Kidney stone help please!

Hi All, we have a 9.5yr old female Dutch who has just been diagnosed with a kidney stone, following bloods, ultrasound and X-ray yesterday. She obviously has deteriorated as kidney function is being impaired. She is underweight and we (and vet) don’t believe she is strong enough to attempt kidney removal! So we are going to give it everything to try and boost her up and increase her weight in the hope an op might be possible, referral would be to Iain Cope who has done this before and he also knows Gracie, as he did her spay and mammary removal in Sept-Oct last year while she was at the Rabbit Residence.

In the meantime, please can I have thoughts on Fortekor and Tremadol? We are caught between a rock and a hard place with analgesia because obviously metacam would cause more damage BUT she needs pain meds. I’m hoping Tremadol is an option, if so what is the recommended dosage? I know Fortekor can be used to assist with kidney failure, what is the current recommended dosage?

For ref. She weighs 1.7kg and is having 0.9ml of Metaclop and 0.5ml of Ranitadine both twice daily and, against vet advice, we have been giving low dose metacam twice a day 0.2ml of dog metacam. She is also having supplementary feeds of critical care. The vet yesterday was reluctant to show us how to give sub cuts and has left that task to her normal vet at our follow up on Monday. In the meantime we have some Bio-lapis to give orally.

Is their ANYTHING else we can do, ask, feed etc?
Thanks in advance

Hoping photos come out below and not just mega text links...

Bumping this for you

Thanks so much Karen

Hi and welcome to the forum :wave: Gracie is very lovely

I haven't had experience of a rabbit with kidney stones but there are several forum members who have and hopefully one of them will be along soon to offer some advice.

I know also that some forum members have used Tramadol as pain relief and Fortekor for kidney problems, but although they can give advice on their effectiveness and use, the actual dosage will need to be determined by your vet who is treating Gracie.

Some ideas to try to get her to gain weight would be to feed a small amount of dry oats. I have also used FibaFirst sticks to feed as treats several times a day to try to get a doe to gain weight.

I hope you can get some medication sorted out for her. I must say it seems very harsh for the vet not to have given some sort of pain relief, although I can understand the problems with Metacam.

Your photos have come out fine btw.

Sending Gracie lots of vibes for her vet visit on Monday and also her ongoing treatment.

Hope you get some replies soon from folk with experience. Sorry if I have missed info, but is she drinking for herself? Does she use a bottle or bowl?

As Omi said, hopefully other forum members with experience of kidney issues will be able to advise. Dosages should, obviously, be decided by the vet who knows Gracie's full medical history (well as far back as possible anyhow).

There is some info re. dosages of Fortekor here (benazepril is the active ingredient)

http://wildpro.twycrosszoo.org/S/00Chem/ChComplex/Benazepril.htm

I'm still looking for similar info re. Tramadol but I recall from a while back that some of the exotics vets were recommending higher doses than were documented in the literature at that time so I wonder if anybody could confirm whether that is the case or if I've got it confused with something else.

I hope somebun can come along with some advice for you. I would be sure you get the right dosage of Fortekor - my Toby was on that for his heart. Just for your information he was taking Fortekor pal tabs 2.5mg. He weighed 2.9kg and had half a tablet daily. But as again was for his heart and your vet needs to work that out for you. I hope somebun has some more experience for you xx

Sent from my GT-I9195 using Tapatalk

I found this for Tramadol
http://www.medirabbit.com/Safe_medication/Analgesics/safe_analgesics.htm

KarenM said:

I found this for Tramadol
http://www.medirabbit.com/Safe_medication/Analgesics/safe_analgesics.htm

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Judging by that it would appear that Tramadol does not have the same issues for rabbits with kidney issues as Metacam, which has "Should not be used in rabbits suffering from liver or kidney failure" alongside it. So I would be hopeful that the vet could prescribe this.

Omi said:

Judging by that it would appear that Tramadol does not have the same issues for rabbits with kidney issues as Metacam, which has "Should not be used in rabbits suffering from liver or kidney failure" alongside it. So I would be hopeful that the vet could prescribe this.

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Very true, hopefully that will be the case.

It can make rabbits very sleepy sometimes so it can be a case of getting an adequate dosage for pain relief but without making them so drowsy that they don't want to eat.

