What they asked
“16-year-old Yorkshire Terrier with recurrent severe pulmonary edema, mitral valve disease and kidney dysfunction – looking for veterinary opinions Hello, I'm reaching out to ask for veterinary advice regarding my 16-year-old Yorkshire Terrier, who has been struggling with recurrent pulmonary edema...”
Read the thread →I see you provided the rest of the information. Rule of thumb for emergency azotemia is that halfing the highest creatinine value is considered a successful management for the aoztemia. Kidney damage is not reversible due to having a set number of nephrons that take damage with kidney injury events. I suspect at a physiological level that the diuretic efficiency has decreased as there are less nephrons for the medication to work on. You have to increase dosages to achieve a therapeutic level (level where the drug actually works). The only other medical management help I can think is to add a thiazide diuretic or sodium sparing diuretic to work at another level of the nephron. Those additions would require frequent bloodwork to make sure electrolyte abnoramilities won't develop. Unfortunately, his kidneys may be unable to keep up with a balanced fluid state due to his progression and he will keep having fluid backup into his lungs.

Dylan Wilson, DVM
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