Sonopath Forum

Acute renal failure in a Pug

My colleague was presented with a 5 yo intact female Pug x that had vomiting and diarrhea for 5 days. Dog had been eating the chicken jerky treats from China… When it presented it was dehydrated, and had bloodwork consistent with severe renal failure. There were amorphous crystals seen in the urine (tech couldn’t make it fit the appearance of melamine crystals). Radiographs were non-specific. No pyometra present.

Ultrasound of kidneys below – dog had a very prominent medullary rim sign and I did note upon ultrasounding the RK that the liver appeared a bit hypoechoic. Otherwise, I didn’t feel there was much change. Owners had not given permission for a full abdominal scan (just genitourinary).

I know that the MRS is found in normal patients, but given this dog has c/s of renal disease I figured it’s relevant?

Main ddx – lepto, acute tubular necrosis, or chronic interstitial nephritis? Any others?

We haven’t seen lepto in our area before, but have started tx to target it just in case….

Any comments on this case would be GREATLY appreciated!

Thanks

Jennifer

Comments

rlobetti

May 22, 2014 at 3:31 pm -

Renal ultrasound and

Renal ultrasound and presentation more with acute kidney injury than chronic kidney disease. What was the SG? I assume that serum calcium and potassium were normal?

Toxic etiologies important – melamine, NSAIDs, raisins, heavy metals. Addison’s as a possiblity should also be considered.

rlobetti

May 22, 2014 at 3:31 pm -

Renal ultrasound and

Renal ultrasound and presentation more with acute kidney injury than chronic kidney disease. What was the SG? I assume that serum calcium and potassium were normal?

Toxic etiologies important – melamine, NSAIDs, raisins, heavy metals. Addison’s as a possiblity should also be considered.

jlc960

May 22, 2014 at 3:51 pm -

Thanks for the reply.
Forgot

Thanks for the reply.

Forgot to include – ACTH stim was normal.

USG 1.020 after 12hrs IV fluids

potassium – normal, 5.4

calcium – low, 1.8

increases in BUN, CREA, ALT, Phos too high to read, ALP 2x normal

thanks

Jennifer

jlc960

May 22, 2014 at 3:51 pm -

Thanks for the reply.
Forgot

Thanks for the reply.

Forgot to include – ACTH stim was normal.

USG 1.020 after 12hrs IV fluids

potassium – normal, 5.4

calcium – low, 1.8

increases in BUN, CREA, ALT, Phos too high to read, ALP 2x normal

thanks

Jennifer

rlobetti

May 22, 2014 at 4:02 pm -

Would go with a toxic

Would go with a toxic etiology and manage as for acute injury – fluids (but watch overhydration), monitor urine production, anti-emetics, gastric protectants, phosphate binders.

rlobetti

May 22, 2014 at 4:02 pm -

Would go with a toxic

Would go with a toxic etiology and manage as for acute injury – fluids (but watch overhydration), monitor urine production, anti-emetics, gastric protectants, phosphate binders.

May 23, 2014 at 12:52 am -

Medullary rim is aspecific

Medullary rim is aspecific often found in normal kidneys. I agree with remo acute insult are you treating for lepto?? IV ampicillin?

May 23, 2014 at 12:52 am -

Medullary rim is aspecific

Medullary rim is aspecific often found in normal kidneys. I agree with remo acute insult are you treating for lepto?? IV ampicillin?