Boudicca-Backup said:

Hi All, we have a 9.5yr old female Dutch who has just been diagnosed with a kidney stone, following bloods, ultrasound and X-ray yesterday. She obviously has deteriorated as kidney function is being impaired. She is underweight and we (and vet) don’t believe she is strong enough to attempt kidney removal! So we are going to give it everything to try and boost her up and increase her weight in the hope an op might be possible, referral would be to Iain Cope who has done this before and he also knows Gracie, as he did her spay and mammary removal in Sept-Oct last year while she was at the Rabbit Residence.

In the meantime, please can I have thoughts on Fortekor and Tremadol? We are caught between a rock and a hard place with analgesia because obviously metacam would cause more damage BUT she needs pain meds. I’m hoping Tremadol is an option, if so what is the recommended dosage? I know Fortekor can be used to assist with kidney failure, what is the current recommended dosage?

For ref. She weighs 1.7kg and is having 0.9ml of Metaclop and 0.5ml of Ranitadine both twice daily and, against vet advice, we have been giving low dose metacam twice a day 0.2ml of dog metacam. She is also having supplementary feeds of critical care. The vet yesterday was reluctant to show us how to give sub cuts and has left that task to her normal vet at our follow up on Monday. In the meantime we have some Bio-lapis to give orally.

Is their ANYTHING else we can do, ask, feed etc?
Thanks in advance

Hoping photos come out below and not just mega text links...

Click to expand...

Hi there and welcome to the Forum

I am really sorry to hear about Gracie's diagnosis, and certainly sub-cut fluids are essential. When my rabbit was in kidney failure I did sub-cut fluids every day, and sometimes twice a day, and it helped enormously. I also gave Fortekor, but the dose really should be decided by your vet, as we are not qualified to suggest a dose on here. That is a very helpful drug though. Similarly with Tramadol - one vet that I spoke with was reluctant but I think it's certainly worth considering if she is in severe pain.

Anabolic steroids can also help to improve appetite and maintain weight and also help with anaemia. You could also ask your vet about erythropoietin injections, which help also for anaemia.

A low calcium diet is usually advised, so cutting out pellets. Although of course this may contribute to further weight loss. I also find that the calcium in water can make bit difference, so worth looking at that too.

I fed some porridge oats, which you can either feed dry or else add some water or apple juice.
Adding bio-lapis or Avipro to the water can encourage drinking, which is a very good thing. Also, using a bowl rather than a bottle, which may be something you do now anyway.

With some simple changes, a rabbit can hopefully have a good quality of life for a decent length of time.


Here's a thread by a member of this Forum, and if you search you will find are examples and how members have been helped:

http://forums.rabbitrehome.org.uk/showthread.php?344951-Kidney-failure-in-rabbits

Some further reading:

https://www.petmd.com/rabbit/conditions/urinary/c_rb_renal_failure

http://www.medirabbit.com/EN/Uro_gen_diseases/Mech_diseases/Urolithiasis.htm

http://www.medirabbit.com/EN/Uro_gen_diseases/Stone_reduction/Stone_red.htm

http://wildpro.twycrosszoo.org/S/00dis/Miscellaneous/ChronicRenalLagomorph.htm#MedicalTreat

I have experience of kidney stones in a rabbit, thankfully only in one kidney so he had it removed. He did have initial surgery just to remove the stones but they returned so we reluctantly went for kidney removal. He was under the care of Frances Harcourt-Brown and given that he also had a chronic issue with bladder sludge (and had been on Metacam for a few years) she decided we needed to continue with Metacam. He wasn't in kidney failure at that time though as only one kidney was affected. He was aged 7 when this happened and lived another 2 years with the one kidney and daily Metacam.

It is now eight years ago, I can't remember Fortekor being discussed and Tramadol was only given immediately after his surgeries for the recovery days.

Boudicca-Backup said:

Hi All, we have a 9.5yr old female Dutch who has just been diagnosed with a kidney stone, following bloods, ultrasound and X-ray yesterday. She obviously has deteriorated as kidney function is being impaired. She is underweight and we (and vet) don’t believe she is strong enough to attempt kidney removal! So we are going to give it everything to try and boost her up and increase her weight in the hope an op might be possible, referral would be to Iain Cope who has done this before and he also knows Gracie, as he did her spay and mammary removal in Sept-Oct last year while she was at the Rabbit Residence.

In the meantime, please can I have thoughts on Fortekor and Tremadol? We are caught between a rock and a hard place with analgesia because obviously metacam would cause more damage BUT she needs pain meds. I’m hoping Tremadol is an option, if so what is the recommended dosage? I know Fortekor can be used to assist with kidney failure, what is the current recommended dosage?

