Help! My Boston Terrier May Have Kidney Failure

I have two Boston Terriers, both 7 years old. We have had our boy since he was a puppy. Our girl, Pixie, we rescued two years ago. She was abused for five years of her life and it’s hard when we have no history of the dogs we’ve rescued. But she has learned to trust us and to give us hugs and kisses, which makes us happy.

Every six months I take both of my dogs in for a wellness exam, which includes blood work. Everything until this past January was fine, but then Pixie’s alk phos came back high at 1600. Six months prior they were 300. Pixie has been overweight since we brough her home and has a semi pot belly. The vet suspected Cushing’s disease.

So we did an ultrasound. Her liver was enlarged. There were no diabetes and no thyroid issues. We did a low dex test and it came back negative. We then did an ACTH stim test and it came back negative. By then, I’d already switched to my third vet. They didn’t think it was necessary to treat for Cushing’s since Pixie wasn’t showing any signs of the disease. I agreed with the vet because I knew treatment was extensive and could cause more harm than good.

Well, we took her in two weeks ago for her six-month blood work panel. She was on Denamarin for about three months and her alk phos had dropped to 1300, which is a good sign (I hope). Her GGT was elevated and her urine had 3+ protein. The vet wanted to run a ratio test on the urine (I can’t recall the name) and it came back 3.5 where normal, she said, is .015. So she now tells me that Pixie may have kidney failure.

I am pulling my hair out and I’m at a loss. They want to start her on Benazapril, which is a blood pressure medication, yet they have not checked her blood pressure. I don’t mind giving her this if necessary, but I believe in holistic approaches as well. I asked the vet if diet could cause high protein in the urine (Pixie was not fasting) and she said that it can sometimes, but that she did not think that was the case in Pixie’s situation. I feed them Pinnacle holistic trout and sweet potato formula, salmon oil pills and a vitamin E pill each day. Any advice you can give will be greatly appreciated. Thank you in advance for your time.

– Annette

Hi Annette,

It sounds like you have a complicated case on your hands. These kinds of cases are always so frustrating for everyone because the answer to her problem is not clear based on the routine testing. Cushing’s in particular is especially frustrating as it can take multiple tests and a significant expense to diagnose the illness. Some dogs can have “atypical Cushing’s,” where the usual tests all come back normal and a special adrenal sex hormone panel must be submitted to the University of Tennessee.

An extremely high alkaline phosphatase such as Pixie’s is most commonly caused by Cushing’s disease; however, liver disease and certain medications that induce hepatic enzymes can also cause elevations in the value. The GGT enzyme is often associated with a problem in the biliary system (the gall bladder). Because the alkaline phosphatase is persistently elevated and the GGT is also elevated, further evaluation of the liver should be performed to make sure there is no other underlying issue. This could include repeating the ultrasound, performing a fine needle aspiration or even a biopsy of the liver.

Protein in the urine is not normal and can be from a lower urinary tract infection (the urine can be cultured to rule out a lower urinary tract infection before assuming it is due to failure of the kidneys) or from a problem in the kidneys allowing leakage of protein. The urine protein creatinine ratio test is likely the one performed in Pixie’s case and is a quantitative measure of how much protein is present. Usually, these tests are done in a series (every two weeks) to see if the proteinuria is persistently elevated, as well as to see if the numbers are increasing, decreasing or remaining the same. Persistent proteinuria without a lower urinary tract problem indicates a problem in the kidneys.

Often, drugs such as Benazapril or Enalapril are prescribed to help lower the protein levels in the urine. Although these are traditionally used to control high blood pressure, they also work to minimize protein in the urine. They are, unfortunately, not very good for the kidneys, however, and can have effects on the kidneys themselves, which sometimes makes their use controversial. In cases of both liver disease and kidney disease, it is important to minimize the amount of protein in their diet as excessive protein levels are taxing on both the liver and kidneys. Sometimes a special prescription diet (such as Hills Prescription Diet k/d or Purina Veterinary Diet NF) is recommended, which both have much lower levels of dietary protein than what is available in over-the-counter diets. Antioxidants are beneficial for the liver and it looks like you are already giving a good supply of them in your supplements. You might also consider taking a look at reishi and green tea supplements.

Because of the complicated nature of her case, Pixie would benefit from consultation with an internal medicine specialist. These veterinarians are specifically trained in the management of complicated cases such as hers that involve multiple problems. You can usually find an internist in your area by visiting the American College of Veterinary Internal Medicine website and clicking on “Search for a Specialist.”

I wish you and Pixie the best of luck and hope that you find the answers to get her back on the road to health.

PHOTO: iwannapet.com