Preventing Infectious Kidney Failure

In the past few months I've seen two heartbreaking cases of dogs that were diagnosed with acute renal failure that probably could have been prevented.  But before we talk about failing kidneys, let's talk about what healthy kidneys do for our pets. (and us for that matter).

The major functions of the kidneys is to filter waste products of the blood into the urine, maintain a state of homeostasis (constant state in the body), and stimulate red blood cell production.  There are other hormonal functions but let's stick to the biggies here.  When we do a blood test and tell you that your pet's kidney function is good, we are actually measuring the levels of Urea Nitrogen and Creatinine (two toxic by products of protein metabolism).  these levels will be maintained within a narrow normal range until about 75% of the filtering units  (glomeruli) in the kidneys are damage.  Kidney function can also be evaluated by measuring the concentration of the urine as well as looking for things in the urine that shouldn't be there, such as protein and cells. When the filtering units are damaged, the waste products build up and the condition is called azotemia, or uremia.  hen the tubules ( different part of the kidneys) are damaged, we will see dilute urine or cast like structures in the urine.  Leaking membranes in the glomeruli may allow the filtering of wast products but facilitate the leakage of protein into the urine.  When caught early, the progressive nature of renal disease can often be mitigated.  However, once the glomeruli are damaged, they are gone, and no new ones will replace them.

We had a dog present to the clinic a few months ago.  It lived in Nassau county, never went out east, mostly lived in the yard in a suburban environment that was not particularly wooded.  This labrador was not feeling well and when blood work was performed, it was in azotemic (elevated BUN/Creatinine) renal failure with severe levels of protein in the urine.  It was also positive for exposure to Lyme disease.  The owners had not vaccinated it against Lyme disease because they did not think it was at risk for exposure.  Indeed it was at low risk based on life style assessment, but no dog on Long Island is at no risk.  They also were not using any flea or tick control.  Lyme nephritis is a kidney disease caused by the body's reaction to Borrelia burgdorferi, the bacteria that causes Lyme disease.  (Note Lyme not Lyme's).  Unfortunately for this dog, once the kidneys are involved, the prognosis is guarded.  In fact, this dog did not make it and was put to sleep after a week in the hospital receiving intensive care.  While we do not see a lot of dogs in our practice that are ill with Lyme disease, we do see many that are exposed to the bacteria and therefore at risk.  This is why we recommend testing every dog every year for heartworm and tick borne diseases.  we also recommend tick control for all dogs.

The second dog presented two weeks ago with a rapidly worsening, acute renal injury.  This young German Shepherd Dog was losing weight, not eating, and had decreased energy, His blood work showed a worsening azotemia, increased levels of protein in a dilute urine, and he tested positive for leptospirosis, a bacterial disease.  Leptospirosis is spread by the urine of infected animals, in our area, dogs, raccoons, mice and rats.  While usually more common in the summer, it is obviously around all year here on Long Island.  It's prevention is complicated by the fact that there are many serovars (types of Lepto bacteria), and the vaccination only covers the 4 most common and virulent.  Many clients are reluctant to vaccinate because they have read that the vaccine causes reactions, or is dangerous.  The truth is that while vaccine reactions do occur, most often, they are similar to the type of reaction we get when we get a flu vaccine or a tetanus shot. And while we hate our dogs to have any reaction, it is better than renal failure.  Lepto is also contagious to people so having a dog that is unknowingly shedding this bacteria in the urine puts all of us at risk.  This puppy (he is only 2 1/2 years old) is still undergoing treatment with antibiotics and Intravenous fluids.  It looks like he may make it but will most likely have permanent damage to it's kidneys.

We have to remember that there are many diseases that can affect our pets (and sometimes us).  prevention is always better than treatment.  While vaccination is not always a completely benign procedure, modern vaccine science has come a long way in our fight to protect our pets from infectious diseases.

