Urinalysis Results

[macoduck]

Bandit, age 13, had a recent a basic blood panel showing these abnormalities:

 

albumin 2.1 (normal 2.5-4.0)

total protein 4.8 (normal 5.1-7.8)

BUN 35 (normal 7-27)

creatinine 2.2 (0.4-1.8)

 

After those results came in the vet called and asked me to bring in a urine sample. I did not know to bring in a fresh catch. Bandit's results were:

 

blood +3

bilirubin +1

protein +4

specific gravity 1.040

PH 6.5

leuk normal

nitrate negative

urob normal

ketone negative

glucose negative

 

Bandit has not been having any symptoms, eats, pees and poops fine, good energy level for his age. He does like to lick his hoo hoo a lot but I do not see any blood or pus.

 

The vet will be calling me tomorrow to discuss the results. The vet tech said he may recommend medication.

My first thought is that another test should be run using a fresh catch. Should I allow them to run the test in-house again or ship it out?

Do any of those numbers look like a crisis in the making?

 

Bandit is not on any medications other than heartworm meds and Comfortis (I know that's not well-liked here but it works). I have stopped the rimadyl and am giving Fresh Factors instead.

[NeylasMom]

I don't see any bacteria results. Was his urine positive or negative for bacteria? You need to rule out an infection first so if the urinalysis was negative for bacteria, then I would get a sterile urine draw and run a culture. ETA: I would do that either way actually so you can know the best AB to treat with if he's got bacteria.

 

The increased BUN (although very slight), creat, the blood and protein in teh urine and the low spec gravity are all causes for concern in my opinion. Do you have previous "normal" blood work to compare his values to? Greyhound creat levels tend to run high - Neyla's typical sat around 1.6 but could go as high as 1.8. 2.2 is a little higher than I would want to see, but if all other things were normal it wouldn't necessarily concern me. With the +4 of protein though and the low specific gravity, I would start to worry about kidney disease. But the +3 blood in the urine to me is an indication that this could be an infection.

 

Has he been tested for TBDs?

 

Oh, I just saw you said you stopped Rimadyl. How long was he on it and were you running blood work periodically? Rimadyl can cause damage to the kidneys so it's recommended to do blood work periodically to watch for it (and liver disease as well).

 

Sorry, not trying to scare you, especially with the blood in the urine I would definitely focus on an infection for right now, but I do think it's good you stopped the Rimadyl.

Edited January 31, 2011 by NeylasMom

[tbhounds]

Actually the 1.040 sg is great! He's concentrating his urine beautifully. The protein is not good. It's why most likely his albumin is low- He's losing protein through his kidneys. This is not an uncommon event for our hounds- I'm sure you have heard of PLN or GN here before. You do need to rule out an infection -- I would run your pup in so your vet can obtain a sterile urine sample that they can send out to the lab for a culture. If the culture comes back clean then i would run a urine protein creatine ratio. I would also get your hounds blood pressure checked..

[NeylasMom]

Actually the 1.040 sg is great!

Doh! Sorry, I read it as 1.004. Anything above 1.020 is considered good.

[tbhounds]

Actually the 1.040 sg is great!

Doh! Sorry, I read it as 1.004. Anything above 1.020 is considered good.

Ha- thought you did!

[Guest Energy11]

Actually the 1.040 sg is great! He's concentrating his urine beautifully. The protein is not good. It's why most likely his albumin is low- He's losing protein through his kidneys. This is not an uncommon event for our hounds- I'm sure you have heard of PLN or GN here before. You do need to rule out an infection -- I would run your pup in so your vet can obtain a sterile urine sample that they can send out to the lab for a culture. If the culture comes back clean then i would run a urine protein creatine ratio. I would also get your hounds blood pressure checked..

 

 

Excellent advice :-))

[macoduck]

To answer some of your replies:

-he was tested for TBD and all were negative

-we have no record of previous urinalysis ever being done by his previous owner

-given his extreme nervousness at the vet I don't think we'd get an accurate BP reading even if I left him there for the day

 

Comparing to bloodwork done a year ago when we adopted him, there are some changes:

-albumin now 2.1 then 2.8

-total protein now 4.8 then 5.2

-BUN now 35 then 23

-creatinine now 2.2 then 1.4

 

Given that he feels fine, has normal water intake/outgo, that he is 13 years old, hates car rides and going to the vet, my questions for the vet will be:

-can we repeat the urinalysis with a fresh catch instead of a sterile draw?

