Melissa Kaplan's
Herp Care Collection
Last updated January 1, 2014

Iguana Kidney Failure: Personal Perspective

Final update: December 14, 1997

Melissa Kaplan

Treatment
Quick Link to Status Report
Some Final Maunderings...

Wally...
Wally is the first iguana I raised from a baby. He has been my "main" iguana: he has accompanied on my travels around the state, attended all of the educational events and schools I've done, hit the bookstores, hardware stores and other non-food stores with me; in short, highly tamed and socialized, and an excellent teacher in his many expressive, non-verbal ways. You can read about some of my experiences with raising him and the research I started doing in my Wally article. In brief, Wally got small (and decreasing) amounts of dog food and tofu when a baby to about 9 months of age, with the dog food continuing until I cut it out completely at about 2.5-3 years of age, being finally convinced that they did not require it.

Wally has had a few bouts of resistant abscesses from iguana bites, necessitating surgery to clean them out and systemic antibiotics, either amikacin sulfate (Amiglyde-V) or enrofloxacin (Baytril). In 1996, he had two very resistant abscesses which were being treated Baytril. When they failed to resolve in a reasonable period of time, cultures were done which confirmed Baytril was the right drug; the dose was doubled as per recommendations for resistant infections.

In the fall of 1996, Wally suddenly went blind. No cause was ever found, and he did regain his sight (and confidence) after several weeks. Residually, he has problems using is hind feet - just the feet, not the legs - but again nothing has been found. He ambulates well, still climbs up things (down is a little harder and, in some situations, impossible), displays and chases off subordinate males, and most recently has been using them to grip in an attempt to avoid injections.

Onset
In the last week of August 1997, Wally became quieter than usual, but not usually so for a pre-shed period. On Thursday, August 28, I awoke to find that he had become dramatically dehydrated and lost a visible amount of weight overnight. This is a sign I associate with end-stage kidney failure, having been through it too often before with rescued iguanas. I immediately started injecting him with saline (15-20 ml/kg/24 hrs).

He was having trouble eating as his tongue didn't seem to work right - it seemed to be more than just the thickened saliva due to the dehydration, so feeding had to be assisted. At times he would sit with his mouth slightly agape, the tongue sticking out. There was no sign of respiratory infection (of which gaping is a common sign). I was, along with fluid injections, giving him fluids orally, with a long, soft plastic, 3 cc eye dropper, mixing liquid calcium and vitamins in with the Pedialyte or water that I was using.

On the off chance that it might be a kidney infection due to a systemic infection, I also started to give him Baytril, but became concerned that all the Baytril he's been on in the past year may have precipitating the kidney problem, so stopped. Instead, I started giving him colloidal silver. This is a sort of old-fashioned antibiotic in liquid form, in wide use before penicillin was discovered. I have no idea if it really works or not; all I knew was that it would not hurt him.

Course of action
Weak as he was, I could not safely restrain him to give him intraperitoneal (IP, also called intracoelomic, or IC) injections of fluids - that is, fluids injected right into the abdominal cavity (coelom). You can inject a greater amount here than you can subcutaneously (subQ, or SQ), and it is absorbed better. Care must be taken when giving IC injections as you have to avoid the ventral vein that runs close to the surface right down the midline of their chest and abdominal cavity, and you have to avoid sticking any organs or the intestines. When working with a lizard with incredibly thick, hard skin (Wally's is like rows and clusters of serrated knives over most of his body, specially his ventral surfaces) who is thrashing around, it is best to have assistance when doing ICs. Fortunagely, I have a friend who has worked in wildlife rehab before and wasn't afraid of working with Wally. Glenn has been wonderful about coming over every day so that Wally can get at least one IC injection, with all the other fluids being injected SQ during the course of the day. We are both spending a lot of time just holding, cuddling and petting Wally so that he doesn't start associating contact, especially with Glenn, with just the pain and stress of the injections.

Past experiences I've had with kidney failure have been acute and abrupt. Behavioral changes begin to occur up to two weeks before the acute onset of the rapid dehydration and weight loss, with the latter happening within 24 hours, with continued dehydration and weight loss despite fluid and nutritional support (with no interest whatsoever in food), lethargy lapsing into unconsciousness, seizures, with death following within 24-48 hours. (Other signs I've seen or heard of include severe swelling of the eye orbs and drooping of the lids, and extensive and sudden swelling of the neck and dewlap (not the swelling of the subtympanic scale area, associated with normal male maturation)). When iguanas have remained non-responsive, or progressed to the seizure state without any improvement, rather than let them linger till death, I have euthanized them.

