IMHA and Kidney Disease

Keymaster

Hi Tracy,
I’m sorry to read about this difficulty with the treatment. It reminds me to explain that this condition, IMHA, is variable for a number of reasons, one of which is that it tends to be more predominant in certain breeds. There are always other triggers that combine to set off IMHA and in Cocker Spaniels one of these triggers is this genetic breed tendency.

Stabilizing at a PCV or HCT of 20% is quite common in the many dogs we have seen here. There can be a few reasons for this but the most common is called Anemia of Chronic Disease. And indeed, kidney disease is one such chronic condition that will most definitely lead to anemia.

Why? The kidneys have this complex relationship with the bone marrow, where all blood cells types are made. The kidneys are part of a very complex feedback loop that monitors the body and the need for oxygen going to the body cells.

So anemia, by definition, is not enough oxygen getting to the body cells. They “complain” and send a message to the kidneys “hey we need more 02 right now!” The kidneys then produce a hormone erythropoietin (EPO) that is responsible for stimulating the bone marrow. This causes the marrow to begin the blood making process called erythropoiesis. When the kidneys are not working well, this doesn’t happen, the message is not sent and the bone marrow “naps.”

So your vet should have explained this to you, considering there is a complication with kidney disease.

So at his age, with this condition, we can’t expect him to recover 100%. But we also can respect the quality of life that he is capable of having with good care. Monitoring the kidneys like your vet is doing, is a good way to evaluate his quality of life.

Older humans can begin to have kidney function loss and they can receive treatments for anemia if they chose not to get frequent transfusions. So, there are some treatments that humans get for the anemia due to poor kidney function. More recently two drugs with Erythropoiesis-Stimulating Agents (ESAs) have been approved by the FDA for use in humans. But an older ESA is a manufactured erythropoietin that is injected that has also been effective. This is called Epogen. Neither of these drugs are approved by the FDA for use in dogs, but never-the-less if a vet can obtain Epogen then it can provide a suitable treatment.

I was once in the position where the vet thought this might help Chance, since we could not figure out why he was not making blood. My vet had a connection with a local prison where she was able to obtain Epogen that was kept in supply at the prison for patients. Once it expired, they would donate that supply to her. So this is one avenue to explore.

As for the cyclosporine, he’s clearly having some trouble with it and this is not abnormal, the only significant side effect found in trials was this gastrointestinal problem but it tended to be short lived. I am cautious to advise that this drug may not be what is needed right now, but nevertheless, the prednisone needs to be decreased slowly now as the side effects are showing up such as poor body condition, shifting body fats, tremors, dehydration, weakness. The continued vomiting is causing dehydration and reducing the electrolytic blood balance. We need to change this to keep him stable!

In this case, since he is tossing the dose, it would be best to halve the dose at morning and night. Give the dose with a small portion of the morning meal and with a good snack at bedtime. This is going to significantly lower the effective dose, but if he keeps it down, as studies in dogs have shown, then after about a week or so he should be able to tolerate a slow increase and weaning the food supplementation. Dogs tolerate cyclosporine (Atopica) well and the side effects are much less than prednisone. That is why it has been so successful as a maintenance dose for dogs with severe allergies. If there are side effects, unlike prednisone, when the drug is stopped those side effects go away immediately.

So quality of life includes keeping him hydrated and eating a nutritious diet that works well with his kidney disease. I am going to send you to a friend’s website, Mary Straus has been keeping this complete site on nutritious alive and updated for many years. If you want to understand anything about diet, diseases and dogs, she has that for you. In particular please read her information on dogs and kidney disease. Once you have read that, click on her Diet for Dogs With Kidney Disease and follow one of several sample diets. I assure you that these kinds of diets work wonders for kidney dogs and contribute greatly to quality of life. You have the capacity to do this very well.
http://www.dogaware.com/health/kidney.html

If you have any more questions or just want to feel more love, please keep writing!
my best, Patrice

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