Although the April newsletter touched on kidney disease, the emails I received over the last two months in conjunction with all the consultations for dogs with kidney disease make me think another conversation is warranted. By the time blood test results specific to kidney disease alert us to the problem, about fifty percent of kidney function has been lost. (DiBartola, S.P. (2005) Renal Disease: Clinical Approach and Laboratory Evaluation. Textbook of Veterinary Internal Medicine, 6th Ed., Vol 2: 1716-1730) Some people claim that blood tests alert us only when function has been lost by 75%, and here`s an example of that:
In a recent clinical study, Oregon State University researchers showed that SDMA identified disease much earlier in the disease progression, when the kidney had suffered far less damage that results in permanent loss of function—up to four years earlier in at least one animal.Typically, a diagnosis is made when 75% of kidney function has been irreversibly lost, at which point, the prognosis can be poor. However, on average, SDMA detected kidney disease when only 40% of function had been lost and, in some cases, 25% of function.
In January 2015, IDEXX La boratories Inc. announced this symmetric dimethylarginine (SDMA) test and the fact that they would include it as part of their chemistry panels. Indeed my clients have seen their dog`s test results via this test and emailed me with concern. While I am not a vet, I work via vet referrals often, and certainly with dogs that have kidney disease. I`m not sure what to think of this test, and neither are most of the vets I`ve spoken with. On one hand, being able to address something early seems to make good sense. On the other, nobody can say if this translates to increasing the longevity of a dog. In other words, if you didn`t know that the dog had kidney trouble until typical test results pointed to the problem (the creatinine value on blood test results was elevated, urine was dilute, and the protein:creatinine ratio was of concern)...would it make a difference to the outcome?
According to this IDEXX page the steps to follow after receiving a report with elevated SDMA are the same as when seeing elevated creatinine alone. In other words, run a urine culture with sensitivity, urinalysis, protein:creatine ratio, check for infectious diseases, etc. With all of that covered, I imagine we should be able to see how/if the SDMA test does indeed change the outcome. In the meantime, I don't see a reason to panic. If this test detects kidney disease early and even if that doesn't improve the outcome, your dog is not in worse shape than before the test. In other words, the only thing that's changed is that you're aware of it. Your dog should be on a diet that supports compromised kidneys. Lower phosphorus, keep to a 2.5:1, 3:1 calcium to phosphorus ratio, consider the importance of vitamin D especially in these early cases (read my blog about this), don't feed plant-based oils, ensure good intake of vitamin B vitamins, and focus on antioxidants.
Keep The Urinary Tract Healthy
Some unfriendly bacteria has a way of creeping into places it doesn't belong. For instance, e.coli UTIs are incredibly common. Leave it long enough and you can end up with a kidney infection (that's why tests to rule out a UTI are performed when kidney values aren't right on blood test results), and if that goes on long enough, kidneys can be damaged. Dogs that have compromised kidneys may be more likely to get UTIs as well. The jury is out on that because the documentation is poor to none, but I'm going by what I've seen over the last 15 years. Without fail, these dogs have shown me that they're more likely to pick up UTIs. Maybe it's because these dogs can "leak" a bit and end up licking their privates and contaminating them. Maybe it's because they tend to urinate more often and are in contact with grasses, dirt, dirty snow etc. Whatever the reason, I've become insistent on measures being taken to avoid the problem as much as possible. That translates to acidophilus which has been shown to help women who get e.coli UTIs; Quest D-Mannose with Cranberry which unlike so many products on the market actually works wonders for prevention, and this CoQ10 which helps kidneys (and heart - bonus!) By doing all you can to keep the urinary tract healthy, you can help to support kidney health as well.
" My heart says Cavalier, my brain says no dogs...and I am in the middle"