5 month old pup with azotaemia

Re: 5 month old pup with azotaemia

Martin Atkinson — Thu, 11 Nov 2010 18:13:12 GMT

[quote user="Bob Russell"]

Hills 'wet' food can be made more palatable by sliding it out of the tin, cutting it into 'burgers' and frying in a little cooking oil. Not sure how RC tinned food comes out of the tin!!!

[/quote]

Does it come with a bun and a side order of fries? Seriously sounds worth a try with those that 'won't' eat renal food.

Re: 5 month old pup with azotaemia

Bob Russell — Thu, 11 Nov 2010 13:05:36 GMT

Hills 'wet' food can be made more palatable by sliding it out of the tin, cutting it into 'burgers' and frying in a little cooking oil. Not sure how RC tinned food comes out of the tin!!!

Re: 5 month old pup with azotaemia

Richard Fox — Mon, 08 Nov 2010 21:15:33 GMT

Damn on both counts - damn for the pup and dam for the knowledge :(

Re: 5 month old pup with azotaemia

emma o'connor — Mon, 08 Nov 2010 20:48:51 GMT

Urine results back, culture negative, no casts/crystals/rbc/wbc or bacteria seen. confirmed proteinurea, prt:creat ratio 2.6 . The owner requested euth this morning as pup had been seizuring again over the weekend and did not wish to pursue further diagnostics or treatment, declined pme also so unfortunately i will never really know the cause.

Re: 5 month old pup with azotaemia

emma o'connor — Fri, 05 Nov 2010 16:58:57 GMT

Richard - the ultrasonographers reports said that the kidneys were both normal size for this dog (5.5-6cm) with a smooth capsule, no irregularity in shape.

Thanks for all the renal diet suggestions but the owner is still digging her heals in about changing to a prescription diet

I also forgot to mention that this puppy was the sole surviver of a litter born by caesarean section where the others were mummified or resorbing, so doesn't sound like it had the best start in life!

Re: 5 month old pup with azotaemia

Richard Fox — Fri, 05 Nov 2010 08:11:48 GMT

I would probably expect pyrexia and at least a neutrophilia with bilat pyelonephritis - response to aggressive Ab's would be interesting. Cyto of Cysto urine as above would help and can be used to monitor response to treatment. But bilateral disease is probable more common than unilateral disease. Are the kidneys irregular in shape or enlarged that might suggest nephropathy? However most dysplsasias/nephropathies onset later on in life (i.e. over a year) unless they are very severe when the parenchyma undergoes severe fibrosis and become chronically scarred etc.

Re: 5 month old pup with azotaemia

Gillian Mostyn — Fri, 05 Nov 2010 00:53:33 GMT

Re: 5 month old pup with azotaemia

Michael Woodhouse — Fri, 05 Nov 2010 00:45:32 GMT

[quote user="Gillian Mostyn"]the owner returned for some more the day after as he loved them[/quote]

He know's it only works if the dog eats the food...............

Re: 5 month old pup with azotaemia

Gillian Mostyn — Fri, 05 Nov 2010 00:25:32 GMT

I find the purina diets to be very palatable. Prescribed some tins for an old renally compromised sheltie a few days ago and the owner returned for some more the day after as he loved them. We don't get many tins/bags returned at all.

Re: 5 month old pup with azotaemia

Michael Woodhouse — Fri, 05 Nov 2010 00:22:47 GMT

[quote user="Mark Holmes"]Can somebody let me know the secret of getting them to eat renal food? [/quote]

Put a dog on the Eukanuba renal food. Came in a couple of weeks later for a second bag, asked how they were getting on with it. Turns out he wouldn't eat it unless they put half a pint of Bisto instant gravy on it. Discussed high salt content, but came to conclusion that renal diet + Bisto might be better than normal dog food..........

Re: 5 month old pup with azotaemia

Mark Holmes — Thu, 04 Nov 2010 23:46:49 GMT

Can somebody let me know the secret of getting them to eat renal food? I have tried changing very gradually, not feeding it at the clinic only when sent home, warming it. I've tried biscuits and wet food. Lots of different manufacturers. Still struggle. An often elderly animal, with potential for gastritis and therefore naturally picky is not the best candidate for a diet change. Also you need to avoid them becoming catabolic so you cannot wait it out. So many times I gave had to resort to " well kd/ renal diet is what I would prefer him to eat but if he's happy on prawns well feed him prawns and if you can add some phosphate binders that would be lovely" Sometimes I wonder, if the diet is going to stress the cat and owner for the remainder of it's life why bother?

Re: 5 month old pup with azotaemia

Christopher Saul — Thu, 04 Nov 2010 23:05:25 GMT

The fact you didnt get a cysto sample is not the end of the world; cystocentesis is good to elinimate false positives on c and s but a non-cysto sample is still very useful for spg, cytology, sediment and prot:creat etc.... if you have a leukonuria and casts etc, then this would indicate pyelonephritis even in the absence of a reliable culture.

I'd send blood to the external lab for an FBC.... not sure I always trust in house analysers.

