A 9 year old spayed female poodle was presented to AcaseAweek Clinic with a one month history of bloody urine which has progressively gotten worse in the past 2 weeks. The owner claims to have seen blood clots passed in the urine recently. The patient has not been eating well for the past 2 days and has vomited 4 times in the past 24 hours. Animal is unvaccinated and has no history of flea or heartworm prevention. Dog is fed home-made food.
Physical exam:
- Weight: 7.04 kg
- Temperature: 105.2 F
- Pulse: 112 bpm
- RR: 54
- MM: pale
- CRT: 2 sec
Complete Blood Count:
- Hct: 27% (37-55)
- RBC: 5.2 x109/L (5.5-8.5)
- Hb: 10.3 g/dL (12-18)
- WBC: 3.2 x 109/L (6-16.9)
- Grans: 1.7 x 109/L (3.3-12)
- PLT: 374 x 109/L (175-500)
- TP: 9 g/dL (5.2-8.2)
- nRBC : 1%
Biochemistry Profile:
- AP: 65 U/L (23-212)
- ALT: 35 U/L (10-100)
- Glob: 4.9 g/dL (2.5-4.5)
- Alb: 2.6g/dL (2.7-3.7)
- BUN 33 mg/dL (7-27)
- CREA 1.3 mg/dL (0.5-1.8)
Urinalysis:
- Colour: Red
- Odour: Strong
- Turbidity: 3+
- G: 1.019
- pH: 8.5
- Glucose: -ve
- Bilirubin: -ve
- Ketones: -ve
- Protein: 4+
- Blood: 3+
- RBC: 3+
- WBC: 3+
- Squamous: few
- Transitional epi: -ve
- Tubular epi: -ve
- Bacteria: 3+
- Casts: -ve
- Crystals: 2+ (struvite)
Abdominal radiographs were taken as shown below (click on the image to enlarge):
What are radiographic findings?
What is your diagnosis?
What further diagnostic tests will you perform?
How will you treat and manage this case?
