 Welcome to pure dog talk. I am your host Laura Reeves and as always I am very very excited to have my friend Dr. Marty Greer here and we are going to talk about something we have not touched on previously in our veterinary voice conversations which is which is saying something because Marty you and I have covered a lot of territory here. We have so but tonight we're going to talk about kidney diseases and ailments and things that can go wrong with our dogs from random to specific. So I'm very excited about this conversation as almost always most of our veterinary voice topics are things that I personally have experienced in a dog in my care and this is no exception so welcome to it yeah yeah yeah yeah we have managed to cover a lot of ground sometimes not even on purpose not like squirrel what are you yeah okay talk to us about kidneys they're an important item in our dogs they really are you're supposed to have two all of us are supposed to have two um and they're supposed to both work effectively but it doesn't always go that way and a lot of people take kidneys for granted because they you know they've heard well you can donate a kidney so you must not really need to have two kidneys and you know as much as I love most of my family other than a family member I would not give up a kidney because you really do need the reserve of an extra kidney in case something goes wrong with one or both um just like your liver just like almost all of our organs they're duplicated so we should have two and they should both work effectively so we need to take good care of our kidneys and that of our dogs so super important we do that and there's a long list I started typing out a list of all the things that can't go wrong and it's a really long list and then the diagnostic like top five most common I mean I don't you know I think that'll probably yeah we can do a full time yeah we can do that the most common um the first thing we always think of in dogs in our practice is leptosporosis and secondly is Lyme disease because we see those two infections frequently causing kidney problems which are related to an infection in the kidneys and glomerular nephritis which is inflammation of the cells inside the kidney um so those are really important age is also a really important category so we'll talk about infectious diseases age inherited diseases toxins and pre-renal failure or other causes that cause blood pressure to go down and kidney failure kidney function to fail so then there's another list of other things that we need to talk about but things like Fanconi syndrome and leishmaniasis not common so we're not going to spend much time on those but toxins very important antifreeze in cats don't want to leave the cats out lilies um non-steroidal anti-inflammatories amino glycoside antibiotics so there's a lot of toxic and we use drugs sometimes that are toxic to the kidneys even deliberately knowing that we have to be really careful with them so those are kind of the the common things a lot of older dogs ended with kidney disease and a lot of older cats do too but this is a dog program so I don't want to delve into cats too much but we see if cats a little minute I mean cats can yeah yeah we don't want to leave the cats out but a cat in kidney failure will live two or three maybe four years a dog in kidney failure a dog in kidney failure a much shorter time period so I want to really clearly describe the difference between those and that you know if you go in your cat's b u n is a little high and you're in specific gravity is a little low you know you take good care of that cat it's going to live four more years you go on with a dog with the same situation they are circling the drain pretty fast unless you are really on it with a veterinary clinic that is into finding the underlying problem and managing it well and sometimes even under the best of circumstances it doesn't go well in dogs so let's start with let's start with before we go into any of the various things how do I know my dog is having a problem with its kidneys what am I seeing sure the symptoms that most people catch first are a change in water consumption and increase in water consumption and increase in urination now that's not the only reason that dogs can drink more need to drink more and urinate more and what goes in must come out so remember if your dog is drinking more it's likely urinating more and if your dog is urinating more it's probably because it's drinking more so those usually go hand in hand but I sometimes am surprised by the answers I get from clients when they are asked these questions and they don't give a good answer and sometimes the dog is drinking more and they're urinating someplace that the owner just hasn't found yet so they may have an indoor bathroom that's secret to you but not secret to them so sometimes that happens so the most common thing are changes in water consumption changes in urination now other things that frequently cause that are going to be diabetes which happens in dogs and cats cushing this disease which happens in dogs which is an adrenal gland dysfunction and other things like pyometra high calcium that can be related to a form of different forms of cancer so there can be other things that we're looking for but we're going to start looking at kidneys diabetes and cushing's disease in the dog most commonly and so you're basically going to go in tell the vet that your dog is drinking too much urinating too much and we're going to get blood work and a urinalysis as our basic starting point but that's not the only place we're going to go we're going to start with those two things because