# Need advice.. feed PMR but need low-protein?!



## Puff_The_Magic (Sep 1, 2011)

Hi all. I have a 5lb dog who is on Enalapril and Furosemide for heart problems. Labwork has shown that his kidney values are a little high; and my vet suggested Prescription K/D. Mind you she is NOT against raw-diet at all; she just explained that in his case, he would be better off on a low protein diet as we are basically just playing a game of keeping both his heart AND kidneys from failing. I left with a bag of K/D. He is eating it, but not nearly with the enthusiasm he had toward raw! 
I want to do what's best for my dog; and if he can't have PMR I wondered if there were any HOME made, fresh ingredient diets I can still make for him; that have the BENEFITS of the Rx K/D diet but with higher quality ingredients. I'm really not sure if there's a way to have a "low protein" version of raw.... though healthy dogs have no problems processing it; in his case I certainly don't want to make his kidneys work any harder. 
Would love any advice on diet suggestions; especially from anyone who has dogs with congenital heart issues. The little guy has been through SO much already and is just 6months old.


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## Liz (Sep 27, 2010)

How low a protein is he talking about? What percent?


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## tem_sat (Jun 20, 2010)

You may wish to read this: Kidney Diet | B-Naturals.Com Newsletter

I would definitely join the K9KidneyDiet list on Yahoo and do more research on my own.


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## cprcheetah (Jul 14, 2010)

Actually low protein can be harmful to kidney failure patients as it causes muscle wasting. What you DO want to be concerned about is Phosphorus levels. I. Her is an awesome handout I found: http://www.windyhollowvet.com/Document/info/ChronicRenalFailureDiet.pdf
Here is more information about Kidney Failure and protein restriction:
http://www.dogfoodscoop.com/support-files/bovee_protein_renal.pdf "Those recommendations are based on a myth. In fact, the whole theory of low-protein diets for dogs with kidney disease was blown apart in 1975 by David Kronfeld, PhD, who was at the time a veterinary researcher at the University of Pennsylvania. His concept was not to feed less protein but rather to feed higher-quality protein." "Evidence that high protein diets enhance renal function in normal dogs has led to confusion among veterinarians who have been told for decades that low protein diets may be beneficial for kidney function."

DogAware.com Kidney Disease: Is a Low-Protein Diet Desirable or Necessary?


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## Puff_The_Magic (Sep 1, 2011)

Well, the k/d has a protein of just 12-16%. But after reading the articles I wonder what the point is. If the issue is the QUALITY of protein wouldn't the PMR be fine? That seems to be the gist I'm getting. Isn't "low quality" protein just kibble...? So you'd think that any raw would be better. I will join the group above, need to do some more reading tomorrow. I hate not trusting my vet; but there are a lot of areas in particular I feel more comfortable doing my own digging on rather than blindly trusting....


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## Tobi (Mar 18, 2011)

Puff_The_Magic said:


> Well, the k/d has a protein of just 12-16%. But after reading the articles I wonder what the point is. If the issue is the QUALITY of protein wouldn't the PMR be fine? That seems to be the gist I'm getting. Isn't "low quality" protein just kibble...? So you'd think that any raw would be better. I will join the group above, need to do some more reading tomorrow. I hate not trusting my vet; but there are a lot of areas in particular I feel more comfortable doing my own digging on rather than blindly trusting....


Hills, and SD generally use "lower quality" proteins. The kidney thing has always been counter intuitive because they want low protein diets but they add a ton of fillers into the mix, which IMO aren't good for a healthy dog in the first place. You're absolutely entitled to not be a lemming, and i understand completely with you not trusting your vet, I've been through that with my dog, and since not feeding kibble he's not been to the vet! Dig away, spend a few days reading, and searching old posts, forums, and come to your own conclusions, it's by far one of the best things you can do for your loved pet. :smile:


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## DaneMama (Jun 27, 2008)

Puff_The_Magic said:


> Well, the k/d has a protein of just 12-16%. But after reading the articles I wonder what the point is. If the issue is the QUALITY of protein wouldn't the PMR be fine? That seems to be the gist I'm getting. Isn't "low quality" protein just kibble...? So you'd think that any raw would be better. I will join the group above, need to do some more reading tomorrow. I hate not trusting my vet; but there are a lot of areas in particular I feel more comfortable doing my own digging on rather than blindly trusting....


I really hope you find a better alternative to k/d. It's crap in a bag and won't do your dog any justice. 

Can you find out which kidney values were high? Or better yet, post a picture of the blood work he had done? This would be most helpful in helping you!


