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  Discussion on Mystery kidney problem
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New Member:
Lsweeney

Posted on Saturday, Aug 28, 2004 - 2:34 pm:

Here is my story.

Nikki is a Friesian. Barefoot, lives on 3 acres of pines and oak trees. Some star thistle. Don't know of any other toxic sources. We are casual weekend riders. Her diet is grass hay and an occasional carrot, apple, handful of oats. She lives with a horse with founder history, so we are very careful with high caloric feed. Nikki's weight is about right, perhaps a little more on the ribs, but not overweight.

We have had issues with her in the pond, though. Because we keep the feed light, she supplements it herself, by wading into the pond and eating the tulies. Her feet are wet everyday, so this is a daily activity.

I have had problems with abscesses in the feet this year. A couple of full blown abscesses - 3 legged lame, and then some slight lameness. Different feet, including one hind foot once. The vet has treated these with bute and antibiotics. One looked like a puncture wound. I found a board with a nail in it in the pond. I think the other lamenesses have been due to either her feet being soft, and her hitting a rock, or once she had some thickening in her tendon, and I think she may have gotten her feet stuck in the mud, and then pulled them out suddenly.

The horse has been in this pasture for 7 years, and only lately has the pond really been an issue.

So we plan a camping trip.... The night before, I notice that she is not putting all of her weight on one foreleg while eating, but it is subtle, it is dark, and I blow it off. We put her in the trailer at 4am, I ask my husband about the lameness and he says he doesn't see anything (which really doesn't mean anything). We get to our campgrounds and go for a ride. Nothing strenuous. No lameness, or if it is there, not dramatic enough to notice. He trots up this hill which has some rocks, and then she is lame. Limping. Take her back to camp. She is pointing with one foot. That night I give her 2 grams of bute, thinking that we might have an abscess on the way.

There are several other horses in pipe corrals close by. She is showing to them, in season. She is eating.

She has hay in front of her while camping most of the time, however in the morning we notice that she is shivering, and she really hasn't cleaned up the hay. She is also not really interested in treats, carrots, etc. I had debated blanketing her because we were in the high sierras, but it wasn't that cold, and my blankets are made for 30 degree weather. I thought it would be overkill. I'm wondering if she is just cold. However, it is odd.

Take her temperature. 101.5. The lameness in the right foreleg appears to be gone. We stick an easy boot on it, just in case she has a stone bruise, and first walk her through the meadow. She is kind of picking at the grass, but appears to perk up some. We take a very light ride. Mainly around the meadow. She still doesn't seem quite herself. Just not as interested in her surroundings. Go back. With easyboots, no lameness, but when I take the boot off, it looks like she is still pointing with that foot. Take her temperature. 104.5. I give her 3 grams of bute, and find some old sulfa antibiotics in my trailer. Give her 15 tabs. I'm thinking that I'm dealing with an abscess. The high fever is scaring me. However, in hind site, she did run a fever once before with an abscess, but it was around 102. Not this high.

The fever is down by the evening. Back to 101 or so. She is eating. Feels better. Next morning, fever is down, no lameness. I give her another 2 grams of bute, and another 15 tablets of the sulfa drug. We walk her around the meadow, then load her up and go home. Temperature normal at home. No drugs, so my vet can see her without them in the morning.

Fax my vet the symptoms, that there is no lameness, and no fever, but this is what happened over the weekend. However, we are still noticing that she is not eating like normal. Picked at her hay in the trailer. Eating 1/2 of a carrot. I'm concerned about giving her antibiotics and not completing a series. I suggest blood work. He comes out Tuesday, and takes blood. She is given no drugs/antibiotics since Sunday morning.

He calls me Wednesday, freaks out, and tells me to throw her in the trailer and go to UC Davis.

I get to UC Davis. The vet examines my horse. She looks normal. Eating grass. Temperature normal. Not dehydrated. Heart rate normal. No signs of colic. Feces solid. Pooped in the trailer on the way down. Gastric noises. No upper respiratory issues. The vet wants to know what about her makes me think she is sick. I say, she eats 1/2 of a carrot.

She looks at my vet's bloodwork. The calcium, BUN, and Creatinine parameters are high. The calcium and Bun were a few points over normal (don't remember exact settings), and the Creatinine was at 4.7.

They do bloodwork. Everything is normal, except the BUN is higher then the previous blood panel, and the Creatinine is at 4.0. No sign of infection. Blood is normal from that standpoint.

