Sonie's Protein/creat Ratio Test Results

[Guest HersheysMom]

So we got the results back from Sonie's protein/creat ratio test. It is 9.3!!! I was shocked.

 

Is it possible that the protein could still be residual from one of the two infections she recently had? She's had off and on UTIs and crystal problems since we adopted her. Her most recent infection was discovered on June 29th and the sample contained bacteria, crystals and red and white blood cells. We did a ten day course of Baytril and this most recent infection was treated and cleared (supposedly) with the most recent sample being tested on July 22 - the sample came up clear of bacteria and crystals. She then had two accidents in her sleep the other night, but none since then. The vet thinks she could still have a low-grade infection not showing up in the urinalysis.

 

Amongst all this she had a bad tooth infection - the tooth was pulled on July 16th and she was put on antibiotics which we finished on July 26th.

 

She seems like she feels great despite all this. Right now the plan of action is to put her on a six week course of Baytril to make sure we've eliminated the UTI infection completely. Then rerun the protein/creat ratio test. We also had the option of a sterile needle culture, a kidney ultrasound and biopsy or all of these. I do want to make sure she does not have glomerulonephritis, but I'm not eager to put her under anesthesia again so soon. She's been under a few times in the past few months already, been though an awful lot and she is a spook which makes things even harder. But I don't want to miss anything either. I am now considering requesting an awake ultrasound to rule out glomerulonephritis though that will also put stress on her.

 

Or since there were two different infections going on that could have skewed the results, I could wait as planned and do the six-week course of Baytril and if the protein/creat is still high then do the ultrasound. Does this plan sound reasonable? Sorry it's an awful lot to absorb.

Edited July 29, 2010 by HersheysMom

[Batmom]

Tough one. Did she have a urine culture and sensitivity so you know for sure that Baytril will work against the bacteria? Is her bloodwork (BUN and creatinine) good?

[Guest HersheysMom]

Good questions! Unfortunately, the last sample wasn't cultured. I wanted a culture but they (the person at the desk who who took the sample) would not do one from a free catch, which I understand is theoretically reasonable but later found out when I talked to the vet that if she had had her say they would have made an exception and done it from a free catch. Her last infection WAS cultured and found to be ecoli, so I'd had Baytril in the house from that infection and started her on it. After one or two doses of Baytril her symptoms were gone. I do still have the option of bringing another free-catch in now and having them try to grow a culture (even tho no bacteria seen last week)

 

She had preop bloodwork done in midJune and kidney values were "very good"

[Guest TeddysMom]

Baytril is a really strong antibiotic and 6 weeks is a long time to be on it. I think I would ask about claxomox or some other antibiotic since she has been on the Baytril for 10 days already. JMHO

[Guest ChasesMum]

curious if they did a tick test because an elevated urine pr/cr ratio was one of the signs of Chase's ehrlichiosis.

 

just an off the wall thought.

[Batmom]

I would do the culture. To hedge your bets, could ask the vet for a sterile sample cup to take home and make sure you get a midstream catch. If the culture is clean, then you've likely got a different issue.

[Guest HersheysMom]

Teddysmom unfortunately she can't have Clavamox. There are several antibiotics she has a bad reaction to but Baytril is not one of them. That is a consideration though. I do understand it's a strong drug. I'll look on the Baytril website and see how long they suggest is the longest to be on it. My vet actually suggested only four weeks, but since we're going away the first week of Sept wanted to keep her on it until I get back.

 

I'm going to call and ask about the culture. I'll also look up her last tick test. She had lyme at one point, but it was treated and she came up clean - I think it was in March. I'll check.

 

This is all so confusing.

[Batmom]

Not a big deal to be on Baytril for 6 weeks altho if there is a question of kidney issues, my vet prefers Zeniquin (same class as Baytril, even more expensive ). But it really depends on what the organism is sensitive to, hence the culture. Gidget's UTI came back from the lab as sensitive to both clavamox and the Baytril/Zeniquin class; we already knew clavamox wouldn't kill it as she'd been on it for nearly a month when we did the culture.

[Guest HersheysMom]

Thanks again Batmom, I couldn't find the longest safe period online. So far we know Sonie can't have Clavamox or any Ceph antibiotic - we have to be careful with her. I can't imagine a Baytril-class drug being MORE expensive than Baytril. This is costing me $350, and with a discount

[Guest ChasesMum]

sometimes drug companies have samples, or can help out. i used to call all the time to drug reps in a human clinic.

 

for example, zeniquin is made by Pfizer at 1-800-366-5288. its also on 1800petmeds

 

just random ideas

[Guest mcsheltie]

Here are random thoughts, make of them as you will...

 

I think your vet's plan is totally reasonable.

 

Unless the symptoms have returned, I don't know that you would get a decent culture just coming off a course of antibiotics. I would only do sterile samples from now on with this dog, not free catch. Vets do those relatively easily and they do not have to be put under. They will give you a better idea of what is going on.

