Unexplained seizure leading to Kidney disease diagnosis - advice for feeding
-
Hi Everyone - it's been a LONG time since I've been on these forums - looking for some advice from you experienced basenji owners.
Lenny is 12.5 years old and always been really healthy until about a month he suddenly had a seizure while we were on vacation. We took him to an emergency vet who did some bloodwork and urinalysis and told us he has stage 2 kidney disease. Probably unrelated to the seizure but a side finding. They recommended putting him on a senior diet, as well as a kidney health supplement and 2.5mg of Benazepril per day. We put him on the new food immediately but have not yet started the Benazepril. We came back from vacation and I started researching home made diets for kidney disease, re-joined the yahoo k9kidneydiet group (i was a member years ago when I had Tayda, our Fanconi-afflicted B), and unfortunately they have not been very helpful. I think the moderators have too much going on in their real lives to answer all of the member's questions. Anyway, they did look at his test results and suggested that he probably had a UTI - so last friday I took Lenny to our local vet and they did a urinalysis. It came back negative for bacteria and WBC but I still asked them to do a culture and sensitivity test to be extra sure. That test came back with no bacteria grown. So we are sure there is no UTI. I'm attaching photos of his bloodwork and urinalysis from June and his urinalysis from last friday. Noteworthy values:
June results:
BUN = 37.52
Creatinine = 1.75
Urine Specific Gravity = 1.026
Protein = ++
UPC = 1.4August Results:
Urine Specific Gravity: 1.033
Protein = 500 mg/dL
UPC ratio = 0.76.Only difference between June and August is that in June we were feeding him a grain free high protein diet, and in August we switched him to the senior kibble that presumably is lower in protein.
Questions:
- Is it correct to say that he's got Stage 2 kidney disease AND proteinuria? Or are they one in the same?
- Anyone else give their B's Benazepril? The emergency vet said to give him 2.5mg but the local vet said 5mg was the right dose. He weighed in a couple pounds different between the two visits so maybe he's right on the cusp?
- What side effects can I expect from the Benazepril?
- Can anyone advise on a homemade diet for Lenny? Based on materials I'm finding I'm targeting about 25-30 grams of protein per day and less than 400mg of phosphorus per day. The recipe I just made contains: 555 cal/30g protein/381mg phos/136mg calcium. To that recipe I add about 1/2 tsp of ground up eggshells to balance the phosphorus and I'm not adding any additional phosphorus binder since his phosphorus is currently in the normal range.
I think that's in for now! Thanks to anyone who has any advice for me!!!
Michelle
–--------------------------
Michelle
-
replied to Tayda_Lenny on last edited by DebraDownSouth
I have zero idea, but I'll run it by a couple of vet friends and vet techs who are experienced with kidney disease.
One thing I would strongly suggest... get him on subQ fluids immediately. Our basenji went from "early stage" to kidney failure in less than 3 mos. I don't know if early fluids would have bought us a lot of time, but I still regret not starting them even though the vet said optional that early on. :(
-
Okay I got a response already from Dr Laura.
Benazapril is like enalapril, does some things for blood pressure and is used in protein-losing nephropathy. The lower protein food helps the kidney by reducing the amount of waste to get rid of. Diet sounds reasonable but I am not a nutritionist<<
This is a pretty complex article on the staging of kidney disease. Sadly, proteinuria is a symptom of kidney disease, not a stage. It can be present even in stage 1 according to this, so yes, your dog can be Stage 2 and have proteinuria
CKD that is categorized as Stage I or early Stage II CKD (nonazotemic CKD) could be diagnosed in dogs with renal proteinuria (persistent proteinuria with an inactive urine sediment), urine concentrating deficits, increases in serum creatinine over time that remain in the normal range (e.g., serum creatinine that increases from 0.6 to 1.2 mg/dL could indicate a 50 percent reduction in nephron numbers), or abnormal renal palpation or imaging findings. The above stages are further classified by the presence or absence of renal proteinuria and systolic hypertension (See Table 2).<<
http://veterinarynews.dvm360.com/staging-and-management-canine-chronic-kidney-disease
The drop in the UPC is excellent:
Proteinuria is a negative prognostic indicator for both dogs and cats with chronic kidney disease. In dogs
with chronic kidney disease, an initial urine protein: creatinine ratio (UPC) of >1.0 was associated with a
threefold greater risk of developing a uremic crisis and death. The relative risk of adverse outcomes
increased 1.5 times for every increase in the UPC by 1. In another canine study, proteinuria correlated
with the degree of functional impairment, as measured by glomerular filtration rate; dogs with UPC of
