Question Details
Protein Losing Nephropathy In A Dog
by fdzenitsky - May 20, 2024    View Case Report
Hey Steve,

Long story short, I've been treating this 4YO golden retriever w/ Lyme nephritis that did not recover well from rDVM's course of doxy. Based on UPC (2.8), I started him on BWDHW, then started Clear Spiro. Although UPC decreased by Feb. (0.7), kidney function and mild non-regen. anemia persisted. I tested for co-infections, Rickettsia and Bartonella positive, so I did another round of doxy and added enrofloxacin, both 4 weeks, also XCHT + Qin Jiao in April, continued BWDHW (both full doses). On recheck this month, much improved clinically and improved renal function and CBC but now UPC is 7.5 (not sure how much 2+ occult blood in urine affecting that) and serum albumin is lower than ever at 1.7! Tongue is not as pale as it was, pulse is deep, tones, broad. I wanted to check w/ you if I stay the course w/ modifications. From a similar case posted here, you state, "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." What are your thoughts on adding Huang Qi to BWDHW and dropping or continuing XCHT + QJ and/or do you have other suggestions to repair glomeruli? Renal values put him at stage 1 CKD right now which is great except for the kidneys are albumin sieves!

Thanks as always for your time!
Franchesca
Replies
by fdzenitsky
May 25, 2024
Hi Steve, following up in case you didn't see the post, thanks!
Franchesca
by naturevet
May 25, 2024
Hi Franchesca,

With a toned broad deep pulse, it suggests an internal stasis condition, most likely a Shao Yang disharmony given the high UPC. If azotemia is minimal at present, I would stop BWDHW for now and use only Xiao Chai Hu Tang plus Qin Jiao. I'd maybe dose a bit more robustly. It is especially likely to work if you find the pulse improves with acupuncture or acupressure treatment of GB points like GB 34.

Otherwise, if the pulse does not moderate with GB points, but instead with massage of BL 40, then I would look at a Kidney tonic (like continued Rehmannia Eight with Huang Qi added). Either that, or Du Huo Ji Sheng Tang.

Why wouldn't the dog have improved by now if it is was a Shao Yang disharmony? I find that if I hedge my bets and use both a Rehmannia formula and a Bupleurum formula, I just don't see as much benefit. I think the reasoning is that the kidneys are still somewhat acutely damaged (calling for Bupleurum) yet Rehmannia keeps driving blood to the area, limiting how much decongestion and glomerular repair can actually occur. By isolating the two formulas into two distinct phases of treatment (first decongestion, then replenishment), I find I have done better in my kidney cases at least.

Hopefully this advice helps you out! Please let us know how things turn out!

Steve
by fdzenitsky
May 25, 2024
Thanks much Steve, that makes good sense. With my last official Dr duty done (getting herbs to this patient), I am signing off for the long lovely weekend ahead...I hope yours is fun-filled perfect weather too! ~Franchesca :)
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