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Proteinlosing Nephropathy

by swaneysue - November 23, 2009

Hettie is a 8 year old female not spayed old English Sheep dog. Dx with protein losing nephropathy and hypertension in Aug o9, she was stated on enalapril , low protein diet pepcid and Cerena. By internal medicine vet. Her urine protein levels dropped from 6.8 to 4.1 and creatinine has gone from 2.2 to 4.9. Her blood pressure is now normal .

I just saw her for the first time a few days ago:

Tongue = pale pink little dry
Pulse=thin wiry, jumps up to hit fingers

Appetite finiky in am , better later, some days not want eat, others ok
Can vomit in am , liquid mostly
No temp preference
Not a big drinker-

Active points Bl 23, Bl 40
Pulse improves Tonify Bl 40 and BL 23 , IT SOFTENS WITH TOO MUCH WITH BL 22 SEDATION .

QUESTIONS the active points suggest a need to tonify the kidneys. Which will need to be done once the kidney inflammation is resolved. I am just not sure it is improved enough to start a kidney tonic like Rehmannia 8 . Is it safe to start a low dose kidney tonic even with the protein /creatinine level at 4.9 ? her albumin is 1.9.
I was originally thinking San Ren Tang first but the active points don’t support it. Maybe a mix of both ? I am also unsure if her gut will tolerate the Rehmannia 8 and not aggrevate the vomiting.

Other question : Will Xiao Chai Hu Tang aggrevate high blood pressure since it moves up and out ?

Thanks Sue

by marneemadsen

November 24, 2009

HI Sue!
I have that dog I have been working with the past year and no troubles with hypertension and the XCHT - in fact he is off the enalapril and on XCHT and pressure good. I wonder if you are getting real sense of pulse with the BL22 sedation? What about LWDHW if you are concerned about Damp, but want the blood flow? I like the SRT, too.

My two cents....

Good luck,
Not Steve

by naturevet

November 24, 2009

Hi Sue,

When the UPC ratio drops, to lower numbers, then that is a signal to me you're moving out of the excess (Stasis or Damp) phase of the pathology, and toward the phase when renal blood flow must be increased to further cause inflammation to subside, while improving renal filtration. A worsening of creatinine on a low protein diet and enalapril also supports the idea, as especially does the response to your acupuncture, that the dog needs increased renal blood flow to thrive. That being said, proceed with caution, by introducing Rehmannia Eight, gradually increasing to a full dose over a few days, and checking the bloodwork after a few weeks to ensure azotemia is stabilizing (UPC ratio, too, for that matter). If the azotemia is worse still, then an anti-inflammatory treatment like SRT or XCHT is called for. But if I had a case like yours (very well presented by the way), I'd go with BWDHW first. It's warming effect on the GI and anti-Damp properties should help to reduce the morning vomiting, which is due to an excess in the Tai Yin (Damp). Mornings are when Tai Yin hits high tide, so that's when we see the vomiting due to Damp.

Good luck with your case. Please let us know how it goes for you.

Steve

by swaneysue

December 15, 2009

Update + Hettie

10 days after starting Rehmannia 8 follow up apt acupuncture
P= the most wiry pulse I ever felt, thin jumped up quick but intense wiry
T= pale lavender swollen
Active BL 18, 19, 20, 22, GB 34, GB 25

Pulse less wiry a little rolling with Sedate GB 25, 34, Bl 22, tonify BL 20, Ki 3

RX stay on Rehmannia 8 1 bid add Benefit Hips and Knee(Xiao Cahi Hu Tang +) 1 bid
Benazapril bid
Acupuncture

7 days later had follow up with internist:
CR up 4.9 was 3.7
PCV 35 was 25.3
Albumin 1.9 was 2.7
Prot/CR ration 4.1 was 6.8
Blood pressure normal

10 days later
Ok , not want to eat til 10 am but then ok appetite, sleeping more, likes warmth but likes eat crushed ice.

T= pale lavender
P= thin soft wiry
Active pts Bl 20, 21, 22 , GB 25
Pulse improve –ie less wiry little roll with sedate BL 22 , GB 25 sedate, Bl 17 and BL 20 tonify

RX Rehmannia 8 1 bid , BHK increased 2 bid

1 week later vomiting lethargic, not eating-blood work elevated Bun 93, CR 6.5
total protein 4.7, albumin 1.9, Hct 18.9 , nonreg. RBC low 2,67, WBC normal 6, ooo
U/A RBC many, protein +++ ph 6 , SG 1.015. culture pending

Reg vet gave carafate and procrit injection, IV fluids and ampicillin IV

Also this is a unsprayed female .

I have not seen her so cant report on active pts and pulse.
Did I cause any issues with the BHK ???
Any ideas , first where is the blood from in urine Sp not holding - Bu Zhong Yi Qi Tang . Would Rehmannia 8 be enough to improve RBC ?–I like Eucomm and Rehmannia formula but maybe with the vomiting not a good idea but it seems to do more for bone marrow stim. I know hard to answer with pout other information but any ideas of options would help thanks Sue

by naturevet

December 15, 2009

Hi Sue,

Your use of Xiao Chai Hu Tang is precisely what I would have tried, given the increase in azotemia on BWDHW.

Given that it didn't help, I guess the next thing to try is San Ren Tang plus BWDHW. SRT has good anti-vomiting effects, so it may help here. It also fits the points (esp. BL 22) and the lavender tongue. At this point, I'd settle for the dog stabilizing and not necessarily experiencing an azotemia reversal.

If the hematuria is trace, then this is not inconsistent with inflammation, I don't think.

Hang in there with this tough case!

Steve

by swaneysue

December 24, 2009

Hi, final upsate , unfortunatly Hettie crashed and was put to sleep yesterday. The owner found out that this is the third in a litter of 4 that has died from the PLN. I guess you cant escape your genetics . Thanks for your help Sue

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