Kidney Disease Cases

My dog Pixel will soon be 19 years of age and currently weighs 5.5 kg. Never would eat kibble. He has had Addison's disease for about 9 years and Florinef med has helped manage this (occasional Predinose when needed) . He has always been an active dog. The Addison's did affect his appetite and I started cooking for him more.
A heart murmur was detected about 2 years ago and was placed on Vetmedin to try and stave off progression. At this point he was not even at Stage 1 Kidney disease.
This past December he had CHF. He was placed on Fuorsemide, the Vetmedin was  increased to 3 xs p/day (from 2 xs) and also given Spironolactone. A second visit to a different Vet emerg. clinic advised to remove the Spironolactone from his meds. At this point, they were seeing the Kidney disease at Stage 2.
He was placed on Pronefra (phos binder), omega 3 and already was taking RX Vitamins Amino Bplex, and low protein, low phos home cooked food.
Our last visit in July showed Stage 3. They have also noticed the heart chamber has increased in size and have gone off label with Vetmedin to a dose of 1.875 3xs p/day. The Vet thinks the meds are increasing his kidney values. They don't want to do fluids because of the heart disease. I'm wondering if this is the right course?
I have noticed an appetite change in the last 5 weeks.  He is eating less and not wanting his usual veggies or homemade cookies etc...This has resulted in a loss of weight of a half pound from when he last weighed in May.
The Vet changed the phos binder to Epatikin on August 2nd and I think he had a reaction to this. On August 8th he started having terrible diarreah - lasted 3 days. I took him off the Epatikin on the second day. He has been going from diarreah to constipation and the Vet has him on Restoralx for 2 days now. Yesterday he had a very small poop.
His appetite has really changed too. He was eating pretty good before the diarreah started. He is really only wanting protein, cucumbers and pasta with potatoes, some cooked kidney and bone broth.
I have him on Kidney Gold Support by Petwellbeing, Omega 3, Probiotics (Proviable), Balance Liquid Formula vitamins, Cerenia for nausea and started Mertazipine today and it looks to be imoroving his appetite already. Just recently added 60 mg CoQ10. 

I have lab work and there were some kidney value increases within a 2 week period and the Epatkin was supposed to reduce Phos but it actually increased it!

I contacted a Holistic vet and sadly she is not able to help and she is now not responding to my call or email. I pray that you will be able to help.

Dr. Steve's Advice - phosphate binders can kill a dog's appetite. Most dogs seem to enjoy eating Tums which probably works as well. Maybe try that as a binder?

Vetmedin has been known to worsen cardiac performance. The question is, what if it's helping and you take it away? You could make things worse. 

Before taking it away, I'd see if you could boost cardiac output to the brain and the kidneys using herbs. I'd suggest Blood's Palace from Kan Essentials, which you can source from Aleksandra Topic at      aleks.topic.1@gmail.com. Find your dog's weight in the table at https://nphc.ca/using/dosage and give that amount twice daily. If you see your dog continue to brighten, then they are not as reliant on the Vetmedin, and you could try a lower dose. If lowering the Vetmedin does not seem to aggravate the situation, and your dog continues to improve, then continue weaning him off it, under the supervision of your vet, who can listen to the lungs along the way

If you see continued improvements, I would try to move back to a real food diet. It will lower systemic blood pressure and support the kidneys and heart further. The idea that limiting protein may lower renal hypertension may not be true at all in this case. It may actually be making renal perfusion worse, so keep this step in mind if you can start your dog rallying again.

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My 16-17ish year old rescue beagle Juno has stage 4 kidney failure, mild cognitive problems, anemia with back leg weakness, and severe arthritis.
Through a whole food diet, high quality supplements and vitamins, and no vaccines if been able to keep her with me for longer that the vets thought.
I have an appointment for Tuesday to put her to sleep because she’s having difficulty walking and getting up on her own. I started Ferrum metallicum yesterday after reading a post here on your recommendation for anemia. I’m not sure if it’s my imagination but she’s less wobbly today. How long do I give the Ferrum metallicum to work? I’ve been giving 2 30c pellets every few hours.
The kidney failure is mostly under control at this point. She’s incontinent and very underweight (vet said from ckd and anemia) but has been eating really well recently. I’ve been giving her beef liver and kidney with green beans, spinach, sweet potato, and whole grain oats for some extra calories. She also gets raw goats milk.
I’d give just about anything for more time with Juno.
Here’s what I give her in addition to the Ferrum metallicum.
Myos canine muscle formula
Adored beast healthy guy
Kidney support gold
Dr Harvery kidney health
Dr Mercola ubiquinol
Ginkgo biloba 30 mg 1x a day
Phos bind
Adored beast liver tonic
Nordic naturals omega 3
Ellevet cbd 1 - 6mg soft gel (makes her sleepy so only at night)
Melatonin 1 mg before bed
Is there anything else I haven’t tried? 

