Kidney disease experience?

[tgramsey]

Hi, does anyone have experience with kidney disease in an adult squirrel - and can help analyze a blood panel? I'm working with a lovely vet who treats exotics, but is admittedly not all that familiar with squirrels. She diagnosed possible/probable kidney disease based on normal panels for rats -- but we both agree we need a second opinion(s).

[tgramsey]

Hi again, does anyone have experience with renal failure/kidney issues that can advise me? I'd love to talk with someone - I can't find much online. Also, if there's a resource for normal squirrel bloodwork levels, please point me in the right direction. Thank you.

[SamtheSquirrel2018]

Hi again, does anyone have experience with renal failure/kidney issues that can advise me? I'd love to talk with someone - I can't find much online. Also, if there's a resource for normal squirrel bloodwork levels, please point me in the right direction. Thank you.

Hi Tgramsy:
I have not had direct experience treating a Squirrel with kidney "failure" and I wanted to make that known to you beforehand as this was mentioned in you post as being a possible requirement for response. I know that this particular bit of experience would be ideal but if you would like some general commentary about kidney issues or potential kidney issues with of course, a focus on Squirrels; I would be glad to try to be of at least some help! If that would be ok with you, I have a couple of questions first off: 1) what is your Squirrel's name? 2) What is the history of your Squirrel; age, prior medical history, symptoms, etc, and in particular why was a "blood panel" performed on this Squirrel? 3) where any other lab tests or other diagnostic studies performed? 4) do you have access to the lab reports and can you post them?
Regards,
SamtheSquirrel

[Diggie's Friend]

I sent you a PM.

Diggie's Friend

[Diggie's Friend]

https://thesquirrelboard.com/forums/...18#post1225018

See easy links for PDF file to be able to enlarge and copy to send to vet if you need to.

[tgramsey]

Hi STS,
Thank you for the response. It's a bit of a long story. The squirrel's name is Atticus. He is an 8-year-old male Fox squirrel, 636 grams currently. Atticus was my first rehab baby. He fell from a tree in my backyard in 2015. I raised and then released Atticus in the spring of 2016. He has been a constant visitor all these years and is very special to me.

Around Labor Day Atticus showed up looking very thin and lethargic. Surprising since I'd just seen and even photographed him the week before - looked totally normal and healthy. I caught him pretty easily, brought him in and discovered an abscess near his penis and the lymth nodes around his anus felt like marbles. He saw two different vets trying to get to the bottom of it. First three antibiotics failed and the situation got worse. Finally the fourth antibiotic, Doxycycline, worked and resolved the abscess. Nodes are not back to normal, but much improved. Still, Atticus wasn't/isn't himself, so the vet ran bloodwork and here we are. She suspects chronic renal disease based on a comparison to healthy rat values. She couldn't locate a reliable resource for healthy Fox squirrel values. I'll post the lab results with handwritten rat values on the side.

She thinks Atticus' immune system was probably down due to the kidney issue, which led to the more obvious infection we battled for over two months.

I haven't done a uralysis yet but the vet is willing to do that if I want.

I can go on with more details, but I'll stop here for now. Let me know what other questions come to mind.

Thank you and any advice is much appreciated.

Hi Tgramsy:
I have not had direct experience treating a Squirrel with kidney "failure" and I wanted to make that known to you beforehand as this was mentioned in you post as being a possible requirement for response. I know that this particular bit of experience would be ideal but if you would like some general commentary about kidney issues or potential kidney issues with of course, a focus on Squirrels; I would be glad to try to be of at least some help! If that would be ok with you, I have a couple of questions first off: 1) what is your Squirrel's name? 2) What is the history of your Squirrel; age, prior medical history, symptoms, etc, and in particular why was a "blood panel" performed on this Squirrel? 3) where any other lab tests or other diagnostic studies performed? 4) do you have access to the lab reports and can you post them?
Regards,
SamtheSquirrel

[tgramsey]

Thank you so much! I'll send these over to my vet on Monday.

https://thesquirrelboard.com/forums/...18#post1225018

See easy links for PDF file to be able to enlarge and copy to send to vet if you need to.