Puppy and Kitten Vaccine Schedules

So, if you have been following, you'll see that I am back on schedule, even though this required two posts in one week.  There was a lot of information in the last post, but not all of it useful for the average pet owner.  I know, I can be a science wonk sometimes.  Here is a summary of our vaccine recommendations for puppies and kittens.  The first thing that you'll notice is that some shots are repeated.  We will discuss which vaccines your particular pet needs for their life style and risk factors.  We'll also tell you that your new pet (especially your puppy) can't go outdoors where other dogs go until they are finished with their pediatric vaccines. 

 

Why can't my puppy go outside until it's had all of it's shots?  

I get this question all of the time.  It is really a simple answer, although hard for most owners to swallow.  Most puppies and kittens are born with some immunity from their parents.  this is transferred across the placenta and via milk when nursing.  The maternal immunity will decrease over time, disappearing in most pets around the age of 16 weeks.  While this immunity will protect your pet while it is very young, they will become vulnerable to infection as the levels drop.  In addition, this maternal immunity will interfere with the vaccines that we are giving.  So, since we do not know when a particular individual's maternal immunity is low enough to allow the vaccines to work most effectively and we do not know when the vaccine induced immunity is high enough to be completely effective, we make a vaccine schedule that is designed to offer protection in what has proven over time to be a statistically effective way.  That is, we vaccinate periodically until 16 weeks of age so that maternal immunity is gone and vaccine immunity is present.  If your pet goes outside before this time and is exposed to one of the infectious agents that we are vaccinating for before it is completely immune, it is at risk of catching a very serious disease.

 

Now this isn't magic and the diseases are spread by infectious agents, viruses, bacteria, and mycoplasmas.  If you can take your dog outside where no other dogs go, then these agents willnot be present and your dog will not be at risk.  This is why we say that you can take your dog outside in the yard for training if you have a spot where no other dogs go.  No dogs, no viruses, no risk.  This means your yard, no puppy classes, no trips to the pet shop, no walks to the bus stop.  I'm not being mean, I'm just trying to recommend the best practices for your pet.  I went through the frustrations when Bella was a puppy and I do understand, but she didn't get a walk to the local fire hydrant until her vaccines were complete.

 

 

Puppy Vaccine Schedule

We recommend vaccinating all Puppies for DHPPV (see previous post for vaccine descriptions) every 3 - 4 weeks from 6 weeks of age until they are 16 weeks of age.  In our area, most puppies also get two leptospirosis vaccines incorporated with two of these injections.  Bordetella is given once, intranasally, usually around 12 weeks of age and Rabies vaccine is given at 16 weeks (18 weeks in small puppies to minimize reactions by giving too many antigens at once)

 

Dogs that will be at risk of Lyme disease are vaccinated twice as an initial series, usually in the two weeks between the DHPPV vaccines.  K9 Flu can also be given at that time (twice, between DHPPV vaccines for dogs that will be boarding.  The adult vaccination program is reviewed with the owners at this point and most vaccines will be boosted one year later.

Kitten Vaccine Schedule

Kittens can often complete their core vaccines by 12 - 14 weeks of age.  They need an FVRPC every 3 - 4 weeks form 6 weeks until they are 14 weeks old.  New recommendations are for all kittens to receive Feline Leukemia Vaccines, even if that is not continued as an adult.  This vaccine can be given with the FVRPC.  Rabies can be given after 3 months of age.  Initial boosters are one year later and the adult vaccine protocol will be discussed at this time.

 

While we try to explain the vaccine programs in advance to owners, they are usually overwhelmed with having a new pet.  Usually we just tell them when to come in next and when they do, we explain what we will be giving.  However, we have found those little health records helpful in cases where owners want the entire schedule laid out for them in advance, so we can accommodate you either way.  

 

 

I can't answer specific health questions, but you can ask questions of a general nature on twitter.  My account there is @KNVet.  Follow me and drop me a line.