The weakness and cognition are the reasons for considering putting her to sleep. She’s still a love and I believe still knows who I am. 

Dr. Steve's Advice - It seems you've been doing a really good job with your little guy. I would look at introducing Rehmannia Eight from Kan Veterinary Essentials and use the dose recommendations found at https://nphc.ca/using/dosage. Rehmannia Eight has been shown in studies to restore renal blood flow, improve blood work, improve urine concentration, raise the RBC count (like Ferrum is doing) and enhance cognition.

Failing that, you should at least triple the dose of the Dr. Harvey's product, as long as it doesn't cause any loose stools or anything. The single herb Rehmannia, but not the other seven herbs that make up Rehmannia Eight, are in the Dr. Harvey's product, but the current dose may simply not be enough to make any difference. Rehmannia Eight is designed to allow big doses of Rehmannia to be used without any side effects and also contains plants that interact synergistically with it to improve older animals' continence, hind limb strength, cognition and urine concentration.

As for the Ferrum, I would keep going with it. You might a find a couple of weeks on the above regimen (including the Ferrum) really improves your dog. If you see improvements, another thing you can do is add a formula called Three Seeds Combination.

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My 15 year old Bobby has kidney disease and possibly megacolon. He has needed an enema on 9/12, didn’t pass anything so we had to had another one on 9/19 and after a weekend of trying and nothing had another vet trip with an enema today. He is on a low phosphorus canned food diet and is taking Cissapride (2.5 mg twice a day, vet doubled that dose today) and Lactulose (3ml twice a day). We also give him 100ml of subq fluids daily (12lb cat). His blood work shows high Calcium so we did a new blood panel including ionized calcium and thyroid today (results will take a couple of days). 

We have also had him on MiraLax (until today, I may cut that out since it’s not helping), and tried psyllium husk fiber in the very beginning but it didn’t help.

I would appreciate any advice. Now that he is “cleaned out” can we do anything to keep things moving? Looks like his feces gets stuck at the very end and doesn’t come out and keeps building. Before this latest awful trend he would need an enema every couple of months, which was already stressful, but now we have graduated to a whole new level.

Dr. Steve's Advice - probably the safest thing most effective thing to try that might help both the constipation and the kidney issues is a combination of two herbal formulas. They are available from Natural Path through vets as San Ren Tang (Three Seeds Combination) and Yi Guan Jian (Glehnia and Rehmannia). If your vet won't prescribe herbal medicines, then Kan Veterinary Essentials sells them as Three Seeds Combination and as Glehnia and Rehmannia. People often can find those on Amazon.

The two formulas together will safely boost renal blood flow and thus urine concentration to help maintain your kitty's hydration so he's not as prone to constipation. At the same time, Three Seeds will help promote GI motility and reduce inflammatory bowel tendencies, both of which will help reduce constipation. Glehnia and Rehmannia will help moisten the intestinal tract to allow the easier passage of stool.

If those two help, a real food meat-based diet will dramatically help your cat, even though your veterinarian may protest, claiming that the phosphorus and protein levels would be too high. The reality is that a lot of meat-based diets have low to normal phosphorus and normal protein levels. In our decades of experience, a real food diet together with herbs will maintain animals with kidney issues for many yeas, if the above formulas prove helpful.

So just keep that in mind, but meanwhile, try to track down the herbs. When you find them, dose as per the instructions at https://nphc.ca/using/dosage

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My beautiful best friend(cat) has chronic kidney and IBD. First diagnosed at the end of 2020 when a UTI brought eveything to light and her numbers were off the charts and didn’t give her much hope.I got her in quickly with internal medicine at OSU. She’s of course on a few different meds and a prescription diet. She’s pretty much been kicking butt ever since until recently she had some stones i her ureter that caused some problems so she had to get an bypass system put in. This was about a month ago. I’m headed back out for another check up this month. While I know she can’t go without her meds, I’m wondering if there is anything more holistically I can do to help her as well. Thanks a bunch from me and Minnie! Btw she’s 8 years old and hope she still has any more trips around the sun! She does love indoors, this was from her previous days as farm kitty.

Dr. Steve's Advice - it sounds like you're pretty lucky to have such excellent care for your cat. A safe thing you can try among all the other things you're doing is Kan Essentials' Rehmannia Eight Combination. It helps support good renal blood flow, helps prevent kidney infections, resolves low grade renal inflammation, and helps prevent the formation of some stones.

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Our little kitty is getting to the point of needing sub Q for his kidney failure and I wondered what else we can do to prolong his life. We have done everything our vet has suggested. Are there any supplements that are known to really help this sort of thing? We don't want to lose him, thank you. 

Dr. Steve's Advice - be sure to get a urine culture done, to ensure there is no kidney infection causing the azotemia. If there is, treating that will be a quick fix for the kidneys. 