if the dog is still able to concentrate their urine well then that tells us something different than if the dog's urine was really dilute and if the BUN and creatinine start to go up once that happens that means that only one fourth only 25 percent of the dog's kidneys are still working correctly unless it's a secondary cause from dehydration like vomiting diarrhea other causes of dehydration so super important that you go in you and if your vet says we should do lab work you shake your head up and down and you say yes yes we should yes please do not argue with them do not fight them on it because you can very quickly tell from a urinalysis and a blood panel is my dog diabetic does my dog have a pyrometra does my dog have Lyme disease leptosporosis high calcium some form of cancer some other form of dehydration or one of the other multitudes of things so shake your head up and down and please please please take your dog in with a full bladder and let your veterinarian collect a urine sample there we have lots of clients that volunteer to bring urine samples but the problem with those are they're not usually sterile they're usually not very well collected they're oftentimes not really fresh so trot in with your dog without letting him urinate between the car and the veterinary clinic and in our practice when we know a dog is coming in for a urinalysis we do it by cystocentesis which means we look at the bladder on ultrasound we put a needle directly in it it kind of freaks people out doesn't bother the dogs or the cats one little bit they just lay on the table like oh this is cool now if they were putting a needle into your bladder you'd probably freak out a little bit just because I thought it you know but it doesn't hurt if it hurt dogs and cats wouldn't just lay there and look at us blankly like oh okay so make sure that you let him get a urine and get it collected it sterile that way it's fresh and urine sample over time not only does the bacteria change in it but the kind of crystals change and so a whole lot of things change so if you collected it the night before put it in your refrigerator and then took it into the vet clinic in the morning you're going to get a whole different result so if your vet says I would like to ultrasound your dog's bladder and collect a urine sample along with saying yes to the blood samples say yes to the urinalysis because the urinalysis the ua in hand in hand with the blood sample tells us a whole lot more than either one alone so collaboratively they tell us a bunch now if they come back high b ua and high creatinine so that's what I was going to do I was going to interrupt you just for a second marty and have you explain what is b u n like I've looked at an awful lot of cbc's in chemistry panels but not everybody has what's a what's a b u n what's a chemist what's a creatinine creatinine and then talk to us about specific gravity and what that means those seem to be the three things on kidneys yeah and we'll throw another one in there too a couple more so b u n stands for blood urea nitrogen that is one of the two waste products that we should see eliminated through the kidneys if the kidneys are working correctly creatinine and b u n typically go up parallel so when those go up that tells us that there's something wrong with the kidneys either it's renal so meaning kidney and origin pre renal meaning that the dog is dehydrated and therefore is seeing those waste products go up because the dog isn't able to flush them out of the system by drinking enough like vomiting like diarrhea like pyometra like a lot of other things or post renal meaning that the dog is obstructed now heaven help us that we don't know that the dog is obstructed and unable to urinate and I do mean urinary obstruction not bowel obstruction so those are the three so we classify them renal pre renal and post renal that's where we start with did we just did like two months ago we did kidney stones so anybody that's that's worried about obstruction and kidney stones there's a podcast for that there's a podcast so go look it up so go find that one and listen to that one on kidney stones but okay so b u n creatinine and then specific gravity talk to that one well let's that's sdma first and then we'll come back to specific gravity so sdma is a test that has been developed by idax that is a predictor of kidney disease before the b u n and creatinine start to go up so it's pretty interesting the b u n and creatinine don't go up until the dog is living on 25 percent of their kidney function sdma goes up before that so it's predictive except in puppies it's always high in puppies so if you go in and your dog has a blood panel done before their spay or neuter or whatever surgery they're going to have and your vet comes in and says oh the sdma is high if it's a puppy it's not accurate and even yeah yeah below 12 months even idax doesn't have a great explanation for it but just be aware do not freak out that your dog's in renal failure if the sdma is high and it's like five months old just relax okay urinalysis tells us a lot of things we look at chemistries on the urinalysis mostly we look at specific gravity and chemistries and the specific gravity is the ability of the kidney to concentrate urine once the kidney is damaged at 66 percent so only 33 percent of it's continuing to work then the kidney can no longer concentrate urine so the specific gravity becomes isosthenaric isosthenaric means between 1.008 and 1.012 that's isosthenaria so that tells us that the kidneys can't concentrate the urine so that's an earlier predictor that there's kidney problems not as early as sdma