They put her on a water drip therapy, and take an ulrasound of her kidney. They are enlarged and show changes.

Next day, blood shows BUN normal and Creatinine at 3.

Next day, blood shows all normal, and Creatinine at 2.3. 2 being high normal. They are going to slow the drip, and then take her off and observe the blood work.

Same day, they walk her around. Vet says that she was quite high, bucking. (While she has been at the vet, she has been eating, drinking and pooping normally.) They take her temperature, and it is at 103. During the night it spiked to 102. It is now normal again. Vet is puzzled relative to the fever - why?

In previous discussions, the vet thinks that the Bute and Sulfa may have caused the kidney changes. However, has no answers for spikes in temperature.

My local vet has seen several horses with spiked temperatures, that then go to normal, but followed by depression, off behavior. He says that another vet is seeing the same thing. He has not done blood work on these horses.

He is suspicious of West Nile. While the horses have been innoculated, he is wondering what West Nile looks like if they get it after innoculation. My horse has probably 2 years of innoculations. (Twice a year.)

They are going to test my horse for West Nile antibodies.

So......any thoughts, ideas?
Member:
Lsweeney

Posted on Saturday, Aug 28, 2004 - 3:13 pm:

Update from today. Running a lower grade fever, 102. Vet says could come from IV. Blood work came back everything normal, except Creatinine at 2.2, down from 2.3 the day before (positive direction), and her platelets are low. She said there was a slight nasal discharge that they are testing-they have done a nasal swab. Vet is testing for Ehrlichiosis, a bacteria that comes from the same tick that causes Lyme disease due to the low platelets count. My horse is in an area that have the ticks that cause Lyme disease.

There are no symptoms of swelling anywhere.
Member:
Lsweeney

Posted on Saturday, Aug 28, 2004 - 3:20 pm:

Equine and Human Granulocytic Ehrlichiosis
The same tick that spreads Lyme disease appears to be the culprit in another disease of humans and horses, granulocytic ehrlichiosis. This condition,
which mimics Lyme disease, was once thought to be two separate diseases.
Through equine research headed by the UC Davis Center for Equine Health's
Dr. John Madigan, it was found that both conditions, Equine Granulocytic
Ehrlichiosis (EGE) and Human Granulocytic Ehrlichiosis (HGE), were caused
by a bacterial organism called Ehrlichia equi (E. equi).
The clinical signs of EGE in horses include fever, depression, jaundice, limb swelling, incoordination, low white blood cell count and a decreased number of blood platelets. In humans, the clinical signs of HGE mimic the flu and include fever, headache, shaking, chills and nausea.
EGE and HGE are easily treated in the early stages using tetracycline antibiotics. If not treated quickly with appropriate antibiotics, the organism may spread throughout the body causing significant damage to internal organs and possible death in both horses and humans.
Member:
Lsweeney

Posted on Saturday, Aug 28, 2004 - 4:21 pm:

I found this under another topic under this section re: kidney failure and foot abscess - see below. Sure sounds like the combination that I had administered to my horse. My horse got 2-3 grams of bute and 15 tabs of Sulfamethoxazole and Trimethoprim Tablets, 800mg. and then 2 grams of bute and 15 tabs of the same sulfa drug the following morning. Then nothing after that.

The bute dose, though high, but was not exorbidant. I went over to a pharmocology resource and found this under the trimethoprim/sulfa topic:

Drug Interactions - Sulfonamides may displace other highly bound drugs, such
as methotrexate, phenylbutazone, thiazide diuretics, salicylates, probenicid and
phenytoin. Although the clinical significance of these interactions is not entirely clear, patients
should be monitored for enhanced effects of the displaced agents.

Perhaps the antibiotic created a higher than average circulating level of bute, resulting in a toxic interaction. I must say this is not a well known feature of this drug and is used together with bute all the time. Though this increases our understanding of why this may have happened I still believe the horse may have had a sensitivity to the medication. I will include this experience inour newsletter since these two medications are used together all the time.
Moderator:
DrO

Posted on Saturday, Aug 28, 2004 - 5:07 pm:

Hello Laurie,
I guess we wait for the lab results but a few comments. Uncomplicated foot abscesses should not be treated with bute and/or antibiotics, see Equine Diseases » Lameness » Diseases of the Hoof » Hoof Abscesses, Bruises, and Gravels.

