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Chronic Renal Failure In A Dog

by ajerger - October 14, 2025 View Case Report

Hi there!
Finley is a 14yr old 77lb mixed breed MN dog. He has had CRF for several years with mild azotemia. He came to me 6/2025 for a second opinion the help with the azotemia. He also has a history of pancreatitis twice in the Month of May but several years ago and just this last week I hospitalized him for another bout of diarrhea and eventually vomiting. The IV fluids provided a positive response with lowering the creatinine and improving appetite,
He is super picky with food, not hungry in the am , but seems to have good energy levels.
Pulse: Deep, thin , slight finger lift, not very toned and difficult to find many times
Tongue: Light pink with lavender center
He is warm GV14 area, warm on LI 10 area, BL 17 Area. The pulse improves slightly with BL40, KI3,and GV14
He is currently on Ba We Di Huang Wan 1.5tsp BID
San Ren Tang- 1/8th tsp twice daily
I am adding Yi Guan Jian 1/4tsp twice daily
3 days post IV fluids his creatinine went up to 6.3, HCT 25%,UPC is 0.5
The owner is also doing SQ fluids at home.

What else can I do? Can I continue to increase the Ba Wei? What herbs can I use to address the Pancreatitis?

by naturevet

October 18, 2025

Hi Allison,

That jump in creatinine is a little mystifying when the dog did well at the clinic, but I still think you're on the right track. Adding Yi Guan Jian should address pancreatitis tendencies and more robustly support the Kidneys, Liver and Stomach (and thus the appetite). The pulse definitely says "tonify" and not to worry about the Shao Yang. The age also says "tonify". If there is a bit of an improvement with the YGJ, you can even fully commit to it instead of Rehmannia Eight for a while, since by draining Dampness, the latter may dry the Stomach somewhat, and a response to YGJ would tell you that might be an issue.

Hopefully, this helps your patient out! Let us know how things go!

Steve

by ajerger

January 3, 2026

Hi,
Finley is doing much better, the addition of the Yi Guan Jian created an improved appetite and seemingly energy levels. I am rechecking him this week, but so far so good! Thank you!

by naturevet

January 5, 2026

That's great news! Thanks for that update!

S

by ajerger

February 12, 2026

Hi there,
Finley had a little set back with rising creatinine to 8, BUN went up a little as well, cholesterol went up a bit as well. Appetite is low, seems uncomfortable, had been slipping a little more and having more difficulty going up stairs. He loves the snow we have here, wants to actually sit in the snow, in the face of a deficient state.
No vomiting, normal stools. I thought at first it was a low grade pancreatitis, and
I hospitalized him on IV fluids, but his creatinine went up to 9. Bun and phosphorus is trending downward.UPC is pending. His appetite and spirits are better.
He is still receiving Yi Guan Jian and Bai Wei Di Huang Wan.

His pulses were deep, not very toned, normal rhythm and slight increase in rate, somewhat resists compression and slight finger lift.
Tongue is light pink with lavender center.

TCM:
Deficient/empty heat?
Kidney Yin Deficiency
Damp

Is this inflammatory and IV fluids worsened the issue?
Should I start Chai Hu Jia Long Mu Gu Li Tang? Is this a Shao Yang presentation worsening the renal azotemia?
Thank you so much,
~Allison

by ajerger

February 14, 2026

Sorry, both BUN and Creatinine have gone up in spite of being on IV fluids, not just the creatinine. The UPC is 1.5, a few months ago it had been <0.5.
I rechecked him today, his pulses modulated when I applied pressure to GB 34. After acupuncture today he did feel better. I am seeing him again tomorrow.

by ajerger

February 14, 2026

Sorry, both BUN and Creatinine have gone up in spite of being on IV fluids, not just the creatinine. The UPC is 1.5, a few months ago it had been <0.5.
I rechecked him today, his pulses modulated when I applied pressure to GB 34. After acupuncture today he did feel better. I am seeing him again tomorrow.

by naturevet

February 14, 2026

Hi there!

Yes, I would consider this a Shao Yang issue and look at some variant of Minor Bupleurum to help you. If the dog is seeking snow and ice to cool itself off despite being aged and decrepit, then Shao Yang disharmony is strongly suggested. The deep toned (i.e., resistant to compression) pulse and the intolerance of IV fluids are also suggestive as is the picture of central Stasis in the tongue.

