Canine Renal Failure

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njac said:
I'm not asking for medical advice.

How often do you see glomerular renal failure in dogs? Asymptomatic? What really causes it?
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Well, we were just covering this in Urinary, so off the top of my head: (And someone please come and correct me if I mess up on something because my mind is on pharmacology right now.)

You don't see it nearly as often in dogs as you do in cats. (I assume you're talking about chronic renal failure, as opposed to acute.) Usually you find chronic renal failure on routine senior bloodwork and urinalysis panels or in older patients coming in with vomiting, anorexia, etc. You'll see a low specific gravity (usually isothenuric--Sp. Grav similar to that of plasma) and an increased BUN and creatinine levels on a chem panel. The low level of specific gravity clues you in that it's renal azotemia. Radiographically the kidneys will appear smaller than normal. At more advanced stages of disease, you'll often see hypertension, protenuria, acidosis, hyperphosphatemia, hypocalemia. I can't remember the causes.

Hope this helps!
 
I hadn't ever really heard of glomerular nephritis as opposed to renal tubular disease, so I looked it up. According to Merck, and also an article I found on VIN, it seems to be caused by the formation of immune complexes, probably related to platelets and mediators of the arachidonic acid pathways, thus treatment aimed at immunosuppression and anti-coagulative therapy may be of benefit.

But as Pressmom, says, we have our heads full to overflowing with pharmacology right now (exam on Monday), so I could be full of it.

Here's the Merck:

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/130605.htm
 
I'm not asking for medical advice! My dog is under the care of our own DVM but I know that students can often explain things more clearly (as they've had to learn it more recently) than practicing vets sometime.

Not the corgi in the picture (that is Bert, he is 5) but Tori, my 10 year old Pembroke went in last week for a senior wellness exam before scheduling a dental for her. SCr was ~6, BUN ~70 (I can't remember actual numbers and she hasn't given me a copy yet), Albumin 4 and a high amylase (she said amylase is cleared by the kidneys - the dog is obviously not malnourished and doesn't look like she has pancreatitis). I believe her phosphate was slightly elevated.

So she slowed down the last couple of months - she needs a running start to jump but she still plays with me and the other corgi, loves to go on walks, no change in appetite. No increase in urination, I leave them sometimes for 12 hours and no accidents. So I brought in a urine sample, low specific gravity and protein in the urine. We did a urine creatinine😛rotein ($85?!?!?! VCA is such a rip...) and she called to let me know that the results from this were indicative of a glomerular process vs a latent pyelonephritis. She goes in monday for xrays and we'll discuss ultrasound ($$$$ poor pharmacy student here!). I believe we'll also be starting benazepril.

I'm just so stressed about this - she keeps using the "renal failure" term and all I can think is people and dialysis etc. I appreciate you guys answering my question! As I get more information from the vet I'm sure I'll have more questions. I've been a wreck since she called me last Weds with her Chem panel results...
 
I see. Well, dogs with renal failure tend to do much better than people in renal failure. My own (late) dog did extremely well with sub q fluids, phosphate binders, and a renal diet. In fact, she did so well, that she died of other causes more than 2 years after her diagnosis of renal failure. In other words, her kidneys were not the cause of her death.
 
If your looking for good general info check out the Merck Veterinary Manual it is relatively straight forward and will answer most of your questions. You could also look at http://www.veterinarypartner.com/ they should have good information it is the client info side of veterinary information network.
 
just to clarify, you brought in the urine?

How'd you collect it?
 
chris03333 said:
just to clarify, you brought in the urine?

How'd you collect it?
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she pees like immediately when she goes out in the morning. Tiny gladware container and made sure I was fast enough to get there midstream.

It was much easier than I expected it to be!
 
njac said:
she pees like immediately when she goes out in the morning. Tiny gladware container and made sure I was fast enough to get there midstream.

It was much easier than I expected it to be!
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Have they asked about getting a sample via cystocentesis?
 
njac said:
yes, we're doing that tomorrow (while we do x-rays and other stuff) to get urine for a culture.
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good👍

Hope it all goes well
 
ok, so I took her in today for x-rays and a cystocentesis. Her x-rays looked good - no masses, nice smooth kidneys with no visible cysts or anything. A little spine arthritis but that's not surprising considering her age and breed.

Apparently communication over the phone wasn't totally clear - maybe things aren't quite as dire as I was thinking. Her liver enzymes look good, but her albumin is actually 1.8, her SCr is "only" 3.1 (but much better than 6!) and her BUN is 70. Amylase is 1737, Phos of 6.7, Cholesterol 337. Her UA was 3+ for protein, the specific gravity was 1.018 and there was trace occult blood. The urine had 480.9 mg/dL of protein and her Urine Protein:Creatinine ratio was 3.8 (or almost 8x normal).

I got a Rx for benazepril and the DVM will speak with an internist on weds and see what he thinks.

How do you measure GFR (or Creatinine Clearance) in dogs?
 
Same as in people. Collect all urine over a set time period and measure urine volume, and urine and serum creatinine and plug it into a formula. For exogenous creatinine clearance, you administer creatinine first. It's not used a lot because it's a pain to collect all the urine.

The best way is renal scintigraphy, looking at clearance of 99mTc-DTPA by each kidney. But this is available only at specialty centers.
 
Bill59 said:
The best way is renal scintigraphy, looking at clearance of 99mTc-DTPA by each kidney. But this is available only at specialty centers.
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I 😍 renal scintigraphy. I spent my whole summer doing a research project on the diuretic kind! It's just so much easier than the creatinine clearance, but like Bill said, it's not widely available.
 
what about an estimated GFR, like the cockroft-gault equation in humans (plug in age, ideal body weight, serum creatinine)

Is there any way to estimate it besides doing a 24 hour urine collection?
 
As mentioned above, the best way is scintigraphy, which doesn't require urine collection.

Clearance of inulin or iohexol has also been used and doesn't require urine collection. With these you administer inulin or iohexol, which are excreted only by GFR, then take several serum samples at specific times to see how much is eliminated over time.

Serum creatinine or urea nitrogen gives you a rough indication of % of normal GFR. But there are some non-renal variables you have to account for, especially with BUN.
 
I wonder what the list price of that is at a human clinic and whether it could ever translate down to vet med. 99mTc is such a useful, and short-lived, isotope.
 
** New Question **

After about 2 weeks on the ace inhibitor and renal diet we did labs again - no big changes other than K 5.8 (from 5.1) and phosphorus 7.3 (from 6.7). Since then she's been on a phosphate binder (Epakitin) and an "enteric dialysis" (Azo-dyl).

I've done some research on some homemade renal diets and many of them mention being high potassium - in humans we restrict potassium in renal patients. Am I misreading or is this a different pathology or? I'm feeding the Hill's K/D btw.
 
Some dogs with polyuric renal failure will become potassium depleted because of the diuresis (this is much more of a problem in cats though). So many renal diets will have a mild increase in potassium compared to maintenance.

However, some dogs will tend to get hyperkalemic so you have to keep a watch on serum K.
 
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