cush dog with kidney failure please help
Hi, I have an 11yr old dog and I really need some advice what to do for her. She was determined to have all of these problems by way of various lab tests:
a skin infection, a urinary tract infection that has spread into the kidneys and become pyelonephritis, PDH cushings disease, and an ultrasound showed a possibility of mild pancreatitis.
In brief, my dog was given an injectable gentocin antibiotic for the pyelonephritis, developed acute renal failure due to it and was hospitalized. They told me that she would surely die in a few days and tried to convince me to euthanize her, but she looked just fine to me other than not eating so I had them keep her on IV fluids. She was released about a week later on subQ fluids and has shown good improvement since. But she is supposed to eat KD and she doesn't like it, she has lost a lot of weight and she needs to start eating twice as much as she currently is. She would gladly eat chicken but it's bad for the kidneys... I know that I can give her 15mg mirtazapine to get her eating KD, but I am afraid to do that because I don't want to make her renal failure any worse than it is, and medication is what got her in trouble to begin with.
Her last tested kidney values are: Creatinine 4.9, BUN 71, Phosphorus 6.5
Questions:
#1 My dog is on 500ml lactated ringers twice daily, the vet wants to lower the dose to 300ml twice daily beginning on 11/21, is this advisable? How long and at what dose should subQ ordinarily be given?
#2 I am worried about an edema or other complications related to fluids, especially if this becomes a long term chronic condition, isn't there any way to prevent an edema?
#3 My dog hates the taste of the KD food. I am mixing chicken in with it so that she will eat it. This is barely working though, what can I feed her that is safe and she would like to eat? I couldnt find any dietary intake values for renal dogs online.
#4 Do you think it is safe or would you recommend just giving mirtazapine to force the dog into eating pure KD food? For how long would this be safe, and how do we know it won't damage her further, as she is already on several other medications: epikitin, famotidine,
azodyl, and the lactated ringers solution. Uncleared medication becomes toxic right?
#5 How serious is it if an infection returns to her kidneys now while she has renal failure? Could anything be done to save her if that happens?
History:
[10/01/11] begins amoxicillian for urinary tract infection and skin infection (labs have not shown yet that the UTI is resistant), cushings is confirmed with low dose dex test.
[10/04/11] initial kidney values are slightly elevated: BUN 32, Creatinine 1.0, Phosphorus 5.1, specific gravity 1.007 (she was not concentrating urine.) -- Dr. says the kidneys look fine to him and she is OK to start trilostane
[10/06/11] begins on trilostane (100mg compounded), she weighed 33kg at this time.
[10/13/11] I start to notice a bad reaction to trilostane; hind leg weakness, loss of appetite, lethargy -- I suspect kidney damage or an addisonian reaction, Dr. assures me all is fine and to continue.
[10/18/11] symptoms become more severe; front & rear leg weakness and trembling so bad that she cannot sit, not eating or drinking
[10/20/11] trilostane ends today, ACTH test done and cortisol still high which rules out the reaction to trilostane as an addisonian response. Put on ketochlor shampoo for skin infection, 1 dose of comfortis flea pill given.
[10/26/11] dog begins to eat normally again
[10/28/11] An ultrasound is taken, showing pyelonephritis. Labs say its a resistant strain of ecoli. It's decided to treat this infection before any further attempts to treat the cushings disease.
[10/30/11] begins gentocin injections, which are contraindicated for renal affected patients, described as a little risky but a benefit since the drug will have more effect on the kidney and should rid the infection better, kidney values tested
[11/03/11] dog's kidney values tested again and apparently still look ok, I don't have the lab results for this day
[11/05/11] dog doesn't eat her dinner at 11pm, it goes unnoticed until the next morning
[11/06/11] sunday, vet is closed, not knowing what to do I give another dose of gentocin
[11/07/11] dog hospitalized and put on IV fluids at 4pm, diagnosed with acute renal failure
[11/12/11] dog sent home with 250ml lactated ringers once daily, azodyl, epikitin, famotidine.
[11/13/11] dog stops eating and drinking again, appears lethargic, taken to an ER and an ER doctor changes orders to 500ml lactated ringers twice daily.
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