Question Details
Acute Renal Failure In A Dog
by ajerger - May 20, 2025    View Case Report
Hi there!

I have a 5.5 yr old Australian Shepherd as a second opinion for acute renal failure. Patient stopped eating at home ( processed) , sneezing and coughing and hyporexic. Patient was initially pu/pd upon presentation.
BUN129, Creatinine 12, Phosphorous 9, Cholesterol 400, UPC 4.9, SG 1.012.

Due to the UPC and cholesterol and lack of response to fluid therapy at the referral hospital I summized this to be the inflammatory phase of renal failure.

Patient was hospitalized, place on a very low rate of IV fluids, gastroprotectants, phosphate binders and Xiao Chai Hu Tang for a few days.

Initially both the BUN and Creatinine were creeping down very slowly, but now has gone back up to above 12 for creatinine and >130 for BUN, phosphorous is a little higher as well. Today I d/c the XCHT and added San Ren Tang at 1/4 tsp BID Natural Path....Patient is 20lbs

Pulses today were toned, somewhat wiry, increased in rate. The tongue is pale pink with lavender center. The patient is still alert and taking low protein syringe feeding very well, still coughing some, she has slowed down with the pu/pd.

BL 25 was active today and modulated the pulse when sedated.

I repeated the labs and the creatinine went down to 8.5, BUN 123, cholesterol 389 ( 110-320) phosphorous is 15.2 ( 6.8 is high normal). I can't believe this happened so quickly!

TCM:
Triple Burner Obstruction
Damp obstructing flow of kidney Qi

How long do I keep her on San Ren Tang? I am assuming to add Rehmannia when the inflammatory phase passes?

Thank you so much!

~Allison
Replies
by naturevet
May 20, 2025
Hi Allison!

These are tricky cases and you're doing an excellent job! San Ren Tang makes more room for blood flow in the kidneys, suggesting the dog may even benefit from Rehmannia Eight even before the UPC gets to < 3. I would check again in another 7 to 14 days, and stick with San Ren Tang until things plateau (or slightly bounce back up). Once that happens, then you can add in the Rehmannia for sure.

Meanwhile, the dramatic response to SRT suggests that the processed food is a big cause of this inflammation, so making a move off processed to real food is advisable. You can wait if you want until the UPC is about 3 or less. At that point, the dog will be very tolerant of the increased renal blood flow that a normal protein/phosphorus level produces. Until then, it can be tricky to get the protein right in at least some dogs.

Hopefully this helps. Again, you're doing awesome!

Steve
by ajerger
May 21, 2025
Hi there,
Unfortunately her Creatinine went back up to 12, super bummed. Not sure why, Should I add rehmannia?
by naturevet
May 22, 2025
Yes, I think so. Don't stop the Three Seeds yet, and don't be too bummed if she still seems to be doing okay clinically. Hopefully the Rehmannia will set wheels in motion!

S
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