-7 year old DSH
-long history of PU/PD ever since cat was young, USG 1.005-1.007, previously “worked up” elsewhere with no diagnosis
-recent episode of hyporexia and weight loss, improved with no treatment
-while boarding 2 days ago, noted port wine-colored urine, did not spin down, not turbid, no intact cells present
-CBC showed non-regenerative anemia (verified by clinical pathologist), Hct ~28, dropped to 26 today; otherwise normal CBC
-FIV – light positive BUT vaccinated in 2009, FeLV negative; verified at reference lab
-7 year old DSH
-long history of PU/PD ever since cat was young, USG 1.005-1.007, previously “worked up” elsewhere with no diagnosis
-recent episode of hyporexia and weight loss, improved with no treatment
-while boarding 2 days ago, noted port wine-colored urine, did not spin down, not turbid, no intact cells present
-CBC showed non-regenerative anemia (verified by clinical pathologist), Hct ~28, dropped to 26 today; otherwise normal CBC
-FIV – light positive BUT vaccinated in 2009, FeLV negative; verified at reference lab
-Panel – ALT 154, Amylase 1340 mildly increased AST, normal CK, BUN 16 creatinine 1.0
-rads – unremarkable
-recent hx of griseofulvin for ringworm
-today (2 days after significant hemoglobinuria noted), urine is completely clear, looks like water!
-U/S show changes that look like interstitial nephritis to me,.
I’m just trying to put his whole clinical picture together with episodic severe hemoglobinuria with gradually dropping Hct and non-regenerative anemia. The change in color of his urine is really astounding.
thanks! Suzanne
Comments
With the anemia
With the anemia intravascular hemolysis is of primary concern. cats get non regen anemia often.
CBC path review in order
diff HGBNuria with Myogmnuria by spinning down the urine:
Supernatant stays pigmented with hemoglobinuria and myoglobinuria but sediments in hematuria
High serum CPK: myoglobinuria.
Hemoglobinuria can be a manifestation of thromboembolic disease as well just to keep in the back of your mind.
The kidneys look a little swollen, mildly hyperechoic wiht mildly thickened cortices. This is aspecific but can go with lots of things such as pigment shower, amyloid, interstitial nephrosis…There is a mild medullary rim line in the kidney which is also aspecific. I would 25g FNA the kidneys and see if anything comes up.
Chrionic infectious to consider since FIV +… Toxo Bartonella special Texas bugs:) The ringworm Hx in a 7 year old tells me the immune system is not optimal so supports this potential.
Dry FIP can do medullary rim as well.
Here are soem quick diffs in the basic search for medullary rim kidney but also can be normal.
http://sonopath.com/members/case-studies/search?text=medullary+rim&species=All
Remo any input here?
With the anemia
With the anemia intravascular hemolysis is of primary concern. cats get non regen anemia often.
CBC path review in order
diff HGBNuria with Myogmnuria by spinning down the urine:
Supernatant stays pigmented with hemoglobinuria and myoglobinuria but sediments in hematuria
High serum CPK: myoglobinuria.
Hemoglobinuria can be a manifestation of thromboembolic disease as well just to keep in the back of your mind.
The kidneys look a little swollen, mildly hyperechoic wiht mildly thickened cortices. This is aspecific but can go with lots of things such as pigment shower, amyloid, interstitial nephrosis…There is a mild medullary rim line in the kidney which is also aspecific. I would 25g FNA the kidneys and see if anything comes up.
Chrionic infectious to consider since FIV +… Toxo Bartonella special Texas bugs:) The ringworm Hx in a 7 year old tells me the immune system is not optimal so supports this potential.
Dry FIP can do medullary rim as well.
Here are soem quick diffs in the basic search for medullary rim kidney but also can be normal.
http://sonopath.com/members/case-studies/search?text=medullary+rim&species=All
Remo any input here?
Dropping hematocrit with
Dropping hematocrit with hemoglobulinuria spells some form of hemolytic disease. The non-regenerative anemia may only be that the bone marrow has not yet kicked in.
DDx: immune-mediated hemolytic anemia, drug reaction, Mycoplasmosis, FeLV, splenic mast cell tumor/lymphoma. Anemia is reported as a side effect to griseofulvin.
Would be great to see the previous work-up for the PuPd.
Is it common for the
Is it common for the hemoglobinuria to be so sporadic?
The CBC with retic count did have a path review from a clinical pathologist who decided it was non-regenerative. It’s certainly possible the bone marrow has not yet kicked in. CK was normal and the pigment did not spin down.
The cat has been off the griseofulvin for awhile. The whole household was treated for ringworm; I’m not sure how clinical this cat was for it.
I only have a list of charges for the previous work-up. They did a fairly basic work up from what I can deduce.
I am rechecking the PCV on Wednesday and will see if it continues to drop. The owner is to watch for hemoglobinuria too.
Thanks,
Suzanne
Dropping hematocrit with
Dropping hematocrit with hemoglobulinuria spells some form of hemolytic disease. The non-regenerative anemia may only be that the bone marrow has not yet kicked in.
DDx: immune-mediated hemolytic anemia, drug reaction, Mycoplasmosis, FeLV, splenic mast cell tumor/lymphoma. Anemia is reported as a side effect to griseofulvin.
Would be great to see the previous work-up for the PuPd.
Is it common for the
Is it common for the hemoglobinuria to be so sporadic?
The CBC with retic count did have a path review from a clinical pathologist who decided it was non-regenerative. It’s certainly possible the bone marrow has not yet kicked in. CK was normal and the pigment did not spin down.
The cat has been off the griseofulvin for awhile. The whole household was treated for ringworm; I’m not sure how clinical this cat was for it.
I only have a list of charges for the previous work-up. They did a fairly basic work up from what I can deduce.
I am rechecking the PCV on Wednesday and will see if it continues to drop. The owner is to watch for hemoglobinuria too.
Thanks,
Suzanne
Another possiblity would be a
Another possiblity would be a form of porphyria. Link to an article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2942057/
Another possiblity would be a
Another possiblity would be a form of porphyria. Link to an article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2942057/