21 Details – Summary
FIGURE 6. Tubules from a renal biopsy from a 3.2-year-old spayed female Laborador Retriever with proteinuria, hypoalbuminemia, azotemia and hypertension
- TX B140804
- 2.5; UPC, 6.0; SAlb, 1.9; SysBP, 230 initially; then 132 while receiving antihypertensive medications
- Evaluated for an acute renal disease causing azotemia, proteinuria, hypoalbuminemia, and hypertension. Leading considerations for the cause of this disease are leptospirosis (based on an increased original titer, but a convalescent titer was not increased) and Lyme nephritis (based on quant C6, 444), or possibly pyelonephritis.
- Patient was inappetant for ~ 2 weeks and she vomited once (associated with receiving medications). She was diagnosed with acute kidney injury (IRIS grade 3; BUN, 79-64-80; SCr, 3.1-3.1-3.4) with Usg, 1.029 and 1.035 despite fluid administration and proteinuria (3+ and 4+, UPC not done due to hematuria and bacteriuria noted on initial urinalysis) as well as hyperphosphatemia (PO4, 6.8-5.8-7.3) and renal gucosuria (1+) with active urine sediment (2-5 WBC/hpf and 2+ granular casts) on the first urine sample obtained by cystocentesis. However, a urine culture obtained after a few antibiotic doses was negative. Other findings have included progressive hypoalbuminemia (SAlb, 1.7), anemia (Hct, 29.3; retics, 28,700), neutrophilia (Neuts, 12,540), persistent marked thrombocytopenia (Plts, 44,000 to 7,000 with clumps noted), positive serologic tests for Lyme (SNAP 6, positive; quant C6, 444), hypertension (SysBP, 230), and transient edema and gelatinous dermal palpation noted.
- After referal, an abdominal ultrasound exam showed nearly normal corticomedullary distinction with mildly hyperechoic renal cortices and no stones, masses or pyelectasia in either kidney.
- The patient’s clinical status was fair. She received a low volume of IV fluids (1/4 maint) and gained weight (3+ kg). Her blood pressure was 132. Repeated tests showed persistent azotemia (BUN, 101; SCr, 3.4) with hypoalbuminemia (SAlb, 1.6; Glob, 3.4), anemia (Hct, 32.8), and thrombocytopenia (Plts, 50,000 to 120,000). Results of serologic tests for leptospirosis were: Grippo, 1:3,200; Aut, 1:3,200; Brat, 1:80; Pomona, 1:800; and Icto, 1:400.
- Two days later (at the time of biopsy), the laboratory results were those listed at the top of the clinical history. She was also anemic (Hct, 30).
- One week after biopsy, the patient developed pulmonary thromboembolism and was euthanized.
