Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
Oh that is too bad about Virbac. :( I never had any issue with their products and it is a real shame that Novifit will no longer be available to help dogs.
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
That is very, sad. It did help some dogs and for it to no longer be available is going to be a hard it for many.
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
Hi! Looking for some guidance ...
Abbie goes in to the vet tomorrow for her 3 month ACTH and super chem. Since she is now peeing every two hours and has had three accidents in the house, I asked for a urinalysis & culture. Vet wanted to do just the urinalysis but I have requested both.
Because Abbie's UPC is so high but other kidney markers are normal (and now she is having urinary issues), I also asked for an SDMA. Since my vet uses Antech labs and the SDMA is not part of its chem panel, I asked them to check on the cost. When I got a call back, the tech said that vet did not think the SDMA is necessary.
Abbie has been taking amlodipine and telmisartan to control her BP and try to lower the UPC. We have had no success lowering the UPC -- instead it has gone up (now 6.6!). All of the other kidney markers are normal. The pharmacy where I purchased the telmisartan has been sold and the new owners are not honoring the previous company's prices. Their price is three times as much and I cannot afford it. The telmisartan is the third drug we have tried in order to lower the UPC.
Now we will need to decide if we are just going to treat the high BP and not worry about the UPC. My thinking was that, if SDMA shows no kidney issues, we can look at the UPC as an aberration. From what I have read in past articles and the new article from Dr. Wooten that Lori posted, it is possible to have a normal creatinine level and still have kidney disease. I am unsure as to whether I should push getting the SDMA.
Your thoughts?
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
Hi Judy,
For me, I guess the question would be, what would you do differently even if the SDMA was elevated? You are already medicating to control Abbie's blood pressure, I think you are giving Omega-3s, and you've instituted a degree of protein restriction to her diet. This should also be helping with phosphorous control which is a main dietary concern for animals with kidney disease, although perhaps that's an area that could bear more attention with an elevated SDMA.
However, at this stage, as long as her creatinine and BUN are still normal, I'm not sure how much else you'd be doing to actively intervene with the proteinuria and early kidney disease even if the SDMA is indeed elevated. Here's a great set of FAQs, though, that IDEXX offers to help with deciding about the usefulness of the SDMA, and also what steps to take based on test results. If you look through it thoroughly, you may find some suggestions or info specific to Abbie's situation that I am missing or confusing.
https://www.idexx.com/files/small-an.../sdma-faqs.pdf
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
Marianne -- thanks so much for the link to the IDEXX FAQs. It really was a thorough discussion. It is apparent that, since Abbie has already been diagnosed with proteinuria and high blood pressure, the SDMA would not offer any new information. I usually do give my vet the benefit of doubt -- guess I will this time as well!
The only aspect of kidney disease control that I have not instituted is changing Abbie's diet. She is very picky these days and, from hearing from others about how unpalatable the renal prescription food is, I have been hesitant to try it. This afternoon I spent 10 minutes getting her to her bowl to even try to eat -- this was the first time this has happened so not sure what is going on. I do think that canine dementia comes in to play as she appears more confused more frequently.
Anyhoo, her current prescription dry food has 21% protein; her prescription canned food has 6% protein. I would have to look at the renal prescription food to compare.
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
I totally understand your reservations about the commercial Rx diets. When my Peg was troubled by acute pancreatitis attacks, I realized we needed to try to make some low fat dietary changes but I was so put off by the ingredients in the Rx foods that I balked at using them. I ended up trying to find other commercial foods that shared a similar nutrient profile but contained ingredients that seemed of higher quality to me. It wasn't easy, but I did find some. However, palatability was never an issue for us -- Peg would eat anything. :o
The other thing I've been told, though, is that as distasteful as the ingredient lists for the Rx diets may be, sometimes dogs really do like them. I'm not sure that is true of the renal diets, but do bear in mind that Abbie probably may not benefit from the very low protein Rx diets at this point. Probably only moderate restriction would be recommended right now, and so those foods might be more palatable. For instance, I think Royal Canin has two renal versions: a moderately restricted food as well as a lower protein food.
Marianne
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
Hi, all! Abbie had her 3 month ACTH along with a super chem and urinalysis/culture last Thursday.
Her ACTH pre was 3.1 and post was 8.3 (5/13/16 results were pre of 3.4 and post of 6.9). Since I have not seen her back legs collapse the last few weeks, I am going to keep her Vetoryl dose as is even though cortisol has gone up a bit. Her alkaline phosphatase was only slightly elevated at 157 (range of 5-131; 5/13/16 result at 147). Potassium is still elevated at 6.0 (range 3.6-5.5; 5/13/16 result at 5.8).
Of concern is the urea nitrogen (also known as BUN) which is now elevated at 39 (range 6-31; was normal on 5/13/16 at 30). From what I have read the kidneys must be damaged to the point that 75% of the kidneys are nonfunctional before this will increase. The BUN/creatinine ratio is higher at 39 (range 4-27; 5/13/16 at 33). However, creatinine remains normal.