-should we do a culture and a urine protein creatinine ratio then too?

-can we just treat for infection using doxy, then retest urine?

-given his age, how much should we explore all of this?

 

Knowing how this clinic likes to push prescription foods, I would rather not do that. Would a kidney diet food really change that +3 blood and +4 protein in his urine?

[GeorgeofNE]

George has NEVER had a "normal" creatinine level--after about the fifth test, I send his blood/urine to Dr. Couto, who told me they were "perfectly normal for a Greyhound." So I can tell you that I think that one level, at least, is OK!

[joejoesmom]

To answer some of your replies:

-he was tested for TBD and all were negative

-we have no record of previous urinalysis ever being done by his previous owner

-given his extreme nervousness at the vet I don't think we'd get an accurate BP reading even if I left him there for the day

 

Comparing to bloodwork done a year ago when we adopted him, there are some changes:

-albumin now 2.1 then 2.8

-total protein now 4.8 then 5.2

-BUN now 35 then 23

-creatinine now 2.2 then 1.4

 

Given that he feels fine, has normal water intake/outgo, that he is 13 years old, hates car rides and going to the vet, my questions for the vet will be:

-can we repeat the urinalysis with a fresh catch instead of a sterile draw?

-should we do a culture and a urine protein creatinine ratio then too?

-can we just treat for infection using doxy, then retest urine?

-given his age, how much should we explore all of this?

 

Knowing how this clinic likes to push prescription foods, I would rather not do that. Would a kidney diet food really change that +3 blood and +4 protein in his urine?

 

I would get the urine to culture before you start an antibiotic. If the antibiotic kills some of the bacteria but is not totally effective, the reduced bacteria count could make it difficult to culture. The culture/sensitivity shouldn't be terribly expensive (around $70 here) and will also tell you what antibiotic will work best. You can always start an antibiotic the day of the sample and change it if need be.

 

At his age, I would certainly check for a UTI and if none, check kidney function with a protein/creatinine ratio. If it indicates kidney disease, I would definitely do a blood pressure. Perhaps a vet could visit your home for the BP check or even loan you a machine (most are totally automatic now). These are actually pretty routine and very common tests. They can point out issues that are easily treatable.

 

If it is kidney disease causing the protein in his urine, you need to keep the blood pressure in line (a $4 a month drug with little side effects). You can do a homemade kidney diet instead of a prescription kibble. It is important to reduce phosphorus and provide protein from quality sources. If you reduce phosphorus as low as you can and he still has protein in his blood, then you need to reduce the protein in his food. My 12 year old Shelby (whippet/labrador mix) had significant protein 3+ and by changing to a prescription early stage renal diet it dropped the protein to 1+. This kept up for two years. Recently she has started to need to pee every 4 hours and the protein has crept back up. I have had to move her to a more aggressive kidney diet. She continues to be a very happy 14 year old.

 

These relatively simple steps can protect the kidneys and possibly prevent total kidney failure.

 

There is a k9 kidney group on yahoo. They can be a wealth of information.

 

Here's hoping that it is just an easily curable infection..

Edited February 1, 2011 by joejoesmom

[NeylasMom]

I really think you need to do the culture before you do anything else and that typically requires a sterile urine draw, which means taking him in (they insert a needle into his bladder while using ultrasound to guide the needle).

 

Believe me, Neyla was terrified at the vet so I was very hesitant to do any of this type of stuff when she started displaying signs of a kidney issue and I opted for trying to treat prophylactically with ABs. In retrospect, I think that is okay in a younger dog who is more likely to just have an infection, but in an older dog where at least some of the signs also point to a kidney issue, I think you need to do the culture. I was shocked at how quickly the urine draw was done. I had insisted my vet let me come back with Neyla while they did it, and then felt stupid afterward for doing so.

 

A culture can also be false negative, but it's much less likely too than repeat urinalyses are and I really think given all of the results, you need to know what you're dealing with.