I don't think the ideal dose of omega 3 has been worked out, of if it has I don't know it ( I confess I just stick em on a renal diet, as all of these are supplemented with omega 3). However, an article in the sept 2010 JSAP suggests a dose of 40mg/Kg EPA and 25mg/Kg DHA for animals with cardiac disase. Another option is just to give em some 'gomega' spray and dose as recommended on the bottle

Re: 5 month old pup with azotaemia

emma o'connor — Thu, 04 Nov 2010 20:43:11 GMT

Thank you all so far for your help, it is much appreciated. In reply to Christopher, i did send a small sample of the urine in edta for cytology, unfortunately the referal ultrasonography could not get a cysto sample due to the uncooperative nature of the puppy, and i also failed, and was too much of wimp to sedate him given his compromised renal status, so elected for a sample via a urinary catheter which he tolerated well (not ideal i know). You mentioned omega 3 supplementation, what dose is recommended?

Richard i did run a haematology in house and he had a wbc count in normal range, as were the lymphocytes and neutrophils, would this mean infecction is less likely? Rectal temperature was also normal.

I hope to get the results in a few days for the cytology, culture and prt:creat ratio.

Emma

Re: 5 month old pup with azotaemia

Richard Fox — Thu, 04 Nov 2010 12:28:29 GMT

Urine sample cytology should reveal inflammation if a pyelonephritis and so should the dogs temp and peripheral blood. An infection is probably most common but as said above not concrete. Juvenile nephropathy I would think is high on the list. Is there a significant proteinuria (i.e has it been quantified) that would be suggestive of GN or amyloidosis (obviously you are waiting for ratios to come back)? obviously biopsy can be useful but I feel more of a last resort to characterise renal disease rather than replace clinical tests :)

Re: 5 month old pup with azotaemia

HMC — Thu, 04 Nov 2010 10:47:50 GMT

A colleague once called the RVC to ask about making a homemade renal diet (at the request of another weird owner)- I don't know who she spoke to but the advice was that trying to make such a diet would be difficult and that a prescription food would be much better. I know my colleague found a recipe for renal diets in a very old textbook, but would you really trust that and recommend that over a presciption food??? I would not!

Re: 5 month old pup with azotaemia

James Allsop — Thu, 04 Nov 2010 09:23:25 GMT

I had a similar case - a little older (2-3yrs) a Braco Italiano, they wanted to investigate as suspect familal (father died and mother has renal disease). bloods all normal, pu/pd recurrent cystitis and UPCR at diagnosis = 12 (after cystitis cleared), dropped to 8 with renal diet - sent for biopsies at referral and started ACEi whilst awaiting results. Unfortunately in this case biopsy indicated severe amyloidosis and dog PTS shortly after so not sure what effect ACEi had. I was also suggested by referral to start omega 3 as some suggestion may be helpful but not proven.

Re: 5 month old pup with azotaemia

Christopher Saul — Wed, 03 Nov 2010 22:16:02 GMT

Chronic pyelonephritis is a major differential for renal dysfucntion and needs to be eliminated so I think you are right to get a culture and sensitivity (ideally from cysto). A word of caution though; if the urine is VERY dilute then you can get false negatives on C&S ( the bacteria lyse in very dilute urine). Have you submitted a request for cytology? (remember for this you need to submit a small of urine in a plain blood tube with a drop or two of formalin)... this would allow the pathologist to identify any casts etc which may be indicative of pyelonephritis. One would hope that this is pyelonephritis because you may be able to effect a cure.

If it turns out not to be pyelonephris then I would recommend referral to an internal medicine specialist but if they won't then your hands are tied to some degree.

Not sure you can assume it's dysplasia because there are a number of juvenile nephropathies including dysplasia, immune mediated glomerulonephritis, primary glomerulonepropathy, and amyloidosis (polycystic also but the ultrasound would have found this). I don't think it makes much difference however because without a diagnosis all you can really do is to treat the chronic kidney disease - manage proteinuria, blood pressure, phosphate, electrolytes etc.

With regards to nutrition/ renal diets..... In all honestly I would suggest you request some advice from one of the vet schools, or even ring hills or royal canin for some advice because in particular I'm not sure how much (if at all) you should restrict protein in a juvenile.. if anyone knows better I'd be interested to hear. Personally I've never had to do a home cooked protocol for a renal failure patient so I can't help you with that, but I really would try to hammer home to the owners the value of dietary support in general...

I was at a BSAVA lecture in 2007 which stated that dietary modification alone can double survival times, and is the biggest single thing we can do for renal patients. General guidelines for diet would include phosphate restriction, omega 3 fatty acid supplementation, high soluble fibre ( the idea behind this is that it encourages colonic bacteria thus acting as a 'nitrogen trap') , mild protein restriction, and water-soluble vitamin supplementation.

Re ACE inhibitors: I don't believe there is any proof that managing protienuria actually improves survival in dogs but what is known is that the severity of proteinuria at diagnosis is negatively correlated with survival ( there's a good chapter in the BSAVA manual on this), so conventional wisdom would dictate using them if proteinuric (remember off label in dogs).

Hope this helps

Chris

Re: 5 month old pup with azotaemia

emma o'connor — Wed, 03 Nov 2010 20:53:36 GMT

I am sure someone just asked what the urine specific gravity was, but the post seems to have disappeared, think it was Mark Holmes who asked the question. I may have pressed the wrong thing when trying to reply, bear with me this is my first posting on vetsurgeon! Any way the specific gravity was 1.011 on a sample obtained first thing in the morning.

Emma