Fenway's Mystery Pee Problems - Ultrasound Results: Kidney Damage

[gracegirl]

Two weeks ago I traveled for business for a week. I don't do that often. Grace stayed with my parents and Fenway stayed with my boyfriend and his Airedale. Almost every day that I was gone, Fenway had an accident in his house. Ryan would come home at lunch to let the dogs out, and then would come home again right after work to let them out and feed them. He'd then typically go to the gym, and would come home to a pee accident.

 

I got home from my business trip and rather than staying at Ryan's house I decided to stay at my own house and try to get Fenway back in his routene, thinking the peeing accidents were behavioral. They continued at my house, even with a mid-day dog walk. (They always have a dog walker that comes every day - pee problems or not.) At this point I wasn't so sure it was behavioral, but given that I had a really hard time housebreaking him as a puppy (he was 4 months when I got him) I still couldn't say with certainty. Problem was, I was only home for a week between my business trip and a week long vacation. Bad timing.

 

I had my brother take a urine sample to the vet while I was on vacation. It came back that he was not concentrating his urine. So at that point the vet recommended that I bring him in upon my return for another urinalysis and bloodwork. Still more accidents while I was gone...this time he stayed at my house with Grace, my roommate and my brother...and still had the dog walker coming at lunch.

 

Second urine sample, he's still not concentrating his urine and I've noticed an increase in his water consumption. And he's still having accidents. Blood and urine sample were sent in on Saturday for full work up. Got results back this morning...and everything looks fine. (I was hoping for some kind of bacterial infection...easily treated with ABs.) There are two things that look fishy...first is that he's not concentrating his urine (we knew that) and second is that his creatinine is at the top of the range at 1.6 (but no change from last time he had bloodwork one year ago).

 

So at this point the vet recommends an abdominal ultrasound, he said mostly at this point it's to rule anything out. There could be something there we see and say "a-ha, that's it" but the vet is not quite sure what could be going on in a dog this young. Fenway is four years old. He also mentioned it could be early kidney compromise. So possibly it could be as simple as putting him on a kidney-friendly diet. I did ask about putting him on a course of ABs, just to see, but the vet said that there was no evidence of infection or inflamation in the urine sample so he would not recommend that.

 

This post is longer than I inteneded, so thank you for reading. I'd love to hear any thoughts, ideas, or experience anyone might have with similar symptoms/issues. I think I'll go ahead and schedule the ultrasound so we can see what's really going on in that belly!

Edited March 9, 2011 by gracegirl

[Guest mcsheltie]

I would do a course of antibiotics. I can't tell you the countless times no infection has shown up on tests, but an antibiotic has cleared up the problem.

 

Glad you are doing the ultrasound.

[macoduck]

Wasn't the urine sample a first-of-the-morning fresh catch or one caught later in the day? Could make a difference in concentration.

[gracegirl]

Wasn't the urine sample a first-of-the-morning fresh catch or one caught later in the day? Could make a difference in concentration.

 

Both were first morning catches, which is why the poor concentration is of concern.

 

I would do a course of antibiotics. I can't tell you the countless times no infection has shown up on tests, but an antibiotic has cleared up the problem.

 

Glad you are doing the ultrasound.

 

The ultrasound is not as outrageously proced as I thought. It should be under $300...I was initally embracing the idea of spending $500 or more. That said, I think I will do the ultrasound and then if it's still a mystery I think I will push for the ABs. I've heard the same thing from several others here as well. Susan and George come to mind.

[greyhead]

Shane had accidents and leakage for months because the vet looked at the urine and said she was sure there was no infection, so there was no reason for a culture. She considered it incontinence. Finally he refused food and got floppy, and then a culture revealed E. coli, which we are still fighting after numerous rounds of a/b's. Was a culture done or just a urinalysis for Fenway. Btw, IIRC a creatinine of 1.6 is not high for a greyhound. Shane routinely runs at 2.1 and concentrates his urine just fine. Fenway's urine may be dilute because of all the water he's drinking?