but earlier than b1 and creatinine now if your dog eats a lot of canned food eats a raw diet if your cat eats canned food that can sometimes be less accurate but if you're you know looking at a fasting blood sample and urine sample first in the morning it should be pretty well concentrated it should be above 1012 probably above 1020 in a dog and yes above 1030 in a cat that's just normal so if I have an old cat that comes in or an old dog that comes in and they're 1020 but they're b1 and creatinine they're still okay I'm still going to be talking about you you know starting to change diet make sure that the dog has access to plenty of water you never deprive it of water so it becomes dehydrated and then further accelerates the kidney problems so those are all bits and pieces that you need to know so we're not trying to talk a weird language or confuse anybody it's just when you have 24 chemistry played those those are like really important things that you're going to look for if it's a kidney thing and that yes that's going to hand you that piece of paper and it's going to look like it's written in greek and those are the three things that you can look for right right and your vet is going to look at this and interpret it fairly quickly you're going to be scrutinizing it and trying to understand every word but you know after you've looked at uas and cbc chemistries for as many years as your veterinarians have they basically can just glance down the paper and go okay here's a problem so that's where we start so your analysis in addition to the specific gravity we can look at chemistries on there so we can look at the protein the glucose the ketones the bilirubin there's a whole bunch of nuances to that and if there's too much protein in the urine and it's fairly concentrated then the next test we're going to do on that is going to be a urine protein creatinine ratio upcr because that tells us how much protein is leaking through the kidneys and if there's protein leaking into the kidneys and into the urine that's bad but it can be managed if you catch that early so again this is an earlier indicator of kidney problems that allow us to jump in and start making some modifications in the dog's diet medications some other things that we can do that can really effectively help prolong that dog or cat's life expectancy so very cool on that then also on the urinalysis we look under the microscope when we look for white blood cells red blood cells crystals casts a cast is a cellular piece of material that tells us that there's actually active damage happening in the kidneys it's the tubules sloughing cells that's bad crystals go along with our our stones that we talked about last time so we're not going to go into that and red blood cells white blood cells and bacteria will tell us if there's an infection what kind of an infection it is and those kinds of things so we can see bladder infections and we can see kidney infections and a lot of people confuse those because they think it's all part of the same system bladder infections dogs and cats don't get sick they may be uncomfortable they may urinate frequently they may have blood in their urine they're not sick if they come in with white blood cells in their urine and they're sick they're running a fever they're they're ill they're not eating well that's a probable infection in the kidneys called pylonephritis very bad not nearly as common as bladder infections but you got to jump on those and get them treated before there's permanent damage to the kidneys so it's really important that we get an accurate and sterile urine sample so we can test for this stuff we are at the kentucky anna cluster of dog shows and i'm talking to dr karen potter she is a german wire hair pointer breeder trepanion breeder and she's also a veterinarian and karen's going to talk about what trepanion means to her as a breeder and also what it means for her as a veterinarian when i became a trepanion breeder and i sent my letters out i knew that they were going with 30 days of coverage had one of my owners have an emergency with them that's comforting to me as a breeder to know that they can get help as a veterinarian there are many cases where we have to make decisions on how to treat things based on financial restraints and when the financial restraints come into play we can't always do absolutely everything for that pet so if my puppies are covered at least for those first 30 days i know that if they get sick they can get the best possible care so i you can see me going yeah yeah i have questions um i know it's all over my hand language um okay can a bladder infection go to the kidneys number one it can it's not common but it can okay so more commonly more commonly you'd see pus in the urine from the kidneys not the other way around okay so what's going to cause a kidney infection where's our causation it's usually hematogenist meaning it starts off in the bloodstream so it can start as a pyometra it can start as any way the bacteria get into the bloodstream but usually the kidneys are protected by the fact that the urine is concentrated so that helps to kill bacteria and remember urine is flowing from the kidneys down the ureters and into the bladder so that constant flushing should keep bacteria from being able to ascend up into the ureter and up into the kidney so can they still happen yes they can they're not at all common but they happen and they're tricky to diagnose because sometimes they just it doesn't look obvious so that's where um that blood in the urine sample is really important because it is lifesaving to a dog um or cat to have that diagnosed