Renal Biopsy To Confirm Glomerulonephritis

[Guest HersheysMom]

I was wondering if anyone who has had this procedure done on their dog could share with me the recovery time and if there were any complications with the procedure. If possible, could you tell me approximately what year you had this done as I think the method to do a renal biopsy has changed some over the last few years so the procedure is not as invasive as it used to be. Thanks!!

[Batmom]

I haven't done it. Is there any difference in treatment that one would expect to gain from the findings?

[Guest KennelMom]

We're going through this with Stella at the moment. We had an ultrasound done last week by the internal medicine specialist. Based on the findings of the ultrasound, we'll do two more urine checks and then proceed with treatment. At this point the specialist has not recommended a biopsy (our regular vet said they probably wouldn't). Have you done an ultrasound/is that a possibility?

[Guest HersheysMom]

No difference in treatment, but it would confirm that Sonie actually has glomerulonephritis before we would put her on a drug for it.

 

We have looked into I think every other possible explanation for Sonie's extremely high protein/creat ratio. Ran a u/a, then a sterile culture - both came back negative. Ran extensive bloodwork including a very through tick panel. That all came back good. This is not related to the resolved tooth infection, according to the pathologist, the number is just way too high.

 

Looking at two options right now. The clinical pathologist is encouraging us to still do a 4-6 week course of Baytril. She says there could still be a hidden infection despite the fact that even the culture would not grow (which is REALLY frustrating!!), and she said to clear it completely we may need several weeks of antibiotics. The worry I have with that is building an antibiotic resistant bacteria.

 

The other choice is to go ahead and do the ultrasound w/biopsy to see once and for all of she does have glomerulonephritis.

 

We are trying to decide between these two options right now.

 

ETA to KennelMom - I asked my vet that and she seems to be waffling on whether we will get enough info form an ultrasound alone, without the biopsy. This has been on the table for some time and we keep going back & forth.

Edited August 17, 2010 by HersheysMom

[NeylasMom]

Following this thread with interest - a long time friend's dog (and also my former foster dog) recently started having trouble. Excessive thirst and urination, weight loss, possibly some muscle wasting and an incredibly high protein/creat ratio (something around 3). U/A and culture were both negative, 4D test negative for heartworm and TBDs. Ran a test to check for Cushing's and results were inconclusive. Owners are thinking about an ultrasound or the additional test (sorry, specific names are slipping my mind) to figure out if it's Cushings or something else.

 

Unfortunately I don't have any input for you, except to say that I hope you get some answers.

 

I guess my only thought would be that I've read that even if you confirm the dx, glomerulonephritis can be caused by so many things, how would that help you determine a course of treatment?

[Batmom]

A 4-6 week course of Baytril won't build antibiotic resistant bacteria.

[Guest KennelMom]

Hersheysmom - we arrived at the same point as you via the same path of elimination/tests. The only thing we didn't do (wasn't given as an option) was the course of Baytril.

 

It's hard to not seriously consider the 4-6 week course if Baytril if there's a chance it could resolve an underlying infection that's otherwise been missed and not have to put the pup through the ultrasound/biopsy. They didn't have to do any anesthesia for Stella's ultrasound and the diagnosis was pretty obvious from what they could see so maybe that's why they didn't suggest the biopsy. If the ultrasound had been inconclusive that may have been our next step.

[Batmom]

P.S. I clicked Post too soon. The time you worry about encouraging the growth of antibiotic resistant bacteria is when people are given a 10-day course of abx and give it to their dog for only 3 days. Doing a long course of antibiotics when there is no reason to -- that's potentially a public health issue but not an issue for the individual taking the antibiotics. In your case, sounds like there might be a reason to. It took 4+ weeks of Zeniquin (even more expensive than Baytril) to get rid of Gidget's infection; admittedly hers grew a culture but some organisms are good at hiding, especially if the pup is drinking/peeing kind of a lot. Hugs and best luck.

[tbhounds]

Personally I'm not sure if you would gain much by doing the biospy. Have you done urine p/c ratios? My girl had GN and Dr Couto put her on aspirin and enalapril -- didn't perform a biopsy. I'm assuming you're talking about a GH? The progession of GN is very slow (and common) in GHs compared to other breeds.

