Friday, January 25, 2013

The economics of renal failure - 7-year-old male Maltese

Veterinary info can be overwhelming to many students.
This case study is to help vet students understand for their examinations, more about the treatment of kidney failure and the terms azotaemia, pre-renal azotaemia and post-renal azotaemia. 

PATIENT: Maltese, Male, 7 years

Jan 11, 2013
A Veterinary Clinic.
No appetite and vomiting for 2 days. Vet 1 did a blood test which revealed renal failure, hypoglycaemia, hyponatremia, hyperkalemia and hyperphosphatemia in this dog which has a lower than normal rectal temp of 37.2C.
He advised 10 days of drip as the dog had kidney failure. The owner would have to do the drips at home as well.
The owner consulted Toa Payoh Vets for a second opinion.

Jan 12, 2013
Toa Payoh Vets.
Dr Jason Teo hospitalised the dog for 5-7 days of IV driip and blood test after the drip. Dr Daniel took over the case. He put the dog on IV drip for 2 days. No blood test was done as the owner had said that there was one done earlier. No urine test was done, possibly due to owner's reluctance to spend more money. Urine analysis would be useful if done by Vet 1 to differentiate between pre-renal or post-renal azotaemia.

Azotaemia refers to the increase of serum urea and creatiine as shown in the blood test done by Vet 1.
Pre-renal Azotaemia - Due to increase in protein intake
Renal Azotaemia - Kidney not filtering urine normally e.g. obstruction.
Post-renal A - Obstruction in the urinary tract after the kidney

No urine test was done. If done, the USG will be useful. If USG is normal, the kidneys will be normal and there will not be renal failure in the first place. If USG is below normal, it is kidney failure (renal azotaemia). If USG is high, kidneys are normal.

IN THIS CASE STUDY, the dog was eating on Jan 14, 2013 and went home with K/D and clavulox for 7 days. However on Jan 22, 2013, the mother phoned to say that the dog was not eating and had to be force fed. His weight dropped from 5.4 kg to 4.7 kg when the mother finally admitted the dog for IV drip as advised by me, on Jan 23, 2013. The rectal temp in this dog is unusually low, at 37 deg C on Jan 23 Jan and had not gone up to 38 deg even on discharge today Jan 25, 2013. Blood test showed no more azotaemia and the dog ate on 2nd day i.e. today Jan 25. The glucose was still below normal in the blood test as the dog was not eating.

Blood test by Vet 1 - total WCC was normal.
Blood test on Jan 25 at Toa Payoh Vets - WCC 21.7 (6-17), N 85%   Absolute 13.4. L 4%, M11%, E 0% and B 0.6%. There was a bacterial infection but serum urea was normal. at 4.3 (4.2 -6.3). Creatinine was 66 (89-177).  As the dog ate a can of A/D, he was sent hme with different antibiotics.
Urine test would have been useful as there would be bacteria or not.     

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