 

I don't know, but I've heard lots of times infections aren't caught even with cultures!

[BootsyCollins]

I have trouble concentrating in the morning, too. Maybe Fenway's peepee just needs a cup of coffee.

 

Seriously, I have no advice. But I do hope you get it figured out soon.

Edited February 28, 2011 by CMoon75

[GeorgeofNE]

George's creatine is 2.2, and Dr. Couto told me that was nothing to be concerned about given his other labs, which are totally normal. The lowest his creatine has ever been is 1.9.

 

What exactly is the specific gravity of the urine?

 

As you probably know, George has had pee issues since day one.

 

We are currently towards the tail end of a 20 week course of Doxy--

 

Lest everyone think I am INSANE, we ruled out EVERYTHING but it responds to antibiotics.

 

Before I spent the money on an ultrasound, I'd insist on 2 weeks of Baytril.

 

If there is no change, then go ahead with it.

 

I'd also start measuring his water intake. I am not sure how you can do that with two dogs...

[gracegirl]

Shane had accidents and leakage for months because the vet looked at the urine and said she was sure there was no infection, so there was no reason for a culture. She considered it incontinence. Finally he refused food and got floppy, and then a culture revealed E. coli, which we are still fighting after numerous rounds of a/b's. Was a culture done or just a urinalysis for Fenway. Btw, IIRC a creatinine of 1.6 is not high for a greyhound. Shane routinely runs at 2.1 and concentrates his urine just fine. Fenway's urine may be dilute because of all the water he's drinking?

 

I don't know, but I've heard lots of times infections aren't caught even with cultures!

 

I believe that it was cultured, but I'll call back to ask. Good point!

[gracegirl]

What exactly is the specific gravity of the urine?

 

Before I spent the money on an ultrasound, I'd insist on 2 weeks of Baytril.

 

I'd also start measuring his water intake. I am not sure how you can do that with two dogs...

 

Thanks for the response, Susan. You and George came to top of mind when I was trying to figure out what's going on with Fenway.

 

To answer the above points:

1. Specific gravity...I didn't write down the numbers. Boo on me! I have a call into the vet tech to get that info. Twice his first morning sample was "not concentrating".

2. I'm going to see if I can suggest this again. Or maybe instead of suggest I can insist this time. I'll tell the vet I did additional research. I also asked to confirm that his urine was cutltured, and I asked that it be cultured if it was not already.

3. Measuring his water...no clue there with two dogs either, none of whom are confimed and both of whom share bowls. Easy/easier to do when I'm home. Impossible to do when I'm at work. Unless I start to crate Grace again. (Fenway howels like a banshee when he's crated, and is much more anxious...so I can't really crate him. I have not crated Grace in 4 years so I have no idea how she'd do.)

[turbotaina]

I wouldn't worry about the creatinine, esp. if the BUN:Creat. ratio is normal.

 

Are your vets looking at diabetes insipidus? It's not uncommon in greyhounds, so they should really consider if if they're not already.

 

Good luck!

[gracegirl]

I wouldn't worry about the creatinine, esp. if the BUN:Creat. ratio is normal.

 

Are your vets looking at diabetes insipidus? It's not uncommon in greyhounds, so they should really consider if if they're not already.

 

Good luck!

 

It has not been mentioned yet, but I will discuss with the vet. Thank you for the advice!

 

I have trouble concentrating in the morning, too. Maybe Fenway's peepee just needs a cup of coffee.

 

Seriously, I have no advice. But I do hope you get it figured out soon.

 

Touche Christie! Well played.

[NeylasMom]

The first question is really whether the urine was cultured. If it wasn't, the negative urinalyses mean virtually nothing. I saw that you have a call in to find out. When you hear back, why don't you just have them fax over results of everything they did so that when we have more questions, you have answers.

