Protein in urine.

Dr. Marie replied:

Thanks for an excellent question. I have a similar case in my practice right now and I can tell you that cases like this can be difficult to figure out!

So, let's see if I can help to make things a little less complicated and hopefully together we can figure Angel's situation out.

Protein in the urine can mean several things. Yes, if a dog is in kidney failure we can see protein in the urine. However, finding protein in the urine (proteinuria) does not necessarily mean that the kidneys are not working properly. Another possible reason for proteinuria is high blood pressure. When the blood pressure is high, this pushes more protein through the kidneys and this protein ends up in the urine. And another reason is something called cushing's disease. I'll talk more about this later.

So, how do we know if the kidneys are failing? The main factor is how well they are concentrating urine. Did your vet mention to you what her specific gravity is? This number tells us how worried we need to be about the kidneys. If this number is between 1.008 and 1.015 then I would be focusing my efforts on protecting the kidneys. However, if it is higher, then the kidneys are not the primary problem.

You can ask your vet if cushing's disease is a possibility. This condition can cause protein in the urine. It usually causes a great increase in thirst and urination and makes dogs hungry all of the time.

I think Hill's CD is a great food. It really shouldn't cause protein in the urine. It will help greatly to keep her from producing crystals in her urine.

It does sound like your vet is doing all of the same things that I would do.

This type of case can be confusing, so feel free to respond if you have more questions! I'll be online for about another 30-60 minutes tonight.

Dr. Marie.


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Dr. Marie replied:

You're very welcome!

Amlodipine is a very safe medicine and the dose that was prescribed to Angel is what I would prescribe.

The next step now is to see what happens after she has been on the medicine for a while. Unfortunately this will require more visits though, but these are necessary. Your vet will want to recheck her blood pressure in the next 2 weeks or so to see if the medicine is getting the blood pressure down. If so, then this really should cause the protein levels in the urine to go down. Your vet will likely also check her protein levels at this time as well.

Regarding food for the kidneys, I think the question we need to ask is whether or not there really is a kidney problem. At this point we know there is a problem with crystals and so c/d is a good food. But, we don't know that there is a kidney problem.

It would be great if you could find out what the specific gravity of her urine was. You can post back a response to this question once you have that number and I can tell you more about how worried we need to be about her kidneys.

While there is a special food that can be fed to help protect the kidneys it sounds like right now, the crystals are more important.

Dr. Marie replied:

This is not the number that I'm looking for. It would be great if you could call your vet's office tomorrow and ask if they could tell you what the specific gravity of the urine was. They'll say a number that starts with the word "ten".

So, if they say, "Ten fiften", this translates as 1.015.

If they say, "Ten thirty", this translates as 1.030.

If you can find this out tomorrow, then post back and I'll give you more of my thoughts. Again, it is this number that tells us how worried we need to be about the kidneys.

Dr. Marie replied:

OK, this number tells us a lot! The number is likely 1.044, which would be called, "ten, forty four". This number tells me that the kidneys are concentrating urine really well. We get worried when the number gets between 1.008 and 1.012. So, a number of 1.044 tells us that the kidneys are not the primary problem.

It looks like your vet has zoned in on high blood pressure being the problem and from what you have written this is probably what is going on. Hopefully the medication helps to keep the blood pressure down!

A thyroid problem is not likely to cause protein in the urine in a dog. In a cat, we can see hyperthyroidism which can cause high blood pressure. But, dogs always get hypothyroidism and we don't see blood pressure issues along with hypothryoidism.

So, to answer your question about food, I would stick with the c/d that was prescribed.

Dr. Marie replied:

Oh, I'm sorry to hear that your girl's kidneys are not doing well. I am really concerned by the Creatinine level of 4.5.

Fluids are by far the best thing that can be done for ailing kidneys.

As far as foods go, I am a big fan of prescription foods for kidney disease such as Hill's k/d, Medical or VMD Reduced protein or other similar foods. These foods have protein molecules that are easier for the kidneys to handle. Plus they are a little bit higher in fat than most diets. This encourages animals to eat and also helps them to get some extra calories.

I do not feel that Tripsy is worthwhile. I classify this in the group of products that people put out there to take advantage of people's desperation.

I do occasionally prescribe a supplement called Azodyl for kidney disease which sometimes helps to get the Creatinine levels down. I am also a fan of Epakitin which is a phosphorus binder. You can ask your vet if your dog's phosphorus level is high as often happens with kidney disease. If so a product such as Epakitin may help.

Another drug that I use often for kidney disease is famotidine (pepcid). This is something that helps with the nausea that often goes along with kidney disease. (Also, if your dog has black stools this could be a sign of bleeding in the stomach and famotidine will help with this.) Famotidine is the same thing as Pepcid. You can buy it in the drug stores over the counter, but you will need to get your vet's permission first.

I hope things improve soon!
Dr. Marie.

p.s. Thank you for the bonus!

Dr. Marie replied:

You're very welcome.

If her appetite is not good, then I would actually give her whatever she wants to eat.

But, if she is willing to eat, then I would recommend any good quality regular adult food. If you can get it, a food for senior dogs would be even better as this tends to be a little bit lower in protein.

Don't try to read food labels and pick based on protein levels because it's almost impossible to read a dog food label properly!

I don't think bottled water will make a difference. I think tap water is perfectly fine.

Hope that helps!

I'll be heading offline now (bedtime here) but I'll check in on your question in the morning in case you have more questions.

Dr. Marie replied:

As far as exercise goes, let your dog be the judge. If she wants to go out and seems to handle the walk well, then this is good. But if she seems to be tired or is really pooped out afterwards then keep exercise to a minimum.

There is nothing specific to help the creatinine, just all of the things that we mentioned above.

Just so you know, I'll be offline till this evening.

Hope your girl has a good day!

Dr. Marie replied:

I don't get too worried when a dog goes a couple of days without a bowel movement. It's likely because she hasn't been eating as much as usual.

The fact that the previous stool was dark and runny is probably because she's not feeling well because of her kidney disease. Hopefully the treatments will help her to feel better.

Dr. Marie replied:

Unfortunately I can't legally advise you on dosing medications...you'll need to get your vet's advice on that one. It won't be causing any negative effects though!

Dr. Marie replied:

Hmm...not sure how much I can help here John. My main concern would be that this is not because of the food but rather than the kidney condition is getting worse.

She certainly may have thrown up because she had a lot of food at once. It's likely a good idea to keep doing small frequent meals.

If she continues to have soft stools you can talk to your vet about possibly giving her some probiotics. These may help. But, if she is having these problems because her kidneys are getting worse then this is definitely not good.