High kidney levels - what am I looking at here?

[fivestrideline]

One of my horses seems to have something going on with his kidneys. The vet school ran his blood as a standard pre-op procedure (bone chip removal), and it was noted that his creatinine and BUN levels were mildly elevated.

Creatinine was 1.8 mg/dL (high end of normal is apparently 1.7?). They ran fluids overnight which resulted in 1.7mg/dL creatinine. Following surgery (and more fluids!), he tested at 2.1 mg/dL creatinine at which point NSAIDs were discontinued and he was discharged.

I had the vet out two days after surgery to run bloodwork again, and his creatinine is now 2.4mg/dL. Horse is on a hunger strike but is drinking well.

Anyway, historically this horse pees a TON. Probably the most out of everyone. He drinks well, is generally in okay weight (BSC of 4 preceding surgery, he eats a TON) and good coat, happy and relaxed.

I don’t even know where to start in managing this/monitoring it. I do know that NSAIDs are generally off the table now.

I’m wondering if this is a chronic elevation issue? They want to run fluids again but I think he might kill me if I load him up again! I’m attaching the most recent panel if anyone wants to take a look.

[adultponyhunter]

Ugh, best of luck. Increased creatinine can make them feel pretty bad and is likely the cause of the hunger strike.

My horse just went through acute kidney failure and it was a horrible experience. It was triggered by a specific drug (oxytetracycline), but they do think he had a low lying undetectable level of chronic kidney disease beforehand that made him more susceptible. He spent 6 days at the vet school on fluids and bloodwork run every 6 hours, and it ended up being a much quicker recovery than they anticipated. They made it sound like it can be a very hard, long road. NSAIDS and certain antibiotics are off the table for the rest of his life, keep protein low in the diet. Can you identify a trigger? Was he on NSAIDs before surgery? I am not a vet - but to my knowledge the increased BUN and higher Ca indicate it may be chronic and not acute.

[fivestrideline]

Thank you for your story!

I don’t have “six days in the hospital” funds right now, as much as it pains me to admit. At least, it would not be wise lol! This surgery came out double what I was quoted/expected - I had a cushion but not quite THAT much of a cushion especially considering the only “extras” I did were fluids. So of course, he does this .

I’m talking with my vet, but this is an issue that’s way out of my purview. When they ran fluids before surgery, 18 hours of IV fluids brought him down .1mg/dL. I’m guessing something at the hospital set him off - nothing unusual was used, but they had him on hella bute. Which sucks - he’s had quite a bit of bute over the last year because he has a penchant for injuring himself. We never would have known if I hadn’t taken him to the school.

The elevated levels are making my vet and I think this may be chronic and exacerbated by the NSAIDs. But I’ve been doing a lot of googling and getting… minimal information.

[NaturallyHappy]

I’m not much help…but going forward, maybe ask your vet about Tylenol.

[fivestrideline]

Yes, he’s on Tylenol now actually! The school put that in his file. I’m interested to see if it helps at all.

Hopefully it’ll make him feel good enough to start eating more. He was slurping up alfalfa soup when I was there earlier, so that’s good.

[StormyDay]

Can you have your local vet bring fluids and show you how to set it up? Then maybe they can come out and retest in a few days. It would certainly be cheaper and less stressful for the horse.

[Simkie]

Eons ago we had a poster here with a horse that had an unusual kidney disease. It was diagnosed via ultrasound, iirc. Polycystic kidney disease, maybe?

If his values don’t normalize off nsaids perhaps it would be worth considering?

[fivestrideline]

I think the plan right now is to monitor over the weekend and I’ll see about running fluids on-farm next week if needed. I’m hoping that pulling him off the NSAIDs will normalize his levels.

My vet did say an ultrasound wouldn’t be out of line, but that’ll probably need to wait for a bit. I’ll definitely have it done for knowledge purposes at some point in the near future. I’ll also be adding regular bloodwork to his vaccine appointments.

Apparently his CBC panel was normal (and his insulin, if that’s different).

[LovieBird]

It’s been my understanding that acute kidney disease animals tend to look sicker than the chronic kidney cases. Not sure if that helps any.

[adultponyhunter]

How is the horse doing?

[fivestrideline]

He’s doing well - back to eating and drinking normally! He got back on course once we started omeprazole and Tylenol.

We are going to run bloodwork once more and see what his normal baseline is outside of the surgery complications. 24 hours of fluids only brought him down .1mg/dL (I don’t recall the before and after numbers right now), so I chose to see how he is “normally” and go from there.

[ladipus]

@fivestrideline I own a mare that now has chronic kidney disease …she’s 13 and I’ve owned her since she was 4…never had any problems or indication of kidney issues until October of 2023 when she had a vaccine reaction which resulted with getting a fever and mildly colicing …we gave typical standard banamine dose but this persisted over the course of a several days -she only ever got banamine once /day …but by day 5 of still not being quite right …very dull, lethargic and minimal appetite we took blood and her creatine was at 5😳…rushed her to a university hospital where she was hospitalized and on IV fluids for a few days …her creatine values came down in the mid 2 range by the time she was discharged (about 10 days after admission)
Once she came home I started her on Hilton Herbs Milk Thistle Plus Gold -this is for Kidney & Liver support , and APF Pro(a liquid adaptogen wellness supplement), and I adjusted her diet -basically removed anything with alfalfa or added calcium-including supplements, and minimize protein as well-which meant I had to stop giving her a typical ration balancer because it contained high protein , added calcium and had an alfalfa base…she gets fed a low sugar & starch diet Low sugar Grass hay with a10 or 11% protein …small amount of Hygain Zero & some Keyflow Sensicare … soaked Pink Mash, and Vermont Blend Pro(forage mineral balancer ) , flax, vitamin E . Her bloodwork has since come back down to normal levels ! I have to be careful and most importantly make sure she’s always hydrated and eating -I make sure to always keep a mental note of her water intake and manure output as well as her demeanor……I now recheck bloodwork every 6 months or so…