughts would be much appreciated. Many thanks, Llewanda
Replies
by naturevet
February 25, 2021
Hi Llewanda!

You really know your stuff, don't you. There's usually not much I can suggest that you have not already thought of. I agree that the improvements you've seen as well as the response to the diuresis in October make this a Rehmannia case. The BUN and creat always have to be interpreted in light of the USG. If it was higher more recently, then the BUN and creatinine may actually be stable or even improved.

For sure, given these results, we should stay away from XCHT, since its renal decongesting effects will reduce renal blood flow, and the improvements are too broad-based with your use of the opposite strategy to believe that is what is needed. So we have three options:

  • Boost the dose of Rehmannia Eight

  • Try Yi Guan Jian (which has proportionately more Rehmannia, as well as Dang Gui, which also boosts renal blood flow)

  • Introduce San Ren Tang


    • Any or all of these may help. I'd try them before going in the Minor Bupleurum direction.

    Hope that helps!

    Steve
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