No signs whatsoever of a UTI. Specific gravity is low normal. Protein remains at 3+.
Due to the cost of telmisartan sky-rocketing, we are switching Abbie to benazepril along with continuing the amlodipine. Four weeks after starting the benazepril we will run a UPC, check blood pressure and run another chem panel. Benazepril is processed primarily through the liver rather than the kidneys so this is a plus.
The vet and I agree that the frequent peeing and accidents in the house are most likely due to the issues with Abbie’s kidneys along with increasing dementia. During the last week Abbie has not been as interested in going to her food bowl at meal times. Once she decides (after much encouragement) to go to the bowl she does eat everything. She has not gone on a walk (other than a very brief one mid-day) in at least two weeks. I have had to carry her from the bed to the kitchen a few times just to get her to go out to pee. She really just wants to sleep. In spite of the lack of exercise, she has lost ½ pound.
Seeing Abbie age is tough to watch – fortunately, none of her issues seem to make her uncomfortable. I am continuing to give her 25 mg. of tramadol every day.
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
Quote:
Originally Posted by
judymaggie
Hi, all! Abbie had her 3 month ACTH along with a super chem and urinalysis/culture last Thursday.
Her ACTH pre was 3.1 and post was 8.3 (5/13/16 results were pre of 3.4 and post of 6.9). Since I have not seen her back legs collapse the last few weeks, I am going to keep her Vetoryl dose as is even though cortisol has gone up a bit. Her alkaline phosphatase was only slightly elevated at 157 (range of 5-131; 5/13/16 result at 147). Potassium is still elevated at 6.0 (range 3.6-5.5; 5/13/16 result at 5.8).
Yep, I agree, I wouldn't raise her dose either. I'm a firm believer that you treat the dog and not those numbers.
Quote:
Originally Posted by
judymaggie
Of concern is the urea nitrogen (also known as BUN) which is now elevated at 39 (range 6-31; was normal on 5/13/16 at 30). From what I have read the kidneys must be damaged to the point that 75% of the kidneys are nonfunctional before this will increase. The BUN/creatinine ratio is higher at 39 (range 4-27; 5/13/16 at 33). However, creatinine remains normal.
There are other things that can elevate that BUN, dehydration is very high in that list that contributes to a high BUN. From my understanding, when high levels in the creatinine are seen there is already 75% of kidney function lost. So it is great news that the creatinine is normal!!! Abbie had a SDMA test right, and if she did, what was her score?
Hugs, Lori
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
Hi, Lori! With regard to the SDMA, my vet didn't recommend it as we already know Abbie has kidney disease. After making my way through the 11 page IDEXX paper, I agreed with him.
I looked in our Resource forum at the section on lab explanations. The first article from Washington State Univ. refers to the 75% in relation to the BUN. That is why I was concerned that Abbie's BUN was elevated for the first time. (I had to move to my Nook as we are in the middle of a really bad thunderstorm so I can't insert the link here.).
Re: Down the Cushings Road Again -- Abbie, 13 year old beagle
Hope the thunderstorm didn't cause any damage, I love those Tstorms except for when it causes a loss in electricity. :eek:
I did find that article and I understand your concern. From researching kidney disease so many things can elevate the BUN, this excerpt lists some of the reasons why BUN may increase:
Quote:
Urea production and excretion do not occur at a constant rate. While renal dysfunction can cause increased BUN concentration, nonrenal causes also often result in increased BUN concentration. In the liver, BUN is a byproduct of the urea cycle and protein catabolism. Urea production and excretion increase after a high-protein meal, so an eight- to 12-hour fast is recommended before measuring BUN concentration to avoid the effect of feeding on urea production. Clinical conditions characterized by increased catabolism (e.g. starvation, infection, fever) also can increase BUN concentrations.
Gastrointestinal (GI) hemorrhage may also increase BUN concentrations because blood is an endogenous protein source. In 52 dogs with hematemesis, melena, or both, BUN concentrations and BUN:creatinine ratios were significantly higher than in age-matched control dogs, suggesting that GI hemorrhage contributes to increased BUN concentrations in dogs as a consequence of increased GI absorption of nitrogenous compounds.9 BUN concentrations may be increased by prerenal factors such as dehydration, which increases urine volume, and some drugs that increase tissue catabolism (e.g. glucocorticoids, azathioprine) or decrease protein synthesis (e.g. tetracyclines), but these effects are usually minimal.9
http://veterinarymedicine.dvm360.com...09%09&pageID=3
Although a high BUN can be worrisome it is when it is paired with an elevated creatinine that a major concern takes place. Since Abbie's creatinine and other kidney markers (phosphorus, sodium, calcium, chloride) are normal than that would make me believe that her kidneys are still functioning pretty good, so the high normal BUN is something I would monitor.
Hugs, Lori
