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viralmd you out there? or any other vets or vet techs? OR anybody who have a dog with kidney issues?
BACKGROUND:
barnaby is a 12-year shih tzu with an enlarged heart and resulting heart murmur (congenital issue that developed from old age). he was diagnosed when he was nine, and has been treated with enalapril since then.
in november 2007, he contracted rickettsia (rocky mountain spotted fever, from a tick bite) and was very, very sick. was treated with a six week course of doxycyline and another antibiotic and recovered normally.
in summer 2008, he contracted bartonella henselae (cat scratch fever from a tick bite, he was around NO CATS) and was again treated with a six-week course of doxycycline.
in november 2008, he again contracted rickettsia (rmsf). this time we were unable to determine if the illness was caused by a new tick bite or it was a relapse from the original illness. vet opinion is divided.
at the time of the november 2008 appt, he was determined to be somewhat dehydated and given a fluid pack. at the beginning of the appt, bloodwork was taken, and his BUN level was determined to be 29 and his creatinine 1.6. vet was concerned about the BUN level at that time and also about the concentrations in his urine sample. it looked too concentrated.
at his appt, yesterday, different vet, same animal hospital took another sample of bloodwork and urine. BUN had increased to 83, creatinine was still 1.6.
this doctor recommends that barnaby see his heart specialist immediately to determine is his heart condition has deteriorated or if he has developed a problem with his blood pressure. either of these things could influence how his kidneys are working. (we also talked about what happens if his heart and blood pressure are fine, and he potentially has kidney damage.)
however, i have been researching and i do see that other factors can influence the BUN numbers. i am not at all undermining the vet's words, i am just trying to get a grip on the big picture (and also not sink into a pit of overwhelming despair).
therefore, i have a couple of...
QUESTIONS:
If you're a vet, vet tech, or doctor (or if you're viralmd), what do you think about this scenario?
If you have a dog with kidney issues or a dog who went into renal failure, what were you originally told about his BUN and creatinine numbers?
Note: Yes, I have already called his heart specialist and am waiting for a callback to make an appt.
I just recently went through the ordeal of a senior dog with compromised kidneys. You really need to talk to people who are involved with canine kidney disease. I don't believe posting another website is allowed on CD, but if you research it you can find a group that deals with k9kidneydisease. There are also suppliers of products for canine kidney failure, i.e., subcutaneous fluids, that can be very helpful.
From my experience, if it is kidney failure the most important thing to do is get dx'ed and get treatment started ASAP.
My dog has chronic tick disease, and also has kidney disease. The best source of information I've found for kidney disease is the yahoo group k9kidneydiet. Yes, it says "diet" in the name, and they do discuss diet, but it's not limited to diet, and those people know just about everything there is to know about kidney disease. I would have been lost without that group when Shiloh was diagnosed with glomulernephritis (pretty sure I spelled that wrong!).
You can upload your dog's lab results to them and they will discuss the results with you. They know all about medications, fluids, supplements, what tests to have done, etc. for kidney disease and anything related to kidney disease (UTIs, crystals, stones, etc). Many people on that list also have experience with dogs that have had both tick disease and kidney disease.
For tick disease, the best group I have found is the Tick Disease Discussion list. There are very knowledgeable people there as well, plus a veterinarian posts there, who has been a huge help to many of us with our questions concerning testing and treatment. A link to that one is available at Tick Links
You mentioned that your dog was dehydrated in November. Is he still dehydrated? Usually in kidney disease both the BUN and Creatinine numbers increase. If the Creatinine is normal and only the BUN is increasing, dehydration is one of the many things that can cause it. But it really needs to be checked out thoroughly either way. Also, in dogs with kidney disease, usually their urine is too dilute (which would show up on the urinalysis as a low urine specific gravity number), whereas your vet was concerned that his urine was too concentrated (high specific gravity number). The people at the kidney group I posted about could tell you more about that.
donsabi and tnp...thanks for sharing your info with me. i will check out these sites.
i am confused because barnaby was dehydrated in november, but now he is drinking A LOT of water.
i really don't know what any of this means. and i am very eager to get him back to the heart specialist to rule out any problem with his heart or blood pressure as this vet has recommended.
i just want to make sure i am as educated as possible about all the possibilities so that i know the questions to ask.
this dog and i have been through the hoops the last couple of years with relation to his health, and i have learned the hard way that my not knowing the right questions to ask can lead to HIM having unneccesary and painful health procedures.
