6-year-old rabbit has kidney failure

[minmelethuireb]

I have a spayed 6-year-old Dutch rabbit, Penelope. I took her to the vet 4 months ago for a routine checkup, and they did blood work and said that her kidney levels were on the high end of normal. She seemed fine until this past Sunday when she stopped eating. I took her to another vet and they did blood work.

Creatinine: Was 1.3, now 3.3 (I think the normal is max 2.3)
BUN: was 18, now 100 (normal is 13-30)

So it got way worse. The vet is telling me it is probably genetic and I didn't do anything wrong, but I am worried because my 8-year-old Mini rex just died about 4 months ago from kidney disease/massive amounts of bladder sludge. I know they are technically seniors, but I've never had this issue with my rabbits.

This is very depressing, because I know kidney failure is not reversible, and considering how it got so much worse so fast I'm afraid she doesn't have long to go.

I feed Oxbow timothy hay, about 1/8-1/4 cup of Oxbow adult Essentials per day, and romaine lettuce. I give filtered water.

I just don't think I can improve this diet much. Out of paranoia, I got rid of the old bag of rabbit pellets and bought Oxbow Garden since that's what Petco had (seems to have good ingredients). I also stopped Romaine and started giving red leaf lettuce, dandelion, and cilantro.

I'm worried it might be E coli from the Romaine, but wouldn't that cause diarrhea? I think I should bring a fecal sample in to check for this.

She is eating now. on Sunday I started feeding Critical Care from a syringe. The only thing she would eat is a bag of dried plantain weed I got from a UK rabbit company (, which had me worried because I can't buy that here.
Monday I took her to the vet and got blood work, sub Q fluids, an antibiotic, and Bene-Bac. I fed about 4 TBSP of Critical Care.
Tuesday she started eating lots of dandelion and some hay. I fed about 2 TBSP of Critical Care, and I also started mixing unflavored Pedialyte into her water.
Yesterday she continued to eat lots of greens and actually ate some pellets, which she hadn't touched since Sunday. I'm having a hard time telling how much hay she's eating, since I put a lot of Timothy and orchard grass hay in for her. I fed 1 TBSP of Critical Care just to make sure she was getting enough food.

 

[JBun]

Has your vet done any xrays? Or was a blood test done to check for e. cuniculi? It can be a common cause of kidney disease in rabbits. And for you to have two rabbits that have it would make me think there is a possible cause like this, that they could have in common. If your rabbit does have EC, I don't know what could be done at this stage, but normally panacur would be given for a month to treat EC, so that might be an option. Though it won't reverse damage already done, it could help reduce further damage caused by the parasite. As regarding e. coli contracted from food, as far as I'm aware it only causes digestive problems in rabbits. Though it is possible for a kidney infection from a bacteria, to cause kidney disease.

Has your vet started your bun on any meds that help with kidney disease, such as an ACE inhibitor or anabolic steroids?
'ACE inhibitor lowers blood pressure and increases renal perfusion, helping preserve the remaining function of the kidneys. (P3.2003b.w1) In a preliminary study, benazepril (0.1 - 0.5 mg/kg daily orally) increased survival rates of rabbits with renal disease; urea and creatinine were decreased (suggesting an improvement in renal function).'
Potassium blood levels can be affected so this will need to be monitored and supplemented if needed.
Anabolic steroids can help reduce uremia, increase appetite, and help stabilize electrolytes.
If your rabbit is anemic, there is also the erythropoietin hormone that might help with red blood cell production.
http://wildpro.twycrosszoo.org/S/00dis/Miscellaneous/ChronicRenalLagomorph.htm

You may also want to ask your vet to show you how to do sub q fluids at home and get a prescription for the fluids, so you will be able to administer them as needed.

So though the damage can't be reversed, there are meds that can be given that will help reduce symptoms, prolong your rabbits life, and make her more comfortable during this time.

Diet wise I'm not sure you can be doing any more than what you are already doing, and making sure to limit calcium. But I think if you aren't already giving those suggested meds and your vet starts your bun on those, they should help with your buns appetite because they'll help her feel a bit better.

 

[minmelethuireb]

The only med i have is trimeth-sulfa which they gave in case there is an infection. My favorite rabbit vet is on vacation this week, but I have an appointment with her on Wednesday

 

[minmelethuireb]

I'll ask her about these other options, thanks

 

[RavenousDragon]

Steroids are very bad for rabbits-- so a vet will not likely prescribe these as you would a cat or a dog. Steroids will lower their immune system so much that normal bacteria could kill them.

E. coli has been known to infect kidneys in HUMANS, but I'm not sure about rabbits. E. cuniculi could be a culprit, but generally E. cuniculi doesn't affect healthy rabbits, just those which are immunocompromised. Is she urinating ok (a blockage from sludge could cause azotemia (high renal values), but not if she's urinating ok)? Was she hydrated at the time of the blood draw for these values as well? Sometimes extreme dehydration (not eating/ drinking) can cause these values, although generally not this high.

 

[minmelethuireb]

She is urinating okay, she might have been a little dehydrated when they did the bloodwork but it's hard to tell

 

[RavenousDragon]

She'd have to be pretty dehydrated to get those values, so I bet you'd notice. This type of renal disease is probably either congenital or E. cuniculi, but high E. cuniculi titers don't necessarily mean E. cuniculi is causing this (it is possible, though). I would get radiographs like Jbun suggested (just in case there is a lot of bladder sludge/ stones) but don't believe that any of this is your fault. Both sludge and general renal disease are often just congenital. Sludge of course, can be caused by a high calcium diet (sludge is calcium oxalate crystals in the urine), but I don't think that's the problem in this case.

 

[minmelethuireb]

Update: Penelope has been eating very well the past week. I took her to the vet today to have her blood rechecked, and her kidney levels are back to normal! 1.2 for creatinine and 19 for BUN. The vet is thinking she was a lot more dehydrated than I thought. She took an X-day and said her kidneys look like a normal size but a little 'abnormal', and she said something odd is that all the organs seem too be pushed low in her belly. Its like her kidneys are floating up where they should be, but her intestines are really low and have a lot of blank space above them. She said she had never seen that before, so she's sending the X-day off for a consult. I am very pleased that her kidney levels went back down, and Penelope is eating and very happy.

 

[JBun]

That's such great news! I'm so glad your rabbit is ok. That's such a scare when you think they might have failing kidneys. I have a rabbit that was drinking loads of water and that was my concern and the vets, but luckily with my rabbit too, it was something else that was fixable.