Herbs and Kidney failure

Re: Herbs and Kidney failure

CatherineThomas — Mon, 25 Jul 2011 11:45:04 GMT

Yes I know how you feel. But if you tell them they are wasting their money they might start demanding money back for treatment that they didn't really need. I really struggled with this when I first started and found these problems. The ones who are on Kidney diets I don't worry about too much, as how much harm will a kidney diet do? But for the ones who are on fortekor it is difficult to come to terms with. Every time I have to agree a repeat prescription it frustrates me that i shouldn't really be doing it. I had one client who complained because I suggested taking a blood sample and urine sample to check kidney function, and she said well he's been on it for years and I don't see the point in extra blood tests because I think he's doing really well and has been ever since he started on the tablets, so I know that the tablets are keeping him healthy. Never mind the fact that he also had the typical "old cat cocktail" (ie dex, laurabolin and vitB) at the same time as starting the fortekor.

Re: Herbs and Kidney failure

Thomas Johnson — Mon, 25 Jul 2011 11:12:57 GMT

[quote user="CatherineBoden"]

I have exactly this problem in my current practice. In some cases where they've only been on it a few months I've suggested a repeat blood test and when that has come back normal I've said that we should try without the tablets and re-check values in a few months. But when they've been on it for years I think its very difficult to say to someone that the cat no longer needs the medication they get a bit awkward about it. They think that if they take him/her off the medication the kidneys will then deteriorate and its very difficult to explain why they wont without telling them the previous vets diagnosis was wrong. And the particular vet was loved by many clients so I think they'd probably never believe that she was wrong.

[/quote]

That tends to be the approach that I've taken as well. The trouble is I know they're wasting their money.

Re: Herbs and Kidney failure

CatherineThomas — Mon, 25 Jul 2011 10:43:26 GMT

[quote user="Thomas Johnson"]

I have worked in a practice where a previous vet was very quick to make a diagnosis of CKD in both cats and dogs. I would regularly see animals for check-ups that had been on renal diet and /or benazapril for a couple of years, often their urea and creatinine would have been mildly elevated when initially diagnosed, but on several subsequent blood tests been normal. How do you tell people that the vet who had treated their animal for several years and that they trusted may have been wrong in their diagnosis?

[/quote]

Re: Herbs and Kidney failure

Thomas Johnson — Mon, 25 Jul 2011 08:37:05 GMT

Re: Herbs and Kidney failure

Anonymous — Sat, 23 Jul 2011 19:41:37 GMT

[quote user="Cat Henstridge"] They would be much better spending their funds on a prescription kidney diet and any supplements as indicated by blood tests.[/quote]

Or further diagnostics if indicated

I wonder if there's an optimal ratio of £diagnositcs to £therapeutics to be aiming for with conditions? A life-time of K/D or benazepril of monthly vet-visits for injections of an anabolic steroid can add up impressively - how confident do you need to be of clinical CKD before starting? 80%? 95%? 99%? I know it's not measurable like that, but I think that clients generally are much more keen to spend money on therapeutics of questionable benefit and enquiries like this one are not uncommon; I think we've all had clients come in after researching a diagnosis on the internet with questions over whether 'supplement X' would help or not, but anyone ever had a client come in after researching CKD and asking for further diagnostics to 'confirm' the 'diagnosis'?

Re: Herbs and Kidney failure

Mark Hedberg — Sat, 23 Jul 2011 19:39:33 GMT

Trouble is, most of my patients HATE k/d. :p

Re: Herbs and Kidney failure

Cat Henstridge — Sat, 23 Jul 2011 18:18:40 GMT

I was asked to look into this by a client and came to the conclusion it was utter guff and a total waste of money. They would be much better spending their funds on a prescription kidney diet and any supplements as indicated by blood tests. Cat

Re: Herbs and Kidney failure

Rob Loxley — Sat, 23 Jul 2011 18:11:29 GMT

[quote user="Luciano Nebiante"]

I think we're a bit off topic here. Though diagnosis of CKD in a dog it's an interesting matter, there will be more space in the forum if raised with a conversation consistent with the title of the topic.

[/quote]

I think when looking at the testimonials and 'evidence' of improvement in renal parameters mentioned on the website, the question of whether those cases truly had chronic kidney disease in the first place is absolutely relevant to assessing whether such a 'treament' might help your dog with CKD.

I've seen a dog that's been on KD for the last 7 years for 'kidney failure' and I'd love to believe that the clever guys at Hills have kept him alive, but deep inside I think the answer to his longevity is in questioning the original diagnosis.

Re: Herbs and Kidney failure

Luciano Nebiante PGCertSAS — Sat, 23 Jul 2011 16:34:32 GMT

[quote user="Michael Woodhouse"]

[quote user="Luciano Nebiante"]I think we're a bit off topic here. Though diagnosis of CKD in a dog it's an interesting matter, there will be more space in the forum if raised with a conversation consistent with the title of the topic.[/quote]

I disagree -

[/quote]

You disagree you're off topic?