Edited 'cause must admit I didn't read your last post-- looks like you had a ton of tests done and I personally I still won't perform such an invasive procedure. Especially because it won't effect the treatment. I think saying your pup has a hidden infection is a stretch especially because we see GN with some frequency in the breed. IMHO

Edited August 18, 2010 by tbhounds

[Guest HersheysMom]

Thanks everyone for giving me a lot to think about.

 

Batmom, I really appreciate you explanation of the antibiotic-resistant bacteria. Makes sense!

 

I'm narrowing in on a decision today, just bumping because I can't believe no one on the board has had the biopsy done! Maybe that should tell me something, but bumping nonetheless.....

[Guest HersheysMom]

Thanks everyone for giving me a lot to think about.

 

Batmom, I really appreciate you explanation of the antibiotic-resistant bacteria. Makes sense!

 

I'm narrowing in on a decision today, just bumping because I can't believe no one on the board has had the biopsy done! Maybe that should tell me something, but bumping nonetheless.....

 

ETA one last thing - she's been having pee accidents in her bed about once every two weeks. At the moment, they are happening while she is sleeping only. But this further complicates things as to whether she still has a UTI despite the clean culture, or if she's beginning to develop incontenence.

[Bevd]

I'm narrowing in on a decision today, just bumping because I can't believe no one on the board has had the biopsy done! Maybe that should tell me something, but bumping nonetheless.....

I'm in a bit of a rush and don't have time to look things up but I just wanted to say that when our little lurcher (Buddy) was ill a few years ago with suspected PLE (which seems to be something to do with Glomerulonephritis) if I am remembering correctly without going back to look at all my notes, my vet explained that the reason he did NOT want to do a biopsy was that if it did turn out to be that condition (and the biopsy was the only was of being 100 sure), then we ran the risk of the biopsy site taking a long time to heal and causing serious complications. So we didn't do it.

 

Just wanted to mention that in case it's important for your dog too.

 

[NeylasMom]

Thanks everyone for giving me a lot to think about.

 

Batmom, I really appreciate you explanation of the antibiotic-resistant bacteria. Makes sense!

 

I'm narrowing in on a decision today, just bumping because I can't believe no one on the board has had the biopsy done! Maybe that should tell me something, but bumping nonetheless.....

 

ETA one last thing - she's been having pee accidents in her bed about once every two weeks. At the moment, they are happening while she is sleeping only. But this further complicates things as to whether she still has a UTI despite the clean culture, or if she's beginning to develop incontenence.

My friends dog that I mentioned above is doing that too and I think she is too young to be developing incontinence. I'm wondering if it's not possible that it's just another symptom of the kidney problem? Did you rule out Cushing's?

[Guest JohnS]

Thanks everyone for giving me a lot to think about.

 

Batmom, I really appreciate you explanation of the antibiotic-resistant bacteria. Makes sense!

 

I'm narrowing in on a decision today, just bumping because I can't believe no one on the board has had the biopsy done! Maybe that should tell me something, but bumping nonetheless.....

 

ETA one last thing - she's been having pee accidents in her bed about once every two weeks. At the moment, they are happening while she is sleeping only. But this further complicates things as to whether she still has a UTI despite the clean culture, or if she's beginning to develop incontenence.

My friends dog that I mentioned above is doing that too and I think she is too young to be developing incontinence. I'm wondering if it's not possible that it's just another symptom of the kidney problem? Did you rule out Cushing's?

 

I'm the friend NeylasMom was referring to. Our dog Hennessey had similar symptoms to Hershey. I've been reading around looking for the right place to post on GT. Hennessey is 8 yrs old and fairly suddenly developed extreme thirst, frequent peeing and this bizarre peeing while sleeping thing. It isn't incontinence in the sense that she has lost control, because she doesn't do it when she is awake. Anyway, we ruled out a UTI with a culture. But similar to Hershey, Hennessey's protein/creatinine ratio test was very high 3.7. We had heavy panting, exercise intolerance and a very fuzzy coat, which had us first leaning towards Cushings. The Cortisol/Creatinine ratio came back at 36 which is considered low high and had my vet leaning away from Cushings and towards some sort of glomerular kidney type issue. She has prescribed switching to low protein food (Royal Canine Renal LT) and a course of benazipril to help metabolize protein and hopefully take some stress off the kidneys.

