PU in Whest Highland White Terrier

Re: PU in Whest Highland White Terrier

Martin Atkinson — Thu, 15 Nov 2012 14:33:11 GMT

[quote user="Agnieszka Grobelna"]

Do you always perform culture and antibiogram from the urine in the normal daily lower urinary tract infections? I usually don't and prescribe antibiotics. Many owners do not want to run the test, they want the treatment, but then I confront the fact that the dogs which don't improve need this kind of examination. The cultures from the dogs which are already on antibiotics are difficult. How do you usually solve it?

Dou you run only Low Dexa Stimulation test for Cushing or do you also send urine for corisol/creatinine ratio? How do you usually get the certainty about the diagnosis and decide to start treatment?

[/quote] First sorry I didn't spot the CBC before I asked about haemotology. normal WBC count would tend to steer away from UTI. I confess I rarely perform a culture in suspected UTIs I will give a broad spectrum antibiotic and so far have got away with it but if I suspected pyelonephritis I would give if for 4-6 weeks. That said we had a very sick (neutrophil count 38,000!) cat last week with suspected pyelonephritis which was referred so it could receive the level of nursing needed over a weekend and the referral centre got a +ve culture of E.coli even after a couple of days on potentiated amoxycilin.

I would run a urine cortisol/creatinine ratio as a screen in suspicious cases but then prefer low dose dex test to ACTH stimulation for diagnosis although I tend to use ACTH stim, and WBC count looking for a stress leukogram (or lack thereof) for monitoring, Hope that helps.

Re: PU in Whest Highland White Terrier

Agnieszka Grobelna — Thu, 15 Nov 2012 12:04:08 GMT

THANK YOU ALL FOR YOUR HELP!

Ultrasound was done unfortunately only for adrenals, because at the point I was convinced about Cushing diagnosis. I thought to do ultra for the bladder, kidneys and prostate as the next step and perform cystocentesis to check if the urine is truly changed or balanoposthitis is contaminating it. Always wanted to make culture with antibiogram straight from the bladder.

DM: normal glucose levels both in the blood in urine?

Hypothyroidism: PU?

I regret but Low Dexa test was done only after 8 hours.

Kate Richardson: do you think it could still be Cushing? The apathy appeared only after 60mg.

No corticosteroids were given during this time.

There are no typical lower urinary tract symptoms. The i=only symptoms is that the dog is urinating during the night at home.

If we assume that urinary tract infection can be still a problem: why there were absolutely no improvement after antibiotics (the urine was perfect after the therapy, no WBC). I gave also local treatment for balanoposthitis at the first course of antibiotics, maybe that improved the results?

Additional questions for all of you:

Dou you run only Low Dexa Stimulation test for Cushing or do you also send urine for corisol/creatinine ratio? How do you usually get the certainty about the diagnosis and decide to start treatment?

Re: PU in Whest Highland White Terrier

Kate Richardson — Wed, 14 Nov 2012 17:34:48 GMT

Hi and welcome!

Good work up so far. I'd still be suspicious of Cushings in this dog but he is a bit young, however that doesn't rule it out- so worth considering if the second test is possibly an error not the first, but also would check liver function. With your low dose dex suppression test did you test at 4 hours or just at 8 hours post dex?

was he given any corticosteroids at all for his skin that could explain the raised ALKP? Although the alkp is getting higher not lower.

What side effects did you get with the trilostane and was that only when you increased the dose?

I would also be suspicious of an ongoing UTI as well especially if cushingoid and as Robin suggested a minimum of 4 weeks antibiotics may be indicated, ideally following C&S from a cystocentesis sample, otherwise I would choose amoxycillin-clavulanic acid or trimethorpim sulphonamide.

Is it just PUPD the dog is showing or are there signs of cystitis or increased frequency of urination?

[quote user="Robin Grimmer"] Most urinary problems in male dogs tend to be prostate-related, so it's slightly unusual in a neutered male dog.[/quote]

Agree except for prostatic neoplasia, unlikely in this age of dog but I believe more common in neutered dogs than entire.

Re: PU in Whest Highland White Terrier

Robin Grimmer — Wed, 14 Nov 2012 16:38:16 GMT

I'd be suspicious of a uti from the history. I'd try a long course eg 4 weeks of a suitable antibiotic eg amoxycillin, trimethoprim/sulphonamide. Most urinary problems in male dogs tend to be prostate-related, so it's slightly unusual in a neutered male dog. Have you done any imaging for the urinary tract eg to check for stones?

Your main abnormailty on blood is the high ALP. Possible causes are endocrine (hypothryoidism, Cushings, DM), liver dx, or post-hepatic eg pancreatitis. I agree a bile acid stimlation test would be useful to check liver function.

Also - how are you getting your urine samples? If free-catch or even catheterised then you will likely be getting some contamination if there is obvious balanitis. Try a cysto instead.

Re: PU in Whest Highland White Terrier

Agnieszka Grobelna — Wed, 14 Nov 2012 14:33:38 GMT

Oh... I'm sorry. I used > as simple arrow. It was supposed to mean "after 8 hours".

Yes, we have done haematology (that is what I ment by CBC) and there was no important abnormalities.

Which antibiotic you would try if you can't get any culture from the urine (for pyelonehritis)?

Re: PU in Whest Highland White Terrier

Martin Atkinson — Tue, 13 Nov 2012 12:57:35 GMT

Have you done any haematology? Liver disease is certainly a possibility but you will need a more specific liver test, with bile acids especially pre and post prandial - eating if that doesn't translate to Finnish! However I don't quite understand your cortisol level results the > sign means greater than to me but it seems you may be using it as an arrow meaning from -> to, can you clarify this. Could however still be a UTI sometimes pyelonephritis cases persists with negative urine cultures and a longer course of antibiotic may be indicated.