and and be able to resolve that so that's that's where we're going to go with that now if there's pus in the urine whether it's from the bladder or the kidneys we're going to want to culture it find out which bacteria is living there what antibiotic is going to be most effective and if it's a bladder infection we'll typically treat for you know the very first bladder infection maybe three to five days after that typically 14 days if it's pylonephritis a kidney infection that dog is going to be on antibiotics for a minimum of four weeks absolute minimum so the other infections like we kind of mentioned at the beginning that can cause kidney damage don't necessarily leptosporosis actually lives in the kidney Lyme disease does not live in the kidney Lyme disease can live in other parts of the body but any of those infections can set up glomerular nephritis which is this big you know giant word but basically it's inflammation of the cells of the kidney and oftentimes proteins are getting produced in this whole thing and they start clogging up the tubules in the kidney and causing some really serious damage so that's where Lyme nephritis Lyme disease causing kidney failure comes in is it's glomerular nephritis not the bacteria itself but the inflammatory changes that happen with it leptosporosis are bacteria that actually live in the kidneys and those again are very serious and we see several cases of lepto a year in our practice you can vaccinate for Lyme disease you can vaccinate for lepto if you live in Utah you probably don't need it it's dry they don't have a lot of lepto they don't have a lot of Lyme if you live in other parts of the country listen to your veterinarian especially if you're new to that part of the country or you travel there for that's where you spend the winter or you go there for dog shows a lot listen to the local veterinarians because they know what infections what diseases that they see and they're going to help you decide what vaccinations and what preventives you should use to try and manage some of these things to keep your dog's kidneys healthy okay okay so i'm i've got a dog that has been consistently my old vet called it pupd so i know there's a special name for that drink too much pee too much um and you see this and you're like something's not quite right but you know mostly they're fine they're running around whatever and then one day dog decides i'm gonna try and die and i have 105 temperature and blah blah blah and so you take your dog to the veterinarian you pull your blood panel you pull your urinalysis you look at what your antibiotics are then where are we going from there well that we're going to want to culture the urine right we're going to want to get the dog on fluids okay we're going to want that urine protein creatinine ratio to see if there's leaking of the protein whether we need to put the dog on blood pressure medications or other drugs to keep the protein from leaking we're going to want to use the appropriate antibiotic there if they're in kidney failure and they're running a fever they're going on IV fluids man um subcube fluids are fine for little things you know maybe a little vomiting maybe a little diarrhea if your dog's in kidney failure they need to be in the hospital on IV fluids a lot of people will prefer 24-hour day hospitals but sometimes those are hard to get into or difficult to be able to afford so at least I mean what we do in our practice is we'll put in an IV catheter and really hit the dog hard with fluids during the eight to ten hours that we're open and then send him home at night with the catheter and come back the next day it takes a minimum of three to four days of heavy duty IV fluids diarrhea reasing the patient before we can see any kind of a change in the kidney values and this is where it it comes with a lot of experiences that you know when you're a new veterinarian you start the dog on fluids and you're like okay we're going to check the blood every 12 hours or every 24 hours we're going to see how that's going I never see that BUN and creatinine start to drop for the first 72 hours and all you do if you run blood work is you run up a bill and then you get more and more discouraged that the dog is not going to improve because the BUN and creatinine don't move for 72 hours and then when it moves it's either going to move miraculously down like plummet or all that fluid is going to start filling up the dogs legs and body cavities and you're going to be like yeah so no matter how good the numbers look at three days if the dog looks terrible the dog's not getting better that's not a good situation so it takes a minimum of three days on heavy duty IV fluids and antibiotics to get these guys to turn around and if you don't have the resources to do three days of treatment it's just going to be a losing proposition and it's expensive but it and it's it's difficult and it's painful to watch your dog go through this but it's kind of it's kind of tough it's kind of the way it is so um additional diagnostics you're going to want to test the dog for lepto now there's a PCR test which looks for the bacteria in the urine that has to be done before the antibiotics are started and then a titer test now the titer will tell us if it's a rising titer but it can take three weeks for the titer on a leptosporosis dog to start to go up so we usually do both the PCR and titer because we don't want to wait three weeks to start treatment if it's lepto if it's Lyme disease we're going to do that snap 40x or the other equivalent Lyme tests and if that comes back positive we're probably going to want to do a c6 to see if that