 

I'm debating between doing the ACTH stim test to confirm/rule out Cushings or whether to go straight to an ultrasound. It seems like they ultimately provide the same info (the ultrasound should reveal inflamed adrenal glands if there is Cushings) but might also reveal something about GN. My vet got excited that it might be "Alabama Rot" because Hennessey had a history of slow healing skin lesions that she thought might be related (I feel they were hotspots that she just obsessively licked, they cleared up once we were militant about keeping an e-collar on her all the time). She also had a bout of pancreatitis a year ago January that I've seen mentioned as possibly being linked to GN. I hadn't heard that GN was common in greyhounds, so that is very interesting.

 

HersheysMom, I'll be very interested to hear what you all decide to do and be sending our prayers. A biopsy seems like a big step especially if it doesn't lead to a specific treatment path? But I hate the idea of saying, ok, let's do an ACTH, now an ultrasound, now an ultrasound guided biopsy just from a $ perspective. It seems like you are doing different tests that ultimately get you to the exact same place, and we might as well at least skip the ACTH and go straight to ultrasound.

 

I sent our info to OSU to get a second opinion and hopefully some guidance. Any thoughts that anyone cares to share are always appreciated.

[Guest KennelMom]

Just wanted to add, we've had sleeping incontinence with Stella as well. Initially our vet suspected Cushings (she has several other classic symptoms) as in Hennessey's case but that's been ruled out for her at this time.

[NeylasMom]

Hi John.

 

You might get more answers if you post your own thread. Put it here in H&M (health and medical).

[kudzu]

Most people do not choose renal biopsy & I was among those with a prior dog. We went with the 4 week course of anti-b's, Baytril + Clavamox combo, to knock out any possible infection even though my guy at the time had nothing on culture. After that he was given the presumptive diagnosis of "nephritis" with the vet thinking glomerulo-. GP vet, IMS, neurologist with IM specialty also, all concurred that biopsy would be needed to confirm diagnosis but none recommended it. IMS said it would be quite rare for her to recommend it because it does little to change treatment plan & so she usually feels it is not worth the risk. GP is holistic vet so not surprising that she did not recommend biopsy. Neurologist felt that confirming a GN diagnosis would not matter to overall treatment or disease progression.

 

Going from memory of a few years ago I can say that I only know two people who did renal biopsy. Here is a small, very unscientific study in relation to renal biopsies of 4 cases where GN was suspected:

 

Case 1- No biopsy, presumptive diagnosis of GN with corresponding treatment but diagnosis later changed to tubulonephritis. Tubulonephritis presumed to be result of renal damage as opposed to the type of ongoing renal disease process often associated with GN. [This was my dog. He was born with just one kidney & one adrenal gland. ACTH stim tests, two given two years apart, were normal. Kidney had suffered a great many insults. He had proteinuria for at least 6 years & 'renal failure' or if you prefer 'renal insufficiency' for 4 years. He died *with* renal failure but not *from* it.

Case 2- No biopsy, treated as GN but later SNAP test showed positive for Lyme disease. Treated with Clavamox & diagnosis changed to Lyme nephritis. (I have no idea how that differs from GN.) Dog lived for two more years before succumbing to renal failure. [This was a friends Lab. He had a good life until the last couple months. He had done quite well until a relapse of Lyme & then Leptospirosis from which he could never fully recovered.]

Case 3- Renal biopsy done with easy recovery. GN diagnosis confirmed with no appreciable change from initial treatment when GN was merely presumed.

Case 4- Renal biopsy done with some complications & delayed recovery. (Going from memory & do not recall any permanent probs from biopsy.) Found not to have GN & other had causes searched for. ACTH stim test confirmed Addison's. [i consider this a vet med screw up. ACTH stim test should have been run *before* biopsy was even considered. If memory serves, after Addison's treatment started, renal values returned to normal. ]

 

Note: All of the above dogs were already in the "renal failure" category before GN or biopsy were ever mentioned or considered. I do not know the outcome of the last two cases.

 

Am not saying you shouldn't have biopsy done. Just know that for my dog it was not something I considered. Did not seem it would effect treatment and so it seemed an unnecessary risk. He did have many other problems that were far more of an immediate concern than something as minor as early renal failure. (And can you even believe I just referred to renal failure as "minor"?!)