[SamtheSquirrel2018]

Hi STS,
Thank you for the response. It's a bit of a long story. The squirrel's name is Atticus. He is an 8-year-old male Fox squirrel, 636 grams currently. Atticus was my first rehab baby. He fell from a tree in my backyard in 2015. I raised and then released Atticus in the spring of 2016. He has been a constant visitor all these years and is very special to me.

Around Labor Day Atticus showed up looking very thin and lethargic. Surprising since I'd just seen and even photographed him the week before - looked totally normal and healthy. I caught him pretty easily, brought him in and discovered an abscess near his penis and the lymth nodes around his anus felt like marbles. He saw two different vets trying to get to the bottom of it. First three antibiotics failed and the situation got worse. Finally the fourth antibiotic, Doxycycline, worked and resolved the abscess. Nodes are not back to normal, but much improved. Still, Atticus wasn't/isn't himself, so the vet ran bloodwork and here we are. She suspects chronic renal disease based on a comparison to healthy rat values. She couldn't locate a reliable resource for healthy Fox squirrel values. I'll post the lab results with handwritten rat values on the side.

She thinks Atticus' immune system was probably down due to the kidney issue, which led to the more obvious infection we battled for over two months.

I haven't done a uralysis yet but the vet is willing to do that if I want.

I can go on with more details, but I'll stop here for now. Let me know what other questions come to mind.

Thank you and any advice is much appreciated.

Hi Tgramsy:
I'm so sorry about Atticus's change in status! I hope he will quickly recover and my best wishes and hopes are with him!

As far as the lab report goes, I can only give you my humble opinions and suggestions. As I've pointed out before, I am not a Veterinarian! I do see where your Veterinarian has concerns about kidney disease. Variations from the "normal" ranges of the lab report for BUN, creatinine and phosphorus are certainly consistent with renal dysfunction (kidney disease) of some degree BUT these "normal" ranges are NOT for Squirrels, per se!

I have found that there are very limited data regarding "normal" chemistry values for Squirrels and certainly there is even more of a paucity of data pertaining to specific species of Squirrel!

I want thank DF for sending some lab studies to you! One of my primary but certainly not all-inclusive sources of laboratory parameters that I use is the Exotic Animal Laboratory Diagnosis published originally in 2020. It even has a chapter on Squirrels! No specific Fox Squirrel data is listed but they do tabulate Persian Squirrels (Sciurus anomalus) and Gray Squirrels (Sciurus carolinensis). The BUN which is one of the primary indices that is used in evaluating kidney status is actually cited from another reference and is listed for Grays as ranging from 4-70 mg/dl and the Creatinine which is another primary index is listed only for Persian Squirrels and ranges from 4/036-4.75 mg/dl.

One of my primary concerns with the lab report that you posted has nothing really to do with the choice of tests performed but what must be inferred from at least one of the values and that is the value for Glucose which is listed as being<10! This is simply an impossible value for Glucose in an active and interactive mammal (not just Squirrels) and being even more blunt to illustrate the degree of error, a value of <10 is in fact incompatible with life!

There are three main types of laboratory errors based upon where in the total lab process they originate. By far the largest number of errors occur during the Pre-Analytical phase which is prior to the actual testing performed by the lab. There are a multitude of possibilities such as (for illustration purposes only) using the wrong tube, keeping a tourniquet on for excessive times, keeping the specimen warm when it should be kept cold (or vice versa), not rocking the tube when it should be rocked, not spinning the tube in a centrifuge when it should have been and many, many more.

