Advise on next step - Kidney issues

Re: Advise on next step - Kidney issues

Dagmar Steele — Sat, 19 Mar 2011 06:08:06 GMT

If I haven't misread anything this dog so far had no kidney scan? There is a hereditary familiary nephropathy in Border Terriers that should show on a scan, best to be diagnosed by biopsy. Most of them show proteinuria but not all. Ignore if I have missed something.

Re: Advise on next step - Kidney issues

Michael Woodhouse — Fri, 18 Mar 2011 23:11:28 GMT

[quote user="Stephen Courtney"]I often delegate this to our lab, and ask for a cytology, sediment exam and urine chemistry,[/quote]

I try to have a look first as some crystals can dissolve in the sample in transit to the lab. I also think it makes me better by comparing my findings to the lab report.

Re: Advise on next step - Kidney issues

Louise6732 — Fri, 18 Mar 2011 22:07:52 GMT

[quote user="Louise Alexander"]

Check and monitor USG (can't see this in OP? Sorry if have missed!)

Check and monitor blood pressure

Get on renal diet ASAP to help kidneys out a bit

Check phos and electrolytes as previously suggested

Worth sending a sample for full analysis at outside lab i.e. culture and sens, sediment, UPC (Very important figure to get I think)

You will then be better informed as to pre, renal or post cause, and differentials will come flooding in (!)

Louise

[/quote]

P.s. Is he entire? Check prostate?

Re: Advise on next step - Kidney issues

Louise6732 — Fri, 18 Mar 2011 22:06:44 GMT

Check and monitor USG (can't see this in OP? Sorry if have missed!)

Check and monitor blood pressure

Get on renal diet ASAP to help kidneys out a bit

Check phos and electrolytes as previously suggested

Worth sending a sample for full analysis at outside lab i.e. culture and sens, sediment, UPC (Very important figure to get I think)

You will then be better informed as to pre, renal or post cause, and differentials will come flooding in (!)

Louise

Re: Advise on next step - Kidney issues

Laurence Webb — Fri, 18 Mar 2011 21:44:21 GMT

[quote user="Utlendigur"]I was under the impression that benazacare was only helpful if proteinuria is present (ie not a cure-all for renal insufficiency) but the dipstick showed no urine protein, Personally I'd be cautious about using it as it can cause hypotension and worsen renal problems[/quote] It'll reduce GFR via efferent arteriole vasodilation in the glomerulus and lowered blood pressure. it's beneficial in CRF cases with proteinuria. Without proteinuria it's use is less proven although I think they generally feel better for it. It could tip kidneys that are already on a knife edge over by dropping GFR.

If the urine's very dilute then dipsticks won't pick it up, so UPC would be useful as long as the urine has an inactive sediment

Re: Advise on next step - Kidney issues

Stephen Courtney — Fri, 18 Mar 2011 21:44:02 GMT

Urine samples are essential - dipsticks and specific gravity especially - no consulting room should be without a refractometer. Urine SG will tell you more about renal function than the blood sample on its own. The leukocyte patch on human dipsticks is useless in vet medicine, it should be ignored. the protein patch is less than reliable, and the specific gravity patch is pretty unreliable too.

In addition examining centrifuged sediment looking for casts, inflammatory or neoplastic cells, bacteria ( preferably intracellular) and crystals, is helpful. I often delegate this to our lab, and ask for a cytology, sediment exam and urine chemistry, Culture is often included in the more valuable tests, often being better value to get the lab to go for the whole lot.

In the absence of proteinuria the use of ACE inhibitors is probably not helpful. Ultrasound is useful to visualise renal architecture .

Re: Advise on next step - Kidney issues

Utlendigur — Fri, 18 Mar 2011 20:42:02 GMT

What were the original symptoms? By UTI do you mean cystitis type symptoms or more kideny related - if the dog is not pupd, no blood, protein or WBC in the urine, are you just going by the elevated renal parameters?

Any electrolytes on the biochem? If so what are the potassium and phosphates like?

I was under the impression that benazacare was only helpful if proteinuria is present (ie not a cure-all for renal insufficiency) but the dipstick showed no urine protein, Personally I'd be cautious about using it as it can cause hypotension and worsen renal problems - I have seen this happen where a dog with mild renal insufficiency was put onto fortekor and presented a few days later with K+ through the roof and severely raised BUN and creatinine

One thing I would be wondering about with vague, fluctuating signs and raised renal parameters is Addisons - may be worth an ACTH stim.

Re: Advise on next step - Kidney issues

Laurence Webb — Fri, 18 Mar 2011 20:21:57 GMT

Dipsticks aren't reliable for leucocytes - false negatives in dogs and false positives in cats. Have you looked at the sediment and checked SG?

Culture would be the obvious step - if it's got an infection you'll be able to target the most appropriate antibiotics and it may take a few weeks of treatment to get an infection under control. Some pyelonephritis cases will give a negative culture anyway though. UPC will be useful although if it's got an infection and active sediment that's not going to differntiate a glomerulonephritis from a UTI. Ideally get a cysto sample if you can. The glycosuria without hyperglycaemia would suggest tubular damage.

Ultrasounding the urinary tract would be helpful both to look at the kidney parenchyma and search for uroliths or other things that can harbour persistant infections. X-rays with or without intravenous urography would be an alternative but you need to be cautious not to make things worse in azoatemic patients so I'd avoid it for now.