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  Discussion on Renal disease
Author Message
Member:
rangler

Posted on Friday, Apr 20, 2007 - 10:46 am:

Dr O

I would be interested if you have any other views/suggestions on my situation.

On April 12 I moved my 9-yr old TB to a new barn (which she had been at previously, and she went with some friends). On April 13 while on a lunge line she tied up. She had been being worked 3-4 times a week, and what she did on the lunge line should not have been tough for her. Her regular vet was out of town, and the back-up came. He diagnosed the tie-up (which was mild), but did not take any blood samples. On April 16 the regular vet saw her and took blood samples, which came back not good. On April 17 we trailered her down to the vet where she stayed until April 19 and was diagnosed as having renal disease. Because her BNU and creatin numbers seemed to have leveled off, the vet did not think that the tie-up caused the renal problems, and that likely the renal problems started some (unknown) time ago. Here were her BNU and creatin results (the night of 4/17 she had 5 liters IV, and also drank 2 five-gallon buckets of water):

4/17 at 2216 - BNU 41 mg/dl; Cre 3.3 mg/dl
4/18 at 0725 - BNU 31 mg/dl; Cre 2.4 mg/dl
4/18 at 0743 - BNU 29 mg/dl; Cre 2.4 mg/dl
4/19 at 1107 - BNU 30 mg/dl; Cre 2.3 mg/dl

The renal disease diagnosis was also based on other factors, not just the BNU and creatin scores. She has bad breath, has been behaving oddly for a month or so (spooking at odd things, which everyone ascribed to it being Spring and her being a TB mare), drinking/urinating alot, and other factors.

I'm a new horse owner (just since July) and am grasping at straws. Do you have any to throw me?

I have opted to not have a biopsy done, because at this point I don't see the need for the risk or expense to find out what caused the renal problems.

She's been put on a low protein, low carb diet (which she doesn't like). Does anyone out there have any suggestions for foods to give her that might get her to eat? Right now the biggest challenge will be keeping her weight on (which is very good at the moment). She already doesn't like vegetable oil.
Member:
wgillmor

Posted on Friday, Apr 20, 2007 - 12:50 pm:

We have an older horse (26 years) with renal disease (BUN and Creatine significantly higher than yours). She is also difficult to get to eat. We have found that we need to change her feed regularly. She does about two bags of a given feed and then stops. So we switch. We're hoping that when we run out of new feeds, she will have forgotten that she didn't like the first one.

We have also had to make some compromise with low protein in order to keep her weight up.

She also gets a shot of an anabolic steroid every six weeks, which seems to help her appetite.

Good luck, I hope she keeps improving.

Wiley
Member:
rangler

Posted on Friday, Apr 20, 2007 - 12:56 pm:

Wiley,

Thank you for your response. Can I ask how long since your horse was diagnosed with the renal disease? I had not heard anything about the steroid shot, but will keep it in mind. Do you ride her at all? My vet said light pleasure riding would probably be ok, but I haven't decided on that yet. I only do light riding myself, but don't want to put her through anything more than she's already going through.
Member:
wgillmor

Posted on Friday, Apr 20, 2007 - 4:16 pm:

Kathryn,

I don't know how parallel Star's situation is to your horse's because of the age difference, but here is a summary of what has happened.

Star is 26 and has been semi-retired for several years due to general age and condition (including navicular disease.) She did work lightly two years ago. She was diagnosed with renal disease last summer when she lost weight. We were successful at getting weight back on her by the methods of my first post. She taught round pen work to one of the children at the barn, but we didn't think she should be ridden.

She lost a lot of weight this winter -- it was the worst in Colorado in the 15 years I've been here, and we're struggling to put weight back on again. Our current thinking is that as much as we will miss her, we will not ask her to go through another winter.

I did notice that you said you had your horse on a low carb diet. Is that because of the tying up? We have believed that carbs (particularly in hay( is the best source of calories in Star's case.

Wiley
Member:
rangler

Posted on Friday, Apr 20, 2007 - 5:38 pm:

Wiley,

I think I was hoping you'd tell me she'd been diagnosed 20 years ago... Like I said, I'm grasping at straws.

The vet recommended the low-carb diet, but it is something that I could ask her about. There's
been so much going on, that it's a little overwhelming.