All equine veterinarains see lots of horses with fevers of unknown origin. Because we don't routinely test uncomplicated fevers for flu, herpes viruse, etc these diseases go as undignosed fevers. But even when I get intested enough to pursue a exact diagnosis often I cannot find the culprit. Most of these are transient problems and the higher the fever usually the faster it goes away, Equine Diseases » Fever of Unknown Origin.

I am greatly concerned about the elevated creatinine and enlarged kidneys. The resolving numbers are comforting. I don't believe 2 doses of bute is a likely cause but as you point out there are circumstances that may have made this worse. YOu should also note that the sulfa drugs are also directly toxic to the kidney though this is not usually a problem in the well hydrated horse. For more causes of acute kidney disease and proper treatment see, Equine Diseases » Urinary System » Kidney Disease and Failure in the Horse. Note that your oak trees are suspect also.

Lastly check the article on WNV it explains the range of clinical signs and how vaccination might effect it, » Equine Diseases » Nervous System » West Nile Virus.
DrO
Member:
Dres

Posted on Saturday, Aug 28, 2004 - 5:42 pm:

hi Laurie.. i have a gal friend here in northern ca. her mare has just come down with Ehrlichiosis as well.. strange as this is not really tick season right now.. anyway.. never off, no swelling , but off her feed , depressed and spiked a fever.. they are treating her with antibiotics.. within 6 hours the mare was back to her old self..

good luck Ann
Member:
Lsweeney

Posted on Sunday, Aug 29, 2004 - 12:43 pm:

Update from my visit yesterday. Still waiting for Sunday's blood work.

I got there and she looks like crap. Much worse than when I brought her in. She is now running a 103.2, and has been hanging in this range for about 24 hours. She was really not interested in any of the treats I had for her. She had a snotty nose. In looking at the feed in the stall, they had gone from grass hay to alfalfa and even some mixed pelleted feed. It was clear that they were trying to get her to eat now. My horse is only on grass hay, and alfalfa to her is like candy. You would NEVER see alfalfa sitting around with this horse. The vet had said I could take her out of the stall. So I thought I would just let her get a change of scenery. I took her out and she brightened up. Screamed at the other horses. Finally settled down and ate quite a bit of grass on the lawn. The vet showed up and said that she looked brighter, but agreed that the nose was a little snottier than what she had seen. She had coughed just twice with me. Passed a normal bowel movement. All of a sudden standing in the sun, I started to feel funny, so I had the vet take her back. I had gotten too hot in the sun. It was a lot hotter today, and I hadn't really consciously realized it. Back at the stall, I put some water on her, and then the nurse came in with an alcohol bath. I took her temperature and it was 104.6. The vet thinks it was from standing in the sun. Came back to the house later and checked the weather and it was 102 in Davis. So, yeah, it was hot.

I left Davis, went to get some fluids for myself. Walked out of Del Taco, and I had a flat tire. By the time I changed the tire, my battery was dead in the car, because the air had been on. I'm feeling that there is a plot against me. Had the car jumped. Went back to Davis, disturbed over the high temperature.

Horse looks a lot better. Extremely pissed over the fact that they have put the catheter back in. Foul mood. Tries to kick me when I tried to take her temperature. She was eating the alfalfa in a somewhat slow motion mode. Her temperature was 103.1. They were going to put her back on fluids and give her a non-steroidal anti-inflammatory (which by the way I notice is still hard on the kidney from your paper, but it is too late now).

The Ehrlichiosis was negative. A urine analysis proved to be normal. The nasal swab can't be run until Monday.

They had installed a very large mister for her stall, and it was now very cool and refreshing in there. This apparently helped a lot. She was 102.6 by the time I left.

Because we have no history on this horse relative to blood work or kidney ultrasounds, you really don't know if she already had a problem before I gave her the bute/TMS combination. She was hydrated when I gave her these drugs, because we were camping, and I could see what she was drinking. She was actually drinking a lot. She never looked dehydrated.

We really don't know if she has been eating acorns for the last 7 years, and slowly damaging her kidney, like an alcoholic with their liver, but we didn't know it. Then I give her a lethal combination of kidney-killing drugs.

My concern now is getting too aggressive treating the fever. She may just have a virus, that she is fighting off the normal way - feeling like crap, with a snotty nose, off, etc. I don't want her treated with anything that is going to make the kidney problem worse.

All I know until the blood work comes back today.




Member:
Lsweeney

Posted on Sunday, Aug 29, 2004 - 12:51 pm:

PS Regarding treating the abscess. With one abscess, I had let it go to run its course. She ended up three legged lame, to the extent that she wouldn't come down to the barn where her water was. She was running a fever and was very dehyrated by the time the vet came out. He treated her with bute and antibiotics that time.