dog has an active Lyme infection or an old Lyme infection because once the snap test turns positive on Lyme disease that will stay positive for years maybe not the dog's whole life but a pretty long time so without a c6 you don't know if it's an active infection or an old infection we lost three dogs last year to Lyme disease in our practice one of them had a c6 of over 800 so it's dramatically high anything below 30 is not an active infection above 30 it is an active infection but at 836 it's pretty bad so you want to know yeah you want to know the Lyme results the lepto results the urine culture results the urine protein creatinine ratio so those are all important things you want to make sure that there's no underlying disease going on does the dog have a pyometra does the dog have endocarditis and there's they're throwing bacteria in the bloodstream because of a heart problem you know what other underlying problems are going on do they have Cushing's disease because Cushing's disease causes them to the dogs to drink a lot and urinate a lot that's the pupd polyuria polydipsia polyuria means many urine so like urinating a lot polydipsia means drinking a lot so those are you know words that we throw around in veterinary medicine because pupd is easier to say than all the other things that go to me I'm sure because I can't say all those other words no it gets complicated so you're going to want to look for underlying problems so those are all the things we're probably going to want to talk about an ultrasound is the kidney looking normal on the ultrasound does the dog have a congenital kidney problem there's polycystic kidney disease there's renal dysplasia there's hydronephrosis there's all these things that we can see on ultrasound I had a dog that came into the practice this weekend to be bred and I did her pre-breeding exam and I felt her abdomen and I could feel this big structure in her abdomen and I'm like okay this isn't supposed to be here so I put her on the table did an ultrasound so okay this isn't supposed to be here put her on the x-ray table took an x-ray said this isn't supposed to be here she probably has an hydronephrodic kidney hydronephrosis means this huge amount of fluid had built up in the kidney so she had basically one functioning kidney and one kidney that wasn't functioning so that's why you really want to have two so all those things we're going to look for underlying problems to find out does the dog have renal amyloidosis which we can see in certain breeds like Sharpeis and chow's so we're going to be looking for things does she have kidney failure does she have kidney kidney cancer you know does she have cancer somewhere else like an anal sac or lymph nodes that's causing the calcium level to go high and it reflects as a high calcium in the blood but increased water consumption increased urination pupd because the dog is trying to flush that calcium level out because the kidneys will start to build up calcium and calcium in your kidneys turns them into little rocks and they don't function very well so there's there's lots of nuances to this is not just you walk in and say okay your dog has kidney failure it's just an old dog don't worry about it there's nothing else we can do it's going to die we've had dogs come to our practice like that and we will chase it down and find out well you know what your dog has lepto and if we treat the lepto your dog's going to be fine we take care of a whip it that came to us four years ago on halloween night and she he was diagnosed as oh yeah he's three years old but he's in kidney failure he's going to die in the next three weeks well that was four years ago because we found the lepto treated the lepto and the dog is fantastic you ever see a fat whip it i have a very very i i i have but it's not coming no he eats kd because that's good for his kidneys and that made him fat which is really fun to see a fat whip it that was supposed to be dead three and a half years ago it's pretty fun so all those things are important so talk a little bit there are any number of i hate to you know go too far down this rabbit hole that some of you mentioned cushing some of the more common breathe specific kidney disorders fankoni you mentioned earlier which is besenji right um and and pops up i think a few other places what are some of the other things that people should put in a differential on this um polycystic kidney disease pretty common in the shih tzus the losses some of those breeds it's common in certain breeds of cats as well like persians um renal dysplasia again that's an inherited disorder that we can see i've seen it in all breeds so you can't specifically i've seen it in newfoundland schnauzers you know you can't really classify it too hard and fast is just one but on ultrasound you can generally tell if the dog has polycystic kidney disease or renal dysplasia so those are pretty important things hydro hydronephrosis of course shows up pretty readily on ultrasound it looks like a big pocket of fluid like the dog has two bladders but it's not supposed to they're only supposed to come with one um renal amyloidosis yeah usually that's the sharp haze the the um the chow's um oh the other thing we didn't talk about that can cause kidney failure is a stone in the ureter or in the kidney itself instead of being in the bladder again you hear kidney stones in people fairly often we don't see them in dogs and cats often at all um they probably exist we can sometimes see them on x-ray but they are not nearly as common in dogs and cats as they are reported to be in people so those are all i think important things to know and