 

YES! Infection can be the cause of the test result. The P/C test is very sensitive so you have to rule out transient and other other medical causes of protein loss before assuming the loss is persistent and the result of renal disease. Dehydration, infection, blood pressure, heart problems, fever and kidney stones will influence the test. As will increases of exercise and stress.

 

I rarely have had to anesthetize for an ultra sound. Most will tolerate it awake.

 

Make sure her blood pressure has been checked. It is a factor with both glomerulonephritis and the P/C test. Is her Albumin level in the norm?

 

6 weeks on Baytril is not a problem.

 

Crystals are usually found in reoccurring UTIs. But a dietary cause is worth discussing with your vet if it keeps reoccurring.

[Guest HersheysMom]

Thanks very much everyone for your well thought out ideas. We've just returned from the vet - right after I posted last I called and they squooze us in for an ultrasound-guided sterile culture, so I went racing over there. We also got to look at her bladder and confirmed there are no bladder stones. Both vets commented that the sample looked a bit green and "suspicious" but could also be from protein. So for the first time I'm hoping for an infection here. Will know in a few days.

 

McSheltie, I think you are right no more free-catches. We've had a couple missed infections from free-catches alone already. Yes, her blooedpressure was recently (about two weeks ago) checked and was good. Do not know her Albumin level but this is easy for me to look up from her last u/a. You mentioned a special diet - what would you recommend? Since I currently feed raw I know my vet was going to look into a renal-friendly homecooked diet. We do need a diet change I think, as she'd has an ongoing problem with recurring infections. I don't mind doing homecooked - I will also consider kibble or canned, but don't want that do be her entire diet.

[Guest TeddysMom]

Teddysmom unfortunately she can't have Clavamox. There are several antibiotics she has a bad reaction to but Baytril is not one of them. That is a consideration though. I do understand it's a strong drug. I'll look on the Baytril website and see how long they suggest is the longest to be on it. My vet actually suggested only four weeks, but since we're going away the first week of Sept wanted to keep her on it until I get back.

 

I'm going to call and ask about the culture. I'll also look up her last tick test. She had lyme at one point, but it was treated and she came up clean - I think it was in March. I'll check.

 

This is all so confusing.

 

I am just sorry you and your baby are having to go through this. The Baytril is not a problem it is just one of the "big guns" and if she could take something else it would be great but since she has a sensitivity to some antibiotics it is best to stick with something tried and true. Good luck and hugs to your and her.

[Guest mcsheltie]

Thanks very much everyone for your well thought out ideas. We've just returned from the vet - right after I posted last I called and they squooze us in for an ultrasound-guided sterile culture, so I went racing over there. We also got to look at her bladder and confirmed there are no bladder stones. Both vets commented that the sample looked a bit green and "suspicious" but could also be from protein. So for the first time I'm hoping for an infection here. Will know in a few days.

 

McSheltie, I think you are right no more free-catches. We've had a couple missed infections from free-catches alone already. Yes, her blooedpressure was recently (about two weeks ago) checked and was good. Do not know her Albumin level but this is easy for me to look up from her last u/a. You mentioned a special diet - what would you recommend? Since I currently feed raw I know my vet was going to look into a renal-friendly homecooked diet. We do need a diet change I think, as she'd has an ongoing problem with recurring infections. I don't mind doing homecooked - I will also consider kibble or canned, but don't want that do be her entire diet.

Diet would depend on what kind of crystals were present. One is base, the other acidic. Like I said, crystals are usually present with an infection, so it is the old game of deciding which came first, the chicken or the egg. You don't necessarily need a diet change due to crystals. It is just something to keep in the back of your mind if the infection keeps coming back.

 

I wouldn't jump to the conclusion your dog has renal disease yet. Just because you are experiencing a persistent infection doesn't mean renal disease. I've been through about the same thing with two dogs and they have no kidney problems once we got the infection taken care of. The male also had an enlarged prostrate, so I was getting very nervous. But everything went back to normal.

 

I can help you with a kidney friendly diet if the need arises. You want high quality/high biological value protein. The worse the renal failure the more important this is. Also keep the dietary phosphorus level down while maintaining the correct Calcium/Phos ratio.

 

But first you have to get the diagnostics done and the infection under control, then see where you are. Odds are you will fine!

 

ETA: Albumin would be on her last chem panel. It is one of the measurements of liver function and elevation is seen in conjunction with glomerulonephritis.

Edited July 29, 2010 by mcsheltie

[Guest HersheysMom]

Teddysmom unfortunately she can't have Clavamox. There are several antibiotics she has a bad reaction to but Baytril is not one of them. That is a consideration though. I do understand it's a strong drug. I'll look on the Baytril website and see how long they suggest is the longest to be on it. My vet actually suggested only four weeks, but since we're going away the first week of Sept wanted to keep her on it until I get back.

 

I'm going to call and ask about the culture. I'll also look up her last tick test. She had lyme at one point, but it was treated and she came up clean - I think it was in March. I'll check.

 

This is all so confusing.

 

I am just sorry you and your baby are having to go through this. The Baytril is not a problem it is just one of the "big guns" and if she could take something else it would be great but since she has a sensitivity to some antibiotics it is best to stick with something tried and true. Good luck and hugs to your and her.