[Guest HersheysMom]

John S Welcome to the board! Yes, Sonie seems to have all of the same symptoms as your dog. And you and I are about in the same spot. Honestly, I've not heard of the ACTH stim test before today - a quick google search seems to pull up it's a test for both Addison's and Cushings? Now I am also wondering if I should do this test first (before an ultrasound) Are Hennessey's symptoms still the drinking a lot, night accidents and protein in urine? That's what we've got with Sonie. She is really happy and playful, not acting "sick" at all. I agree w/Neylasmom - I would copy & paste your whole post into a fresh one with a new title and you may get some more bites on what's going on with Hennessey.

 

Kudzu thanks a lot! I'm glad to know that the 4-week course of antibiotics is a reasonable step before proceeding further. That's exactly the decision I made this morning. 4 weeks of Baytril (she can't have Clavamox) and rerun the protein/creat ratio test. If it has not lowered at all, I am either doing the ACTH test or ultrasound, but no biopsy, even if I have to go to a different vet to do the ultrasound without the biopsy. The biopsy is making me very nervous quite frankly.

 

And no, it wouldn't effect treatment. From what I understand the treatment would be benezipril (sp?) no matter what. The renal biopsy would tell us how far along the disease is, long-term prognosis, etc. That's how I understand it.

[GeorgeofNE]

Thanks everyone for giving me a lot to think about.

 

Batmom, I really appreciate you explanation of the antibiotic-resistant bacteria. Makes sense!

 

I'm narrowing in on a decision today, just bumping because I can't believe no one on the board has had the biopsy done! Maybe that should tell me something, but bumping nonetheless.....

 

Whenever my vet proposes something like this (for me money IS an issue!), I ask "what difference will the outcome make for the treatment." I find all too often the vet says, "Nothing, we'd just know for sure." My next question is always "What happens if we just assume you're correct, and treat for that?" And often the answer is, "Well, if he responds, then we'll know I was right." So I usually opt to do that!

 

Re: the Baytril--

 

George had some kind of infection two years ago, and rather than continue testing and testing and finding NOTHING, he went on Baytril for 12 weeks. His inappropriate urination (AKA Unruly Pee!) went away for 2 years. Sadly, he's started up again, and now we're back to testing! I had the vet prescribe Baytril, and after FOUR DAYS he stopped peeing; there have been two accidents in a month, so I'm all for continuing, but my new vet wants to stop. I've agreed to stop so we can test his urine (her staff threw out his urine sample for some bizarre reason before I put him on it!) to look for blood, etc. If the urine shows nothing, and he continues, I'm going to insist on the additional month of Baytril. From what I've read, a kidney infection can be surprisingly hard to detect, and requires at LEAST 4-6 weeks of Baytril.

[tbhounds]

They did check the blood pressure, right?

[Guest JohnS]

John S Welcome to the board! Yes, Sonie seems to have all of the same symptoms as your dog. And you and I are about in the same spot. Honestly, I've not heard of the ACTH stim test before today - a quick google search seems to pull up it's a test for both Addison's and Cushings? Now I am also wondering if I should do this test first (before an ultrasound) Are Hennessey's symptoms still the drinking a lot, night accidents and protein in urine? That's what we've got with Sonie. She is really happy and playful, not acting "sick" at all. I agree w/Neylasmom - I would copy & paste your whole post into a fresh one with a new title and you may get some more bites on what's going on with Hennessey.

 

Kudzu thanks a lot! I'm glad to know that the 4-week course of antibiotics is a reasonable step before proceeding further. That's exactly the decision I made this morning. 4 weeks of Baytril (she can't have Clavamox) and rerun the protein/creat ratio test. If it has not lowered at all, I am either doing the ACTH test or ultrasound, but no biopsy, even if I have to go to a different vet to do the ultrasound without the biopsy. The biopsy is making me very nervous quite frankly.

 

And no, it wouldn't effect treatment. From what I understand the treatment would be benezipril (sp?) no matter what. The renal biopsy would tell us how far along the disease is, long-term prognosis, etc. That's how I understand it.

 

The ACTH Stim Test is one of two 2nd level tests they can do to confirm Cushings. As I understand it from my vet and the web, they do the Urine Cortisol/Creatinine ratio test first because it is easier and cheaper. Our result was higher than normal but inconclusive (medicine's favorite word after ideopathic ). If Cushings was present you would expect lots of cortisol. I know greyhounds have higher levels of creatinine typically so I questioned whether that was throwing off the ratio.

