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Friday, October 8, 2010
Solution for case 22
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Tentative diagnosis: Protein-loosing nephropathy. 

Differential diagnosis: Glomerulonephritis, amylodosis, idiopathic glomerulopathy, liver disease, right sided heart failure, protein loosing enteropathy.  

Further diagnostic tests:
1. Abdominocentesis: Analysis of fluid revealed transudate nature.

2. Urine Protein:Creatinine ratio: more than 4 (less than 1 is normal)

3. 4DX snap test: Negative in this case. 

4. Renal Biopsy: To formulate prognosis by differentiating between glomerulonephritis and amylodosis. Renal biopsy was not done in this case. 

5. Fecal float for GI parasites: no parasite eggs were found. 

Although there are many causes for abdominal effusion or ascites, hypoalbuminemia, due to protein losing enteropathy or liver failure, can be ruled out at this time based on normal liver enzyme, negative fecal float and balanced diet for this patient. The abdominal fluid sample tested yielded a transudate, a potential cause could include a protein losing nephropathy/enteropathy or liver disease. In this case the hypoalbuminemia, hypercholestrolemia, proteinuria and urinary hyaline casts are hallmark of protein loosing nephropathy (nephrotic syndrome). Thromboembolism is a potential complication in such cases because of the reduced antithrombin III.

Most probable suspected cause here is the idiopathic.

This patient also had severe peridontal disease. 

Therapeutic Plan:  
Treatment is usually difficult and unrewarding. Prognosis is guarded in this case.
Abdominocentesis to make animal comfortable.
Sodium restricted diet. High quality low quantity protein diet (Hill’s k/d)
Enalapril: Vasodilator, Reduced sodium retention and reduce proteinuria and hypertesion.
Restricted activity and anticoagulants (aspirin) to reduce chances of thromboembolism.
posted by Dr Banga's Websites @ 12:00 AM  
  • At October 8, 2010 at 11:38 AM, Anonymous Anonymous said…

    Dr. Banga,
    In this kind of clinical presentation, how about putting pregnancy also on the rule out list?

    Overall a very mind stimulating case.

  • At October 8, 2010 at 12:41 PM, Blogger Dr Banga's Websites said…

    Thanks TJ,

    You are right Pregnancy can also be on the ddx as this was an intact female.

    However, no history of mating, ballotment of abdomen, weight loss and high protein content in urine, radiograph and ultrasound will rule out the pregnancy.

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