Fondue is a 4 y.o. Pomeranian who survived from distemper. He has sudden onset of vomiting, the referrer vet suspected for intestinal intussusception or GI obstruction. I found out that both kidneys have hyperechoic renal cortices but not so sure about liver (was it normal?). The blood tests revealed
– WBC = 20.1 x10^3 cells/uL (Neutrophils = 14,673 cells/uL, Eo = 201 cells/uL, Lym = 3,216 cells/uL, Mono = 2,010 cells/uL)
– RBC = 5.12 x10^6 cells/uL
– HCT = 39%
– PLT = 31000 (neg blood parasites from buffy coat smear)
– BUN = 117 mg/dL (10-28)
Fondue is a 4 y.o. Pomeranian who survived from distemper. He has sudden onset of vomiting, the referrer vet suspected for intestinal intussusception or GI obstruction. I found out that both kidneys have hyperechoic renal cortices but not so sure about liver (was it normal?). The blood tests revealed
– WBC = 20.1 x10^3 cells/uL (Neutrophils = 14,673 cells/uL, Eo = 201 cells/uL, Lym = 3,216 cells/uL, Mono = 2,010 cells/uL)
– RBC = 5.12 x10^6 cells/uL
– HCT = 39%
– PLT = 31000 (neg blood parasites from buffy coat smear)
– BUN = 117 mg/dL (10-28)
– Cr = 8.3 mg/dL (0.5-1.5)
– Calcium = 7.54 mg/dL
– Phosphorus = 17.1 mg/dL (2.6-6.2)
– TP = 4.6 g/dL (5.4-8)
– Alb = 1.9 g/dL (2.3-4.1)
– SGPT = 150 U/L (21-102)
– ALP = 282 U/L (0-140)
– SNAP cPL = normal
So, the questions are, is the liver normal? and could this be Leptospirosis?
Comments
Interstitial nephrosis
Interstitial nephrosis pattern truly chronic as something has been doing this for some time. Chronic lepto can do this but other causes as well. I only see 2 images on the kidney but If the rest of the renal parenchyma looks like this then looks like there is not a whole lot to work with here. renal bx necessary to confirm and define. In the meantime chase lepto, blood pressures and urine culture. i like IV ampicillin first line for lepto then doxycycline 6 weeks if confirmed + but Remo is the expert here on this.
With the low albumin I am assuming PLN here. Lepto hepatitis can drop the BUN but usually takes a number of days for the liver failing til the albumin drops.
The liver is unremarkable but lepto will do anything to to the liver if its acute then the liver looks structurally norma as acute insults have not have time to change the parenchyma yet. But chronic lepto will look like CAH.
Do a basic search on leptospirosis in the sonopath archive and you will see similar cases.
http://www.sonopath.com/members/case-studies/search
Save the kidneys on this guy. Hx check for other chronic toxin exposure necessary as well…. food recall???
Interstitial nephrosis
Interstitial nephrosis pattern truly chronic as something has been doing this for some time. Chronic lepto can do this but other causes as well. I only see 2 images on the kidney but If the rest of the renal parenchyma looks like this then looks like there is not a whole lot to work with here. renal bx necessary to confirm and define. In the meantime chase lepto, blood pressures and urine culture. i like IV ampicillin first line for lepto then doxycycline 6 weeks if confirmed + but Remo is the expert here on this.
With the low albumin I am assuming PLN here. Lepto hepatitis can drop the BUN but usually takes a number of days for the liver failing til the albumin drops.
The liver is unremarkable but lepto will do anything to to the liver if its acute then the liver looks structurally norma as acute insults have not have time to change the parenchyma yet. But chronic lepto will look like CAH.
Do a basic search on leptospirosis in the sonopath archive and you will see similar cases.
http://www.sonopath.com/members/case-studies/search
Save the kidneys on this guy. Hx check for other chronic toxin exposure necessary as well…. food recall???
Here are some views on both
Here are some views on both kidneys.
Here are some views on both
Here are some views on both kidneys.
Yes the left looks a bit
Yes the left looks a bit better than the right but my responses are the same. Kidneys have microinfarcts and fibrosis. Subjectively the kidneys look +/- 50% compromised
Yes the left looks a bit
Yes the left looks a bit better than the right but my responses are the same. Kidneys have microinfarcts and fibrosis. Subjectively the kidneys look +/- 50% compromised
The dog passed away last
The dog passed away last night. Urine PCR was positive for Lepto. Lepto Ab IgG titer was 1:2000.
The dog passed away last
The dog passed away last night. Urine PCR was positive for Lepto. Lepto Ab IgG titer was 1:2000.
Makes sense thanks for
Makes sense thanks for providing the follow-up. Its too bad he didnt make it.
Makes sense thanks for
Makes sense thanks for providing the follow-up. Its too bad he didnt make it.