You mentioned that your dog was dehydrated in November. Is he still dehydrated? Usually in kidney disease both the BUN and Creatinine numbers increase. If the Creatinine is normal and only the BUN is increasing, dehydration is one of the many things that can cause it. But it really needs to be checked out thoroughly either way. Also, in dogs with kidney disease, usually their urine is too dilute (which would show up on the urinalysis as a low urine specific gravity number), whereas your vet was concerned that his urine was too concentrated (high specific gravity number). The people at the kidney group I posted about could tell you more about that.
This is backwards: the CREATININE goes up with dehydration, not the BUN, yielding a 'pre-renal' azotemia picture. If the cr is >20 x the BUN that's classical pre-renal azotemia.
Lack of concentrating ability is a universal problem with renal disease, not one single type, although there are MANY different reasons for the kidney to lose its concentating ability.
The BUN can be elevated due to steroids, hypermetabolic state and a number of other conditions.
But the mainstay of analysis of renal disease are a) the urinalysis (the pH, the concentration, the presence of casts (which are really old, dead cells all together in the shape of renal tubules) the presence of white blood cells and/or red blood cells), b) the urine culture for detection of any potential bacteria or fungi (like yeast) - NORMAL urine is STERILE and, finally, c) an ultrasound of the kidneys. The ultrasound is extremely helpful because kidneys that are disease do one of two things: they get big or they get small. Big kidneys are commonly seen with diabetes. They're big, but they don't work, because of the deposits seen in the basal lamina of the glomeruli. With hypertension kidneys get small, scarred and pitted. That's also the case with chronic glomerulonephritis (a chronic infection of the kidneys) and the kidneys of the elderly.
This is backwards: the CREATININE goes up with dehydration, not the BUN, yielding a 'pre-renal' azotemia picture. If the cr is >20 x the BUN that's classical pre-renal azotemia.
If that is true, then these references, all written by vets, are awfully confusing, because they say dehydration can cause high BUN, among many other things including of course, kidney disease. One entry says pre-renal azotemia can be caused by dehydration. My own vet said that an elevated BUN without an elevated Creatinine can mean dehydration. Not trying to argue with you or anything, just trying to understand why all the references to dehydration if it is not so.
"BUN stands for blood urea nitrogen and is the primary end product of protein metabolism. High levels indicate kidney failure or disease, dehydration, shock, high protein diet, certain toxin ingestions, poor circulation to the kidneys and urinary obstruction." Understanding Blood Work: The Biochemical Profile for Dogs
"Elevations in the blood of nitrogen containing products is known as azotemia.
Prerenal azotemia - Some causes include: increased protein catabolism (high protein diet), corticosteroids, necrosis, starvation, prolonged exercise, infection, fever, or decreased renal perfusion due to shock, dehydration or cardiovascular disease."
BUN (http://www.vetmed.wsu.edu/courses_vm546/Content_Links/Clinical_Pathology/ChemPanel/bun.htm - broken link)
Quote:
Lack of concentrating ability is a universal problem with renal disease, not one single type, although there are MANY different reasons for the kidney to lose its concentating ability.
But her vet said the urine was too concentrated, which is the opposite of lack of concentrating. My vet is always happier to see urine that is too concentrated rather than too dilute.
barndog,
From my limited experience I found the same situation when my dog was dehydrated from time to time and yet drank volumes of water. With compromised kidneys their bodies cannot rid toxins and try to drink more water to compensate. From your posts I think you need to find a vet who either specializes in canine kidney failure or in canine senior care. Other signs to look for is a tucked tail, rigid abdomen, if the hindquarters are pulled down, (hard to explain that one), difficulty urinating or in starting a urine stream especially on the first outing. Without a dx it is hard to help, but I would see a vet about the excessive drinking ASAP.
I agree with donsabi. I would see the vet ASAP. Whenever my dog starts drinking more than usual, most of the time it's the first indicator that there's something going on with his kidneys. He goes up and down with his kidney problems, so I always take him to the vet as soon as I notice him drinking more, unless there's a good reason like if he's been outside more than usual on a hot day or something.
okay, you all have definitely helped me outline a course of action. it seems like instead of taking him to the heart specialist immediately, what i need to do is take him back to the internal medicine specialist who has treated him since late 2007. at that clinic, they have all kinds of specialists, and i would have access to...who treats kidney issues?...is that a nephrologist? maybe THAT should be the first thing i look up.
then i would know whether to go to the heart specialist or not. or rather, he does need to go back to the heart specialist for a re-check separate from this. but i feel like this kidney issue is my most important worry right now.
and, yes, viralmd, he DOES have casting. that did come back in the results from the november appt and the appt last week.
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