Polycythaemia with renal changes on ultrasound - primary or secondary

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

Rob Davis — Wed, 10 May 2017 18:27:28 GMT

No experience of leaches, but I have used hydroxyurea in the dim and distant past. From memory the dog did very well for a prolonged period before succumbing to an unrelated problem.

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

Joyce Whitehead — Wed, 10 May 2017 13:37:51 GMT

No experience with leeches, but we had a dog with similar levels of polycythaemia, in her case due to a reverse shunting PDA, and in her latter stages we took a full blood bag (500ml ish) every 2 weeks, and that kept her stable for a few months. She was also a lab, about 25kg body weight.

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

Anthony Dennison — Wed, 10 May 2017 10:39:00 GMT

Update on this:

Rescanned. Heart fine. No neoplasia in the kidneys, though the vasculature of the left kidney is abnormal - there were a couple of really quite dilated veins in the cranial pole. Blood flow to the right kidney is reduced.

Guy who did the scan has ruled out renal neoplasia, and I trust his judgement. Trying to find a lab that measures EPO because NWL aren't doing it at the moment and they aren't aware of anyone else doing it!

So going to go with managing the high PCV. Options are hydroxyurea and regular phlebotomy, or leeches. Anyone had any experience of using leeches for this? I spoke to BioPharm, the company that make them, and a dog his size would require about 10-15 leeches, which could work out pretty expensive!

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

David Mills — Mon, 08 May 2017 22:40:47 GMT

Kidneys are ripe for a trucut biopsy under sedation if fna didn't work (and indicated by next scan).

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

Anthony Dennison — Mon, 08 May 2017 17:34:16 GMT

Update on this case - renal biopsy was unequivocal, poor sample representation. Next step is getting an echo done by a more experienced scanner, who will also have a look at the kidneys again.

Potentially may be using leeches to help with the polycythaemia though!

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

Anthony Dennison — Fri, 28 Apr 2017 11:38:52 GMT

Sorry, the dogs gums have only been like this since an ex-lap and multiple enterotomies about 3-4 years ago.

I scanned the kidneys myself on Wednesday, they didn't look particularly abnormal to me, but I still took a renal FNA, so we'll wait to see what comes back with this. No abnormalities on thoracic ausc, no clinical signs of cardiac dz. May be worth considering cardiac dz though.

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

Sarah Bolt — Thu, 27 Apr 2017 02:11:21 GMT

Hi, I'm probably thinking a little bit too outside the box, but mainly because you said 'owner reports mucous membranes have always looked like this'... is it worth doing a quick check of the heart to make sure no congenital defects causing shunt related polycythaenia? I know you've found a likely source of the problem with the kidney looking abnormal and it's most likely all linked to that. But went to a cpd where the speaker reported incidents of congenital shunts going undetected for years. Also just made me wonder cos you said mm worse despite fluids. I'm posting the question more for my own learning as have not encountered a polycythaemic patient before.

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

Anthony Dennison — Wed, 26 Apr 2017 09:43:54 GMT

Thanks, plan is to do the FNA today. I took just over 100ml blood off the dog yesterday as his membranes were getting even more congested.

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

Laura Marshall — Tue, 25 Apr 2017 14:51:52 GMT

I would definitely agree with Davids advice. I had a very similar case, which I diagnosed with lymphoma on cytology from FNAs.

RE: Polycythaemia with renal changes on ultrasound - primary or secondary

David Mills — Tue, 25 Apr 2017 13:34:19 GMT

[quote user="Anthony Dennison"]

I've just inherited a case that was admitted at the weekend, 8yr old lab with vomiting/diarrhoea/lethargy. Brick red mucous membranes, pyrexic, owner reports gums have always been like that. In house bloods gave a PCV of 81%, then repeated yesterday after a night of fluids, down to 79%. Polycythaemia has been confirmed by an Idexx haematology at 73%. Film examv says erythrocytes appear normal.

He had an ultrasound scan yesterday, which was unremarkable except abnormal kidneys - increased echogenicity, loss of normal architecture. These were intracapsular changes, kidney was still the same shape, slightly enlarged at 7cm long. No azotaemia on bloods.

Dog isn't insured and I'm trying to choose which is the next step to take - either a renal biopsy OR a bone marrow biopsy (to determine whether its primary or secondary), or biopsy both, or just do a bit of blood letting and start on hydroxyurea.

Would getting biopsies change anything with regards to treatment, or will the dog end up on hydroxyurea whatever we do investigation wise?

[/quote]

They're normally carcinoma or lymphoma, latter is supposed to be rarer. If changes are bilateral there is limited therapy except symptomatic but I've not had much success.

I'd be tempted to FNA one/both kidneys and have a quick look in house - lymphoma would be easy to spot. Seeding is a theoretical risk but the dog will probably be dead in 3m anyway whether due to the cancer or 2ry effects of the syrup blood.