Wally, on the other hand, while being lethargic, still spent some time alert to his surroundings, and seemed interested in food although he would give up when he couldn't get it down unless I assisted him (altered food preparation and squirted fluids in his mouth when he was trying to work it down his tongue, pushing the food a bit with the eyedropper). Instead of getting worse, he seemed to rally, enough so that Glenn was finding his arms tattooed with the raised, keeled edges of Wally's scales after holding him for injections. On Wednesday, September 3, I took Wally to my vet for a blood work-up. Despite being bathed and pooped before we left home, Wally kindly gave the vet a fecal sample to be tested while he was there (found positive for protozoans, so he is being treated metronidazole now, as well). He told me when I picked him up later than he believed he felt the kidneys when palpating the ventral area. Healthy normal kidneys cannot be felt, nor seen on x-rays, as they are hidden inside the pelvic girdle. When swollen and hardened, they can be felt and sometimes visualized on radiographs. We decided to not x-ray at this time, nor do a biopsy.

Blood Chemistry
I have always stressed that people should take taking reptiles to vets who are experienced with reptiles. Not only are reptiles different from mammals and birds, their parasites and blood chemistries are different, too. A good reptile vet will also use a lab who is experienced in reptile pathology, as reptilian norms are different from those of other types of animals. In this case, the blood was sent to a lab in Sacramento (Cal Vet Diagnostics) for the running of the Exotic and Reptile blood panels.

Treatment
At this time, I am continuing with the fluid injections, oral fluids, nutritional support, and liquid vitamin supplements. Reptile vet Ken Harkewicz (Berkeley, CA) and some others have been trying phosphate binders to help stabilize early kidney failure. Dr. Harkewicz recommends using Amphojel (an over-the-counter liquid antacid, active ingredient 64 mg aluminum hydroxide per 1 ml) at the rate of 0.5cc/kg, twice daily for 21-30 days, continuing the supportive fluid and nutritional support.

In the course of the physical exam, my vet found that the inside back of Wally's mouth was all swollen. This was something neither of us had ever seen before. Dr. Harkewicz. says that it is usually due to elevated levels of uric acid, and can be reduced using methyl-prednisolone injections (1 mg/kg IM).

While success is not necessarily assured, it is something to try...so try I will. Wally is starting to glare at my hand, inspecting it closely for needles and syringes whenever I simply pet him now. While I would not blame him in the least if he tried to take a chunk out of me or Glenn, he has not made any suggestion of biting. It is so sad to see him suck his tummy in, trying to get away from the needle. He also gives great exhalations of breath, sounding anthropomorphically like deep sighs, when he finally submits to the numerous SQ sticks as I shove 10cc at a time into each area, doing 30-60 cc at a each session.

Status Report

Sept 9
Wally has by now had his Depo-Medrol (methyl-prednisolone) injection to reduce the inflammation in the back of his throat. The swelling has started to go down, but he still has to be cajoled into eating (I'd hoped the steroid would boost his interest in food). His tongue hasn't stuck out since he got the Depo-Medrol, so that seems to confirm that the swelling has abated somewhat.

He's been on the Amphojel daily now for 6 days, and still gets a rather surprised look on his face from the minty flavor.

I was starting to get blood every time I tried to do an IC injection so I gave his belly a rest for a few days and went strictly with SQ...even using a topical anesthetic (Bactine, which contains lidocaine), he has grown so tender and strong enough to make the dozens of sticks a day an ordeal. Yesterday, I thought I would try to get him to drink more, and to administer fluids orally.

He is, physically, looking better: his skin doesn't look or feel so dried out, shed is coming off easier, and he has filled out, losing those lateral horizontal and vertical folds associated with serious dehydration.

One new concern is his tail. When being held vertically for the belly sticks, Glenn, to give me wide enough access to the belly to fit my hand and the 60 cc syringe in at the shallow angle I needed, was holding Wally with one hand across the shoulders, both supporting his forearms and using a finger or two to rub his chin and dewlap, which does seem to help distract his focus from the injection when done vigorously enough. Glenn's other hand was placed below the pelvic girdle, and several inches down the tail. As Wally struggled when feeling the sticks, Glenn would hold with both hands to try to gently restrain him, both of us fearing the needle breaking off in the belly or it being forced too deeply and puncturing something. Well, Wally's tail has been twitching and vibrating when touched or petted in that area now, looking uncomfortably like the movement of an autotomizing tail (preparatory to part of the tail being released from the main tail), making me fear that he will drop it. It's almost as if one of the trigger points that starts a tail-release has been activated (injured? severed?), and drop signals are being fired, but incompletely, so the drop has not occurred. Since the sensitive point is barely a few inches below the bottom of his hemipenes, it's made me quite nervous.