You can try CHJLGMLT, but the deep pulse suggests even Xiao Chai Hu Tang with (15g of) added Qin Jiao will likely help. Scale back on the tonics if they are not improving the kidney function. The XCHT may aid the pancreatitis.

Hopefully, this helps you out. Let us know how things go.

Steve

by ajerger

February 20, 2026

Hi So far the Creatinine is down to 10 from 12, the BUN/Phosphorus elevated slightly, He is on Xiao Chai Hu Tang 1 tsp BID, Yi Guan Jian 1/2 tsp BID, Epikaitin and B12.
Pulses are still deep, normal rhythm and rate, not a lot of tone, slight finger lift.
tongue is light pink with lavender center.
The owner notes he has more energy, normal stools, not eating well, she is syringe feeding, drinking normally and not going to the remaining snow like we was.
I am going to keep him on this protocol until his pulses modulate and the creatinine plateaus.
Do I go back to the Ba wei when his pulses modulate? And do I just have to monitor him for a timeline as to when that will happen?
Thank you!
~Allison

by naturevet

February 23, 2026

Hi again,

I'm glad you're seeing progress. Because YGJ has Rehmannia in it, there may be no need to switch to Rehmannia Eight later. The 'anti-inflammatory' approach seems borne out by your success thus far. If you stall out in your progress, try a few days of reduced YGJ dose. If he perks up further, continue. If he doesn't, then restore the YGJ dose and try a reduced dose of XCHT. See if that allows further improvements to accrue. As long as there are slow continued improvements, you can continue with the current mix.
Continued good luck!

Steve

by ajerger

March 3, 2026

Hi
Finley is doing better, energy is pretty good, creatinine is dropping, now 8.8 (we started at 12) , BUN is lower as well. The only thing is now the Alkaline Phosphatase is steadily increasing - 1400 ( 23-212)
The pulses are still somewhat deep, moving to mid depth though as treatment continues.I have him on a super low protein diet, the owner is syringing him his food, he is super picky even on his best days.

I am having difficulty discerning where is he warm on active points, except GB34, GV14, GB 20.
I am also not sure how to interpret the rising ALK Phosphatase.
Thank you...
~Allison

by naturevet

March 15, 2026

Hi Allison,

I'm glad you're continuing to eke out improvements, manifesting with both lab and pulse improvements.

High ALP suggests hepatic congestion, possibly from the YGJ, but we daren't change the protocol until you hit some sort of plateau. Then you would approach that situation as described in my response on February 23. The continued activity of GB points, especially if their treatment leads to a softening of the pulse, suggests Xiao Chai Hu Tang is doing most of the heavy lifting, making a reduction in YGJ the first thing that you would try.

The low appetite is understandable. It may not really reappear until the creatinine is much lower (and renal filtration much higher).

Again, if you want to experiment, I'd wonder about reducing the YGJ first, but only by about 25%. No more than 50%. Follow up rigorously. If there were any backward steps, reinstate it at the previous dose

Continued good luck!

Steve

by ajerger

March 17, 2026

Hi there, creatinine went down again, this time just a smidge to 7.1, BUN and phosphorus are trending down as well. He is only on XCHT and a very low protein diet.
He is not eating on his own, the owner is syringe feeding. His energy levels are good. He is still wanting cool temps, drinks cold water and will jump up out of a dead sleep to go outside.
In NYC recently, we had a few unexpected very warm days, and Finley was very lethargic, but then bounced back to his normal energy levels after 1 day.
His ALP is very high (1600), the highest it has been.
How do I address this liver congestion without affecting his progress in any way?
His pulses are about the same- mid depth to deep, slightly increase in rate, not very toned, does resist compression, slight finger lift.
Tongue is a light pink with lavender center.
He is drinking normal, not excess, formed stools.
Thank you so much!
~Allison

by naturevet

March 17, 2026

Okay, so if he is just on XCHT, then you may need to add YGJ in. I would use half doses and then recheck everything in ten to fourteen days

S

by ajerger

March 31, 2026

Hi
I ended up seeing Finley today, so I was not able to restart the Yi Guan Jian. He is doing well.Creatinine is down to 7.0 from 7.6. Appetite is still not great, but is taking syringe feeding ok. The ALP is also coming down, energy is good. The only thing is his HCT is 22%. Can I add Bu Zhong? Not sure how to stimulate the bone marrow and not increase perfusion to the kidneys.
Thank you so much!
~Allison

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