Dog with possible kidney failure

prairie_loveJuly 30, 2009

Questions for Meghane and others that know about kidney failure in dogs.

Our nine-year old, spayed female dog had a urinalysis yesterday that showed very low specific gravity (1.002). She also has a "significant" UTI. She has had minor vomiting (I'd call it spitting up more than vomiting) and loss of appetite on those days (three times in last 10 days). Yesterday she was somewhat listless. She had been seeking cool areas. She did have a fever (103.something).

Vet is concerned about beginning stages of kidney failure and put her on Hill k/d. I am wondering if the UTI caused increased drinking and urination leading to the abnormal sp. gravity. BUN and creatinine were normal, as were all other blood and urine results.

We will recheck urine in two weeks, she is on clavamox in the meantime.

Do you think this is beginning kidney failure or a result of the UTI or unable to tell? Also, how would you distinguish acute and chronic kidney failure?

She is much perkier this morning.

Thanks for any comments!

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Unable to tell at this point. UTI can decrease USG significantly; only way to tell if kidneys are OK is to clear UTI and recheck. I'd be concerned with pylenephritis, an infection of the kidneys, especially considering the fever, vomiting, and anorexia. A simple lower urinary tract infection doesn't cause these signs, but a kidney infection certainly could. Pylenephritis can be seen on ultrasound. Requires much longer antibiotic course than simple UTI (at least 8 weeks vs. 2 weeks). So it would be worth pursuing that possibility.

We usually look at the physical exam to determine acute vs chronic renal failure. Animal in excellent body condition and only recently sick usually has acute renal failure. Animal in poor body condition usually has a chronic problem. Gray areas abound though, because if acute renal failure is severe, kidneys may not recover leading to chronic renal failure. Or an animal can be in chronic renal failure and get an major insult to the kidneys (dehydration especially) causing acute renal failure on top of it. The major difference is that acute renal failure is reversible with aggressive treatment (IV fluids, address the underlying injury if possible). Chronic renal failure is permanent. But the only way to tell is to address the renal failure aggressively for a few days and see what happens.

If USG is still low after negative urine culture, then I'd look for causes such as renal disease, cushing's disease, liver failure, etc.

Her kidneys are definitely working. Non-working kidneys produce isosthenuria, or a USG of 1.008-1.012. Anything above or below that range means there is kidney function. How much is anyone's guess, but with normal BUN and creatinine her kidneys are least 25% functional.

Biggest thing is get the urine cultures, make sure the infection is cleared, then see what happens. Good luck.

    Bookmark   July 30, 2009 at 8:16PM
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Thank you Meghane. My home internet isn't working and I was frustrated that I couldn't look to see if you had responded until this morning!

Anyway, thank you. It sounds like you would do exactly as we are doing - get the infection cleared, recheck, and proceed accordingly. We are to bring her in when she finished the antibiotics (in two weeks) for another urinalysis (not sure if she will have another CBC at that point or not). I was worried about waiting even two weeks if there is a kidney problem but I guess we do have to clear the UTI before figuring it out, huh? That's why I asked about acute.

This dog had multiple UTIs as a puppy, one quite severe - worried about pyelonephritis then and gave her four weeks of antibiotics after which she was clear.

FWIW, she is feeling MUCH better! I now realize she was droopy for several days or more but not so ill that it was obvious. Now she is bright eyed and waggy tailed again and I see it. She stole DH's socks this morning and I realized she hadn't done that for awhile. It's good to see her happy.

Thank you again.

    Bookmark   July 31, 2009 at 11:01AM
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