The fact that there is an obvious error of at least one parameter and that being the value for Glucose; even if there seems to be a likely explanation for this, actually puts the entire specimen and report in question. It is expected that an experienced clinician (veterinarian or physician) will recognize obvious errors as your Veterinarian has done but it is also human nature to still utilize the remainder of the lab report if this can be done and often, any remaining values especially if they are at all plausible are still utilized for diagnosis. This isn't necessarily wrong but with one utterly impossible lab value, I would humbly recommend rejecting the entire specimen and lab report and start anew!

My suggestion would be for Atticus to be adequately sedated for another blood draw and being restrained, agitated and frightened can actually effect certain lab parameters and of course, we should be as kind as possible and sedation is usually the very best road to take for invasive procedures, even for relatively simple ones such as a blood draw.

Also, with the sedation (usually with an inhaled anesthetic), a specimen for urinalysis can be obtained via a catheter passed through the urethra into the bladder or if the bladder is full and the Vet is experienced with this it can be obtained by what is called Cystocentesis which is where a a small needle is passed from the outside of the lower abdomen directly into the bladder to obtain a urine specimen.

If another specimen and/or the urinalysis is going to be performed, especially if looking for renal disease; I would suggest that Atticus have at least a day or two of you actively ensuring that he is adequately hydrated before the new testing is performed!

Again, what I have posted are only my personal comments, impressions and suggestions! I do wish Atticus my very best!

Sorry for another one of my "books!"

Regards,
SamtheSquirrel

[SamtheSquirrel2018]

Hello again Tgramsey:
Another suggestion I have would be IF you are going to have Atticus sedated for further lag studies or whatever; that the "lymph nodes" near the anus be biopsied at the same time. This may further aid in understanding what has been going on with this little guy!
Regards,
SamtheSquirrel

[tgramsey]

Thank you so much for this great info. Yes, the vet did tell me and noted on the report that there is an error on glucose due to the sample sitting in the tube too long before the lab ran the test. You make an excellent point that if one value is off, they could all be off!

FYI - Atticus was sedated to draw this blood sample -- drawn at the same time the vet performed the last lance/drain/flush from the abscess.

I'm going to send the vet DF's research -hopefully she has time to look it over. I'll also mention the squirrel chapter in the Exotic Animal Laboratory Diagnosis. She specializes in exotics so I bet she has that one or is familiar. Ill just see what she suggests, but I'm leaning toward more bloodwork and a urine test.

Thank you again.

Hi Tgramsy:
I'm so sorry about Atticus's change in status! I hope he will quickly recover and my best wishes and hopes are with him!

As far as the lab report goes, I can only give you my humble opinions and suggestions. As I've pointed out before, I am not a Veterinarian! I do see where your Veterinarian has concerns about kidney disease. Variations from the "normal" ranges of the lab report for BUN, creatinine and phosphorus are certainly consistent with renal dysfunction (kidney disease) of some degree BUT these "normal" ranges are NOT for Squirrels, per se!

I have found that there are very limited data regarding "normal" chemistry values for Squirrels and certainly there is even more of a paucity of data pertaining to specific species of Squirrel!

I want thank DF for sending some lab studies to you! One of my primary but certainly not all-inclusive sources of laboratory parameters that I use is the Exotic Animal Laboratory Diagnosis published originally in 2020. It even has a chapter on Squirrels! No specific Fox Squirrel data is listed but they do tabulate Persian Squirrels (Sciurus anomalus) and Gray Squirrels (Sciurus carolinensis). The BUN which is one of the primary indices that is used in evaluating kidney status is actually cited from another reference and is listed for Grays as ranging from 4-70 mg/dl and the Creatinine which is another primary index is listed only for Persian Squirrels and ranges from 4/036-4.75 mg/dl.

One of my primary concerns with the lab report that you posted has nothing really to do with the choice of tests performed but what must be inferred from at least one of the values and that is the value for Glucose which is listed as being<10! This is simply an impossible value for Glucose in an active and interactive mammal (not just Squirrels) and being even more blunt to illustrate the degree of error, a value of <10 is in fact incompatible with life!

