Geriatric Rabbit and Possible Renal Failure

Question
QUESTION: Our rabbits Marshmellow and Nunzio are 9 years old.  Both started having litter box problems a few months ago and have lost weight. I'm assuming they are having renal failure or something along those lines. Marshmellow took a turn for the worse today, so the situation is becoming critical. These are my babies and I'm heartbroken that we do not have the money to have all the necessary test done. I'm considering taking out a loan. My questions is this, after all the expensive tests, if it is renal failure, is there anything affordable that can be done to help them? I HATE putting a price tag on my furbabies lives, but circumstances are forcing me to be practical.

ANSWER: Dear Elizabeth,

Renal failure can cause wasting and loss of function, but so can other things.  Weight loss can result from an inability to eat properly due to molar spurs, which is eminently treatable. Please read:

www.bio.miami.edu/hare/dental.html

And their inability to get into the litterbox could be simply due to arthritis, which can be treated with some of the excellent analgesics (e.g., metacam, tramadol) available for rabbits now.

Please see an experienced rabbit vet:

www.rabbit.org/vets

for an oral exam and general checkup.  If the problem is renal failure, the only thing to do is offer supportive care.  But if might not be that.  And I'd hate to think of your bunnies wasting away from something that could be quite treatable.

I hope this helps.

Dana

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

QUESTION: Thank you for answering so quickly.  Marshmello's molars are fine (she is eating well) and she can get in and out of her litter box with no apparent stiffness.  The weight loss and urinating outside of the box started along with a marked increase in her water intake. I love my vet but we just finished paying off a 1,200 bill for my sweet Gizmo that we lost at the age of 22. Is there any way to treat renal failure?  I'm guessing not, but I've got to ask.

Answer
Dear Elizabeth,

The increased fluid intake isn't a good sign, as you know.  The only treatment for renal failure is palliative: subQ fluids only when the bunny is feeling poorly.  I am NOT a big fan of "prophylactic" subQ fluids.  When one introduces high levels of LRS, one also causes imbalances of multiple electrolytes.  

In many cases, a bunny with renal disease seems well able to manage control of the condition with excessive drinking.  When this happens, I do not interfere unless the bunny has a "bad day" and is lethargic and unhappy.  In this case, fluids seem to help flush the system.  But otherwise, I let the bunny regulate his/her own fluid intake, since the body's own homeostatic mechanisms are *amazingly* good at telling the animal exactly how much fluid to ingest.

This is becoming more common practice in human medicine dealing with renal disease, and I'm surprised more vets are not following suit.  I really believe that you can do more harm than good with excessive fluid therapy.

So unless your bunnies start to show signs of lethargy, neurological signs, etc. I would let them manage their own condition and stay the course.

I hope they'll be able to maintain their health for a long time.

Dana