Question Details
Proteinlosing Nephropathy In A Dog
by tainab25 - February 24, 2023    View Case Report
my patient Shep is a very nice german Shepard, diagnosed with PLN in November 2022 and 5x 7 isoechoic Liver mass (r/o hepatoma vs carcinoma).
At the time values were: Sdma 34, Crea 3.2, Bun 81, Phos 4.9, Alb 1.8, UPC 6.5
He was started on Enalapril
1/13/23 Sdma 38, Crea 3.5, Bun 85, Phos 7.8, UPC 11
Appetite has been very finicky at the time and due to worsening of UPC, Enalapril was traded for Telmisartan, which O quickly also discontinued due to appetite being even lower on it.
I saw Shep first time End of January, his appetite has been extremely finicky
(eating Tripe, Darwins RX rarely, canned kidney diet and sausages (low sodium), egg yolks).
He still had pretty good energy and spirits, normal stools.
Tongue Lavender, Pulse slippery/wiry strong.
I started him on: Slippery Elm, Standard Process K9 renal support and Renatrophin PMG, Gastrex, XCHT 1 tablet bid to start, then 2 bid, B12 and B complex added to 500 ml LRS SID.
Appetite seemed to be improved in first week.
2. Visit 1 week later : We added 1 bid XFZYT. After the visit DNAP Bl 18, 20, 21, 23, St 36, Gb34 r, Ki3, Shan Gen. Same day appetite got much worse and remained poor for remainder of the week.
3rd visit 1 week later: Shep was low energy, less happy and more vocal/groaning during exam.
BCS 4/9, MM dry, mild abdominal discomfort, cold ears, warm paws.
Recheck blood showed much worsened Azotemia: BUN 129, Crea 6, Sdma 37, 11.8, Alb 2.1, Phos 11.8, Ca 11.6, Chol 443, Plt 473, UPC 8.9.
Increase XCHT to 2 TID and stopped XFZYTmodified because O is somewhat overwhelmed with his care.
Decided to hospitalise 2/14, was released by specialty place after 24 hours due to values not improving. Received Doxy, Baytril, the whole battery of acid blockers, also started on Amlodipin and Clopidrogel because his BP went from 154 when admitted to 240 and then 190, he did not eat at the hospital.
AUS showed bilateral severe degenerated kidneys.
Was released home for Hospice/Euthanasia.
Continued Wednesday with XCHT 2 tid, Slippery elm bid, Renatrophin, started on Arsenicum homeopathic, Charcoal binder at night. Cerenia, Entyce.
Friday added Cleavers, Parsley, Marshmallow tea and chopped Ceavers/Parsley in food .
He is eating treats and sausage, but appetite is finicky, he wants food and he doesn't, turns his head, low energy, quivering when sleeping. I was unsure if this means he is cold but O reports he prefers cool, so maybe just crummy feeling? O is forcing kidney diet. LRS 500 ml bid.
My questions are:
Should I stay with current dose XCHT or increase.
How can I help his appetite, nausea, Gi ulceration? Add San Ten Tang, Rehmannia 8, 6 Gents?
How can high Phos be helped in natural ways, I have not gotten myself to add ALOH...
What else?
Any other thoughts are much appreciated.
Thank you
Final Status: much worse as of day 18 of treatment
by tainab25
February 24, 2023
Shep was briefly better after my acupuncture on Monday, which only lasted till the next day.
PE: Pulse slippery, Tongue pale lavender, MM moist (used to be dry), thin, BCS 4/9, mild abdominal discomfort, quivering when laying (cold SQ fluids?), O reports he prefers cool, refuses to take treats for first time, happy to see me and springy gait, BL 19sensitive. DNAP Bl 19, 20, 23, St 36, Gv21, Shan Gen, Ki3, Li11 r, CV12
The Owner continues to struggle with his very finicky appetite. He will only eat a bit egg yolk and some sausage and then walk in the kitchen like he wants something and then leaves kitchen again. O is force-feeding wet kidney diet with added Parsley and Cleavers as well as Parsley and Cleavers tea, Slippery Elm BID, XCHT 2 TID, Standard Process renal support and renatrophin, Solidago Comp by Heel TID, SRT 1 tid. The recent addition of SRT did not help his appetite, Cerenia doesn't seem to help, frankly it seems like anything I throw at him does nothing. What should I change? Start Rehmannia 8? Thank you
by tainab25
February 24, 2023
Sorry this might be confusing, but my first post was supposed to be posted last week 2/17, I posted it wrong and it didn't show up in the Forum. So my second post is from Monday and check in today, his appetite is still very poor, energy decent, normal drinking.
by naturevet
February 27, 2023
HI Bettina,

With such an extremely high UPC, he likely won't respond to Rehmannia. I suspect your dose of XCHT is probably far too low. Additionally, you probably should use a version that is more powerfully anti-inflammatory. Benefit Hips & Knees has added Qin Jiao, which ups the power of the formula in renal inflammation. Dose according the guidelines at rather than what is written on the bottle

As for phosphorus binding and control of stomach acid and inflammation, the easiest most palatable and side effect free way of doing that is probably to try him on Tums. I've never seen a dog refuse them.

Try to focus your acupuncture just on GB points (e.g., GB 25, GB 34, BL 19) and if you can effect a change in the pulse, resist the urge to add more points. If those points don't change the pulse, explore Dampness points like BL 20 and SP 9

Hopefully those measures help and you see a gradual improvement over the next few weeks. Once you have things moving in the right direction, Rehmannia Eight or equivalent might eventually have more merit

Reply to this question.
You must be logged in to reply