He is still rather quiet. The saliva in his mouth is still thick, so I continue to do squirts, including to help get food down. He's been sleeping on my bed at night - something he's never been interested or willing to do since I've had him. He will only stay there if I put him there later in the evening, usually after an hour or so of an extended cuddle session. Between the towels and heating pad over him, he is warm enough, and seems to be making himself comfy enough propped up like a raja on the comforter and pillows. His sleeping there is more for me than for him - I can reach out and touch him at night, monitor his respiration, and will know if, heaven forbid, he starts seizing.

And so starts another day...

Sept 10
Yesterday, while doing a little al frescodining outdoors on chard and grape leaves, I didn't get my finger out of his mouth quick enough when helping him get some greens in, and his uppoer teeth bit through the middle fingernail on my right hand. Since he is still not self-feeding as much as I'd like, today I'm blending together some squash, liquified alfalfa, vitamins, calcium, lemon balm, golden seal, and some Endura-Jel (boost calories without boosting volume) to tube him in addition to what he is self-feeding... He's still looking filled out and alert, though still quiet.

I talked briefly by email yesterday with a fellow I know whose huge, handsome 10-year old iguana, Hood, died suddenly earlier this year of kidney failure. Later in the day, I got a call from a friend of mine who just lost one of her six-year old iguanas, also to kidney failure. One of the vets she saw in the week that Stimpy was ailing said that he is seeing and hearing from others of a rash of big, otherwise healthy older males who are succumbing to kidney disease.

Between these mounting deaths despite what we know to be proper care, and too damn many phone calls and email from people trying to find homes for their "beloved" 6-7 year old iguanas because they are too big/take up too much room/won't let their owners pick them up despite the owners' claims that they are "very "tame. I continue to question whether these lizards should even be kept in captivity since, despite decades of captive care, we still can't seem to keep most of them alive anywhere near their wild lifespan...

Sept 17
Well, we're still here. Wally is still getting the phosphate binder, and got his second dose of metronidazole. He has not been eating or drinking as much as I would like, so I have started forcing slurry on him again. Glenn brought some lovely rose petals and squash blossoms over last night, and got Wally to eat those along with some squash, collards, and grape leaves. He was very quiet again yesterday - alert, but quiet.

Sept 24
Still very quiet, still not defecating, though he did do a little bit yesterday (from all the praises he got, you'd have thought he scored 1600 on the SAT or something). He still will not drink on his own, so I've powered up the syringes again, hung a new bag of saline from my kitchen cabinet, and will be picking up another box of needles from the vet today. I'm still giving the Amphojel, but will be switching from giving mineral oil orally to trying it at that other end of his digestive tract. His face is getting bony. He's already lost most of those magnificent soft swellings on his head and his jowls, but now the bony postorbital ridges caudal to his eyes are painfully apparent...

Sept 28
Well, as they say, be careful what you wish for. Wally isn't constipated any more, nosiree. I must have done more loads of bedding and towels (including my king-size comforter twice!) in the past 24 hours than I have all year! Wally is now going but it is all liquid - major diarrhea. He seems particularly prone to going shortly after (or during) forcefeeding and fluid injections... I'd like to think it's because he feels well enough to try to get back at me, but I fear it's more basely physiological than that. So, along with being force fed and injected with fluids, he is also getting Kao-pulgite. The force-feeding slurry I will squirt into my mouth to show him how yummy it is (this week, it's strawberry Boost, mashed banana, calcium glubionate, mixed together with some some goldenseal, echninacea and B-complex), but I draw the line at the Kao... He is still painfully thin looking, more so than the last time I wrote. He's been lethargic, too, more so than he was for a bit. I can't believe we are in our third week...it seems like it's been going on forever...

Oct 2
I got to thinking earlier this week that it has been more than just three weeks - I remembered that I had to leave a meeting early in late August to get home and do fluid injections, so we are really in our sixth week... No change from last weekend - still dehydrated, constipated again, being force fed and getting fluid injections and by mouth. He's a little incontinent, dribbling urates out (especially after injections and force feeding) so I'm still doing loads of laundry. Six weeks is good...right?

Nov 1
First off, Wally is still here, well, in the bathtub, to be exact. I've been getting some mail from folks who have been concerned at not seeing updates, fearing the worst had happened. Well, it hasn't as of yet. The lack of updating (and overall website work and dealing with my @sonic email) has had more to do with my own health than with Wally...

He continues to require daily fluid and nutritional support, only rarely showing any interest in food. I have been able to get him to eat a little solid food, but have to rely on forcing slurries into him. I've been trying to give him some needle-free days now and then, just to give him and his poor skin a break from getting stuck several times a day. Not that he's particularly thrilled with having all that fluid administered by mouth, but we are dealing.

One other ongoing problem, besides the daily routine of forcing fluids and food, is the fact that he is always bloated. He is still somewhat incontinent, never able to get it all out at once. The bathing and massaging isn't doing the trick, nor is anything else I'm giving him working to relieve the situation.