 

Thank you

 

mcsheltie just pulled chem panel from 6/18 - Albumin result was 3.4, reference range 2.5-4.0 Seems right-down-the-middle normal to me!

[Guest mcsheltie]

Teddysmom unfortunately she can't have Clavamox. There are several antibiotics she has a bad reaction to but Baytril is not one of them. That is a consideration though. I do understand it's a strong drug. I'll look on the Baytril website and see how long they suggest is the longest to be on it. My vet actually suggested only four weeks, but since we're going away the first week of Sept wanted to keep her on it until I get back.

 

I'm going to call and ask about the culture. I'll also look up her last tick test. She had lyme at one point, but it was treated and she came up clean - I think it was in March. I'll check.

 

This is all so confusing.

 

I am just sorry you and your baby are having to go through this. The Baytril is not a problem it is just one of the "big guns" and if she could take something else it would be great but since she has a sensitivity to some antibiotics it is best to stick with something tried and true. Good luck and hugs to your and her.

 

Thank you

 

mcsheltie just pulled chem panel from 6/18 - Albumin result was 3.4, reference range 2.5-4.0 Seems right-down-the-middle normal to me!

Good! Will be looking for the culture results.

[Batmom]

FWIW, we've never had a problem with midstream catch. The issue would be if it were contaminated by exterior genitalia, nonsterile container, etc. -- you'd be cluttering up the results. The times I've sent a catch for culture, it's been totally clean. At my vet the ultrasound-guided cystocentesis is pretty cheap so we have done that, too, but if I've got a nice fresh sample and we don't have any reason to look at the bladder again, we culture my catch. YMMV. I do agree with mcsheltie about making sure you've got any infection cleared before assuming something else is wrong. Fingers crossed! ..... P.S. When we have a persistent/recurring problem, we usually check urine after @ 5 days on antibiotics (should be clean), last day of antibiotics or day after (should be clean), and 7-10 days after antibiotics are finished (you hope this is clean too). That's a lot of checks, but as already noted, sensitivity in the lab and sensitivity in the dog can be 2 different things. If that first sample after several days on the antibiotic is still showing bacteria/white cells, you may need to talk to the lab that ran the sensitivity and pick a different antibiotic to continue with.

[GeorgeofNE]

Baytril is a really strong antibiotic and 6 weeks is a long time to be on it. I think I would ask about claxomox or some other antibiotic since she has been on the Baytril for 10 days already. JMHO

 

Never mind! What I was going to say was already said!

Edited July 30, 2010 by GeorgeofNE

[Guest Fasave]

Thanks very much everyone for your well thought out ideas. We've just returned from the vet - right after I posted last I called and they squooze us in for an ultrasound-guided sterile culture, so I went racing over there. We also got to look at her bladder and confirmed there are no bladder stones. Both vets commented that the sample looked a bit green and "suspicious" but could also be from protein. So for the first time I'm hoping for an infection here. Will know in a few days.

 

McSheltie, I think you are right no more free-catches. We've had a couple missed infections from free-catches alone already. Yes, her blooedpressure was recently (about two weeks ago) checked and was good. Do not know her Albumin level but this is easy for me to look up from her last u/a. You mentioned a special diet - what would you recommend? Since I currently feed raw I know my vet was going to look into a renal-friendly homecooked diet. We do need a diet change I think, as she'd has an ongoing problem with recurring infections. I don't mind doing homecooked - I will also consider kibble or canned, but don't want that do be her entire diet.

 

Carolyn, if you do go to home cooked, there is a great nutritionalist at Angell. She did the recipe for Safari when he was so sick. I can give you her information if you need it. Also, I don't mind cooking for Sonie for 10 days:-)

[Guest HersheysMom]

Also, I don't mind cooking for Sonie for 10 days:-)

 

LOL Melissa I don't think it will come to that! She'll never want to come back home then Aren't you glad now I'm leaving them, with you for ten days Not to worry, this will all be straightened out by then. I'm determined to have it straightened out.

 

So I'm thinking it's less and less likely she has glomerulonephritis. For these reasons: She has normal bloodpressure, normal kidney values, a normal albumin level, a normal urine specific gravity, and isn't losing weight or muscle. It just doesn't add up. But my vet did remind me she could still have it without classic symptoms. But so far her only symptom is the high amount of protein in the urine.

 

Will post the culture results, thanks everyone again.

[Guest gretzky]

Wonder's ratio was never that high. That said, she never had "normal" symptoms. All her other tests were normal except specific gravity and that was just the slightest bit off. She was tested because of excessive water consumption. Vet did a p/c ratio and Cushings test trying to figure out what was up.

 

I hope it all gets straightened out after the course of Baytril.

[KF_in_Georgia]

Just to reassure you: a sterile needle sample doesn't require sedation. Jacey had that done. She stood there while I held her head, talked to her, rubbed her ears for her, and she couldn't have cared less what the vet was doing under her belly with that needle.