there's i do want to make sure that we mention the ivus website um or the iris website it's the international renal information society iris like the flower like the and that's a great website for veterinarians and for clients it has um classifications of kidney failure stage one a stage one b stage one two a two b so you can kind of follow the playbook with your veterinarian there's a nice little compact guide that puts it all under one page but it goes into a lot of detail as well is when your dog's b u n gets to this level and the specific gravity is this and the protein in the urine is this that this is what you do for medication this is what you do for diet this is what you do for fluids so it's basically the playbook that's pretty universally um been accepted by most veterinarians because it was written by a bunch of veterinary experts that do renal failure you know all the nephrologists got together and said okay this is how we think we should manage these cases so it's really helpful for you to read through that so you're educating yourself and you're going into the vet and maybe you take the little pocket guide in and say so i have this um can you help me understand like am i here now and what do what do we do next um and we'll see sometimes dogs that do live several years with kidney failure if they're diagnosed early managed well and you're lucky that the dog has the reserves to do it and you can afford it um because it it is a little more expensive to buy prescription food it is um not terribly expensive for most of the medications that we use so if we use um benazapril and alapril tell them a certain um any of those to reduce the amount of protein loss in the kidneys those are very inexpensive medications um the last model middle size moderate size dog i put on tell them a sartan it was $16 for a month's worth so it's not it's not terribly expensive so you can very effectively manage these guys so super super important that people know that if they do some checking on prescriptions and and are careful with how they spend their money on their food and their their medications that they can actually do a pretty good job with these guys excellent okay well i cannot tell you how much i appreciate your time on a complicated and sort of deep topic that's hard to sort of pigeonhole so um i i really appreciate it and i think that there's an awful lot of us out there that have you to thank for the health and well being of our dogs true true well thanks so one other thing i do want to briefly mention is if the b u n is high and the creatinine is not it may be because your dog is eating a lot of meat or raw meat diet in particular so make sure you're honest with your veterinarians about what you're feeding and if your veterinarian says i think you need to do a diet change again you need to shake your head up and down because they did some really important work at the university of minnesota a couple of years ago a number of years ago where they compared dogs on regular dog food and prescription dog food for kidney failure and they were going to do a two-year study on these dogs so they had people bring in the bag of dog food that they were feeding and they mixed it all together in a hopper half of the dogs went out the door with a mixture of over-the-counter dog food half the dogs went out the door with hills kd diet and at the end of the first 12 months of the study they were going to go for two years they called the study off because so many more dogs were alive on the kd than on the over-the-counter dog food that they considered to be immoral and unethical to continue the study so they called it at a year so please listen to your veterinarians manage their diet manage their medications do what they ask you to do because you can get much better longevity if you do this with your head up and down and agree and don't continue to feed the other food or the raw meat diet or whatever else you're feeding or fail fail to give medication because you don't believe in medication i know how you it's not a religion people it's not a religion it's shocking but true and and so one final point and i think you've alluded to this but i really want to underline it having made my own special diet for a pug that was in kidney failure so having lived through this kidney problems low protein right yes protein low protein super protein yes yes so the snacks the treats need to be few and far between but not chicken not cheese not sausage watch the sodium you know be careful with that stuff if you insist on giving snacks give something that is approved by your veterinarian or the prescription diet companies because they do make lists of things carrots should be things like carrots are great like carrots yeah carrots Cheerios you know stuff like that not grapes and raisins that's really bad for their kidneys so avoid those just to say well and i mean there's a whole topic we can do on renal failure from consuming grapes and raisins but that's like a whole another thing yes and i think they're getting closer to figuring out the specifics of that so i think we need to rely on that because i think there's some newer information that will be coming soon oh cool well as soon as it exists marty will tell me and we will bring it to you guys there you go we'll be on it awesome as always well marty thank you so very much i really appreciate it listeners marty and i have finally made our way to youtube so if you want to enjoy all of the the benefit of the podcast with all of our silly facial expressions by all means by youtube and see my cluttered desk and marty's cool couch so all right thanks a lot marty bye