 

Second, creatinine of 1.6 is first of all, within normal (albeit at the high end) for any dog, but TOTALLY normal for a greyhound. Neyla's ranged from 1.6-1.8 all of her life.

 

Third, would also like to know the specific gravities. Yes, I saw you already asked for those as well, I'm just being a PITA.

 

Lastly, I would consider doing ABs prophylactically before doing the ultrasound in a dog that young if nothing else presents. I would probably start with something other than Baytril (Baytril is sort of the big gun that you keep in reserve and priced accordingly). Most UTI's respond to Clavamox (or is it Cephalexin, I am forever confusing those two - I think it's the former, but I have some at home that I can check to confirm). Would do this simply because a UTI is much more likely than kidney disease.

[gracegirl]

Okay...just got off the phone with the vet tech. Here are the stats:

 

Specific gravity of urine: 1.014 and 1.015 for the two different samples

BUN: 20 (normal is 6-31)

BUN to creatinine: 13 (normal is 4-27)

 

So BUN is okay, indicating no kidney problems. But he's not concentrating at the same specific gravity for two weeks in a row. I'm going to bring him in first thing in the morning tomorrow for a sterile sample and they will culture that. I also talked to the vet tech and told her I wanted to start ABs tomorrow. Then, depending on what the culture produces, we'll continue with the same AB for two weeks or we will change to an AB that will kill the yuckies.

 

After that, if no improvement....I'll mention the DI and also consider the ultrasound.

 

I'll also get all copies of all paperwork tomorrow.

 

Here is some info I found online:

 

Moderately concentrated urine: USG 1.013 to 1.029 (dog) Patients producing samples with USG within this range often have adequate renal renal function, but similar these values can be associated also with partial impairment of renal function due to renal kidney disease, or to some other factor inhibiting the ability to retain water, such as partial deficiency or inhibition of tubular responsiveness to ADH.

 

If dehydration is evident, moderately concentrated urine can be considered to be 'inappropriately dilute', warranting further investigation as indicated below.

 

If hydration is normal and there is no other evidence of renal kidney or other disease, it may be useful to reassess USG at intervals before undertaking additional studies. Any: only animals failing to produce concentrated urine (USG >1.030 for dog, >1.035 for cat) requires further investigation: possible options include testing urine concentrating ability in response to water deprivation and/or ADH administration, determining glomerular filtration rate (GFR), renal ultrasound examination, and renal biopsy.

Edited February 28, 2011 by gracegirl

[NeylasMom]

Lauren, I am certainly not an expert, but I believe those specific gravities could be caused by the increased water consumption you are seeing (which could very well be from a UTI). Technically you don't want to see SG go below 1.020, but those values are not far below and they're unaccompanied by any other signs in the blood or urine of a kidney problem (there was no protein in the urine, right?).

 

I think your plan to start AB and culture the urine is a good one. I'm pretty surprised actually that your vet would recommend an ultrasound before a culture. Also, I did doublecheck - it's Clavamox that I would suggest you go with to start. Pulling from teh depths of my memory here, but I believe what my vet said is that the vast majority of UTIs are caused by e. coli, which should respond to Clavamox. I may be remembering the reason she gave me incorrectly, but I am certain we chose Clavamox b/c it was most appropriate when you don't know the bacteria.

 

If the culture is negative and the AB don't help, don't forget Meredith's diabetes suggestion.

 

that the ABs help.

[Guest tricolorhounds]

You should also ask them to check his blood pressure. I discovered Coppers BP/kidney issues when I took him in for what I thought would be a routine UTI...

[gracegirl]

You should also ask them to check his blood pressure. I discovered Coppers BP/kidney issues when I took him in for what I thought would be a routine UTI...

 

Question, because I know noting about this stuff....are the BP and kidney issues related? Maybe I'll ask the tech tomorrow if she'll do that when they do the sterile urine draw.