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## Khan (Jan 17, 2010)

Puff_The_Magic said:


> Well, the k/d has a protein of just 12-16%. But after reading the articles I wonder what the point is. If the issue is the QUALITY of protein wouldn't the PMR be fine? That seems to be the gist I'm getting. Isn't "low quality" protein just kibble...? So you'd think that any raw would be better. I will join the group above, need to do some more reading tomorrow. I hate not trusting my vet; but there are a lot of areas in particular I feel more comfortable doing my own digging on rather than blindly trusting....


When Shelby had a reaction to some NSAID her kidney levels were soo high she had to have IV Therapy for 3 days. During that time, we thought she was going to to have to have a permanent diet change. I started looking into and researching and found it's exactly what you found. It's not the amount vs the type. 
My vet is awesome, and when I came to him with the research,and he actually agreed! He sent me home with a few pages of Home cooked recipes for kidney disease.
If your vet is open to raw, I'm sure this conversation will be accepted in the same way.


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## Puff_The_Magic (Sep 1, 2011)

Honestly the only level that was elevated was his BUN, at 31 (normal range 7-27.) So not by much at all. We just had the Chem 10 done and everything else in normal range. I guess I'm trying to nip any possible problems in the butt so to speak. She prescribed the K/D more as a precaution because she was worried the kidneys would only get worse the longer he was on the medication.

I joined the Yahoo group; holy %#&@ talk about an interrogation to join LOL... after about 2 surveys I have access and it is SO worth it. Thanks so so much for the link. 

Meanwhile if anyone else has any thoughts please let me know. From what I've read, some places have suggested feeding soley Raw Green Tripe and that being nutritionally balanced in itself. Gonna do some more digging and see if I can find any other plans. TBH it's a bit overwhelming at first... I am used to "natures simplicity" (lol) of prey model raw.... my boyfriend asked me last night if there was some type of "dog food pyramid." I responded, "Yeah, a cow."
LOL.. so, I hope you can see where I'm coming from. I firmly believe nature knows best, but most of the kidney plans I'm finding are high in grains, veggies, fruits etc... I find it hard to believe that there isn't a simpler way to balance everything without needing supplements up the whazzoo. Admittedly I still have a lot to learn. If I can find a way to modify the usual "Prey Model Raw" diet that would be ideal. I could do the green tripe for the 80% meat, or if anyone else has suggestions on the best quality protein that's low in phosphorus I'm all ears.. I can use egg shells to compensate for the bone which is allegedly high in phosphorus... I believe liver and kidney are also; but since they are SUCH a small fraction of the diet is it necessary to reduce them? Oy vay...


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## DaneMama (Jun 27, 2008)

Uh...you have ZERO reason to change your dog's diet. If the BUN was only elevated just outside the reference range that's not an indication of kidney disease. First, raw fed dogs typically have higher BUN scores than kibble fed dogs because their diet is almost exclusively protein. These higher values are normal for raw fed dogs. Second, I would check a urine sample to make sure kidneys are working well. If the urine is nice and concentrated then you've got nothing to worry about. Looking back through my own dog's blood work they all have higher BUN and creatinine levels. 

I would also recheck blood work in a few months. One set tells you a basic picture but repeated blood work will show chronic trends which is a better tool for assessing kidney disease, etc.


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## eternalstudent (Jul 22, 2010)

Totally agree with natalie here.

The two drugs your pup is on are not that bad for the kidney. To be honest Enalapril is used to stop kidney disease in diabetes. The first sign of any problem will come from a rise in potassium which can be a side effect of Furosemide.

I think your vet is trying to cover basses which at the moment probably dont need attention.

I would definitely get regular blood works carried out, especially in the short term to plot a baseline.

Considering how old he is I would put him on the best food possible as he will will be on the Rx stuff essentially for life which IMHO will cause far more issues than it could solve.

Hope everything works out and don't forget to keep us posted


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## cprcheetah (Jul 14, 2010)

I have a cat who has Renal Failure, of course the vet I work for wants her on a low protein Kidney diet, well she's had it for almost 2 years and has had better success just eating Kirkland Signature cat food (she REFUSES wet food of any kind), her levels have gone down and are staying stable. My dad actually has a cat who has had renal failure for 3 years, he refuses to eat ANYTHING but Friskies/Fancy Feast & Whiskas canned food. Moisture in the diet REALLY REALLY helps, so IMO Raw would be ideal.


