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#1 MrSnappy

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Posted 09 December 2003 - 07:42 AM

On Saturday November 29th my 7 year old border collie Red Dog stopped eating. Anything I could convince him to eat (which was practically nothing) he promptly brought back up again within a couple of hours. For about 4-5 days before this he has been a little lethargic (but still playing and eating and drinking normally) and very sore and stiff. I thought the stiffness was related to his CHD, as the weather had turned alternatley cold and rainy here, and he tends to get more stiff and slow in the winter.

I brought him in for an exam and blood tests on Monday. The vet said his heart rate, colour and temperature were normal and didn't think blood tests were necessary, but I insisted. They came back with positive indication of renal failure. Here were the results:

WBC- 19.5 (Normal 4.0-15.0)
MD-Neutr - 16.80 (Normal 2.80-10.56)
MD-Lymphs - 0.582 (Normal .960-4.800)
MD- Monocytes - 2.050 (Normal 0.000 - 1.231)
Blood Urea Nitrogen - 57.8 (Normal 2.5-9.20)
Creantinine - 712 (Normal 68-141)
Phosphorous - 4.17 (Normal 0.72-2.08)

It also says

Chronic Inflammation and stress Lymphopenai
Renal Insufficiency - lepto?
K- artifact
CL - Loss
Amalyse - Due to Renal
Hematuria
No mucus or bacteria

We started him on Sub Q fluids Tuesday night and he spent the next two days at the clinic receiving IV Fluids. We then retested on Friday to see if his kidneys were responding to the treatment.

Their thoughts were that he has Lepto, which is so uncommon here they doubt it (also my other dogs are fine, and none of them are vaccinated for Lepto and they are always together). They sent a Letpo titer for analysis, but it can take up to 14 days to get the results because it has to go to the US as no Labs tests for it here in Canada because of the rarity. They couldn't wait that long for results.

His urine showed no toxins or crystals, so they have ruled out poison, antifreeze etc. They said it's possible that he could have poly-something cysts on his kidneys, due to cancer, so he has to go for an ultrasound once we get the Lepto titer back, if it is negative. And they gave him IV antibiotics just to be safe. He is on a course of Amoxi now, though he was getting Amphycillin while at the vet clinic.

I brought him home Thursday night and he has been eating normally since then and his energy levels have improved a lot. However, he is urinating and drinking a LOT.

The secondary tests, done last Friday, indicated that his BUN (15.9), Creatinine (276) and Phosphorous (142) had all gone way down, though were still too high. His WBC indicated the same (I have not gotten those test results with me physically) but the vets were very impressed with his improvement and said things like "miraculous improvement" and whatnot.

Yesterday morning I brought a urine sample in for a urine specific gravity test and the results indicate that he is not concentrating his urine. Now we are back to square one, and they would like to do an ultrasound of his kidneys if the Lepto test comes back negative.

Any insight any of you might have would be lovely. I am scared for him. He is so stoic, and funnily enough the vet didn't want to do blood tests because he thought RD was "just off his food" but I know my dog well enough to know something was really wrong. All of my dogs are raw fed, have been for three years now, and RD has never had a health problem in all the years I've had him, which has been almost his whole life. He does have CHD, but I don't think that's particularly revelant.

I've done a lot of reading but I'm still confused because none of it is really specific and we don't know what could cause this problem. If he has cysts or tumours on his kidneys, what are the options then? If he has Lepto, can it be cured? If neither of these are the case, what could be causing the renal damage? What else can I do for him?

RDM
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#2 Lucy Goosey

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Posted 09 December 2003 - 07:46 AM

I can't answer your questions, but I'm awfully sorry you and Red Dog are going through this. :rolleyes:

#3 juliepoudrier

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Posted 09 December 2003 - 10:37 AM

RDM,
I sent you a private message, but I wanted to ask about the blood test results you posted. Did you inadvertently switch the creatinine and phosphorous values in the original list? I don't know about dogs, but with cats, creatinine values in the single digits are considered high. Anyway, you might want to check and make sure those values are correct.

J.

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#4 MrSnappy

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Posted 09 December 2003 - 10:41 AM

Originally posted by juliepoudrier:
RDM,
I sent you a private message, but I wanted to ask about the blood test results you posted. Did you inadvertently switch the creatinine and phosphorous values in the original list? I don't know about dogs, but with cats, creatinine values in the single digits are considered high. Anyway, you might want to check and make sure those values are correct.

J.

Thanks Julie,

I did your message and I will reply shortly. I didn't switch the values, I just double checked the lab reports. He is all out of whack :rolleyes:

RDM
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#5 kajarrel

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Posted 09 December 2003 - 01:18 PM

You might look at the following links:

http://www.veterinar...S=1&SourceID=42

http://www.vin.com/P...ital/M00530.htm

http://www.news.corn...tospirosis.html

I've got a few other good links in my website (Health/Infectious Disease) - some which talk about differential diagnosis which you may find helpful. Sorry about your pup . .