<1.0 lived 2.7 times longer on average than dogs with a UPC >1.0. <<https://cvm.ncsu.edu/wp-content/uploads/2016/11/Standard-of-Care-for-Proteinuria-.pdf
-
I've found a FaceBook group with files (with references) that are very helpful. I don't think you have to join to go through all of the files. They may also offer more advice if you join and post, but won't necessarily provide a specific diet: https://www.facebook.com/groups/211455130573/
I've had around a dozen Fanconi b's spend time in my home. Currently, I have an 11.5 year old Fanconi b boy who has been at stage 3 CKD for at least 4.5 years. He first came to me the day he was to be euthanized 5.5 years ago at 2/3 of his current 'healthy' weight. He was scheduled to be euthanized because of his poor condition. Just recently, he has tested at the top end of the range for stage 3 CKD, so I am just now modifying his diet. He has not been on a kidney diet for all of the years (5.5) that he has been with me. I did, however, always make sure that his meals were well-hydrated. He has been on a kibble diet with 26% protein - kibble always soaked in water prior to feeding (amount of water has been increased so that the relative moisture went from being like cooked food to raw food and now, with more water added, like renal canned food). His environment and handling has been much more important to his overall health than a kidney diet - he was extremely stressed and very untrusting of vets prior to his arrival here. He has a couple of other issues that are currently affecting his Fanconi (and kidney) condition.
While dealing with his issues and the kidney disease of other dogs, I've found that the knowledge and practice in the vetting community varies greatly and have seen varying consequences because of it. I've also found that getting the right supplies can be a challenge. It sounds like you are well-equipped to be your canine patient's advocate. Keep asking lots of questions. If you would like any more feedback from me, please let me know. -
Thanks both of you for your responses. Yes, I was happy to see his UPC went down - the only thing that changed between June and August is that we switched him from his high protein grain free food to the senior diet by recommendation of the Canadian vet. His August tests were also conducted right after his seizure so not exactly his normal state. I talked to his local vet yesterday and we agreed that I'd fully switch him to my homemade diet and recheck his values in a few weeks and see if they come down even more. If not, I will start him on the Benazipril. Fingers crossed!
@flbasenji - I joined that same FB group and posted about lenny a couple times. The first time a couple people told me he had a UTI which is why I got it checked again - but it came back negative. I posted again yesterday and no one responded. :( I'd be interested to hear more about what you've done with your B's with kidney issues - what have you fed them? Any supplements?
-
replied to DebraDownSouth on last edited by
@debradownsouth sorry from my ignorance but please what are subQ fluids? My bitch has been diagnosed with early kidney disease too.
-
@patty said in Unexplained seizure leading to Kidney disease diagnosis - advice for feeding:
@debradownsouth sorry from my ignorance but please what are subQ fluids? My bitch has been diagnosed with early kidney disease too.
SubQ fluids are given under the skin to assist in hydrating. Looks hard to do, but really pretty easy. https://vcahospitals.com/know-your-pet/subcutaneous-fluid-administration-in-dogs
-
replied to Patty on last edited by
@patty said in Unexplained seizure leading to Kidney disease diagnosis - advice for feeding:
@debradownsouth sorry from my ignorance but please what are subQ fluids? My bitch has been diagnosed with early kidney disease too.
Tanza is, as always, right.
Basically you put a needle under the skin and allow a large water pocket to form. The dog absorbs the fluid to help the kidney. The more fluid the better. It isn't hard and your vet can easily show you. Many stores in the US, like walmart, carry kits cheap.
-
Pat and Debra, thank you. I will have to get them from my vet but as you say not difficult to give especially with the instructions in the link. She'll be far happier than leaving her with the vet. You folks are great. Excuse the bump please, Tayda- Lenny.
-
Please let us know how things are going.
-
replied to Tayda_Lenny on last edited by flbasenji
@tayda_lenny - I see Tony has now responded.
My approach to helping basenjis with kidney issues covers everything in basenjis' lives - a base of healthy home management supporting a vet & owner team resolving specific medical issues. I've had around 200 basenji fosters from all kinds of breeding, from many different home environments and with many different health issues. Many issues (health and behavioral) that they have when they first arrive are improved just by changing the environment to suit what each individual needs (not always easy to figure out what is best for each). Anything I do medically ends up being more effective with less vetting effort or medication.
