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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 24440
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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I recently lost one of my dogs to kidney disease and

Customer Question

Hi,
I recently lost one of my dogs to kidney disease and now my 15 year old ***** ***** Terrier has been diagnosed - by his Vet - with Chronic Kidney Disease based on his blood and urine tests results. I have been asked to changed his diet to a prescription renal diet (I choose Purina NF) and he has also been prescribed Enacard 2.5 (1.5 tables per day).
I have been reading a lot about kidney disease and trying to understand the test results. I have read that sometimes Addison's disease or Cushing's disease can be mistaken for, or be the cause of, kidney disease.
My questions are:
1) Could my dog have been misdiagnosed and could he have another disease
2) Is Enacard 2.5 going to help if he has kidney disease and could it pose risks if he has Addison's or Cushing's disease.
3) What is the best food brand or phosphate binders to give him if he does have kidney disease?
I have written the results below to help you answer the question. I thank you in advance and appreciate any advise you can give me.
Calcium: 2.74 mmol/l
Sodium: 146 mmol/l
Potassium: 6.56 mmol/l
Sodium : Potassium 22.26
Total Protein: 65.5 g/l
Albumin: 28.8 g/l
Total Globulin: 36.7 g/l
Urea: 17.6 mmol/l
Creatinine: 130 umol/l
ALP: 136 u/l
ALT: 243 u/l
Phosphate: 1.63 mmol/l
Urine Protein 579.0 mg/l
Urine Creatinine 4.8 mmol/l
Urine protein : Creatinine 1.07
Submitted: 7 months ago.
Category: Vet
Expert:  Dr. Michael Salkin replied 7 months ago.
Thank you for posting the above information. The sodium:potassium ratio of less than 23 supports Addison's disease and the minor elevations in Paddy's renal values (BUN, creatinine) are consistent with Addison's disease; in other words, this appears to be a pre-renal azotemia (the kidneys would be suffering because of the Addison's disease rather than being ill themselves causing toxins to build up in his blood stream). At Paddy's age, however, that assessment isn't so clear cut because there's bound to be a certain amount of renal insufficiency in a 15 year old. An ACTH stim test will tell you if Addison's is present. There might also be lack of a stress response in his complete blood count which I'd like to review, please. Paddy's elevation in his ALP is significant but an elevation in that enzyme at his age isn't unexpected and we're not certain what it implies in our geriatrics. The ALT, however, is elevated significantly but it's meaning is unclear without additional testing of his liver. His serum albumin is low normal likely because he's losing an appreciable amount of protein through his kidneys. The enalapril is reasonable. Without a complete urinalysis I can't assess his kidneys properly. Unless Paddy is eating you out of house and home and drinking like a fish, he's not cushingoid. Please respond with further questions or concerns if you wish.

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