Pyrexia, abdominal pain, proteinuria???

Re: Pyrexia, abdominal pain, proteinuria???

James Laidlaw — Wed, 13 Feb 2013 07:43:55 GMT

Can also get glomerulonephritis with proteinuria, increased UPC and granular casts, secondary to a source of inflammation. Good explanation in detail and ddx in ettinger if you have it.

Re: Pyrexia, abdominal pain, proteinuria???

David Mills — Tue, 12 Feb 2013 23:31:17 GMT

You may have a couple of things going on with this. I think the proteinuria, caudal abdo pain and granular casts indicate a primary renal issue even if no azotaemia (depends how many nephrons affected) which you're covering for with abx, ivft and pain relief. It may be worth while adding in a second antibiotic to cover all bases. The main problem you have is that you don't know whether this is infectious or inflammatory.

The bile acids could be simply due to a return to wellness with resolving bile stasis or could indicate a secondary hepatopathy in conjunction with the mildly raised enzymes - I would wager that this is 2y to the primary renal problem and may well resolve with time.

Re: Pyrexia, abdominal pain, proteinuria???

Busybee — Tue, 12 Feb 2013 22:53:57 GMT

Abdominal ultrasound - all looked fine (done by colleague)

BAST - pre levels normal, post levels elevated to ~45 - guess this is significant!

Urine (free catch, dog wouldn't permit cysto) - prot +++ USG 1.028, UPC 5.4, granular casts +++ (yay! I got it right!)

Re: Pyrexia, abdominal pain, proteinuria???

Busybee — Sun, 10 Feb 2013 14:56:19 GMT

[quote user="robloxley"]

[quote user="Busybee"]

[quote user="robloxley"]There's a small company doing repairs that often advertises in back of the Vet Times that has had some good write-ups on here; maybe worth a look monday[/quote]

Due to be fixed next week - not helpful for this weekend!

[/quote]

Sheesh, won't bother replying in the future!

[/quote]

Angry face wasn't aimed at you! It was because I can't work up the case like I want to at present! Sorry!

Re: Pyrexia, abdominal pain, proteinuria???

Rob Loxley — Sun, 10 Feb 2013 14:47:55 GMT

[quote user="Busybee"]

[quote user="robloxley"]There's a small company doing repairs that often advertises in back of the Vet Times that has had some good write-ups on here; maybe worth a look monday[/quote]

Due to be fixed next week - not helpful for this weekend!

[/quote]

Sheesh, won't bother replying in the future!

Re: Pyrexia, abdominal pain, proteinuria???

David Mills — Sun, 10 Feb 2013 10:43:12 GMT

If you've got an iPhone or other generic smartphone you can normally take pictures down the microscope lens if you wanted to post an image here of the sediment? Any inflammatory cells?

Re: Pyrexia, abdominal pain, proteinuria???

Busybee — Sun, 10 Feb 2013 10:37:52 GMT

Abdominal pain seems much reduced, temperature also down to normal now - v likely due to nsaids though. Eating very well, no vomiting.

But....

Dog passed orange faeces this morning. Urinalysis - same as yesterday. Got the microscope working but only on lowest power, but think I can see casts - ?granular or cellular - but there are a lot of them. Possible also bilirubin crystals (spiky anemone-looking things from a distance). However, there are no signs of jaundice and no increase in bilirubin on bloods??

Re: Pyrexia, abdominal pain, proteinuria???

David Mills — Sat, 09 Feb 2013 23:23:37 GMT

Pyelonephritis has to be consideration. To this end a sediment exam can be very informative followed by ultrasound. Consider an ultrasound-guided fna of kidney.

Re: Pyrexia, abdominal pain, proteinuria???

Busybee — Sat, 09 Feb 2013 18:54:17 GMT

[quote user="Claire Fisher"]

Pancreatitis?

Did bloods include lipase/cPLI?

Ultrasound of abdomen would be my next step.

[/quote]

Can't rule it out completely but pain is in the wrong area if you ask me. Our bloods include amylase (normal) but not lipase or cPLI - again, these would have to wait til monday.

Temperature now 39.7 so coming down slowly. Dog is also eating very well in with us and seems fairly bright. May also be deaf which again makes me think she is much older than stated.

Re: Pyrexia, abdominal pain, proteinuria???

Claire Fisher — Sat, 09 Feb 2013 17:39:33 GMT

Pancreatitis?

Did bloods include lipase/cPLI?

Ultrasound of abdomen would be my next step.

Re: Pyrexia, abdominal pain, proteinuria???

Busybee — Sat, 09 Feb 2013 16:12:37 GMT

[quote user="robloxley"]There's a small company doing repairs that often advertises in back of the Vet Times that has had some good write-ups on here; maybe worth a look monday[/quote]

Due to be fixed next week - not helpful for this weekend!

No Vet-test so again, the UPC will have to wait til Monday.

[quote user="robloxley"]are you sure she's spayed[/quote]

Dog's Trust dog from 4 years ago and owners assure me she's spayed.

[quote user="robloxley"]can you do some imaging[/quote]

Plan for tomorrow if no drastic improvement on meds

[quote user="robloxley"]fluids, antibiotics, NSAIDs and opiods[/quote]

All on board :)

Re: Pyrexia, abdominal pain, proteinuria???

Rob Loxley — Sat, 09 Feb 2013 16:06:28 GMT

[quote user="Busybee"]I agree, however our microscope is out of order [/quote]

There's a small company doing repairs that often advertises in back of the Vet Times that has had some good write-ups on here; maybe worth a look monday.

[quote user="Busybee"]no in-house facility to measure UPC (as far as I know, unless anyone can tell me how??)[/quote]

If you've a vet-test you can run the test (if you have the slides in stock!), but I'd want to do microscopy first to rule look for signs of a UTI.

If you're looking for some better thoughts - are you sure she's spayed; can you do some imaging; I'd be thinking about looking at a blood smear (maybe one to get in the post?); otherwise fluids, antibiotics, NSAIDs and opiods.

Re: Pyrexia, abdominal pain, proteinuria???

Busybee — Sat, 09 Feb 2013 15:49:24 GMT

I agree, however our microscope is out of order and we have no in-house facility to measure UPC (as far as I know, unless anyone can tell me how??)

Re: Pyrexia, abdominal pain, proteinuria???

James Laidlaw — Sat, 09 Feb 2013 15:41:35 GMT

UPC ratio and sediment exam might be helpful?