Normoglycaemic glycosuria in a cat

Re: Normoglycaemic glycosuria in a cat

Tom Ward — Wed, 04 Feb 2015 16:43:54 GMT

OK. Reached a plan after all of your help and discussing it with vets in house too.

Suspect tubulointerstitial disease --> nephrotic syndrome and diabetes insipidus (renal origin), hence hyposthenuric urine. Fructosamine must be abberantly slightly high?

Plan:

Started semintra, renal diet and antibiosis already. Going to add in plavix (vs hypercoagulable state) and check blood pressure. The O is going to try SC fluid injections at home. I'm going to recheck bloods/urine in 2wks time.

Thanks again for all your help!

Re: Normoglycaemic glycosuria in a cat

Hannah Wynne Richards — Wed, 04 Feb 2015 10:51:43 GMT

I'm totally bewildered, and if the owners were willing, I'd be referring this one.

Wynne

Re: Normoglycaemic glycosuria in a cat

Yantha Smyth — Tue, 03 Feb 2015 21:59:09 GMT

Some random not necessarily coherent thoughts....So with a mildy elevated fructosamine at some point there has been a period of sustained hyperglycaemia- but likely not due to DM if seen to be normoglycaemic as well. When the azotaemia, phosphate etc was measured was the cat severely dehydrated or hypovolaemic? I agree that hyposthenuric urine suggests active dilution, therefore implies kidney function is present. Glomerular disease with proteinuria- and/ or tubules possibly leaking amino acids and glucose like a fanconi syndrome? Are there any other metabolic or endocrine issues that could cause the changes? Aldosterone? But normal potassium.... Have further urine samples been tested to check glucosuria is persistent vs transient?

Re: Normoglycaemic glycosuria in a cat

Stephen Courtney — Tue, 03 Feb 2015 21:02:41 GMT

Glucosuric effect in diabetic cats typically gives an SG of about 1.025 I do have an issue with that quoted SG as to get it that low the tubule cells have to be pumping water molecules INTO the glomerular filtrate. That takes high functioning cells not consistent with renal disease.

Re: Normoglycaemic glycosuria in a cat

Tom Ward — Tue, 03 Feb 2015 08:12:56 GMT

Just to add to the confusion with this case, Fructosamine came back yesterday:

BIOCHEMISTRY

Fructosamine * 335 umol/l 146-271 (Norma

INTERPRETATION

Serum fructosamine measures the glycation of serum proteins and is an accurate measure

of the average serum glucose concentration over 1-3 weeks in the cat.

High levels are indications of uncontrolled diabetes mellitus or poor metabolic control

of diabetes mellitus.

To monitor the efficiency of insulin therapy the following ranges may be helpful.

Glycaemic control..................................................Fructosamine umol/l

Prolonged hypoglycaemia......................................<300 umol/L

Excellent control..................................................... 350-400 umol/L

Good control............................................................400-450 umol/L

Fair control...............................................................450-650

umol/L

Poor control.............................................................>650 umol/L

Total protein and albumin levels will affect the results.

Re: Normoglycaemic glycosuria in a cat

Prathayini Parameswaran — Mon, 02 Feb 2015 21:51:53 GMT

I believe you can get glycosuria with adv CKD as sort of said already

Re: Normoglycaemic glycosuria in a cat

Tom Ward — Mon, 02 Feb 2015 15:29:24 GMT

Haven't checked a blood pressure actually, worth considering though. I thought that a significant glycosuria could cause hyposthenuric urine by osmotic effect (particularly if it was isosthenuric to start!)?

Re: Normoglycaemic glycosuria in a cat

Stephen Courtney — Sun, 01 Feb 2015 17:41:37 GMT

Have you done a blood pressure? I'd also recheck that reported urine specific gravity - that would imply (extremely) active dilution, therefore good renal function! so something must be wrong with the result. Was it from a calibrated refractometer or the SG bit of a human dipstick? those don't work reliably withanimal urine so best ignored.

I'd also give empirical antibiotics at this stage, and would be wondering about the possibility of a few days on IV fluids then repeat bloods.

Agree a fairly cautious to grim prognosis.

Re: Normoglycaemic glycosuria in a cat

Tom Ward — Fri, 30 Jan 2015 17:38:29 GMT

UPCR is 4.32:1. I've never seen one so high! Going to continue with amox/clav for 6-8wks and start semintra. Guarded prognosis!

Re: Normoglycaemic glycosuria in a cat

Richard Carter — Thu, 29 Jan 2015 10:08:16 GMT

the urine glucose dip stick would also be positive for other products such as ethylene glycol

Re: Normoglycaemic glycosuria in a cat

Kate Richardson — Wed, 28 Jan 2015 18:49:02 GMT

That's pretty dilute urine- I rarely see USG that low in cats! Pretty obvious kidney disease taking into account bloods and pretty serious azotaemia given I assume eating ok? Check Protein:creatinine ratio for a quantitative protein measurement, Not sure about hypernatraemia but likely all tied in with tubular dysfunction. Also check BP given tachycardia and murmur. CM diff often poor in older cats and not specific to particular renal diseases. I would be tempted to give antibiotics in this case despite negative culture and sediment given the SG- I check a lot of urine samples in cats and don't think I have ever seen one this low! Did you send a swab from the urine?