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IMHA and Kidney Disease

Tracy

Guest

Hi all,

Bernie, our 14 and a half yr old male Cocker Spaniel has recently been diagnosed with IMHA. About a month ago he collapsed so he was rushed to hospital and spent 4 days there receiving a blood transfusion, tests, ultrasounds/xrays and fluids.

He was discharged from hospital with a PCV of 30 and prescribed 25mg Prednisone (along with Famotidine). A week later his PCV dropped to 23, then 17 the following week after that.

His PCV is now at 20 which hasn’t moved for 2 weeks. Because of this, he’s been prescribed 120mg Cyclosporin along with 37mg Clopidogrel.

We’re really worried that this dose for Cyclosporine is too high as his left arm started shaking rapidly after only one dose, and he has been sick with diarhea which has really scared us and also considering Bernie weighs around 30lbs, along with the fact that all these drugs work on the kidneys. He is at stage 2 for kidney disease.

We’re having his PCV checked weekly and his kidney blood tests every 2 weeks.

We’re praying the Cyclosporin works to get Bernie’s PCV up but worried what kind of affect this is going to have on his kidneys.

He’s on a combination of a strict renal diet along with our own home made renal food which we measure in terms of phosphorus, protein etc. and add appropriate ipaketine.

We’re now none the wiser as to what vitamins we should be putting him on in case these ‘strengthen’ his immune system thus making the IMHA harder to treat? or which supplements can affect his medication.

We really would appreciate any help anyone could give us with this.


Details

Vally

Keymaster

Hi Tracy, and welcome to the site. I’m sorry to hear about Bernie. A steady PCV of 20 is good in that it’s not dropping.

It’s not unusual to drop after a blood transfusion because the transfusion is just really there to give them time for the drugs to start working. It doesn’t do anything to correct the problem. The drugs will do that.

The prednisone dose I believe is a little low, and yes I do think the cyclosporine dose is high. The recommendation is 5mg per kg. This is the link to the resources and you’ll see cyclosporine is the second item on the page. If you click on that, it will open up the product insert. 30lb should be 50mg.
https://www.secondchanceaihadogs.com/AIHA_Terms/cyclosporine
and
https://www.secondchanceaihadogs.com/medication-resources

I would ring your vet and mention the bad diarrhea and check the dosage – I’m wondering if they are doing a double dose to start with – but ring them. Some dogs do have a gastro effect when starting to use cyclosporine and it does settle. It should be given with no food and away from other meds.

Prednisone should always be given with food instead.

Don’t worry too much about extra supplements for now. You can go to the Dog Aware site which has some fabulous information about feeding. Start here:
https://www.secondchanceaihadogs.com/nutrition-resources

Please don’t hesitate to call out. Happy to help.

Vally

https://www.secondchanceaihadogs.com/medication-resources


Details

Tracy

Guest

Hi Vally, thanks so much for your reply. It is such a relief to be able to talk to you as you have been through this yourself, and as you probably know that when you are in the thick of things, it gets so scary that you get to a point where the treatment seems worse than the anemia, especially as Bernie is suffering with renal aswell.

We discussed the dose of 120mg Cyclosporine with our vet which he said was the correct dosage, but lately Bernie has been vomiting all his food back up exactly an hour after taking Cyclosporine with some on-off diarrhea. He’s also looking very ‘lost’ every time he takes Cyclosporine.

Apart from splitting the dose to 60mg in the morning and 60mg at night, the vet has mentioned possibly switching to Chlorambucil which he mentioned doesn’t have much research on its effectiveness?

Have you any opinion on this drug or experience of any dogs that have been treated with this, at all?

Again, thank you so much for your kind response, and look forward to hearing from you, Tracy


Details

Patrice

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


Details

Vally

Keymaster

Tracy, Patrice knows so much about this disease, as well as having lived through it as well.

Go with her suggestion of splitting the dose for now, and give with a little food.

Take care.