I do whatever I can to minimize stress, including heat stress. Our basenjis are not allowed to spend much time sun-bathing (or time under heavy covers, though I will cover them with light covers if it is too cool). Those with health issues spend just enough time out during the middle of the day to take care of potty business. Of course, in our house, everyone always has companions. While some may tolerate being alone and may have difficulty getting along with others initially, b's are pack animals. Being alone is stressful for most. For those that might have to be separated, I use music or tv to sub as companionship. Something with talking (in the middle of music or on tv) can make them feel like humans are around even if they aren't. The noise also helps to reduce stress by eliminating silence. Basenjis will listen for something exciting to break the silence - hunter listening for prey - so a constant drone of noise reduces the strain of anticipation. There is the stress of aging as well. Eyesight changes will affect some more than others. To help minimize the stress, particularly when traveling, making sure he is surrounded by familiar scents can help. Some folks think that DAP or some oils, like lavender, are soothing. CBD oil may also help. I am trying CBD oil for the first time on my senior miracle Fanconi b. He's not impressed with the taste based on the faces he makes, but he does seek it out, reminding me if I'm behind schedule. It is one of those things I'm trying because I've found nothing to suggest that it will hurt.
Basenjis share many cat-like characteristics. One most likely to be quietly harmful to them is the tendency to not drink enough. Vets now associate the large increase in cats with kidney disease to the major use of dry kibble as a cat's diet. They evolved to get a large portion of their needed moisture intake from their food, so they tend to not drink enough to make up for the lack of moisture in kibble. I have found basenjis to be the same way and have had many fosters who didn't drink enough, including many NON-Fanconi b's. One thing that I do for all of my guys is that I never feed dry kibble (if you can home-cook, that's great - with the number I have and considering some are fosters who may be adopted by someone who can't cook for them, kibble is my compromise). I always soak it in boiling hot water for at least 20 minutes, then make sure it is cool prior to feeding. 1:1 kibble:water generally makes the kibble moisture equivalent to cooked food; 1:2 ≈ raw food; 1:3 ≈ renal diet canned food. We are in the heat of the summer and I do have an aging pack, so everyone is getting at least a 1:2 kibble:water ratio. For those that I still worry about dehydrating, like my senior Fanconi b, I use a rabbit water bottle in addition to having multiple water dishes which are changed a few times a day. B's like to lick and can't stand 'stray' water, so the Lixit-like nipple slightly dripping water from the rabbit bottle encourages them to drink. A plastic bottle allows me to increase the watering rate by squeezing the bottle. It has been the perfect fix to a serious problem with my old Fanconi boy, helping me to avoid having to do sub-q fluids (which I do have on hand just in case). I have given my old guy sub-q fluids by myself when it was not critical so that I know what he will tolerate and how I can handle his future care needs. In case you haven't noticed, I am very concerned about sufficient water consumption...
As for food, I have so many b's needing help and under my care now that I haven't had time to go through specifics of what I'd need to switch to homemade diets. For now, I still rely on kibble, even for my old Fanconi b (though added sweet potato makes it more palatable for him). Once I could get him to eat normally (he arrived as an anorexic and had to learn how to be a 'normal' b...), he was on the same kibble as everyone else in our pack, Earthborn Holistic Meadow Feast (26% protein, 1%min phosphorus). His phosphorus level just shifted into the 'needs binder' range, so I have incorporated aluminum hydroxide and switched to a weight management formula (Wellness, 24% protein, 0.6%min phosphorus - I've noted renal formulas at 0.4%), noting the phosphorus level is almost as low as the renal formulated kibble. Unfortunately, we also need to address an elevated calcium level. We will run more bloodwork before deciding what else needs to be done for that (though he is, of course, getting no calcium supplement now and the kibble has a lower percentage than the previous kibble). I give my old guy a multivitamin once a week. He also requires a potassium supplement, which I administer four times a day. I give him a bicarb or two four times a day, but I use that with caution. Needs vary, depending on stress (heat or challenging activities) and hydration. He is close to anemic, so I'm giving him B vitamins with iron specifically formulated for dogs needing more health support. He's also on antibiotics now, not given with anything else. He is more sensitive to everything now, so I watch for changes throughout the day.
Bloodwork test results are just a snapshot of a very dynamic system. I appreciate the vets who want to treat the individual, not just the numbers. I've had many other b's who were much less sensitive than my old Fanconi boy (well, every other b has been less sensitive - this boy takes it all to a new level...). I've had senior non-Fanconi b's who, with all of the testing and interpretation now available, might have been diagnosed with kidney disease, though vet exams suggested no problems. I am very conscious, though, of hydration levels, adding more water to kibble if I'm even slightly concerned.