I had asked him on one occasion why we got such dramatic results with just 2 grams of bute, he had said that the bute took the pain away, which allows her to move around on the foot, and might encourage the abscess to move.

So with this history under my belt. The first night, when she was lame, I just gave her the 2 grams of bute. And she was fine by morning. What I really think she had was just a stone bruise. Not an abscess, in hindsight. However, when she had a 104.5 fever that afternoon, I jumped to the conclusion that it really was an abscess, not realizing that this fever was probably too high for an abscess. That is why I kicked in with the antibiotics.

Again, with perfect 20/20, I think she had a stone bruise and a virus. I then came along with a bad combination of drugs for the kidney.

One more interesting piece of information. Her full sister had some weird thing where she went off feed and ended up with liver damage. The cause was unknown. The guess was that she went several days without eating, she was overweight, and it ended up having something to do with fatty liver disease.

And then I remembered that her mother died of oleander poisoning. Supposedly mixed in her feed. I don't have any specifics, so I don't know what the symptoms were, if blood work was done, did they actually find oleader, or was this a supposition? Just kind of interesting all these close relatives ending up with renal-related problems.
Member:
Lsweeney

Posted on Sunday, Aug 29, 2004 - 1:12 pm:

PSS Read the articles. My vet has always tried to dig out the abscesses. However, several times he has been unsuccessful, partly because my horses feet are extremely hard. So he has advised soaking, which I also did. Being a layman, I didn't want to start digging around in my horse's foot.

Remember, I was in the boonies, camping.
Member:
Lsweeney

Posted on Sunday, Aug 29, 2004 - 2:50 pm:

Talked to the vet. She is only going to call me if her blood work is off normal. She is doing much better. The temperature DrOpped to normal in the night and has stayed there. Expressed concern with the non-steroid anti-inflammatory and the kidney, and she said that with the drip she was hydrated and it was a very low dose. Her nose is snottier and she is coughing now. She appears to be running the normal course of a viral infection.
Member:
Lsweeney

Posted on Sunday, Aug 29, 2004 - 3:33 pm:

Question. The sulfa drug I gave her was Sulfamethoxazole and Trimethoprim tablets 800mg/160mg. They had been prescribed originally for my Arab that is 14.1 hands and about 700 lbs. My Friesian is about 1,300 lbs and 16.1 hands. So in my thinking back on that fateful weekend, that if I followed the dosage for the Arab, it would probably be a lower dosage given the differences in body weight and conservative. However, if I go over to your drug page for this drug, it says 11mg per lb. I'm not sure how this works, 960 mg per tabet? So if I take 11mg X 1,300 lbs / 960 mg, I get 14.9 tablets. This was what the dosage was for my 14.1 Arab at 700 lbs. So it sounds like it was high for the Arab, but just about right for the Friesian. Would this be correct? Also, in reading the instructions on the bottle, it has specific instructions for people with impaired renal functions, and has specific dosages or non-dosages for various creatinine levels.

Also, I just want you to know, that everytime I search for information on the internet, the best hits keep coming from your web pages.
Member:
Lsweeney

Posted on Monday, Aug 30, 2004 - 2:08 am:

Well, the trip to Davis was well worth it tonight. Made my day.

We brought Nikki a bag of carrots, bag of apples, and 1/2 of a watermelon. Hoping something would appeal to her. What a difference a day makes. We get there, and she is ecstatic to see us. As soon as she realizes that we have treats, she tries to knock down the stall door. I have to put on my isolation uniform. Coat, plastic gloves and plastic feet. I take the watermelon and put it in the feed bucket they had in there. She inhales it. She drinks the juice in the bottom of the bucket and literally licks the bucket clean. One of the nurses shows up and they gave me her creatinine reading which is 2.0. High-end normal. No fever. Very good news.

I can't tell you the difference between yesterday and today. She was poking at all of the spots she wanted me to itch. Munching on grass hay. Very interested in what else we had brought. And I caught her eyeing the bottom half of the stall door when it was opened. Like, maybe I can quickly fit under there.

I think we have rounded the corner.

