Thursday, December 12, 2013

1261. Audit of case of kidney stones causing kidney failure

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
Date:   15 November, 2013  
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
The Silkie had double kidney stones Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate:   15 November, 2013 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Silkie Terrier, F, spayed, 13 yearsFed dry food + bread since 5 years of age (adopted from another owner who migrated).

2 days ago, presented with vomiting and diarrhoea. I treated and advised blood tests and X-rays if the symptoms persisted. The dog came back yesterday, "dying" according to Dr Daniel who got the X-rays and blood tests done.
A rare case of kidney stones in the 2 kidneys was diagnosed based on evidence. Dogs usually suffer from bladder stones. No urine tests done in this case. 

Blood urea and creatinine are extremely high. The dog vomits dark brown fluid in the crate and has heavy abdominal breathing as at 11.14 am Nov 13, 2013 when the lady owner came to visit as I phoned her to say that the dog was suffering in pain and was on the last leg of his life. The dog vomited white froth on the reception room floor.

The owner will bring home for today and had decided on euthanasia later in the day.
Two kidneys are packed with stones
Vomiting and diarrhoea can be a sign of kidney failure although most cases are due to gastroenteritis. This dog was treated for gastroenteritis at the first consultation without blood test so as to reduce medical costs. As the vomiting persisted, I advised a blood test and Dr Daniel took it since I was out. This was a case of renal urolithiasis resulting in kidney failure. 
Updates will be on this webpage:

Dec 13, 2013
I review the case medical records today to do a retrospective study.

41099 Silkie, Female, spayed, Born 2000.
Aug 23, 2010. First consulted Toa Payoh Vets. 10 years old.
                        Left ear tumour at base of ear and rotten teeth. Advised treatment. Just wanted antibiotic.

Sep 3, 2010    Treatment done for above conditions.
Nov 11, 2013  13 years old. Bloody diarrhoea. Vomited greenish stuff 2 days. Not eating and drinking.
Does not want blood test (recorded in case file). Wanted I/V drip & medication.  Vet is myself (Dr Sing Kong Yuen)

Nov 13, 2013
Respiratory distress. Dr Daniel Sing
Blood test - severe azotemia
ALT 73 (<59 br="">Urea 86  (4.2-6.3)
Creatinine 1129 (89-177)
Total white cell count 11.9 (6-17)  -- OK

   Neutrophils 86%   Abs  10.18
   Lymphocytes 6%   Abs 0.70
   Monocytes  8.3%   Abs 0.99
   Eosinophils 0%
   Basophils 0.1%

Platelets 459 ( 200-500) -- OK

X-rays - calcified cores in both kidneys

Owner elected euthanasia.

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