 

Jen, when I talked to the tech today I requested ABs to get started on something. She said she get the script and leave it for me tomorrow. I hope it's clavamox. It sounded like he didn't culture because there was no sign of any trouble (bacteria/inflimation) in the sample I brought in, just the low concentration. I'm sure most dogs with UTI present something in a urinalysis. Maybe the culture will turn up something...but if not and the ABs don't help, then I guess next step is ultrasound.

 

I read up on a kidney diet after that was mentioned, though he shows none of the other indicators for kidney failure in his bloodwork. He's always had trouble with higher protein foods. I've tried him on some grain-free which have had higher protein % and his poo turns to mush. Interesting. Even if there is no connection, still interesting.

[4My2Greys]

You should also ask them to check his blood pressure. I discovered Coppers BP/kidney issues when I took him in for what I thought would be a routine UTI...

 

Question, because I know noting about this stuff....are the BP and kidney issues related? Maybe I'll ask the tech tomorrow if she'll do that when they do the sterile urine draw.

 

 

Avadogner posted a very good explanation of the kidney's function in the thread Kidney Disease and Hind End Weakness, I found very informative that you might want to read.

[NeylasMom]

You should also ask them to check his blood pressure. I discovered Coppers BP/kidney issues when I took him in for what I thought would be a routine UTI...

 

Question, because I know noting about this stuff....are the BP and kidney issues related? Maybe I'll ask the tech tomorrow if she'll do that when they do the sterile urine draw.

 

Jen, when I talked to the tech today I requested ABs to get started on something. She said she get the script and leave it for me tomorrow. I hope it's clavamox. It sounded like he didn't culture because there was no sign of any trouble (bacteria/inflimation) in the sample I brought in, just the low concentration. I'm sure most dogs with UTI present something in a urinalysis. Maybe the culture will turn up something...but if not and the ABs don't help, then I guess next step is ultrasound.

 

I read up on a kidney diet after that was mentioned, though he shows none of the other indicators for kidney failure in his bloodwork. He's always had trouble with higher protein foods. I've tried him on some grain-free which have had higher protein % and his poo turns to mush. Interesting. Even if there is no connection, still interesting.

Actually, cultures have a significantly lower rate of false negatives than urinalyses do. Here's an article from Antech that has a lot of interesting information regarding bacterial infections in dogs.

 

Regarding the kidney diet, please don't switch Fenny to a low protein diet. The current evidence supports adjusting phosphorus only until the dog reaches the later stages of kidney disease and actually suggests that feeding a slightly higher protein level (in the form of an easily digestible protein) may be warranted simply because the kidneys are letting some of it pass into the urine unabsorbed by the body. Information on IRIS (official) stages of chronic kidney failure progression. Generally protein restriction wouldn't be suggested until the dog was at least in stage 3 of progression, but it depends on clinical signs.

 

But I really think it's unlikely Fenny has chronic renal disease so I wouldn't worry too much until you get some answers re: the culture and ABs.

 

Oh, I meant to add that yes, BP and kidney problems can be related, but keep in mind that it can be difficult to get a good BP reading at the vet's office b/c the dog is often aroused/anxious.

[Guest 2dogs4cats]

I would ask the tech if there was protein in the urine first. Another indicator of kidney issues. Just any FYI - 1st stage kidney disease, the blood work could be normal range and the UA would be off. I wouldn't think kidney problems though since he is young, however he could have eaten or drank something that could effect organ function. Also, I know stuff on the internet says that 1.013 specific gravity could still be normal, but most likely isn't unless he drank a whole lot of water before the test. I know mine don't drink that much at night so morning urine should be concentrated. If you have a doubt, maybe repeat the SPG after a 12 hour water hold. This test costs about $10. Also, look at SPG on his past UAs to see what is "normal" for him. In my opinion, prescription kidney diets are crap and the dog will probably waste away from malnutrition before the kidneys go.

 

Also, may want to separate the 2 dogs to see how much he is drinking. If water consumption is up, will help you figure out the problem too. Blood work should indicate Diabetes or no. Usually the symptoms you describe is either kidney or diabetes, but vet should be able to rule out diabetes with blood work.

