Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Kent, Odd chemistsry, Imuran?

Hi All, I've got some questions some of you might be able to help with from experience... Warning, its a long post but thanks in advance for looking. Kent had a relapse in the second week of November, low rbc and platelets,evans syndrome basically. He is in recovery. He was put on 30mg pred and was doing okay but not great. His platelets went up but his rbc and hematocrits were up and down. Crit had been 38%in house but showed as 31% from lab beginning of December. After hospital crit 28% platelets up. December 1 - crit 38% inhouse 36% lab, platelets fine. December 18 - crit 38% inhouse, 31% lab, platelets jumped out of normal to 600(high). That his crit and associated rbc had lowered like this concerned us and our vet, and Kent was started on Imuran on the 21st, 25mg daily to raise his crit and rbc. On December 28 his crit was 35% lab,rbc 4.5, and platelets 422. But in addition to that, some strange things happened with his chemistry that has us worried about his kidneys and pancreas (and the every present worry about the liver). The Superchem tests are from right when he relapsed vs the 28th of December - a six week period. we dont have the tests from right after he came out of hospital - trying to get them, but the essence is this: Urea Nitrogen was 14 became 59H creatine .7 1.5 alka phospate 48 724 (very high) alt (sgpt) 15 295 (very high) ast 21 42 Calcium - stable 9 - 10 Phosphorus 3.8 6.9 (high) sodium stable normal Potassium 4.4 5.8 bun/creatinine 20 39 (high) Lipase 281 1044 (whoa nelly v.high) amylase 1687 863 (down) cpk 52 138 GGTP <5 240 (WHOA very high!) It looks to me like he is going to have kidney problems soon if not already though i am no doctor or vet and have a hard time deciphering all the numbers and especially what they mean and indicate. Any info here would be great. Maybe these are all haywire due to the drugs and will resolve themselves, or maybe he is starting to get damaged by one or both drugs which we want to avoid if possible. It has been suggested that he be put on cyclosporine in addition to pred and imuran, lowering the pred. I am not convinced he HAD to be on imuran to start with. I wonder if he could just be on pred and that dosage lowered. I wonder how long and how to wean him off imuran which he has been on under 2 weeks. I wonder if its not the imuran that is giving us the above results. And i wonder if imuran cant be replaced by the cyclosporine if he needs something in addition to pred. Our Vet is worried about his urine test which showed elevated proteins in his urine. Our specialist suggests bladder infection which can be cleared up easily, and that kent may have a mild GI bleedout due to urea nitrogen level. After his latest relapse, kent started taking pet-tinic and pet-tabs and went on a liver cleansing diet (first he loved it now he prefers his dry food) and also started milk thistle. He takes tagamet and sucralfate to protect his stomach from the pred and imuran. Any input is very much appreciated, thank you Christine and Kent

Christine

Hi All, Since i wrote this post last week and posted it, Kent was switched to cyclosporine 3 days ago and taken off the Imuran. He has not had a blood test, but seems to be responding very poorly to the cyclosporine. Today he is lying in the bathroom, looks confused and hurt, and will not eat anything at all. He has had diarhea the last 2 days but very little coming out as he wont eat. He ate a little turkey out of our hands this morning, thats it, a bite or two. Last night he had started to tremble all over. This is terrible. Can anyone tell us what their dogs went through and for how long when they started cyclosporine? Thanks, Christine

Christine Florida

Hi Christine, I just wanted to add some input in regards to the chem panel. How old is Kent? There are a few numbers on there that are of concern, especially since there was also protein in the urine. Did the vet say how much? The BUN can be elevated for reasons other than the kidneys such as food, dehydration, etc. The creatinine level however is more kidney specific, as well as the phosphorus level. While the creatinine level is still in the high normal range its better to run some more test before that number rises. The BUN rises much faster than the creatinine. You might want to have them do a urine protein/creatinine ratio test along with a urinalysis. It could be an infection but its better to run those test now so no irreversible kidney disease develops. You might want to ask the vet a good food that is low in phosphorus to see if that helps some. Some vets will say low protein diets are good too because it lessens the load on the kidneys, therefore helping the urine protein loss. I hope this helps some. Please keep us posted. You can also go to the following link and click on all the idividual test and it will explain what they are and what high and low numbers mean: http://www.diaglab.vet.cornell.edu/clinpath/modules/

Teresa va

sorry...forgot to add something. The trembling may be a sign that Kent is in pain. Is that happening right after he eats?

Teresa va

Hi Teresa, Thank you for your comments, i really appreciate it. Kent is now 10 1/2 years old, is a mini-schnauzer and weighs 35lbs now, used to be 30lbs before prednisone. The trembling is happening after he gets the cyclosporine and goes to lay down. He doesnt want to eat at all, nothing, none of his favorites. Though as of this evening, after 6pm, he suddenly 'woke up' and is acting more normal, and barking for baked sweet potato chips. He is drinking plenty and peeing plenty. I will ask my vet to run a snep test for the kidneys. Thank you.

christine Florida

Hi all, I just found at that early this morning when kent went to poo, he just went on the cement patio out back - which he never does- and it was just clear honey-like liquid, 1/3 cup about, and that was all. He's been pretty disoriented too - banging his head into the door frame when he goes to walk through a door, hitting his head on the wall, stuff like that. I just took him for a walk around 6ish though and he pood a bit of liquid, that was it.(i added flagyl this afternoon). He walked a good ways but at a very slow steady plod. He seems tonite to be perking up a bit but his stomach is very noisy, sounds like a waterfall in there.

christine

Christine: Daisy and I are 5 months into this as well. She is a 80 lb female yellow lab. She had a great deal of stomach problems with the cyclosporin also. We switched her to Immuran along with the Prednisone and her "bowel and stomach" problems cleared up. Her PCV isn't where it should be yet. If you sent me your e-mail address I will send you a spreadsheet of a progression of CBC's and CHEM 25 panels which you might compare. My dogs liver functions are still way off, and we also tried the Liver Cleansing Diet for a while but she developed diarrhea (maybe not from the diet) so I went back to California Natural kibble (no grains or soy etc.) It is frustrating....my dog is almost 9. Good Luck

Ron B San Mateo

Hi Christine, My TC is 10 and he is only on the predisone but he has always had a problem with loose stools. The pred makes it worse, I tried pumpkin and the pills from the vet but what really worked for TC is Olewo it is a German product, my Holistic pet store recommended it. Olewo is pure dehydrated carrots, you reconstitute and mix with their food, it really works! Very cheap too.

Wendy Tampa FL

Hi All, As of last night kent was switced back to Imuran and today is doing way better. He is barking for rice cakes, had his first good poo this morning; and is breathing good - not panting or rapid shallow breathing. His personality is also back and he is no longer like a dog thats been given dirty water and hallucinogenic drugs. Next blood test is on Friday. Rob, i'll definitely contact you later today - thanks! Christine

Christine Florida

This thread was discussed between 07/01/2008 and 09/01/2008

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