Haley presented one week ago for vomiting, lethargy and some loos stool. Hx of hyperthyroidism, on methimazole. Hx UTI previously and asthma as a young cat (has not required tx since using pred briefly years ago).
PE- mild murmur, thin, BP 145 sytstolic
Labs – initial TCa 13.3, iCa 1.65, BUN 38 (normal creat), PCV/TP 34/9, T4 4.4 (4.8 high end of normal), glucose 221, UA – SpG 1.040, ++++proteinuria, glucosuria, on cytology there are some cocci (no WBCs noted), occasional renal tubular cells and transitional epithelial cells
Haley presented one week ago for vomiting, lethargy and some loos stool. Hx of hyperthyroidism, on methimazole. Hx UTI previously and asthma as a young cat (has not required tx since using pred briefly years ago).
PE- mild murmur, thin, BP 145 sytstolic
Labs – initial TCa 13.3, iCa 1.65, BUN 38 (normal creat), PCV/TP 34/9, T4 4.4 (4.8 high end of normal), glucose 221, UA – SpG 1.040, ++++proteinuria, glucosuria, on cytology there are some cocci (no WBCs noted), occasional renal tubular cells and transitional epithelial cells
U/S – enlarged kidneys, right kidney has irregular border and shadowing renoliths; one ureterolith seen on right w/ mild distension of ureter, but not distended further distally. Scant effusion around rounded splenic head. Some thickening of submucosa in sections of jejunum.
Radiographs – Mild peribronchiolar pattern in lungs, radiodense fecal material in colon, some mineralization in kidneys, fluid filled small bowel loops
FNA of right kidney – low cellularity, some peripheral blood (did 3-4 aspirates on 2 different attempts and received same results)
FNA of spleen -extramedullary hematopoeisis
Repeat iCa and TCa 4 days later – both WNL, TCa 10.9, iCa 1.32. HCT was 27% (had been 36 at presentation). Glucose WNL.
Problems/Rule outs – hypercalcemia appears to be spurious so not sure how much to pursue (originally were going to do parathyroid and PTHrp testing), progressing hyperthyroidism (was 1.6 on treatment one year ago, so we increased dose given high normal result this time), irregular kidneys (infiltrative ds/lymphoma, pyelonephritis, nephroliths w/o current evidence of obstruction), non regenerative anemia, anorexia/vomiting (rule out unregulated T4, IBD/GI lymphoma).
My options at this point would be PARR on the slides submitted and intestinal biopsies since I did appreciate some thickening in the submucosa. Just wondering what your impression of the images provided and where you might go next? I really appreciate any input on this case – of course a great cat and nice owners.