Canine Kidney Trouble – Not Good, Not Dire

Now that it seems Lilly has been free from bladder bacteria for a few weeks, after nearly 6 straight months of back-to-back bladder infections, we turned our attention to the levels of protein in her urine. Infections can produce high urine protein levels, so we checked again, 2 weeks after Lilly’s last clear urine culture — where her protein level as a 2 (zero is normal). And … it wasn’t good news.

Rather that merely looking at protein levels, which with Lilly have been as high as a 4 in recent months, we ran a fancier test for the protein-creatinine ratio in Lilly’s urine. The ratio came back high. Silly, silly, silly high — 4.5.

I found a page on the Cornell vet school site that said dogs on long-term steroids can have a ratio of 1.3 or so. So, I burst out laughing with worried surprise when our vet called to share the 4.5 number.

Yikes!

Lilly officially has proteinuria. Essentially, her body is throwing off protein through her kidneys.

While this isn’t yet full-blown kidney disease, it could easily go there. So, Lilly needs intervention soon to protect her kidneys from further damage.

My knee-jerk reaction is to blame the MANY meds Lilly takes to keep her rabies vaccine-induced brain and spinal cord inflammation at bay, but a friend who is a veterinary professor says it’s just another outcome from her primary inflammatory reality.

Either way, we need to take action. The most likely treatment includes a medicine (drug decision pending our veterinary neurologist’s return from the ACVIM conference in Seattle this week) AND to change Lilly’s diet to one MUCH lower in protein.

Usually, you add the med and change the diet and recheck everything in a month. It’d be really interested to try just meds or just food and retest, but we don’t really have time to risk fiddling around. The usual protocol is to do both.

While I wait for a meds decision, I’m exploring my food change options — both on my own and through my contacts at a couple big pet food companies, with science-based therapeutic food lines. We don’t think we need to go whole hog into a true kidney diet, but we do need to get Lilly’s dietary protein down to around 20%.

I’m waiting to hear from her current dog food company on the true levels of protein in her current food. You cannot go by the guaranteed analysis on the label (which in this case says 32% protein). You need to look at the dry matter % chart for the real number. I suspect it’ll still be higher than 20%, but I want to know before I go making a change so that I’m clear on where we were and where we are going.

We lost our dalmatian at 14 1/2 to kidney disease. The special kidney diet gave us 3 more years, so I know diet helps a lot.

Initially, I took the news hard, then I convinced myself it wasn’t that bad, then I came full circle … all the way back to discouraged … after reading this from a 2012 review article:

“Increase in urinary protein excretion correlates with decrease in survival and this is independent of any other factor. Proteinuric renal disease progresses more rapidly than nonproteinuric renal disease and reduction in urinary protein excretion slows progression of renal disease and renal interstitial inflammation in humans and dogs. Thus it is speculated that proteinuria itself contributes to ongoing renal damage. If proteinuria is present and persistent then efforts should be made to diagnose the cause and reduce the level. UP/C values > 0.5 in the dog and > 0.4 in the cat are significant.”

Now, I’m mostly tired.

Lilly has another round of cytarabine injections (yesterday and today), so we’ve been busy with that. I also have some heavy deadlines this week, but there is a delay with some info I need to write, so I had a couple minutes to draft a quick blog post.

IN OTHER NEWS, I took Lilly to the Golden Farmer’s Market Saturday morning before her veterinary appointment. She has only been there twice since getting so sick. It was actually pretty funny.

I suppose because everyone gives her love and food at the veterinary hospitals we visit and because those are the only places Lilly has gone for a long, long time … she assumed everyone she saw LOVED her.

She truly tried to mooch attention and food from almost everyone we passed. If they ignored her, she would SIT and scoot closer and closer until they noticed her.

I had to laugh. It was super sweet.

I’m sorry I don’t have any pix. It took everything I had to take care of her in the crowd and such.

In fact, we bought some dog treats from the new vendor since our old one shut down, and somehow we got home without them. I don’t know if I never put them in my bag after paying or if I set them down while buying something else or dropped them. We were SO bummed when we got home with no treats.

Clearly, I was distracted.

Ah, well. It was a nice little outing for our silly-silly girl.