Kathryn
Member:
wgillmor

Posted on Friday, Apr 20, 2007 - 9:24 pm:

Kathryn,

I would like to hear what DrO has to say, but I wouldn't think you are at the grasping at straws point yet. The BUN and Creatinine levels look stable or improving.

Star is BUN 31.1, Creatinine 7.4. Our vet's statement was "Usually when the Creatinine hits 10 or higher, the horse will start to feel ill and decline from there." On that count you have a way to go.

I'm hoping I'm right.

Regards,
Wiley
Moderator:
DrO

Posted on Saturday, Apr 21, 2007 - 10:18 am:

Kathryn have you had a urinalysis performed (see article for explanation)? I find the above a little perplexing and remain unconvinced that your horse has serious renal disease but cannot rule it out either. Mild dehydration would be another explanation for the lab results.

It is important that the UA be performed at least a week after having received forced oral or IV fluids as this will artificially lower the specific gravity. Some would even remove water for 24 hours before checking to see if the horse is concentrating urine but this must be done under the direction of your veterinarian.
DrO
Member:
wgillmor

Posted on Saturday, Apr 21, 2007 - 1:38 pm:

Kathryn,

This got me started and I looked up more of Star's history. She was diagnosed in September '05 (not last summer), so we've actually made it through two winters. I hate getting old.

We did have urinalysis done, I don't have the figures, but I do remember that the urine was dilute and she was not concentrating it. (That is, if we want to trust my memory this time.)

I'm glad to read that DrO is unconvinced.

Regards,
Wiley
Member:
rangler

Posted on Saturday, Apr 21, 2007 - 3:02 pm:

Dr O and Wiley

Thank you again for your input. A Urinalysis was not done while the horse was at the vet as they were unable to catch a sample. We have since gotten a sample and have sent it in (no results heard yet). However, it has not been a week since the IV was given. This is something I'll definitely bring up.

Dr O, could I ask specifically what you find perplexing? Perhaps I have misinterpreted something or left out pertinent information (as I see my BNU should be BUN). If not, maybe I can be a little hopeful...

And special thanks to you Wiley!
Moderator:
DrO

Posted on Monday, Apr 23, 2007 - 7:20 am:

kathryn, the diagnosis should be made on the finding of an inability of the kidneys to concentrate urine combined with an inability to remove BUN and creatinine appropriately.
DrO
Member:
rangler

Posted on Sunday, Jun 3, 2007 - 10:41 am:

Updating...

Several blood tests and urinalysis later, the BUN and creatinine numbers are pretty much about the same. On two urinalysis tests though, the horse is actually concentrating urine (I don't have the specific numbers available right now, but can get them if needed). The vet is still calling it chronic kidney disease, although this seems at odds with what Dr O says in his articles and posts. I'm curious as to what Dr O would think is causing this, and also how others would proceed. Since the original tie-up/diagnosis, she's undergone a personality change and is much much happier, calm, horsey. Should I bring in another vet? Take her to a hospital? Wait it out (the vet is going to come out in a couple months and do another blood test)?
Moderator:
DrO

Posted on Monday, Jun 4, 2007 - 6:51 am:

How about for an explanation that your horse normally runs a little high in these numbers? The lab values for normal usually created using one standard deviation of the population: 5% of the normals fall out of the lab's normal range. However on the other hand basic renal physiology is consistent on this fact: horses (and all species of animals veterinarians work with regularly) loose the ability to concentrate urine long before they loose the ability to remove BUN and creatnine from the blood.

Why your horse does this I do not have a clue but the levels you have are not a health problem. Your veterinarian need to reconsider this diagnosis based on the fact the kidneys can concentrate urine.

But let's get back to your original problem of tying up, which is not related to elevated levels of BUN or Cr anyway. I recommend you carefully review the article on Tying Up and let's see if something turns up. However just one episode of tying up may just indicate a need to ease up on the work a bit and bring the horse along a little more slowly until she mentally adapts to the new environment. Your first post suggests this is taking a while.
DrO
Member:
rangler

Posted on Tuesday, Jun 5, 2007 - 1:54 pm:

Dr O, thank you very much for your response. Needless to say, it is very encouraging! I will read the article on Tying Up. That's kind of been overlooked in the whole kidney issue... We've put Horse back into light work (just easy w/t/c), and she's been wonderful - calm, relaxed (in spite of wind and construction work). Hopefully we'll keep progressing in this direction. And thank you for having this fantastic resource for advice, research, support.
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