Details

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Reply To: IMHA and Kidney Disease
Your information:







Tracy
Guest

Hi all,

Bernie, our 14 and a half yr old male Cocker Spaniel has recently been diagnosed with IMHA. About a month ago he collapsed so he was rushed to hospital and spent 4 days there receiving a blood transfusion, tests, ultrasounds/xrays and fluids.

He was discharged from hospital with a PCV of 30 and prescribed 25mg Prednisone (along with Famotidine). A week later his PCV dropped to 23, then 17 the following week after that.

His PCV is now at 20 which hasn’t moved for 2 weeks. Because of this, he’s been prescribed 120mg Cyclosporin along with 37mg Clopidogrel.

We’re really worried that this dose for Cyclosporine is too high as his left arm started shaking rapidly after only one dose, and he has been sick with diarhea which has really scared us and also considering Bernie weighs around 30lbs, along with the fact that all these drugs work on the kidneys. He is at stage 2 for kidney disease.

We’re having his PCV checked weekly and his kidney blood tests every 2 weeks.

We’re praying the Cyclosporin works to get Bernie’s PCV up but worried what kind of affect this is going to have on his kidneys.

He’s on a combination of a strict renal diet along with our own home made renal food which we measure in terms of phosphorus, protein etc. and add appropriate ipaketine.

We’re now none the wiser as to what vitamins we should be putting him on in case these ‘strengthen’ his immune system thus making the IMHA harder to treat? or which supplements can affect his medication.

We really would appreciate any help anyone could give us with this.

Details
Vally
Keymaster

Hi Tracy, and welcome to the site. I’m sorry to hear about Bernie. A steady PCV of 20 is good in that it’s not dropping.

It’s not unusual to drop after a blood transfusion because the transfusion is just really there to give them time for the drugs to start working. It doesn’t do anything to correct the problem. The drugs will do that.

The prednisone dose I believe is a little low, and yes I do think the cyclosporine dose is high. The recommendation is 5mg per kg. This is the link to the resources and you’ll see cyclosporine is the second item on the page. If you click on that, it will open up the product insert. 30lb should be 50mg.
https://www.secondchanceaihadogs.com/AIHA_Terms/cyclosporine
and
https://www.secondchanceaihadogs.com/medication-resources

I would ring your vet and mention the bad diarrhea and check the dosage – I’m wondering if they are doing a double dose to start with – but ring them. Some dogs do have a gastro effect when starting to use cyclosporine and it does settle. It should be given with no food and away from other meds.

Prednisone should always be given with food instead.

Don’t worry too much about extra supplements for now. You can go to the Dog Aware site which has some fabulous information about feeding. Start here:
https://www.secondchanceaihadogs.com/nutrition-resources

Please don’t hesitate to call out. Happy to help.

Vally

https://www.secondchanceaihadogs.com/medication-resources

Details
Tracy
Guest

Hi Vally, thanks so much for your reply. It is such a relief to be able to talk to you as you have been through this yourself, and as you probably know that when you are in the thick of things, it gets so scary that you get to a point where the treatment seems worse than the anemia, especially as Bernie is suffering with renal aswell.

We discussed the dose of 120mg Cyclosporine with our vet which he said was the correct dosage, but lately Bernie has been vomiting all his food back up exactly an hour after taking Cyclosporine with some on-off diarrhea. He’s also looking very ‘lost’ every time he takes Cyclosporine.

Apart from splitting the dose to 60mg in the morning and 60mg at night, the vet has mentioned possibly switching to Chlorambucil which he mentioned doesn’t have much research on its effectiveness?

Have you any opinion on this drug or experience of any dogs that have been treated with this, at all?

Again, thank you so much for your kind response, and look forward to hearing from you, Tracy

Details
Patrice
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

Details
Vally
Keymaster

Tracy, Patrice knows so much about this disease, as well as having lived through it as well.

Go with her suggestion of splitting the dose for now, and give with a little food.

Take care.

Details
Viewing 5 posts - 1 through 5 (of 5 total)
Reply To: IMHA and Kidney Disease
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