Bailey: 11 year old French Brit. Span.
Back in 8/2016 presented ADR…lyme +, 5+proteniuria but active sediment. BUN of 51 and Creat of 2.3. Lepto panel was negative. Responded to Doxycycline; Kidney number improved slightly…BUN 54/Creat 1.9
November of 2016 severe UTI…C&S showed Klebsiella >100,000/ml colonies…used clavamox and improved but some hormonal incontinence evident.
Bailey: 11 year old French Brit. Span.
Back in 8/2016 presented ADR…lyme +, 5+proteniuria but active sediment. BUN of 51 and Creat of 2.3. Lepto panel was negative. Responded to Doxycycline; Kidney number improved slightly…BUN 54/Creat 1.9
November of 2016 severe UTI…C&S showed Klebsiella >100,000/ml colonies…used clavamox and improved but some hormonal incontinence evident.
Today presents w/ UTI symptoms…Sp Grav of 1.015, 5+ proteinuria, cocci & rods in sediment w/ 30-60 wbc/hpf…C&S pending. Creat at 3.4 and BUN of 70 and yet the dog feels fine.
I’m trying to decide if pyelonepritis might be lurking here. The kidneys have diffusely increased echogenicity of the cortices, I’m assuming supportive of a chronic nephritis. I feel like there may be some pyelectasia present in both kidneys, but would like some confirmation. The medulla looks hypoechoic to me but I’m not sure???
I had to go intercostal to get the kidney images.
Thanks in adavance for any insights.
Sam
Comments
There is a trace bit of
There is a trace bit of pyelectasia on the left kidney but not on the right. they look fine otherwise. Pyelectasia without pelvic fat inflammatory pattern can be from resolving pyelonephrotis or scanning form prior insult. peracute lepto can be negative but given the protracted history I would look for other causes of azotemia such as addisons and of course cover for pyelo thats residual but I doubt Pyelo is the cause of azotemia here.
Thanks
Thanks
We have a dog in the clinic
We have a dog in the clinic now that is Azotemic with a urine SG of 1.031.
Resting Cortisol < 0.5. We are running an ACTH stim test now.
Normal electrolytes. Always have to keep Atypical Addisons in the back of your mind.
We talked about this w/ the
We talked about this w/ the owner back in August of 2016, but they declined. My predicatment w/ these dogs is most come back sl depressed but not bottomed out (<0.2) and I was taught that unless they are truly bottomed out that it’s likely the suppression is secondary to underlying disease….Does anyone have any thoughts on this?
ACTH Stim after Cortrosyn was
ACTH Stim after Cortrosyn was still less than .5. Need to confirm. Also your SG was in the isoshenuric range.