Question Details
Renal Disease In A Dog
by AuroraB2 - November 5, 2023    View Case Report
I am having trouble determining the TCVM pattern in this case. Josie is an 11 year old FS HuskyX, 68 lbs (31 kg) with a Woody personality. Over the last month she has become progressively more polyuric, and her appetite is declining. Blood work from 1 month ago showed an SDMA of 19, CRE of 1.6, and BUN of 26. AlkP of 656. Lab work from 24 hours ago showed SDMA of 25, CRE of 3.1, and BUN of 41. ALP is 687. Cholesterol was elevated in both panels as well and is just slightly above normal.
Urine is dilute with an S.G. of 1.010. There was no proteinuria in the sample from 1 month ago. Trace proteinuria in the recent sample. UPC is pending. Urine culture negative.
Tongue is lavender centrally with darker pink (but not really red) edges, pulses are deep and weak - very hard to find.
She has been showing symptoms of a developing KI deficiency for the last year. Hind end weakness with moderate ventral spondlylosis of the lumbar spine (and more recently some hind leg trembling), increasing hearing loss which became most pronounced over the last few months, and sporadic ear discomfort which always self resolved until 1 month ago. This past summer she showed more heat intolerant signs - wanting to sleep on the floor (although carpeted) rather than get up on the bed. More recently she has started to get on the bed again, however. I'm uncertain as to whether this is due to external weather factors, or an internal change. She has no significant arthritis in her other joints.
One year ago she had a liver abscess which she seemed to have fully recovered from, although her AlkP never fully returned to normal. She has had a long-standing issue for years of licking her vulva, but discharge/urinary leakage has never been present.
Supplements for the past year (although not the past month) have included Benefit Hips and Knees and Spine Lithe, Milk Thistle, Omega 3 FA's and Liver Support powder from Standard Process. Getting pills into her has become a problem because of her poor appetite.
Current diet is home cooked, which she only eats sporadically. She will readily take dog biscuits and other treats.
My biggest concern is the rate of progression, which has caused me to question if there could be an excess pattern here.
Could there be a TH blockage, or is it just a progressive KI Qi and Yin deficiency pattern?
What is the best supplement for her at this point in time?
Your help is appreciated and I will be happy to post progress on the case.
by naturevet
November 10, 2023
Hi there,

The weak pulse speaks to a deficiency more than an Excess. The main excess would have been Shao Yang disharmony, but you've been treating that with Benefit Hips and Knees. The only other Excess that could be present is Dampness, but the preponderance of Kidney deficiency symptoms suggests and Dampness is secondary and not the primary problem.

I would probably start with Rehmannia Eight and look at this as a Heart and Kidney disconnect, resulting in a lack of Source Qi with which to fuel the Spleen and drive appetite. That It won't really impact the ALP but other signs are consistent:
- a purple tongue body signifying Cold coagulation internally, pushing Yang to the exterior, creating the occasional heat intolerance despite her weakness
- a deep weak pulse, signifying the lack of Yang and its mobilization; as well as the lack of Essence (Yin) from the secondary Spleen deficiency
A UPC of less than 3 would confirm this is likely the right approach. If you're concerned about Dampness as well, you could add in San Ren Tang (Three Seeds). Meanwhile, to get maximum impact of the Rehmannia, I'd stop the Benefit Hips and Knees, since it has a renal decongesting effect and we want to promote increased renal blood flow

Hopefully this helps you out!
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