There are three main types of laboratory errors based upon where in the total lab process they originate. By far the largest number of errors occur during the Pre-Analytical phase which is prior to the actual testing performed by the lab. There are a multitude of possibilities such as (for illustration purposes only) using the wrong tube, keeping a tourniquet on for excessive times, keeping the specimen warm when it should be kept cold (or vice versa), not rocking the tube when it should be rocked, not spinning the tube in a centrifuge when it should have been and many, many more.

The fact that there is an obvious error of at least one parameter and that being the value for Glucose; even if there seems to be a likely explanation for this, actually puts the entire specimen and report in question. It is expected that an experienced clinician (veterinarian or physician) will recognize obvious errors as your Veterinarian has done but it is also human nature to still utilize the remainder of the lab report if this can be done and often, any remaining values especially if they are at all plausible are still utilized for diagnosis. This isn't necessarily wrong but with one utterly impossible lab value, I would humbly recommend rejecting the entire specimen and lab report and start anew!

My suggestion would be for Atticus to be adequately sedated for another blood draw and being restrained, agitated and frightened can actually effect certain lab parameters and of course, we should be as kind as possible and sedation is usually the very best road to take for invasive procedures, even for relatively simple ones such as a blood draw.

Also, with the sedation (usually with an inhaled anesthetic), a specimen for urinalysis can be obtained via a catheter passed through the urethra into the bladder or if the bladder is full and the Vet is experienced with this it can be obtained by what is called Cystocentesis which is where a a small needle is passed from the outside of the lower abdomen directly into the bladder to obtain a urine specimen.

If another specimen and/or the urinalysis is going to be performed, especially if looking for renal disease; I would suggest that Atticus have at least a day or two of you actively ensuring that he is adequately hydrated before the new testing is performed!

Again, what I have posted are only my personal comments, impressions and suggestions! I do wish Atticus my very best!

Sorry for another one of my "books!"

Regards,
SamtheSquirrel

[tgramsey]

Good idea. The vet did insert a needle early on and got no sample material. I'll ask again. They have improved - not as large as they were. What I understand is the nodes are the last to recover after an infection.

Hello again Tgramsey:
Another suggestion I have would be IF you are going to have Atticus sedated for further lag studies or whatever; that the "lymph nodes" near the anus be biopsied at the same time. This may further aid in understanding what has been going on with this little guy!
Regards,
SamtheSquirrel

[tgramsey]

Thank you, DF!


QUOTE=Diggie's Friend;1363962]https://thesquirrelboard.com/forums/...18#post1225018

See easy links for PDF file to be able to enlarge and copy to send to vet if you need to.[/QUOTE]

[Diggie's Friend]

Was an x-ray taken at his last visit? If so, was there evidence of skeletal MBD? If not, then with his going down it is going to be very stressful to both transport and get an x-ray in his present condition. With your vet thinking the cause is Kidney failure, I would treat him for this condition.
Please be aware that up to, "Late stage" kidney failure or disease as it is also known; according to the rat research, the kidneys can improve with treatment. (see narrative by the research veterinarian posted below)


For reason that kidney disease being an age related progressive increase in phosphorus retention by the kidneys and with the also age related reduction in calcium bone retention; to address this condition would require using the MBD treatment, save with Calcium citrate instead of Calcium carbonate, because Calcium citrate was found to improve lowered kidney function in rats, but Calcium carbonate also tested did not improve kidney function. With this treatment, if he begins to per up you will know you have hit the target.

This is an excerpt from a researcher vet's journal on this issue that is a bit more technical, but not a lab journal:

Rats with kidney problems are generally quite thin. They are not as active as they once were and have a general appearance of ill health (malaise). Much of that malaise is due to high levels of toxins circulating in their blood stream because their kidneys are no longer capable of removing those toxins from their body. The situation is called uremia or azotemia.

