https://www.vetsurgeon.org/f/clinical-questions/29505/what-are-my-best-options-for-treating-oa-pain-in-a-13-year-old-azotemic-dog-pre-renal-vs-renal This dog is painful and needs to be on something but we have just stopped meloxicam due to increase urea and creat on routine blood screening. I do need to confirm this is renal and not pre renal as I&#39;ve had one concentrated urine sample and one minimallyen-USTelligent Community 10https://www.vetsurgeon.org/thread/227094?ContentTypeID=1Wed, 02 Dec 2020 20:46:03 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:69fe57e3-c829-442a-bb71-39a3ee3f3edcAndrew Kent<p>Hi Bibs,</p> <p>Apologies for the slow reply to this!</p> <p>I agree from the above this could be pre-renal so reviewing urine with concurrent blood work would be appropriate to clarify this. It may be we don&#39;t need to be so concerned about the kidneys.</p> <p>If the dog does have chronic kidney disease then I think we have to weigh up the pros and cons of which analgesia is best. I will still sometimes use NSAIDs with mildly azotaemic patients if they are stable based on the fact they are likely the most effective drugs we have for OA.</p> <p>But I generally use a lot of paracetamol as well and that would be what I would use in the short term while you get to the bottom of whatever else is going on!</p> <p>Hope that helps,</p> <p>Andy</p><div style="clear:both;"></div>