Hypoalbuminaemic labrador - next logical step

Re: Hypoalbuminaemic labrador - next logical step

Utlendigur — Fri, 09 Jan 2015 18:41:20 GMT

[quote user="John Flynn"]

[quote user="Michael Woodhouse"]Without teaching you to suck eggs it's then about lack of production (liver) or increased loss (gut).[/quote]

...or increased urinary loss (I wouldn't exclude this based on 2 x negative dipsticks in a patient with notable urinary clinical signs)

[/quote]

No, wouldn't exclude it, but as globulin also sounds like it is reduced it would be more likely to be GI loss or lack of production

Interesting comment about Vettest. We have a Vetscan machine that last year gave us several results of Alb <10 - one in an asymptomatic lurcher, and two in the same JRT (which did have mild D+) but done 1 week apart. In each case an external lab got a normal result.

Re: Hypoalbuminaemic labrador - next logical step

Anthony Dennison — Fri, 09 Jan 2015 09:30:52 GMT

If the prostate is a concern it might be worth collecting the urine sample by catherisation, and then you can do a prostatic wash at the same time?

Re: Hypoalbuminaemic labrador - next logical step

Anthony Dennison — Fri, 09 Jan 2015 09:30:51 GMT

If the prostate is a concern it might be worth collecting the urine sample by catherisation, and then you can do a prostatic wash at the same time?

Re: Hypoalbuminaemic labrador - next logical step

Andrew Kent — Fri, 09 Jan 2015 08:21:05 GMT

Hi Kerry,

I think the advice to check that this albumin is real is a good one.

If it is then also agree that I would look at what the liver is doing with a BAST. The fact that the globulin is normal makes it less likely (though not impossible) to be gut loss, which I guess the lack of gut signs also supports.

Were the urinalysis performed on a cysto sample or free catch? Male dogs can have lots of bugs in the prepuce so I would get a cysto sample for analysis, sediment and exam and (if the sediment is inactive) a UPC as the reliability of test strips to exclude proteinuria can be low especially in more dilute urine. If there is bacteria on a cysto then a culture would be a good plan.

Prostatic pathology would make a lot of sense in a dog with a difficult to treat UTI - amox/clav will not penetrate well into the prostate and so is unlikely to resolve the infection if there is a concurrent prostatitis - so based on a culture going for TMPS, clindamycin or a fluoroquinolone would be a good idea. If you do a cysto under ultrasound guidance then that could also be an opportunity to image the prostate at the same time.

Despite the fact the dog is asymptomatic if this is a real result it is concerning and so I would at least offer additional diagnostics.

Let us know how you get on,

Andy

Re: Hypoalbuminaemic labrador - next logical step

John Flynn — Thu, 08 Jan 2015 21:36:19 GMT

[quote user="Michael Woodhouse"]Without teaching you to suck eggs it's then about lack of production (liver) or increased loss (gut).[/quote]

...or increased urinary loss (I wouldn't exclude this based on 2 x negative dipsticks in a patient with notable urinary clinical signs)

[quote user="Michael Woodhouse"]We had a Vettest that fell out with albumin evey now and again.[/quote]

I always wondered if the problems with albumin results being low in VetTest machines related to this being the first slide loaded usually and over-enthusiastic wiping of the pippette tip prior to replacing it could lead to wicking some serum out and insufficicient sample being deposited on the first test slide?

Re: Hypoalbuminaemic labrador - next logical step

Graham Bilbrough — Thu, 08 Jan 2015 21:08:45 GMT

I think it's a great idea to get an estimate of the TP using a refractometer. However, be sure to check your refractometer's calibration first using distilled water. There is usually a little screwdriver in the box for the purpose of adjustment. You may already be in the habit of doing so, but, unfortunately, it is rarely done.

All best wishes

Graham

Re: Hypoalbuminaemic labrador - next logical step

Kerry Peak — Thu, 08 Jan 2015 20:05:32 GMT

Thanks for the replies so far. I am a bit concerned about the prostate. We castrated him last year (I think at the same time as an anal adenoma removal). I examined the sediment myself so can confirm the bacteria. Urine culture is probably going to be my next step. We've run loads of samples today and last week and other albumin levels seem to be ok but sending it away is a great point so I will do that! I guess I will probably do some bile acid tests next just to make sure it's not hepatic, though with normal bloods otherwise I think this seems unlikely. Oh and I will double check with the refractometer!

Re: Hypoalbuminaemic labrador - next logical step

Michael Woodhouse — Thu, 08 Jan 2015 19:49:44 GMT

I'd send a sample to an external lab. We had a Vettest that fell out with albumin evey now and again. Did you check a total solids by refractometer?

Without teaching you to suck eggs it's then about lack of production (liver) or increased loss (gut).

I wouldn't be happy with such a low albumin - assuming it's a real result.

Re: Hypoalbuminaemic labrador - next logical step

John Flynn — Thu, 08 Jan 2015 19:45:37 GMT

Hi Kerry, I've no answers on the low albumin but some thoughts on reading your post in case of help:

1) I don't normally feel a prostate in a castrated dog, certainly not one that feels assymetric and possibly enlarged, so that might be a good starting place.

2) If there's still evidence of bacteria in urinary sediment then I'd love a culture on this, preferably with MIC values.

3) Are the bacteria definitely bacteria (seeing is believing, so if I've not seen the sediment with my own eyes I always have a slight question-mark in my mind)

4) Is the mild reported polydipsia quite an acute finding in the week or 2 prior to presentation or a longer standing observation of the owner?

5) I would feel justified to ultrasound the kidneys/bladder/prostate in this asymptomatic patient and/or xray depending on the answers to the above points.

John

PS - I'm no expert, so hang on and see what advice follows