[quote user="Michael Woodhouse"]

the place a thread ends up can be far more interesting than where it started.

[/quote]

That's right, but there were few opinions on what I asked, and more discussion on CKD in dog. I think it's interesting, but it's far from

the purpose of my topic.

[quote user="Michael Woodhouse"]

The strange herbs have no science behind them and amount to quackery. I am more surprised that a Veterinary Surgeon needs to ask if such a random website has scientific merit. A diuretic herb to a dog with renal problems is likely to be harmful. You shouldn't need that pointing out.

[/quote]

I wasn't asking about scientific merit of the website, or the herbs. You may have missed the point. As this is a community I thought that somebody out there could have been asked the same from their clients. This doesn't seem your case, so you've given your opinion, and fair enough I appreciate it.

Re: Herbs and Kidney failure

Michael Woodhouse — Sat, 23 Jul 2011 16:01:44 GMT

I disagree - the place a thread ends up can be far more interesting than where it started.

Re: Herbs and Kidney failure

Luciano Nebiante PGCertSAS — Sat, 23 Jul 2011 15:24:40 GMT

Hi Guys,

I think we're a bit off topic here. Though diagnosis of CKD in a dog it's an interesting matter, there will

be more space in the forum if raised with a conversation consistent with the title of the topic.

I'm sceptic as well about these herbs, and I'm not suggesting those to the owner, I wasn't clear enough maybe.

But as I'm not an expert I asked you more about it. You may have more experience than me.

Thanks for sticking with the topic title.

Luciano

Re: Herbs and Kidney failure

Anonymous — Sat, 23 Jul 2011 15:08:33 GMT

Thanks Mark, I thought that was the case.

I probably don't think that the prevalence of CKD (or at least clinically significant CKD) in dogs is all that high - hence probably why I'd be looking more proof before telling an owner I had a 'diagnosis' of CKD, or even a 'probable diagnosis' - I'd probably limit myself to 'suspected CKD' if investigation pretty limited, or 'possible CKD' if I'd just done the minimums you suggested initially. I appreciate this is all just semantics really - but it was the 'testimonial' section of the website that brought it up. All those dogs with high creatinine levels, and the owners had rightly or wrongly taken away a diagnosis of 'kidney failure', getting better with herbs (and we're not even talking veterinary-licensed herbs ...)

I'd be interested to know what other people feel is a 'minimum' work-up before reaching a 'diagnosis' of CKD in a dog? Would that differ in a cat where the condition is generally thought to be more common?

Re: Herbs and Kidney failure

Mark Hedberg — Sat, 23 Jul 2011 14:55:59 GMT

No, you're right on the physiology; I was going from the prevalence angle. I don't disagree with anything you're saying, just how i would go about sorting a suspected kidney case. Naturally if symptoms and test results raise red flags, i'd consider other differentials. (i do broader profiles than just bun, crea, sg when investigating disease in older patients; you were asking minimums and i replied with my minimums. ) :)

Re: Herbs and Kidney failure

Anonymous — Sat, 23 Jul 2011 14:12:31 GMT

Hi Mark, not sure if we're just talking cross-purposes, but I think my understanding (which may well be totally flawed or one-sided dogma from vet school days) differs from yours.

[quote user="Mark Hedberg"]I'm saying there's elevation and elevation.[/quote]

With reference to creatinine: I'm not sure I agree. Chronic kidney disease can obviously be present with normal creatinine, while pre-renal or post-renal causes of azotaemia can lead to extremely high creatinine levels - I'm not aware of any ceiling above which a creatinine level on its own suggests that the azotaemia is renal in origin.

[quote user="Mark Hedberg"]If he's got 5 over the reference range I'm inclined to think dehydration. If he's got 50 over the reference range then I'd think kidneys may have an issue. [/quote]

I'm not convinced of the distinction here - see above. I appreciate you're saying may and not that you have reached a diagnosis of chronic kidney disease (CKD) on this basis.

[quote user="Mark Hedberg"]The dehydrated one will probably have more concentrated urine, the kidney one will have less.[/quote]

Agreed. The dehydrated, azotaemic dog should have more concentrated urine, unless there is something causing an inability of the kidneys to concentrate urine. This something could be CKD, but it could also be hyperadrenocorticism, pyometra, liver disease, hypercalcaemia, hyponatraemia etc.

On the above point, I'm not sure if we're differing on a fundamental physiological point, or simply on the prevalence of chronic kidney disease compared to other differentials?

