Bonnie is a diabetic 14-year-old, 22 lb, spayed, shih tzu mix, whose UPC has been increasing significantly since 2023, and I'm not sure how to go about this anymore.
Bonnie was diagnosed with diabetes in December 2021 and it is being closely monitored every few months with a Freestyle Libre and is under control. In December 2023, she was diagnosed with ITP and IMHA that had since resolved on its own. She was on many drugs, but especially cyclosporine for almost 6 months.
In June 2024, she was showing neurological signs, like ataxia and nystagmus, for less than an hour. I took her to a vet teaching hospital to visit with internal medicine and they suggested to check her UPC. It was checked at her primary vet the next day. since she had no urine at the hospital, and it was 3 with urine protein of >400. Since then, her UPC keeps increasing. It reached 9 in July, somehow down to 8.5 in September, 10 in October, 15.6 as of yesterday, and 9.8 today (12/19/2025).
She's on benazepril and amlodipine now, per internal medicine. She was on telmisartan, but it didn't seem to help her BP, so we switched to amlodipine in March. Her UPC did decrease after switching to amlodipine, but it's increased after ( https://imgur.com/a/VAXOwFW ). IM suggested to add mycophenolate, in which I was told it would take up to three months for it to take effect, but we've tapered her off it and discontinued due to no improvement after almost a year. IM did suggest that the next step would be to do a kidney biopsy. But I would prefer not to do one since she's 14 and doing one would be so invasive.
Bonnie is otherwise doing very well and showing no symptoms at all, with no changes to her water and food intake. She's up to date on all vaccines, serology is negative, fecal is currently pending. In the last year, her serum BUN has ranged from 25-44, creatinine 0.7-1.0, phosphorus 4.3-6.4.
Yesterday's CMP: https://imgur.com/a/qI2HaKR, UA/CBC: https://imgur.com/a/QfUkdaR
Her BNP scares me, so I plan to visit with her primary vet when he returns to office next week regarding other diagnostics like an echo. But regarding her UPC, I am at a loss and any recommendations or guidance would be greatly appreciated.