For ref. She weighs 1.7kg and is having 0.9ml of Metaclop and 0.5ml of Ranitadine both twice daily and, against vet advice, we have been giving low dose metacam twice a day 0.2ml of dog metacam. She is also having supplementary feeds of critical care. The vet yesterday was reluctant to show us how to give sub cuts and has left that task to her normal vet at our follow up on Monday. In the meantime we have some Bio-lapis to give orally.

Is their ANYTHING else we can do, ask, feed etc?
Thanks in advance

Click to expand...

Hello

I have had numerous Rabbits diagnosed with renal problems and I have the problem myself. Analgesia is a challenge when Kidney function is impaired, in both animals and humans That said, dose rates of analgesics can be titrated to accommodate the limitations of renal function. With Tramadol the dose rate is usually decreased and given less frequently. The same can apply with other analgesics including NSAIDs. Supportive subcutaneous fluid therapy may be very helpful. This can be done by the caregiver at home, hopefully your usual Vet will be able to accommodate this if you request it.

These links contain some information about Renal Failure in Rabbits, apologies if they have already been posted

http://wildpro.twycrosszoo.org/S/00dis/Miscellaneous/ChronicRenalLagomorph.htm

http://www.medirabbit.com/EN/Uro_gen_diseases/Mech_diseases/Urolithiasis.htm

https://rabbitwelfare.co.uk/rabbit-health/further-reading/urolithiasis/

With regards to Benazepril (Fortekor), my Vet has prescribed this for some of my 'Renal Rabbits'. It is used to treat chronic renal failure in Cats, but can be used 'off licence' for Rabbits via the Veterinary prescribing cascade

http://www.noahcompendium.co.uk/?id=-462287

https://www.bsava.com/Resources/Veterinary-resources/Medicines-Guide/Prescribing-cascade

This diet sheet may be useful to refer to :

https://www.harcourt-brown.co.uk/ar...t-for-rabbits-with-urinary-tract-disease/view

Iain Cope is certainly an expert Vet to be referred to and I know of a few RU members who's Rabbits have had complex surgery carried out by him. But whether proceeding with surgery is an option is obviously a decision that can only be made on an individual case basis. Sometimes just because a procedure is possible it may not be 'right' to do for a specific Rabbit.

Best wishes for Gracie

I can’t give any advice as I haven’t had experience of this in rabbits, but I’m sending lots of vibes for Grace xx

Thank you everyone for your VERY helpful advice, comments and links! We have trawled through everything!! Gracie decided she had had enough of meds, syringe food and water today, so we went back to the vets to get some more sub-cuts and this time demanded some to bring away to administer at home! We also saw a different vet and she understood the dilemma of no pain meds = pain = not eating vs painkiller which causes further damage but bun is happier and eating, so she ageeed we have little to lose so we are back on Metacam 0.5ml twice daily and we also have some tremadol to supplement it. She had managed to put on 50g which reversed the downward weight loss trend.

We completely appreciate the ethos of ‘just because we can doesn’t mean we should’. It’s a dilemma that we all grapple with when we are decision making with our much loved fur babies. We are weighing up all the options and assessing on a day by day basis. She hasn’t picked up much today, so tonight and overnight will be critical. We see her actual vet tomorrow at 4.30 when all options will be discussed.

Today’s vet hadn’t used Fortekor for rabbits so that’s something to discuss tomorrow as well. We also asked about ketamine for pain relief and she said Gracie would have to stay in and have it via IV.

I forgot to say she is a house rabbit and she has a bowl for water.

To help us with our decision making, we’d like to know your experience of kidney op recovery. Is it a difficult and painful op to recover from, or do they generally bounce back fairly quickly and well? How much intensive care is required post op?

Thanks Again

YAY finally back as myself!! Had a problem logging on, hence temporary account Boudicca-Backup! :thumb:

Boudicca-Backup said:

Thank you everyone for your VERY helpful advice, comments and links! We have trawled through everything!! Gracie decided she had had enough of meds, syringe food and water today, so we went back to the vets to get some more sub-cuts and this time demanded some to bring away to administer at home! We also saw a different vet and she understood the dilemma of no pain meds = pain = not eating vs painkiller which causes further damage but bun is happier and eating, so she ageeed we have little to lose so we are back on Metacam 0.5ml twice daily and we also have some tremadol to supplement it. She had managed to put on 50g which reversed the downward weight loss trend.