I'm just bummed that I didn't get the picture of her smashing her face into that watermelon. (I hunted down a nurse to tell them what I had done. It was a seedless watermelon, and before she licked the bucket clean, it looked like she was now bleeding some watery fluid.)
Moderator:
DrO

Posted on Monday, Aug 30, 2004 - 8:30 am:

Yes the way the trimeth-sulfa is dosed is based on the combined weight of the two active ingredients. We can get away with this because the ratio is fixed in all commercial preparations, including smaller tablets, liquids and injectables. Your calculations are correct.

Delighted that things are looking better and thanks for the kudos.
DrO
Member:
Lsweeney

Posted on Monday, Aug 30, 2004 - 9:25 am:

One more question. Any feeding suggestions for helping the kidney? I know low protein is better. She gets grass hay right now and no supplements other that carrots, apples, handful of oats. (We have to watch our weight.) I'm thinking that if there is something specific that I can give her, I would like to do so. I think I saw somewhere on the net Omega 3 and potassium.
Member:
Lsweeney

Posted on Monday, Aug 30, 2004 - 9:51 am:

And one more thing......If I hadn't had the blood work done, which I asked for, I would have never known that she had a kidney problem. The creatinine was already on its way down between my vet's blood work and UC Davis. So she could have gotten the snotty nose, and we would have all gone, Oh, it's a virus. Perhaps without continuing the bute and TMS, we would have been out of the woods, not ever knowing that we were in them. So how frequently are we giving drugs that are really impacting our horses organs, and we have know idea. For example, it looks like my Arab got TWICE the recommended dosage of TMS a while back. Makes me feel like we should be running blood work ALL of the time.
Member:
Dres

Posted on Monday, Aug 30, 2004 - 10:08 am:

Laurie, is Ehrlichiosis still a cause for any of this???

Ann
Moderator:
DrO

Posted on Monday, Aug 30, 2004 - 7:04 pm:

I believe the article on chronic renal disease has feeding recommendations for horses with kidney disease, but with the normal blood work I am not sure you need worry much about diet as long as it is reasonable.

We have often commented on the folly of running blood work on healthy horses. Your horse was ill and it was uncertain why. Following a good physical exam it there are uncertainties for why a horse is displaying signs of illness blood work helps fill int he picture. It is the physical exam that directs what tests should be done.
DrO
Member:
Lsweeney

Posted on Tuesday, Aug 31, 2004 - 1:07 am:

Thank you Dr. Oglesby. Your site has been very helpful. And yes, a little paranoia is setting in.

No Ann. The Ehrlichiosis was negative.
Member:
Lsweeney

Posted on Friday, Sep 10, 2004 - 1:06 pm:

A week has gone by since my horse was admitted to UC Davis. We did a blood test and the kidney panel came back with the creatinine and BUN in normal ranges. However, her red blood cell count is low. My vet wants to run a Coggins test on her for Equine Infectious Anemia. Given the symptoms above, what do you think? We live in California, and I take her camping into the high sierras by Tahoe.
Member:
Lsweeney

Posted on Friday, Sep 10, 2004 - 1:11 pm:

One more thing. She is at home now. Came back a week and a half ago. My other mare did get a little snotty nosed last week, her temperature was elevated (within normal range but higher from what she had been during this time) to 101.5, and I noticed some filling in her back hind legs. She never went off feed, was a little dull when her temperature was higher, but that's it. The snotty nose is gone. Both mares are eating, good spirits, no filling in the legs, pretty much back to normal. So the only symptom now is the low red blood cell count on the Friesian mare that had the kidney problem.
Member:
Lsweeney

Posted on Friday, Sep 10, 2004 - 4:12 pm:

My vet faxed UC Davis the blood results. Hemoglobin is 10.9 and RCB 5.86. The UC Davis vet says the blood work looks good, and actually, the RCB is on the rise from what it was when they were doing blood work. (It was lower from when my vet at home originally took blood.) The UC Davis Vet feels that it would be normal for these to be low with the kidney issue.
Moderator:
DrO

Posted on Friday, Sep 10, 2004 - 6:54 pm:

Laurie what is the hematocrit? Was the horse exercised before taking the sample (see article Equine Diseases » Cardiovascular, Blood, and Immune System » The Diagnosis of Anemia).
DrO
Member:
Lsweeney

Posted on Thursday, Sep 16, 2004 - 4:54 pm:

I don't know, but they just drew blood again today, after a week of Red Cell. When he calls with the results, I will post back what this value was.

I will say that for a sick/dying horse, she is now banging on the fence with her hoof, whinneying at me when I drive home and runs as fast as she can to meet me, and demands that she get more feed than anyone else. In other words, back to normal......
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