Case Examples – Nutritional Management of Medical Conditions


Author: Dr. Clarissa Noureddine, DVM, MS, MS

As we head into the month of May, our ‘Paws to Protect’ focus will highlight the topic of nutrition. We want to kick off the month with a blog focusing on some really cool things we can do to help medical conditions by using targeted prescription diets. At first, it may seem unlikely that feeding a special diet could have such a profound impact on a medical condition. Yet, when you start thinking about the science behind the prescription diet, it really all makes a lot of sense!
Check out these real-life case examples of Lawndale Veterinary Hospital patients that have benefited tremendously from prescription diets!

Case 1: Chronic Kidney Disease

Veterinarian: Dr. Waterman
Patient: Gaby Allen
Breed: Standard Poodle
Age: 13.5 years old
History: Gaby presented to Lawndale Veterinary Hospital for her routine annual examination in March of 2017. Gaby’s owner felt Gaby was happy and doing great at home.
Physical Exam Findings: No physical examination concerns.
Diagnostic Findings: Routine senior wellness labwork revealed that Gaby had developed kidney disease. Her kidney values were elevated: Blood Urea Nitrogen (BUN): 37 (Normal 9-31); Creatinine: 1.7 (Normal 0.5-1.5)
Diagnosis: Stage II Chronic Kidney Disease (CKD)
Treatment Plan: Gaby was slowly transitioned from her diet to Hill’s Prescription diet k/d (kidney diet). No other medical therapies were initiated at that time.
The International Renal Interest Society (IRIS) has developed a chronic kidney disease (CKD) staging system to help in understanding where a patient falls in the progression of CKD. Since Gaby was diagnosed with Stage II CKD, this means she had less than or equal to 33 percent of her kidney function remaining. Dogs in early stages of kidney disease can benefit tremendously by simply placing them on a prescription kidney diet. The kidneys help filter waste and toxins from the body and also maintain fluid and mineral balances within the body. Animals who develop kidney disease have damaged kidney tissues. They may also lose muscle because of a decreased appetite.

Hill’s Prescription Diet k/d helps support the animal by:

  • Lowering phosphorous to slow kidney disease progression
  • Lowering sodium to help control clinical signs associated with kidney disease
  • Reducing protein to a level that meets nutritional needs while minimizing kidney disease symptoms
  • Providing high levels of essential amino acids to help with muscle mass
  • Providing antioxidants to reduce the stress on kidneys and reduce cellular oxidation
  • Containing therapeutic levels of L-carnitine and Omega-3 fatty acids to help slow the progression of kidney disease

Studies have shown that pets diagnosed with kidney disease who are fed k/d will have a slower progression of kidney disease and exhibit fewer clinical signs. In fact, a two-year study with k/d found dogs with CKD that were fed k/d lived twice as long as dogs fed a typical grocery store food.

Follow-Up: One year later, Gaby’s values are doing great (BUN: 26; Creatinine: 1.6)!

Case 2: Struvite Stones

Veterinarian: Dr. McGlothlin
Patient: Momo Nall
Breed: Shiba Inu Mix
Age: 7 years old
History: Momo presented to Lawndale Veterinary Hospital on November 2, 2017 with reports of a “brownish” tint to the urine. Momo was also hiding and not herself.
Physical Exam Findings: Dr. McGlothlin was actually able to feel bladder stones in Momo’s bladder.

Diagnostic Findings:

A urinalysis revealed Momo had blood in her urine, a bladder infection, struvite crystals (see picture above, left), and alkaline urine.

Abdominal x-rays showed two large bladder stones (see the large mineralized structures in the bladder just in front of the hind limbs in the x-ray above, right)
Diagnosis: Bladder stones and crystals; urinary tract infection.
Treatment Plan:
1. Treat the urinary tract infection with antibiotics.
2. Remove the stones. Surgical removal is certainly an option for bladder stones. In this case, since Momo had struvite crystals, it was likely that the stones were also struvite. Momo’s owner wanted to try medical management before moving to surgery. This is possible in the case of struvite stones, because there is a prescription diet that can work dissolve the stones. We selected Hill’s Prescription Diet s/d in an attempt to medically manage the stones.
3. Recheck to follow up on the progress of the infection and the bladder stones.

The technical term for struvite crystals is magnesium ammonium phosphate crystals. Struvite crystals and stones most often develop in the urinary tract due to the presence of an infection with urease-producing bacteria. These bacteria form ammonia, which is then converted to ammonium. This causes the urine pH to increase (it becomes more alkaline). The ammonium is then also available to form magnesium ammonium phosphate crystals (struvites) in the bladder. The crystals can then form urinary stones.
Once you understand the process of struvite formation, it starts to make sense that if you (1) treat the infection and then (2) alter the conditions in the urine through diet, you can potentially remove the problem.

Hill’s Prescription Diet s/d works by:

  • Acidifying the diet to increase the solubility of the struvites
  • Decreasing protein levels (which decreases the substrate needed by the urease-producing bacteria)
  • Decreasing levels of magnesium and phosphorous (components of the struvite crystals)
  • Providing antioxidants


A follow-up in January 2018 showed the bladder stones were 25% smaller (x-ray above, left). Then, on March 16, 2018 x-rays revealed the bladder stones were no longer visible (x-ray above, right)! Since s/d is not a diet that should be fed long-term, once the stones had dissolved, Momo was gradually switched to a different diet that will help prevent the development of bladder stones in the future.

These are just two case examples of many pets who have been helped through prescription veterinary diets. Are you wondering if a different diet may benefit your pet? Then talk with our team today!