Low Wbc Count, Protein In Urine

[Guest LindsaySF]

When Andy came to me as a foster back in December, we ran bloodwork and a urinalysis because of his age and his physical condition (obese, limping badly, we wanted to start Rimadyl, etc). His bloodwork was fine but he had elevated protein in his urine (3+), high pH, and elevated Bilurubin. A BUN-creatinine ratio was normal, and a urine culture was negative, so we began Rimadyl. We monitored the protein in his urine and while it was still 3+ on February 18, and 2+ on April 20, by the time of his dental on May 15 there was "trace protein" in his urine which the vet said was normal, and Bilurubin was 1+ which is normal. Physical therapy addressed his leg/muscle pain so we weaned him off the pain meds, including the Rimadyl, by early May.

 

At the time of his dental his urine looked great, but his bloodwork showed a decreased WBC count (3.94, ref range 5.05 - 16.76). The vet proceeded with the dental (he didn't need any extractions, just a minor scaling, so she didn't see a need to postpone it), and we gave antibiotics for 2 weeks. His bloodwork at the 2-week point showed the WBC count still low (I don't have those numbers in front of me). I requested another 4Dx which was negative.

 

If his WBC count is still low at the next recheck (next week, a month from the last check), what other tests should we run? A full tick panel? He does not have any signs of illness or infection. Aside from the occasional loose stool, and sometimes bad breath, he seems totally normal to me, good appetite, etc. I am deworming him right now (Panacur) as a precaution. I will request another urine recheck as well. What could be causing this? The vet said it could just be WBC fluctuations that are normal for him, most people don't check bloodwork this often, anyone ever heard of that?

 

 

 

~Lindsay~

[tbhounds]

Sounds like that Judy might his WBC norm. There's research out there finding some hounds WBC as low as 1800. What was his neutrophil count?

Regarding the proteinuria - awesome news the protein within his urine is decreasing over time. Many times it's glomerulonephritis in Ghs. To quantitate the protein you usually need to run a urine protein creatinine ratio (UPC). Has he been concentrating his urine all along? I ask because if you find +3 protein in a dilute sample and a +1 in a concentrated sample you will interpret that differently-- that's when the UPC is of value to run

Fwiw- Dr Urie at Ohio State explained to me that there should never be protein found in the urine-- including trace amounts. Claims too many vets discount trace amounts as ok when in her opinion

finding any protein at all warrants further diagnostics (ie-UPC, cultures....)

I would send your blood work/us results to Osu so the pros can give it a looksie.

[JJNg]

Greyhounds tend to have a lower WBC count than other breeds, so his low WBC count may be normal. Here's a couple links:

Greythealth article on Greyhound Bloodwork

OSU Greyhound Newsletter about bloodwork

 

If his urine protein:creatinine ratio (did you mean this when you said BUN-creatinine ratio?) is normal, and/or the protein in his urine has resolved now, I wouldn't worry about that either.

[Guest LindsaySF]

Thanks guys!

 

For the urine, every sample has been very concentrated with a high specific gravity. I don't think he drinks enough water (his water bucket is always more full than the other hounds) so I add water and canned food to his kibble. His urine in December, February, and April had a high pH though (7.5, 8.5, and 8.0, respectively) which kind of stumped the vet. pH was 7.0 on May 15 though. Ooops Jing, yes I meant UPC. In January his UPC was 0.5 (reference range said 0.5 and below was normal). I don't think I have a newer UPC. I will ask for details about the recent trace protein. That was also a concentrated sample (SG 1.042).

 

His WBC count was normal back in December (8.8 ref range 4.0 - 15.5). On May 15 it was low (3.94, ref range 5.05 - 16.76), neutrophils were low then too (2.50 ref range 2.95 - 11.64), and low eosinophils (0.00 ref range 0.06 - 1.23), lymphocytes, monocytes, basophils were okay. His platelets were a tad low as well, but vet didn't seem concerned about that (PLT 115 ref range 148 - 484, PCT 0.13% ref range 0.14% - 0.46%). I can't find the bloodwork paperwork from May 30, it must have been left off this fax. But I know the vet said WBC was still low, so we'd recheck in a month. When I started freaking out about the WBC still being low the vet said it might be normal fluctuation for him, but she wants to recheck because it was higher back in December. The December bloodwork was at a different vet though, so probably a different lab. Would different labs affect the WBC count, or the reference ranges should account for that?

 

 

 

~Lindsay~

[Batmom]

Different labs wouldn't affect the white count that much. I'd suggest he had an infection back in December and cleared it himself. His white count and differential are pretty much greyhound-normal now.

 

Platelets are fine. Eosinophils can be zero; that isn't a problem at all.

[Guest LindsaySF]

Thanks. I feel better now. Fingers crossed for good levels at next week's recheck.

[Guest LindsaySF]

I forgot to update this! We rechecked his bloodwork last week. WBC's were back in normal levels.

 

He did have 1+ protein in his urine, in a very concentrated sample. The vet wasn't worried about it at all. Should I be?

 

 

 

~Lindsay~

[Burpdog]

No. I've had a lot of seniors with 3+ protein and as long as the ratios are good, we (vets & I) don't worry about it.

[tbhounds]

No. I've had a lot of seniors with 3+ protein and as long as the ratios are good, we (vets & I) don't worry about it.

You should be---always check the UPC!

[Burpdog]

So, all my vets are wrong? Hmmmm......I said if the ratios are good, we don't worry about it.

[Guest LindsaySF]

The vet did not suggest a UPC this time. (Past UPC was normal when protein was 3+). She wasn't worried about the 1+ protein because the sample was so concentrated. Should I ask about a UPC?

 

My vet (a different vet than the one I'm referring to with Andy) botched Rogan's toe amputation surgery yesterday, so that's where my focus is right now.

[MaryJane]

Never assume that protein in the urine is normal. Sometimes you can have a condition that causes the protein overflow (like infection) and the protein leaking will only be for a short duration. In this case, vets may not worry because they are assuming that once the infection clears the protein will also clear.

 

If it doesn't clear it is a problem .... the kidneys act like a filter and they are supposed to keep the protein and eliminate the bad stuff. if protein is getting out, the filter mechanism is not working properly and the filtering mechanism could even be more damaged as time goes on if this is not addressed.

 

If there is still protein in the urine after clearing up an infection (for example), the amount of protein in the diet needs to be decreased so you don't have the "leakage". In effect, you are giving only the amount of protein that the kidneys can handle. Sometimes, you can't get to the point where there is no overflow of protein and "other means" to help the kidneys might be necessary.

 

Of course, all this also depends on the blood levels of the BUN and creat and the value of the specific gravity of the urine.