Kim

#6 MrSnappy

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Posted 09 December 2003 - 03:04 PM

Originally posted by kajarrel:
You might look at the following links:

Thanks for those links. We got the results of the Lepto titer back today and he apparently does not have Lepto. The vet has also ruled out Addison's disease. So we are back at the beginning - we have no idea what is wrong with him :rolleyes:

RDM
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#7 juliepoudrier

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Posted 09 December 2003 - 03:25 PM

RDM,
Have you checked for tick-borne diseases? I don't know if your Red Dog has other symptoms that are consistent with any of the TBDs, but renal failure can be a consequence of TBDs. And if you're back at square one, then it's one place to start....

J.

#8 Tassie

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Posted 09 December 2003 - 04:05 PM

No helpful suggestions, RDM ? just good thoughts for you and Red Dog ? it?s hard enough when they?re sick and we know what?s wrong, but much harder when we don?t. Give that beautiful boy pats from us.
Barb

#9 AK dog doc

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Posted 09 December 2003 - 11:07 PM

Hi RDM
Like the others, I'm awfully sorry to hear that Red Dog is having problems.

Part of the reason for the sudden improvement might be that he has acute renal failure, rather than chronic. You can have acute, chronic, or acute-on-chronic (which is a dog with longterm problems that has an acute episode that temporarily worsens the situation). Chronic renal disease is not reversible, but acute can be. Fluid support and finding and eliminating the underlying cause are the way to go there.

Rule of thumb about acute renal failure (ARF) is that the animal is in good body condition - has not lost weight, has not been drinking excessively for a long time, has no indications of uremia (oral ulcerations, or bloody or tarry stools for example), is not anemic - but is abruptly ill. These ones are often much sicker with lower BUN and creatinine than the chronic ones. Many are reversible and not progressive.

Rule of thumb for chronic (CRF) is that the animal is usually in poor(er) body condition - has been steadily losing weight in the face of a good appetite, may have uremic ulcers or metabolic bone disease (not arthritis), generally has had an increased water intake for some time, often have anemia - but has felt reasonably well with fairly high BUN and creatinine. These are progressive and not reversible (though you can slow them down with treatment in many cases).

Your lab values are quite a bit different than the ones we use, but every lab has its normals. My take on the labs would be a couple of things. One, there IS a stress leukogram (an abnormal proportion of white cells types due to a physical stressor), but the total white count is high, which suggests at least the possiblity of infection to me; I'd at least entertain the thought that this might be a kidney infection, if this were my patient. These can be serious, and can cause irreversible damage to the kidneys, but they also might not.

Two, I'd say the ultrasound is a dang good idea, but I'd also include the bladder, and an Xray might not be a bad thought either. Azotemia (the high BUN and creatinine) has three possible sources: pre-renal, reanl, and post-renal. Pre-renal is something that happened before the blood got to the kidneys for filtering: dehydration, excessive protein intake, something like that. Renal is something wrong with the kidneys themselves, such as infection, degenerative or congenital disease, cancer, etc. Post-renal is something that happened AFTER the kidney, such as kidney stones blocking the ureters or urethra (hence the Xray, since I personally am not a good enough ultrasonographer to pick up a stone in the ureter, IMO, but I'd catch at least some of them on Xray - though some stones are invisible on Xray.)

Ultrasound will tell you if there is polycystic kidney disease (this is a hereditary &/or congenital disorder in which the kidney does not develop normally) and it would also be helpful in looking for tumors and infarcts and sometimes even sigs of infection, as well as certain other kinds of kidney damage. If the kidney has an abnormal shape or texture, this will help you find it.

The thing about the amylase being due to renal is that the kidneys filter out amylase, and enzyme levels rise when the kidneys are on the fritz.

One further point - in general I do not see hematuria in CRF cases, unless it's an acute-on-chronic. I DO, however, see it in both acute cases (especially with infection), and in post-renal azotemics (as in bladder, kidney, utrethral and ureteral stones).

Anyway, as always, I can't see him so go with what your vet says; but I'll be thinking of you, and I hope there is good news on the horizon.
It is illegal for me to diagnose your dog over the internet. I respectfully decline to answer e-mail or PM requests for medical advice or diagnosis. I will respond to questions posted in the public fora as I have time and at my own discretion. Thank you for your understanding.