 

Also, everything Jane said, but I wanted to stress the culture point.

[macoduck]

Not a single vet in this town makes house calls, not even to put a pet to down.

I'll ask about borrowing a BP cuff.

Not a single vet in town has an ultrasound machine. I hope that means they have experience doing a sterile draw without one.

[Batmom]

I'd just get a clean container (boiling water is good to clean, then air dry) and do a midstream catch. Send that off for the culture and get him started on some antibiotics.

[NeylasMom]

Not a single vet in town has an ultrasound machine. I hope that means they have experience doing a sterile draw without one.

Lots of vets do them without ultrasound. Although I was surprised - my regular vet has one. We're not talking the high end specialty equipment, she just has an old one that's useful for guiding the needle, possibly spotting obvious large tumors, things like that.

 

Batmom's suggestion is a good one too.

[AEB]

Greys do have slightly different "normal" values for kidney related values and they are explained on the OSU website in an article. I wish I could remember all values off the top of my head but they've faded-away since losing Sadie.

 

As for BP it is not a bad idea to get one if possible, or at least try. WHat our vet did because Sadie could not relax in the office (despite her being the Queen of the office) was put her in the car and let her relax for about ten minutes (the car was her cocoon of safety). Then a tech went out and sat in the car with her and the machine and took her pressure (which also runs slightly higher in greys). It helped us confirm she needed to go on Enalipril.

 

JoeJoe'smom has greyt suggestions. If you have kidney issues going on, try to avoid the low protein diets for as long as possible. Low protein diets are hard on these guys.

[macoduck]

Given that Bandit at age 13 is doing fine with his water intake/urine outgo, appetite and bowel movements, my vet wants a conservative approach.

 

Even if we did a cardiac ultrasound and BP monitoring, we're still dealing with kidneys losing their optimum function as a process of old age. And dealing with a dog who is super-stressed at the vet's (especially if we have to wait as he won't lay down and is wobbly on his old broken hock) and hates car rides. The closest ultrasound vet is over an hour away and is the one who was horrible to Thane during his ultrasound (the day he died).

 

Vet suggested starting a low dose of enalapril and a re-testing of blood and urine within 30 days. He did mention that sometimes enalapril can have an opposite effect from what you want. I will make sure that the next urine sample I bring in is the fresh catch.

[tbhounds]

Sounds like a good plan. My girl had GN secondary to an immune mediated disease and the enalapril worked really well for her.

[AEB]

 

He did mention that sometimes enalapril can have an opposite effect from what you want.

 

Yes, Enalapril and other ACE inhibitors have been linked to kidney failure. It is not understood why, however. It is theorized that dogs/people taking these medications may already have compromised kidney function and the declining function is coincidental and has nothing to do with the medication. There may be a link, however. It is, of course, difficult to parse out when the patient is taking it for kidney failure.

 

I can tell you that Sadie took Enalapril for nearly two years. She began at 10mg and eventually increased to 20mg. I do not believe that it "caused" kidney failure.

[EllenEveBaz]

My Scout had glomular nepharitis (spelling? anyway, GN) that was controlled well for several years with Enalapril and a low phosphorous diet. His blood pressure was checked often but we lucked out and it didn't become a problem until his last few months, when all his many medical problems escalated.

 

He also had accupuncture for his kidneys.

 

His rapidly rising creatinine in his last few months was helped somewhat by the supplement Azodyl which may help reduce toxins in the blood.

 

Sending ear scritches to Bandit.

Edited February 3, 2011 by EllenEveBaz

[tbhounds]

Sounds like a good plan. My girl had GN secondary to an immune mediated disease and the enalapril worked really well for her.

I wanted to mention that you might want to ask your vet (or OSU) about starting Bandit on a low dose aspirin. Hounds with GN tend to throw clots--Ohio state had my girl (50lbs) on 20mgs daily. It's a low enough dose that it didn't interfere with the other medications she was taking including prednisone.

[NeylasMom]

Did you ever take in a sample for a urine culture? I'm wondering why you would start on a medication without first ruling out infection?

[AEB]

Sounds like a good plan. My girl had GN secondary to an immune mediated disease and the enalapril worked really well for her.