(This article is a narrative by a veterinarian on Kidney Disease in Rats, which explains how kidney disease develops, and ways to improve it; not a lab journal.)

https://vetspace.2ndchance.info/chro...-your-pet-rat/

Secondary to the MBD treatment, you can try giving him yogurt thinned with a bit of water and pulled up with a feeding syringe to give slowly at a 45 degree angle to the side of the face with the tip just inside the lip. Using this has brought back squirrels that have gone down to restore them when they stop eating and or reduced in weight.

Note To prevent the earlier onset of kidney disease, lower the amount of the diet by a bit every couple of years, and likewise increase the Calcium using Calcium citrate at the same time to bring up the Ca:P ratio a couple of points every couple of years from mid-life on, as this will help to counter the rexcess retention of phosphorus by the kidneys that increases progressively with aging.

[Diggie's Friend]

Please let us know what specific cells were found from the biopsy.

[tgramsey]

Thanks for the valuable info, DF.

No x-ray was done. We were battling what we thought was just a nasty infection until the blood results came back.

I ordered calcium citrate and other supplements you recommend. I'm taking away known high phosphorus foods, though he isn't eating much anyway.
I'm also giving subQ fluids every other day per vet's recommendation.

Was an x-ray taken at his last visit? If so, was there evidence of skeletal MBD? If not, then with his going down it is going to be very stressful to both transport and get an x-ray in his present condition. With your vet thinking the cause is Kidney failure, I would treat him for this condition.
Please be aware that up to, "Late stage" kidney failure or disease as it is also known; according to the rat research, the kidneys can improve with treatment. (see narrative by the research veterinarian posted below)


For reason that kidney disease being an age related progressive increase in phosphorus retention by the kidneys and with the also age related reduction in calcium bone retention; to address this condition would require using the MBD treatment, save with Calcium citrate instead of Calcium carbonate, because Calcium citrate was found to improve lowered kidney function in rats, but Calcium carbonate also tested did not improve kidney function. With this treatment, if he begins to per up you will know you have hit the target.

This is an excerpt from a researcher vet's journal on this issue that is a bit more technical, but not a lab journal:



(This article is a narrative by a veterinarian on Kidney Disease in Rats, which explains how kidney disease develops, and ways to improve it; not a lab journal.)

https://vetspace.2ndchance.info/chro...-your-pet-rat/

Secondary to the MBD treatment, you can try giving him yogurt thinned with a bit of water and pulled up with a feeding syringe to give slowly at a 45 degree angle to the side of the face with the tip just inside the lip. Using this has brought back squirrels that have gone down to restore them when they stop eating and or reduced in weight.

Note To prevent the earlier onset of kidney disease, lower the amount of the diet by a bit every couple of years, and likewise increase the Calcium using Calcium citrate at the same time to bring up the Ca:P ratio a couple of points every couple of years from mid-life on, as this will help to counter the rexcess retention of phosphorus by the kidneys that increases progressively with aging.

[SamtheSquirrel2018]

Hi Tgramsey:
How is Atticus doing?
Regards,
SamtheSquirrel

[tgramsey]

Hi STS,
Thank you for asking. Nothing good to report - he is not feeling any better. Reached out to the vet for her opinion on getting another blood test but haven't heard back. Thinking I might wait a week or so as I'm trying to keep protein down.

Hi Tgramsey:
How is Atticus doing?
Regards,
SamtheSquirrel

[SamtheSquirrel2018]

Hi STS,
Thank you for asking. Nothing good to report - he is not feeling any better. Reached out to the vet for her opinion on getting another blood test but haven't heard back. Thinking I might wait a week or so as I'm trying to keep protein down.

Thanks for the update, Tgramsey! I'm sorry that Atticus is not improved! I hope that the Vet will get back with you expeditiously! It would be good to have the "nodes" effectively biopsied and it would be advantageous to have another blood chemistry as well as a urinalysis.