 

Essenitally in the ACTH thing they inject your pup with some of the hormone that should signal the pituitary to cut back on cortisol, you then come back in 4 or 8 hours and if nothing happens and cortisol levels remain high they know things are out of whack and likely Cushings. Then they typically follow up with an ultrasound to confirm whether both adrenal glands are inflamed (indicating a pituitary tumor) or just one gland (indicating adrenal based). It sounds like it affects treatment whether it is one or the other. The thing is that I was quoted $250 for the ACTH and that point, why not just go to the ultrasound? Still waiting on clarification on that.

 

If you haven't done the Cortisol/Creatinine ratio test, you might ask your vet about it. Cushings has a lot of the same symptoms as GN excessive thirst, incontinence, heavy panting, muscle loss, hair loss (though in our case Hennie has an excessively furry coat, as if she never shed her winter coat). Most dogs get increased appetite (hard to tell in our gh), thin skin (again same). It is basically the same as if you keep a dog on cortisone for too long.

 

Strangely after all this, today I was home all day and Hennessey didn't consume nearly as much water and only had one very small accident. I'm starting to track exactly how much water she is drinking and urination frequency, just to see if there is a real change. At its worst she was drinking upwards of 15 cups of water a day.

 

Thanks for the tip on starting a new thread (suggested by NeylasMom as well ), will do.

[Guest HersheysMom]

Thanks everyone for giving me a lot to think about.

 

Batmom, I really appreciate you explanation of the antibiotic-resistant bacteria. Makes sense!

 

I'm narrowing in on a decision today, just bumping because I can't believe no one on the board has had the biopsy done! Maybe that should tell me something, but bumping nonetheless.....

 

Whenever my vet proposes something like this (for me money IS an issue!), I ask "what difference will the outcome make for the treatment." I find all too often the vet says, "Nothing, we'd just know for sure." My next question is always "What happens if we just assume you're correct, and treat for that?" And often the answer is, "Well, if he responds, then we'll know I was right." So I usually opt to do that!

 

Re: the Baytril--

 

George had some kind of infection two years ago, and rather than continue testing and testing and finding NOTHING, he went on Baytril for 12 weeks. His inappropriate urination (AKA Unruly Pee!) went away for 2 years. Sadly, he's started up again, and now we're back to testing! I had the vet prescribe Baytril, and after FOUR DAYS he stopped peeing; there have been two accidents in a month, so I'm all for continuing, but my new vet wants to stop. I've agreed to stop so we can test his urine (her staff threw out his urine sample for some bizarre reason before I put him on it!) to look for blood, etc. If the urine shows nothing, and he continues, I'm going to insist on the additional month of Baytril. From what I've read, a kidney infection can be surprisingly hard to detect, and requires at LEAST 4-6 weeks of Baytril.

 

Wow are you kidding me?? Makes me think I should definitely pursue the Baytril route before anything else. I picked it up last night, with a huge hit to my pocketbook.

 

tbhounds, yes, bp is normal. In fact, she has no other classic hallmarks of glomerulonephritis. Only the protein in the urine. That's it. Her blood kidney values are fine, albumin level is normal, urine specific gravity is normal, she is not losing weight or muscle wasting. That's what's so perplexing.

 

JohnS thanks for your explanation thanks of the ACTH. A more involved test than I anticipated. Think I'll go with the ultrasound if we need to investigate further.

[Guest ss556]

Carolyn, that's what Alan had and we didn't do a biopsy. Have Sonie's blood pressure checked as well as the BP is usually high w/ GN. I did a lot of research years ago when Alan was diagnosed, including Dr. Couto - I spoke to him and he spoke to my vet. Alan was on benazepril, baby aspirin and spironolactone and his GN progressed very slowly. In addition, I cooked for him as well. Good luck with Sonie.

[Guest Fasave]

Carolyn, that's what Alan had and we didn't do a biopsy. Have Sonie's blood pressure checked as well as the BP is usually high w/ GN. I did a lot of research years ago when Alan was diagnosed, including Dr. Couto - I spoke to him and he spoke to my vet. Alan was on benazepril, baby aspirin and spironolactone and his GN progressed very slowly. In addition, I cooked for him as well. Good luck with Sonie.

 

Just curious about the diet you cooked for Alan. Has I understand it, with kidney issues you need low protein and low phosphorus as the most important key factors. I too cooked for one of my guys who had kidneys issues but he had a ton of other problems as well.

[Burpdog]

How much protein in the urine?

 

I would not do a kidney biopsy.