I wanted to mention that you might want to ask your vet (or OSU) about starting Bandit on a low dose aspirin. Hounds with GN tend to throw clots--Ohio state had my girl (50lbs) on 20mgs daily. It's a low enough dose that it didn't interfere with the other medications she was taking including prednisone.

 

We too had Sadie on a baby aspirin at first I then discussed some concerns with the vet (it has downsides too) and decided to eliminate it, on balance. It was a personal decision based in part on what i believed was her reaction and certain risks and her situation.

 

Her food contained EFAs which are supposed to help as well. Supplementing with these may be worth discussing with the vet.

[Figma]

 

He did mention that sometimes enalapril can have an opposite effect from what you want.

 

Yes, Enalapril and other ACE inhibitors have been linked to kidney failure. It is not understood why, however. It is theorized that dogs/people taking these medications may already have compromised kidney function and the declining function is coincidental and has nothing to do with the medication. There may be a link, however. It is, of course, difficult to parse out when the patient is taking it for kidney failure.

 

I can tell you that Sadie took Enalapril for nearly two years. She began at 10mg and eventually increased to 20mg. I do not believe that it "caused" kidney failure.

 

 

He did mention that sometimes enalapril can have an opposite effect from what you want.

 

Yes, Enalapril and other ACE inhibitors have been linked to kidney failure. It is not understood why, however. It is theorized that dogs/people taking these medications may already have compromised kidney function and the declining function is coincidental and has nothing to do with the medication. There may be a link, however. It is, of course, difficult to parse out when the patient is taking it for kidney failure.

 

I can tell you that Sadie took Enalapril for nearly two years. She began at 10mg and eventually increased to 20mg. I do not believe that it "caused" kidney failure.

 

Our Grey, although his BUN is within normal, is losing protein in his urine. His BP was rather high in the office. Our Vet put him on 10 mg Enalapril he said to help keep the pressure down in the kidneys. I took Dr Dodd's advice and have him on Natural Balance Fish and Sweet Potato with some canned. Some days he eats and some days not. Sometimes once a day and sometimes twice. I did try the canned tripe this morning and he ate that right down with his kibble. He is still active, loves his daily walks, but still looks awfully thin and is drinking a lot of water.

[AEB]

He did mention that sometimes enalapril can have an opposite effect from what you want.

 

Yes, Enalapril and other ACE inhibitors have been linked to kidney failure. It is not understood why, however. It is theorized that dogs/people taking these medications may already have compromised kidney function and the declining function is coincidental and has nothing to do with the medication. There may be a link, however. It is, of course, difficult to parse out when the patient is taking it for kidney failure.

 

I can tell you that Sadie took Enalapril for nearly two years. She began at 10mg and eventually increased to 20mg. I do not believe that it "caused" kidney failure.

 

He did mention that sometimes enalapril can have an opposite effect from what you want.

 

Yes, Enalapril and other ACE inhibitors have been linked to kidney failure. It is not understood why, however. It is theorized that dogs/people taking these medications may already have compromised kidney function and the declining function is coincidental and has nothing to do with the medication. There may be a link, however. It is, of course, difficult to parse out when the patient is taking it for kidney failure.

 

I can tell you that Sadie took Enalapril for nearly two years. She began at 10mg and eventually increased to 20mg. I do not believe that it "caused" kidney failure.

 

Our Grey, although his BUN is within normal, is losing protein in his urine. His BP was rather high in the office. Our Vet put him on 10 mg Enalapril he said to help keep the pressure down in the kidneys. I took Dr Dodd's advice and have him on Natural Balance Fish and Sweet Potato with some canned. Some days he eats and some days not. Sometimes once a day and sometimes twice. I did try the canned tripe this morning and he ate that right down with his kibble. He is still active, loves his daily walks, but still looks awfully thin and is drinking a lot of water.

 

Sadie was like this- active but thin for a year before we lost her. We believe she had other serious problems as well. She was a picky eater. Keep an eye on the weight as it can drop off suddenly. I wish I had found GT when she was ill. Discuss with your vet but our vet got to a point where weight was just as important as kidneys and he did not care what we fed her. Keep that weight up!! I wish your pup all the best.