Otherwise, the advice for cats is very much the same as the advice for #kidneydiseasedogs, so take a look at those posts. The very first thing that should be tried is a real food meat-based diet, which you can easily find in boutique pet supply stores. Ask the store staff for what sells particularly well. Cats may not want to eat raw food per se, but if there are no bone chunks in the raw diet, you can cook it if you like. Otherwise, they may have cooked diets for cats as well. Or you can make your own (see posts from Gold Standard Herbs and Aleksandra Topic in Featured posts, above).

A herbal formula you should try to source is Rehmannia Eight from Kan Essentials, which is often available online (from Amaon if you're in the US). If you don't change the diet, get Three Seeds Combination from the same place (another Kan Essentials formula). It will help undo some of the damage that processed food diets tend to do to feline kidneys, and will also enhance the effects of Rehmannia.

If your cat is already on a raw diet and has renal issues, then one formula people have found to help is Cessorex from Gold Standard Herbs

Those are the places to start anyway. Let us know how things go! Dose the formulas according to the table at https://nphc.ca/using/dosage

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My vet and I really need your help as we are unsure how to proceed. My DVM has your book, studied TCVM and has been to several of your lectures. I studied dog holistic nutrition and we are both a little stumped.  

My Yorkie, Darla (13 yrs) has been having elevated Kidney levels for about the past month. We originally thought this was stemming from a C.Perf infection/dehydration from about 2 months ago when we first saw her levels elevated. 

She has had issues with IBD in the past and frequently daily regurgitation and burping.  She can seem a little bloated. A recent ultrasound showed mucosal changes and some thickening in her stomach and small intestine. Those findings are similar to an ultrasound 6 months ago after another an initial C. Diff/ C Perf infection. So this inflammation seems to be chronic. Her kidneys via ultrasound were of normal size, architecture and smoothness.  She was on a raw whole food diet, but Ive switched to cooked per my vets advice after having the nasty Clostridium infections. We treated the clostridium with FMT, Chinese herbs/ozone insufflation, to avoid antibiotics.

Fast forward to current situation:

She has been getting sub q fluids every other day for about a week and a half. When we first discovered her elevated values, I put her on a “kidney tonic” of Hawthorn berries, Ginkgo, Astragalus, Rehmannia, Burdock, Couch Grass Rhizome, Marshmallow, Nettle and Dandelion.  Her Creatinine has slowly been coming down, but her BUN goes up and down as does her SDMA (please see attached photo).

After reading your book, we decided to implement the minor bupleurum (didn’t have 3 seeds, yet) along with the above kidney tonic. We did that for 2 days and today her hydration was much better (we didn’t give fluids today), energy is sooo much better, burping and regurgitation is also improved. BUT: SDMA went up to 18! This after being normal 2 days ago.  But her Creatine is down to 1.4 and BUN 51.

What in the world?  Today I gave her the 3 seeds and minor bupleurum and stopped the above kidney tonic.  She has also been getting rectal ozone treatments and some acupuncture. 

My questions are:

Do you think this would be better suited to a Rehmannia combo?

How do we treat the stomach small intestine inflammation in addition to the kidneys? The constant burping and regurgitation is really hard on her. She is frequently nauseous, and sometimes refuses food in the am.

If this is stemming from an infection or inflammation issues, do you have any other recommendations? 

She is also getting marshmallow, L-glutamine, DCL, aloe powder and soil probiotics for stomach issues. She takes a digestive enzyme. I’m open and thankful and very much looking forward to any advise you may have. I would be happy to contact you privately for a reimbursed consultation if thats a possibility.  Thank you so very much for taking the time to read this.  My vet speaks so highly of you! Attached are past tests. All other levels are normal except for Creatine & Bun. (And at this time. SDMA)

Dr. Steve's Advice - I think you're on the right track with Darla. Despite the much vaunted SDMA test, the truest test of whether kidneys are improving is if the creatinine levels are dropping. They are inversely correlated with renal perfusion, so they more they drop, the higher the renal blood flow.

At some point, improvements will likely plateau. Usually that's after a few weeks. That will be your cue to add in or even replace XCHT with a Kidney tonic. Given the chronic mucosal inflammation, I would suggest Yi Guan Jian. It will hopefully take the improvement in GI signs to the next level, even as it helps creatinine resume its drop. As for the BUN and SDMA, you can largely ignore those two, I find.

As to when to make that shift, you can be somewhat scientific about it. Generally, when the urine protein:creatinine (UPC) ratio is less than about 3, Darla will be ready for the switch to Yi Guan Jian, along with at least a dose reduction if not the elimination of XCHT. San Ren Tang is fine to continue with either. If the UPC is still over 3 and you're still seeing small improvements in creatinine every couple of weeks, then you should persist with your current approach, or use Yi Guan Jian only in small doses

Lastly, regarding diet, rice is tantamount to 'empty calories' for a dog. Using plant starch sources like sweet potatoes, etc., means the dog is getting a significant hit of protein, fiber and vitamins at the same time as the starch

Hope that helps!

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