I would like to make a suggestion in light of the facts that there has apparently been no significant improvement in Atticus's status and that right now, waiting for the Vet continues; and for you to consider beginning Henry's Emergency Treatment for MBD. I certainly don't feel that Atticus has MBD but on the other paw, I certainly can't rule it out. Some of his signs are consistent with this and although many of us have heard that Wild Squirrels do not get MBD; I really don't believe we can make this statement with conviction as all that we can really say is that we probably do not have definitive evidence of MBD in Wilds and even that may not be the case and somewhere there is evidence of this. IMHO, I strongly believe that MBD strikes wilds as well as captive Squirrels but in the wild, the afflicted Squirrels are likely to die "in the field" or be prey and are never seen or taken in for care and treatment and we simply do not get the evidence!

I would to suggest that you consider trying a week of Henry's Emergency Treatment of MBD and frequently observe for any changes in Atticus's status. If you may be interested in doing this, here is a link to Henry's guidelines for MBD Treatment;

https://www.ebay.com/itm/23438305511...8AAMXQL99SccBN

Please keep on Atticus updates!

Regards,
SamtheSquirrel

[tgramsey]

Thank you. I'll look into this - and will call the vet again tomorrow. I've been doing home urine testing stips and his protein shows high every time. FYI - I reached out to Dr. E's office in Florida hoping for a zoom appointment, but she doesn't book those. I sent an email with all the dets (staff suggestion) hoping I can at least get her advice - no word yet.
Thank you again.

Thanks for the update, Tgramsey! I'm sorry that Atticus is not improved! I hope that the Vet will get back with you expeditiously! It would be good to have the "nodes" effectively biopsied and it would be advantageous to have another blood chemistry as well as a urinalysis.

I would like to make a suggestion in light of the facts that there has apparently been no significant improvement in Atticus's status and that right now, waiting for the Vet continues; and for you to consider beginning Henry's Emergency Treatment for MBD. I certainly don't feel that Atticus has MBD but on the other paw, I certainly can't rule it out. Some of his signs are consistent with this and although many of us have heard that Wild Squirrels do not get MBD; I really don't believe we can make this statement with conviction as all that we can really say is that we probably do not have definitive evidence of MBD in Wilds and even that may not be the case and somewhere there is evidence of this. IMHO, I strongly believe that MBD strikes wilds as well as captive Squirrels but in the wild, the afflicted Squirrels are likely to die "in the field" or be prey and are never seen or taken in for care and treatment and we simply do not get the evidence!

I would to suggest that you consider trying a week of Henry's Emergency Treatment of MBD and frequently observe for any changes in Atticus's status. If you may be interested in doing this, here is a link to Henry's guidelines for MBD Treatment;

https://www.ebay.com/itm/23438305511...8AAMXQL99SccBN

Please keep on Atticus updates!

Regards,
SamtheSquirrel

[SamtheSquirrel2018]

Thank you. I'll look into this - and will call the vet again tomorrow. I've been doing home urine testing stips and his protein shows high every time. FYI - I reached out to Dr. E's office in Florida hoping for a zoom appointment, but she doesn't book those. I sent an email with all the dets (staff suggestion) hoping I can at least get her advice - no word yet.
Thank you again.

Thanks Tgramsey! I didn't realize that you had test strips for urinalysis but that is very helpful though your findings are not encouraging! Protien being found in the urine is one of the hallmark signs of kidney disease! Since you were able to check this and recheck this and consistently found protein in the urine, I would suspect that the original diagnosis of kidney disease may be the case although further testing is necessary!

With the above in mind, it may be best now to hold off on consideration of the MBD treatment because excessive Calcium should ordinarily be avoided if kidney disease is present. I was hoping that something could be done while you were "waiting" as really it was and that was you were checking Atticus's urine and finding protein!

Although the treatment for MBD is generally considered quite safe, it's use if kidney disease is really present is an important to consider exception and I would now recommend NOT starting this treatment until kidney disease can be definitively ruled out!

Thanks and sorry about my need to retract my prior recommendation!

Please give Atticus a little back rub from me!

Regards,
SamtheSquirrel