View Question

Chronic Colitis And Renal Dysfunction

by amymatthews - October 9, 2009

Hi Steve,

I have a 6 year old MN collie who was diagnosed at 1.5 years of age with mild azotemia and dilute (but not isosthenuric) urine, with microalbumin wnl at evaluation yesterday. Abdominal US showed small kidneys with thin cortices. He has been on a kidney diet over the past years, and his azotemia and dilute urine have been pretty stable, maybe creeping up a little over the past year since he's been off the kidney diet due to worsening colitis.

Colitis, or intermittent diarrhea with increased urgency and mucous and sometimes blood, has also occurred since he was young. He is responsive to tylan (more so than to metronidazole). His colitis has worsened over the past 7 months, and he has required tylan almost full time to keep his clinical signs managed.

He came to see me yesterday. He has a very stiff back (which I worked on chiropractically). His tongue is pink, smooth, and highly toned. His pulse is rapid and superficial. Neither of these seem to fit with Yang Def, but his GV points were very active and his pulse softened with GV point use (I wasn't confident enough to tonify or sedate). However, his pulse was also responsive (softened, deepened) with SP9, LV13, and BL20).

So, I was inclined to try Zhi Bai Di Huang Wan, with it's effectiveness for both decreased kidney function and colitis and signs of heat in pulse (tongue I'm not sure about - the high tone is something I don't know how to interpret - but it is not the classic red heat or yellow coat). However, the great response to the GV points is making me feel like Wei Ling Tang may be something this dog needs. What do you think?

thanks so much for being here - having access to the forum is really helping me and my patients!

Amy

by amymatthews

October 9, 2009

Sorry, somehow when I flip between pages it's reposting my question!

Amy

by naturevet

October 9, 2009

Hi Amy,

I agree that ZBDHW may be worth a try. GV points are used either to add Yang into the body (when tonified) or remove it (when sedated). Tonification is tantamount to having an invigorating effect that helps move circulation outwards. Sedation is tantamount to an epithelial anti-inflammatory effect that moves blood inwards to the splanchnic circulation with its high venous capacitance. Zhi Bai Di Huang Wan seems to have a dual effect of being anti-inflammatory and cooling for the epithelium overall, yet improving renal filtration. So it's got an interesting hemodynamic that makes it well suited to this case. It doesn't fit the Spleen points, but I'd give it a try, given the history of concomitant colitis and renal failure.

The only formula that fits those points, addresses renal failure, and treats colitis is San Ren Tang. Animals that benefit often have a deep wiry pulse, not a rapid superficial one. But keep it in mind, especially if the response to ZBDHW is poor.

Good luck!

Steve

by amymatthews

November 22, 2009

tough call. We changed the diet to resolve teh colitis, but that means he's no longer on the KI diet that has kept his azotemia in the low range. On the new (fish kibble) diet, his colitis has been entirely calm (and the dog LOVES fish), but his BUN/Cr have almost doubled, despite the ZBDHW. On recheck, tongue was pink and moist; pulse was deep and a little choppy.

I was considering keeping the dog on ZBDHW and moving back to a low protein, low phos kidney diet...but reviewing how the pulse has changed, and your previous reply, now I'm thinking he may be telling me that San Ren Tang would be a better formula to fit him. He's such a low energy dog, with no heat in his tongue (though I know tongues can be unreliable, just need to remind myself), and so cautious about being touched...hm.

Any thoughts?

by naturevet

November 22, 2009

For animals whose azotemia gets worse on higher protein diets, we try formulas that disperse blood to the periphery (from the kidney). San Ren Tang is thus still fair game, and can be used simultaneously with ZBDHW if you want. I'd try it. Or Xiao Chai Hu Tang if the dog doesn't strike you as Damp, but more as having Stasis.

Steve

by amymatthews

February 15, 2011

Seems he also does poorly on azathioprine started by the other vet for IBD - Lr values soared.

Didn't tolerate steroids well, either. Do you ever see non-Damp dogs who can't tolerate steroids - he just doesn't strike me as Damp.

I am starting to wonder about SRT...although he's done pretty well on ZBDHW for a while, his IBD signs have recently really flared up. And KI values normalized nicely without being on ZBDHW (was off it for a few weeks while the azathioprine crisis was being diagnosed), so I'm wondering if we need to switch strategies.

Haven't gotten to actually SEE him for updated tonguepulse info yet, though! Sorry about that...

Amy

by naturevet

February 16, 2011

Hi Amy,

If it's boiling down to GI and liver issues, then a Liver Spleen harmonizer like Xiao Yao San may help. Keep that in mind when you see him next.

Cheers,

Steve

You must be logged in to reply

CuredCases.com