Yogi has a histroy dating from June 2014 of recurrent UTI’s, low urine specific gravity and renal values that are trending up. SpG is 1.010. BUN has gone from 18 in 2014 to 42 this January. Creat went from 0.9 to 1.5 in same time frame. This January, most recent free catch urine sample showed WBCs and rod bacteria that cultured positive for e-coli. No protein noted on this UA. He was placed on a 2 week course of Clavamox. Just finished and presented today to have a limited ultrasound of kidneys, prostate, urinary bladder and testicles.
Yogi has a histroy dating from June 2014 of recurrent UTI’s, low urine specific gravity and renal values that are trending up. SpG is 1.010. BUN has gone from 18 in 2014 to 42 this January. Creat went from 0.9 to 1.5 in same time frame. This January, most recent free catch urine sample showed WBCs and rod bacteria that cultured positive for e-coli. No protein noted on this UA. He was placed on a 2 week course of Clavamox. Just finished and presented today to have a limited ultrasound of kidneys, prostate, urinary bladder and testicles.
Concerned about the hyperechoic appearance of the left kidney and the prostate + the cystic areas in the prostate. For now, opting to get him neutered and will put him back on antibiotics based on a repeat urine cysto C&S today, but would love input regarding aspirating the cyst and what your thoughts are about the gradually increasing renal values and isosthenuric urine.
Comments
needs an ADAIN procedure
needs an ADAIN procedure draining the prostatic cysts/abscess and neutering. Pyelectasia is suggestive for pyelonephritis but can be scarring. Recurrent uti with these changes needs to address the chronic nidus in the prostate and kidney. ADAIN and 6 weeks baytril would be recommended here carrying forward dependent on UA cultures. Clavamaox doesnt penetrate the prostate well. Best prostatic ABs are quinolones and supha but wiht the chronic prostate changes here it will be tough to clear withuot neuter.
Here’s the ADAIN link in resources/interventional procedures
http://www.sonopath.com/resources/instructional-library-sonopodcasts-interventional-procedures
Here is my garden variety template for chronic UTI
Chronic UTI Protocol
I recommend Enrofloxacin (5 mg/kg SID PO) in late pm after urination to maximize urinary concentrations overnight. This assumes that culture supports this use. Repeat culture at 3-4 weeks and continue treatment at least 7-10 days post negative urinary sediment and negative culture. Note: Negative culture does not necessarily mean lack of UTI. Other favorite antibiotics for chronic UTI include third generation Cefa (Ceftiafur or similar sid injectable) or Clavamox. If suspicion of occult urinary incontinence is present then phenylpropanolamine (PPA) (1-2 mg/kg BID) can be employed long term to enhance urethral tone.
Thank you, Eric.
Thank you, Eric.