Re: Herbs and Kidney failure

Julian Earl — Sat, 23 Jul 2011 09:45:11 GMT

[quote user="David Beattie"]

Rena-Cleanse

Ingredients: Juniper berries, Uva Ursi leaf, Corn silk, Horsetail herb, Burdock root and seed, Pipsissewa leaf, Parsley leaf and root, Goldenrod flower tops and Marshmallow root.

Our formula contains herbs that kill most urinary infections, clean and repair the kidneys and it is also a diuretic."

[/quote]

Why on earth would you want to give a diuretic to a kidney patient anyway? A surplus of bodily fluids is the least of its worries.

Re: Herbs and Kidney failure

Mark Hedberg — Sat, 23 Jul 2011 07:59:24 GMT

I'm saying there's elevation and elevation. If he's got 5 over the reference range I'm inclined to think dehydration. If he's got 50 over the reference range then I'd think kidneys may have an issue. The dehydrated one will probably have more concentrated urine, the kidney one will have less. If he's got 5 over and very dilute urine - sure, I won't rule out kidney failure on that one. :)

Re: Herbs and Kidney failure

Anonymous — Fri, 22 Jul 2011 22:24:52 GMT

[quote user="Mark Hedberg"] in a dehydrated patient i would expect elevated urea but not creatinine. [/quote]

Are you saying you don't think creatinine would be elevated in a dehydrated patient simply due to dehydration and pre-renal azotaemia?

Re: Herbs and Kidney failure

Mark Hedberg — Fri, 22 Jul 2011 22:12:34 GMT

Well, you could add in a blood glucose to check for diabetes, sure; except that cats get stress glucosuria. That said, in a dehydrated patient i would expect elevated urea but not creatinine. And yes, urine sample before the ivft, if possible. :)

Re: Herbs and Kidney failure

Anonymous — Fri, 22 Jul 2011 22:05:28 GMT

Not trying to provide a trick question. Maybe I just require an unrealistic amount of proof before reaching a diagnosis (I do often reflect that I make very few 'diagnoses' in general practice). I might be happy saying probably has kidney failure based on those findings in a case which fitted the bill otherwise from general history and physical examination, but I wouldn't feel comfortable saying I had diagnosed renal failure.

If the dog was clinically dehydrated at the time of presentation and sampling, then there's a host of potential differentials to consider (e.g. closed pyometra etc.).

If the dog wasn't clinically dehydrated, then there's still alternatives to consider (hypercalcaemia and hyponatraemia), so I guess my minimum database in a dog that wasn't clinically dehydrated on presentation and had simultaneous blood sampling and urine collection showing azotaemia and isothenuria would include calcium and sodium levels.

Then there's the major headache: the dog that presented with azotaemia and was put on to IVFT and then had a urine sample collected later. I've never been sure if I can tell anything from that at all regarding inappropriate urine concentration...

Re: Herbs and Kidney failure

Michael Woodhouse — Fri, 22 Jul 2011 21:55:13 GMT

[quote user="David Beattie"]

So if a dog had azotaemia and a SG of approx 1.008-1.012, would you tell a client it had a diagnosis of renal failure?

[/quote]

Are you posing me a trick question? In a real world then yes.

What would you consider a minimum database?

Re: Herbs and Kidney failure

Anonymous — Fri, 22 Jul 2011 21:30:13 GMT

So if a dog had azotaemia and a SG of approx 1.008-1.012, would you tell a client it had a diagnosis of renal failure?

Re: Herbs and Kidney failure

Mark Hedberg — Fri, 22 Jul 2011 21:14:21 GMT

Call me Mr Boring, but BUN, blood creatinine, and urine SG would be the three minimums that spring to mind...

edit: rats, he beat me :p

Re: Herbs and Kidney failure

Michael Woodhouse — Fri, 22 Jul 2011 21:14:17 GMT

[quote user="David Beattie"]What would people consider a minimum work-up to diagnose kidney failure in a dog?[/quote]

Urea, creatinine, phosphate and USG.

Re: Herbs and Kidney failure

Anonymous — Fri, 22 Jul 2011 20:45:54 GMT

Rena-Cleanse

Ingredients: Juniper berries, Uva Ursi leaf, Corn silk, Horsetail herb, Burdock root and seed, Pipsissewa leaf, Parsley leaf and root, Goldenrod flower tops and Marshmallow root.

Our formula contains herbs that kill most urinary infections, clean and repair the kidneys and it is also a diuretic."

Pharmaceutical parsley in particular has always brought a smile to my face.

If the client wanted my opinion, I'd advise them it appeared a total waste of money and there was no reason to believe it would make any difference (not because they've been disproved or anything, just absolutely no rationale behind them).

That said, my concern seems to be more with the readiness with which canine renal failure can be diagnosed (as seen in the testimonial pages).

What would people consider a minimum work-up to diagnose kidney failure in a dog?