Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Rory Bell — Wed, 16 Jul 2014 21:31:06 GMT

apologies for the questions rather than any advice, but how high were the titres and against what serovars if this was a serological assay? Or was it a PCR? Was the urine culture negative? A urine protein:creatinine ratio of that magnitude with some haematuria is uninterpretable; haematuria could easily cause that. The glycosuria reflects tubular damage in the absence of hyperglycaemia, and it's probably acute damage, but it's no more specific than that. Is it possible to assess renal architecture via ultrasonography? That might help differentiate between acute versus acute-on-chronic disease.

I think it's necessary to answer those questions before attempting to address whether this dog has a primary tubulopathy. It would be very unlikely for a dog to suddenly exhibit signs of an inborn error of metabolism (inheritable or primary tubulopathy) at 12 years of age. I think,most likely, that you are dealing with an acute, or acute on chronic, renal insufficiency.

Apologies for the questions...but let me know if you have have the answers.

cheers

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Busybee — Wed, 16 Jul 2014 20:33:06 GMT

Sero-positive with high titres. Money run out so it's a try-and-see.

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Martin Atkinson — Wed, 16 Jul 2014 14:12:44 GMT

[quote user="Busybee"]Quick update - dog turned out to be Lepto positive, [/quote]By lepto positive do mean the presence of leptospires in urine or sero-positive?

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Andrew Kent — Wed, 16 Jul 2014 10:28:02 GMT

[quote user="Busybee"]

Quick update - dog turned out to be Lepto positive, currently on Amoxy-clav and Doxycycline and is holding his own so far...

[/quote]

Thanks for the update, fingers crossed you will see a good response.

Andy

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Busybee — Tue, 15 Jul 2014 19:13:04 GMT

Quick update - dog turned out to be Lepto positive, currently on Amoxy-clav and Doxycycline and is holding his own so far...

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Stephen Courtney — Wed, 18 Jun 2014 23:33:59 GMT

Fanconis is caused by tubular damage - if you treat the UTI then there is some scope for recovery, but in my experience the UTI is probably secondary to bacterial infection predisposed by all that lovely glucose in dilute urine...

I'd see how it responds to antibiotics in the first instance and watch the urine. worth a blood pressure too if you can - my last one was markedly hypertensive, but did brilliantly on amlodipine and , and it always worth looking at the prostate with an ultrasound if he is un neutered and you have one available.

Overall Fanconi cases tend to show progressive renal deterioration, and they are predisposed to infection, but can have a good quality of life for a surprising length of time - i've had several in the last few years while my colleagues tend not to see them at all. Go figure...

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Sarah Keir — Wed, 18 Jun 2014 21:06:45 GMT

Your summary seems pretty comprehensive. Don't rule out that it could have two coexisting conditions eg falconis syndrome to give glucosuria and coexisting prostate problems or UTI to give blood and protein in urine. I would think that like in diabetics, a UTI is highly likely now or in the future.

Urine has to be grossly contaminated with blood to affect the protein levels so I am guessing the same must be true for glucose.

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Busybee — Wed, 18 Jun 2014 18:39:18 GMT

Cysto urine sample from yesterday:

USG 1.010, pro +, gluc +++, bld ++. UPC 3.99. No WBC or bacteria seen on microscopy. Culture pending.

Dog has improved slightly from last week WRT vomiting and appetite. Still PUPD. Prostate appears fine on palpation.

Ddx for normoglycaemic glucosuria: congenital causes (unlikely due to dog's age); acute renal failure with significant proximal tubular lesions (possible), CRF (possible), acquired Fanconi due to poisoning (unlikely, no known exposure), drug reaction (no history of this).

Of these, ARF or CRF seem most likely (or an ARF on CRF). Of the causes for ARF, the possibles are nephrotoxicity (though unlikely), lepto, lymes (though no other symptoms), glomerulonephritis (proteinuria not significant enough?), pancreatitis, lymphosarcoma.

As is often the way, money is fairly tight but I will try to persuade them to run a lepto screen. Would it be worth getting on benzepril +/- amoxyclav in the mean time anyway?

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Andrew Kent — Sun, 15 Jun 2014 22:40:44 GMT

[quote user="Rob Davis"]

If there is significant blood in the urine, there will also be glucose, so isn't necessarilly that significant. I would agree that repeating urine sample and doing culture and sediment would be sensible. If blood glucose was normal, I wouldn't be rushing to repeat that or do fructosamine at present - what are you hoping to find?

[/quote]

I'm not sure the amount of glucose in blood would give a positive on a urine dipstick due to contamination - we certainly see quite a lot of dogs with varying degrees of haematuria and I can't recall any having glycosuria (unless for another reason) so I would certainly investigate it even in the presence of haematuria.

I have mixed feelings about fructosamine in these kind of cases but it could have a use in an intermittently hyperglycaemic dog.

Andy

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Elisabeth Knappett — Sun, 15 Jun 2014 21:49:02 GMT

Do you have access to ultrasound? maybe check his prostate to check that looks 'normal' as well. Agree repeat urine sample, do in house microscopy to look for cells/bacteria, submit for C&S, can do a UPC once inflammation is settled to rule in/out CKD. With normal blood glucose I wouldn't worry about diabetes as yet, though worth monitoring if glucosuria is persistent after treatment.

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Rob Davis — Fri, 13 Jun 2014 11:20:24 GMT

Re: Primary renal glucosuria, Fanconi, pyelonephritis or simply CKD?

Andrew Kent — Thu, 12 Jun 2014 22:31:38 GMT

Sounds a good start but would look for lepto as well as could fit with other parts of your history and is presumably unvaccinated.