 

I also agree with the many who recommended a culture.

 

Good luck! It's never easy not knowing what is wrong.

[gracegirl]

Culture is happening now. He's def drinking more water, but both urine samples that have been tested recently are first morning catches and both indicate that he's not concentrating. he did not drink any water before either sample was collected.

 

I'll post images of paperwork in a sec. As of now, the ONLY symptoms are drinking more, peeing more (inside) and not concentrating his urine. We'll see what the culture produces, and we'll see if the ABs help.

 

Thanks for all the info, guys!

[gracegirl]

Here is bloodwork and urinalysis from last weekend.

 

 

 

The urinalysis from two weeks ago:

 

[GeorgeofNE]

Culture is happening now. He's def drinking more water, but both urine samples that have been tested recently are first morning catches and both indicate that he's not concentrating. he did not drink any water before either sample was collected.

 

I'll post images of paperwork in a sec. As of now, the ONLY symptoms are drinking more, peeing more (inside) and not concentrating his urine. We'll see what the culture produces, and we'll see if the ABs help.

 

Thanks for all the info, guys!

 

Lauren, my vet INSISTED that George must be drinking too much water--not sure how she decided that--so I did measure it for four days in a row. He drinks EXACTLY 2 cups during a day--way less than normal!

 

Can you just put a baby gate between the two of them some how to measure?

[cmc333]

I had a senior girlie that would periodically get UTI's. I got so good at diagnosing them before they did a urinalysis that they would give me abs and then do a culture. She had bladder stones which was causing her problems; she was also 15 years old. Baytril for 2 weeks would usually do the trick for her. All her bloodwork and tests were totally normal and the urinalysis never showed an infection.

 

Connie

[gracegirl]

I had a senior girlie that would periodically get UTI's. I got so good at diagnosing them before they did a urinalysis that they would give me abs and then do a culture. She had bladder stones which was causing her problems; she was also 15 years old. Baytril for 2 weeks would usually do the trick for her. All her bloodwork and tests were totally normal and the urinalysis never showed an infection.

 

Connie

 

Interesting. Again, this is all new for me..so I sounds like I don't know what I'm talking about, I don't!

 

Are you saying that when your girl had a UTI, her bloodwork and urinalysis would be normal...but that you were able to culture and find something there?

 

Also, how did you determine she had bladder stones? That's one of the possible things we'd be looking for in an ultrasound. I'm curious!

[gracegirl]

Culture is happening now. He's def drinking more water, but both urine samples that have been tested recently are first morning catches and both indicate that he's not concentrating. he did not drink any water before either sample was collected.

 

I'll post images of paperwork in a sec. As of now, the ONLY symptoms are drinking more, peeing more (inside) and not concentrating his urine. We'll see what the culture produces, and we'll see if the ABs help.

 

Thanks for all the info, guys!

 

Lauren, my vet INSISTED that George must be drinking too much water--not sure how she decided that--so I did measure it for four days in a row. He drinks EXACTLY 2 cups during a day--way less than normal!

 

Can you just put a baby gate between the two of them some how to measure?

The vet didn't insist that he was drinking more...I did! He gulps water when he comes inside. He used to just take a few sips, now he'll finish 1/3 of the bowl. I'm going to have to get creative to seprate them. Like, really creative. I'm thinking now. I live in a house built in 1902. I can't attach, bolt or screw anything to the doorframes, they are original to the house. And the doorways are wide, too wide for a standard baby gate. The main floor, where they stay when I am gone, is one hallway and three rooms. You walk into the hallway from the front door, which leads to the kitchen at the back of the house. To the right are the living room and the dining room. (And a doorway between each of them too.) I suppose the best might be able to crate Grace and see how she feels about that! It's been about 4.5 years since she was crated. Wow! I've had Grace for that long!

 

I'm might look for an ex pen on craigslist...then I could let Grace have one couch and Fenny the other. That might work too.