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## Puff_The_Magic (Sep 1, 2011)

THANK YOU!!! I had completely forgotten about the difference in lab results. I feel silly; I even had this bookmarked before:

http://www.mountaindogfood.com/RawHelp/Raw_Food_Study.pdf

It was Dr Jean Dodd's study done on the lab results of raw fed dogs. And just as you said, it explains about the BUN:

Blood Urea Nitrogen (BUN): BUN is produced in the liver from the breakdown of
protein and is filtered from the blood by the kidneys. Low levels are commonly seen
with low protein diets (I.e. such as the plant proteins primarily used in dry dog food),
insufficiency of the liver and anabolic steroid use. High levels are an indication of
conditions that reduce the kidney’s ability to filter body fluids or those that alter the
breakdown of protein. Dogs being fed a raw diet have access to animal based protein
sources that have a balanced amino acid profile. It makes sense then that they have
higher circulating levels of BUN simply because more amino acids available for the
liver to use as an energy source. As indicated from results of human testing high BUN
values can occur as a result of eating large amounts of protein rich foods.

I will certainly be printing a copy to bring in the next time we do labwork. I am going to drop off a urine sample sometime next week to get a better idea of how the kidneys are. Whew... I feel silly rushing into changing his diet. Should've stuck with my gut instinct. Now, what to do with an opened bag of K/D?? It's Rx so don't think I can donate it to shelters...


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## minnieme (Jul 6, 2011)

You should be able to bring the K/D back to your vet for a full refund so they can send it back to the company...... at least that's what we do where I work.


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## DaneMama (Jun 27, 2008)

The only good thing about the Hill's corporation is that they will give 100% refunds for any of their products. Your vet clinic SHOULD take it back and give a full refund, but if not...contact Hill's directly for a refund. They may not even take it back as a return...in that case feed it to the squirrels since its better formulated for them anyways :thumb:


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## Puff_The_Magic (Sep 1, 2011)

Thanks all. I called the vet to verify and yes they'll give a full refund on the K/D. I'm just going to use it as "credit" to have a urinalysis done... will be dropping it off tomorrow. Also going to leave them a copy of the "Raw food study" so they don't jump to conclusions next time we get labwork done since all of my crew is on raw.


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## Dude and Bucks Mamma (May 14, 2011)

I don't know what other kinds of pets you or your friends have but we are using our leftover bag of kibble as training treats here and there when we don't have anything else and the majority has gone to our two rat girls since they love it and it helps wear down their teeth.


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## Puff_The_Magic (Sep 1, 2011)

Dude and Bucks Mamma said:


> I don't know what other kinds of pets you or your friends have but we are using our leftover bag of kibble as training treats here and there when we don't have anything else and the majority has gone to our two rat girls since they love it and it helps wear down their teeth.


That's actually what I've been doing with the leftover Taste of The Wild we had! I have two rats myself and they often get "leftovers" of anything. They love the variety. 

Returned the bag today, figured if I could still use it as a refunded credit to my account it may as well pay for the urinalysis. But my little boy decided to pee before I had a chance to let him out this morning, so there went my 'first mornings urine' for the day LOL. Hoping for better luck tomorrow.


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## DaneMama (Jun 27, 2008)

Definitely keep us posted on everything....


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## cprcheetah (Jul 14, 2010)

Zoeys BUN has been 31 since she was 1 year old. She had an ultrasound of her kidneys done and they are normal. Some dogs just run 'higher' than normal. Especially raw fed dogs. Zoeys has always been a little high, but her CREA has always been normal. Usually they go by the CREA levels for kidney failure/damage.


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## Puff_The_Magic (Sep 1, 2011)

Well we dropped off his "first mornings pee" today. Vet called a little later to talk to me... said the protein was slightly high. (From my days working for the vet this was an evaluation based on color change on a test strip; I didn't see it myself.) I am curious if anyone here knows if this is still similar to the elevated BUN; and is just normal for a raw fed dog? It makes sense that it is, but I'd rather someone with more knowledge chime in about that. The raw food study I had only covered Blood lab results, not urine.

I did give her the raw food printout and asked them to keep it in my folder. She admittedly said when she called that she hasn't done research on raw and only knows what Science Diet claims... which I love that she was honest. She said they just have done studies that proved dogs who had kidney problems that were fed K/D had longer lifespans. But didn't pressure or say anything bad about raw; just that she hadn't done research on it to offer advice about it.

The specific gravity was 1.025.

Anyone have any insight on these results? She didn't seem overly concerned, just that it "could" be an early indication of kidney issues caused by his medications.


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## DaneMama (Jun 27, 2008)

Sounds completely normal. Usually dogs on a raw diet will have traces of protein in their urine. Or dogs on a high protein grain free kibble. 

The specific gravity is average, meaning that the solute concentration is good. In other words your dog's kidneys are working well because his urine is still in the average range for SG. 

The studies done by Hills with kidney patients was mostly like done on dogs fed k/d vs dogs fed something completely inappropriate. Thats the kicker when it comes to "scientific proof"....the studies were done by industry PAID professionals. They got to design the studies, with the ideal outcome in mind. At least this is what I've found.


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