A couple of times over the past week or so, he has climbed down from his basking area in the den and made his way into the Iguana Room, his old hang-out. Even though he hasn't been there in a while, and even though he isn't moving with his old speed and his ability to climb is impaired, his presence is enough to cause Rugwort to turn dark and Frankie to immediately lose his bright orange-and-white coloring as he goes scurrying out of the room, crabwalking to get by Wally. Guanie remains as out-of-sight as he can get from Wally, creeping by the doorways of the rooms Wally is in. It is interesting that, despite Wally's drastically altered behavior and even appearance (he should be looking like a pumpkin at this time of year, in full breeding season color, but is instead has even less orange than his usual out-of-season dominant male coloring), he is still considered to be the alpha male by the other males here and treated/avoided accordingly. Which is just as well....the stress of being challenenged could well destroy the fine balancing act currently being maintained by his overly taxed immune system.

Yesterday, Wally tried to climb up onto the top of the basking area in front of the window...but couldn't get all the way up. I heard his attempts and so went in to assist. I provided traction for his hindlegs and he made it to the top...whereupon his swung his head around and nipped at me as I pet his head and neck. It was as if he was upset at having had to be helped up and so took it out on the nearest target. He seemed happy enough after spending several hours there to return to the den after another bath. Having been a caretaker to seriously ill and terminal humans, and knowing many chronically ill people who have daily caretakers and personal aides, I see some definite similarities between some of Wally's behavior and reactions to me. I am now his caretaker/aide in a way far surpassing that of the usual healthy iguana/owned human relationship. His occasional snappishness, especially when frustrated at not being able to do things he used to be able to do with ease, occasional querulousness during feeding and fluid time, the sometimes resigned, sometimes grumpy air with which he tolerates my working with him getting him cleaned up or in and out of the bath...

And that's the way it is, here in Week 11... Wally and I both send our thanks for the kind thoughts and letters from those of you who have written to enquire about his health...

December 13
During the last month and a half, Wally has been up and down. Never up enough to say he's much better, but at least able to show his continuing displeasure at being stuck with needles and have syringes stuck in his mouth for feedings.

This morning, after a couple of days of increasing edema, he went downhill very fast. Breathing problems, obvious discomfort, unresisting when I put the needle in for morning fluids...I decided to give it an hour or so to see if it continued or got worse, in which case I was going to have him put to sleep. Perhaps not wanting yet another needle stuck into him, Wally died shortly thereafter.

While he was not my first iguana, he was the only one I ever intentionally acquired. He has been my constant companion for all but a few days during the past almost 7 years. He has seen me through the death of my husband, my own health ups and downs, traveled with me, moved across state with me, gone to school with me, and has been an effective educator and ambassador himself, communicating eloquently both on the importance of preserving the remaining rainforests as well as the plight of reptiles in the pet trade, especially that of green iguanas. His commanding presence and patient soul and will be greatly missed...

Thank you all who have been so supportive to the two of us through the past several months...your kindnesses and thoughtfulness has been greatly appreciated...

Some final maunderings...
What we don't really know, of course, is what the mortality rate is in the wild. Some research has been on wild iguanas which indicates that there is a surprisingly low survival rate of hatchlings in the wild - more than I would have thought (I don't know why, actually - it is estimated that of a clutch of 70-80 alligator eggs, only two will survive to reproductive age...). Researchers have done estimates of iguana ages when doing capture/mark/releases; when they return to the study site the next year, they capture iguanas again and make survival estimates based on the number of marked iguanas they catch and new age estimates...even if they do hundreds of iguanas like this over a period of many years, we are still just scratching the surface.

I'd be interested in knowing the survival rates and causes of death in Puerto Rican iguanas. They are not indigenous to that island, having colonized there from people who brought them or as stow-aways. They have figured out what plants to eat - and are seen to eat animal protein. The colonies in the Florida Keys would also be an interesting study group, as they too are not native to that area and are living on non-traditional foods.

Are the iguanas in captivity who are developing kidney failure at relatively young ages (2-5 years) doing so because genetically they are weak in some area, and have survived as long as they have because they were in captivity and not in the wild? While, on the one hand, the pet trade and effects of captivity are devastating to exotic species, responsible for killing animals who would have survived to reproduce for a normal life span in the wild, we are also keeping alive animals who might never have survived their first year in the wild... The former is reprehensible, of course...is the latter any better? Ethically, environmentally, socially, and politically, this opens up a whole new arena of discussion, debate, and soul-searching...

Related Articles

Wally

Kidney Failure in Green Iguanas

Clinician's Approach to Kidney Disease in Lizards

Fluid and Fluid Therapy

Iguana Bibliographies: Melissa Kaplan, Adam Britton