My dog has chronic elevated kidney value tests and is not doing well. What can I do next?

Question: 

On a routine checkup, my 11-year-old dog displayed very high kidney function levels of bun (178) and creatinine (5). After 10 days of IV therapy, the numbers came down to 35 bun and 2.1 creatinine. Over the next 10 days, after stopping the therapy, he was very low on energy and unwell. I took him for a check up and his creatinine had shot up to 6.4; his bun was 125. Since then he has been given SubQ fluids (under the skin at home), and it has been a week. Yesterday, we added Lasix (a diuretic). A few days ago, his creatinine level was 4.1 and his bun was 75. I started him on Royal Canin Renal Diet and am giving him just that. His eye is definitely affected. Please advise as to what I can do for him.

Answer: 

The high kidney values indicate a defect in the kidneys’ ability to concentrate urine and eliminate the body's waste products. It is unclear from your dog's history if the disease process is more acute (and possibly reversible) or more chronic (the damage is not reversible, but the disease may be manageable). If there is an underlying cause, it is very important to identify and treat it so that further kidney damage is minimized. Once the kidney is more permanently damaged, diagnostics and therapeutics are aimed at slowing the further progression of disease. Diet therapy is important in the management of kidney disease; however, it is only the tip of the iceberg relative to many other therapeutic intervention points that should be explored. 

You mentioned your dog is on Lasix (furosemide, a diuretic). This drug is not typically used in patients in kidney failure. There are a few unique, critical care situations (in a hospital setting) when kidney failure patients are no longer making urine and this drug may then be used. You also indicated that your dog's eye is being impacted by the disease and I presume this is due to high blood pressure. There are several very good blood pressure control agents that can be used to lower blood pressure - Lasix is NOT one of them (although it is sometimes used in people with certain types of high blood pressure, it would be contraindicated in your dog). A board-certified veterinary internal medicine specialist (http://www.acvim.org/) will be the individual with the most training and experience in helping treat your dog's kidney disease. You should ask your local practitioner for a referral to a board-certified specialist.