Presentation:
A 12 year old spayed female Labrador was presented to AcaseAweek Clinic with one week history of vomiting, decreased appetite and lethargy. Bad breath of the pet was also a complaint. The patient was brought to clinic 4 month back for ehrlichia and mild azotemia. She is currently on Hill’s k/d diet.
Physical exam:
What is your tentative diagnosis?
Give differentials for your diagnosis.
What further diagnostic test(s) will be performed to confirm the tentative diagnosis?
How will you treat and manage this case?
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Tentative Diagnosis:
Chronic Renal failure (CRF)
Differentials Diagnosis:
Hypoadrenocorticism
Hypothyroidism
Renal Secondary Hyperparathyroidism
Inflammatory Bowel Disease
Further Diagnostic Tests:
(1) Abdominal Ultrasound to detect changes in kidney size and presence of renal neoplasia
(2) Blood Pressure Measurement using Doppler techniques
(3) Echocardiogram to evaluate hypertensive heart disease as a sequela to renal failure
(4) TSH Stimulation Test
Treatment and Management:
(1)Fluid therapy to address dehydration
(2) Sodium, protein and phosphorus restricted diet and free access to fresh water at all times
(3) For Hypertension, calcium channel blocker Amlodipine and ACE inhibitors Enalapril
(4)Cimetidine at 10mg/kg initial dose followed by 5 mg/kg q 8-12 h to minimize vomitting
(5) Eryhtropoietin Replacement such as r-HuEPO (Epogen and Procrit, give ferrous sulfate before and simultaneously