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#10 MrSnappy

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Posted 10 December 2003 - 07:27 AM

AK Dog Doc,

Thank you for this information; it's the most comprehensive information I've gotten do far. My vet did feel that it was an "acute attack" because of the suddeness of which it appeared and then corrected (well, mostly). He still feels strongly that it was some kind of infection, and still suggests antifreeze. For that reason, RD is on amoxicillin for I think it's 20 days, at which time we will once again retest his levels.

RD has certainly improved since the IV treatments and his appetite has returned in full force; he is active and bouncy and playful. But since his kidneys are not concentrating urine, he is also perpetually thirsty and he pees like a racehorse. He had no ulcers, diarrhea, weight loss (well, he lost weight during the 4 days he didn't eat anything, but that's to be expected) and he had no fever or anything similar.

The vet doesn't want to do anything else right now other than wait for the ultrasound, check his urine specific gravity on a weekly basis and keep him on a low protein diet and his amoxi, until we can get in for the ultrasound. Does this sound like a reasonable course of action to you?

Thanks again

RDM
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#11 AK dog doc

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Posted 10 December 2003 - 08:14 AM

That sounds great. If it is a kidney infection, you might be on AB's for longer than 20 days, but that's a great start.

There are reasons for low specific gravity in the urine that have nothing to do with any injury to the kidneys. I went over that a little in a thread I think was entitled "low specific gravity" in this section of the boards, dated 11/18 and 11/19, if you want to have a gander at it. I have a school program to do this morning (Finn to be the demo dog!) so I can't recap it now, but if you have questions let me know and I'll do so after we return.

I'm glad to hear things are going better! and happy to be of help.
It is illegal for me to diagnose your dog over the internet. I respectfully decline to answer e-mail or PM requests for medical advice or diagnosis. I will respond to questions posted in the public fora as I have time and at my own discretion. Thank you for your understanding.

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#12 mandiefurniss

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Posted 15 December 2003 - 12:29 AM

RDM, been wondering how Red Dog is going. Hope he is back to normal.
Mandie

#13 MrSnappy

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Posted 17 December 2003 - 07:36 AM

Originally posted by AK dog doc:
That sounds great. If it is a kidney infection, you might be on AB's for longer than 20 days, but that's a great start.

The vet extended his Amoxi prescription for another ten days, and after that he'll be on Doxycycline for another two weeks. Apparently Doxycycline is the drug they use for Lepto, but because it's a fairly powerful antibiotic they felt it would be worth trying.

There are reasons for low specific gravity in the urine that have nothing to do with any injury to the kidneys. I went over that a little in a thread I think was entitled "low specific gravity" in this section of the boards.

Thanks, I went back and read through that. They believe it's related because the drinking/urinating thing didn't happen until after he was released from the clinc being on IV fluids. He continues to drink and pee like mad, but I noticed that over the last few days he can now go out in the morning and pee in several places, rather than dashing madly to have a single three minute long pee. I am hoping this is indicative of something repairing itself!

Mandie, thanks for asking how he is. Red Dog seems to be doing good - we have had no more incidents of vomiting, he is maintaining his weight, his appetite is great and he is more active than he has been for a while. He is keeping up with the youngesters, no problem. he did lick his IV site into a festering wound (I think it was itchy with the hair growing back) but that has now cleared up.

One thing that is strange though is that Tweed has suddenly taken to humping RD for no good reason, as often as he can. This understandly makes RD angry, so they have squabbles over it. I'm not sure it's at all related to RD's illness though ... Tweed recently discovered how to lift his leg and mark things (he's almost four years old, how sad he was so developmentally delayed!) and I think this comes with the territory.

RDM
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#14 AK dog doc

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Posted 17 December 2003 - 08:41 AM

I'm glad RD is doing so much better... could Tweed's social gaffes be due to the fact that RD was ill and maybe looked like he might be vulnerable enough to push down one notch on the hierarchy? Just a thought. On the other hand, maybe Eau de Vet Hospital is an irresistable doggie aphrodesiac. *I* certainly feel I come in for more than my fair share of these attentions (attempted, anyway) while at work....
It is illegal for me to diagnose your dog over the internet. I respectfully decline to answer e-mail or PM requests for medical advice or diagnosis. I will respond to questions posted in the public fora as I have time and at my own discretion. Thank you for your understanding.

Besides, I have to go make some wine now.

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#15 Tassie

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Posted 17 December 2003 - 05:16 PM

Thanks for the update on Red Dog, RDM - glad he's feeling better, and hope that continues. The humping thing is strange, isn't it. My friend had 2 Golden males, the older one entire and the younger one neutered - never did learn to lift his leg to pee. But -- you guessed it -- it was the younger one which tried to hump the older one - and what was worse, unlike Red Dog, the older Golden didn't tell him off for it, although in other respects he was boss dog. Go figure!
Barb


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