We completely appreciate the ethos of ‘just because we can doesn’t mean we should’. It’s a dilemma that we all grapple with when we are decision making with our much loved fur babies. We are weighing up all the options and assessing on a day by day basis. She hasn’t picked up much today, so tonight and overnight will be critical. We see her actual vet tomorrow at 4.30 when all options will be discussed.

Today’s vet hadn’t used Fortekor for rabbits so that’s something to discuss tomorrow as well. We also asked about ketamine for pain relief and she said Gracie would have to stay in and have it via IV.

I forgot to say she is a house rabbit and she has a bowl for water.

To help us with our decision making, we’d like to know your experience of kidney op recovery. Is it a difficult and painful op to recover from, or do they generally bounce back fairly quickly and well? How much intensive care is required post op?

Thanks Again

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You are very welcome, and I'm glad the info and links were of some use

Perhaps something here will help?

http://wildpro.twycrosszoo.org/S/00...Indiv_TechniquesRabbit/Nephrectomy_Rabbit.htm

https://www.binkybunny.com/FORUM/tabid/54/aft/108585/Default.aspx

http://forums.rabbitrehome.org.uk/showthread.php?435268-Nephrectomy-how-serious-is-it


And I quote from Parsnipbun, who has loads of experience:

There are several issues to consider:

Kidney stones are very painful, and when they start to move round or grow or break up she will be in a a LOT of pain - more than metcam can cover - and tbh more than bupronorphine can cover either.

Bits can also break off and start to travel down the tubes and can block them.

The operation is difficult - and it also depends which kidney it is how difficult it is - one is more difficult than the other for a variety of reasons. One also needs more abdominal handling than the other (which is a risk with post surgical adhesions).

However if you can persuade your vet to contact a UK specialist vet in advance for guidance and instruction, and the vet surgeon you have is generally good (and experienced in rabbit aneasthesia generally) then taking a kidney out should be feasible for them.

I should say that rabbits with kidney issues need a diet high in fluids and low in sugars and concentrates - so no dried pellets but lots of fresh foods and forage.

Also low calcium - so if the water you have is high calcium then try bottle low calcium water.

My rabbit that had an ossified kidney was 9 years old and sailed through the op.

I would definitely put another rabbit through the op if there was a decision to be made -

however i do have a specialist rabbit vet/surgeon.

If your vet needs to contact a vet that has done this and does it relatively 'frequently' (relative as its still not common for rabbits) then the contact details for mine are Iain Cope at Cambridge Vet Group 01223 249331.

Boudicca said:

YAY finally back as myself!! Had a problem logging on, hence temporary account Boudicca-Backup! :thumb:

Click to expand...

I thought it was you, but didn't like to ask !! :lol:

Lots more vibes being sent

Boudicca said:

YAY finally back as myself!! Had a problem logging on, hence temporary account Boudicca-Backup! :thumb:

Click to expand...

And to add, I thought this was you posting, and I was about to email to check when you posted

Jack's-Jane said:

I thought it was you, but didn't like to ask !! :lol:

Lots more vibes being sent

Click to expand...

MightyMax said:

And to add, I thought this was you posting, and I was about to email to check when you posted

Click to expand...

:lol: I was sort of, but not really, in disguise LOL

Thank you for the vibes we definitely need them!!

Our little lady has been back to the vet and on the way there there her head was at a bit of a strange angle and the first signs of some nystagmus, which was a bit of a blow, reckon EC is catching up with her in her weakened state or maybe the cause of the kidney issues?!?

My partner managed to ‘catch’ a wee sample but it didn’t show obvious UTI, but then it was a small sample and quite clear because of hydration etc our vet also checked protein levels for potentially using Fortekor but decided against that for now! She pondered giving a dose of sulfatrim for a potential UTI but opted for a slow release injection of engemycin as she thought in the big scheme of things that would be better alongside some panacur.

This may seem very futile for an older bun BUT until this she never acted like an older bunny, to the point we believed her medical history from the rescue was wrong!! She also still has periods of being very bright and runs into the kitchen to be with us if we leave the lounge. Today she has ploughed through several large handfuls of fresh grass... which is apparently so much tastier than every other veg and herb that Sainso has to offer :roll::lol: it is not her time just yet!! If a miracle happens and she picks up Iain Cope is primed and ready for the referral!!

My partner Ellie has been messaging Parsnipbun (Twigs) and we owe her a massive debt of gratitude, her advice has been invaluable the second new events unfold!