Kidney stone

Question
QUESTION: I have a 2 year old male Flemish Giant rabbit.(not neuter) I saw him pee blood and took him to the vet.  The vet did a Xray and found that he has kidney stones.  I have been treating him for about two weeks to help melt the stones away. Some of them have gone, but still have some.

I give him 2cc of Sulfatrim Suspension twice a day, and 100cc of Lactated Ringers once a day, he also is getting 500mg of Vitamin C. He does not eat as much as he did before, but still is eating. I have listed his last blood
results from 6/30/08.
BUN/UREA 52mg/dl, CA 15.2mg/dl, CREA 6.7mg/dl, PHOS 3.2mg/dl.  His blood level was very low, where the color of his eyes where more pink, than red.  This has improved and his color are much clearer.

I have taken him off of Alpha pellets for these are high in calcium. Is there something else I can do to help him
melt these kidney stones. Should I have them surgical removed or is what I am doing enough.  He does not seem to be in any pain,he plays and acts the same.

Any thing you can give me would be great.
Thank you for being available to answer my questions
Jeani Soares


ANSWER: Dear Jeani,

Kidney stones really cannot be surgically removed in a rabbit without doing serious damage.  If the stones are gradually going away, I'd keep up the treatment and hope for the best, especially if he's acting fine.

At the moment, his blood values for kidney function are not the best.  His BUN and creatinine are both high, though his phosphorus is in the normal range.  This suggests that the stones have done some damage.  But I hope with supportive care and continued treatment, he will be able to deal with it for a long time to come.  If he is anemic, then it's possible that his adrenal function is also compromised, as this is where epogen is made, which stimulates the production of red blood cells.  Hence, anemia often accompanies renal disease.

I think the condition is being treated as well as it can be.  All that's to be done now is hope for recovery.  And give him lots of love and spoiling!  :)

Dana

---------- FOLLOW-UP ----------

QUESTION: It looks like my earlier question did not reach you.
My bunny is not doing very well.  He is unbalance and I am giving him crital care from Oxbone to get someting in his stomach.  I have changed to 200cc of ringers a day and to Baytral.  I was wondering if I give him stereos would it  help his balance. Should I stop the ringers, are they hurting him.  Do you know if there is anything else I can do for him that will remove the kidney stones. Are there many reports on rabbits that have made it through kidney stones.  How do rabbits get kidney stones. This is a hard time for me and my bunny and I thank you very much for wanting to help me on my questions.

ANSWER: Dear Jeani,

I'm so sorry that your friend is not doing well.  Unfortunately, at this point it is not so much the kidney stones themselves that are the problem, but his failing kidneys.  In the last stages of renal failure, the patient is unable to remove toxins from the bloodstream at all, and very often begins to show neurological signs of trouble.  

You don't say how much he weighs, nor if he is drinking a lot on his own.  Sometimes excessive fluid therapy can do more harm than good, throwing his electrolyte balance out of whack.  If his kidneys still have some functionality, he may be able to regulate his fluid intake on his own.  But to know how far gone his kidneys are, we'd need to have recent blood values for BUN and creatinine (and others).  Once these levels start to rise, it is very difficult to keep them down.

Steroids will not really help all that much, since inflammation is not the main problem.  They might make him feel somewhat better for a short time, but they are not a permanent fix.  Please ask your vet about getting him some powerful pain medication, as renal failure can be very uncomfortable, especially once neurological signs begin.

I wish I could tell you there was something more that you could do.  I have nursed several bunnies through renal failure myself, and it is never a happy thing.  The bunny love of my life left me from this very disorder at the age of only three, and there was nothing I could do.  Renal disease is one of the most terrible and frustrating disorders because there is only so much one can do.  Dialysis for rabbits just doesn't exist, and that would be his only hope once the kidneys fail completely.

Kidney stones are a by product of metabolic bone disease, and because rabbits excrete excess calcium via the kidneys (unlike most other mammals, which excrete it mostly through the digestive system), they are very prone to calcification of the kidneys.  And this can cause the kidneys to fail.

Rabbits can survive kidney stones if they can pass them.  But it sounds as if your bunny's kidneys may already be so calcified that they are no longer functioning.  It's time to talk to your vet about doing another blood value check, and go from there.  In the meantime, give your bunny all the love and spoiling you can give him.

I wish there was more that could be done.  But there probably is not.

Dana

---------- FOLLOW-UP ----------

QUESTION: HI DANA.  Hope you are doing well.  I wanted to let you know that I lost my baby boy this Saturday.  He went to his vet visit and his blood level went down to 9 and the BUN and Crea was higher than before. How can I prevent this from happening again when I am ready to get another bunny.  

My sister told me that there is a new medicine they are using on cats and dogs called AZODYL. It helps with their Renal disease.  Could this be used for rabbits. It seems they have the same problems.

Thank you again for your help in answering my questions.
Jeani

Answer
Dear Jeani,

I am so sorry to hear of the loss of your friend.  Your descriptions of his condition didn't sound very hopeful; renal failure is not something that can be reversed.  I'm glad you were with him, and that he had the best loving care any bunny could have.

Unfortunately, no one knows why kidneys fail.  It can have a genetic component, especially if the bunny has metabolic bone disease that causes calcification of the kidneys and associated structures.  Sometimes environmental insult can cause it--but that would be a case of poisoning that you probably could not predict.  In short, there is really nothing one can do to predict or prevent this problem except provide a healthy diet, a stress-free environment, and an overall healthy home.

I've not heard of Azodyl, and have never heard of its use in rabbits.  From what I see of the product description on the web, it sounds pretty promising.  I'll have to check with our pharmacologist rabbit rescuer and see if he's heard anything.

But I hope you never have to worry about it again with another bunny, and that if you have another bun in your heart and home that all will be well.

Take care,
Dana