diabetic glomerulonephropathy

Re: diabetic glomerulonephropathy

Christopher Saul — Thu, 23 Dec 2010 22:45:29 GMT

[quote user="Hannah Chilton"]I'm thinking I might do a cysto/culture/sediment exam as the next step.[/quote]

Good plan - you can't atttibute the proteinuria to glomerular protein loss until you've eliminated UTI ( these being quite common in diabetics). Don't forget to add a request for cytology ( formalin fixed sample) - this may add useful information

Re: diabetic glomerulonephropathy

HMC — Thu, 23 Dec 2010 13:21:50 GMT

[quote user="Richard Carter"]he is a yorkie so think of checking HAC[/quote]

This was done in January (ACTH stim) - normal.

I'm thinking I might do a cysto/culture/sediment exam as the next step.

Thanks everyone

Re: diabetic glomerulonephropathy

Richard Carter — Thu, 23 Dec 2010 10:12:07 GMT

[quote user="Hannah Chilton"]below the renal threshold of 14mmol/l [/quote]

mmm - I work on 11mmol/l but digestion peaks will push the glucose higher. Two things - he is a yorkie so think of checking HAC, second if has UTI then may explain the flat curve or apparent insulin resistence.

Re: diabetic glomerulonephropathy

Mark Holmes — Wed, 22 Dec 2010 20:09:49 GMT

It sounds like a case of diagnostic imagining to me. Somebody has seen something unusual on ultrasound and remembered a few renal related syllables which they have pasted together in a "that MUST cover it" diagnosis. I cannot see how ultrasound can make a diagnosis of renal disease on a cellular level. It will pick out gross structural change "consistent with X Y or Z ", dilated pelvis consistent with pyelonephritis, ureteric obstruction etc for example. You cannot make a diagnosis on a histological scale though. I would do some urine cultures and sediment exams, put it on a change in antibiotics and focus on improving glucose control

Re: diabetic glomerulonephropathy

Richard Fox — Wed, 22 Dec 2010 19:10:11 GMT

I have heard of diabetic glomerulopathy (thickening of basement membranes in the glomerulus and also found this on diabetic nephropathy:

http://emedicine.medscape.com/article/238946-diagnosis

However I have not heard it can be diagnosed on US - surely US is there to rule out other causes of renal disease?

However I am not up on what can be done with US - perhaps with ultra high def US maybe?

Re: diabetic glomerulonephropathy

HMC — Wed, 22 Dec 2010 18:53:16 GMT

[quote user="Richard Fox"]

Is that possible?

[/quote]

I don't know! I haven't come across diabetic glomerulonephropathy before!

Re: diabetic glomerulonephropathy

HMC — Wed, 22 Dec 2010 18:52:03 GMT

[quote user="Richard Carter"] would have thought the current BGC is showing that the diabetes is not currently under control and the persistent glucosuria more likely from hyperglycaemia.[/quote]

It's not really a curve is it? But the values are all below the renal threshold of 14mmol/l (please correct me if I am wrong about the threshold; this is testing my memory from uni).

[quote user="Richard Carter"]Done any sediment exam on urine because looks like some sort of UTI?[/quote]

No, not yet; I wanted people's opinions on the best next step. He had an empirical course of antibiotics recently following very similar UA results and this is the follow up UA (he finished the synulox a fortnight before this second UA).

Re: diabetic glomerulonephropathy

Richard Fox — Wed, 22 Dec 2010 18:34:24 GMT

[quote user="Hannah Chilton"]I have a case of a dog with diabetic glomerulonephropathy (as diagnosed by ultrasound in March)[/quote]

Is that possible?

Re: diabetic glomerulonephropathy

Richard Carter — Wed, 22 Dec 2010 18:14:57 GMT

I would have thought the current BGC is showing that the diabetes is not currently under control and the persistent glucosuria more likely from hyperglycaemia. Done any sediment exam on urine because looks like some sort of UTI?