Ruger is a 9 1/2 year old neutered male Lab.
Owner brought in on 10/31 with complaint of PU/PD, but also concerned about cancer having just lost last dog to it…
Lab work was unremarkable except for Alk Phos of 962, and a urine SG of 1.005 w/ 30mg/dl proteinuria and a mostly begign urine cytology. Dog was put on prednisone 20mg BID and Clindamycin.
Dog improved and owner cut pred to 20mg sid and for the past 2 days was giving 10mg sid.
Ruger is a 9 1/2 year old neutered male Lab.
Owner brought in on 10/31 with complaint of PU/PD, but also concerned about cancer having just lost last dog to it…
Lab work was unremarkable except for Alk Phos of 962, and a urine SG of 1.005 w/ 30mg/dl proteinuria and a mostly begign urine cytology. Dog was put on prednisone 20mg BID and Clindamycin.
Dog improved and owner cut pred to 20mg sid and for the past 2 days was giving 10mg sid.
U/S dog today and for the most part found nothing terribly abnormal. Liver looks uniformly hyperechoic with fine texture likely due to steroids. the spleen is enlarged with multiple, I forget what they’re called…lipogranulomas??? I’m wondering if anything stands out in the kidneys…They have some capsular irregularity and some changes in the medulla…I wondering about a sneaky pyelonephritis? I did scan adrenal glands…the left was normal and could not make out the right.
I checked the urine SG again today..and it’s still 1.005 but I’m not sure how much the prednisone is influencing that. the protein was again 30mg/dl and the sediment was quiet.
My plan is to pull off the steroids and recheck SG in a couple weeks…then go from there.
Thoughts greatly appreciated
Sam
Comments
The spleen looks a bit
The spleen looks a bit precarious folded on itself with lipogranulomas. If painful on palpation I would take it out honestly. Kidneys are nsf. Images are a bit dark but nsf. If no azotemia I would try to get off th epred and see if concentration can occur on its own or wiht 1/2 day water restriction then go from there. May just be medullary washout.
Reminder: please stick to short bullet points on the forum wiht just specific items to the case so we can all reference rapidly thanks
i.e.:
Ruger is a 9 1/2 year old neutered male Lab.
–10/31 with complaint of PU/PD, any cancer?
–Alk Phos of 962, urine SG of 1.005 w/ 30mg/dl proteinuria benign urine cytology. Dog was put on prednisone 20mg BID and Clindamycin.
–Dog improved and owner cut pred to 20mg sid and for the past 2 days was giving 10mg sid.
–U/S today nsf. Liversteroid hepatopathy pattern, spleen is enlarged with multiple, I forget what they’re called…lipogranulomas??? anything stands out in the kidneys?.. sneaky pyelonephritis?
–adrenal glands…the left was normal and could not make out the right.
–urine SG again today still 1.005. Prednisone is influencing that? Protein still 30mg/dl and the sediment was quiet.
–Plan is to pull off the steroids and recheck SG in a couple weeks…then go from there.
Here’s my PUPD Workflow if
Here’s my PUPD Workflow if you find it helpful:
Lindquist Quick PUPD Checklist:
This is my quick PUPD checklist after ensuring detectable & repeatable PUPD is present
(USG<1.020).
Note: Always get a USG and ensure it is < 1.020 & urine cortisol elevation is present before considering Cushings & running ACTH stim or LDDST. Cushings Dx is a stepwise diagnosis.
PU > 50 ml/kg/day
PD > 100 ml/ kg/ day
Note: Hyposthenuria cannot be renal failure alone.
Isosthenuria is same osmolality as plasma
Check these pathologies off in your patient and see what’s left:
DDx PUPD:
DM
Primary renal glucosuria
CRF
ARF
Post-obstructive diuresis
Medullary washout
Pyometra
Hypercalcemia
Liver failure
Pyelonephritis
Cushings
Addison’s
Hyperthyroidism
Hypertension
Diet
Drug
Psychogenic
DI
Consider gradual partial water deprivation test to rule out psychogenic and renal vs central DI
if the check list results in these potentials remaining.
Remember isosthenuria will wash out bacteria especially in older cats (common occult UTI) so negative urinary culture or negative bacteria does not rule out occult infection especially if pyelectasia is present on the renal sonogram.
Consider diabetes insipidus.
Consider diabetes insipidus. Urine is hyposthenuric.
Sam- why are your images so dark? I can’t see anything.
Are they that way on your end too?
Medullary washout and DI are
Medullary washout and DI are my main DDx’s…Images are not that dark on my end…seems to be an issue when I transfer them to windows format.
Eric, sorry for the long intro..I tend to give sl. more detail on my U/S findings as part of my reason for posting is evaluation/improvement of my scanning/interpretation skills, but I see ways I can abbreviate that now, so thanks for the shorthand suggestions.
U bet you have great posts
U bet you have great posts and threads just trying to refine the process:)
With the hyposthenuria would
With the hyposthenuria would do a modified water deprivation test: over a 3-4 day period reduce the water, after that no further water and if the USG does not concentrate then adminsinster ADH. This method will rule in both medullary solute washout and central diabetes insipidus.